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Guňka I, Krajíčková D, Leško M, Jiška S, Hudák A, Šimůnek L, Raupach J. Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke. Rozhl Chir 2022; 101:388-394. [PMID: 36208934 DOI: 10.33699/pis.2022.101.7.388-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
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Hudák A, Guňka I, Lojík M, Leško M, Jiška S, Caisberger F, Krajíčková D. Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery - case repor. Rozhl Chir 2019; 98:252-255. [PMID: 31331182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Česák T, Adamkov J, Poczos P, Kanta M, Krajina A, Krajíčková D, Herzig R, Vališ M. Correction to: Multidisciplinary approach in the treatment of spinal dural arteriovenous fistula-results of endovascular and surgical treatment. Acta Neurochir (Wien) 2018; 160:2449. [PMID: 30302559 DOI: 10.1007/s00701-018-3698-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The author J. Adamkov was incorrectly captured in the original article and is now corrected in this article.
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Affiliation(s)
- T Česák
- Department of Neurosurgery, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec, Králové, Czech Republic
| | - J Adamkov
- Department of Neurosurgery, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec, Králové, Czech Republic
| | - P Poczos
- Department of Neurosurgery, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec, Králové, Czech Republic
| | - M Kanta
- Department of Neurosurgery, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec, Králové, Czech Republic
| | - A Krajina
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic
| | - D Krajíčková
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Králové, Czech Republic
| | - R Herzig
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Králové, Czech Republic
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Králové, Czech Republic.
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Leško Ml M, Guňka I, Lojík M, Krajíčková D. [Free-floating thrombus in the internal carotid artery treated by anticoagulation and delayed carotid endarterectomy]. Rozhl Chir 2016; 95:325-328. [PMID: 27650565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Dorňák T, Herzig R, Kuliha M, Havlíček R, Školoudík D, Šaňák D, Köcher M, Procházka V, Lacman J, Charvát F, Krajina A, Krajíčková D, Král M, Veverka T, Roubec M, Hajduková L, Zapletalová J. Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial. Clin Radiol 2015; 70:e20-7. [PMID: 25703459 DOI: 10.1016/j.crad.2015.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- T Dorňák
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - R Herzig
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurosurgery, Military University Hospital Prague, Czech Republic.
| | - M Kuliha
- Comprehensive Stroke Center, Department of Neurology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - R Havlíček
- Comprehensive Stroke Center, Department of Neurology, Military University Hospital Prague, Czech Republic
| | - D Školoudík
- Department of Neurology, Palacký University, Olomouc, Czech Republic
| | - D Šaňák
- Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - M Köcher
- Comprehensive Stroke Center, Department of Radiology, Palacký University and University Hospital Olomouc, Czech Republic
| | - V Procházka
- Comprehensive Stroke Center, Department of Radiology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - J Lacman
- Comprehensive Stroke Center, Department of Radiology, Military University Hospital Prague, Czech Republic
| | - F Charvát
- Comprehensive Stroke Center, Department of Radiology, Military University Hospital Prague, Czech Republic
| | - A Krajina
- Comprehensive Stroke Center, Department of Radiology, Charles University and University Hospital Hradec Králové, Czech Republic
| | - D Krajíčková
- Comprehensive Stroke Center, Department of Neurology, Charles University and University Hospital Hradec Králové, Czech Republic
| | - M Král
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - T Veverka
- Department of Neurology, Palacký University, Olomouc, Czech Republic; Comprehensive Stroke Center, Department of Neurology, University Hospital Olomouc, Czech Republic
| | - M Roubec
- Comprehensive Stroke Center, Department of Neurology, Ostrava University and University Hospital Ostrava, Czech Republic
| | - L Hajduková
- Comprehensive Stroke Center, Department of Neurology, Military University Hospital Prague, Czech Republic
| | - J Zapletalová
- Department of Medical Biophysics, Palacký University Olomouc, Czech Republic
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