PURPOSE: TACE induces variable systemic effects by producing factors that promote inflammation, oncogenesis, and angiogenesis. Here we compare concentrations of microRNAs (miR-21, miR-210 and miR-34a) and vascular endothelial growth factor (VEGF) in hepatocellular carcinoma (HCC) patients undergoing TACE with degradable (DSM) and nondegradable (DEB) particles and potential use of these biomarker changes for prediction of patient outcomes. MATERIALS AND METHODS: Overall, 52 patients with HCC treated with DSM TACE (24 patients) and DEB TACE (28 patients) were included in this prospective study. Concentrations of studied biomarkers were measured from blood plasma preprocedurally, immediately (< 90 min) postprocedurally, and 24-h after TACE. Levels were compared between DSM and DEB TACE and correlated with treatment response six and 12 months after the first TACE. RESULTS: Both DSM and DEB TACE elevated plasma levels of miR-21, miR-34a, and miR-210 at 24 h post-procedure compared to baseline levels (FC 1.25-4.0). MiR-34a elevation immediately after TACE was significantly associated with nonprogressive disease compared to those with progressive disease at both six months (FCa: p = 0.014) and 12 months (FCa: p = 0.029) post-TACE. No significant biomarker changes were found between the embolization particle groups. However, VEGF levels showed a decrease only in the DSM TACE group (FC24: p = < 0.001). CONCLUSION: Embolization particle type did not significantly impact miRNA or VEGF changes post-TACE. However, miR-34a elevation immediately after the procedure predicts better patient outcome and may prove useful as a biomarkers for the monitoring of clinical outcomes. LEVEL OF EVIDENCE: Level 3 Prospective cohort study.

• MeSH
• Biomarkers blood   MeSH
• Chemoembolization, Therapeutic * methods   MeSH
• Carcinoma, Hepatocellular * therapy   blood   genetics   MeSH
• Middle Aged MeSH
• Humans MeSH
• MicroRNAs * blood   MeSH
• Biomarkers, Tumor * blood   MeSH
• Liver Neoplasms * therapy   genetics   blood   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Vascular Endothelial Growth Factor A * blood   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: A third of endovascularly treated patients with stroke experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3), and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed the literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy. METHODS: A systematic review of MEDLINE, Embase, and PubMed up until March 1, 2024, using a predefined strategy. Only full-text English-written articles reporting rates of either favorable (ie, delayed reperfusion (DR) or no new infarct) or unfavorable progression (ie, persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. The primary outcome was the rate of DR and its association with functional independence (modified Rankin Scale score, 0-2) at 90 days postintervention. Pooled odds ratios with 95% CIs were calculated using a random-effects model. RESULTS: Six studies involving 950 patients (50.7% female; median age, 71 years; interquartile range, 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on magnetic resonance imaging perfusion imaging, while 2 studies used diffusion-weighted imaging and noncontrast computed tomography imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI 2b50 or 2c. DR occurred in 41% (interquartile range, 33%-51%) of cases 24 hours postintervention. Achieving DR was associated with a higher likelihood of functional independence at 90 days (odds ratio, 2.5 [95% CI, 1.9-3.4]). CONCLUSIONS: Nearly half of eTICI <3 patients achieve DR, leading to favorable clinical outcomes. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (eg, intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05499832.

• MeSH
• Endovascular Procedures * methods   MeSH
• Ischemic Stroke * surgery   diagnostic imaging   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Reperfusion methods   MeSH
• Aged MeSH
• Thrombolytic Therapy methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) with neoadjuvant embolization is a treatment strategy for brain arteriovenous malformations (AVMs), especially for those with large nidal volume or concomitant aneurysms. The aim of this study was to assess the effects of pre-SRS embolization in AVMs with an associated intracranial aneurysm (IA). METHODS: The International Radiosurgery Research Foundation AVM database from 1987 to 2018 was retrospectively reviewed. SRS-treated AVMs with IAs were included. Patients were categorized into those treated with upfront embolization (E + SRS) vs stand-alone SRS (SRS). Primary end point was a favorable outcome (AVM obliteration + no permanent radiation-induced changes or post-SRS hemorrhage). Secondary outcomes included AVM obliteration, mortality, follow-up modified Rankin Scale, post-SRS hemorrhage, and radiation-induced changes. RESULTS: Forty four AVM patients with associated IAs were included, of which 23 (52.3%) underwent pre-SRS embolization and 21 (47.7%) SRS only. Significant differences between the E + SRS vs SRS groups were found for AVM maximum diameter (1.5 ± 0.5 vs 1.1 ± 0.4 cm 3 , P = .019) and SRS treatment volume (9.3 ± 8.3 vs 4.3 ± 3.3 cm 3 , P = .025). A favorable outcome was achieved in 45.4% of patients in the E + SRS group and 38.1% in the SRS group ( P = .625). Obliteration rates were comparable (56.5% for E + SRS vs 47.6% for SRS, P = .555), whereas a higher mortality rate was found in the SRS group (19.1% vs 0%, P = .048). After adjusting for AVM maximum diameter, SRS treatment volume, and maximum radiation dose, the likelihood of achieving favorable outcome and AVM obliteration did not differ between groups ( P = .475 and P = .820, respectively). CONCLUSION: The likelihood of a favorable outcome and AVM obliteration after SRS with neoadjuvant embolization in AVMs with concomitant IA seems to be comparable with stand-alone SRS, even after adjusting for AVM volume and SRS maximum dose. However, the increased mortality among the stand-alone SRS group and relatively low risk of embolization-related complications suggest that these patients may benefit from a combined treatment approach.

• MeSH
• Adult MeSH
• Endovascular Procedures methods   MeSH
• Intracranial Aneurysm * therapy   MeSH
• Intracranial Arteriovenous Malformations * therapy   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoadjuvant Therapy * methods   MeSH
• Radiosurgery * methods   adverse effects   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Embolization, Therapeutic * methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

Cílem této práce je prezentovat případ, kdy došlo na podkladě ruptury společné karotické tepny ke vzniku pseudoaneurysmatu u pacienta, který v minulosti podstoupil operaci a ra- dioterapii krku pro maligní nádor. Endovaskulární léčba byla preferována před chirurgickou vzhledem k terénu postradiační fibrózy v dané krční oblasti a zahrnovala embolizaci zevní karotické tepny (ACE) a zavedení samoexpandibilního stentgraftu přes krček pseudoaneu- rysmatu na přechodu společné (ACC) a vnitřní (ACI) karotické tepny.

The aim of this report is to present a case where a rupture of the common carotid artery led to the formation of a pseudoaneurysm in a patient who previously underwent surgery and radiotherapy of the neck for a malignant tumor. Endovascular treatment was preferred over surgery due to post-radiation fibrosis in the affected cervical area and involved embolization of the external carotid artery and the placement of a self-expanding stent-graft across the neck of the pseudoaneurysm at the junction of the common and internal carotid artery.

Cíl: Zhodnocení zkušeností jednoho centra s olejovou kontrastní lymfografií a perkutánní embolizací ductus thoracicus u pacientů s lymforeou po operacích v oblasti hrudníku a břicha. Metodika: Od července 2015 do prosince 2024 bylo na našem pracovišti léčeno pět pacientů s pooperační lymforeou (tři ženy a dva muži) ve věku od 37 do 75 let pomocí lymfografie olejovou kontrastní látkou (k.l.). U jednoho pacienta byla lymfografie spojená s embolizací hrudního mízovodu transabdominálním přístupem. Hodnotili jsme technickou a klinickou úspěšnost výkonu, výskyt periprocedurálních komplikací a radiační zátěž. Výsledky: Technická a klinická úspěšnost olejové lymfografie byla 100 %. Ve dvou případech se jednalo o pedální a ve třech případech o intranodální způsob aplikace k.l. Na lymfografii navazovala embolizace ductus thoracicus u jednoho pacienta, protože pacient si přál provést embolizaci hrudního mízovodu v rámci lymfografie. Nebyla zaznamenána žádná procedurální komplikace a u všech pacientů došlo k zástavě lymfatického úniku. Nemocní jsou sledování v intervalu 6–91 měsíců (medián 26 měsíců). Během sledování nedošlo k recidivě lymforey. Závěr: Dle našich zkušeností mají perkutánní výkony zahrnující olejovou kontrastní lymfografii a embolizaci hrudního mízovodu u pooperační lymforey v oblasti trupu vysoký terapeutický efekt s minimálními komplikacemi.

Aim: To evaluate the single-centre experience with oil contrast lymphography and percutaneous ductus thoracicus embolization in patients with lymphorrhea after thoracic and abdominal surgery. Methods: Five patients (3 females and 2 males) aged between 37 and 75 years had postoperative lymphorrhea and they were treated with oil contrast lymphography at our center from July 2015 to December 2024. In one patient, lymphography was associated with thoracic lymphatic duct embolization via transabdominal approach. We evaluated the technical and clinical success of the procedure, the incidence of procedural complications and radiation exposure. Results: Oil lymphography was followed by ductus thoracicus embolization in one patient. No procedural complications were noted and the lymphatic leak disappeared in all patients. Patients were followed up between 6–91 months (median 26 months). No recurrence of lymphorrhea was occurred during follow-up. Conclusion: In our experience, percutaneous procedures involving oil contrast lymphography and thoracic duct embolization for postoperative lymphorrhea in the thoracic region have a high therapeutic effect with minimal complications.

Pacientka náhle v domácím prostředí dušnost, kolaps a bezvědomí. Provedena laická telefonicky navigovaná kardiopulmonální resuscitace, po příjezdu lékaře rychlé záchranné služby úspěšná rozšířená kardiopulmonální resuscitace a poté pacientka převezena na oddělení urgentního příjmu Nemocnice České Budějovice. Byla provedena základní stabilizace klinického stavu, zajištění pacientky, intubace a odvoz na CT. Zde byla pomocí CT verifikována masivní bilaterální plicní embolie. Ihned v prostorách urgentního příjmu byla provedena trombolýza, stabilizace oběhu a pacientka byla uložena na ARO. Za hodinu na oddělení ARO znovu těžká oběhová nestabilita – vysoká podpora oběhu noradrenalinem. Provedeno UZ a následně CT břicha s nálezem masivního hemoperitonea. Urgentní chirurgické konzilium a doporučena operace z vitální indikace. Provedena urgentní laparotomie u hemodynamicky těžce nestabilní pacientky s TK 60/30 a pulzy 180/min. Za masivní oběhové podpory a převodů erymasy odsáty 4 l zcela nesrážlivé krve v oblasti jater. Játra byla tržena na několika místech od zlomených žeber a nejvíce dorzálně v levém laloku v oblasti jaterních žil. Chirurgicky při těžké oběhové nestabilitě neověřitelné a bylo rozhodnuto o stabilizaci pomocí perihepatického packingu a pacientka byl uložena na ARO RES. ARO pokračuje v konzervativní terapii a dochází k postupnému zmenšení odpadů do drénu. Provedena second-look operace za 48 hod – revize původní ranou, odstranění roušek. Nalezeny mnohočetné trhliny na pravém laloku od zlámaných žeber a dorzálně silně krvácející jaterní žíla. Provedena kombinace selektivních sutur s elektrokoagulací trhlin, pro přetrvávající oběhovou nestabilitu se znovu rozhodujeme dát pouze perihepatický packing. Pacientku znovu necháváme na ARO k oběhové stabilizaci a domlouváme se znovu na operační revizi po stabilizaci oběhu za 48 hod. Přistupujeme k další operační revizi. Provádíme znovu revize perihepatického prostoru a anatomickou resekci jaterního segmentu II a III a selektivní podvaz jaterní žíly. Následně dochází k hemodynamické stabilizaci oběhu. V rámci pooperačního průběhu nejprve dochází k rozvoji fluidothoraxu, který byl vyřešen hrudní drenáží, a akutní akalkulozní cholecystitidě, která byla vyřešena punkční cholecystostomií. Pacientka je nyní primárně zhojena a angiologiem nasazena trvalá antikoagulační terapie. Příčina plicní embolizace nebyla zjištěna.

The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, successful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours – revision of the original wound and removal of the drapes. Multiple fissures were found in the right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.

BACKGROUND: Chronic thromboembolic pulmonary hypertension results from mechanical obstruction of major pulmonary artery lumina with fibrotic tissue. Main treatment has been pulmonary endarterectomy, a complex surgical procedure removing vascular obstruction. However, at least 40% of patients are not candidates for pulmonary endarterectomy because of technical inoperability, comorbidities, or limited access to surgery. Balloon pulmonary angioplasty (BPA) has emerged as an interventional treatment for these patients. OBJECTIVES: The International BPA Registry (NCT03245268) was designed to investigate BPA practice across 18 established centers in the United States, Europe, and Japan. METHODS: A total of 500 patients were prospectively and consecutively enrolled between March 2018 and March 2020, with follow-up until March 2022. Of these, 484 patients were included in the analysis set. RESULTS: Regional differences were seen in patient characteristics (fewer patients with prior pulmonary endarterectomy and more elderly women in Japan) and procedural details (less medical pretreatment, more jugular access, more segments and more occlusive lesions treated per session and patient, less conscious sedation, less contrast and less radiation, shorter intervals between BPA sessions in Japan). Female sex, procedure in Europe/United States, pulmonary hypertension medications at any time, and higher baseline pulmonary vascular resistance (PVR), calculated as transpulmonary pressure gradient divided by cardiac output, emerged as independent predictors of complications during BPA. After a median of 5 (Q1-Q3: 3-6) BPA sessions per patient within a median time of 4.9 months (Q1-Q3: 1.7-11.0 months), a 15-mm Hg (38%) decrease in mPAP, a 332 dynes/s/cm-5 (57%) decrease in PVR, and a 3.2% increase in arterial saturation (medians; P < 0.001) were observed, and there were significant improvements in functional class, 6-minute walk distance, serum levels of N-terminal probrain natriuretic peptide, and Borg dyspnea index. BPA complications occurred in 11.3% of sessions and 33.9% of patients and were mostly hemoptyses. No patient died within 30 days of BPA. CONCLUSIONS: Our data are in line with previous reports on changes of clinical and hemodynamic parameters and complication rates of BPA. Centers with more experience providing BPAs were more likely to achieve a higher percentage decrease in PVR.

• MeSH
• Pulmonary Artery surgery   MeSH
• Angioplasty, Balloon * methods   MeSH
• Chronic Disease MeSH
• Middle Aged MeSH
• Humans MeSH
• Pulmonary Embolism * complications   surgery   MeSH
• Hypertension, Pulmonary * etiology   surgery   therapy   physiopathology   MeSH
• Prospective Studies MeSH
• Registries * MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH
• Japan MeSH
• United States MeSH

BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5). OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective. METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups. CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.

• MeSH
• Cost-Benefit Analysis * methods   MeSH
• Endovascular Procedures * economics   methods   MeSH
• Ischemic Stroke * economics   surgery   epidemiology   MeSH
• Quality-Adjusted Life Years MeSH
• Humans MeSH
• Markov Chains * MeSH
• Decision Trees * MeSH
• Aged MeSH
• Thrombectomy * economics   methods   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Germany MeSH

Cíl: Cílem tohoto systematického přehledu bylo ověřit úlohu urgentní mikrochirurgické embolektomie a extrakraniálního-intrakraniálního bypassu jako třetí linie léčby v případech uzávěru velké mozkové cévy po selhání standardní léčby. Soubor a metodika: Provedli jsme rozsáhlou rešerši osmi zdrojů publikované i nepublikované literatury. Dva recenzenti nezávisle na sobě provedli analýzu názvů, abstraktů, plných textů a poté provedli kritické hodnocení a extrakci dat z vybraných studií pomocí standardizovaných nástrojů. Výsledky zahrnutých studií jsme narativně syntetizovali. Výsledky: Vyhledávání identifikovalo osm relevantních článků, zahrnujících 12 pacientů s urgentním uzávěrem velké cévy (terminální krkavice nebo střední mozková tepna) a selháním standardní léčby, kteří podstoupili mikrochirurgický zákrok do 24 hodin od vzniku příznaků. Mikrochirurgická embolektomie byla provedena ve čtyřech případech (33 %), extrakraniální-intrakraniální bypass v pěti případech (42 %), jejich kombinace ve dvou případech (16 %) a manipulační intraoperační rekanalizace v jednom případě (8 %). Skóre na škále National Institutes of Health Stroke Scale se předoperačně pohybovalo v rozmezí 7–25 bodů a pooperačně (1–7 dní po operaci) v rozmezí 1–18 bodů. Funkční nezávislosti (modifikované Rankinovo skóre 0–2) bylo dosaženo u devíti pacientů (75 %) po 3–12 měsících po operaci. Závěr: Urgentní mikrochirurgická embolektomie, extrakraniální-intrakraniální bypass nebo kombinace těchto metod se jeví jako bezpečná a potenciálně účinná třetí linie léčby u pacientů s urgentním uzávěrem velké cévy v přední mozkové cirkulaci.

Aim: This systematic review aimed to verify the role of emergent microsurgical embolectomy and extracranial-intracranial bypass as third-line treatments in cases of intracranial large-vessel occlusion after failure of standard treatment. Materials and methods: We extensively searched eight sources of published and unpublished literature. Two reviewers independently performed titles, abstracts, and full text analyses, and then performed critical appraisal and data extraction from selected studies using standardised tools. We narratively synthesised the findings of the included studies. Results: The search identified eight relevant articles, including 12 patients with emergent large-vessel occlusion (carotid terminus or middle cerebral artery), and standard treatment failure who underwent microsurgery within 24 h from symptom onset. Microsurgical embolectomy was performed in four cases (33%), extracranial-intracranial bypass in five cases (42%), their combination in two cases (16%), and manipulative intraoperative recanalization in one case (8%). National Institutes of Health Stroke Scale score ranged pre-operatively from 7 to 25 points and postoperatively (1–7 days after surgery) from 1–18 points. Functional independence (modified Rankin Scale score 0–2) was achieved in nine patients (75%) at 3–12 months postoperatively. Conclusion: Emergent microsurgical embolectomy, extracranial-intracranial bypass, or a combination of these methods appear to be a safe and potentially effective third-line treatment for patients with emergent occlusion of large vessels in the anterior cerebral circulation

• MeSH
• Ischemic Stroke * surgery   MeSH
• Humans MeSH
• Microsurgery methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH