Browsing by Author "Sirin, H"

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    Superior mesenteric artery branch - jejunal artery aneurysm
    Kurdal, AT; Cerrahoglu, M; Iskesen, I; Sirin, H
    Visceral artery aneurysm (VAA) is a relatively uncommon disorder and it shows some vague symptoms. Therefore, the clinical diagnosis is difficult and these aneurysms are discovered and diagnosed only after rupture in many cases. This case report describes the history of a woman who had a superior mesenteric artery (SMA) branch aneurysm. A 62-year-old woman presented with fatigue and moderate to severe epigastric and mid-back pain. A computed tomography of the abdomen and pelvis demonstrated a partially thrombosed aneurysm (38x40 mm) rising from the jejunal branch of the SMA. The aneurysm which contains mural thrombus is resected, and a saphenous vein graft interposition is performed between the ends of the same jejuno-jejunal artery. The patient's recovery was unremarkable, and she was discharged on postoperative day 7. Rapid diagnosis, localization, and surgical or endovascular interventions are necessary to avoid devastating consequences in VAAs. Saphenous vein graft interposition is a good choice for surgical intervention for patients not suitable for endovascular treatment. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
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    Trimetazidine reduces oxidative stress in cardiac surgery
    Iskesen, I; Saribulbul, O; Cerrahoglu, M; Var, A; Nazli, Y; Sirin, H
    Background Trimetazidine is an anti-ischemic agent that is used to treat angina and it has cardioprotective effects without inducing any significant hemodynamic changes. It inhibits the long-chain mitochondrial 3-ketoacyl coenzyme A thiolase enzyme in the myocyte and can improve cardiac mitochondrial metabolism, as well as scavenge free radicals. The aim of this double-blind prospective randomized study was to investigate the effect of preoperative use of trimetazidine on the reduction of oxidative stress during coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods and Results The study group (group T) and the control group (group C) each comprised 12 patients. Pretreatment began 2 weeks before CABG with trimetazidine (60 mg/day po); the control group did not receive any medication. Serial blood samples were collected before and after CPB for measurement of the serum concentrations of these major endogenous antioxidant enzyme systems, which are markers for oxidative degradation of the cellular membranes; postoperative levels were significantly different between the groups (p < 0.05). There were no significant difference in hemodynamic values. Conclusion The findings suggest that Pretreatment with trimetazidine alleviates malondialdehyde production and preserves endogenous antioxidant capacity during CABG with CPB and cardioplegic arrest.
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    Calcium dobesilate reduces oxidative stress in cardiac surgery
    Cerrahoglu, M; Kurdal, AT; Iskesen, I; Onur, E; Sirin, H
    Aim. Calcium dobesilate (CD) is a synthetic benzene sulfonate derivative and an angioprotective agent used orally. It can be used in patients who have diabetic retinopathy or chronic venous insufficiency. The aim of this study was to investigate the effect of CD on the reduction of oxidative stress during coronary artery bypass graft operations on cardiopulmonary bypass. Methods. A double-blind prospective randomized study was carried out on 30 patients who underwent coronary artery bypass operations. The control and study groups were composed of 15 patients each. Pretreatment with CD started two weeks before. the operation. Serial blood samples for superoxide dismutase, glutathione peroxidase were collected for the serum concentration measurements of the major endogenous, antioxidant enzyme systems and malondialdehyde for scavenging capacity. Results. After the release of cross clamp levels of superoxide dismutase and glutathione peroxidase. they were significantly higher in the study group than in the control group (P<0.05). Malondialdehyde levels in the study group were significantly lower than those of the control group (P<0.05). The cardiac function after aortic declamping was affected by CD, indicating contribution of CD to myocardial injury from ischemia/reperfusion. Conclusion The study suggests that pretreatment with CD alleviates malondialdehyde production and preserves endogenous antioxidant capacity during cardiopulmonary bypass and cardioplegic arrest.
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    The effect of piroxicam on the prevention of postoperative retrosternal and pericardial adhesions
    Iskesen, I; Aksoy, O; Cerrahoglu, M; Sirin, H
    Background - The presence of adhesions after heart operations increases the risk of life-threatening damage to the heart and extracardiac grafts. Infections, tissue injury and inflammations are suspected aetiologic agents. The main purpose of our study is to evaluate the effect of an antiinflammatory agent piroxicam on the formation of retrosternal and pericardial adhesions in a rabbit model. Material and methods - 23 of forty-two New Zealand white rabbits were labelled as group P (piroxicam group) and the others as group C (n = 19, control group). All animals were subjected to median sternotomy and abrasion was applied to the epicardium and pericardium. Piroxicam was given only to group P animals 10 mg/kg/day intramuscularly on the day of operation and twice daily for 2 days postoperatively. All animals were sacrificed on the 10(th) postoperative day. After cardiectomy, the pericardium was totally excised; retrosternal and pericardial adhesions were evaluated and scored. t-PA (tissue plasminogen activator), PAI-I (plasminogen activator inhibitor-I) levels and pericardial tissue myeloperoxidase activities were measured. Results - More severe retrosternal and pericardial adhesions were observed in the control group (P < 0.05). Mean levels of t-PA were higher in the study group than in the control group (P < 0.05). Mean levels of PAI-I were lower in the study group (P < 0.05). Hence pericardial fibrinolytic capacity was significantly higher in the piroxicam group than in the control group. Myeloperoxidase activities in the pericardium were significantly lower in the study group than in the control group (P < 0.05). Conclusion - The use of piroxicam in the perioperative period prevents inflammation, preserves the fibrinolytic capacity of the pericardium and decreases the postoperative pericardial and retrosternal adhesions.
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    Cardioprotective effect of calcium dobesilate during open-heart surgery
    Iskesen, I; Saribulbul, O; Cerrahoglu, M; Onur, E; Tekin, C; Sirin, H
    Objective - The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of calcium dobesilate (CLS2210) on the biochemical markers of myocardial injury during open-heart surgery, and to determine if it has any myocardial protective effects. Methods - Twenty-four patients undergoing elective cardiac surgery were included in this study and randomized into two groups. CLS2210 was given orally to 12 patients for 14 days before the operation (CD group), but not to the other 12 patients (control group). Serum CK, CK-MB, myoglobin and troponin-T levels were measured from venous blood samples before and after the operation for evaluation of the effect of this drug against myocardial damage. Blood samples were also taken from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB), and 2 and 15 minutes after the removal of the cross-clamp in order to measure the lactate levels and calculate the lactate extraction of the myocardium. Results - First, CK-MB levels in patients of the CD group were significantly lower than those of the control group (p < 0.05) at the 2nd and 18th postoperative hour. Third, there was a significant difference in lactate extraction calculation values between the groups at the 2nd minute after removal of the cross-clamp (p < 0.05). Conclusions - We concluded that preoperative use of CLS2210 has some beneficial effects in protecting the myocardium and decreasing the myocardial injury during the cardioplegic arrest period in open-heart surgery.
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    Subfascial endoscopic perforator surgery ameliorates the symptoms of chronic venous ulcer (C6) patiens
    Kurdal, AT; Cerrahoglu, M; Iskesen, I; Eserdag, M; Sirin, H
    Aim. Chronic venous insufficiency and the development of venous ulceration, as a result of this condition affects quality of life. In order to avoid skin changes and allow for quick remedy, subfacial endoscopic perforator surgery (SEPS) has been suggested and gained some popularity. The purpose of this study was to assess the healing rate of venous ulcers in patients undergoing SEPS. Methods. The SEPS procedure by using two ports was applied in 20 patients with active venous ulceration (CEAP-C6). The results were evaluated by Doppler findings, Venous Disability Score (VDS) and Venous Clinical Severity Score (VCSS) before and after the operation. Patients with prior deep vein thrombosis were excluded from this study. Results. The ulcers healed in all patients. Significant clinical improvement according to VDS and VCSS values was obtained in all patients after the procedures. There was no mortality or any other major complication during the follow up period. Conclusion. The advantages of using two-port, video-controlled SEPS procedure may provide freedom from the skin complications that can be seen after Linton operation with quick and sustainable ulcer healing. [Int Angiol 2010;29:70-4]
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    Pleura preservation during coronary operation does not have any beneficial effect on respiratory functions
    Iskesen, I; Kurdal, AT; Yildirim, F; Cerrahoglu, M; Sirin, H
    Aim. According to some reports the destruction the integrity of the pleura during acute myocardial infarction (AMI) harvesting during coronary surgery may also impair respiratory function in the postoperative period. The purpose of this study was to evaluate the influence of preserved integrity of pleura on respiratory function in patients undergoing coronary artery bypass grafting (CABG). Methods. One hundred and forty-three patients who had on-pump-CABG operation with pedunculated LIMA graft were divided to 2 groups. The first group is the study group that pleura opened (group OP; N=69), and the other group is that their pleura protected (group C, N=74). All patients were evaluated with using respiratory function test parameters (functional vital capacity [FVC], force expiratory volume %-at the 1(st) second [FEV1%] in the preoperative period and on the 7(th) postoperative day). Respiratory problems, blood drainage amounts and used blood products in the postoperative period were measured. Results. Preoperative FVC values were not different between the two groups (3.08+/-0.5 in group C and 3.37+/-0.7 L in OP group) (P>0.05). On the VII postoperative day this parameter did not show any significant difference between the groups (2.80+/-0.6 in group C and 2.75+/-0.5 liter in OP group) (P>0.05). Preoperative FEV1% values did not show any difference (77.6+/-4.6% and 76.0+/-2.7% in OP and C groups respectively. There was no significant difference between the postoperative FEV1% values (71.8+/-5.1% and 73.4+/-6.3% respectively) (P>0.05). Patients with protected pleura had significantly lower blood drainage and whole blood unit transfusion (P<0.05). Conclusion. Preservation of the pleural integrity during LIMA harvesting significantly reduces postoperative bleeding but not affects pulmonary functions.
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    Huge pulsating cystic cardiac mass
    Utuk, O; Bilge, AR; Bayturan, O; Sirin, H; Iskesen, I; Teznan, UK
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    Smoking alters VEGF and eNOS expression during coronary artery bypass graft surgery
    Toprak, V; Keles, G; Sirin, H; Ozbilgin, K; Saribulbul, O; Tok, D
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    Efficacy of switching to eletriptan in migraine patients unsuccessfully treated with NSAIDs
    Ertas, M; Komurculu, N; Artug, R; Selcuki, D; Karaali-Savrun, F; Goksan, B; Gokcay, F; Sirin, H; Aksoy, O; Irkec, C; Gur, M; Neyal, M; Mavioglu, A; Kansu, T; Kocasoy-Orhan, E; Sahin, H; Ozbenli, T
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    Gastrostomy in Hospitalized Patients with Acute Stroke: NoroTek Turkey Point Prevalence Study Subgroup Analysis
    Topçuoglu, MA; Özdemir, AÖ; Aykaç, Ö; Milanoglu, A; Gökçe, M; Bavli, S; Çabalar, M; Yayla, V; Erdogan, HA; Özkul, A; Günes, A; Degirmenci, B; Aluçlu, U; Kozak, HH; Güngör, L; Erdogan, M; Acar, ZÖ; Cenikli, U; Kablan, Y; Yilmaz, A; Genç, H; Nazliel, B; Çaglayan, HB; Gencer, ES; Ay, H; Demirbas, H; Akdogan, Ö; Emre, U; Yildiz, ÖK; Bolayir, A; Demir, T; Tanriverdi, Z; Tekan, ÜY; Akpinar, ÇK; Özkan, E; Ilik, F; Sirin, H; Güler, A; Önder, H; Bektas, H; Öcek, L; Bakar, M; Ongun, N; Krespi, Y; Isikay, CT; Aslanbaba, E; Sorgun, M; Gürkas, E; Karadeli, HH; Midi, I; Ilgezdi, I; Bilgiç, AB; Akyol, S; Epçeliden, MT; Atmaca, MM; Kursun, O; Keskin, O; Sirinocak, PB; Baydemir, R; Akçakoyunlu, M; Öztürk, S; Özel, T; Ünal, A; Dora, B; Yürekli, VA; Arlier, Z; Eren, A; Yilmaz, A; Kisabay, A; Acar, B; Bastan, B; Acar, Z; Niflioglu, B; Güven, B; Kaya, D; Afsar, N; Yazici, D; Aytaç, E; Yaka, E; Toplutas, E; Degirmenci, E; Ince, FB; Büyükserbetçi, G; Aydin, I; Çetiner, M; Sen, M; Turgut, N; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Birgili, Ö; Yevgi, R; Kunt, R; Giray, S; Akkas, SY; Senadim, S; Yoldas, T; Asil, T; Duman, T; Atasoy, T; Çinar, BP; Demir, T; Can, U; Ünsal, YÖ; Eskut, N; Aslan, Y; Bas, DF; Sener, U; Yilmaz, Z; Bozdogan, Z; Alioglu, Z; Arsava, EM
    Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NoroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69 +/- 14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (ss): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (ss): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (ss): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (ss): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (ss): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NoroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.
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    Eating attitudes of migraine patients in Turkey: a prospective multi-center study
    Ocal, R; Karakurum-Goksel, B; Van, M; Coskun, O; Karaaslan, C; Ucler, S; Gokcay, F; Celebisoy, N; Sirin, H; Ak, AK; Saritas, AS; Sirin, TC; Bayir, BRH; Ekizoglu, E; Orhan, EK; Bayram, D; Tanik, N; Bicakci, S; Ozturk, V; Inan, LE; Metin, KM; Eren, Y; Dora, B; Oguz-Akarsu, E; Karli, N; Celik, EU; Atalar, AC; Celik, RGG; Mutluay, B; Aydinlar, EI; Dikmen, PY; Semercioglu, S; Emre, U; Buldukoglu, OC; Er, B; Kilboz, BB; Ibis, S; Yagiz, S; Koklu, H; Kamaci, I; Aliyeva, G; Ates, BE; Kara, MM; Altunc, FZ; Kaya, I; Sisman, C
    Background Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study.Methods The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups.Results EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055).Conclusions Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.
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    Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire
    Ertas, M; Siva, A; Dalkara, T; Uzuner, N; Dora, B; Inan, L; Idiman, F; Sarica, Y; Selçuki, D; Sirin, H; Oguzhanoglu, A; Irkeç, C; Özmenoglu, M; Özbenli, T; Öztürk, M; Saip, S; Neyal, M; Zarifoglu, M
    Objectives.-The aim of this study is to assess the comprehensibility, internal consistency, patient-physician reliability, test-retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache. Background.-MIDAS questionnaire has been developed by Stewart et al and shown to be reliable and valid to determine the degree of disability caused by migraine. Design and Methods.-This study was designed as a national multicenter study to demonstrate the reliability and validity of Turkish version of MIDAS questionnaire. Patients applying to 17 Neurology Clinics in Turkey were evaluated at the baseline (visit 1), week 4 (visit 2), and week 12 (visit 3) visits in terms of disease severity and comprehensibility, internal consistency, test-retest reliability, and validity of MIDAS. Since the severity of the disease has been found to change significantly at visit 2 compared to visit 1, test-retest reliability was assessed using the MIDAS scores of a subgroup of patients whose disease severity remained unchanged (up to +/- 3 days difference in the number of days with headache between visits 1 and 2). Results.-A total of 306 patients (86.2% female, mean age: 35.0 +/- 9.8 years) were enrolled into the study. A total of 65.7%, 77.5%, 82.0% of patients reported that they had fully understood the MIDAS questionnaire in visits 1, 2, and 3, respectively. A highly positive correlation was found between physician and patient and the applied total MIDAS scores in all three visits (Spearman correlation coefficients were R = 0.87, 0.83, and 0.90, respectively, P <.001). Internal consistency of MIDAS was assessed using Cronbach's and was found at acceptable (>0.7) or excellent (>0.8) levels in both patient and physician applied MIDAS scores, respectively. Total MIDAS score showed good test-retest reliability (R = 0.68). Both the number of days with headache and the total MIDAS scores were positively correlated at all visits with correlation coefficients between 0.47 and 0.63. There was also a moderate degree of correlation (R = 0.54) between the total MIDAS score at week 12 and the number of days with headache at visit 2 + visit 3, which quantify headache-related disability over a 3-month period similar to MIDAS questionnaire. Conclusion.-These findings demonstrated that the Turkish translation is equivalent to the English version of MIDAS in terms of internal consistency, test-retest reliability, and validity. Physicians can reliably use the Turkish translation of the MIDAS questionnaire in defining the severity of illness and its treatment strategy when applied as a self-administered report by migraine patients themselves.
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    Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study
    Topçuoglu, MA; Arsava, EM; Özdemir, AÖ; Aykaç, Ö; Çetiner, M; Gencer, ES; Günes, A; Krespi, Y; Yaka, E; Öcek, L; Tanriverdi, Z; Tekan, ÜY; Özkul, A; Özkan, E; Sirin, H; Güler, A; Kursun, O; Kunt, R; Cenikli, U; Acar, B; Kablan, Y; Yilmaz, A; Isikay, CT; Aslanbaba, E; Sorgun, M; Bektas, H; Çabalar, M; Yayla, V; Erdogan, HA; Gökçe, M; Bavli, S; Ongun, N; Keskin, AO; Akdogan, Ö; Emre, U; Yildiz, ÖK; Bolayir, A; Akpinar, ÇK; Karadeli, HH; Özel, T; Ünal, A; Dora, B; Arlier, Z; Eren, A; Milanoglu, A; Nazliel, B; Çaglayan, HB; Güven, B; Erdogan, M; Acar, ZÖ; Bakar, M; Giray, S; Senadim, S; Asil, T; Demir, T; Ünsal, YÖ; Eskut, N; Aslan, Y; Bas, DF; Sener, U; Degirmenci, B; Aluçlu, U; Bastan, B; Acar, Z; Niflioglu, B; Yazici, D; Aytaç, E; Ince, FB; Ay, H; Önder, H; Kozak, HH; Ilgezdi, I; Bilgiç, AB; Akyol, S; Güngör, IL; Atmaca, MM; Sen, M; Yevgi, R; Akkas, SY; Yoldas, T; Atasoy, HT; Çinar, BP; Yilmaz, A; Genç, H; Kisabay, A; Ilik, F; Demirbas, H; Midi, I; Sirinocak, PB; Duman, T; Demir, T; Can, U; Yürekli, VA; Bozdogan, Z; Alioglu, Z; Kaya, D; Afsar, N; Gürkas, E; Toplutas, E; Degirmenci, E; Büyükserbetçi, G; Aydin, I; Epçeliden, MT; Turgut, N; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Bilgili, Ö; Baydemir, R; Akçakoyunlu, M; Yilmaz, Z; Öztürk, S
    Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received effective treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.
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    Acute Stroke Management in Türkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NöroTek: Türkiye Neurology Single Day Study
    Topçuoglu, MA; Özdemir, AÖ; Arsava, EM; Günes, A; Aykaç, Ö; Gencer, ES; Çabalar, M; Yayla, V; Erdogan, HA; Erdogan, M; Acar, ZÖ; Giray, S; Kablan, Y; Tanriverdi, Z; Tekan, ÜY; Asil, T; Akpinar, ÇK; Yürekli, VA; Acar, B; Sirin, H; Güler, A; Baydemir, R; Akçakoyunlu, M; Öcek, L; Çetiner, M; Nazliel, B; Çaglayan, HB; Ongun, N; Eren, A; Arlier, Z; Cenikli, U; Gökçe, M; Bavli, S; Yaka, E; Özkul, A; Degirmenci, B; Aluçlu, U; Isikay, CT; Aslanbaba, E; Sorgun, M; Aytaç, E; Ay, H; Kunt, R; Senadim, S; Ünsal, YÖ; Eskut, N; Alioglu, Z; Yilmaz, A; Genç, H; Yilmaz, A; Milanoglu, A; Gürkas, E; Degirmenci, E; Bektas, H; Ilgezdi, I; Bilgiç, AB; Akyol, S; Güngör, L; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Kursun, O; Yildiz, ÖK; Bolayir, A; Kisabay, A; Bastan, B; Acar, Z; Niflioglu, B; Güven, B; Kaya, D; Afsar, N; Yazici, D; Toplutas, E; Özkan, E; Ilik, F; Ince, FB; Büyükserbetçi, G; Önder, H; Karadeli, HH; Kozak, HH; Demirbas, H; Midi, I; Aydin, I; Epçeliden, MT; Atmaca, MM; Bakar, M; Sen, M; Turgut, N; Keskin, O; Akdogan, Ö; Emre, U; Bilgili, Ö; Sirinocak, PB; Yevgi, R; Akkas, SY; Yoldas, T; Duman, T; Özel, T; Ünal, A; Dora, B; Atasoy, T; Çinar, BP; Demir, T; Demir, T; Can, U; Aslan, Y; Bas, DF; Sener, U; Yilmaz, Z; Bozdogan, Z; Özdemir, G; Krespi, Y; Öztürk, S
    Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neurointerventional therapy in Turkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0-2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +/- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +/- 6; hospital stay, 24 +/- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +/- 13 years; NIHSS: 14.1 +/- 6.5; length of hospital stay, 33 +/- 31 days), 19% in those who received combined treatment (age: 66 +/- 14 years; NIHSS: 15.6 +/- 5.4; length of hospital stay, 26 +/- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +/- 13 years; NIHSS: 7.6 +/- 7.2; length of hospital stay, 21 +/- 28 days). The symptom-to-door time was 87 +/- 53 minutes in the IV treatment group and 200 +/- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +/- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +/- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0-2 was 41%, while the rate of mRS 0-1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0-2 was 31% and mRS 0-1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +/- 107 and 95 +/- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Turkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the Directive on Health Services to be Provided to Patients with Acute Stroke.