BACKGROUND: Patients with high stroke risk and atrial fibrillation who are unsuitable to oral anticoagulants (OACs) require other stroke prevention strategies. A novel permanent coil filter directly placed into both common carotid arteries (CCAs) was designed to capture emboli >1.4 mm in diameter. OBJECTIVES: The multicenter, nonrandomized, first-in-human clinical CAPTURE (Carotid Artery Implant for Trapping Upstream Emboli for Preventing Stroke in Atrial Fibrillation Patients) trial sought to determine the feasibility and safety of bilateral CCA filter placement. METHODS: Eligible patients had atrial fibrillation, CHA2DS2-VASc (Congestive heart failure, Hypertension, Age 75 years, Diabetes, Stroke/transient ischemic attack, Vascular disease, Age 65 to 74 years, Sex category) ≥2, OAC unsuitability, CCA size 4.8 to 9.8 mm, and no carotid stenosis >30%. Under ultrasound guidance, after direct transcutaneous carotid puncture with a 24-gauge needle, a motorized unit expels the filter to unfurl in the artery. Patients received aspirin/clopidogrel for 3 months, and aspirin thereafter. Primary endpoints were: 1) procedural success-bilateral, properly positioned CCA filters; and 2) 30-day incidence of major adverse events-death, stroke, major bleeding, filter migration, CCA thrombus, or stenosis. Carotid ultrasounds were conducted post-procedure, pre-discharge, at 1 week, and at 1, 3, 6, and 12 months. RESULTS: At 3 centers, 25 patients were enrolled: age 71 ± 9 years, CHA2DS2-VASc = 4.4 ± 1.0, prior embolism in 48%. Procedure success was 92% (23 of 25 patients); 1 patient had unilateral deployment. There were no device/procedure-related major adverse events; minor puncture site hematomas/edema occurred in 5 of 25 (20%). After 6-month mean follow-up, asymptomatic thrombi were detected in 4 patients (1 bilateral, 4 unilateral), adjudicated as captured (n = 3), unclassified (n = 2), or in situ (n = 0). In all patients, the thrombi dissolved with subcutaneous heparin. In 1 patient, 2 device/procedure-unrelated minor strokes occurred. CONCLUSIONS: Permanent carotid filter placement for stroke prophylaxis is technically feasible and safe. (Carotid Artery Implant for Trapping Upstream Emboli for Preventing Stroke in Atrial Fibrillation Patients [CAPTURE]; NCT03571789).

• Klíčová slova
• atrial fibrillation, carotid filter, common carotid artery, embolic protection, oral anticoagulation, stroke prevention,
• MeSH
• antikoagulancia terapeutické užití   MeSH
• arteria carotis communis * diagnostické zobrazování   MeSH
• Aspirin terapeutické užití   MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• fibrilace síní komplikace   MeSH
• fibrinolytika terapeutické užití   MeSH
• heparin terapeutické užití   MeSH
• inhibitory agregace trombocytů terapeutické užití   MeSH
• injekce subkutánní MeSH
• intervenční ultrasonografie MeSH
• klopidogrel terapeutické užití   MeSH
• lidé MeSH
• plicní embolie prevence a kontrola   MeSH
• pomůcky zabraňující embolii * MeSH
• primární prevence přístrojové vybavení   MeSH
• prospektivní studie MeSH
• senioři MeSH
• tromboembolie diagnostické zobrazování   farmakoterapie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• Aspirin MeSH
• fibrinolytika MeSH
• heparin MeSH
• inhibitory agregace trombocytů MeSH
• klopidogrel MeSH

PURPOSE OF REVIEW: A novel permanent carotid filter device for percutaneous implantation was developed for the purpose of stroke prevention. In this review, we cover rationale, existing preclinical and clinical data, and potential future directions for research using such a device. RECENT FINDINGS: The Vine™ filter was assessed for safety in sheep and in 2 observational human studies, the completed CAPTURE 1 (n = 25) and the ongoing CAPTURE 2 (planned n = 100). CAPTURE 1 has shown high procedural and long-term implant safety. A control group was not available for comparison. A mechanical filter for permanent stroke prevention can be implanted bilaterally in the common carotid artery safely and efficiently. A randomized trial is planned for 2021 (n = 3500, INTERCEPT) to demonstrate superiority of a filter + anticoagulation strategy over anticoagulation alone in patients at high risk for ischemic stroke.

• Klíčová slova
• Atrial fibrillation, Carotid filter, Common carotid artery, Embolic protection, Stroke prevention,
• MeSH
• arteria carotis communis MeSH
• cévní mozková příhoda * etiologie   prevence a kontrola   MeSH
• fibrilace síní * komplikace   MeSH
• lidé MeSH
• ovce MeSH
• protézy a implantáty MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Since its introduction in 1982, transcranial Doppler ultrasound (TCD) has become an important diagnostic and monitoring tool and its usefulness has been well established in many clinical applications. In carotid artery stenting (CAS), TCD has mostly been reserved for the optimization of emboli protection devices. Currently, with increasing use of proximal protection systems resembling surgical clamps, TCD has become invaluable in providing the operator an insight into a patient's cerebral hemodynamic status. Additionally, in selected patients, adverse peri- or post-procedural cerebral outcomes may even be predicted allowing the operator to adjust the therapeutic strategy. This review summarizes the current knowledge regarding the use of TCD in patients undergoing CAS and suggests potential directions of future research.

• MeSH
• artefakty MeSH
• arteria carotis interna diagnostické zobrazování   MeSH
• design vybavení MeSH
• intrakraniální embolie diagnostické zobrazování   prevence a kontrola   MeSH
• karotická endarterektomie MeSH
• lidé MeSH
• pomůcky zabraňující embolii MeSH
• senzitivita a specificita MeSH
• stenóza arteria carotis diagnostické zobrazování   terapie   MeSH
• stenty * MeSH
• ultrasonografie dopplerovská transkraniální metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. METHODS AND RESULTS: Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction < or =40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age > or =80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68+/-9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80+/-9% and 7+/-9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. CONCLUSION: DCAS is feasible and can be performed with an acceptable risk in high-risk patients.

• MeSH
• cévní mozková příhoda etiologie   prevence a kontrola   MeSH
• dysfunkce levé srdeční komory komplikace   MeSH
• infarkt myokardu komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozeček MeSH
• následné studie MeSH
• nemoci koronárních tepen komplikace   MeSH
• nemoci ledvin komplikace   MeSH
• plicní nemoci komplikace   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   terapie   MeSH
• stenty * 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
• práce podpořená grantem MeSH

• MeSH
• arteria carotis interna patofyziologie   MeSH
• balónková angioplastika přístrojové vybavení   MeSH
• cerebrovaskulární poruchy prevence a kontrola   MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• pomůcky zabraňující embolii * MeSH
• stenóza arteria carotis terapie   MeSH
• stenty * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH

OBJECTIVE/BACKGROUND: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. METHODS: Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. RESULTS: In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. CONCLUSION: In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

• Klíčová slova
• Carotid artery stenosis, Carotid artery stenting, Cerebral protection devices, Plaque echolucency, Randomized controlled trial, Stent design,
• MeSH
• asymptomatické nemoci MeSH
• aterosklerotický plát MeSH
• časové faktory MeSH
• cerebrovaskulární poruchy diagnóza   etiologie   patofyziologie   prevence a kontrola   MeSH
• endovaskulární výkony škodlivé účinky   přístrojové vybavení   MeSH
• karotická endarterektomie MeSH
• klinické rozhodování MeSH
• lékařská praxe - způsoby provádění MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• pomůcky zabraňující embolii * MeSH
• protézy - design MeSH
• rizikové faktory MeSH
• rozdělení chí kvadrát MeSH
• stenóza arteria carotis komplikace   diagnostické zobrazování   patofyziologie   terapie   MeSH
• stenty * MeSH
• stupeň závažnosti nemoci MeSH
• výběr pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

The authors investigated the disintegration of red cells by the action of brilliant cresyl blue in patients after an acute cerebrovascular attack and compared them with the disintegration in blood donors. In the patients the disintegration was assessed within 24 hours after the attack and after one year. The disintegration was assessed in two incubation solutions i.e. in isotonic saline and in Krebs-Ringer solution after three hours incubation at 37 degrees C. It was revealed that in the control group the disintegration of erythrocytes in isotonic saline is much greater than in Krebs-Ringer solution. The difference between the action of the two solutions is highly significant. In patients immediately after the attack as well as in the group which did not survive the period of one year (7 patients) and the group which survived the period of one year (8 patients) the difference in disintegration in the two solutions is significant but at a lower level of significance. It is thus smaller than in the control group. However, in the group which survived for one year this difference is again highly significant, similarly as in the control group. The author discusses the problem of metabolic influencing of the elasticity and deformability of the red cell membrane and its impact on the rheology of blood.

• MeSH
• deformabilita erytrocytů účinky léků   MeSH
• erytrocytární membrána účinky léků   MeSH
• lidé MeSH
• oxaziny farmakologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tranzitorní ischemická ataka krev   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• Brilliant Cresyl Blue MeSH Prohlížeč
• oxaziny MeSH

Experience with intracardiac recording of sinus node electrograms (SNE) in 27 patients is described. Under fluoroscopic monitoring the poles of a tri- or quadripolar catheter were positioned at the superior vena cava--right atrium junction. For recording, high amplification of 100 microV/cm and low-pass filters of 0.2-70 Hz were used. SNE was verified by simultaneously recording electrograms from two pairs of poles at the same filter setting and the application of carotid sinus massage. SNE was obtained in 17 patients (63%). It was recognized as a smooth, low-frequency upstroke slope before rapid atrial depolarization. Its amplitude range was 30-90 microV. Directly recorded sinoatrial conduction time (SACT) ranged from 55 to 120 ms (mean 88 +/- 20). In 4 patients with sick sinus syndrome SACT varied from 90 to 220 ms. SACTs calculated by the premature stimulation method and measured directly from SNE were in good correlation (r = 0.61, p less than 0.05).

• MeSH
• dítě MeSH
• dospělí MeSH
• elektrokardiografie metody   MeSH
• koronární nemoc patofyziologie   MeSH
• lidé MeSH
• mladiství MeSH
• nemoci srdečních chlopní patofyziologie   MeSH
• nodus sinuatrialis patofyziologie   MeSH
• sinoatriální blokáda patofyziologie   MeSH
• srdeční arytmie patofyziologie   MeSH
• syndrom chorého sinu patofyziologie   MeSH
• vena cava superior MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH