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

Aim: To describe current scientific knowledge on cognitive impairment and emotional disturbances (anxiety and depression) in younger adult patients after ischemic stroke. Design: A scoping review. Methods: For the search, the following scientific databases were utilized: Web of Science, MEDLINE (Ovid), ScienceDirect (Elsevier), PsycInfo (EBSCO), Scopus (Elsevier), and ProQuest. Relevant studies were identified by searching publications from 2000 to July 2023. Results: A total of eight studies were ultimately included in the review. Cognitive impairment occurred in a range between 39.4% and 40%. This encompassed various aspects of cognitive function, such as working memory, processing speed, global cognitive function, immediate and delayed memory, attention, and executive functioning. Depression had an incidence rate ranging from 10.8% to 16.8%. Several risk factors were associated with a higher likelihood of developing generalized anxiety. These included younger age, more depressive symptoms, lower education, unemployment, a history of depression, and alcohol use. In the context of depressive symptoms, a higher risk was linked to lower education and unemployment. Conclusion: The included studies highlighted the need to assess these issues not only at the time of patient discharge but, more importantly, during the stage of further recovery. This can contribute to the creation of tailored interventions for these individuals.

• MeSH
• deprese diagnóza   etiologie   MeSH
• dospělí MeSH
• ischemická cévní mozková příhoda * diagnóza   komplikace   patofyziologie   MeSH
• klinická studie jako téma MeSH
• kognitivní dysfunkce * etiologie   klasifikace   prevence a kontrola   MeSH
• lidé MeSH
• mladý dospělý MeSH
• propuštění pacienta MeSH
• rizikové faktory MeSH
• úzkostné poruchy diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

The safety and efficacy of intravenous thrombolysis (IVT) are well established in anterior circulation stroke (ACS) but are much less clear for posterior circulation stroke (PCS). The aim of this study was to evaluate the occurrence of parenchymal hematoma (PH) and 3-month clinical outcomes after IVT in PCS and ACS. In an observational, cohort multicenter study, we analyzed data from ischemic stroke patients treated with IVT prospectively collected in the SITS (Safe Implementation of Treatments in Stroke) registry in the Czech Republic between 2004 and 2018. Out of 10,211 patients, 1166 (11.4%) had PCS, and 9045 (88.6%) ACS. PH was less frequent in PCS versus ACS patients: 3.6 vs. 5.9%, odds ratio (OR) = 0.594 in the whole set, 4.4 vs. 7.8%, OR = 0.543 in those with large vessel occlusion (LVO), and 2.2 vs. 4.7%, OR = 0.463 in those without LVO. At 3 months, PCS patients compared with ACS patients achieved more frequently excellent clinical outcomes (modified Rankin scale [mRS] 0-1: 55.5 vs. 47.6%, OR = 1.371 in the whole set and 49.2 vs. 37.6%, OR = 1.307 in those with LVO), good clinical outcomes (mRS 0-2: 69.9 vs. 62.8%, OR = 1.377 in the whole set and 64.5 vs. 50.5%, OR = 1.279 in those with LVO), and had lower mortality (12.4 vs. 16.6%, OR = 0.716 in the whole set and 18.4 vs. 25.5%, OR = 0.723 in those with LVO) (p < 0.05 in all cases). In PCS versus ACS patients, an extensive analysis showed a lower risk of PH both in patients with and without LVO, more frequent excellent and good clinical outcomes, and lower mortality 3 months after IVT in patients with LVO.

• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. METHODS: We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. RESULTS: In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. DISCUSSION/CONCLUSIONS: Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."

• MeSH
• cévní mozková příhoda * komplikace   MeSH
• ischemická cévní mozková příhoda * MeSH
• kvalita života psychologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• úzkost etiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články 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

Cíl: Zjistit, jaké jsou životní zkušenosti pacientky po prodělané ischemické cévní mozkové příhodě (iCMP) v mladém věku a jaký vliv mělo toto onemocnění na kvalitu jejího dalšího života (Health Related Quality of Life, HRQoL). Metodika: Pilotní studie měla charakteristiku interpretativní fenomenologické případové studie. Sběr dat byl realizován prostřednictvím hloubkového polostrukturovaného rozhovoru se zaměřením na oblasti zkoumaného fenoménu. Přepis rozhovoru byl analyzován na základě interpretativní fenomenologické analýzy (IPA). Participantka: 45letá žena, 2 roky po prodělané iCMP, před nemocí OSVČ provozovatelka baru. V důsledku přetrvávajících následků po iCMP (únava, expresivní fatická porucha, lehká paréza PHK a deprese) je v invalidním důchodu. Výsledky: Bylo identifikováno celkem osm témat, která popisují pacientčinu zkušenost s následky iCMP. Tato témata jsme charakterizovali jako: Bylo to mimo mě – včasné a adekvátní poskytnutí zdravotní péče; Byla jsem nikdo – následky těžké afázie; Byla jsem živá, veselá, divoká – ztráta integrity; Únava – změna denního rytmu; Byla jsem všude, teď pořád doma – sociální izolace; Naučila jsem se už chodit a mluvit – přínos intenzivní RHB a logopedické péče; Úspěchy po malých krůčcích – postupný návrat do normálního života; Partner a rodina jako pomoc, podpora a motivace – nový rozměr vztahů. Závěr: I přes významné zlepšení klinického stavu po iCMP mohou být její dopady pro kvalitu života velmi výrazné. U referované mladé pacientky trvalo její zotavení řadu měsíců až let i přes intenzivní rehabilitační, logopedickou a psychologickou podporu. Dlouhodobě přetrvává únava, depresivní ladění, abulie, společenská izolace. Pro adekvátní péči o tyto pacienty je potřeba vysoce individuálního přístupu multidisciplinárních týmů.

Objective: To find out the life experiences of a patient after an ischemic stroke (IS) at a young age and what effect this disease had on the quality of her further life (Health Related Quality of Life, HRQoL). Methodology: The pilot study had the characteristics of an interpretative phenomenological case study. Data collection was carried out through an in-depth semi-structured interview focusing on the areas of the investigated phenomenon. The interview transcript was analysed based on interpretative phenomenological analysis (IPA). Participant: 45-year-old woman, two years after IS, self-employed bar operator before the illness. As a result of the lingering consequences after IS (fatigue, expressive phatic disorder, slight right arm paresis and depression), she is on disability pension. Results: A total of 8 themes were identified that describe the patient's experience with the consequences of IS. We characterized these themes as: It was beyond me – timely and adequate provision of health care; I was nobody – the consequences of severe aphasia; I was lively, cheerful, wild – loss of integrity; Fatigue – change in daily rhythm; I was everywhere, now always at home – social isolation; I have already learned to walk and talk – the benefit of intensive RHB and speech therapy care; Successes in small steps – a gradual return to normal life; Partner and family as help, support and motivation – a new dimension of relationships. Conclusion: Despite the significant improvement of the clinical condition after IS, its impact on the quality of life can be very significant. In the case of the referred young patient, her recovery took many months to years despite intensive rehabilitation, speech therapy and psychological support. Fatigue, depressive mood, abulia, social isolation persist for a long time. Adequate care for these patients requires a highly individualized approach by multidisciplinary teams.

• Klíčová slova
• interpretativní fenomenologická analýza,
• MeSH
• cévní mozková příhoda * psychologie   terapie   MeSH
• dospělí MeSH
• kvalita života MeSH
• lidé MeSH
• rehabilitace po cévní mozkové příhodě MeSH
• rozhovory jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH