BACKGROUND: Thrombectomy is an effective treatment for acute ischaemic stroke (AIS). AIMS: The aim of this study was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath lab. METHODS: This was a single-centre, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin Scale (mRS) after three months. RESULTS: Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 patients (13%) had proximal internal carotid artery (ICA) occlusion, 27 patients (13%) had tandem (ICA+MCA) occlusion, 39 patients (18%) had terminal ICA (T-type) occlusion, and 26 patients (12%) had vertebrobasilar (VB) stroke. Favourable clinical outcome (mRS ≤2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but in only 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalisation success (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions. CONCLUSIONS: Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes. Visual summary. Endovascular intervention of isolated MCA or ICA occlusions provides greatest clinical benefit, while interventions in posterior circulation have lower chance for clinical success.
- MeSH
- arteria carotis interna diagnostické zobrazování chirurgie MeSH
- arterie MeSH
- cévní mozková příhoda * etiologie chirurgie MeSH
- endovaskulární výkony * MeSH
- ischemická cévní mozková příhoda * MeSH
- ischemie mozku * chirurgie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- stenty MeSH
- trombektomie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: This study analyzed the learning curve effect when a new stroke thrombectomy program was initiated in a cardiac cath lab in close cooperation with neurologists and radiologists. BACKGROUND: Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available. METHODS: An endovascular treatment program for acute ischemic strokes was established in the cardiac cath lab of a tertiary university hospital in 2012. The decision to perform catheter-based thrombectomy was made by a neurologist and was based on acute stroke clinical symptoms and computed tomography angiographic findings. Patients with a large vessel occlusion of either anterior or posterior circulation were enrolled. The primary endpoint was the functional neurological outcome (Modified Rankin Scale [mRS] score) of the patient at 3 months. A total of 333 patients were enrolled between October 2012 and December 2019. RESULTS: The clinical (mRS) outcomes did not vary significantly across years 2012 to 2019 (mRS 0 to 2 was achieved in 47.9% of patients). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%). Embolization in a new vascular territory occurred in 6 patients (1.8%). CONCLUSIONS: When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke in regions where this therapy is not readily available due to the lack of neurointerventionalists.
Úvod: Mechanická trombektomie (MT) se ukázala být účinnou léčebnou metodou u pacientů s akutní ischemickou cévní mozkovou příhodou (iCMP) vzniklou uzávěrem proximálního úseku velkých mozkových tepen. Cílem této studie bylo porovnat závažnost neurologického deficitu pacientů, kteří podstoupili MT v závislosti na jejich základních klinických charakteristikách. Metody: Prospektivní observační monocentrický registr pacientů léčených mechanickou trombektomií pro akutní iCMP. Stupeň neurologického deficitu byl kvantifikován pomocí modifikované Rankinovy škály (mRS 0–6) s odstupem tří měsíců od vzniku iCMP. Dle závažnosti neurologického postižení byli pacienti rozděleni do dvou skupin – mRS 0–2 vs. mRS 3–6. Výsledky: Celkem bylo do registru zařazeno 111 pacientů (průměrný věk 65,9 roku, muži 55 %). Klinicky příznivého výsledku (mRS ≤ 2 za tři měsíce) bylo dosaženo v 39,8 % (44 pacientů). Tito pacienti (mRS ≤ 2) byli v porovnání s druhou, klinicky horší skupinou (mRS 3–6) mladší (61 let vs. 70 let, p < 0,01), měli větší zastoupení aktivních kuřáků (45,5 % vs. 25,4 %, p < 0,002) a menší prevalenci fibrilace síní (25 % vs. 53,7 %, p < 0,001). Mezi skupinami nebyly výrazné rozdíly v zastoupení jednotlivých pohlaví (muži 50 % vs. 58 %, p = 0,27), v hodnotě indexu tělesné hmotnosti (27,8 vs. 29,2, p = 0,21), v prevalenci arteriální hypertenze (70,5 % vs. 77,6 %, p = 0,26), diabetes mellitus (15,9 % vs. 25,4 %, p = 0,15), chronické renální insuficience (11,4 % vs. 22,4 %, p = 0,08) a ani v hodnotě NIHSS (National Institute of Health Stroke Scale) při příjmu (15 vs. 18, p = 0,69). Závěr: Mechanická trombektomie dosahuje lepších klinických výsledků u mladších pacientů, u kuřáků a u pacientů s iCMP, která nebyla způsobena embolizací při fibrilaci síní.
Background: Direct catheter-based thrombectomy (d-CBT) was proven to be an effective treatment for proximal occlusions of the major intracranial arteries in acute stroke patients. The aim of this study was to compare clinical outcomes of patients treated by d-CBT depending on their baseline characteristics. Methods: A single center, prospective, observational registry of consecutive patients (pts) treated by d-CBT for an acute ischemic stroke. The degree of dependence after a stroke was measured by the modified Rankin scale (mRS) at 3 months follow-up and pts were divided into 2 subgroups based on functional independence/dependence (mRS 0–2 vs. 3–6). Results: A total of 111 consecutive patients (mean age 65.9 ys, men 55%) have been enrolled. A favorable outcome (mRS ≤ 2 at 3 months) was reached in 39.8% (44 pts). The pts with favorable outcome (mRS ≤ 2) compared to pts with poor outcome (mRS 3–6) were younger (61 ys vs. 70 ys, p < 0.01), had higher prevalence of cigarette smoking (45.5% vs. 25.4%, p < 0.002) and had lower prevalence of known atrial fibrillation (25% vs. 53.7%, p < 0.001). There were no significant differences between the subgroups in: sex (men 50% vs. 58%, p = 0.27), body mass index (27.8 vs. 29.2, p = 0.21), arterial hypertension (70.5% vs. 77.6%, p = 0.26), diabetes mellitus (15.9% vs. 25.4%, p = 0.15), chronic kidney disease (11.4% vs. 22.4%, p = 0.08) and NIHSS on admission (15 vs. 18, p = 0.69). Conclusions: Mechanical thrombectomy achieved better clinical results in younger patients, in smokers and in patients with stroke not caused by atrial fibrillation.
- MeSH
- časové faktory MeSH
- cévní mozková příhoda terapie MeSH
- ischemie mozku * terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanická trombolýza * MeSH
- neurologické manifestace MeSH
- prospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
AIMS: The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology centre. METHODS AND RESULTS: This single-centre, prospective observational registry based on the pre-specified protocol included three months of follow-up. The decision to perform acute stroke intervention was made by a neurologist based on the clinical and imaging findings. Inclusion criteria were moderate-to-severe acute ischaemic stroke (NIHSS ≥6), <6 hours from symptom onset, no large ischaemia on the admission CT scan and CT evidence for an occluded large artery. The primary outcome was functional neurologic recovery (mRS 0-2) at three months. Key secondary outcomes were the angiographic recanalisation rate and symptomatic intracranial bleeding. A total of 115 consecutive patients (mean age 66 years) were enrolled during a period of four years: 84 patients underwent d-CBT and 31 patients bridging thrombolysis with immediate catheter intervention (TL-CBT). The annual number of procedures increased from 13 (initial 12 months) to 41 (last 12 months). Angiographic success (TICI flow 2b-3) was 69% after d-CBT and 81% after TL-CBT. It was higher in isolated occlusions of the middle cerebral artery (MCA, 74% and 100%) or of the proximal internal carotid artery (ICA, 80% and 100%), while it was lower in combined ICA+MCA occlusions (63% and 70%) and in basilar or vertebral occlusions (57% and 50%). Neurologic recovery (mRS ≤2 after 90 days) was achieved in 40% of patients. It was higher (43%) in anterior circulation strokes than in posterior circulation strokes (25%). Direct CBT led to neurologic recovery in 36%, while in TL-CBT this was 52%. Best clinical outcomes (51% and 71% neurologic recovery rates) were achieved among patients with isolated MCA occlusion. Any symptomatic intracranial bleeding was present in 3.6% (d-CBT) and 6.5% (TL-CBT). Vessel perforation or major dissection occurred in 5.2% overall, and distal embolisation to other territory in 3.5% of patients. CONCLUSIONS: Direct catheter-based thrombectomy may be considered in patients with contraindications for thrombolysis or in patients with very short CT-groin puncture times. A randomised trial is needed to evaluate better the role of direct catheter-based thrombectomy. Acute stroke interventions performed in close cooperation among cardiologists, neurologists and radiologists are feasible and safe.
- MeSH
- arteria carotis interna chirurgie MeSH
- cévní mozková příhoda terapie MeSH
- dospělí MeSH
- endovaskulární výkony metody MeSH
- kardiologové MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologové MeSH
- prospektivní studie MeSH
- radiologové MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombektomie * metody MeSH
- týmová péče o pacienty MeSH
- výsledek terapie 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
- pozorovací studie MeSH
AIMS: To assess the feasibility of direct catheter-based thrombectomy (d-CBT) performed jointly by cardiologists, neurologists and radiologists. METHODS AND RESULTS: Computed tomography (CT) was completed within <6 hours from onset of acute ischaemic stroke and excluded bleeding or developed ischaemia in 23 patients who fulfilled pre-specified entry criteria. The mean NIHSS was 17 (8-24). Mechanical recanalisation was successful in 19/23 patients (83%). The mean symptom onset – CT time was 81 min, CT – sheath insertion 47 min, sheath – reperfusion 46 min. Three patients died within 30 days, two others within 90 days (overall three-month mortality 22%). The mean mRs at 90 days for the entire group was 3.19, among survivors 2.31 and among survivors treated within <120 minutes 1.17. Favourable functional outcome (mRs ≤2) was achieved in 48% of patients. Five patients (22%) had full (mRs=0) or nearly full (mRs=1) neurologic recovery. Seven patients were able to be discharged from neurology ICU directly home after a short (<7 days) hospital stay. Two patients had symptomatic intracranial haemorrhage. CONCLUSIONS: Acute stroke treatment by d-CBT jointly by neurologists, cardiologists and radiologists provided promising results especially in patients reaching the cathlab within <2 hours from stroke onset.
- MeSH
- celková anestezie MeSH
- cévní mozková příhoda chirurgie MeSH
- dospělí MeSH
- intervenční radiografie * MeSH
- ischemie mozku chirurgie MeSH
- katétry MeSH
- kooperační chování MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- počítačová rentgenová tomografie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční katetrizace MeSH
- stenty MeSH
- trombektomie 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
- práce podpořená grantem MeSH
BACKGROUND: Obstructive sleep apnea (OSA) is a condition contributing to oxidative stress. The aim of this study was to ascertain if there is any connection between OSA and novel oxidative stress-related markers. Matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), high sensitive C-reactive protein (hsCRP), pregnancy-associated plasma protein-A (PAPP-A), soluble receptors for advanced glycation end-products (sRAGE), zinc (Zn) and copper (Cu) were measured. Further biochemical markers were evaluated. MATERIAL/METHODS: Fifty-one men suspected for OSA indicated for night polygraphy were included. Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean blood hemoglobin oxygen saturation (SpO2) and time of blood hemoglobin oxygen saturation below 90% (SpO2 <90%) were measured. Morning venous blood samples were taken. RESULTS: For body mass index (BMI) we found strong positive correlation with levels of Cu, MMP-9, hsCRP and fibrinogen, and negative correlation with sRAGE. Concerning ventilation parameters, we found positive correlation of ODI and SpO2 <90% with markers MMP-9 and hsCRP. sRAGE level correlated with AHI and ODI negatively. SpO2 correlated negatively with Cu, MMP-9, hsCRP and fibrinogen. There was no correlation between ventilation parameters and markers MMP-2, PAPP-A and Zn. Compared to severity of OSA, there was significant difference in levels of hsCRP and Cu between patients with AHI ≤5 and AHI ≥30 independent of BMI. CONCLUSIONS: MMP-9, hsCRP, sRAGE and Cu seem to be strong predictors of oxidative stress in OSA patients. The strong correlation between oxidative stress-related markers and OSA is elucidated by connection of these to BMI, which is probably a primary condition of oxidative stress, but OSA is an additive condition.
- MeSH
- biologické markery metabolismus MeSH
- C-reaktivní protein metabolismus MeSH
- dospělí MeSH
- kyslík metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- matrixová metaloproteinasa 9 metabolismus MeSH
- měď metabolismus MeSH
- obstrukční spánková apnoe enzymologie metabolismus patologie MeSH
- oxidační stres MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
We identified association of restless legs syndrome (RLS) with PTPRD at 9p23-24 in 2,458 affected individuals and 4,749 controls from Germany, Austria, Czechia and Canada. Two independent SNPs in the 5' UTR of splice variants expressed predominantly in the central nervous system showed highly significant P values (rs4626664, P(nominal/lambda corrected) = 5.91 x 10(-10), odds ratio (OR) = 1.44; rs1975197, P(nominal/lambda corrected) = 5.81 x 10(-9), OR = 1.31). This work identifies PTPRD as the fourth genome-wide significant locus for RLS.
- MeSH
- 5' nepřekládaná oblast genetika MeSH
- genetická predispozice k nemoci * MeSH
- jednonukleotidový polymorfismus * MeSH
- lidé MeSH
- studie případů a kontrol MeSH
- syndrom neklidných nohou genetika MeSH
- tyrosinfosfatasy receptorového typu, třída 2 genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Kanada MeSH
- Německo MeSH
- Rakousko MeSH
