PURPOSE: To investigate the safety and efficacy of baseline antiplatelet treatment in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS: Baseline use of antiplatelet medication before MT for (AIS) may provide benefit on reperfusion and clinical outcome but could also carry an increased risk of intracranial hemorrhage (ICH). All consecutive patients with AIS and treated with MT with and without intravenous thrombolysis (IVT) between January 2012 and December 2019 in all centers performing MT nationwide were reviewed. Data were prospectively collected in national registries (eg, SITS-TBY and RES-Q). Primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months; secondary outcome was ICH. RESULTS: Of the 4,351 patients who underwent MT, 1,750 (40%) and 666 (15%) were excluded owing to missing data from the functional independence and ICH outcome cohorts, respectively. In the functional independence cohort (n = 2,601), 771 (30%) patients received antiplatelets before MT. Favorable outcome did not differ in any antiplatelet, aspirin, and clopidogrel groups when compared with that in the no-antiplatelet group: odds ratio (OR), 1.00 (95% CI, 0.84-1.20); OR, 1.05 (95% CI, 0.86-1.27); and OR, 0.88 (95% CI, 0.55-1.41), respectively. In the ICH cohort (n = 3,685), 1095 (30%) patients received antiplatelets before MT. The rates of ICH did not increase in any treatment options (any antiplatelet, aspirin, clopidogrel, and dual antiplatelet groups) when compared with those in the no-antiplatelet group: OR, 1.03 (95% CI, 0.87-1.21); OR, 0.99 (95% CI, 0.83-1.18); OR, 1.10 (95% CI, 0.82-1.47); and OR, 1.43 (95% CI, 0.87-2.33), respectively. CONCLUSIONS: Antiplatelet monotherapy before MT did not improve functional independence or increase the risk of ICH.

• MeSH
• Aspirin škodlivé účinky   MeSH
• cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• intrakraniální krvácení chemicky indukované   MeSH
• ischemická cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• ischemie mozku * diagnostické zobrazování   terapie   MeSH
• klopidogrel škodlivé účinky   MeSH
• lidé MeSH
• mechanická trombolýza * škodlivé účinky   MeSH
• trombektomie škodlivé účinky   MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• Aspirin MeSH
• klopidogrel MeSH

INTRODUCTION/PURPOSE: Mechanical thrombectomy (MT) for acute ischemic stroke (IS) can be performed also in patients on anticoagulation therapy (AT); however, sufficient and reliable data about safety and efficacy of MT are still missing. Thus, we aimed to compare these parameters between patients treated on AT and without AT. MATERIALS AND METHODS: All consecutive IS patients treated with MT using stent retrievers were included in the retrospective analysis. Neurological deficit was scored using National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale with a score 0-2 for good outcome. Recanalization was rated using Thrombolysis in Cerebral Infarction (TICI) scale. Symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS-MOST criteria. RESULTS: Out of 703 patients treated with MT, 88 (12.5%) patients (46% males, mean age 75.5 ± 11.8 years) were on AT with an admission median NIHSS of 17 points. Recanalization (TICI 2b-3) was achieved in 80% and complete (TICI 3) in 65% of patients on AT and in 80 and 65% of patients without AT (p-1.000). SICH after MT was detected in 9% of AT and 5% of non-AT patients (p-0.136). Good outcome was present in 36% of AT patients (p-0.03). AT patients with poor outcome had more frequently atrial fibrillation (93%, p-0.005), higher admission NIHSS (17, p-0.004) and higher rate of SICH (14.5%, p-0.047). CONCLUSION: MT seems to be safe also in patients on AT. Poor outcome may be related to higher admission NIHSS, higher rate of SICH and presence of atrial fibrillation.

• Klíčová slova
• Anticoagulation therapy, Clinical outcome, Ischemic stroke, Mechanical thrombectomy, Symptomatic intracerebral hemorrhage,
• MeSH
• antikoagulancia terapeutické užití   MeSH
• cévní mozková příhoda chirurgie   MeSH
• ischemie mozku chirurgie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trombektomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antikoagulancia MeSH

BACKGROUND AND PURPOSE: Experienced multidisciplinary stroke team and well-organized hospital management are considered necessary to achieve good results after mechanical thrombectomy (MT) in acute ischemic stroke patients. We analyzed the technical results of MT performed in the Czech Republic in the year 2016 to provide relevant data for further quality improvement. MATERIAL AND METHODS: All centers performing MT in the CR were called for detailed technical and clinical data from year 2016, which were anonymously analyzed and relevant technical key time intervals were compared. Clinical outcomes were assessed according to the HERMES meta-analysis. RESULTS: In the 2016, 1053 MTs were performed in the CR. Of 15 dedicated centers, the data from 12 centers and from 886 (84%) patients (49.2% males, mean age 69.8 ± 12.3 years) were analyzed. The overall median of time from hospital arrival to groin puncture (GP) was 77 min with a range from 40 to 109 min among individual hospitals, from GP to first passage of stent retriever 20 (15-40) min and from GP to maximal reached recanalization 42 (33-80) min. The median of recanalization time was 240 (219-320) min. The recanalization (TICI 2b-3) was achieved in 81.7% of patients, 44.1% of patients had a good 3-month clinical outcome and 6.3% suffered from symptomatic intracerebral hemorrhage. Peri-procedural complications were recorded in 89 (10%) patients. CONCLUSION: Despite achieved good overall results, a great variability in some of the analyzed key time intervals among individual centers performing MT warrants further quality improvement.

• Klíčová slova
• Acute ischemic stroke, Complications, Mechanical thrombectomy, Technical results, Time intervals,
• MeSH
• cévní mozková příhoda komplikace   chirurgie   MeSH
• ischemie mozku komplikace   chirurgie   MeSH
• lidé MeSH
• mozek chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trombektomie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND AND PURPOSE: Rigorous and regular evaluation of defined quality indicators is crucial for further improvement of both technical and clinical results after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Following the recent international multi-society consensus quality indicators, we aimed to assess trend in these indicators on national level. MATERIAL AND METHODS: The prospective multicenter study (METRICS) was conducted in Czech Republic (CR) in year 2019. All participating centers collected technical and clinical data including defined quality indicators and results were subsequently compared with those from year 2016. RESULTS: In the 2019, 1375 MT were performed in the CR and 1178 (86%) patients (50.3% males, mean age 70.5 ± 13.0 years) were analyzed. Recanalization (TICI 2b-3) was achieved in 83.7% of patients and 46.2% of patients had good 3-month clinical outcome. Following time intervals were shortened in comparison to 2016: "hospital arrival - GP" (77 vs. 53 min; p<0.0001), "hospital arrival - maximal achieved recanalization" (122 vs. 93 min; p<0.0001), and "stroke onset - maximal achieved recanalization" (240 vs. 229 min; p p<0.0001). More patients with tandem occlusion were treated in 2019 (7.8 vs. 16.5%; p<0.0001) and more secondary transports were in 2019 (31.3 vs. 37.8%; p=0.002). No difference was found in 3-month clinical outcome and in the rate of periprocedural complications. Results of the METRICS study met all criteria of multi-society consensus quality indicators. CONCLUSION: Nationwide comparison between 2016 and 2019 showed improvement in the key time intervals, but without better overall clinical outcomes after MT.

• Klíčová slova
• Ischemic stroke, Mechanical thrombectomy, Metrics, Quality indicators,
• MeSH
• benchmarking MeSH
• cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• ischemická cévní mozková příhoda * MeSH
• ischemie mozku * diagnostické zobrazování   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombektomie škodlivé účinky   metody   MeSH
• ukazatele kvality zdravotní péče 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
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: While mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC). METHODS: We conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers. Standard safety outcomes (3-month mortality, symptomatic intracranial hemorrhage) and effectiveness outcomes (3-month functional independence: modified Rankin Scale scores of 0-2) were compared between patients meeting and failing TTEC. RESULTS: The sample consisted of 349 (60%) controls fulfilling TTEC and 234 (40%) non-TTEC patients. Control patients meeting TTEC for MT tended to have higher functional independence rates at 3 months (47% vs 39%; p=0.055), while the rates of symptomatic intracerebral hemorrhage (sICH) were similar (9%) in both groups (p=0.983). In multivariable logistic regression models, adherence to TTEC for MT was not independently related to any safety outcome (sICH: OR 0.71, 95% CI 0.30 to 1.68, p=0.434; 3-month mortality: OR 1.27, 95% CI 0.69 to 2.33, p=0.448) or effectiveness outcome (3-month functional independence: OR 0.81, 95% CI 0.48 to 1.37, p=0.434; 3-month functional improvement: OR 0.73, 95% CI 0.48 to 1.11, p=0.138) after adjusting for potential confounders. CONCLUSIONS: Approximately 40% of patients with AIS with ELVO offered MT do not fulfill TTEC for MT. Patients who did not meet TTEC had high rates of good clinical outcome and low complication rates.

• Klíčová slova
• Stroke, Thrombectomy,
• MeSH
• cévní mozková příhoda diagnostické zobrazování   terapie   MeSH
• dospělí MeSH
• ischemie mozku diagnostické zobrazování   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza škodlivé účinky   metody   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombektomie škodlivé účinky   metody   MeSH
• výběr pacientů 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
• multicentrická studie MeSH
• pozorovací studie MeSH

BACKGROUND AND PURPOSE: Higher admission serum glucose levels have been associated with poor outcomes in patients with acute ischemic stroke (AIS) treated with IV thrombolysis. We sought to evaluate the association of admission serum glucose with early outcomes of patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). METHODS: Consecutive AIS patients due to ELVO treated with MT in three tertiary stroke centers were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), complete reperfusion, mortality, functional independence (modified Rankin Scale (mRS) score of 0-2), and functional improvement (shift in mRS score) at 3 months. The association of admission serum glucose and admission hyperglycemia (>140 mg/dL) with outcomes was evaluated using univariable and multivariable binary and ordinal logistic regression models. RESULTS: 231 AIS patients with ELVO (mean age 62±14 years, 51% men, median admission National Institute of Health Stroke Scale score 16 points (IQR 12-21), median admission serum glucose 125 mg/dL (IQR 104-162)) were treated with MT. Admission hyperglycemia was associated with a lower likelihood of functional improvement (common OR 0.53; 95% CI 0.31 to 0.97; p=0.027) and higher odds of 3 month mortality (OR 2.76; 95% CI 1.40 to 5.44; p=0.004) in multivariable analyses adjusting for potential confounders. A 10 mg/dL increase in admission blood glucose was associated with a higher likelihood of sICH (OR 1.07; 95% CI 1.01 to 1.13; p=0.033) and 3 month mortality (OR 1.07; 95% CI 1.02 to 1.12; p=0.004) in multivariable models. There was no association between admission serum glucose or hyperglycemia and complete reperfusion. CONCLUSIONS: Higher admission serum glucose and admission hyperglycemia are independent predictors of adverse outcomes in ELVO patients treated with MT.

• Klíčová slova
• Stroke, Thrombectomy,
• MeSH
• cévní mozková příhoda krev   mortalita   chirurgie   MeSH
• hyperglykemie krev   mortalita   chirurgie   MeSH
• ischemie mozku krev   mortalita   chirurgie   MeSH
• krevní glukóza metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• příjem pacientů trendy   MeSH
• prospektivní studie MeSH
• reperfuze škodlivé účinky   trendy   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trombektomie škodlivé účinky   trendy   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
• Názvy látek
• krevní glukóza MeSH

PURPOSE: To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. METHODS: In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. RESULTS: Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. CONCLUSION: Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

• MeSH
• akutní nemoc MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   přístrojové vybavení   metody   MeSH
• ischemie mortalita   chirurgie   MeSH
• končetiny * krevní zásobení   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• trombektomie škodlivé účinky   přístrojové vybavení   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Appropriate thrombus-device interaction is critical for recanalization. Histology can serve as a proxy for mechanical properties, and thus inform technique selection. OBJECTIVE: To investigate the value of histologic characterization, we conducted a systematic review and meta-analysis on the relationship between thrombus histology and recanalization, technique, etiology, procedural efficiency, and imaging findings. METHODS: In this meta-analysis, we identified studies published between March 2010 and March 2020 reporting findings related to the histologic composition of thrombi in large vessel occlusion stroke. Studies with at least 10 patients who underwent mechanical thrombectomy using stent retriever or aspiration were considered. Only studies in which retrieved thrombi were histologically processed were included. Patient-level data were requested when data could not be directly extracted. The primary outcome assessed was the relationship between thrombus histology and angiographic outcome. RESULTS: A total of 22 studies encompassing 1623 patients met inclusion criteria. Clots associated with good angiographic outcome had higher red blood cell (RBC) content (mean difference [MD] 9.60%, 95% CI 3.85-15.34, P = .008). Thrombi retrieved by aspiration had less fibrin (MD -11.39, 95% CI -22.50 to -0.27, P = .046) than stent-retrieved thrombi. Fibrin/platelet-rich clots were associated with longer procedure times (MD 13.20, 95% CI 1.30-25.10, P = .037). Hyperdense artery sign was associated with higher RBC content (MD 14.17%, 95% CI 3.07-25.27, P = .027). No relationship was found between composition and etiology. CONCLUSION: RBC-rich thrombi were associated with better recanalization outcomes and shorter procedure times, suggesting that preinterventional compositional characterization may yield important prognostic and therapeutic guidance.

• Klíčová slova
• Clot, Histology, Ischemic stroke, Large vessel occlusion, Meta-analysis, Stent, Systematic review, Thrombectomy, Thrombus,
• MeSH
• arteriální okluzní nemoci * MeSH
• cévní mozková příhoda * terapie   MeSH
• ischemie mozku * etiologie   MeSH
• lidé MeSH
• stenty škodlivé účinky   MeSH
• trombektomie metody   MeSH
• trombóza * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

BACKGROUND We investigated the properties and effects of 5 mechanical thrombectomy procedures in patients with acute ischemic stroke. The relationships between the type of procedure, the time required, the success of recanalization, and the clinical outcome were analyzed. MATERIAL AND METHODS This prospective comparative analysis included 500 patients with acute ischemic stroke and large-vessel occlusion. We compared contact aspiration thrombectomy (ADAPT, n=100), stent retriever first line (SRFL, n=196), the Solumbra technique (n=64), mechanical thrombectomy plus stent implantation (n=81), and a combined procedure (n=59). RESULTS ADAPT provided shorter procedure (P<0.001) and recanalization times (P<0.001) than the other techniques. Better clinical outcome was achieved for ischemia in the anterior circulation than ischemia in the posterior fossa (P<0.001). Compared to the other techniques, patients treated with ADAPT procedure had increased odds of achieving better mTICI scores (P=0.002) and clinical outcome (NIHSS) after 7 days (P=0.003); patients treated with SRFL had increased odds of achieving better long-term clinical status (3M-mRS=0-2; P=0.040). Patients with SRFL and intravenous thrombolysis (IVT) had increased odds of better clinical status (3M-mRS=0-2; P=0.031) and decreased odds of death (P=0.005) compared to patients with SRFL without IVT. The other treatment approaches had no additional effect of IVT. Patients with SRFL with a mothership transfer had increased odds of achieving favorable clinical outcome (3M-mRS) compared to SRFL with the drip-and-ship transfer paradigm (P=0.015). CONCLUSIONS Our results showed that ADAPT and SRFL provided significantly better outcomes compared to the other examined techniques. A mothership transfer and IVT administration contributed to the success of the SRFL approach.

• MeSH
• cévní mozková příhoda chirurgie   terapie   MeSH
• ischemie mozku terapie   MeSH
• ischemie terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza metody   MeSH
• prospektivní studie MeSH
• senioři MeSH
• stenty MeSH
• trombektomie metody   MeSH
• trombolytická terapie metody   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
• srovnávací studie MeSH

BACKGROUND: In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and comparison with CTP trials. METHODS: Data of consecutive MT patients (from January 2016 to December 2017) were retrospectively reviewed. All patients with multiphase CT angiography confirmed the presence of anterior circulation large vessel occlusion/s in the intracranial internal carotid artery and/or middle cerebral artery (M1 or M2) and with admission brain CTP analyzed by RAPID software were included into the analysis. RESULTS: Sixty-two patients fulfilled the inclusion criteria (mean age was 70.1 ± 13.6 years, females 48.5%). At baseline, National Institutes of Health Stroke Scale score was 16 (IQR = 13-20), Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7-9), CTP core volume was 20 mL (IQR = 2-36), and CTP penumbra volume was 145.5 mL (IQR = 107-184). Time from stroke onset to imaging was 1 hour 32 minutes, time from stroke onset to reperfusion was 3 hours 50 minutes, and median time from CT to reperfusion was 1 hour 56 minutes. Modified thrombolysis in cerebral infarction 2b/3 was achieved in 42 patients (67.7%). Twenty-three patients (37%) had modified Rankin scale 0-2 at 90 days. CONCLUSIONS: Our analysis of CTP-selected patients for MT supports clinical applicability of automated CTP analysis into everyday clinical practice.

• Klíčová slova
• CT perfusion, Mechanical thrombectomy, RAPID, single-centre experience,
• MeSH
• cévní mozková příhoda diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• CT angiografie metody   MeSH
• ischemie mozku diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• klinické rozhodování * MeSH
• klinické zkoušky jako téma metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• perfuzní zobrazování metody   MeSH
• posuzování pracovní neschopnosti MeSH
• prediktivní hodnota testů MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombektomie metody   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
• srovnávací studie MeSH