Emergency reperfusion is the main method of treatment in the most acute period of acute cerebrovascular accident. To date, several methods of therapy are used: intravenous thrombolytic therapy, intravascular thrombectomy. The ability to choose from these methods allows you to develop an effective treatment strategy, taking into account the individual characteristics of the patient. Objective – demonstration of a clinical case of management of an aged patient with severe stroke and severe cardiac pathology while taking anticoagulants in the most acute period of stroke. Methods. A retrospective analysis of the medical history of an 82-year-old patient hospitalized in the department for the treatment of patients with stroke at the Novokuznetsk City Clinical Hospital N 1 with a diagnosis: «Cerebrovascular disease was carried out. Atherothrombotic ischemic stroke in the MCA pool on the right. Thrombotic occlusion of the ICA bifurcation with thrombus migration to the M1 segment of the right MCA». The diagnosis was verified by spiral computed tomography (SCT) of the brain and angiography of extra- and intracranial vessels. The severity of neurological deficit was assessed using the following scales: NIHSS (National Institutes of Health Stroke Scale), modified Rankin scale, Rivermead Mobility Index. Recanalization was assessed using the TICI (Treatment in Cerebral Ischemia) scale. Results. Endovascular interventions in patients with acute ischemic stroke have been carried out since September 2017 in the department for the treatment of patients with stroke at NGCH N 1 and show their high efficiency. To date, 70 patients have undergone thrombectomy. In the presented patient, the severity of the condition was due to neurological deficit (NIHSS 19 points) and concomitant cardiac pathology: coronary artery disease. PICS, parietal thrombosis of the LV apex. Paroxysmal AF, pulmonary hypertension. When choosing the method of reperfusion therapy, the clinical signs of occlusion of the main cerebral vessel and the use of anticoagulant therapy were taken into account. A decision was made to perform mechanical thrombus extraction. A day after the procedure, the neurological deficit regressed to 11 points, on the 23rd day the patient was discharged with positive dynamics, according to the NIHSS scale 6 points. The degree of functional impairment at the time of discharge was 4 points on the Rankin scale due to existing cognitive impairment. Conclusions. In the presented clinical case, the rationally chosen tactics of using modern methods of reperfusion therapy made it possible to avoid severe neurological deficit and achieve a favorable functional outcome in a patient with occlusion of the main cerebral vessel.

Objective – demonstration of the effective using of modern techniques in the treatment of ischemic stroke by the work of the regional center of cerebrovascular disease in Novokuznetsk. Methods. There is an analysis of the use of intravenous thrombolytic therapy and thromboextraction in patients with verified ischemic stroke. Thrombolytic therapy was carried out with «Actilyse». The dose was calculated of 0.9 mg per 1 kg of patient's weight. Thromboextraction was performed using stent retrievers «Solitaire» or suction system «Penumbra». Results. For the period from 2011 to 2021, there were performed 445 procedures of intravenous thrombolytic therapy at the regional center of cerebrovascular disease N 2. The proportion of patients with TLT procedure ranges from 10.1 % to 12.3 % in different years. The severity of neurological deficit according to the NIHSS scale before the IV TLT procedure averaged 15.6 ± 7.3 points, and at discharge it was 8.1 ± 6.4 points. It was possible to reduce the mortality rate among patients undergoing TLT from 15.5 % to 4.5 % due to more careful selection of patients in recent years. Also in 2019 the procedure of mechanical recanalization (thrombextraction) was performed in 15 patients, 2020 – 17 patients, 2021 – 8 patients. The use of this method made it possible to reduce the severity of neurological deficit from an average of 18.1 ± 6.3 points to 6.5 ± 4.2 points. Conclusions. When used in practical medicine, TLT and TE have shown high efficiency in the treatment of stroke. The growth in the use of these techniques is due to a number of reasons: 1) transportation of the patient to the nearest vascular center for specialized care; 2) the arrival of young specialists who are ready to apply modern methods of treatment to the department; 3) close cooperation with ambulance workers; 4) use of a special telephone connection from the patient's bed; 5) continuity in the work of medical services – laboratory, radiation, endovascular surgery, neurosurgery; 6) raising awareness of the population about the symptoms of stroke.

Objective – demonstration of a clinical case of management patient with severe stroke and severe comorbid pathology. Methods. There is a retrospective analysis of the medical history of a 74-year-old female patient. She was admitted to the department for patients with acute cerebrovascular accident Novokuznetsk State Hospital N 1 with a diagnosis of ischemic stroke was carried out. The diagnosis was verified by spiral computed tomography (SCT) of the brain. Assessment of the severity of neurological deficit was conducted on the scales: NIHSS (National Institutes of Health Stroke Scale), modified Rankin Scale, Index Rivermead mobility. Results. The severity of the patient's condition was due to the extensive ischemic zone, which captures two basins of cerebral circulation. Neurological deficit – NIHSS 19. Treatment according to the ischemic stroke protocol was started. On the 5th day after the acute event, due to the increase in edema and dislocation syndrome, the patient's condition worsened – focal neurological symptoms increased – NIHSS 34, consciousness was depressed to the level of coma 1. The patient was transferred to the ventilator through the ETT. After 4 days, against the background of the therapy, there was a positive trend - cerebral symptoms regressed to sopor, minimal movements appeared in the distal parts of the right extremities. Hemodynamics has stabilized. Subsequently, the cerebral symptoms regressed - the level of consciousness was normal, the strength in the right extremities increased, and attempts to swallow independently appeared. After 20 days, the patient did not need respiratory support and was transferred to spontaneous breathing. After 31 days from the acute event, the patient was transferred to continue treatment at the local neurological department (NIHSS-15). Conclusions. In the presented clinical case, a complete complex personalized treatment made it possible to achieve a significant result, despite the prevalence of factors suggesting an unfavorable outcome.

Objective – demonstration of a clinical case of management patient with severe stroke and severe comorbid pathology. Methods. There is a retrospective analysis of the medical history of a 74-year-old female patient. She was admitted to the department for patients with acute cerebrovascular accident Novokuznetsk State Hospital N 1 with a diagnosis of ischemic stroke was carried out. The diagnosis was verified by spiral computed tomography (SCT) of the brain. Assessment of the severity of neurological deficit was conducted on the scales: NIHSS (National Institutes of Health Stroke Scale), modified Rankin Scale, Index Rivermead mobility. Results. The severity of the patient's condition was due to the extensive ischemic zone, which captures two basins of cerebral circulation. Neurological deficit – NIHSS 19. Treatment according to the ischemic stroke protocol was started. On the 5th day after the acute event, due to the increase in edema and dislocation syndrome, the patient's condition worsened – focal neurological symptoms increased – NIHSS 34, consciousness was depressed to the level of coma 1. The patient was transferred to the ventilator through the ETT. After 4 days, against the background of the therapy, there was a positive trend - cerebral symptoms regressed to sopor, minimal movements appeared in the distal parts of the right extremities. Hemodynamics has stabilized. Subsequently, the cerebral symptoms regressed - the level of consciousness was normal, the strength in the right extremities increased, and attempts to swallow independently appeared. After 20 days, the patient did not need respiratory support and was transferred to spontaneous breathing. After 31 days from the acute event, the patient was transferred to continue treatment at the local neurological department (NIHSS-15). Conclusions. In the presented clinical case, a complete complex personalized treatment made it possible to achieve a significant result, despite the prevalence of factors suggesting an unfavorable outcome.