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

Příručka a směrnice, které se zaměřují na farmakoterapii trombóz a embolií u pacientů s různými nemocemi, jako napřílad s fibrilací síní. Určeno praktickým lékařům.

• MeSH
• Anticoagulants MeSH
• Administration, Oral MeSH
• Embolism and Thrombosis MeSH
• Atrial Fibrillation MeSH
• General Practice MeSH
• Publication type
• Handbook MeSH
• Practice Guideline MeSH

• Conspectus
• Farmacie. Farmakologie
• NML Fields
• farmacie a farmakologie
• hematologie a transfuzní lékařství
• všeobecné lékařství

Od počátku operačních výkonů na karotidách byla snaha o nalezení nejbezpečnější techniky karotické endarterektomie a zajištění dostatečné perfuze mozku během výkonu, podobně i endovaskulární výkony se modernizovaly z prosté balonkové angioplastiky na zavádění stentů a vyvíjely se protektivní systémy k zabránění periprocedurálních embolizací. Druhá polovina minulého století se stala důležitou etapou prověřování a srovnávání výsledků karotické endarterektomie a karotického stentingu, hledání a ustálení indikačních kritérií v kontextu s velice účinnou antiagregační léčbou. Na přelomu století s příchodem moderních technik regionální anestezie a intravenózní analgosedace se postupně odklání většina cévních pracovišť od operace karotid v celkové anestezii a dochází k renesanci technik everzní endarterektomie. Z cévního pohledu chirurgie karotid prošla dlouhým, bedlivě sledovaným vývojem a obhájila si své místo první volby v řešení karotických stenóz.

Since the beginning of carotid surgery, there has been an effort to find the safest technique for carotid endarterectomy and ensure sufficient brain perfusion during the procedure. Similarly, endovascular procedures have been modernized from simple balloon angioplasty to stent placement, and protective systems have been developed to prevent periprocedural embolization. The second half of the last century became an important stage in examining and comparing the results of carotid endarterectomy and carotid stenting, searching for and establishing indication criteria in the context of highly effective antiplatelet therapy. At the turn of the century, with the advent of modern techniques of regional anesthesia and intravenous analgosedation, most vascular departments gradually moved away from carotid surgery under general anesthesia and there was a renaissance of eversion endarterectomy techniques. From a vascular perspective, carotid surgery underwent a long, closely monitored development and defended its place as the first choice in the treatment of carotid stenoses.

• MeSH
• Endarterectomy, Carotid history   methods   MeSH
• Humans MeSH
• Carotid Stenosis * surgery   MeSH
• Stents MeSH
• Anesthesia, Conduction MeSH
• Check Tag
• Humans MeSH

Úvod: Karotický web je vzácná, ale klinicky důležitá příčina kryptogenní ischemické cévní mozkové příhody. Jedná se o atypickou formu fibromuskulární dysplazie lokalizované v oblasti karotického bulbu. Cílem této práce je na podkladě kazuistiky prezentovat tuto méně známou příčinu ischemického iktu. Kazuistika: U 55leté pacientky s akutní ischemickou cévní mozkovou příhodou v levém karotickém povodí byl v rámci CT angiografického vyšetření diagnostikován karotický web. Ostatní extrakraniální či intrakraniální mozkové tepny byly bez stenóz či okluzí. Iniciálně byla pacientka efektivně léčena intravenózní trombolýzou, kontrolní MR mozku prokázalo malou kortikální ischemii a podrobným kardiologickým vyšetřením byla vyloučena kardioemboligenní etiologie iktu. V rámci sekundární prevence ischemické cévní mozkové příhody byla pacientka zajištěna protidestičkovou terapií a podstoupila nekomplikovanou karotickou endarterektomii. V průběhu následného 10měsíčního sledování nedošlo k recidivě cerebrální ischemie. Závěr: Karotická endarterektomie představuje bezpečnou a efektivní metodu léčby symptomatického karotického webu.

Introduction: A carotid web is a rare but clinically important cause of cryptogenic ischemic stroke. It is an atypical form of fibromuscular dysplasia localized at the carotid bulb. The aim of this paper is to present this less-known cause of ischemic stroke based on a case study. Case report: In a 55-year-old female patient with acute ischemic strok in the left carotid territory, a carotid web was diagnosed on CT angiography. Other extracranial or intracranial cerebral arteries showed no stenoses or occlusions. The patient was initially treated effectively with intravenous thrombolysis. A follow-up brain MRI revealed a small cortical ischemia and a detailed cardiological evaluation excluded the cardioembolic etiology of the stroke. As part of the secondary stroke prevention, the patient was managed with antiplatelet therapy and underwent an uncomplicated carotid endarterectomy. During a 10-month follow-up period, there was no recurrence of cerebral ischemia. Conclusion: Carotid endarterectomy represents a safe and effective method for treating symptomatic carotid web.

• MeSH
• Fibromuscular Dysplasia * surgery   diagnostic imaging   complications   MeSH
• Ischemic Stroke * etiology   therapy   MeSH
• Endarterectomy, Carotid MeSH
• Middle Aged MeSH
• Humans MeSH
• Carotid Artery Diseases surgery   complications   MeSH
• Secondary Prevention MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Anticoagulants pharmacology   classification   therapeutic use   MeSH
• Administration, Oral MeSH
• Precision Medicine MeSH
• Humans MeSH
• Neoplasms * complications   MeSH
• Nadroparin administration & dosage   pharmacology   therapeutic use   MeSH
• Pulmonary Embolism MeSH
• Aged MeSH
• Thromboembolism * drug therapy   prevention & control   MeSH
• Venous Thrombosis MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

• Keywords
• diagnostika CAT,
• MeSH
• Anticoagulants * pharmacology   classification   therapeutic use   MeSH
• Precision Medicine MeSH
• Vena Cava Filters MeSH
• Drug Interactions MeSH
• Humans MeSH
• Neoplasms * MeSH
• Pulmonary Embolism diagnosis   mortality   MeSH
• Practice Guidelines as Topic MeSH
• Venous Thrombosis * diagnosis   drug therapy   complications   prevention & control   MeSH
• Check Tag
• Humans 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.