Flomin Y. Optimization of treatment strategy in anterior circulation acute ischemic stroke taking into account prognosis of 30-day outcome.

Object of the study: Acute ischemic stroke in the anterior circulation during its first 30-day period. Purpose of the study: To optimize treatment strategy in anterior circulation acute ischemic stroke based on individual prediction of 30-day outcome using relevant prognostic means (models), developed by combined evaluation of clinical, instrumental and laboratory characteristics of patients along with clinical outcomes. Methods of the study: 1. Clinical (general clinical observation and detailed neurological examination). 2. Instrumental (magnetic-resonance imaging, thermometry, electrocardiography, sphygmomanometry). 3. Lab tests (erythrocyte sedimentation rate, white blood cells count, levels of fibrinogen, creatinin, glucose and cytokines in the peripheral blood). 4. Statistical (correlation and regression analyses, comparison and modeling). Practical significance: Clinical, instrumental and laboratory indicators of short-term survival and functional outcome in patients with acute anterior circulation ischemic stroke have been identified. These data contributed to better resource utilization and improved treatment. Simple and effective prognostic models, developed for quantification of survival, good functional outcome and clinical worsening probability, may be used by clinicians in ordinary city hospitals while evaluating heterogeneous patients. Proposed algorithm is ready for introduction to stroke centers' routine. Novelty of the obtained results: New method of anterior circulation acute ischemic stroke initial presentations as well as clinical outcomes registration worked out. Predictors' interrelations and outcomes correlations established. Concepts of systemic reactions to the brain infarction and inaugural differ-ences of survivors and non-survivors further enhanced. Prognostic value of potential predictors quantified and prognostic significance of inflammatory markers proved. Prediction implications and in-hospital treatment strategy optimized. Cytokines levels and their relations to other predictors and clinical outcomes assessed. Introduction: Introduction includes training and research activities in Kharkiv Medical Academy of Post-Graduate Education (Departments of Neurology and Children Neurology, Neurology and Neurosurgery) in addition to clinical practice in the Central Clinical Hospital of Ukrzaliznitsa (Khakiv) and Municipal Clinical Hospital # 7 (City Acute Cerebrovascular Disease Center), Kharkiv. Sphere of application: medicine, Neurology.