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
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
The goal of carotid endarterectomy is prevention of ischemic stroke, one of the most common causes of morbidity or mortality in developed countries. The current indication criteria are primarily based on the grade of stenosis caused by the atherosclerotic plaque. Even though it is known that the character of atherosclerotic plaque may be associated with the risk of clinical symptoms, this parameter is not expressed in the recommendations of the American Heart Association (AHA). The development and the character or the plaque are probably influenced by the hemodynamics in the carotid arteries. The goal of our project is to describe the relationship between the hemodynamic parameters and the character of the plaque. The mathematical calculations will be verified with laboratory modelling. The vision of our project is to obtain a tool that would help in early differentiation between risky and less risky plaques and provide the possibility of early intervention before the onset of clinical symptomatology thus making the preventive measures, such as carotid endarterectomy, more effective.
Cílem karotické endarterektomie je prevence ischemické cévní mozkové příhody, jedné z nejčastějších příčin trvalého postižení či úmrtí ve vyspělých zemích. Současná indikační doporučení jsou založena dominantně na hodnocení stupně stenózy způsobené aterosklerotickým plátem. Přestože je známo, že charakter plátu může souviset s jeho rizikem klinické symptomatologie, zatím není vyjádřen v současných doporučeních American Heart Association (AHA). Na vývoj a charakter plátu má nejspíše velký význam hemodynamika v karotickém řečišti. Cílem našeho projektu je popsat vztah mezi hemodynamickými parametry a charakterem karotického plátu. Správnost našich matematických kalkulací chceme potvrdit pomocí laboratorních modelů karotických stenóz. Vizí našeho projektu je získat nástroj, který by dokázal včas diferencovat rizikové pláty od těch méně rizikových a poskytl možnost časné intervence před rozvojem klinické symptomatologie a tím zefektivnil význam preventivních opatření, jakým je karotické endarterektomie.
- Klíčová slova
- Iktus;, Hemodynamika;, Stenóza karotidy;, Nestabilní aterosklarotický plát;, Stroke;, Hemodynamics;, Carotid stenosis;, Unstable atherosclerotic plaque;,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
Ruptura intrakraniálního aneuryzmatu představuje pro pacienta život ohrožující stav s dodnes vysokou mortalitou a morbiditou. Patogeneze vývoje a případné ruptury aneuryzmatu jsou pořád zahaleny rouškou tajemství, což pro vědce představuje velký prostor pro možnosti bádaní. Přes určité limitace mají experimentální modely intrakraniálních aneuryzmat své nenahraditelné místo. Přehledový článek shrnuje dosavadní publikované výsledky experimentálních modelů zaměřených na modely hlodavců, jejich výhody a také limitace. Zároveň čtenáře seznamuje s výsledky naší pilotní studie experimentálního modelu u laboratorní myši.
Rupture of an intracranial aneurysm represents a life-threatening condition with a still high mortality and morbidity. The pathogenesis of aneurysm development and eventual aneurysm rupture are still shrouded in mystery, representing a great field of research opportunities for scientists. Despite certain limitations, experimental models of intracranial aneurysms have their invaluable place. The review article summarizes the published results of current experimental rodent-focused models, their advantages, as well as limitations. At the same time, it introduces the reader to the results of our pilot study of an experimental laboratory mice model.
- MeSH
- experimenty na zvířatech MeSH
- inbrední kmeny myší MeSH
- inbrední kmeny potkanů MeSH
- intrakraniální aneurysma * diagnóza etiologie patofyziologie MeSH
- klinické zkoušky veterinární jako téma MeSH
- nemoci cerebrálních arterií klasifikace MeSH
- prasklé aneurysma etiologie patofyziologie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND AND OBJECTIVES: Endovascular treatment of cerebral aneurysms has tremendously advanced over the past decades. Nevertheless, aneurysm residual and recurrence remain challenges after embolization. The objective of this study was to elucidate the portion of embolized aneurysms requiring open surgery and evaluate whether newer endovascular treatments have changed the need for open surgery after failed embolization. METHODS: All 15 cerebrovascular centers in Austria and the Czech Republic provided overall aneurysm treatment frequency data and retrospectively reviewed consecutive cerebral aneurysms treated with open surgical treatment after failure of embolization from 2000 to 2022. All endovascular modalities were included. RESULTS: On average, 1362 aneurysms were treated annually in the 2 countries. The incidence increased from 0.006% in 2005 to 0.008% in 2020 in the overall population. Open surgery after failed endovascular intervention was necessary in 128 aneurysms (0.8%), a proportion that remained constant over time. Subarachnoid hemorrhage was the initial presentation in 70.3% of aneurysms. The most common location was the anterior communicating artery region (40.6%), followed by the middle cerebral artery (25.0%). The median diameter was 6 mm (2-32). Initial endovascular treatment included coiling (107 aneurysms), balloon-assist (10), stent-assist (4), intrasaccular device (3), flow diversion (2), and others (2). Complete occlusion after initial embolization was recorded in 40.6%. Seventy-one percent of aneurysms were operated within 3 years after embolization. In 7%, the indication for surgery was (re-)rupture and, in 88.3%, reperfusion. Device removal was performed in 16.4%. Symptomatic intraoperative and postoperative complications occurred in 10.2%. Complete aneurysm occlusion after open surgery was achieved in 94%. CONCLUSION: Open surgery remains a rare indication for cerebral aneurysms after failed endovascular embolization even in the age of novel endovascular technology, such as flow diverters and intrasaccular devices. Regardless, it is mostly performed for ruptured aneurysms initially treated with primary coiling that are in the anterior circulation.
- MeSH
- dospělí MeSH
- endovaskulární výkony * metody MeSH
- intrakraniální aneurysma * chirurgie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrochirurgie metody MeSH
- neurochirurgické výkony metody MeSH
- neúspěšná terapie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- terapeutická embolizace * metody MeSH
- Check Tag
- dospělí MeSH
- 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
- Česká republika MeSH
- Rakousko MeSH
BACKGROUND: Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions. METHODS: We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV). RESULTS: We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study. CONCLUSION: Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.
- Publikační typ
- časopisecké články MeSH
PURPOSE: Stroke, the second leading cause of death globally, often involves ischemia in the vertebrobasilar territory. This condition is underexplored, despite significant morbidity and mortality risks. The purpose of this study is to present a case of occipital artery to V3 segment vertebral artery bypass, emphasizing the role of quantitative magnetic resonance angiography (qMRA) in assessing flow and guiding surgical intervention. METHODS: A 66-year-old man with bilateral vertebral artery occlusion presented acute symptoms. qMRA was employed to evaluate flow dynamics and determine the feasibility of a flow augmentation bypass surgery. The occipital artery to left vertebral artery bypass (OA-to-VA) was performed, utilizing an inverted hockey-stick incision and an antegrade inside-out technique. The patency of the bypass was confirmed using both Doppler probe and Indocyanine green. RESULTS: Postoperative assessments, including computed tomography angiography (CTA) and qMRA, demonstrated the patency of the bypass with improved flow in the basilar artery and left vertebral artery. The patient's condition remained stable postoperatively, with residual peripheral palsy of the left facial nerve. CONCLUSION: In conclusion, the presented case illustrates the efficacy of the OA-to-VA bypass in addressing symptomatic bilateral vertebral artery occlusion. The study underscores the pivotal role of qMRA in pre- and postoperative assessments, providing noninvasive flow quantification for diagnostic considerations and long-term follow-up in patients with vertebrobasilar insufficiency.
- MeSH
- arteria vertebralis * chirurgie diagnostické zobrazování MeSH
- lidé MeSH
- magnetická rezonanční angiografie * metody MeSH
- revaskularizace mozku * metody MeSH
- senioři MeSH
- vertebrobazilární insuficience * chirurgie diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- kongresy jako téma MeSH
- neurochirurgické výkony * MeSH
- Publikační typ
- zprávy MeSH
Cílem naší práce bylo čtenáři neurochirurgovi přiblížit detailní anatomii mozečkové tonzily se zaměřením i na její jednotlivé povrchy, jelikož ve většině publikací je tato prezentována pouze v rámci anatomie celé mozečkové hemisféry, případně anatomie cerebelomedulární fissury nebo průběhu arteria cerebelli posterior inferior. Laboratorní kadaverózní disekce tonzily jsme prováděli na čtyřech (v rovině vermis sagitálně rozdělených) mozečkových hemisférách a jednom kompletním mozečku i s jeho pedunkly a spodinou fossa rhomboidea. Tu jsme využili k demonstraci telovelárního přístupu. Domníváme se, že pro bezpečné zvládnutí telovelárního přístupu na operačním sále je laboratorní disekce velice vhodná a umožní neurochirurgovi poznat i méně známé struktury laterálního recessu, cerebelomedulární fissury i pochopit telovelární junkci. V přehledném referátu dokumentujeme také jednotlivé operace vztahující se k tonzile i telovelárnímu přístupu: operaci Chiariho malformace se syringomyelií, plexus papilomu IV. komory či kavernomu jejího laterálního recessu a cystického hemangioblastomu medulla oblongata. Na základě literárních údajů dokumentujeme historii vzniku operačního přístupu, který je příkladnou ukázkou spolupráce dvou světových neurochirurgů (Rhoton a Matsushima) a byla podložena dlouhodobou laboratorní prací. V referátu se věnujeme vrozeným variantám herniace tonzil mozečku (Chiariho malformace), ale i příčinám sekundárním a možnostem jejich zobrazení. Zmiňujeme klinický význam patologického sestupu tonzil a souvislost se syringomyelií.
The goal of our work was to acquaint the reader-neurosurgeon with the detailed anatomy of the cerebellar tonsil, focusing on its individual surfaces. This is because, in most publications, the tonsil is presented only within the context of the anatomy of the entire cerebellar hemisphere, or possibly the anatomy of the cerebellomedullary fissure or the course of the arteria cerebelli posterior inferior. We conducted cadaveric dissections of the tonsil on 4 cerebellar hemispheres (divided sagittally in the plane of the vermis) and on one complete cerebellum with its peduncles and the floor of the fossa rhomboidea. We used this for demonstrating the telovelar approach. We believe that for the safe mastering of the telovelar approach in the operating room, laboratory dissection is mandatory. It allows the neurosurgeon to recognize even less known structures of the lateral recess, cerebellomedullary fissure, and understand the telovelar junction. In a comprehensive review, we also document individual surgeries related to the tonsil and telovelar approach: the surgery for Chiari malformation with syringomyelia, tumor of the IVth ventricle, cavernoma of its lateral recess, and cystic hemangioblastoma of the medulla oblongata. Based on literary data, we document the history of the surgical approach, which is an exemplary demonstration of the collaboration between two world-renowned neurosurgeons (Rhoton and Matsushima), and was underpinned by extensive laboratory work. In the review, we address congenital variants of cerebellar tonsil herniation (Chiari malformation) as well as secondary causes and their imaging possibilities. We mention the clinical significance of the pathological descent of tonsils and their association with syringomyelia.
- Klíčová slova
- tonsilla cerebelli, telovelární přístup, Chiariho malformace,
- MeSH
- foramen magnum anatomie a histologie chirurgie MeSH
- lidé MeSH
- mozeček * anatomie a histologie chirurgie MeSH
- mozkový kmen anatomie a histologie chirurgie MeSH
- neurochirurgické výkony MeSH
- syringomyelie chirurgie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Cíl: Cílem práce je detailní popis anatomie arteria recurrens Heubneri a zjištění četnosti ischemie v jejím povodí po klipu aneuryzmat arteria communicans anterior. Soubor a metodika: Byla provedena laboratorní mikroskopická disekce arteria recurrens Heubneri a rešerše literatury s popisem jejích variet. V klinické části byly vyhodnoceny snímky CT mozku po operaci 215 aneuryzmat arteria communicans anterior ošetřených klipem na Neurochirurgické klinice v Ústí nad Labem v období 2006–2022. Výsledky: Bylo dokumentováno zdvojení arteria recurrens Heubneri, vyskytující se jen ve 14 % případů, a její extracerebrální anastomóza s perforátory arteria cerebri media, vyskytující se pouze v 10 % případů. V klinické části byla zjištěna četnost ischemie v povodí arteria recurrens Heubneri po operaci aneuryzmat arteria communicans anterior ve 14,4 %, u krvácejících aneuryzmat v 19,6 % a u asymptomatických aneuryzmat v 6 %. Závěr: Arteria recurrens Heubneri je jednou z tepen, jejíž precizní anatomická znalost minimalizuje riziko komplikací při provádění vaskulárních i neuroonkologických operací v oblasti jejího průběhu.
Aim: The work aims to describe in detail the anatomy of the recurrent artery of Heubner and determine the frequency of ischemia in its territory after clipping of aneurysms of the arteria communicans anterior. Sample and methodology: We performed a laboratory microscopic dissection of the recurrent artery of Heubner as well as literature research of a description of its varieties. In the clinical part, we evaluated post-operative brain CT images of 215 aneurysms of the anterior communicating artery treated with clipping at the Department of Neurosurgery in Ústí nad Labem between 2006–2022. Results: We documented duplication of the arteria recurrens Heubneri, occurring only in 14% of cases, and its extracerebral anastomosis with perforators of the middle cerebral artery, occurring only in 10% of cases. In the clinical part, the frequency of ischemia in the Heubneri recurrent artery territory after surgery for anterior communicating artery aneurysms was found to be 14.4%, for bleeding aneurysms it was 19.6% of cases, and for asymptomatic aneurysms it was of 6% cases. Conclusion: Arteria recurrens Heubneri is one of the arteries which precise anatomical knowledge minimizes the risk of complications when performing vascular and neuro-oncological operations in the area of its course.
- MeSH
- arteria cerebri anterior * patologie MeSH
- arteriae cerebrales chirurgie patologie MeSH
- intrakraniální aneurysma chirurgie komplikace MeSH
- ischemie mozku MeSH
- lidé MeSH
- nemoci cerebrálních arterií chirurgie diagnóza MeSH
- neurochirurgické výkony metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
PURPOSE: Intracranial aneurysm (IA) rupture results in one of the most severe forms of stroke, with severe neurological sequelae. Inflammation appears to drive aneurysm formation and progression with macrophages playing a key role in this process. However, less is known about their involvement in aneurysm rupture. This study is aimed at demonstrating how relationship between the M1 (pro-inflammatory) and M2 (reparative) macrophage subtypes affect an aneurysm's structure resulting in its rupture. METHODS: Forty-one saccular aneurysm wall samples were collected during surgery including 13 ruptured and 28 unruptured aneurysm sacs. Structural changes were evaluated using histological staining. Macrophages in the aneurysm wall were quantified and defined as M1 and M2 using HLA-DR and CD163 antibodies. Aneurysm samples were divided into four groups according to the structural changes and the M2/1 ratio. Data were analyzed using the Mann-Whitney U test. RESULTS: This study has demonstrated an association between the severity of structural changes of an aneurysm with inflammatory cell infiltration within its wall and subsequent aneurysm rupture. More severe morphological changes and a significantly higher number of inflammatory cells were observed in ruptured IAs (p < 0.001). There was a prevalence of M2 macrophage subtypes within the wall of ruptured aneurysms (p < 0.001). A subgroup of unruptured IAs with morphological and inflammatory changes similar to ruptured IAs was observed. The common feature of this subgroup was the presence of an intraluminal thrombus. CONCLUSIONS: The degree of inflammatory cell infiltration associated with a shift in macrophage phenotype towards M2 macrophages could play an important role in structural changes of the aneurysm wall leading to its rupture.
