INTRODUCTION: Non-contrast computed tomography (CT) and CT angiography are the gold standard in neuroimaging diagnostics in the case of suspected stroke. CT perfusion (CTP) may play an important role in the diagnosis of stroke mimics (SM), but currently, it is not a standard part of the stroke diagnostic procedure. The project is a multicentre prospective observational clinical research focused on refining the diagnostics of stroke and stroke mimics (SM) in hospital care. AIM: This study aimed to evaluate the degree of specificity and sensitivity of multimodal CT (NCCT, CTA, and CTP) in the diagnosis of SM versus stroke. METHODOLOGY: In this study, we will include 3,000 patients consecutively admitted to the comprehensive stroke centres with a diagnosis of suspected stroke. On the basis of clinical parameters and the results of multimodal CT and magnetic resonance imaging (MRI), the diagnosis of stroke and SM will be established. To clarify the significance of the use of the multimodal CT scan, the analysis will include a comparison of the blinded results for each imaging scan performed by radiologists and AI technology and a comparison of the initial and final diagnosis of the enrolled patients. Based on our results, we will compare the economic indicators and costs that would be saved by not providing inadequate treatment to patients with SM. CONCLUSION: The expected outcome is to present an optimised diagnostic procedure that results in a faster and more accurate diagnosis, thereby eliminating the risk of inadequate treatment in patients with SM. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, NCT06045455.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: This study investigates changes in cognitive function in patients with severe carotid stenosis who underwent carotid endarterectomy (CEA) and carotid stenting (CAS) over two decades. METHODS: We compared cognitive function within 30 days after the procedure in 267 patients (first 100 each for CEA and CAS in two periods: 2008-2012 and 2018-2022) in a single institution. Assessments used Adenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), Speech Fluency Test (SFT), and Clock Drawing Test (CDT), conducted before and 30 ± 2 days after surgery. RESULTS: Patients (mean age 67.2 years, 70%+ carotid stenosis) exhibited different cognitive changes over periods. In 2008-2012, significant declines in MMSE (CEA, p = 0.049) and CDT (CAS, p = 0.015) were observed among asymptomatic patients. On the contrary, in 2018-2022, improvements were observed in ACE-R and MMSE for symptomatic and asymptomatic patients undergoing CEA and CAS. CONCLUSION: Over a decade, advances in interventional techniques and patient management have reduced risks of cognitive decline in patients with asymptomatic carotid stenosis and also have improved cognitive functions in both symptomatic and asymptomatic individuals.
- Publikační typ
- časopisecké články MeSH
- MeSH
- endovaskulární výkony MeSH
- hematologické testy MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA. METHODS: Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman's correlation and Kendall's rank correlation were used to evaluate the results. RESULTS: A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman's correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (r = 0.238), whereas EDV showed a higher correlation (r = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (r = 0.677), while the PSVICA/ICA ratio showed the highest correlation in stenoses with irregular (r = 0.373) or ulcerated (r = 0.382) surfaces, as well as lipid (r = 0.406), fibrous (r = 0.461), and mixed (r = 0.403; p < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (p > 0.05 in all cases). CONCLUSION: PSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.
- Publikační typ
- časopisecké články MeSH
Způsob referování nálezu zobrazovacích metod významným způsobem ovlivňuje nutnost prohlížení CT dokumentace lékařem centra vysoce specializované cerebrovaskulární péče (KCC). V případě dlouhého intervalu při odeslání snímků do archivu KCC je významným způsobem prodloužen transport pacienta mezi centrem vysoce specializované péče o pacienta s iktem (IC) a KCC. Nezbytné je referovat rozsah ischemických změn v povodí ACM pomocí ASPECTS skóre. K vylučování pacientů z intervenční léčby na základě ASPECTS skóre je třeba přistupovat opatrně. Zásadní je dále správně identifikovat etáž okluze (zejména odlišení M1 a M2 úseku ACM), která spolurozhoduje o indikaci mechanické trombektomie. Pro strategii endovaskulárního výkonu je důležitá znalost postižení extrakraniálních tepen (stenózy, uzávěry). Referovat je vhodné anatomii krčních tepen s identifikací aortálního oblouku III. typu a výrazného vinutí krčních tepen, které mechanickou trombektomii komplikují. Tyto nálezy nejsou důvodem pro odmítnutí endovaskulárního výkonu.
The method of reporting the imaging techniques findings significantly affects the necessity of viewing the CT scans by the doctor in comprehensive cerebrovascular centre (CCC). In the case of a long interval when images are sent to the CCC archive, the transport of the patient between stroke centre (SC) and CCC is significantly prolonged. It is essential to report the extent of ischemic changes in the MCA territory using the ASPECTS score. Exclusion of patients from interventional treatment based on ASPECTS scores should be approached with caution. It is essential to correctly identify the level of occlusion (especially the distinction between M1 and M2 of the MCA segments), which co-determines the indication for mechanical thrombectomy. Knowledge of extracranial arteries involvement (stenoses, occlusions) is important for the strategy of endovascular surgery. It is appropriate to refer to the anatomy of the carotid arteries with the identification of the aortic arch type III. and significant looping of the carotid arteries, which complicate mechanical thrombectomy. These findings are not a reason to refuse an endovascular procedure.
- MeSH
- arterie anatomie a histologie MeSH
- CT angiografie MeSH
- infarkt arteria cerebri media diagnostické zobrazování patologie MeSH
- ischemická cévní mozková příhoda * diagnostické zobrazování patologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mechanická trombolýza metody MeSH
- referování a indexace jako téma * MeSH
- ukazatele zdravotního stavu MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- cerebrální infarkt diagnostické zobrazování etiologie MeSH
- cévní mozková příhoda * MeSH
- karotická endarterektomie * škodlivé účinky MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- rizikové faktory MeSH
- stenóza arteria carotis * diagnostické zobrazování chirurgie MeSH
- stenty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
