Background: Endovascular stenting for atherosclerotic stenosis in the intra- and extracranial arteries is a minimally invasive procedure, but comprehensive studies on long-term complications following COVID-19 infection are lacking. Given the potential for increased rates of stent thrombosis, stroke, myocardial infarction, and mortality among COVID-19 patients, understanding the long-term outcomes of stenting for extra- and intracranial atherosclerotic stenosis is crucial for public health. This study addresses the dearth of extensive research on the long-term adverse outcomes associated with endovascular stenting procedures in patients who have experienced atherosclerotic stenosis in intracranial and extracranial arteries following COVID-19 infection. Methods: This retrospective study analyzed data from a tertiary hospital database, focusing on individuals who underwent extracranial or intracranial atherosclerotic stenting procedures at the Central Clinical Hospital JSC, Department of Neurosurgery, between 2016 and 2017, before the COVID-19 pandemic. The primary outcome measures to be evaluated include the incidence of stent thrombosis, ischemic stroke, myocardial infarction, and all-cause mortality. Results: The study followed 93 patients via telephone survey, but 12 did not respond, leaving 81 participants. Of these, 32 reported a prior COVID-19 infection confirmed by PCR testing, forming the COVID-19 group. The remaining 49 without confirmed COVID-19 infection comprised the control group. The 81 participants included 32 in the COVID-19 group and 49 in the control group, with no statistically significant differences in sex or age between the two cohorts. The binary logistic regression analysis revealed that the number of cigarettes smoked per day was a statistically significant predictor of myocardial infarction. This risk factor accounted for 23.6% of the observed myocardial infarctions, demonstrating a direct relationship between the number of cigarettes smoked and the probability of experiencing a myocardial infarction. Conclusion: The study found no significant differences in mortality, stroke, and heart attack rates between the COVID-19 and control groups. However, high blood pressure, heavy smoking, and high stress were linked to worse long-term outcomes.

Background Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. Methods: This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). Results The median age was 63.5 years (IQR: 57–68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age (p=0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with p-values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, 4 patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. Conclusion: ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations.

Introduction. Stroke remains a leading cause of death and disability, with rising global burden. Transient ischemic attack (TIA) is often overlooked despite requiring urgent care. Evidence on stroke awareness, intended action, and access to acute care in Kazakhstan is limited. Aim. To assess public stroke awareness and its sociodemographic distribution, test whether knowledge predicts appropriate intended action, describe barriers in the acute stroke pathway, and identify targets for system improvement. Materials and Methods. Two independent cross-sectional online surveys (StrokeTimeBrain v1.4) were conducted in February–April 2026. Module A included community adults aged ≥18 years (n=383), and Module B included patients and caregivers with a suspected stroke/TIA care contact within the previous 24 months (n=397). Outcomes included a composite knowledge score (0–15), three symptom vignettes, and a four-item care-experience scale. Analyses used χ2 tests, nonparametric comparisons, and logistic/Poisson regression adjusted for age, sex, education, residence, and region. Results. Overall knowledge was modest (mean 6.5/15). Only 20.4% identified the ≤4.5-hour thrombolysis window, and reperfusion-treatment awareness was low, although 94.5% knew the emergency number. Knowledge increased with age, while the youngest respondents were least informed. Appropriate “call EMS” responses declined from 83.6% for slurred speech to 60.8% for transient/TIA symptoms (p<0.001). Correct intended action was associated mainly with urban residence (aOR 3.22), not with total knowledge score. Willingness to use telestroke was high (78.1%). Among care users, satisfaction was high (7.9/10), and imaging delay was the main bottleneck (42.1%). Conclusion. Stroke awareness in Kazakhstan was modest and unevenly distributed. Education should emphasize urgency and TIA, while system improvement should prioritize EMS, imaging, and telestroke capacity, especially in weaker regions. Key words: stroke, transient ischemic attack, health knowledge, emergency medical services, patient satisfaction, health services accessibility.

Background: Trigeminal neuralgia (TN) is often treated with microvascular decompression (MVD), providing long-term pain relief for most patients. However, a subset experiences recurrence requiring reoperation. Endoscopic MVD techniques have gained traction due to enhanced visualization and potentially lower morbidity, yet their feasibility for redo procedures – particularly in complex cases with dense adhesions – remains uncertain. Case Description: We report the case of a 63-year-old male who initially presented with Barrow Neurological Institute (BNI) grade V TN in the V2–V3 distribution. After an endoscopic MVD, the patient achieved immediate pain relief (BNI I) but developed recurrent symptoms 10 months later (BNI III), controlled by carbamazepine. A subsequent escalation (BNI IV) prompted surgical re-exploration. Imaging revealed no residual or new neurovascular conflict. Instead, intraoperative findings demonstrated dense adhesions tethering the trigeminal nerve to the tentorium, causing nerve tension. Careful endoscopic dissection restored nerve mobility and resulted in complete symptom resolution. Conclusion: This case highlights the feasibility and effectiveness of a fully endoscopic redo MVD in recurrent TN where dense adhesions, rather than persistent vascular compression, were the primary mechanism of recurrence. Further investigation is warranted to optimize endoscopic techniques, reduce adhesion formation, and improve long-term outcomes in redo MVD cases.

Background: Ruptured wide-necked or multi-lobulated intracranial aneurysms pose a challenge in the acute phase of subarachnoid hemorrhage (SAH), in which antiplatelet therapy is generally contraindicated. The Woven EndoBridge (WEB) device enables intrasaccular occlusion without requiring antiplatelet agents. However, the treatment of multilobulated aneurysms in this setting remains technically demanding. Case Description: An octogenarian patient presented with a poor-grade SAH due to a ruptured multilobulated aneurysm of the right middle cerebral artery (MCA) accompanied by intracerebral and subdural hematomas. Emergency endovascular treatment was performed using dual-horizontal WEB devices, each deployed in a separate lobule. Antiplatelet therapy was not administered. Subsequently, a neuroendoscopic hematoma evacuation was performed. Postoperative imaging confirmed complete exclusion of the aneurysm and resolution of the hematoma. The patient showed neurological improvement and was transferred for rehabilitation with acceptable clinical outcomes. Conclusion: This case illustrates the feasibility of combining dual WEB deployment with subsequent neuroendoscopic hematoma evacuation during the acute phase of SAH. This strategy may be a viable treatment option for ruptured multilobulated MCA aneurysms in older adults when conventional approaches are unsuitable.