BACKGROUND: Carotid stenting requires dual antiplatelet therapy to effectively prevent thromboembolic complications. However, resistance to clopidogrel, a key component of this therapy, may lead to persistent risk of these complications. The aim of this study was to determine, if the implementation of routine platelet function testing and adjusting therapy was associated with lower incidence of thromboembolic complications and death. METHODS: All consecutive patients treated with carotid artery stenting in a single institution over 8 years were enlisted in a retrospective study. Platelet function testing was performed, and efficient antiplatelet therapy was set before the procedure. Incidence of procedure-related stroke or death within periprocedural period (0-30 days) was assessed. The results were evaluated in relation to the findings of six prominent randomized control trials. RESULTS: A total of 241 patients were treated for carotid stenosis, seven patients undergo CAS on both sides over time. There was 138 symptomatic (55,6%) and 110 asymptomatic stenoses (44,4%). Five thromboembolic complications (2,01%) occurred, four of them (1,61%) was procedure-related. Two patients died because of procedure-related stroke (0,82%). Incidence of procedure-related stroke or death was significant lower compared to the results of CREST study (2,01% vs. 4,81%, P = 0,0243) in the entire cohorts, and to the results of ICSS study in the symptomatic cohorts (2,86% vs. 7,37%, P = 0,0243), respectively. CONCLUSIONS: Tailored antiplatelet therapy in carotid stenting is safe and seems to be related with lower incidence of procedure-related death or stroke rate. Larger prospective studies to assess whether platelet function testing-guided antiplatelet therapy is superior to standard dual antiplatelet should be considered.

• Publikační typ
• časopisecké články MeSH

BACKGROUND AND OBJECTIVES: Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability. METHODS: We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability. RESULTS: Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality pinteraction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04). DISCUSSION: Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Endovascular treatment (EVT) of tandem lesion (TL) in the anterior circulation acute ischemic stroke (IS) usually requires periprocedural antithrombotic treatment and early initiation of dual antiplatelet therapy (DAPT) after carotid stenting. However, it may contribute to an occurrence of symptomatic intracerebral hemorrhage (SICH) in some cases. We investigated factors influencing the SICH occurrence and assessed the possible predictors of SICH after EVT. METHODS: IS patients with TL in the anterior circulation treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and recanalization using the TICI scale. SICH was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of SICH with adjustment for potential confounders. RESULTS: In total, 300 (68.7 % males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7 %) patients and 176 (58.7 %) had mRS 0-2. SICH occurred in 25 (8.3 %) patients. Patients with SICH did not differ from those without SICH in the rate of periprocedural antithrombotic treatment (64 vs. 57.5 %, p = 0.526) and in the rate of DAPT started within the first 12 h after EVT (20 vs. 42.2 %, p = 0.087). After adjustment, admission NIHSS and admission glycemia were found as the only predictors of SICH after EVT. CONCLUSION: Admission NIHSS and glycemia were found as the only predictors of SICH after EVT for TL. No associations between periprocedural antithrombotic treatment, early start of DAPT after EVT and SICH occurrence were found.

• MeSH
• časové faktory MeSH
• cerebrální krvácení * diagnostické zobrazování   etiologie   terapie   MeSH
• duální protidestičková léčba škodlivé účinky   MeSH
• endovaskulární výkony * škodlivé účinky   přístrojové vybavení   MeSH
• fibrinolytika * aplikace a dávkování   škodlivé účinky   MeSH
• hodnocení rizik MeSH
• inhibitory agregace trombocytů * škodlivé účinky   aplikace a dávkování   MeSH
• ischemická cévní mozková příhoda * etiologie   terapie   diagnóza   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• posuzování pracovní neschopnosti * MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Japonsko MeSH

PURPOSE: Endovascular treatment (EVT) of tandem lesion (TL) in anterior circulation (AC) acute ischemic stroke (AIS) represents still a clinical challenge. We aimed to evaluate selected factors related to EVT and assess other possible predictors of good clinical outcome besides the generally known ones. METHODS: AIS patients with TL in AC treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and achieved recanalization using the TICI scale. Symptomatic intracerebral hemorrhage (SICH) was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of mRS 0-2 with adjustment for potential confounders. RESULTS: In total, 300 (68.7% males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7%) patients and 176 (58.7%) had mRS 0-2. Besides the age, admission NIHSS and SICH, admission glycemia (p = 0.005, OR: 0.884) the stent patency within the first 30 days after EVT (p = 0.0003, OR: 0.219), dual antiplatelet therapy (DAPT) started within 12 h after EVT (p < 0.0001, OR: 5.006) and statin therapy started within 24 h after stenting (p < 0.0001, OR: 5.558) were found as other predictors. CONCLUSION: Admission glycemia, start of DAPT within 12 h and statin therapy within 24 h after EVT, and stent patency within the first 30 days after EVT were found as other predictors of good three-month clinical outcome in AIS patients treated with EVT for TL.

• MeSH
• cévní mozková příhoda * diagnostické zobrazování   terapie   etiologie   MeSH
• endovaskulární výkony * metody   MeSH
• ischemická cévní mozková příhoda * diagnostické zobrazování   chirurgie   MeSH
• ischemie mozku * diagnostické zobrazování   terapie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• statiny * MeSH
• trombektomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

K okluzi centrální retinální tepny může dojít na podkladě embolizace z nestabilního aterosklerotického plátu arteria carotis interna. V naší kazuistice byla ztráta monokulárního vidění prvním příznakem závažného průběhu ischemické cévní mozkové příhody, kterou bylo nutné urgentně řešit mechanickou trombektomií. Cílem sdělení je poukázat na často podceňovanou závažnost tohoto stavu. Okluze centrální retinální arterie by dle našeho názoru měla být řešena v akutním režimu, bez prodlení a se zapojením zdravotnické záchranné služby jako každá jiná cévní mozková příhoda. I přes debatu jak v české, tak ve světové odborné veřejnosti, není dosud k dispozici konsenzus v přístupu k této klinické jednotce.

Central retinal artery occlusion can occur secondary to embolism from an unstable atherosclerotic plaque of the internal carotid artery. In our case report, monocular visual loss was the initial presentation of a severe course of ischaemic stroke which required urgent management with mechanical thrombectomy. The aim of the paper is to highlight the often underestimated severity of this condition. In our opinion, central retinal artery occlusion should be managed in an acute mode, without delay, and with the involvement of emergency medical services, just like any other stroke. In spite of the debate in both the Czech and worldwide professional community, no consensus has so far been available on the approach to this clinical entity.

• MeSH
• arteria centralis retinae patologie   MeSH
• ischemická cévní mozková příhoda * diagnóza   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza metody   MeSH
• okluze retinální arterie diagnóza   terapie   MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Cíl: Zhodnocení laboratorní účinnosti námi nejčastěji používaných protidestičkových léčiv: kyseliny acetylsalicylové (ASA), clopidogrelu a ticagreloru. Posouzení efektivity ticagreloru jako alternativní léčby u pacientů, kterým jsme zjistili in vitro rezistenci, neboli HTPR (high on-treatment platelet reactivity) na clopidogrel. Metodika: V našem souboru byla testována účinnost protidestičkových léčiv metodou light transmission aggregometry (LTA) od 16. září 2020 do 5. prosince 2022. Byla sledována účinnost léčby u pacientů převedených na alternativní léčivo a byla hodnocena úspěšnost změny terapie. Výsledky: Ve sledovaném období bylo otestováno celkem 529 krevních vzorků, v případě clopidogrelu (n = 216), ticagreloru (n = 59) a ASA (n = 254). Účinnost léčby clopidogrelem byla 45,4 %, resp. ticagrelorem 93,2 % (p < 0,000). V případě převedení z clopidogrelu na ticagrelor byla léčba úspěšná u 49 z 54 pacientů (90,7 %). Závěr: U testovaných protidestičkových léčiv byly prokázané statisticky významné rozdíly v dosažené účinnosti. V případě clopidogrelu je ticagrelor vhodnou alternativou statisticky významně redukující výskyt HTPR. Zařazením testování účinnosti protidestičkové léčby do algoritmu endovaskulárních výkonů lze významně snížit počet pacientů s HTPR podstupujících implantaci stentů/flow-diverterů.

Purpouse: Evaluation of the laboratory effectiveness of the antiplatelet drugs we use: clopidogrel, ticagrelor, aspirin. Assessment of the effectiveness of ticagrelor as an alternative treatment in patients with in vitro resistance, or HTPR (high on-treatment platelet reactivity) to clopidogrel. Methods: In our set of patients, the effectiveness of antiplatelet drugs was tested using the light transmission aggregometry (LTA) method from 16. 9. 2020 to 5. 12. 2022. The effectiveness of treatment in patients switched to an alternative medicine was monitored and the success of the change in therapy was evaluated. Results: In the monitored period, a total of 529 blood samples were tested for clopidogrel (n = 216), ticagrelor (n = 59) and aspirin (n = 254). The efficacy of clopidogrel treatment was 45.4 %. On the other hand, the efficacy of ticagrelor was 93.2 %, statistically significantly higher (p < 0.000). In case of conversion from clopidogrel to ticagrelor, treatment was successful in 49 of 54 patients (90.7 %). Conclusion: For the antiplatelet drugs tested, statistically significant differences in the effectiveness were demonstrated. In the case of clopidogrel, ticagrelor is a suitable alternative, significantly reducing incidence of HTPR. The number of patients with HTPR undergoing stent/flow diverter implantation can be significantly reduced by including platelet function testing in the algorithm of endovascular procedures.

• MeSH
• Aspirin aplikace a dávkování   MeSH
• inhibitory agregace trombocytů * aplikace a dávkování   MeSH
• klopidogrel aplikace a dávkování   MeSH
• léková rezistence MeSH
• lidé MeSH
• statistika jako téma MeSH
• techniky in vitro MeSH
• ticagrelor aplikace a dávkování   MeSH
• tromboembolie prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• hodnotící studie MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH