Ischemická cévní mozková příhoda je závažný stav zatížený vysokou mortalitou a značně vysokým rizikem trvalých funkčních následků. Léčba akutní ischemické cévní mozkové příhody prodělala trombektomiepři využití mechanické k okluze velkých cév mozku v porovnání s nejlepší medikamentózní terapií zahrnující systémovou trombolýzu, a zásadně tak změnily dosud zavedené paradigma léčby. V současné době je k dispozici široký výběr nástrojů pro mechanickou a nové jsou ve vývoji. Tato práce si klade za cíl shrnout současné možnosti léčby akutní ischemické cévní mozkové příhody metodami mechanické trombektomie a nastínit i další aspekty terapie tohoto onemocnění.

Ischemic stroke is a severe condition with a high mortality and a serious risk of permanent functional dis- ability. The treatment of acute ischemic stroke has undergone a number of major changes in recent years - from systemic thrombolysis to the wide range of current mechanical thrombectomy modalities. Studies such as MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME and others have demonstrated improved outcomes in patients with large vessel occlusion when mechanical thrombectomy was used compared with best medical treatment including systemic thrombolysis. These results have completely changed the treatment paradigm. Currently, a wide variety of endovascular tools are available for mechanical thrombectomy and new ones are still under development. This paper aims to summarize the current options for the treatment of ischemic stroke by mechanical thrombectomy and to outline other therapy aspects of this disease.

• MeSH
• ischemická cévní mozková příhoda * dějiny   terapie   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• mechanická trombolýza * metody   ošetřování   přístrojové vybavení   škodlivé účinky   MeSH
• trombektomie metody   ošetřování   přístrojové vybavení   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

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.

• MeSH
• Aspirin škodlivé účinky   MeSH
• cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• intrakraniální krvácení chemicky indukované   MeSH
• ischemická cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• ischemie mozku * diagnostické zobrazování   terapie   MeSH
• klopidogrel škodlivé účinky   MeSH
• lidé MeSH
• mechanická trombolýza * škodlivé účinky   MeSH
• trombektomie škodlivé účinky   MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

Background: Time is brain! This paradigm is forcing the development of strategies with potential to shorten the time from symptom onset to recanalization. One of these strategies is to transport select patients with acute ischaemic stroke directly to an angio-suite equipped with flat-detector computed tomography (FD-CT) to exclude intracranial haemorrhage, followed directly by invasive angiography and mechanical thrombectomy if large-vessel occlusion (LVO) is confirmed. Aim: To present existing published data about the direct transfer (DT) of stroke patients to angio-suites and to describe our initial experience with this stroke pathway. Methods: We performed a systematic PubMed search of trials that described DT of stroke patients to angio-suites and summarized the results of these trials. In January 2020, we implemented a new algorithm for acute ischaemic stroke care in our stroke centre. Select patients suitable for DT (National Institute of Health Stroke Scale score ≥10, time from symptom onset to door <4.5 h) were referred by neurologists directly to an angio-suite equipped with FD-CT. Patients treated using this algorithm were analysed and compared with patients treated using the standard protocol including CT and CT angiography in our centre. Results: We identified seven trials comparing the DT protocol with the standard protocol in stroke patients. Among the 628 patients treated using the DT protocol, 104 (16.5%) did not have LVO and did not undergo endovascular treatment (EVT). All the trials demonstrated a significant reduction in door-to-groin time with DT, compared with the standard protocol. This reduction ranged from 22 min (DT protocol: 33 min; standard protocol: 55 min) to 59 min (DT protocol: 22 min; standard protocol: 81 min). In three of five trials comparing the 90-day modified Rankin scale scores between the DT and standard imaging groups, this reduction in ischaemic time translated into better clinical outcomes, whereas the two other trials reported no such difference in scores. Between January 2020 and October 2021, 116 patients underwent EVT for acute ischaemic stroke in our centre. Among these patients, 65 (56%) met the criteria for DT (National Institutes of Health Stroke Scale score >10, symptom onset-to-door time <4.5 h), but only 7 (10.8%) were transported directly to the angio-suite. The reasons that many patients who met the criteria were not transported directly to the angio-suite were lack of personnel trained in FD-CT acquisition outside of working hours, ongoing procedures in the angio-suite, contraindication to the DT protocol due to atypical clinical presentation, and neurologist's decision for obtain complete neurological imaging. All seven patients who were transported directly to the angio-suite had LVOs. The median time from door-to-groin-puncture was significantly lower with the DT protocol compared with the standard protocol {29 min [interquartile range (IQR): 25-31 min] vs. 71 min [IQR: 55-94 min]; P < 0.001}. None of the patients had symptomatic intracranial haemorrhage in the DT protocol group, compared with 7 (6.4%) patients in the standard protocol group. Direct transfer of acute ischaemic stroke patients to the angio-suite equipped with FD-CT seems to reduce the time from patient arrival in the hospital to groin puncture. This reduction in the ischaemic time translates into better clinical outcomes. However, more data are needed to confirm these results.

• Publikační typ
• časopisecké články MeSH

The recanalization effect of large-vessel occlusion (LVO) in anterior circulation is well documented but only some patients benefit from endovascular treatment. We analysed clinical and radiological factors determining clinical outcome after successful mechanical intervention. We included 146 patients from the Prague 16 study enrolled from September 2012 to December 2020, who had initial CT/CTA examination and achieved good recanalization status after mechanical intervention (TICI 2b-3). One hundred and six (73%) patients achieved a good clinical outcome (modified Rankin Scale 0-2 in 3 months). It was associated with age, leptomeningeal collaterals (LC), onset to intervention time, ASPECTS, initial NIHSS, and leukoaraiosis (LA) in univariate analysis. The regression model identified good collateral status [odds ratio (OR) 5.00, 95% confidence interval (CI) 1.91-13.08], late thrombectomy (OR 0.24, 95% CI 0.09-0.65), LA (OR 0.44, 95% CI 0.19-1.00), ASPECTS (OR 1.45, 95% CI 1.08-1.95), and NIHSS score (OR 0.86, 95% CI 0.78-0.95) as independent outcome determinants. In the late thrombectomy subgroup, 14 out of 33 patients (42%) achieved a favourable clinical outcome, none of whom with poor collateral status. The presence of LC and absence of LA predicts a good outcome in acute stroke patients after successful recanalization of LVO in anterior circulation. Late thrombectomy was associated with higher rate of unfavourable clinical outcome. Nevertheless, collateral status in this subgroup was validated as a reliable selection criterion.

• Publikační typ
• časopisecké články MeSH

Background: The pathogenesis of adolescent idiopathic scoliosis (AIS), including the role of brain and spinal inhibitory circuits, is still poorly elucidated. The aim of this study was to identify which central inhibitory mechanisms are involved in the pathogenesis of AIS.Design: A prospective neurophysiological study, using a battery of neurophysiological tests, such as cutaneous (CuSP) and cortical (CoSP) silent periods, motor evoked potentials (MEP) and paired-pulse transcranial magnetic stimulation (ppTMS).Settings: Neurophysiological laboratory.Participants: Sixteen patients with AIS (14 females, median age 14.4) and healthy controls.Outcome measures: MEPs were obtained after transcranial magnetic stimulation (TMS) and recorded from the abductor pollicis muscle (APB). ppTMS was obtained at interval ratios (ISI) of 1, 2, 3, 6, 10, 15 and 20 ms. The cortical silent period (CoSP) was recorded from the APB. The cutaneous silent period (CuSP) was measured after painful stimuli delivered to the thumb while the subjects maintained voluntary contraction of the intrinsic hand muscles. The data were analyzed and compared with those from healthy subjects.Results: The CoSP duration was significantly prolonged in AIS patients. A significantly higher amplitude of ppTMS for ISI was found in all AIS patients, without remarkable left-right side differences. No significant difference in MEP latency or amplitude nor in the CuSP duration was obtained.Conclusion: Our observation demonstrates evidence of central nervous system involvement in adolescent idiopathic scoliosis (AIS). Lower intracortical inhibition, higher motor cortex excitability, and preserved spinal inhibitory circuits are the main findings of this study. A possible explanation of these changes could be attributed to impaired sensorimotor integration predominantly at the cortical level.

• MeSH
• elektrická stimulace MeSH
• elektromyografie MeSH
• kosterní svaly fyziologie   MeSH
• lidé MeSH
• mladiství MeSH
• motorické evokované potenciály fyziologie   MeSH
• motorické korové centrum * fyziologie   MeSH
• poranění míchy * MeSH
• prospektivní studie MeSH
• skolióza * MeSH
• transkraniální magnetická stimulace MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

K exacerbaci myasthenia gravis (MG) dochází často při různých infekcích. Onemocnění COVID-19, které se vyznačuje postižením plic se selháním respirace, masivní zánětlivou reakcí a vysokou úmrtností, může vést ke zhoršení řady neuromuskulárních poruch vč. MG. Jednotlivé publikované soubory nemocných s MG a COVID-19 jsou značně variabilní a liší se tíží nemoci i zvoleným terapeutickým přístupem. V našem souboru 11 nemocných s MG se u 3 pacientů jednalo o výrazné zhoršení a u dalších 4 o mírné zhoršení klinických myastenických příznaků. U 3 nemocných byly intravenózně aplikovány vysoké dávky methylprednisolonu, u dvou nemocných byla zvýšena perorální dávka prednisonu na 40 mg/60 mg, jeden nemocný byl léčen imunoglobulinem intravenózně (2 g/kg) a jednomu byl podán remdesivir. U 88leté ženy byla MG diagnostikována až po prodělání infekce COVID-19. 77letý muž po 6 dnech mechanické ventilace zemřel. Infekce COVID-19 vede u značné části nemocných s MG k exacerbaci klinických příznaků. Jde zejména o poruchu ventilace, kdy se zvýšená svalová únavnost v rámci MG kombinuje se zánětlivými změnami plicního parenchymu.

Various infections can frequently lead to the exacerbation of myasthenia gravis (MG). COVID-19 infection characterized by lung impairment with respiration failure, massive inflammatory reaction and high mortality may lead to worsening of many neuromuscular disorders including MG. Published series of patients with MG and COVID-19 are considerably variable and differ in disease severity and selected therapeutic approach. In our group of 11 MG patients, substantial worsening was present in 3 patients, and in 4 there was a mild worsening of clinical myasthenic symptoms. In 3 patients, we used high doses of methylprednisolone intravenously, in 2 patients, the oral doses of prednisone were increased to 40 mg/60 mg a day, 1 patient was treated with intravenous immunoglobulin (2 g/kg), and 1 was treated with remdesivir. An 88-year-old woman was diagnosed with MG after COVID-19 infection. A 77-year-old man died after 6 days of mechanical ventilation. COVID-19 infection leads to an exacerbation of clinical symptoms in a large proportion of MG patients with ventilation disorder due to increased muscle fatigue and inflammatory changes in the lung parenchyma.

• MeSH
• COVID-19 * MeSH
• imunosupresivní léčba MeSH
• lidé středního věku MeSH
• lidé MeSH
• myasthenia gravis * MeSH
• progrese nemoci MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Thrombectomy is an effective treatment for acute ischaemic stroke (AIS). AIMS: The aim of this study was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath lab. METHODS: This was a single-centre, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin Scale (mRS) after three months. RESULTS: Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 patients (13%) had proximal internal carotid artery (ICA) occlusion, 27 patients (13%) had tandem (ICA+MCA) occlusion, 39 patients (18%) had terminal ICA (T-type) occlusion, and 26 patients (12%) had vertebrobasilar (VB) stroke. Favourable clinical outcome (mRS ≤2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but in only 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalisation success (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions. CONCLUSIONS: Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes. Visual summary. Endovascular intervention of isolated MCA or ICA occlusions provides greatest clinical benefit, while interventions in posterior circulation have lower chance for clinical success.

• MeSH
• arteria carotis interna diagnostické zobrazování   chirurgie   MeSH
• arterie MeSH
• cévní mozková příhoda * etiologie   chirurgie   MeSH
• endovaskulární výkony * MeSH
• ischemická cévní mozková příhoda * MeSH
• ischemie mozku * chirurgie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• stenty MeSH
• trombektomie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH