BACKGROUND: Carotid endarterectomy (CEA) after an unstable neurological presentation is still a controversial issue. The aim of this study was to evaluate outcomes of urgent (≤48 hr) CEA in patients with crescendo transient ischemic attack (cTIA) or stroke in evolution (SIE). METHODS: A retrospective analysis was performed using prospectively collected data from all consecutive neurologically unstable patients who underwent urgent CEA during the period from January 2013 to November 2018. End points were 30-day any stroke and death rate, symptomatic intracerebral hemorrhage (ICH), myocardial infarction (MI), surgical site bleeding requiring intervention, National Institutes of Health Stroke Scale (NIHSS) score variation, and functional outcome at 90 days assessed by the modified Rankin scale (mRS). Patients were evaluated according to clinical presentation (cTIA or SIE). RESULTS: A total of 46 neurologically unstable patients with cTIA (20 patients; 43.5%) and SIE (26 patients; 56.5%) were included. The 30-day risk of any stroke or death was 10.0% (2 of 20) in the cTIA group and 7.7% (2 of 26) in the SIE group. No symptomatic ICH or MI was detected after surgery in either study group. A total of 2 patients (4.3%; 1 cTIA, 1 SIE) underwent reoperation for surgical site bleeding. In patients with SIE, the mean NIHSS score on admission was 9.85 ± 5.12. Postoperatively, 22 (84.6%) of the 26 patients with SIE had clinical improvement of their neurological deficit, 3 (11.5%) patients had no change, and 1 (3.8%) patient died. On discharge, the mean NIHSS score was 4.31 ± 6.09 points and was significantly improved compared with NIHSS scores at admission (P < 0.001). At 3 months, 21 patients (80.8%) with SIE had a good clinical outcome (mRS ≤ 2). CONCLUSIONS: Urgent CEA in neurologically unstable patients can be performed with acceptable perioperative risks. Moreover, in well-selected patients with SIE, urgent CEA may be associated with significantly improved final functional outcomes.

• MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnóza   etiologie   mortalita   MeSH
• hodnocení rizik MeSH
• karotická endarterektomie * škodlivé účinky   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• posuzování pracovní neschopnosti MeSH
• registrace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   diagnóza   mortalita   chirurgie   MeSH
• tranzitorní ischemická ataka diagnóza   etiologie   mortalita   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

OBJECTIVE: We analyzed the results of internal carotid artery (ICA) stenosis treatment at our institution according to the treatment modality-carotid endarterectomy (CEA) vs. carotid artery stenting (CAS). METHODS: During 2003-2015, a total of 1894 procedures were performed for ICA stenosis. CEA was done in 1064 cases and CAS in 830 cases.The primary outcome was disabling stroke (mRS > 2) or myocardial infarction within 30 days of treatment. Secondary outcomes were transitory ischemic attacks (TIAs), minor strokes (stroke without impaired activities of daily living), and any other significant complications. RESULTS: Major mortality and morbidity were divided according to their treatment groups; this reached 0.9% in the CEA and 2.5% in the CAS group (p = 0.007). Minor stroke was recorded at 1.5% and 2.7% in the CEA and CAS groups (p = 0.077), TIAs in 1.0% (CEA) and 4.0% (CAS) (p < 0.001), and any complication in 12.4% (CEA) and 13.0% (CAS) (p = 0.694). CONCLUSIONS: CEA is a safe procedure in patients who meet the correct treatment indications. In all subgroup analyses CEA proved to be equal to or better than CAS. This study supports the idea of CEA being the preferred treatment and CAS being reserved for selected cases only.

• MeSH
• dospělí MeSH
• endovaskulární výkony metody   mortalita   MeSH
• karotická endarterektomie metody   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• stenóza arteria carotis mortalita   chirurgie   MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The timing of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) is still a controversial issue. The aim of this study was to assess the safety of early carotid interventions in patients treated with thrombolysis for acute ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data from consecutive patients who underwent CEA for symptomatic internal carotid artery stenosis within 14 days after the index neurological event during the period from January 2013 to July 2016. Patients who had undergone IVT before CEA were identified. The primary outcome measures were any stroke and death rate at 30 days, symptomatic intracerebral hemorrhage and surgical site bleeding requiring intervention. RESULTS: A total of 93 patients were included for the final analysis. Among these, 13 (14.0%) patients had undergone IVT before CEA while 80 (86.0%) patients had CEA only. The median time interval between IVT and CEA was 2 days (range: 0-13). A subgroup of 6 patients underwent CEA within 24 hours of administration of IVT. The 30-day combined stroke and death rate was 7.7% (1 of 13) among patients undergoing IVT before CEA and 5.0% (4 of 80) among those undergoing CEA only (P = 0.690). In the IVT group, there were no cerebral hemorrhages or significant surgical site bleeding events requiring reintervention. CONCLUSIONS: Our experience indicates that CEA performed early after IVT for acute ischemic stroke, aiming not only to reduce the risk of stroke recurrence but also to achieve neurological improvement by reperfusion of the ischemic penumbra, may be safe and can lead to favorable outcomes.

• MeSH
• čas zasáhnout při rozvinutí nemoci * MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnóza   farmakoterapie   etiologie   mortalita   MeSH
• fibrinolytika aplikace a dávkování   škodlivé účinky   MeSH
• intravenózní podání MeSH
• ischemie mozku diagnóza   farmakoterapie   etiologie   mortalita   MeSH
• karotická endarterektomie * škodlivé účinky   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci arterie carotis komplikace   diagnostické zobrazování   mortalita   chirurgie   MeSH
• registrace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombolytická terapie * škodlivé účinky   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
• srovnávací studie MeSH

BACKGROUND: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. METHODS: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. RESULTS: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). CONCLUSION: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

• MeSH
• akutní nemoc MeSH
• arteria carotis interna diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnóza   etiologie   mortalita   patofyziologie   MeSH
• CT angiografie MeSH
• digitální subtrakční angiografie MeSH
• ischemie mozku diagnóza   etiologie   mortalita   patofyziologie   MeSH
• karotická endarterektomie * škodlivé účinky   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozková angiografie metody   MeSH
• mozkový krevní oběh MeSH
• náhlé příhody MeSH
• perfuzní zobrazování metody   MeSH
• posuzování pracovní neschopnosti MeSH
• průchodnost cév MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   diagnostické zobrazování   mortalita   chirurgie   MeSH
• stupeň závažnosti nemoci MeSH
• trombolytická terapie MeSH
• výběr pacientů 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

Autoři uvádějí systematický přehled velkých randomizovaných studií z posledních let, které srovnávají krátkodobý i dlouhodobý efekt endovaskulární a chirurgické metody při léčbě stenózy odstupu vnitřní karotické tepny. Studie prokázaly podobný pozitivní dlouhotrvající efekt pro obě metody. Vyšší četnost komplikací v periprocedurálním období po angioplastice je způsobena častějšími drobnými neinvalidizujícími mozkovými ischemiemi, endarterektomie má větší riziko srdečního infarktu. Pro úspěch léčby je zásadní zkušenost operatéra a správná indikace nemocného k léčbě. Nemocní by měli být léčeni v centrech, která mají k dispozici obě metody a provádějí je s nízkým počtem komplikací.

The authors present a systematic review of recent large randomized studies comparing short and long-term effect of endovascular and surgical treatment of the internal carotid artery stenosis at its origin. The studies showed similar beneficial long-term effect of both methods. Higher rate of complications in angioplasty is caused by minor debilitating ischemic strokes in the periprocedural period while the endarterectomy has higher risk of myocardial infarction. Experience of the operator and appropriate patient indication for therapy are crucial for treatment success. Patients should be treated in centers in which both methods are routinely available with lower rate of complications. Key words: carotid stenting – carotid endarterectomy –randomized study – periprocedural complications – long-term outcomes The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

• Klíčová slova
• karotický stenting, periprocedurální komplikace, studie SAPHIRE, studie EVA-3S, studie SPACE, studie ICS, studie CREST,
• MeSH
• angioplastika * mortalita   škodlivé účinky   MeSH
• arteria carotis interna MeSH
• cévní mozková příhoda epidemiologie   etiologie   MeSH
• infarkt myokardu epidemiologie   etiologie   MeSH
• karotická endarterektomie * mortalita   škodlivé účinky   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• odborná způsobilost MeSH
• pooperační komplikace MeSH
• randomizované kontrolované studie jako téma MeSH
• stenóza arteria carotis * chirurgie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• karotická endarterektomie mortalita   trendy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• následné studie MeSH
• nemoci arterie carotis mortalita   chirurgie   MeSH
• senioři MeSH
• stenty trendy   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: In this article, we present our experience with such operations performed under local anaesthesia. METHODS: From January 1997 to November 2007, there were 387 patients operated on for asymptomatic carotid stenosis. Patient data were retrospectively evaluated. Thirty-day neurological morbidity and mortality from six different subgroups were analysed and compared. The numbers of perioperative transient ischaemic attacks, as well as surgical and other perioperative complications were also evaluated. RESULTS: Overall morbidity and mortality was 1.8% (seven patients). Stroke was noted in 1.3% (five patients). Transitory ischaemic attacks within the first 30 days were observed in 1.6% (six patients). Only those patients who had intraluminal shunt insertion were found to have significantly higher morbidity and mortality. (p = 0.000018). Myocardial infarction was observed in 0.5% (two patients), one fatal. CONCLUSION: We have achieved acceptable morbidity and mortality rates (1.8%) according to the parameters set by previous studies such as Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Stenosis Trial as well as American Heart Association and European Stroke Organisation guidelines. All surgeries were done under local anaesthesia. Shunts were inserted in 22 cases (5.68%).

• MeSH
• cévní mozková příhoda etiologie   mortalita   prevence a kontrola   MeSH
• karotická endarterektomie metody   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální anestezie metody   mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenóza arteria carotis etiologie   mortalita   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• epidemiologické studie MeSH
• karotická endarterektomie metody   mortalita   využití   MeSH
• lidé MeSH
• morbidita MeSH
• mortalita MeSH
• stenóza arteria carotis chirurgie   terapie   MeSH
• stenty využití   MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Experience with Intraoperative monitoring using neurophysiological and haemodynamic indices in 500 operations for carotid endarterectomy is reported. METHODS: Transcranial Doppler technique (TCD), electroencephalogram (EEG) and bilateral median somatosensory evoked potentials (SEP) were performed. Latency and amplitude of SEP, spectral analysis of EEG signal and blood flow velocity in the medial cerebral artery (MCA) were continuously measured. FINDINGS: After two consecutive drops of N20/P25 complex of more than 50%, a warning was given, and when the decrease continued, an the alarm raised. Abnormal EEG changes, if any, appeared after a significant decrease in the N20/P25 amplitude. A mean blood flow velocity drop below 40% of the reference value after cross clamping was rated as a significant warning event.A warning as a result of a decrease in N20/P25 amplitude occurred in 80 operations (16.0%), after an spectral edge frequency decrease in 2 cases (0.4%) and after a V(mean) decrease in 21 cases (4.2%). False negative results were experienced in 2 patients (0.4%). A shunt was inserted in 2.8% of the operations. The overall mortality/morbidity rate was 2.4%. CONCLUSION: A decrease of more than 50% in the amplitude of the thalamocortical somatosensory evoked potential complex N20/P25 proved to be the most reliable warning of danger of ischaemia during carotid endarterectomy.

• MeSH
• arteriae carotides chirurgie   patofyziologie   ultrasonografie   MeSH
• celková anestezie normy   MeSH
• dospělí MeSH
• elektroencefalografie metody   normy   MeSH
• financování organizované MeSH
• karotická endarterektomie metody   mortalita   normy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozek krevní zásobení   parazitologie   MeSH
• mozková hypoxie a ischemie etiologie   patofyziologie   prevence a kontrola   MeSH
• mozkový krevní oběh fyziologie   MeSH
• peroperační komplikace etiologie   patofyziologie   prevence a kontrola   MeSH
• peroperační monitorování metody   normy   trendy   normy   trendy   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• somatosenzorické evokované potenciály fyziologie   MeSH
• stenóza arteria carotis chirurgie   MeSH
• ultrasonografie dopplerovská transkraniální metody   normy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• biomedicínský výzkum MeSH
• dospělí MeSH
• karotická endarterektomie mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový infarkt epidemiologie   prevence a kontrola   MeSH
• prospektivní studie MeSH
• senioři MeSH
• stenóza arteria carotis epidemiologie   farmakoterapie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH