Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke.

INTRODUCTION: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion. METHODS: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score 2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality. RESULTS: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5-13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235-340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3-7; p.

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery - case repor.

INTRODUCTION: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. CASE REPORT: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left common carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. CONCLUSION: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.

Safety and efficacy of mechanical thrombectomy with stent-retrievers in anticoagulated patients with anterior circulation stroke.

AIM: To assess the safety and efficacy of mechanical thrombectomy (MT) with stent-retrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC. MATERIALS AND METHODS: The present retrospective study comprised 285 consecutive patients (115 males; mean age 74±13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score ≥2b), post-treatment imaging findings. The 90-day clinical outcome was assessed using modified Rankin scale (good outcome defined as 0-2). RESULTS: The following statistically insignificant differences were found in 26 patients on OAC versus 259 patients without OAC: occurrence of symptomatic intracerebral haemorrhage 7.7% versus 8.1%, achievement of successful recanalisation 69.2% versus 82.6%, good 90-day clinical outcome 34.6% versus 56.8%, 90-day mortality 26.9% versus 20.8% (p>0.05 in all cases). Age and neurological deficit at the time of treatment were identified as independent negative predictors of good 90-day clinical outcome (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.88-0.94 and OR=0.83, 95% CI: 0.77-0.90, respectively) and as independent positive predictors of mortality (OR=1.12, 95% CI: 1.06-1.18 and, OR=1.17, 95% CI: 1.07-1.27, respectively; p<0.05 in all cases). CONCLUSIONS: MT with stent-retrievers is safe and effective in ACS patients on OAC.

Correction to: Multidisciplinary approach in the treatment of spinal dural arteriovenous fistula-results of endovascular and surgical treatment.

The author J. Adamkov was incorrectly captured in the original article and is now corrected in this article.

Multidisciplinary approach in the treatment of spinal dural arteriovenous fistula-results of endovascular and surgical treatment.

BACKGROUND: The results of treatment for spinal dural arteriovenous fistula (SDAVF) have been controversial. The goal of this study was to compare results of endovascular and surgical treatments to contribute to determining an optimal treatment strategy. METHODS: A retrospective analysis of the set of 24 SDAVF patients (11 in the endovascular and 13 in the surgical group) was performed. The clinical effect (using the modified Rankin scale [mRS]), the radicality, and the number of clinical recurrences as well as the impact of age, the level of impairment, and the duration of symptoms before the treatment were evaluated. RESULTS: The average age was 60.1 ± 8.4 years. The median duration of symptoms before establishing a diagnosis was 12 (1-70) months. Clinical improvement was reported in 11 out of 24 (45.8%) patients (36.4% following embolization and 53.8% following surgery, p = 0.444). Radical performance was achieved in 47.4% of endovascular versus 92.9% of surgical procedures (p = 0.009). Clinical recurrence was reported in 35.3% of patients in the endovascular group, whereas no clinical recurrence was reported in the surgical group (p = 0.0133). The graphical residuum after 1 surgery out of 14 (7.1%) was cured early during the control angiography. Clinical improvement was reported 42.1% of patients with mRS ≤ 3 versus 60% of patients with mRS ≥ 4 and, in 57.1% of patients aged ≥ 60 versus in 30% of patients < 60 years (p > 0.05 in both cases). The impact of the duration of symptoms on the clinical results was not statistically significant. CONCLUSIONS: The surgical treatment of SDAVF appeared to be a more efficient method in terms of the clinical effect, radicality, and lower recurrence rate in comparison with the endovascular treatment. No statistically significant dependence of the clinical result on age, deficit burden, or symptom duration was found.

[Free-floating thrombus in the internal carotid artery treated by anticoagulation and delayed carotid endarterectomy]. / Volne vlající trombus ve vnitrní karotide lécený antikoagulací a odlozenou chirurgickou endarterektomií vnitrní karotidy.

UNLABELLED: Free-floating thrombus in the internal carotid artery is a rare clinical finding. Only case reports and small cohorts of patients are described in the literature. The authors present a case report of a patient with ischemic stroke due to arterio-arterial embolisation from ulcerated internal carotid artery stenosis with a free-floating thrombus. Initially, the patient was treated with anticoagulants, resulting in total dissolution of the free-floating thrombus based on ultrasound documentation, without any further symptomatic embolisation. Endarterectomy was performed in the second step for the critical stenosis of the internal carotid artery. After this combined treatment, the patient showed no neurological deficit. Currently, the opinion on optimal therapy of the free-floating thrombus in the internal carotid artery still remains unclear. KEY WORDS: free-floating thrombus - anticoagulation internal carotid artery.

Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial.

AIM: To evaluate the safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT], to compare particular EVT techniques and identify predictors of clinical outcome. MATERIALS AND METHODS: This retrospective, multi-centre study comprised 72 acute ischaemic stroke patients (51 males; mean age 59.1 ± 13.3 years) with radiologically confirmed BAO. The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings. Thirty- and 90-day outcomes were evaluated using the modified Rankin scale with a good clinical outcome defined as 0-3 points. RESULTS: Successful recanalization was achieved in 94.4% patients. Stepwise binary logistic regression analysis identified the presence of arterial hypertension (OR = 0.073 and OR = 0.067, respectively), National Institutes of Health Stroke Scale (NIHSS) at the time of treatment (OR = 0,829 and OR = 0.864, respectively), and time to treatment (OR = 0.556 and OR = 0.502, respectively) as significant independent predictors of 30- and 90-day clinical outcomes. CONCLUSION: Data from this multicentre study showed that multimodal EVT was an effective recanalization method in acute BAO. Bridging therapy shortens the time to treatment, which was identified as the only modifiable outcome predictor.

[Acute hyperglycemia and reperfusion therapy in stroke patients]. / Hyperglykemie v akutní fázi mozkové ischemie a rekanalizacní lécba.

Current acute therapies for ischemic stroke are limited. Only a small proportion of stroke patients are eligible to receive reperfusion therapy. Acute hyperglycemia has a deleterious effect in stroke patients by accelerating ischemic brain damage. The complex relationship between hyperglycemia and stroke is discussed. In tPA-treated patients, the acute but not chronic hyperglycemic state may hamper fibrinolytic process, delaying reperfusion of ischemic penumbra. Early measures to reduce hyperglycemia may favor early recanalization.

Mechanical thrombolysis of thrombosed hemodialysis native fistulas with use of the Arrow-Trerotola percutaneous thrombolytic device: our preliminary experience.

PURPOSE: To evaluate the feasibility of use of the Arrow-Trerotola percutaneous thrombolytic device (PTD) in the treatment of thrombosed hemodialysis native fistula occlusions. MATERIALS AND METHODS: Ten patients with native fistula occlusion underwent mechanical thrombolysis with use of the PTD. The standard PTD was used in seven patients and the over-the-wire device was used in three patients. Major outcomes of our study included procedure time, clinical success, complication rate, and 3- and 6-month patency rates. RESULTS: The technical success rate was 100% and the clinical success rate was 90% (9 of 10). In all 10 cases, the procedure was associated with angioplasty. There were no major complications. The mean time of successful procedures was 126.1 minutes. The 3- and 6-month primary patency rates were 70% and 60%, respectively; the assisted primary patency rate at 6 months was 80%. CONCLUSION: The PTD is an effective mechanical device for percutaneous treatment of thrombosed hemodialysis access. Our clinically successful initial experience with the PTD shows that the technique is rapid and safe for treatment of native fistula occlusions.

Evaluating the outcome of percutaneous transluminal angioplasty in renal graft artery stenosis using the areas under the time curve of glomerular filtration rate and blood pressure.

The benefit of percutaneous transluminal angioplasty (PTA) of transplant renal artery stenosis for ischemic nephropathy may be adversely affected by rejection or other complications. As a result, assessment of the effect of PTA on renal function or blood pressure is often difficult. In this paper, we evaluated the effect of PTA using the method of integrated glomerular filtration rate (GFR) based upon the area under the curve over a follow-up period (AUC0-1), to express the level of GFR in a simple manner despite its significant fluctuations. A similar procedure was used to evaluate mean arterial pressure (MAP). The method was employed to assess the outcome in 20 individuals before PTA, and 1, 3, 6, 9 and 12 months after PTA. In eight cases, rejection was detected while there was one case of glomerulonephritis in the graft during the follow-up period. Evaluation (AUCCcr)0-12 related to the integrated pre-PTA value of Ccr [(Ccr)0 x 12] revealed a rise in GFR by more than 20 % in 65 % of cases. No improvement was observed in seven individuals with post-PTA complications. When assessing the integrated value of MAP, success of PTA (a reduction by at least 10 %) was found in 85 % of cases. No significant correlation was found between the relative changes of integrated GFR and MAP. Our data suggest that evaluation of the integrated value of GFR or MAP on the basis of AUC0-t allows to characterize, in a simple manner, the level of graft function and MAP throughout the follow-up period in individual cases. Furthermore, it may provide additional information on the average values obtained at different time intervals after the therapeutic procedure.

Artificial emboli based on poly(2-hydroxyethyl methacrylate) particles in animal experiments.

Spherical poly(2-hydroxyethyl methacrylate) particles 0.4-0.6 mm in diameter prepared by suspension polymerization were used for embolization of the internal thoracic artery in ten dogs and the renal artery in two dogs. No signs of toxic or irritating effect of poly(HEMA), either on the artery wall, or surrounding tissues were found in any animal in intervals of observation lasting two weeks, three months or one year. Possible neocapillarity, the presence of fibrous bundles among the particles of poly(HEMA) and, eventually, their slow degradation, were symptomatic of reparative processes.

Intima-media thickness of carotid arteries in borderline hypertensives.

The purpose of this study was to assess the effect of the main risk factors for cardiovascular disease on the process of subclinical atherosclerosis in originally borderline hypertensives. The relation of far wall common carotid artery intima-media thickness (IMT CCA) measured by B-mode ultrasound to smoking, body mass index (BMI), blood pressure, lipids, and angiotensin-converting enzyme (ACE) gene polymorphism was analyzed. In 48 subjects examined (mean age, 61.9 +/- 2.54 years), median IMT CCA was 0.708 mm. Statistically significant differences in BMI (26.5 vs. 29.2 kg/m2, p < 0.025) and HDL-cholesterol level (1.42 vs. 1.1 mmol/l, p < 0.025) between the first and third tertile of IMT CCA were found. No differences were observed between "controls" and "cases" in blood pressure, total cholesterol, and triacylglycerols. No significant differences in IMT CCA were found between smokers and nonsmokers and among different alleles of the ACE gene. These data reflect the importance of HDL-cholesterol and BMI on the process of atherosclerosis within an otherwise homogeneous group of patients.

[Evaluation of the results of percutaneous transluminal angioplasty of arterial stenosis in the transplanted kidney using area under time curves of the glomerular filtration rate and blood pressure]. / Hodnocení výsledku perkutánní transluminální angioplastiky pri stenóze tepny transplantované ledviny na podklade ploch pod casovou krivkou glomerulární filtrace a krevního tlaku.

The benefit of percutaneous transluminal angioplasty (PTA) of renal transplant artery stenosis for renal hemodynamics is frequently adversely affected by rejection or another complication. As a result, evaluation of the effect of PTA is often difficult. Our study was designed to assess the effect of PTA using a method of integrated value of the glomerular filtration rate (GFR) calculated on the basis of the area under the curve over the follow-up period (AUC0-t). A similar procedure was employed to evaluate mean arterial pressure (MAP). The method was used to assess the outcome in 20 individuals before to PTA, and at 1, 3, 6, 9 and 12 months after angioplasty. A rejection episode was diagnosed in eight cases and glomerulonephritis of the graft in one. Using the evaluation of (AUCCcr)0-12 in relation to the integrated value before PTA (Ccr) x 12, a rise in GFR > 20% was found in 65% of cases. PTA failure was observed in seven individuals developing post-PTA complications. When assessing the integrated value of MAP, PTA was found to be successful (a reduction by at least 10%) in 85% of cases. No significant correlation was demonstrated between the integrated values of GFR and MAP. The results support the assumption that the evaluation of the integrated values of GFR or MAP using AUC0-t allows to characterize, in a simple manner, the degree of renal transplant function or MAP throughout the follow-up period, and to furnish additional information to the values obtained at individual time intervals after the therapeutic procedure.

[Percutaneous transluminal angioplasty of the renal artery in transplanted kidneys]. / Perkutánní transluminální angioplastika tepny transplantované ledviny.

UNLABELLED: The objective of the work was to evaluate the contribution of percutaneous transluminal angioplasty (PTA) to treatment of hypertension and the graft function of a transplanted kidney. Angioplasty of the graft artery was performed in 39 patients. Technical success rate: 85%. COMPLICATIONS: 13%--in particular during the first years after introduction of the method. Twenty seven patients were followed up on a long-term basis. Changes of the median arterial pressure (MAP) were evaluated as well as glomerular filtration (GF) assessed by creatinine clearance. Mean values: [table: see text] A statistically significant (p < 0.01) reduction of the median arterial pressure (drop by > 10 mm Hg) along with reduction of the number of antihypertensive drugs was recorded in 70% of the patients during the first year and in 80% kidney recipients in investigations extending beyond one year. A significant increase of glomerular filtration (by > 20%) was found in 40% of the patients, on average the rise was insignificant. During the follow up period 13 kidney recipients were transferred to a dialyzation programme due to failure of the grafts as a result of rejection. CONCLUSION: Percutaneous transluminal angioplasty of a stenosis of the graft artery is the method of first choice in the treatment of hypertension. It is of fundamental importance also in rare cases in order to preserve or improve graft function and thus delay dialyzation treatment.

[Clinical picture and diagnosis of subarachnoid hemorrhage caused by a ruptured aneurysm]. / Klinický obraz a diagnostika subarachnoidálního krvácení z ruptury aneurysmatu.

Ruptured cerebral aneurysm is the most common cause of non-traumatic subarachnoid hemorrhage. Subsequent to this catastrophe, patients have usually evidence of severe headache with sudden onset, signs of meningeal irritation, and depression of consciousness. Difficulties in diagnosis arise when the clinical picture is not classical. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is the leading cause of death and disability after aneurysm rupture. In the presence of a typical history and a normal CT scan, lumbar puncture should be performed with spectrophotometry analysis of the supernatant. After subarachnoid hemorrhage has been confirmed, four-vessel angiography should be performed as soon as possible. The surgical treatment of subarachnoid hemorrhage caused by ruptured aneurysm is the method of choice.

The platelet functions in stroke.

The share of platelets in the process of atherosclerosis and its thrombotic complications depends on the rate of their activation, which can be assessed by investigating the plasmatic levels of platelet factor 4 (PF4). Authors made use of this method in 68 patients with ischemic stroke and searched for the correlation between the found results, clinical picture and supposed etiopathogenesis of the disease. On the grounds of given findings they reached the conclusion that the increased PF4 levels represent no sign of a cerebral complication but only characterize the group of risky patients threatened by their platelets function status.

[Transitory global amnesia. Analysis of our group]. / Tranzitorní globální amnézie. Analýza vlastního souboru.

Syndrome of transitory global amnesia characterized by suddenly appearing and isolated disorder of the short-time memory is a manifestation of dysfunction of structures of the hippocampus-fornix system, dorso-medial nuclei of the thalamus and mediobasal areas of temporal lobes. Histories, clinical pictures and results obtained from auxiliary examinations were in detail analyzed in seven patients with the above diagnosis at the Department of Neurology in Hradec Králové and possible etiology of the disease was considered.

[Contribution of spectrophotometry of the cerebrospinal fluid in the rational treatment of subarachnoid hemorrhage]. / Prínos spektrofotometrie likvoru pro racionální lécbu subarachnoidálního krvácení.

In connection with antifibrinolytic therapy of subarachnoid hemorrhage which reduces, especially at the acute stage, the risk of repeated bleeding, more frequent incidence of other serious complications was observed, i.e. late ischemic neurological deficiency. As this complication is prognostically serious and therapeutical effects are not satisfactory its prevention is necessary, which includes administration of antifibrinolytic drugs for a limited time period. Such period may be determined by means of dynamic study of hemoglobin degradation products in the liquor using liquor spectrophotometry.

[Circulatory disorders in the vertebrobasilar drainage area]. / Obehové poruchy ve vertebrobazilárním povodí.

The authors refer to the clinical symptoms and auxiliary investigation results in 50 out-patients monitored for vascular cerebral disease in attempt to make a reliable diagnosis of vertebrobasilar insufficiency. The computerized brain tomography (CT) and ultrasound vascular investigation though being highly reliable in routinely diagnosing ischaemia of carotid drainage, are of lesser informative value in respect with structures of posterior cranial fossa. The considerable risk of cerebral infarction onset in patients with vertebrobasilar insufficiency in history is mandatory for more efforts as to the etiopathogenetic management of such casualties.

[Longitudinal monitoring of electroencephalographic findings in patients with transitory ischemic attacks]. / Longitudinální sledování elektroencefalografických nálezu u pacientu s tranzitorní ischemickou atakou.

A total of 6 patients with clinical symptoms of transitory ischaemic seizure is referred to, in them the electroencephalographic findings were monitored longitudinally. The importance of early first registration is emphasized in accord to the detectory percentage of pathologic findings, and their long term post-clinical persistency is reported.