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Bendszus M, Fiehler J, Subtil F, Bonekamp S, Aamodt AH, Fuentes B, Gizewski ER, Hill MD, Krajina A, Pierot L, Simonsen CZ, Zeleňák K, Blauenfeldt RA, Cheng B, Denis A, Deutschmann H, Dorn F, Flottmann F, Gellißen S, Gerber JC, Goyal M, Haring J, Herweh C, Hopf-Jensen S, Hua VT, Jensen M, Kastrup A, Keil CF, Klepanec A, Kurča E, Mikkelsen R, Möhlenbruch M, Müller-Hülsbeck S, Münnich N, Pagano P, Papanagiotou P, Petzold GC, Pham M, Puetz V, Raupach J, Reimann G, Ringleb PA, Schell M, Schlemm E, Schönenberger S, Tennøe B, Ulfert C, Vališ K, Vítková E, Vollherbst DF, Wick W, Thomalla G. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402:1753-1763. [PMID: 37837989 DOI: 10.1016/s0140-6736(23)02032-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [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: 09/04/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent evidence suggests a beneficial effect of endovascular thrombectomy in acute ischaemic stroke with large infarct; however, previous trials have relied on multimodal brain imaging, whereas non-contrast CT is mostly used in clinical practice. METHODS In a prospective multicentre, open-label, randomised trial, patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and a large established infarct indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 were randomly assigned using a central, web-based system (using a 1:1 ratio) to receive either endovascular thrombectomy with medical treatment or medical treatment (ie, standard of care) alone up to 12 h from stroke onset. The study was conducted in 40 hospitals in Europe and one site in Canada. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days, assessed by investigators masked to treatment assignment. The primary analysis was done in the intention-to-treat population. Safety endpoints included mortality and rates of symptomatic intracranial haemorrhage and were analysed in the safety population, which included all patients based on the treatment they received. This trial is registered with ClinicalTrials.gov, NCT03094715. FINDINGS From July 17, 2018, to Feb 21, 2023, 253 patients were randomly assigned, with 125 patients assigned to endovascular thrombectomy and 128 to medical treatment alone. The trial was stopped early for efficacy after the first pre-planned interim analysis. At 90 days, endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better outcome (adjusted common OR 2·58 [95% CI 1·60-4·15]; p=0·0001) and with lower mortality (hazard ratio 0·67 [95% CI 0·46-0·98]; p=0·038). Symptomatic intracranial haemorrhage occurred in seven (6%) patients with thrombectomy and in six (5%) with medical treatment alone. INTERPRETATION Endovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection. FUNDING EU Horizon 2020.
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Affiliation(s)
- Martin Bendszus
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; eppdata GmbH, Hamburg, Germany
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Susanne Bonekamp
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research-La Paz University Hospital-Universidad Autonoma de Madrid, Madrid, Spain
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Antonin Krajina
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | | | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Angélique Denis
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Laboratoire de Biométrie et Biologie Évolutive, Université de Lyon, Villeurbanne, France
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Franziska Dorn
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Fabian Flottmann
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, AB, Canada
| | - Jozef Haring
- Department of Neurology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Christian Herweh
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Silke Hopf-Jensen
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Vi Tuan Hua
- Department of Neurology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Kastrup
- Klinik für Neurologie, Klinikum Bremen Mitte, Bremen, Germany
| | - Christiane Fee Keil
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andrej Klepanec
- Department of Radiology, Faculty Hospital Trnava, Trnava, Slovakia
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Stefan Müller-Hülsbeck
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus gGmbH, Flensburg, Germany
| | - Nico Münnich
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | - Paolo Pagano
- Department of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Panagiotis Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen Mitte, Bremen, Germany; Department of Radiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabor C Petzold
- Vascular Neurology Research Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mirko Pham
- Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volker Puetz
- Department of Neurology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany; Dresden Neurovascular Center, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Jan Raupach
- Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Gernot Reimann
- Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Germany
| | | | - Maximilian Schell
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Bjørn Tennøe
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Christian Ulfert
- Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kateřina Vališ
- St Anne's University Hospital Brno, Brno, Czech Republic
| | - Eva Vítková
- Department of Neurology, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | | | - Wolfgang Wick
- Neurologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Sanak D, Kocher M, Zapletalova J, Cihlar F, Czerny D, Cernik D, Duras P, Fiksa J, Husty J, Jurak L, Kovar M, Lacman J, Padr R, Prochazka P, Raupach J, Reiser M, Rohan V, Roubec M, Sova J, Sercl M, Skorna M, Simunek L, Snajdrova A, Sramek M, Tomek A. Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study. J Neurointerv Surg 2023; 15:e123-e128. [PMID: 36002287 DOI: 10.1136/jnis-2022-019176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) due to anterior circulation tandem lesion (TL) remains a technical and clinical challenge for endovascular treatment (EVT). Conflicting results from observational studies and missing evidence from the randomized trials led us to report a recent real-world multicenter clinical experience and evaluate possible predictors of good outcome after EVT. METHODS We analyzed all AIS patients with TL enrolled in the prospective national study METRICS (Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers). A good 3-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS), achieved recanalization using the Thrombolysis In Cerebral Infarction (TICI) scale and symptomatic intracerebral hemorrhage (sICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. RESULTS Of 1178 patients enrolled in METRICS, 194 (19.2%) (59.8% males, mean age 68.7±11.5 years) were treated for TL. They did not differ in mRS 0-2 (48.7% vs 46.7%; p=0.616), mortality (17.3% vs 22.7%; p=0.103) and sICH (4.7% vs 5.1%; p=0.809) from those with single occlusion (SO). More TL patients with prior intravenous thrombolysis (IVT) reached TICI 3 (70.3% vs 50.8%; p=0.012) and mRS 0-2 (55.4% vs 34.4%; p=0.007) than those without IVT. No difference was found in the rate of sICH (6.2% vs 1.6%; p=0.276). Multivariate logistic regression analysis showed prior IVT as a predictor of mRS 0-2 after adjustment for potential confounders (OR 3.818, 95% CI 1.614 to 9.030, p=0.002). CONCLUSION Patients with TL did not differ from those with SO in outcomes after EVT. TL patients with prior IVT had more complete recanalization and mRS 0-2 and IVT was found to be a predictor of good outcome after EVT.
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Affiliation(s)
- Daniel Sanak
- Department of Neurology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Kocher
- Department of Radiology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics and Statistics, Palacky University Olomouc, Olomouc, Czech Republic
| | - Filip Cihlar
- Department of Radiology, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Daniel Czerny
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Cernik
- Department of Neurology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic
| | - Petr Duras
- Department of Radiology, University Hospital Plzen, Plzen, Czech Republic
| | - Jan Fiksa
- Department of Neurology, General University Hospital in Prague, Prague, Czech Republic
| | - Jakub Husty
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czech Republic
| | - Lubomir Jurak
- Department of Neurology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Martin Kovar
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Lacman
- Department of Radiology, Central Military Hospital Prague, Prague, Czech Republic
| | - Radek Padr
- Department of Radiology, University Hospital Motol Prague, Prague, Czech Republic
| | - Pavel Prochazka
- 2nd Department of Internal Medicine, General University Hospital in Prague, Prague, Czech Republic
| | - Jan Raupach
- Department of Radiology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Reiser
- Department of Neurology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Vladimir Rohan
- Department of Neurology, Charles University Faculty of Medicine and University Hospital Plzen, Plzen, Czech Republic
| | - Martin Roubec
- Department of Neurology, University of Ostrava Faculty of Medicine and University Hospital Ostrava, Ostrava, Czech Republic
| | - Jindrich Sova
- Department of Radiology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Miroslav Sercl
- Department of Radiology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Miroslav Skorna
- Department of Neurology, Masaryk University Faculty of Medicine and University Hospital Brno, Brno, Czech Republic
| | - Libor Simunek
- Department of Neurology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alena Snajdrova
- Department of Radiology, Na Homolce Hospital Prague, Prague, Czech Republic
| | - Martin Sramek
- Department of Neurology, Central Military Hospital Prague, Prague, Czech Republic
| | - Ales Tomek
- Department of Neurology, Motol University Hospital, Praha, Praha, Czech Republic
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Klail T, Sedova P, Vinklarek JF, Kovacova I, Bar M, Cihlar F, Cernik D, Kočí L, Jura R, Herzig R, Husty J, Kocher M, Kovar M, Nevšímalová M, Raupach J, Rocek M, Sanak D, Sevcik P, Skoloudik D, Sramek M, Vanicek J, Vaško P, Vaclavik D, Tomek A, Mikulik R. Safety and Efficacy of Baseline Antiplatelet Treatment in Patients Undergoing Mechanical Thrombectomy for Ischemic Stroke: Antiplatelets Before Mechanical Thrombectomy. J Vasc Interv Radiol 2023; 34:1502-1510.e12. [PMID: 37192724 DOI: 10.1016/j.jvir.2023.05.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE To investigate the safety and efficacy of baseline antiplatelet treatment in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS Baseline use of antiplatelet medication before MT for (AIS) may provide benefit on reperfusion and clinical outcome but could also carry an increased risk of intracranial hemorrhage (ICH). All consecutive patients with AIS and treated with MT with and without intravenous thrombolysis (IVT) between January 2012 and December 2019 in all centers performing MT nationwide were reviewed. Data were prospectively collected in national registries (eg, SITS-TBY and RES-Q). Primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months; secondary outcome was ICH. RESULTS Of the 4,351 patients who underwent MT, 1,750 (40%) and 666 (15%) were excluded owing to missing data from the functional independence and ICH outcome cohorts, respectively. In the functional independence cohort (n = 2,601), 771 (30%) patients received antiplatelets before MT. Favorable outcome did not differ in any antiplatelet, aspirin, and clopidogrel groups when compared with that in the no-antiplatelet group: odds ratio (OR), 1.00 (95% CI, 0.84-1.20); OR, 1.05 (95% CI, 0.86-1.27); and OR, 0.88 (95% CI, 0.55-1.41), respectively. In the ICH cohort (n = 3,685), 1095 (30%) patients received antiplatelets before MT. The rates of ICH did not increase in any treatment options (any antiplatelet, aspirin, clopidogrel, and dual antiplatelet groups) when compared with those in the no-antiplatelet group: OR, 1.03 (95% CI, 0.87-1.21); OR, 0.99 (95% CI, 0.83-1.18); OR, 1.10 (95% CI, 0.82-1.47); and OR, 1.43 (95% CI, 0.87-2.33), respectively. CONCLUSIONS Antiplatelet monotherapy before MT did not improve functional independence or increase the risk of ICH.
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Affiliation(s)
- Tomas Klail
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Petra Sedova
- Department of Neurology, St Anne's University Hospital, Brno, Czech Republic; International Clinical Research Centre, Stroke Research Program, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Jan F Vinklarek
- Department of Neurology, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ingrid Kovacova
- International Clinical Research Centre, Stroke Research Program, St Anne's University Hospital, Brno, Czech Republic
| | - Michal Bar
- Department of Neurology, University Hospital, Ostrava, Czech Republic; Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Filip Cihlar
- Department of Radiology, Masaryk's Hospital, Faculty of Health Studies, J.E. Purkinje University, KZ a.s., Ústí nad Labem, Czech Republic
| | - David Cernik
- Department of Radiology, Masaryk's Hospital, Faculty of Health Studies, J.E. Purkinje University, KZ a.s., Ústí nad Labem, Czech Republic
| | - Lubomir Kočí
- Neurocentre, Regional Hospital Liberec, Liberec, Czech Republic
| | - Rene Jura
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Jakub Husty
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Radiology and Nuclear Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Kocher
- Department of Radiology, Palacky University Medical School and Hospital, Olomouc, Czech Republic
| | - Martin Kovar
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
| | - Miroslava Nevšímalová
- Department of Neurology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital and Faculty of Medicine Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic
| | - Miloslav Rocek
- Department of Radiology, 2nd Medical School of Charles University and Motol University Hospital, Prague, Czech Republic
| | - Daniel Sanak
- Department of Neurology, Palacky Medical School and University Hospital, Comprehensive Stroke Center, Olomouc, Czech Republic
| | - Petr Sevcik
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - David Skoloudik
- Center for Health Research, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Martin Sramek
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jiri Vanicek
- Department of Medical Imaging, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Peter Vaško
- Department of Neurology, Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Daniel Vaclavik
- Neurology, Agel Research and Training Institute, Ostrava Vitkovice Hospital, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ales Tomek
- Department of Neurology, 2nd Medical School of Charles University and Motol University Hospital, Prague, Czech Republic
| | - Robert Mikulik
- Department of Neurology, St Anne's University Hospital, Brno, Czech Republic; International Clinical Research Centre, Stroke Research Program, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Raupach J, Masek J, Venugopal S, Renc O, Lesko M, Radovan M. Complex endoleak treatment after failed endovascular aortic repair. CVIR Endovasc 2023; 6:35. [PMID: 37405522 DOI: 10.1186/s42155-023-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has created new possibilities for patients with abdominal aortic aneurysms (AAAs), and in recent years it has become tremendously popular. Use of EVAR in selected groups of patients allows mortality and morbidity to be reduced in comparison to open repair. However, complications such as endoleaks (ELs) can be of great concern and warrant urgent therapy to prevent sac rupture. CASE PRESENTATION The case report presents urgent endovascular treatment of a high-risk type IA EL in a polymorbid 68-year-old patient 7 years after primary EVAR. The principle of treatment was parallel implantation of the proximal SG extension with the renal SG into the right renal artery (chimney technique). The subsequent type II collateral EL was treated by direct transabdominal AAA sac puncture and thrombin embolization. CONCLUSION EL can be a cause for urgent intervention, but specific anatomic features often require specialized SG types which are not readily available. The chimney technique allows the use of immediately available stent grafts to address endoleak in the setting of impending abdominal aneurysm rupture.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic.
- Faculty of Medicine in Hradec Kralove, Radiology, Charles University, Hradec Kralove, Czech Republic.
| | - Jan Masek
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
| | - Sindharta Venugopal
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
| | - Ondrej Renc
- Department of Radiology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 50005, Czech Republic
- Faculty of Medicine in Hradec Kralove, Radiology, Charles University, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Surgery, Charles University, Hradec Kralove, Czech Republic
| | - Maly Radovan
- The 1st Department of Internal Medicine - Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Internal Medicine, Charles University, Hradec Kralove, Czech Republic
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5
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Masek J, Fejfar T, Frankova S, Husova L, Krajina A, Renc O, Chovanec V, Raupach J. Transjugular Intrahepatic Portosystemic Shunt in Liver Transplant Recipients: Outcomes in Six Adult Patients. Vasc Endovascular Surg 2023; 57:373-378. [PMID: 36593684 DOI: 10.1177/15385744221149907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Transjugular intrahepatic portosystemic shunt (TIPS) is regularly used in treatment of clinically significant portal hypertension. Liver transplant recipients are, however, rarely indicated for the procedure. The study retrospectively examines the results of TIPS placement in 6 patients after OLT. METHODS 4 males and 2 females (aged 36 to 62 years), treated with TIPS between 2007 a 2018, were included in the study. 5 patients had previously undergone liver transplantation for liver graft cirrhosis, 1 patient for Budd-Chiari syndrome. The piggyback caval reconstruction technique was selected in 4/6 cases. PH developed after OLT due to the recurrence of underlying liver condition and sinusoidal obstruction syndrome in half of the cases, respectively. Indications for TIPS were refractory ascites in 4 cases and variceal bleeding in 2 cases. RESULTS Standard TIPS technique was used and technical success was achieved in all cases with a procedure-related complication in 1 patient. One patient died shortly after TIPS placement. The remaining patients all reported regression of clinically significant PH. Late complications appeared in 2 patients. Liver retransplantation after TIPS creation was performed in 1 case. Median TIPS patency was 55 months. 2/6 patient continue to thrive with a patent shunt. CONCLUSIONS Transjugular intrahepatic portosystemic shunt in OLT recipients is technically feasible. Favorable clinical outcomes were reported particularly in patients treated for sinusoidal obstruction syndrome who were indicated to TIPS for refractory ascites.
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Affiliation(s)
- Jan Masek
- Department of Radiology, 161959Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
| | - Tomas Fejfar
- Department of Gastroenterology, 48234Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
| | - Sona Frankova
- Department of Gastroenterology and Hepatology, 48214Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Libuse Husova
- 74797Cardiovascular and Transplantation Surgery Centre, Brno, Czechia
| | - Antonin Krajina
- Department of Radiology, 161959Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
| | - Ondrej Renc
- Department of Radiology, 161959Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
| | - Vendelin Chovanec
- Department of Radiology, 161959Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
| | - Jan Raupach
- Department of Radiology, 161959Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Czechia
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6
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Raupach J, Mašek J, Chovanec V, Malý R. Evolution of deep vein thrombosis treatment from leeches to mechanical thrombectomy. Vnitr Lek 2022; 68:508-512. [PMID: 36575068 DOI: 10.36290/vnl.2022.108] [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: 12/23/2022]
Abstract
Deep vein thrombosis (DVT) is one of the most common diseases in developed countries with significant socioeconomic consequences. The severity of DVT lies in the potential for life-threatening pulmonary embolism and the development of chronic venous insufficiency, referred to as post-thrombotic syndrome. Virchow contributed to the understanding of the pathophysiological events that lead to thrombosis by describing three basic risk mechanisms. The first therapeutic attempts in the 17th century included venepuncture and the application of leeches. The first anticoagulant drug was heparin, which entered clinical practice after 1935. Subsequent commercialization of oral vitamin K antagonists (warfarin) and the advent of low molecular weight heparin along with compression therapy allowed the expansion of outpatient treatment of DVT. Recently, new oral anticoagulants have been introduced, leading to improved safety due to lower risk of bleeding complications and simplification of the treatment process. The next step in the development of therapeutic options are invasive methods of early thrombus removal, which significantly shorten the process and aim to reduce the occurrence of late complications. These methods include local catheter-directed thrombolysis using tissue plasminogen activator, mechanical thrombectomy and their combination called pharmaco-mechanical thrombectomy. The latter is currently used in patients with acute ilio-femoral DVT.
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7
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Macinga P, Gogova D, Raupach J, Jarosova J, Janousek L, Honsova E, Taimr P, Spicak J, Novotny J, Peregrin J, Hucl T. Biliary obstruction following transjugular intrahepatic portosystemic shunt placement in a patient after liver transplantation: A case report. World J Hepatol 2022; 14:1038-1046. [PMID: 35721285 PMCID: PMC9157702 DOI: 10.4254/wjh.v14.i5.1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a method used to decrease portal hypertension. Biliary stricture is the rarest of the complications associated with this procedure with only 12 cases previously reported in the literature. None of these cases have documented the resolution of biliary stenosis induced by a stent graft. The only curative solutions reported are liver transplantation or bypassing the stenosis with an artificial biliary tract using advanced endoscopic techniques.
CASE SUMMARY This is the first reported case of biliary obstruction secondary to TIPS placement in a transplanted liver. In our patient, a portosystemic shunt was created to treat severe veno-occlusive liver graft disease manifesting itself primarily by fluid retention. A cholestatic liver lesion and cholangitis with abscesses developed due to a stent graft-induced stricture in the dorsal segment of the right hepatic duct and the stricture diminished following percutaneous drainage. Endoscopic drainage was performed after unsuccessful removal of the percutaneous catheter resulting in a bilio-cutaneous fistula. Although the liver graft now functions well, the stricture remains refractory even after 44 mo of treatment.
CONCLUSION Biliary strictures caused by TIPS in both transplanted and native livers seem refractory to endoscopic treatment.
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Affiliation(s)
- Peter Macinga
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Darina Gogova
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital, Hradec Kralove 50005, Czech Republic
| | - Jana Jarosova
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Libor Janousek
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Eva Honsova
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Pavel Taimr
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Julius Spicak
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jiri Novotny
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Jan Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
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Köcher M, Šaňák D, Zapletalová J, Cihlář F, Czerny D, Černík D, Duras P, Fiksa J, Hustý J, Jurák L, Kovář M, Lacman J, Pádr R, Procházka P, Raupach J, Reiser M, Rohan V, Roubec M, Sova J, Šercl M, Škorňa M, Šimůnek L, Šnajdrová A, Šrámek M, Tomek A. Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers: Results of the METRICS Study. J Stroke Cerebrovasc Dis 2022; 31:106308. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/26/2022] Open
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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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Zahn T, Mhedhbi I, Hein S, Raupach J, Miskey C, Husria Y, Bayanga K, Bartel D, Vieths S, Ivics Z, Oberle D, Keller‐Stanislawski B, Herrlein M, Maier TJ, Hildt E. Persistence of infectious SARS-CoV-2 particles for up to 37 days in patients with mild COVID-19. Allergy 2021; 77:2053-2066. [PMID: 34637150 PMCID: PMC8652783 DOI: 10.1111/all.15138] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND People suffering from COVID-19 are typically considered non-infectious 14 days after diagnosis if symptoms have disappeared for at least 48 h. We describe three patients who independently acquired their infection. These three patients experienced mild COVID-19 and completely recovered symptomatically within 10 days, but remained PCR-positive in deep pharyngeal samples for at least 38 days. We attempted to isolate virus from pharyngeal swabs to investigate whether these patients still carried infectious virus. METHODS Infectious virus was amplified in Vero E6 cells and characterized by electron microscopy and WGS. The immune response was investigated by ELISA and peptide arrays. RESULTS In all three cases, infectious and replication-competent virus was isolated and amplified in Vero E6 cells. Virus replication was detected by RT-PCR and immunofluorescence microscopy. Electron microscopy confirmed the formation of intact SARS-CoV-2 particles. For a more detailed analysis, all three isolates were characterized by whole-genome sequencing (WGS). The sequence data revealed that the isolates belonged to the 20A or 20C clade, and two mutations in ORF8 were identified among other mutations that could be relevant for establishing a long-term infection. Characterization of the humoral immune response in comparison to patients that had fully recovered from mild COVID-19 revealed a lack of antibodies binding to sequential epitopes of the receptor-binding domain (RBD) for the long-term infected patients. CONCLUSION Thus, a small portion of COVID-19 patients displays long-term infectivity and termination of quarantine periods after 14 days, without PCR-based testing, should be reconsidered critically.
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Affiliation(s)
- Tobias Zahn
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Ines Mhedhbi
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Sascha Hein
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Jan Raupach
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Csaba Miskey
- Division of Medical Biotechnology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Younes Husria
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Kathrin Bayanga
- Division of Transfusion Medicine Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Detlef Bartel
- Division of Allergology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Stefan Vieths
- Management board Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Zoltan Ivics
- Division of Medical Biotechnology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Doris Oberle
- Division of Pharmacovigilance Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Brigitte Keller‐Stanislawski
- Division of Pharmacovigilance Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Marie‐Luise Herrlein
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Thorsten Jürgen Maier
- Division of Pharmacovigilance Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Eberhard Hildt
- Division of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
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11
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Hudák A, Guňka I, Raupach J, Leško M, Krajina A, Lojík M. Aneurysm of pancreaticoduodenal arcade caused by medial arcuate ligament syndrome - case report and review of literature. Rozhl Chir 2021; 100:302-306. [PMID: 34465120 DOI: 10.33699/pis.2021.100.6.302-306] [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: 06/13/2023]
Abstract
INTRODUCTION Visceral artery aneurysms are rare vascular pathologies. They are usually incidental findings during the examination for other reasons. The most common clinical symptoms are nonspecific abdominal pain and bleeding caused by their rupture, with a severe clinical presentation. Aneurysms of pancreaticoduodenal arcade are more common in patients with well-developed collateral circulation due to the coeliac trunk stenosis or occlusion. CASE REPORT In this case report the authors present a rare case of a patient with incidental finding of pancreaticoduodenal arcade aneurysm in the setting of severe stenosis of coeliac trunk origin caused by medial arcuate ligament compression. The diameter of the aneurysm was 40 mm and endovascular treatment was not possible because of unfavorable anatomical setting. The patient was successfully treated with resection of the aneurysm and the division of medial arcuate ligament during one surgery. CONCLUSION There is no correlation between the diameter and the risk of rupture of the pancreaticoduodenal arcade aneurysm. Because of high morbidity and mortality of their rupture, most authors recommend active treatment of these aneurysms. The necessity to treat truncus coeliacus stenosis or occlusion remains a controversial issue.
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Terlouw LG, Moelker A, Abrahamsen J, Acosta S, Bakker OJ, Baumgartner I, Boyer L, Corcos O, van Dijk LJ, Duran M, Geelkerken RH, Illuminati G, Jackson RW, Kärkkäinen JM, Kolkman JJ, Lönn L, Mazzei MA, Nuzzo A, Pecoraro F, Raupach J, Verhagen HJ, Zech CJ, van Noord D, Bruno MJ. European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J 2020; 8:371-395. [PMID: 32297566 PMCID: PMC7226699 DOI: 10.1177/2050640620916681] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic mesenteric ischaemia is a severe and incapacitating disease, causing
complaints of post-prandial pain, fear of eating and weight loss. Even though
chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic
mesenteric ischaemia remains an underappreciated and undertreated disease
entity. Probable explanations are the lack of knowledge and awareness among
physicians and the lack of a gold standard diagnostic test. The
underappreciation of this disease results in diagnostic delays, underdiagnosis
and undertreating of patients with chronic mesenteric ischaemia, potentially
resulting in fatal acute mesenteric ischaemia. This guideline provides a
comprehensive overview and repository of the current evidence and
multidisciplinary expert agreement on pertinent issues regarding diagnosis and
treatment, and provides guidance in the multidisciplinary field of chronic
mesenteric ischaemia.
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Affiliation(s)
- Luke G Terlouw
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jan Abrahamsen
- Department of Clinical Physiology, Viborg Regional Hospital, Viborg, Denmark
| | - Stefan Acosta
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Olaf J Bakker
- Department of Vascular Surgery, Sint Antonius hospital, Nieuwegein, the Netherlands.,Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Louis Boyer
- Department of Diagnostic and Interventional Radiology, Montpied University Hospital, Clermont-Ferrand, France
| | - Olivier Corcos
- Department of Gastroenterology, Intestinal Stroke Center, Hopital Beaujon APHP, Clichy, France
| | - Louisa Jd van Dijk
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.,Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Giulio Illuminati
- Department of Surgical Sciences, University of Rome La Sapienza, Rome, Italy
| | - Ralph W Jackson
- Department of Interventional Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jussi M Kärkkäinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Department of Vascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jeroen J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Lars Lönn
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark
| | - Maria A Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alexandre Nuzzo
- Department of Gastroenterology, Hopital Beaujon APHP, Clichy, France
| | - Felice Pecoraro
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Vascular Surgery Unit, AOUP 'P. Giaccone' Palermo, Palermo, Italy
| | - Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hence Jm Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Christoph J Zech
- Radiology and Nuclear Medicine, University of Basel, Basel, Switzerland
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Raupach J, Chovanec V, Kozakova V, Vojacek J. Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure. Eur J Cardiothorac Surg 2020; 57:598-600. [PMID: 31593219 DOI: 10.1093/ejcts/ezz251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022] Open
Abstract
We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Veronika Kozakova
- Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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14
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Gunka I, Krajickova D, Lesko M, Renc O, Raupach J, Jiska S, Lojik M, Chovanec V, Hudak A, Maly R. Outcomes of Urgent Carotid Endarterectomy for Crescendo Transient Ischemic Attacks and Stroke in Evolution. Ann Vasc Surg 2019; 61:185-192. [PMID: 31394223 DOI: 10.1016/j.avsg.2019.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) after an unstable neurological presentation is still a controversial issue. The aim of this study was to evaluate outcomes of urgent (≤48 hr) CEA in patients with crescendo transient ischemic attack (cTIA) or stroke in evolution (SIE). METHODS A retrospective analysis was performed using prospectively collected data from all consecutive neurologically unstable patients who underwent urgent CEA during the period from January 2013 to November 2018. End points were 30-day any stroke and death rate, symptomatic intracerebral hemorrhage (ICH), myocardial infarction (MI), surgical site bleeding requiring intervention, National Institutes of Health Stroke Scale (NIHSS) score variation, and functional outcome at 90 days assessed by the modified Rankin scale (mRS). Patients were evaluated according to clinical presentation (cTIA or SIE). RESULTS A total of 46 neurologically unstable patients with cTIA (20 patients; 43.5%) and SIE (26 patients; 56.5%) were included. The 30-day risk of any stroke or death was 10.0% (2 of 20) in the cTIA group and 7.7% (2 of 26) in the SIE group. No symptomatic ICH or MI was detected after surgery in either study group. A total of 2 patients (4.3%; 1 cTIA, 1 SIE) underwent reoperation for surgical site bleeding. In patients with SIE, the mean NIHSS score on admission was 9.85 ± 5.12. Postoperatively, 22 (84.6%) of the 26 patients with SIE had clinical improvement of their neurological deficit, 3 (11.5%) patients had no change, and 1 (3.8%) patient died. On discharge, the mean NIHSS score was 4.31 ± 6.09 points and was significantly improved compared with NIHSS scores at admission (P < 0.001). At 3 months, 21 patients (80.8%) with SIE had a good clinical outcome (mRS ≤ 2). CONCLUSIONS Urgent CEA in neurologically unstable patients can be performed with acceptable perioperative risks. Moreover, in well-selected patients with SIE, urgent CEA may be associated with significantly improved final functional outcomes.
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Affiliation(s)
- Igor Gunka
- Department of Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
| | - Dagmar Krajickova
- Department of Neurology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ondrej Renc
- Department of Radiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Stanislav Jiska
- Department of Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- Department of Radiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- Department of Radiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alexander Hudak
- Department of Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Radovan Maly
- 1st Department of Internal Medicine - Cardioangiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
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15
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Vajda M, Raupach J, Krajina A, Hoffmann P, Hůlek M, Živný O, Malý R, Vršanská V, Belada D. Emergence of a lymphoma imitating an infectious infiltration surrounding the infrarenal aorta after EVAR. VASA 2019; 48:531-534. [PMID: 31271346 DOI: 10.1024/0301-1526/a000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary retroperitoneal localization of non-Hodgkin's lymphoma is rare but should be considered, even if the circumstances surrounding its emergence point to other direction. We present a case of an appearance of periaortic infiltration after successful endovascular treatment which turned out to be of malignant origin.
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Affiliation(s)
| | - Jan Raupach
- Department of Radiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Antonín Krajina
- Department of Radiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- Department of Radiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Michal Hůlek
- Department of Radiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Ondřej Živný
- Department of Radiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Radovan Malý
- 1st Department of Internal Medicine - Cardioangiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Veronika Vršanská
- 1st Department of Internal Medicine - Cardioangiology, Charles University, Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
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16
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Trlica J, Kučerová Š, Kočová E, Kočí J, Habal P, Raupach J, Guňka I, Nechvátal L, Páral J, Šimek J, Šmejkal K, Frank M, Dědek T. Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study. Eur J Trauma Emerg Surg 2019; 45:943-949. [PMID: 30617603 DOI: 10.1007/s00068-018-01063-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.
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Affiliation(s)
- Jan Trlica
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic. .,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic.
| | - Štěpánka Kučerová
- Institute of Forensic Medicine, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Eva Kočová
- Department of Radiology, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jaromír Kočí
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Petr Habal
- Department of Cardiac Surgery, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital in Hradec Kralove, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Igor Guňka
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Lukáš Nechvátal
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jiří Páral
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Jan Šimek
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic
| | - Karel Šmejkal
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czech Republic
| | - Martin Frank
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Dědek
- Department of Surgery, University Hospital in Hradec Kralove, Sokolska Street 581, 500 05, Hradec Králové, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic
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17
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Krajíčková D, Krajina A, Herzig R, Lojík M, Chovanec V, Raupach J, Vítková E, Waishaupt J, Vyšata O, Vališ M. Mechanical recanalization in ischemic anterior circulation stroke within an 8-hour time window: a real-world experience. Diagn Interv Radiol 2018; 23:465-471. [PMID: 29033392 DOI: 10.5152/dir.2017.17049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to assess the safety and effectiveness of mechanical recanalization in patients with ischemic stroke in the anterior circulation within 8 h since symptoms onset and with unknown onset time. We compared time intervals <6 h vs. 6-8 h/unknown onset time, as only limited data are available for a time window beyond 6 h. METHODS Our cohort included 110 consecutive patients (44 males; mean age, 73.0±11.5 years) with ischemic stroke in the anterior circulation due to the acute occlusion of a large intracranial artery who underwent mechanical recanalization within an 8-hour time window or with unknown onset time. All patients underwent unenhanced computed tomography (CT) of the brain, CT angiography of the cervical and intracranial arteries and digital subtraction angiography. Perfusion CT was performed in patients beyond a 6-hour time window/with unknown onset time. We collected the following data: baseline characteristics, presence of risk factors, neurologic deficit at the time of treatment, time to therapy, recanalization rate, and 3-month clinical outcome. Successful recanalization was defined as Thrombolysis in Cerebral Infarction score of 2b/3 and good clinical outcome as modified Rankin scale value of 0-2 points. RESULTS Successful recanalization was achieved in 82 patients (74.5%): in 61 patients treated within 6 h (73.5%), 7 patients treated within 6-8 h (63.6%), and 13 patients with unknown onset time (81.3%). Good 3-month clinical outcome was achieved in 61 patients (55.5%): in 46 patients treated within 6 h (55.4%), 5 patients treated within 6-8 h (45.5%), and 10 patients with unknown onset time (62.5%). Recanalization success or clinical outcome were not significantly different between patients treated at different time windows. CONCLUSION Our data confirms the safety and effectiveness of mechanical recanalization performed in carefully selected patients with ischemic stroke in the anterior circulation within 8 h of stroke onset or with unknown onset time in everyday practice.
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Affiliation(s)
- Dagmar Krajíčková
- Departments of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
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18
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Raupach J, Vales J, Vojacek J, Hoffmann P, Lojik M, Kamaradova K, Cabelkova P, Chovanec V, Renc O, Krajina A, Maly R. Endovascular Treatment of Symptomatic Thoracic Aneurysm Due to Periaortic Lymphoma. Vasc Endovascular Surg 2018. [PMID: 29528841 DOI: 10.1177/1538574418762649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography-guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.
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Affiliation(s)
- Jan Raupach
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Jan Vales
- 2 Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- 3 Faculty of Medicine, Department of Cardiac Surgery, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Katerina Kamaradova
- 4 Faculty of Medicine, The Fingerland Department of Pathology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Pavla Cabelkova
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Ondrej Renc
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Antonin Krajina
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Radovan Maly
- 5 Faculty of Medicine, Department of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic
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19
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Krajíčková D, Krajina A, Šteiner I, Vyšata O, Herzig R, Lojík M, Chovanec V, Raupach J, Renc O, Waishaupt J, Vítková E, Dulíček P, Čabelková P, Vališ M. Fibrin Clot Architecture in Acute Ischemic Stroke Treated With Mechanical Thrombectomy With Stent-Retrievers - Cohort Study. Circ J 2017; 82:866-873. [PMID: 29176266 DOI: 10.1253/circj.cj-17-0375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i.v. thrombolysis (IVT). Histology of the clots was carried out without knowledge of the clinical findings, including the treatment methods. The components of the clots, their age, origin and semi-quantitative graded changes in the architecture of the fibrin components (e.g., "thinning") were compared via neuro-interventional, clinical and laboratory data. The most prominent changes in the architecture of the fibrin components in the thromboemboli were associated with IVT (applied in 44 patients; OR, 3.50; 95% CI: 1.21-10.10, P=0.02) and platelet count (OR, 2.94; 95% CI: 1.06-8.12, P=0.04). CONCLUSIONS In patients with large artery IS treated with the MT using stent-retrievers, bridging therapy with IVT preceding MT and higher platelet count were associated with significant changes of the histological structure of blood clots.
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Affiliation(s)
- Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Antonín Krajina
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Ivo Šteiner
- The Fingerland Department of Pathology, University Hospital
| | - Oldřich Vyšata
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Miroslav Lojík
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Vendelín Chovanec
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Jan Raupach
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Ondřej Renc
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Jan Waishaupt
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Eva Vítková
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Petr Dulíček
- Fourth Department of Internal Medicine - Haematology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Pavla Čabelková
- Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital
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20
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Solar M, Krajina A, Ballon M, Raupach J, Brozova M, Ceral J. 4114Adrenal venous sampling in primary aldosteronism: cosyntropin infusion increases the success rate of the procedure but can mask the lateralization of aldosterone secretion. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Gunka I, Krajickova D, Lesko M, Renc O, Raupach J, Jiska S, Lojik M, Chovanec V, Maly R. Safety of Early Carotid Endarterectomy after Intravenous Thrombolysis in Acute Ischemic Stroke. Ann Vasc Surg 2017; 44:353-360. [PMID: 28479465 DOI: 10.1016/j.avsg.2017.03.195] [Citation(s) in RCA: 8] [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: 11/12/2016] [Revised: 03/08/2017] [Accepted: 03/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. METHODS A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016. Patients who had undergone IVT before CEA were identified. The primary outcome measures were any stroke and death rate at 30 days, symptomatic intracerebral hemorrhage and surgical site bleeding requiring intervention. RESULTS A total of 93 patients were included for the final analysis. Among these, 13 (14.0%) patients had undergone IVT before CEA while 80 (86.0%) patients had CEA only. The median time interval between IVT and CEA was 2 days (range: 0-13). A subgroup of 6 patients underwent CEA within 24 hours of administration of IVT. The 30-day combined stroke and death rate was 7.7% (1 of 13) among patients undergoing IVT before CEA and 5.0% (4 of 80) among those undergoing CEA only (P = 0.690). In the IVT group, there were no cerebral hemorrhages or significant surgical site bleeding events requiring reintervention. CONCLUSIONS Our experience indicates that CEA performed early after IVT for acute ischemic stroke, aiming not only to reduce the risk of stroke recurrence but also to achieve neurological improvement by reperfusion of the ischemic penumbra, may be safe and can lead to favorable outcomes.
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Affiliation(s)
- Igor Gunka
- Department of Surgery, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic.
| | - Dagmar Krajickova
- Department of Neurology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Ondrej Renc
- Department of Radiology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Jan Raupach
- Department of Radiology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Stanislav Jiska
- Department of Surgery, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- Department of Radiology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- Department of Radiology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
| | - Radovan Maly
- First Department of Internal Medicine-Cardioangiology, Faculty of Medicine in Hradec Králové, University Hospital Hradec Kralové, Charles University, Hradec Kralove, Czech Republic
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22
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Gunka I, Krajickova D, Lesko M, Jiska S, Raupach J, Lojik M, Maly R. Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery. Vasc Endovascular Surg 2017; 51:176-182. [DOI: 10.1177/1538574416674641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. Methods: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. Results: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). Conclusion: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.
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Affiliation(s)
- Igor Gunka
- Department of Surgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Dagmar Krajickova
- Department of Neurology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Stanislav Jiska
- Department of Surgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Jan Raupach
- Department of Radiology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- Department of Radiology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Radovan Maly
- 1st Department of Internal Medicine—Cardioangiology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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Čečka F, Raupach J, Hoffmann P, Motyčka P, Štětina M, Neoral Č. Ruptured Bronchial Artery Aneurysm: Case Report. Acta Med (Hradec Kralove, Czech Repub ) 2017. [DOI: 10.14712/18059694.2017.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bronchial artery aneurysm is a very rare condition. Its rupture can cause a life threatening hemorrhage. We report a case of a 50-year-old patient with a ruptured bronchial artery aneurysm who presented with epigastric pain. It is the first published case with such signs of a rupture of a bronchial artery aneurysm. CT scan confirmed the diagnosis. The patient was treated with endovascular embolization.
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Pennington K, Bareja C, Sullivan SG, Franklin LJ, Raupach J. Influenza surveillance in Australia. Commun Dis Intell (2018) 2016; 40:E315-E316. [PMID: 28278403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Kate Pennington
- Vaccine Preventable Diseases Surveillance Section, Health Protection Policy Branch, Office of Health Protection, Department of Health, Canberra, Australian Capital Territory
| | - Christina Bareja
- Vaccine Preventable Diseases Surveillance Section, Health Protection Policy Branch, Office of Health Protection, Department of Health, Canberra, Australian Capital Territory
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria
| | - Lucinda J Franklin
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Regulation, Health Protection and Emergency Management Division, Department of Health and Human Services, Melbourne, Victoria
| | - Jan Raupach
- Communicable Disease Control Branch, SA Department of Health and Ageing, Adelaide, South Australia
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25
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Cottrell J, Raupach J, Wheaton G. Still Think of Rheumatic Fever in Urban and Regional South Australia. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Solař M, Žižka J, Krajina A, Michl A, Raupach J, Klzo L, Ryška P, Ceral J. Comparison of Duplex Ultrasonography and Magnetic Resonance Imaging in the Detection of Significant Renal Artery Stenosis. Acta Med (Hradec Kralove, Czech Repub ) 2016; 54:9-12. [DOI: 10.14712/18059694.2016.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The aim of our study was to evaluate duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in detection of haemodynamically significant renal artery stenosis (RAS). Methods: The study included patients with high clinical suspicion of renovascular hypertension (RVH). The imaging of renal arteries was performed by DUS, MRA and digital subtraction angiography (DSA). Significant RAS was defined as maximum systolic velocity ≥ 180 cm/sec (DUS) or as 60% reduction of the endoluminal arterial diameter (MRA, DSA). The results of DUS and MRA were assessed in respect to the results of DSA. Results: Arterial supply of 186 kidneys in 94 patients was evaluated. DSA revealed significant RAS in 61 kidneys evaluated. DUS was not able to examine arterial supply in 18 kidneys of 13 patients. In the detection of significant RAS, DUS was characterized by sensitivity and specificity of 85 % and 84 %. MRA achieved satisfactory imaging quality in all but one kidney evaluated. The sensitivity and specificity of MRA in the detection of significant RAS was 93 % and 93 %, respectively. Conclusion: In patients with high clinical probability of RVH, MRA proved to be more reliable and superior in both sensitivity and specificity to DUS in the detection of significant RAS.
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Raupach J, Guňka I. Regarding "Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-year Single Centre Experience". Cardiovasc Intervent Radiol 2016; 39:1082-3. [PMID: 27094690 DOI: 10.1007/s00270-016-1342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Jan Raupach
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - Igor Guňka
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic
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28
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Glass K, Fearnley E, Hocking H, Raupach J, Veitch M, Ford L, Kirk MD. Bayesian Source Attribution of Salmonellosis in South Australia. Risk Anal 2016; 36:561-570. [PMID: 26133008 DOI: 10.1111/risa.12444] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 04/09/2015] [Accepted: 05/24/2015] [Indexed: 06/04/2023]
Abstract
Salmonellosis is a significant cause of foodborne gastroenteritis in Australia, and rates of illness have increased over recent years. We adopt a Bayesian source attribution model to estimate the contribution of different animal reservoirs to illness due to Salmonella spp. in South Australia between 2000 and 2010, together with 95% credible intervals (CrI). We excluded known travel associated cases and those of rare subtypes (fewer than 20 human cases or fewer than 10 isolates from included sources over the 11-year period), and the remaining 76% of cases were classified as sporadic or outbreak associated. Source-related parameters were included to allow for different handling and consumption practices. We attributed 35% (95% CrI: 20-49) of sporadic cases to chicken meat and 37% (95% CrI: 23-53) of sporadic cases to eggs. Of outbreak-related cases, 33% (95% CrI: 20-62) were attributed to chicken meat and 59% (95% CrI: 29-75) to eggs. A comparison of alternative model assumptions indicated that biases due to possible clustering of samples from sources had relatively minor effects on these estimates. Analysis of source-related parameters showed higher risk of illness from contaminated eggs than from contaminated chicken meat, suggesting that consumption and handling practices potentially play a bigger role in illness due to eggs, considering low Salmonella prevalence on eggs. Our results strengthen the evidence that eggs and chicken meat are important vehicles for salmonellosis in South Australia.
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Affiliation(s)
- K Glass
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200, Australia
| | - E Fearnley
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200, Australia
- Communicable Disease Control Branch, South Australian Department for Health, Adelaide, SA, 5000, Australia
| | - H Hocking
- Australian Salmonella Reference Centre, S.A. Pathology, Adelaide, Australia
| | - J Raupach
- Communicable Disease Control Branch, South Australian Department for Health, Adelaide, SA, 5000, Australia
| | - M Veitch
- Tasmanian Department of Health and Human Services, Hobart, Tasmania
| | - L Ford
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200, Australia
| | - M D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200, Australia
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Raupach J, Lojik M, Chovanec V, Renc O, Strýček M, Dvořák P, Hoffmann P, Guňka I, Ferko A, Ryška P, Omran N, Krajina A, Čabelková P, Čermáková E, Malý R. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience. Cardiovasc Intervent Radiol 2015. [PMID: 26202388 DOI: 10.1007/s00270-015-1156-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Retrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA). MATERIALS AND METHODS From 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised. RESULTS We achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %. CONCLUSION Primary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.
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Affiliation(s)
- J Raupach
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - M Lojik
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - V Chovanec
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - O Renc
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - M Strýček
- Faculty of Medicine at Charles University, Hradec Kralove, Czech Republic.
| | - P Dvořák
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - P Hoffmann
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - I Guňka
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic.
| | - A Ferko
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic.
| | - P Ryška
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - N Omran
- Department of Cardiac Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic.
| | - A Krajina
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - P Čabelková
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Sokolska Street, Hradec Kralove, Czech Republic.
| | - E Čermáková
- Computer Technology Center, Faculty of Medicine at Charles University, Hradec Kralove, Czech Republic.
| | - R Malý
- Department of Medicine, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic.
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Guňka I, Leško M, Janata P, Renc O, Raupach J. [Femoropopliteal deep vein thrombosis and popliteal artery pseudoaneurysm as a complication of multiple hereditary osteochondromatosis]. Rozhl Chir 2015; 94:207-210. [PMID: 26112687] [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: 06/04/2023]
Abstract
Osteochondromas (exostoses) are the most common benign bone tumours. In most cases, osteochondroma occurs as a solitary lesion. Hereditary multiple osteochondromatosis is an autosomal dominant disorder manifested by multiple exostoses most commonly located at the metaphyses of long bones, the iliac crest, the ribs, the vertebral borders, and scapulas. Vascular complications of multiple osteochondromatosis are very rare, most frequently affecting the popliteal artery. The authors report the case of a 27-year-old female patient with hereditary multiple osteochondromatosis that was complicated by femoropopliteal deep vein thrombosis and giant popliteal artery pseudoaneurysm.
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Guňka I, Janata P, Leško M, Raupach J, Ferko A. [Popliteal artery entrapment syndrome]. Rozhl Chir 2014; 93:586-589. [PMID: 25472565] [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: 06/04/2023]
Abstract
Popliteal artery entrapment syndrome is a rare cause of lower limb ischaemia. It is caused by an abnormal relationship between popliteal artery and its surrounding musculotendineous structures (anatomic entrapment). Functional popliteal entrapment is characterized by normal anatomic relationships within popliteal fossa. The true incidence is unknown, it usually affects young patients, typically men, and is clinically presented with symptoms of calf claudication, calf cramping, coldness and paresthesia. CT angiography and MR angiography have become an imaging technique of choice. The mainstay surgical procedure is popliteal artery release. In cases of popliteal artery damage autologous saphenous vein bypass grafting offers the best long-term results. Authors on the basis of two case reports describe the clinical course, diagnosis and surgical technique used in the treatment of patients with advanced popliteal artery entrapmentsyndrome.
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Raupach J, Dobes D, Lojik M, Chovanec V, Ferko A, Gunka I, Maly R, Vojacek J, Havel E, Lesko M, Renc O, Hoffmann P, Ryska P, Krajina A. Integration of endovascular therapy of ruptured abdominal and iliac aneurysms in the treatment algorithm: a single-center experience in a medium-volume vascular center. Vasc Endovascular Surg 2014; 48:412-20. [PMID: 25082435 DOI: 10.1177/1538574414544383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the influence of endovascular therapy of ruptured abdominal or iliac aneurysms on total mortality. MATERIALS AND METHODS We analyzed the mortality of 40 patients from 2005 to 2009, when only surgical treatment was available. These results were compared with the period 2010 to 2013, when endovascular aneurysm repair (EVAR) was assessed as the first option in selected patients. RESULTS During 2005 to 2009, the mortality was 37.5%. From 2010 to 2013, 45 patients were treated with mortality 28.9%. Open repair was performed in 35 (77.8%) patients and EVAR in 10 (22.2%) patients. The 30-day and 1-year mortality rates of the EVAR group were 0% and 20%, respectively, and the total mortality rate was 30% during follow-up (median 11 months, range 1-42 months). The 30-day mortality in the surgical group remained unchanged, at 37.1%, and 1-year and total mortality rates were 45.7% and 51.4%, respectively. CONCLUSION Following integration in the treatment algorithm, EVAR decreased total mortality in our center by 8.6%.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Daniel Dobes
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Alexander Ferko
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Igor Gunka
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Radovan Maly
- Department of Medicine, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Eduard Havel
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Michal Lesko
- Department of Surgery, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Ondrej Renc
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Pavel Ryska
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Antonin Krajina
- Department of Radiology, Faculty of Medicine at Charles University and University Hospital, Hradec Kralove, Czech Republic
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Abstract
A one-step supraclavicular approach for the surgical treatment of the aberrant right subclavian artery is described in a case of dysphagia lusoria in a 38-year-old female. The approach allows for safe division of the arteria lusoria and its re-anastomosis to the common carotid artery while the patient benefits from a mini-invasive extrathoracic procedure. doi: 10.1111/jocs.12287 (J Card Surg 2014;29:519-522).
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Affiliation(s)
- Michal Lesko
- Department of Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic
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Holubec T, Raupach J, Dominik J, Vojácek J. "Elephant trunk" and endovascular stentgrafting--a hybrid approach to the treatment of extensive thoracic aortic aneurysm. Acta Medica (Hradec Kralove) 2013; 56:80-2. [PMID: 24069662 DOI: 10.14712/18059694.2014.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, among others, finally replaced the entire thoracic aorta with the use of the hybrid elephant trunk technique.
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Affiliation(s)
- Tomás Holubec
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
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Krajina A, Kalousek I, Lojík M, Chovanec V, Raupach J, Grepl J, Renc O, Reháček V, Cermáková E. [Endovascular treatment of obstetric hemorrhage]. Ceska Gynekol 2012; 77:588-594. [PMID: 23521203] [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: 06/01/2023]
Abstract
PURPOSE To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy. MATERIALS AND METHODS All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years. RESULTS Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03). CONCLUSION Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.
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Affiliation(s)
- A Krajina
- Radiologicka klinika LF a FN, Hradec Kralove.
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Sembera S, Jirkovský V, Fejfar T, Safka V, Renc O, Raupach J, Chovanec V, Lojík M, Krajina A, Hůlek P. [Survival of patients after TIPS in the University Hospital Hradec Kralove]. Vnitr Lek 2011; 57:1038-1044. [PMID: 22277039] [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: 05/31/2023]
Abstract
AIM To analyze survival of patients after TIPS (transjugular intrahepatic portosystemic shunt). PATIENT SAMPLE AND METHODOLOGY Between September 1992 and August 2010, TIPS was created in 848 patients of the University Hospital Hradec Kralove. These patients were divided into groups. Survival was analyzed using Kaplan-Meier survival curves. Differences between groups were evaluated using log-rank test. RESULTS Ten percent of patients do not survive one month after TIPS, 40% of patients survive 5 years and 20% of patients survive 10 years. There were statistically significant differences between groups divided according to Child-Pugh classification (A vs B p = 0.0053; B vs. C p < 0.0001), indication for surgery [prevention of bleeding recurrence differed from refractory ascites (p = 0.0001) and the indication to stop acute bleeding (p = 0.026)]; aetiology of the liver disease [patients with alcoholic cirrhosis differed from patients with Budd-Chiari syndrome (p < 0.0001) and from patients with chronic viral hepatitis (p = 0.024)]. CONCLUSION Survival of patients after TIPS is influenced by Child-Pugh score, indication and aetiology of the liver disease.
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Jirkovsky V, Fejfar T, Safka V, Hulek P, Krajina A, Chovanec V, Raupach J, Lojik M, Vanasek T, Renc O, Ali SM. Influence of the secondary deployment of expanded polytetrafluoroethylene-covered stent grafts on maintenance of transjugular intrahepatic portosystemic shunt patency. J Vasc Interv Radiol 2010; 22:55-60. [PMID: 21106389 DOI: 10.1016/j.jvir.2010.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [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: 01/14/2008] [Revised: 04/14/2010] [Accepted: 09/02/2010] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the effects of secondary deployment of expanded polytetrafluoroethylene (ePTFE)-covered stent grafts in the treatment of dysfunctional transjugular intrahepatic portosystemic shunts (TIPSs) in comparison with other common approaches (conventional angioplasty or implantation of bare metal stents). MATERIALS AND METHODS A retrospective review of 121 dysfunctional bare metal TIPS presenting between 2000 and 2004 was conducted. The group was divided into four subgroups according to the type of intervention: conventional angioplasty (52 cases; 43%), bare metal stent deployment (35 cases; 28.9%), nondedicated ePTFE-covered stent-graft deployment (15 cases; 12.4%), and dedicated ePTFE-covered stent-graft deployment (19 cases; 15.7%). In all four groups, the primary patency after the specific intervention was calculated and mutually compared. RESULTS Primary patency rates after 12 and 24 months were 49.7% and 25.3%, respectively, in conventional angioplasty; 74.9% and 64.9%, respectively, with bare metal stents; 75.2% and 64.5%, respectively, with nondedicated ePTFE-covered stent grafts; and 88.1% and 80.8%, respectively, with dedicated ePTFE-covered stent grafts. CONCLUSIONS In the treatment of dysfunctional TIPS, better patency after the intervention was obtained by deploying dedicated ePTFE-covered stent grafts in comparison with conventional angioplasty, bare metal stents, and nondedicated ePTFE-covered stents.
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Affiliation(s)
- Vaclav Jirkovsky
- Second Department of Internal Medicine, Teaching Hospital of Charles University, Sokolska, Hradec Králové, Czech Republic.
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Jiska S, Danek T, Belobrádek Z, Dobes D, Raupach J. [A case report of endoleak type Ib and IIIa combination after endovascular subrenal aneurysm repair]. Rozhl Chir 2010; 89:24-27. [PMID: 21351400] [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: 05/30/2023]
Abstract
Authors describe a case report of complications and theirs solutions after endovascular abdominal aneurysm repair. There was symptomatic progression of aneurysmal sac due to endoleak type Ib in this patient 4 years after successful stentgraft treatment. Endovascular treatment was done with optimal effect, but aneurysm sac rupture had early become. The patient was urgently operated. The cause of the rupture was endoleak type IIIa, that was diagnosed perioperatively. This complication was solved with direct suture of disconnected parts of stentgraft. Despite of postoperative complications the patient vas released home in a good condition after 23 days of hospital staying. Endoleaks and their management are discussed in the article.
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Affiliation(s)
- S Jiska
- Chirurgická klinika Lékarské fakulty UK v Hradci Králové a Fakultní nemocnice Hradec Králové.
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Ballon M, Ceral J, Solar M, Krajina A, Raupach J, Ungermann L. [Is confirmation of an adrenal adenoma in patients with primary aldosteronism sufficient for indication of adrenalectomy?]. Vnitr Lek 2009; 55:555-559. [PMID: 19662886] [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: 05/28/2023]
Abstract
BACKGROUND Primary aldosteronism is one of the most common forms of secondary arterial hypertension. Adrenalectomy is effective in patients with proven unilateral hypersecretion of aldosterone whereas pharmacotherapy is indicated in bilateral forms of the disease. We can meet the opinion that in patients with confirmed primary aldosteronism and finding ofsuprarenal adenoma > or = 1 cm on computed tomography (CT) scanning, adrenalectomy can be recommended without further investigation. On the other hand we can perform adrenal venous sampling (AVS) to prove unilateral overproduction of aldosterone. OBJECTIVES To evaluate whether AVS is necessary in all patients with unilateral adenoma > or = 1 cm. METHODS We analyzed data from patients with proven primary aldosteronism, CT finding of adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland, and successfully performed AVS. RESULTS Out of 107 patients with proven primary aldosteronism, indicated for AVS, we included 30 patients with CT finding of suprarenal adenoma > or = 1 cm along with normal morphology of contralateral adrenal gland and successful AVS. Unilateral overproduction of aldosterone was found only in 17 cases (56.7%), the results in remaining 13 patients (43.3%) did not confirm activity of adenoma. CONCLUSION Our results support necessity of performing AVS in all patients with primary aldosteronism in whom surgical treatment is considered, CT confirmation ofan adenoma is insufficient in this indication.
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Affiliation(s)
- M Ballon
- I interní klinika Lékarské fakulty UK a FN Hradec Králové.
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Cecka F, Jon B, Havel E, Lojík M, Raupach J, Bĕlobrádek Z, Neoral C, Subrt Z, Ferko A. [Truncus coeliacus stenosis in duodenopancreatectomy]. Rozhl Chir 2009; 88:192-195. [PMID: 19645145] [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: 05/28/2023]
Abstract
INTRODUCTION Patients with celiac axis stenosis are asymptomatic due to the rich collateral blood supply through superior mesenteric artery. Ligating and dividing gastroduodenal artery during pancreatoduodenectomy can cause ischemic threat especially to liver, less frequently stomach and spleen, or failure of anastomoses. CASE REPORT The authors present a case of 27-year-old female who underwent duodenopancreatectomy for pseudopapillary tumour of the head of pancreas. Celiac axis stenosis was found peroperatively and proven during angiography. Although an attempt of endovascular dilatation of celiac axis was unsuccessful, blood supply to the liver was sufficient and therefore we did not perform any other intervention to improve blood flow to the liver. Postoperative course was uneventful. DISCUSSION Celiac axis stenosis can be caused by tumour infiltration or lymphadenopathy in malignant disease, atherosclerosis or compression of the median arcuate ligament. The stenosis can be managed by endovascular treatment or arterial reconstruction. In conclusion the authors propose a management algorithm to prevent the consequences of celiac axis stenosis.
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Affiliation(s)
- F Cecka
- Chirurgická klinika Lékarské fakulty Univerzity Karlovy a Fakultní nemocnice v Hradci Králové.
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Jirkovsky V, Fejfar T, Hulek P, Krajina A, Tycova V, Safka V, Chovanec V, Vanasek T, Lojik M, Raupach J, Skodova M, Renc O. Abstract No. 304: TIPS for Treatment of Portal Hypertension Due to Extramedullary Hematopoiesis in Patients with Myelofibrosis Secondary to Myeloproliferative Diseases. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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McPherson M, Kirk M, Raupach J, Koehler A. Risk Factors of Sporadic Human Infection of Shiga Toxin Producing Escherichia coli O157 and Non-O157 in Australia. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Subrt Z, Ferko A, Hoffmann P, Tycová V, Ryska M, Raupach J, Chovanec V, Dvorák P. Temporary liver blood-outflow occlusion increases effectiveness of radiofrequency ablation: An experimental study on pigs. Eur J Surg Oncol 2008; 34:346-52. [PMID: 17196361 DOI: 10.1016/j.ejso.2006.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 10/09/2006] [Accepted: 11/22/2006] [Indexed: 01/17/2023] Open
Abstract
AIM To evaluate the feasibility of liver blood outflow (LBOF) occlusion and its impact on the effectiveness of radiofrequency ablation (RFA). METHODS The experiment was performed on 10 pigs. The animals were divided into groups A and B according to RFA protocol. In group A (n=5) the RFA time was that taken to reach the target temperature of 105 degrees C, whereas group B (n=5) had a constant RFA temperature of 105 degrees C and constant time of 8min. The liver blood flow (LBF) was quantified using Doppler ultrasonography before LBOF occlusion and after that. RFA were performed using an expandable 3cm RF needle. Two liver ablations created in different liver lobes were compared; the first ablation was created before balloon inflation and the second one was created under LBOF occlusion. The time required for RFA procedure, liver ablation volumes, shape and microscopic changes of the thermoablated zones were recorded. RESULTS The LBF dropped significantly in all liver vessels after balloon inflation. The volume of the ablated area was 8.2+/-2.2cm(3) and increased significantly after LBOF occlusion to 17.4+/-3.8cm(3) (p<0.001), in group A. A significant enlargement of the ablated area with occluded LBF was registered in group B, it was 6.7+/-2.8cm(3) versus 19.4+/-1.8cm(3) respectively (p<0.01). CONCLUSIONS Temporary LBOF occlusion led to a significant reduction in liver blood flow, enlargement of the thermoablated area volume and homogeneity of the coagulated zones.
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Affiliation(s)
- Z Subrt
- Dept. of Field Surgery, Military Health Science Faculty, Hradec Králové, Defense University Brno, Czech Republic.
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Horáková L, Pudil R, Raupach J, Vojácek J. Thrombolytic treatment of thrombosis on the aortic valvular prosthesis complicated by brain embolism. Acta Medica (Hradec Kralove) 2008; 51:59-62. [PMID: 18683671 DOI: 10.14712/18059694.2017.33] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors present a case of thrombosis on the St. Jude Medical 19 aortic valve prosthesis. The diagnosis was confirmed by transthoracic and transoesofageal echocardiography, cardiac fluoroscopy revealed restricted movement of the aortic valve prosthesis leaflet. Thrombolytic therapy was complicated with brain embolism that was successfully percutaneously removed from the cerebral artery by the mechanical device. The patient has fully recovered without any neurological residual symptoms. This case report should be instructive to other clinicians who encounter the same complications after thrombolytic treatment.
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Affiliation(s)
- Lucie Horáková
- 1st Department of Medicine, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic.
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Cecka F, Raupach J, Hoffmann P, Motycka P, Stetina M, Neoral C. Ruptured bronchial artery aneurysm: case report. Acta Medica (Hradec Kralove) 2008; 51:241-243. [PMID: 19453092] [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: 05/27/2023]
Abstract
Bronchial artery aneurysm is a very rare condition. Its rupture can cause a life threatening hemorrhage. We report a case of a 50-year-old patient with a ruptured bronchial artery aneurysm who presented with epigastric pain. It is the first published case with such signs of a rupture of a bronchial artery aneurysm. CT scan confirmed the diagnosis. The patient was treated with endovascular embolization.
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Affiliation(s)
- Filip Cecka
- Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Department of Surgery, Czech Republic.
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Lojík M, Krajíeková D, Kubíková M, Krajina A, Raupach J, Chovanec V, Schreiberová J. [Endovascular treatment of carotid artery stenosis with cerebral protection: 5-year experience]. Rozhl Chir 2007; 86:513-520. [PMID: 18064788] [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: 05/25/2023]
Abstract
BACKGROUND Percutaneous transluminal angioplasty and stenting with cerebral protection is a minimally invasive method for carotid artery stenosis treatment, which may be an alternative to surgical endarterectomy. The aim of our study is to evaluate results of endovascular treatment in patients at high risk of endarterectomy. PATIENTS AND METHODS Between years 2001-2006, 210 carotid artery stenoses in 204 patients were treated in our department. Fourty seven percent of patients suffered from symptomatic stenosis, asymptomatic stenosis was proved in 53% of patients. All asymptomatic patients had stenosis more than 70% measured according to NASCET, mostly with contralateral carotid artery occlusion. RESULTS The procedure was technically successful in 99% of patients, mortality was 0.49%. Periprocedural embolic complications based on transient ischemic attack were observed in 2.39% of patients, symptoms of minor stroke in 0.47% and symptoms of major stroke in 0.47% of patients. The mortality and disabled morbidity rate in the whole group was 0.96%. One hundred and fifty three patients (73%) were followed up, during this time, 7 patients (3.9%) developed hemodynamically significant restenosis. CONCLUSION Endovascular carotid artery stenosis treatment with cerebral protection seems to be a safe method of treatment with acceptable short-term results. However, long-term follow-up is needed to get enough data about safety and effectiveness of this method compared to endarterectomy and best medical therapy.
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Affiliation(s)
- M Lojík
- Radiologická klinika LF a FN, Hradec Králové
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Raupach J, Ferko A, Lojik M, Krajina A, Harrer J, Dominik J. Endovascular Treatment of Acute and Chronic Thoracic Aortic Injury. Cardiovasc Intervent Radiol 2007; 30:1117-23. [PMID: 17874164 DOI: 10.1007/s00270-007-9053-2] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 01/21/2007] [Accepted: 03/07/2007] [Indexed: 10/22/2022]
Abstract
Our aim is to present midterm results after endovascular repair of acute and chronic blunt aortic injury. Between December 1999 and December 2005, 13 patients were endovascularly treated for blunt aortic injury. Ten patients, 8 men and 2 women, mean age 38.7 years, were treated for acute traumatic injury in the isthmus region of thoracic aorta. Stent-graftings were performed between the fifth hour and the sixth day after injury. Three patients (all males; mean age, 66 years; range, 59-71 years) were treated due to the presence of symptoms of chronic posttraumatic pseudoaneurysm of the thoracic aorta (mean time after injury, 29.4 years, range, 28-32). Fifteen stent-grafts were implanted in 13 patients. In the group with acute aortic injury one patient died due to failure of endovascular technique. Lower leg paraparesis appeared in one patient; the other eight patients were regularly followed up (1-72 months; mean, 35.6 months), without complications. In the group with posttraumatic pseudoaneurysms all three patients are alive. One patient suffered postoperatively from upper arm claudication, which was treated by carotidosubclavian bypass. We conclude that the endoluminal technique can be used successfully in the acute repair of aortic trauma and its consequences. Midterm results are satisfactory, with a low incidence of neurologic complications.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, Charles University and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
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Paral J, Jiri P, Ferko A, Alexander F, Plodr M, Michal P, Raupach J, Jan R, Hadzi-Nikolov D, Dimitar HN, Dolezal D, David D, Chovanec V, Vendelin C. Laparoscopic Diagnostics of Acute Bowel Ischemia Using Ultraviolet Light and Fluorescein Dye: An Experimental Study. Surg Laparosc Endosc Percutan Tech 2007; 17:291-5. [PMID: 17710051 DOI: 10.1097/sle.0b013e3180dc9376] [Citation(s) in RCA: 19] [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] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim of the study was to show the diagnostic potential of laparoscopy using fluorescein dye and ultraviolet light in acute bowel ischemia. MATERIALS AND METHODS The study involved 12 domestic pigs. Under general anesthesia, the peripheral branch of the superior mesenteric artery was embolized using polyvinyl-alcohol microparticles. Two hours after the embolization, optical filters were placed into the laparoscopic set to produce ultraviolet light. Fluorescein dye was given intravenously, and the bowel was inspected. Clips were placed on the border of the ischemia that was visualized with fluorescein. Resection of the ischemic part of the bowel and anastomosis of the viable parts were carried out using laparoscopic linear cutting staplers. After 24 hours, a laparoscopic second-look procedure was carried out to verify the viability of the anastomosis. RESULTS The method was in all cases able to recognize intestinal ischemia and reliably differentiate ischemic bowel segments from viable bowel. Microscopic analysis of the ischemic specimens showed beginning ischemic changes of the bowel tissues. CONCLUSIONS The method should be considered a valuable diagnostic procedure both for diagnostics of early stage of acute bowel ischemia and for second-look procedures.
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Affiliation(s)
- Jiri Paral
- Department of Surgery, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic.
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Smejkal K, Zvák I, Trlica J, Raupach J, Neumann J. [Traumatic pseudoaneurysm of arteria femoralis profunda--the case report]. Rozhl Chir 2007; 86:116-9. [PMID: 17591417] [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: 05/16/2023]
Abstract
Authors present the case report of the pseudoaneurysm of deep femoral artery caused by the injury of the vessel wall during the open femur fracture. This fracture was primarly treated by repoisition and stabilization by the external fixator (Rohr system, Synthes GmbH, Switzerland), which was nine days later converted into the intramedullar osteosynthesis by the unreamed nail UFN (Synthes GmbH, Switzerland). The first clinical signs of the pseudoaneurysm occurred several days after the patient had been dismissed. In the clinical picture there dominated the painful swelling of thigh but no perfusion or innervation disorders in the periphery of the extremity were noticed and the finding was concluded as myositis ossificans. Proper diagnosis was set only 6 weeks later on the basis of the ultrasound and angiographic investigations. The situation was then solved by the angiographic embolization of pseudoaneurysm. In the discussion also other opinions from the literature are presented.
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Affiliation(s)
- K Smejkal
- Katedra válecné chirurgie, Fakulta vojenského zdravotnictví UO, Hradec Králové.
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Jirkovský V, Fejfar T, Safka V, Hůlek P, Chovanec V, Krajina A, Raupach J, Lojík M. [The impact of secondary insertion of ePTFE-coated stent on sustainable TIPS patency]. Vnitr Lek 2007; 53:123-8. [PMID: 17419172] [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: 05/14/2023]
Abstract
OBJECTIVE Retrospective evaluation of the effect of secondary insertion of ePTFE-coated stent in the treatment of TIPS dysfunction versus other current options (simple angioplasty, insertion of additional non-coated stent). PATIENT SET AND METHODOLOGY: From the beginning of 2000 to the end of 2004, there were 121 interventions for TIPS dysfunction performed in our centre in which a non-coated stent was used to make up the shunt at the time of intervention. Depending on the type of intervention, the patient set was divided in 4 groups: simple angioplasty (52 cases, 43%), insertion of non-coated stent (35 cases, 28.9%), insertion of non-dedicated ePTFE-coated stent (15 cases, 12.4%), and insertion of dedicated ePTFE-coated stent (19 cases, 15.7%). All patients were monitored on a regular basis after the intervention for shunt patency with the use of clinical examination and Doppler ultrasonography, or also portal venography. Primary shunt patency after the intervention was evaluated in all four groups by Kaplan-Meier analysis. The primary shunt patency results after the intervention were compared with the use Cox F text and logrank test. RESULTS The intervention was successful in 120 cases (the overall technical success rate of all interventions was 99.2%). The primary shunt patency was 49.7 % after 12 months and 25.3 % after 24 months following sole angioplasty intervention; 74.9% after 12 and 64.9% after 24 months following intervention involving the insertion of non-coated stent; 75.2 % after 12 months and 64.5% after 24 months following intervention involving the insertion of non-dedicated ePTFE-coated stent, and 88.1% after 12 months and 80.8% after 24 months following intervention involving the insertion of a dedicated ePTFE-coated stent. A statistically significant improvement in shunt patency was obtained in the group of interventions involving the insertion of dedicated ePTFE-coated stent and in the group of interventions involving the insertion of non-coated stent as compared with the group of interventions involving sole angioplasty (p < 0.01). CONCLUSION From among all the currently used methods of therapeutic intervention for TIPS dysfunction, the best, the best subsequent TIPS patency was obtained after intervention involving insertion of dedicated ePTFE-coated stent.
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Affiliation(s)
- V Jirkovský
- II. interní klinika Lékatská fakulty UK a FN Hradec Králové.
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