The retrograde approach in chronic total occlusion (CTO) interventions often encounters significant challenges, particularly, when aligning the retrograde microcatheter (MC) with the antegrade system is difficult, complicating or even preventing standard externalization. To address these issues, techniques like the "tip-in" have proven to be effective backup strategies. We introduce the "Manual Microcatheter-tip Modification" (MMM) technique as an alternative when the "tip-in" method faces complications. We present a case of a left anterior descending CTO where MMM was successfully employed for the first time, enabling successful revascularization by manually modifying the MC tip to engage the retrograde guidewire. We explore the technical details within the framework of contemporary CTO PCI. This new technique could enhance the management of CTO interventions, offering innovative solutions when traditional externalization methods are problematic.

• MeSH
• balónková koronární angioplastika přístrojové vybavení   MeSH
• chronická nemoc MeSH
• design vybavení * MeSH
• koronární angiografie * MeSH
• koronární angioplastika přístrojové vybavení   MeSH
• koronární okluze * diagnostické zobrazování   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniaturizace * MeSH
• senioři MeSH
• srdeční katetrizace přístrojové vybavení   MeSH
• srdeční katétry * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Iatrogenní disekce aorty je sice vzácnou, ale život ohrožující komplikací perkutánních koronárních intervencí (PCI). V případě spontánní disekce aorty typu A je doporučena urgentní chirurgická léčba, pro iatrogenní disekce specifická doporučení formulována nebyla. V prvotních studiích dosahovala mortalita chirurgicky léčených pacientů s iatrogenní disekcí aorty až 50 %, dle aktuálních dostupných dat z registrů se však zdá srovnatelná s mortalitou pacientů operovaných pro spontánní disekci aorty typu A (přibližně 16 %). Řada autorů však prezentovala kazuistiky pacientů úspěšně léčených konzervativně s kompletním zhojením disekce, a to i v případě rozsáhlého poškození aortální stěny.

Iatrogenic aortic dissection is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Emergency surgical treatment is recommended for spontaneous type A aortic dissection, but no specific recommendations have been formulated for iatrogenic dissections. In early studies, the mortality rate of surgically treated patients with iatrogenic aortic dissection was as high as 50%, but according to the currently available registry data, the mortality rate seems comparable to that of patients operated on for spontaneous type A aortic dissection (approximately 16%). However, case reports have been presented of patients successfully treated conservatively with complete healing of the dissection, including cases with extensive aortic wall damage.

• MeSH
• angiografie MeSH
• aortální stenóza diagnostické zobrazování   MeSH
• disekce aorty * diagnostické zobrazování   etiologie   klasifikace   patofyziologie   patologie   terapie   MeSH
• iatrogenní nemoci MeSH
• koronární angioplastika * škodlivé účinky   MeSH
• lidé MeSH
• senioři MeSH
• vzácné nemoci diagnostické zobrazování   etiologie   patofyziologie   patologie   terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. METHODS: Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. RESULTS: Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). CONCLUSIONS: In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.

• MeSH
• dospělí MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• rozšířená kardiopulmonální recuscitace MeSH
• urgentní zdravotnické služby * metody   MeSH
• zástava srdce mimo nemocnici * terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Background The FiGARO FFR versus iFR in Assessment of Hemodynamic Lesion Significance and an Explanation of Their Discrepancies trial is a prospective registry searching for predictors of fractional flow reserve instantaneous wave free ratio FFR iFR discrepancy Methods and Results FFR iFR were analyzed using a Verrata wire and coronary flow reserve was analyzed using a Combomap machine b

• MeSH
• frakční průtoková rezerva myokardu * MeSH
• hemodynamika MeSH
• hemoglobiny MeSH
• hemoxygenasa-1 genetika   MeSH
• koronární angiografie metody   MeSH
• koronární stenóza * MeSH
• lidé MeSH
• renální insuficience * MeSH
• synthasa oxidu dusnatého, typ III MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVES: This study aimed to examine coronary angiography (CAG) findings, percutaneous coronary intervention (PCI) results and outcomes in out-of-hospital cardiac arrest patients (OHCA) without return of spontaneous circulation (ROSC) on admission to hospital. METHODS: We analyzed the OHCA register and compared CAG, PCI, and outcome data in patients with and without ROSC on admission to hospital. RESULTS: Between January 2012 and December 2020, 697 OHCA patients were analyzed. Of these, 163 (23%) did not have ROSC at admission. Patients without ROSC were younger (59 vs. 61 years, p = 0.001) and had a longer resuscitation time (62 vs. 18 minutes, p < 0.001) than patients with ROSC. Significant coronary artery disease was highly prevalent in both groups (65% vs. 68%, p = 0.48). Patients without ROSC had higher rates of acute coronary occlusions (42% vs. 33%, p = 0.046), specifically affecting the left main stem (16% vs. 1%, p < 0.001). PCI was performed in 81 patients (50%) without ROSC and in 295 (55%) with ROSC (p = 0.21). The success rate was 86% in patients without ROSC and 90% in patients with ROSC (p = 0.33). Thirty-day survival was 24% in patients without ROSC and 70% in patients with ROSC. CONCLUSIONS: OHCA patients without ROSC on admission to hospital had higher acute coronary occlusion rates than patients with prehospital ROSC. PCI is feasible with a high success rate in patients without ROSC. Despite prolonged resuscitation times, meaningful survival in patients admitted without ROSC is achievable.

• MeSH
• kardiopulmonální resuscitace * metody   MeSH
• koronární angiografie metody   MeSH
• koronární angioplastika * metody   MeSH
• lidé MeSH
• obnovení spontánní cirukulace MeSH
• zástava srdce mimo nemocnici * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Importance: Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. Objective: To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. Design, Setting, and Participants: Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). Interventions: In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). Main Outcomes and Measures: The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). Results: The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. In the main analysis, 39 patients (31.5%) in the invasive strategy group and 29 (22.0%) in the standard strategy group survived to 180 days with good neurologic outcome (odds ratio [OR], 1.63 [95% CI, 0.93 to 2.85]; difference, 9.5% [95% CI, -1.3% to 20.1%]; P = .09). At 30 days, neurologic recovery had occurred in 38 patients (30.6%) in the invasive strategy group and in 24 (18.2%) in the standard strategy group (OR, 1.99 [95% CI, 1.11 to 3.57]; difference, 12.4% [95% CI, 1.9% to 22.7%]; P = .02), and cardiac recovery had occurred in 54 (43.5%) and 45 (34.1%) patients, respectively (OR, 1.49 [95% CI, 0.91 to 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). Conclusions and Relevance: Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference. Trial Registration: ClinicalTrials.gov Identifier: NCT01511666.

• MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• kardiopulmonální resuscitace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mimotělní membránová oxygenace MeSH
• senioři MeSH
• transport pacientů * MeSH
• zástava srdce mimo nemocnici diagnóza   mortalita   terapie   MeSH
• zbytečná diagnóza a terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

OBJECTIVE: The aim of the study was to test the potential role of breast arterial calcification (BAC) in the prediction of coronary artery disease (CAD) in women. The criterion standard for CAD diagnostics was coronary angiography. METHODS: This retrospective study enrolled 163 consecutive women, who underwent digital mammography and coronary angiography in our hospital. We assessed the presence and severity of BAC, and tested whether the presence and/or extent of BAC could be a predictor for CAD, quantified by Gensini score. RESULTS: BAC was presented in 34 patients (21%). Neither the presence of CAD (17 patients, 50%, vs 55 42.6%, P = 0.44), nor the Gensini score (20.5 ± 29.7 vs 15.4 ± 24.1, P = 0.3) differed significantly between BAC-present and BAC-absent patients.A finding of triple-vessel disease, however, more frequently occurred in the BAC-present (seven patients, 20.6%) than in the BAC-absent (nine patients, 7%) group, odds ratio (OR) 3.1, 95% CI 1-9.5, P = 0.049. The presence of BAC did not significantly increase the odds for the presence of CAD (OR = 1.29, P = 0.54). Among the subgroup of patients with CAD, BAC presence was associated with triple vessel disease (OR = 3.34, P = 0.049). CONCLUSIONS: We did not confirm BAC as a predictor of CAD. However, BAC showed association with more severe forms of coronary atherosclerosis (triple vessel disease).

• MeSH
• časná detekce nádoru MeSH
• koronární angiografie MeSH
• lidé MeSH
• mamografie MeSH
• nádory prsu * diagnostické zobrazování   MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• prediktivní hodnota testů MeSH
• prsy diagnostické zobrazování   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• vaskulární kalcifikace * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Background: We tested whether the level of endothelial dysfunction assessed by digital tonometry, and expressed as reactive hyperemia index (RHI), is related to occurrences of a discrepancy between fractional flow reserve (FFR) and the instantaneous wave free ratio (iFR) (ClinicalTrials.gov identifier: NCT03033810).Methods: We examined patients with coronary stenosis in the range of 40-70%, assessed by both FFR and iFR (system Philips-Volcano) for stable angina. We included consecutive patients with FFR and iFR in one native coronary artery, and who had had no previous intervention.Results: We included 138 patients. Out of those, 24 patients (17.4%) had a negative FFR (with an FFR value >0.8) and positive iFR (with a iFR value ≤0.89) - designated the FFRn/iFRp discrepancy group, and 22 patients (15.9%) had a positive FFR (≤0.8) and negative iFR (>0.89) - designated the FFRp/iFRn discrepancy. RHI was higher in the discrepancy groups compared the group without discrepancy (1.73 ± 0.79 vs. 1.48 ± 0.50, p = 0.025). However, this finding was not confirmed in multivariant logistic regression analyses. Patients with any type of discrepancy differed from the agreement group by having a higher occurrence of diabetes mellitus [9 patients (21.4%) vs. 36 patients (39.6%), p = 0.029], active smoking (23 patients or 54.8% vs. 26 patients or 28.6%, p = 0.003) and lower use of calcium channel blockers (9 patients, 21.4%, vs. 43 patients, 46.7%, p = 0.004).Conclusion: The presence of endothelial dysfunction can be associated with a discrepancy in FFR/iFR. However, RHI correlated with risk factors of atherosclerosis, not with FFR or iFR.

• MeSH
• cévní endotel patofyziologie   MeSH
• cévní rezistence MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární stenóza * diagnóza   patofyziologie   MeSH
• laser doppler flowmetrie * přístrojové vybavení   metody   MeSH
• lidé MeSH
• manometrie přístrojové vybavení   metody   MeSH
• mikrocirkulace fyziologie   MeSH
• navrhování softwaru * MeSH
• počítačové zpracování obrazu MeSH
• senioři MeSH
• software MeSH
• zobrazování myokardiální perfuze metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Tako-tsubo kardiomyopatie je relativně vzácný syndrom, pro který jsou charakteristické reverzibilní lokalizované poruchy kinetiky, zejména apikálních a středních segmentů levé komory. Velmi často imituje akutní koronární syndrom. Přesné patofyziologické mechanismy nejsou zcela známy. Za hlavní příčinu této kardiomyopatie je považována silná stresová zátěž. V ojedinělých případech může být tako-tsubo kardiomyopatie způsobena i jinými faktory. Prezentujeme vzácný případ stresové kardiomyopatie vzniklý v souvislosti s léčbou anagrelidem. Anagrelid je nejčastěji podáván pacientům s esenciální trombocytemií. Patří mezi inhibitory fosfodiesterázy III a prostřednictvím specifických signálních drah působí i na myokard. Naše kasuistické sdělení jako první v České republice popisuje případ tako-tsubo kardiomyopatie vzniklé v souvislosti s podáváním vysokých dávek anagrelidu.

Takotsubo cardiomyopathy is a rare syndrome. Most often imitates acute coronary syndrome. It is characterized by transient wall motion abnormalities, especially in the apical segments of the left ventricle. Less frequently it is possible to find transient akinesis or dyskinesis in the mid-ventricular segments of the left ventricle. Pathophysiological mechanisms are not completely clear. The main cause of stress cardiomyopathy is stress insult. But in rare cases takotsubo cardiomyopathy can be caused by other conditions. We reported a rare case of takotsubo cardiomyopathy caused by high dose anagrelide therapy. Anagrelide is most often used in patients with thrombocythemia. It belongs to phosphodiesterase III inhibitors and through specific pathways has certain effects on myocardium. It is the first case of takotsubo cardiomyopathy resulting from anagrelide therapy in the Czech Republic.

• MeSH
• Aspirin aplikace a dávkování   MeSH
• chinazoliny aplikace a dávkování   farmakologie   škodlivé účinky   MeSH
• inhibitory agregace trombocytů farmakologie   škodlivé účinky   terapeutické užití   MeSH
• klopidogrel aplikace a dávkování   MeSH
• koronární angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada léků MeSH
• takotsubo kardiomyopatie diagnostické zobrazování   chemicky indukované   MeSH
• trombocytopenie * farmakoterapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH