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Remollo S, Terceño M, Werner M, Castaño C, Hernández-Pérez M, Blasco J, San Román L, Daunis-I-Estadella P, Thió-Henestrosa S, Cuba V, Gimeno A, Puig J. Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever : Preliminary Clinical Experience. Clin Neuroradiol 2021; 32:393-400. [PMID: 34286344 PMCID: PMC9187553 DOI: 10.1007/s00062-021-01065-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. METHODS We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. RESULTS We included 52 patients (median age, 75 y IQR: 64-83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13-22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0-2). CONCLUSION This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices.
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Affiliation(s)
- Sebastian Remollo
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain.
| | - Mikel Terceño
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain.,Stroke Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Mariano Werner
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain
| | - Carlos Castaño
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain
| | - María Hernández-Pérez
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luis San Román
- Neurointerventional Department C.D.I, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Santiago Thió-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Víctor Cuba
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Alfredo Gimeno
- Radiology Department, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Josep Puig
- IDI-Radiology, University Hospital Dr Josep Trueta, Girona, Spain
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Pérez-Pelegrí M, Biarnés C, Thió-Henestrosa S, Remollo S, Gimeno A, Cuba V, Teceño M, Martí-Navas M, Serena J, Pedraza S, Ruiz-Constantino JS, Puig J. Higher agreement in endovascular treatment decision-making than in parametric quantifications among automated CT perfusion software packages in acute ischemic stroke. J Xray Sci Technol 2021; 29:823-834. [PMID: 34334443 DOI: 10.3233/xst-210898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Estimates of parameters used to select patients for endovascular thrombectomy (EVT) for acute ischemic stroke differ among software packages for automated computed tomography (CT) perfusion analysis. To determine impact of these differences in decision making, we analyzed intra-observer and inter-observer agreement in recommendations about whether to perform EVT based on perfusion maps from 4 packages. METHODS Perfusion CT datasets from 63 consecutive patients with suspected acute ischemic stroke were retrospectively postprocessed with 4 packages of Minerva, RAPID, Olea, and IntelliSpace Portal (ISP). We used Pearson correlation coefficients and Bland-Altman analysis to compare volumes of infarct core, penumbra, and mismatch calculated by Minerva and RAPID. We used kappa analysis to assess agreement among decisions of 3 radiologists about whether to recommend EVT based on maps generated by 4 packages. RESULTS We found significant differences between using Minerva and RAPID to estimate penumbra (67.39±41.37mL vs. 78.35±45.38 mL, p < 0.001) and mismatch (48.41±32.03 vs. 61.27±32.73mL, p < 0.001), but not of infarct core (p = 0.230). Pearson correlation coefficients were 0.94 (95%CI:0.90-0.96) for infarct core, 0.87 (95%CI:0.79-0.91) for penumbra, and 0.72 (95%CI:0.57-0.83) for mismatch volumes (p < 0.001). Limits of agreements were (-21.22-25.02) for infarct core volumes, (-54.79-32.88) for penumbra volumes, and (-60.16-34.45) for mismatch volumes. Final agreement for EVT decision-making was substantial between Minerva vs. RAPID (k = 0.722), Minerva vs. Olea (k = 0.761), and RAPID vs. Olea (k = 0.782), but moderate for ISP vs. the other three. CONCLUSIONS Despite quantitative differences in estimates of infarct core, penumbra, and mismatch using 4 software packages, their impact on radiologists' decisions about EVT is relatively small.
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Affiliation(s)
| | - Carles Biarnés
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | - Santiago Thió-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Sebastià Remollo
- Department of Radiology, Germans Triasi Pujol University Hospital, Badalona, Spain
| | - Alfredo Gimeno
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Cuba
- Department of Radiology, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Teceño
- Department of Neurology-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Marian Martí-Navas
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | - Joaquín Serena
- Department of Neurology-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain
| | - Salvador Pedraza
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
| | | | - Josep Puig
- Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain
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Puig J, Blasco G, Terceño M, Daunis-I-Estadella P, Schlaug G, Hernandez-Perez M, Cuba V, Carbó G, Serena J, Essig M, Figley CR, Nael K, Leiva-Salinas C, Pedraza S, Silva Y. Predicting Motor Outcome in Acute Intracerebral Hemorrhage. AJNR Am J Neuroradiol 2019; 40:769-775. [PMID: 31000524 DOI: 10.3174/ajnr.a6038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.
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Affiliation(s)
- J Puig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Blasco
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Terceño
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science (P.D.-i.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - G Schlaug
- Neuroimaging and Stroke Recovery Laboratory (G.S.), Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - M Hernandez-Perez
- Department of Neurosciences (M.H.-P.), Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - V Cuba
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Carbó
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - J Serena
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Essig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - C R Figley
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - K Nael
- Department of Radiology (K.N.), Icahn School of Medicine at Mount Sinai, New York
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Missouri, Columbia, Missouri
| | - S Pedraza
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - Y Silva
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
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Puig J, Blasco G, Daunis-I-Estadella J, Loshuertos E, Codina J, Cuba V, Ortiz R, Xifra G, Ricart W, Pedraza S, Federici M, Fernández-Real JM. Nonalcoholic fatty liver disease and age are strong indicators for atherosclerosis in morbid obesity. Clin Endocrinol (Oxf) 2015; 83:180-6. [PMID: 25510350 DOI: 10.1111/cen.12698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/15/2014] [Accepted: 12/07/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients. DESIGN, PATIENTS AND MEASUREMENTS We studied 314 consecutive obese subjects (223 women; mean age, 45·04 ± 9·34 years; body mass index 44·3 ± 5 kg/m(2) ) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis [carotid intima-media thickness (cIMT) >0·8 mm and/or presence of plaques] were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients. RESULTS In obese patients, mean c-IMT was greater in those with NAFLD (P < 0·001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5·96 (95%CI, 1·60-22·25; P = 0·008) in men and 8·26 (95%CI, 4·02-16·99; P < 0·001) in women, and the age-associated OR for atherosclerosis was 1·14 (95%CI, 1·07-1·22; P < 0·001) in men and 1·12 (95%CI, 1·08-1·17; P < 0·001) in women. The sensitivity, specificity and positive and negative predictive values of steatosis for atherosclerosis were 78·70%, 70·50%, 74·00% and 75·60% (AUC = 0·840) in men ≥43·5 years and 86·90%, 52·50%, 68·80% and 76·80% (AUC = 0·761) in women ≥47·5 years, respectively. Agreement between ultrasound-diagnosed steatosis and histology was good (ICC = 0·79). Combined NAFLD and age was the strongest predictor of atherosclerosis in obesity. CONCLUSIONS Nonalcoholic fatty liver disease and age may be independent risk factors for carotid atherosclerosis in obese individuals. Obese men and women with steatosis aged over 43·5 and 47·5 years, respectively, should be screened for carotid atherosclerosis. However, further evidence is necessary before suggesting an intervention based on current findings.
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Affiliation(s)
- Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Gerard Blasco
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Josep Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Emili Loshuertos
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
| | - Jaume Codina
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Víctor Cuba
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Rosa Ortiz
- Department of Pathology, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Gemma Xifra
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - José Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Girona, Spain
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Cuba V, Krska Z, Vrbenský L. [Laparoscopic method of surgical treatment of inguinal hernia]. Sb Lek 2001; 100:287-90. [PMID: 11221477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Authors present the both method of laparoscopic inquinal hernia repair. They prefer laparoscopic praeperitoneal approach using prolene mesh 6 x 11 cm.
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Affiliation(s)
- V Cuba
- I. chirurgická klinika 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice, U nemocnice 2, 128 01 Praha 2, Czech Republic
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Duchác A, Cuba V. [Incidence and treatment of gynecomastia]. Rozhl Chir 1990; 69:737-41. [PMID: 2136437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors discuss a group of 128 men with gynaecomastia, examined and treated in a clinic for diseases of the mammary gland in the course of 10 years. Consistent with data in the literature, they used in the majority of young men under 25 years of age as a rule conservative treatment. In older men a surgical approach was indicated in cca 50%. The operations were made in the majority under local anaesthesia with a favourable cosmetic effect.
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Affiliation(s)
- A Duchác
- II. chirurgická klinika FVL UK, Praha
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Duchác A, Cuba V. [Diseases of the male breast]. Rozhl Chir 1989; 68:302-5. [PMID: 2749398] [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: 01/02/2023]
Abstract
The authors analyzed the histories of 164 men with diseases of the mammary gland, examined in 1976 to 1986 in a clinic for breast diseases. Mastopathy was diagnosed most frequently (114 times), followed by mastodynia, mastitis and benign and malignant tumours. Seventy patients with histologically benign tumours were operated, a malignant tumour was revealed on biopsy seven times. Attention is drawn to hormonal factors in puberty and old age. The necessity to pay attention also to the male breast is emphasized.
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Pospísil M, Linhart O, Horácek F, Cuba V. [Some problems of abdominal injuries (author's transl)]. Sb Lek 1979; 81:264-71. [PMID: 493849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Pospísil M, Wierer I, Cuba V. [Problems associated with treatment of fractures of the upper end of the femur in elderly patients (author's transl)]. Sb Lek 1979; 81:117-28. [PMID: 441675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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