Rapid advances have been made in the treatment of acute ischemic stroke over the last 3 decades. Endovascular treatments have become the gold standard treatment in patients with large vessel occlusion, especially in the presence of penumbra, but due to the nature of ischemic stroke, it has become necessary to make treatment decisions in many controversial patient groups such as patients with distal occlusions and lpatients with arge core infarct. It is aimed to achieve good clinical results in more patients through national and international guidelines created all over the world. In this review written about the endovascular treatment of acute ischemic stroke, where there have been very rapid developments in recent years, large studies, meta-analyses and recommendations in international guidelines on this subject are summarized and recommendations are tried to be made for our country.

INTRODUCTION: Evidence based treatment of acute ischemic stroke is intravenous administration of fibrinolytic agents within the first 4.5 hours. The source of cerebral vessel occlusion may be important for recanalization. Current study is designed to find which ischemic stroke subtype benefit more from systemic thrombolysis.
METHODS: Hospital records of patients who received only IV-tPA for acute ischemic stroke treatment are outlined retrospectively. Four etiologic subtypes, large arterial atherosclerosis, cardioembolism, lacunar infarct and other uncommon causes of stroke are included, patients with strokes due to undetermined source are excluded. The reduction of NIHSS score more than 7 or a final NIHSS score between 0-2 are defined as good response to thrombolytic treatment. The percentages of patients reaching to favourable outcome on day 1,7 and 90 are compared between different subtypes together with intracranial bleeding and mortality.
RESULTS: Among 231 patient included, the good response rate was similar in strokes due to large arterial atherosclerosis and cardioembolism at day 1, 7 and 90 (28.8% versus 25% on day 1, 38.8% versus 35.8% on day 7 and 51.3% versus 50.8% on day 90). Lacunar infarcts did not respond to IV-tPA dramatically in the first week (25%), however improve better at the end of three months (75%). The rate of good responders did not significantly vary between different subtypes in all time points (OR: 0.784 at day 1, OR: 0.946 at day 7, OR: 1.219 day 90, p>0.05). Low blood glucose level at the admission and low onset-to-time were significant determinant of early good response after adjustment (p<0.05). Intracranial bleeding was higher in cardio embolic strokes.
DISCUSSION AND CONCLUSION: The etiologic and physiopathologic mechanism of acute ischemic stroke does not affect the response to fibrinolytic treatment. Especially delays in infusion or high initial blood sugar levels lead to poor response. Withholding thrombolysis in patients with definite subtypes or the reverse have not been recommended.

INTRODUCTION: The carotid web is located in the posterior wall at the orgin of the internal carotid artery or carotid bulb. It is a factor especially blamed in the etiology of young and cryptogenic stroke patients. It may be overlooked if contrast-enhanced vascular imaging is not carefully examined. In recent years, articles have been published about its involvement in large vessel occlusion. We present patients in whom we performed mechanical thrombectomy and found CW in the etiology.


METHODS: Between 2020 January and 2023 December, patients who underwent mechanical thrombectomy due to anterior system large vessel occlusion and were diagnosed with carotid web in the etiology of stroke were included in the study. The diagnosis of carotid web was made by looking at the images taken from three different angles after the guiding catheter was placed distal to the common carotid artery during the mechanical thrombectomy procedure.

RESULTS: CW was detected in 11 (1.03%) of 1070 patients who underwent mechanical thrombectomy. Four patients with missing data and unclear stroke aetiology were excluded from the study. CW-related stroke subtype in our study was present in 7 patients (0.65%). Successful recanalisation (mTICI 2b-3) was achieved in 6 of 7 patients (85.7%). For secondary prophylaxis, carotid stenting was performed in 4 patients with mRS 0-3 who were evaluated for clinical outcome at week 1. Ninetieth day good clinical outcome (mRS 0-2) was 57.1%.

DISCUSSION AND CONCLUSION: Carotid Web may cause large vessel occlusion. In patients undergoing mechanical thrombectomy, the presence of CW in the carotid artery bulb should be checked. Secondary prophylaxis in symptomatic strokes due to CW may be performed by carotid endarterectomy or carotid stenting.

INTRODUCTION: This study investigates the effect of ambulatory blood pressure (ABP) and ambulatory heart rate (AHR) measurements on in-hospital mortality and long-term outcomes in patients with acute ischemic stroke (AIS).
METHODS: ABP and AHR were recorded by Holter monitoring at nighttime (21.00-07.00) and daytime (07.00-21.00). Patients were divided into survived and deceased groups, and into favourable and unfavourable outcome groups according to long-term functional outcomes. The 24-hour, daytime and nighttime ABP and AHR measurements were compared.
RESULTS: Nighttime, daytime and 24-hour mean heart rate (MHR) values were found to be higher in deceased group. In the discrimination according to the in-hospital mortality, the cut-off value of daytime MHR was 89.7 with 90.0% sensitivity and 82.4% specificity (p < 0.05). Similarly, the cut-off value of nocturnal MHR was 83.6 with 90.0% sensitivity and 76.5% specificity (p < 0.05). With a 1-unit increase in daytime MHR, the risk of developing mortality will increase 1.120 times [12% increase] (OR=1.120; 95% CI=1.047-1.198).
DISCUSSION AND CONCLUSION: AHR measurements may be more helpful for clinicians to predict in-hospital mortality and long-term functional outcomes in patients with AIS than ABP measurements.

INTRODUCTION: Spontaneous intracerebral hemorrhage (ICH) is associated with a high risk of mortality and poor prognosis. ICH prognosis is closely related to nutritional status. The prognostic nutritional index (PNI) is a novel and useful marker calculated from the serum albumin concentration and lymphocyte count, which reflect inflammatory, immune, and nutritional status. We investigated the relationship between PNI and mortality in patients with supratentorial spontaneous ICH.
METHODS: This retrospective study included patients diagnosed with supratentorial spontaneous ICH between January 2012 and June 2024. The sample was divided into survivors discharged from the hospital (n = 65) and those who died in hospital (n = 52). A PNI cut-off value, determined by receiver-operating characteristic curve analysis, was used to divide the sample further into high and low PNI groups for subsequent analysis..
RESULTS: The low PNI group (< 48.02) had significantly higher National Institutes of Health Stroke Scale scores, hematoma volumes, and lymphocyte and neutrophil counts, but lower hospital stay durations and albumin levels (p < 0.05) than the high PNI group. Univariate logistic regression analysis showed that the 28-day mortality rate was 2.391 times higher in the low PNI group than in the high PNI group (p < 0.005). Multivariate logistic regression analysis adjusted for confounding variables revealed that the 28-day mortality rate was 2.463 times higher in the low PNI group than in the high PNI group. The age subgroup analysis showed that the accuracy of the PNI cut-off value was higher in patients less than 70 years old (65.4%) than in those aged 70 years and older (58%).
DISCUSSION AND CONCLUSION: Lower PNI values were associated with a worse prognosis in patients with supratentorial spontaneous ICH. Further studies in larger populations are needed to validate our findings.

INTRODUCTION: YKL-40, a novel inflammatory factor and has been shown to be involved in angiogenesis, tissue fibrosis, inflammation, and oxidative tissue injury. YKL‐40 was reported to be implicated in the development of ischemic stroke. The aim of this study was to investigate of the levels of YKL-40 in serum from patients with acute ischemic stroke (aIS), and its relationship to infarct volume.
METHODS: A total of 90 subjects, including 50 patients with aIS and 40 healthy controls were enrolled in study. Acute cerebral infarction was defined as area of increase signal intensity on the diffusion weighted images (DWI). To classify acute ischemic stroke according to etiologic subtype, used the Trials of Org 10172 in Acute Stroke Treatment. Serum YKL-40 levels was measured by ELISA. Volume of the cerebral infarction on DWI was measured by a separate investigator by Scion image software.
RESULTS: The patient group consisted of 28 males and 22 females with a mean age of 60.4 ± 7.9 years, while the control group comprised 21 males and 19 females with a mean age of 59.2 ± 6.8 years. Serum YKL-40 levels of aIS patients were significantly higher than controls. Serum YKL-40 levels were 227.28 ± 78,23 ng/ml in aIS patients and 74.78 ± 13,94 ng/ml in controls (p<0.001).There were significantly positively correlated with between serum YKL-40 levels and infarct volume in patients with aIS (r = 0.931, p < 0.001).
DISCUSSION AND CONCLUSION: Our study showed that serum YKL-40 levels increased in aIS patients, and the presence of a positive the relationship between the serum YKL-40 level and cerebral infarct volume. Further studies should clearly establish the effect of YKL-40 on the pathophysiology of acute-subacute cerebral ischemia and aim to predict the risk of stroke recurrence and post-stroke prognosis.

Spinal dural arteriovenous fistulas (SDAVFs) are acquired vascular malformations characterized by spinal cord dysfunction. Patients present with symptoms such as paraparesis, sensory deficits and dysfunction of the bowel and bladder. The gold standard in diagnosis is spinal angiography. However, delays in diagnosis and treatment are common. In this article, we aim to present a case of SDAVF presenting with paraparesis and urinary incontinence. A 40-year-old male patient presented to our clinic with weakness in the legs and difficulty urinating following an upper respiratory tract infection. Neurological examination revealed paraparesis consistent with a 1st motor neuron lesion and sensory deficit was present starting from level T9. Spinal cord MRI showed hyperintense signal changes on T2-weighted sequences enhancing from the T5 to L1 vertebral levels. Spinal MR angiography performed with the diagnosis of SDAVF revealed a vascular lesion resembling SDAVF extending between T4 and L2 vertebrae and the patient underwent endovascular embolization therapy. SDAVFs most commonly occur in the thoracolumbar region and predominantly affect middle-aged male patients. The absence of a typical clinical presentation complicates early diagnosis at initial presentation. Delayed diagnosis can lead to further neurological deficits and more severe outcomes. Therefore, in cases presenting with paraparesis and extensive hyperintense lesions on MRI, SDAVF should always be considered in the differential diagnosis.

Persistent trigeminal artery (PTA) is the most common embryological anastomosis between the internal carotid artery (ICA) and basilar artery, which continues also in adult life. PTA is mostly asymptomatic but has also been described with comorbid conditions such as cerebrovascular pathologies. In this article, two cases of ischemic stroke accompanied by incidentally detected PTA are presented. In the first case, ischemic stroke with ipsilateral ICA hypoplasia and PTA were observed and in the second case, ischemic stroke with ipsilateral critical ICA stenosis and PTA were observed. The presence of minor infarction and low disability in both cases suggests that the presence of PTA may be associated with a better prognosis in ischemic stroke as it supports collateral circulation.