A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery - left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.

• Klíčová slova
• 4D CT angiography, CT perfusion, Carotid artery dissection, Extra-intracranial bypass, Intracranial atherosclerosis, Large vessel occlusion,
• MeSH
• arteria carotis interna chirurgie   MeSH
• cévní mozková příhoda * diagnostické zobrazování   etiologie   chirurgie   MeSH
• ischemická cévní mozková příhoda * komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perfuze škodlivé účinky   MeSH
• revaskularizace mozku * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH

PURPOSE: To compare safety and utility of intraarterial revascularization with use of stents to no revascularization in patients who either failed to respond to intravenous thrombolysis (IVT) or have contraindications to IVT. MATERIALS AND METHODS: The case-control study was approved by local ethics committees; all patients signed informed consent. One hundred thirty-one patients (74 men; mean age, 65.9 years ± 12.3; range, 25-86 years) with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion were enrolled; 75 underwent IVT. No further recanalization therapy was performed in 26 (35%) IVT-treated patients with MCA recanalization (group 1). Patients with IVT failure after 60 minutes were allocated to endovascular treatment (group 2A) or no further therapy (group 2B). Patients with contraindication to IVT were allocated to endovascular treatment within 8 hours since AIS onset (group 3A) or to no recanalization therapy (group 3B). Neurologic deficit at admission, MCA recanalization, symptomatic intracerebral hemorrhage (SICH), and 3-month clinical outcome were evaluated. Favorable clinical outcome was defined as modified Rankin scale score 0-2 at 3 months after stroke onset. Two-sided Mann-Whitney U test, independent samples t test, Fisher exact test, multivariate logistic regression analysis of baseline variables, and complete MCA recanalization for the prediction of favorable clinical outcome were used for statistical evaluation. RESULTS: Median National Institutes of Health Stroke Scale score at admission was 13.5, 16.0, 15.5, 15.0, and 16.0 in groups 1, 2A, 2B, 3A, and 3B, respectively (P > .05); SICH occurred in one of 26 (3.8%), one of 23 (4.3%), one of 26 (3.8%), one of 31 (3.2%), and one of 25 (4.0%) patients, respectively (P > .05). MCA recanalization after endovascular treatment was achieved in 50 of 54 (92.6%) patients. Favorable outcome was significantly different between groups 2A and 2B (10 of 23 [43.5%] and four of 26 [15.4%], respectively; P = .03) and groups 3A and 3B (14 of 31 [45.2%] and two of 25 [8.0%], respectively; P = .004) and was dependent on MCA recanalization (odds ratio, 5.55; P = .006). CONCLUSION: In this controlled trial, intraarterial revascularization with stents was an effective and safe-effective treatment option in patients with acute MCA occlusion with contraindication to IVT or after IVT failure.

• MeSH
• akutní nemoc MeSH
• cévní protézy * MeSH
• dospělí MeSH
• infarkt arteria cerebri media diagnostické zobrazování   epidemiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• odchylka pozorovatele MeSH
• prevalence MeSH
• radiografie MeSH
• revaskularizace mozku přístrojové vybavení   MeSH
• rizikové faktory MeSH
• senioři 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
• klinické zkoušky kontrolované MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

• Klíčová slova
• complete revascularization, meta-analysis, multivessel disease, myocardial infarction, older patients,
• MeSH
• infarkt myokardu s elevacemi ST úseků * mortalita   chirurgie   terapie   MeSH
• koronární angioplastika mortalita   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma * MeSH
• revaskularizace myokardu * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

BACKGROUND: The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). OBJECTIVES: The purpose of this study was to determine the effect of nonculprit-lesion PCI timing on major CV outcomes and also the time course of the benefit of complete revascularization. METHODS: Following culprit-lesion PCI, 4,041 patients with STEMI and multivessel CAD were randomized to staged nonculprit-lesion PCI or culprit-lesion only PCI. Randomization was stratified according to investigator-planned timing of nonculprit-lesion PCI: during or after the index hospitalization. The first coprimary outcome was the composite of CV death or myocardial infarction (MI). In pre-specified analyses, hazard ratios (HRs) were calculated for each time stratum. Landmark analyses of the entire population were performed within 45 days and after 45 days. RESULTS: For nonculprit-lesion PCI planned during the index hospitalization (actual time: median 1 day), CV death or MI was reduced with complete revascularization compared with culprit-lesion only PCI (HR: 0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion PCI planned to occur after hospital discharge (actual time: median 23 days), CV death or MI was also reduced with complete revascularization (HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for intended nonculprit lesion PCI versus culprit lesion only PCI. CONCLUSIONS: Among STEMI patients with multivessel disease, the benefit of complete revascularization over culprit-lesion only PCI was consistent irrespective of the investigator-determined timing of nonculprit-lesion intervention. The benefit of complete revascularization on hard clinical outcomes emerged mainly over the long term.

• Klíčová slova
• complete revascularization, percutaneous coronary intervention,
• MeSH
• časové faktory MeSH
• elektrokardiografie MeSH
• infarkt myokardu s elevacemi ST úseků diagnóza   chirurgie   MeSH
• koronární angiografie MeSH
• koronární angioplastika metody   MeSH
• koronární cévy diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The outcome of tooth autotransplantation depends mainly on the transplant tooth's anatomy-the type of donor tooth and the developmental stage of root formation. Mature teeth display a higher complication rate due to lower pulp revascularization potential, requiring root canal treatment (RCT) pre- or postoperatively to avoid postoperative complications, which extends treatment duration and cost. This report details a 39-year-old patient's autotransplantation of a mature wisdom tooth to replace the first molar after unsuccessful root canal retreatment. During the surgery, an extraoral root resection of the transplanted tooth was performed prior to placement to avoid the need to elevate the Schneiderian membrane, which displayed imperfect healing following the surgical removal of a cystic lesion in the maxillary sinus. RCT was not performed before nor after the procedure. At the 3-year follow-up, the tooth was asymptomatic. The vitality of the autotransplanted tooth was difficult to determine using standard vitality tests, which depend on patients' subjective responses, but the use of pulse oximetry objectively confirmed this. This case not only shows the possibility of a mature tooth transplant revascularization in an older patient but also gives a possible postoperative protocol of how to objectively confirm and measure the revascularization of the autotransplanted tooth.

• Klíčová slova
• case report, mature tooth, pulse oximetry, revascularization, tooth autotransplantation,
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• Klíčová slova
• Acute coronary syndromes, Bare-metal stents, Coronary artery bypass grafting, Coronary artery disease, Drug-eluting stents, EuroSCORE, Guidelines, Heart Team, Medical therapy, Myocardial infarction, Myocardial ischaemia, Myocardial revascularization, Percutaneous coronary intervention, Recommendation, Revascularization, Risk stratification, ST-segment elevation myocardial infarction, SYNTAX score, Stable angina, Stable coronary artery disease, Stents,
• MeSH
• hrudní chirurgie organizace a řízení   normy   MeSH
• lidé MeSH
• revaskularizace myokardu metody   normy   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

We briefly and comprehensively present some of the novel findings in the field of revascularization therapy and management of ST-segment-elevation myocardial infarction (STEMI). We highlight the latest evidence-based advancements in the pharmacological and mechanical treatment of patients who presented with STEMI. Since the last updates to the international guidelines (American College of Cardiology/American Heart Association and the European Society of Cardiology) were published in 2011 and 2012, there have been changes and several important studies have presented their final outcomes. We also highlight some controversial approaches as part of the current debates in the cardiology community. In addition, we share our recent experience in the field of biodegradable scaffold stents as a treatment strategy in STEMI.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• infarkt myokardu terapie   MeSH
• inhibitory agregace trombocytů terapeutické užití   MeSH
• lidé MeSH
• revaskularizace myokardu * metody   MeSH
• rizikové faktory MeSH
• stenty * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antikoagulancia MeSH
• inhibitory agregace trombocytů MeSH

A carotid arterial bed with sclerotic lesions in patients with ischaemic heart disease before myocardial revascularization in extracorporeal circulation raises the risk of development of serious irreversible dysfunction of the central nervous system. The authors report on the results of ultrasound examination of the carotid arteries in 284 patients, hospitalized at the Department of Cardiac Surgery of University Hospital at Hradec Králové prior to myocardial revascularization between 1986-1990. Based on their results, and in agreement with data of the literature, the authors recommend to perform non-invasive examination of the carotid arterial bed in all patients prior to myocardial revascularization and, based on the results of the examination, to follow a strictly individualized investigational and therapeutic algorithm.

• MeSH
• arterioskleróza diagnostické zobrazování   MeSH
• dospělí MeSH
• koronární nemoc komplikace   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci arterie carotis komplikace   diagnostické zobrazování   MeSH
• předoperační péče MeSH
• revaskularizace myokardu * MeSH
• senioři MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To investigate the safety and efficacy of the self-expanding Solitaire stent used during intravenous thrombolysis (IVT) for intracranial arterial occlusion (IAO) in acute ischemic stroke (AIS). MATERIALS AND METHODS: Consecutive nonselected patients with AIS with IAO documented on computed tomographic angiography or magnetic resonance angiography and treated with IVT were included in this prospective study. Stent intervention was initiated and performed during administration of IVT without waiting for any clinical or radiologic signs of potential recanalization. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS), and 90-day clinical outcome was assessed by modified Rankin scale (mRS), with a good outcome defined as an mRS score of 0-2. Recanalization was rated by thrombolysis in cerebral infarction (TICI) scale. RESULTS: Fifty patients (mean age, 66.8 y ± 14.6) had a baseline median NIHSS score of 18.0. Overall recanalization was achieved in 94% of patients, and complete recanalization (ie, TICI 3 flow) was achieved in 72% of patients. The mean time from stroke onset to maximal recanalization was 244.2 minutes ± 87.9, with a median of 232.5 minutes. The average number of device passes was 1.5, with a mean procedure time to maximal recanalization of 49.5 minutes ± 13.0. Symptomatic intracerebral hemorrhage occurred in 6% of patients. The median mRS score at 90 days was 1, and 60% of patients had a good outcome (ie, mRS score 0-2). The overall 3-month mortality rate was 14%. CONCLUSIONS: Combined revascularization with the Solitaire stent during IVT appears to be safe and effective in the treatment of acute IAO.

• Klíčová slova
• AIS, CI, IAO, ICA, IMS, IVT, Interventional Management of Stroke [trial], MCA, NIHSS, National Institutes of Health Stroke Scale, OR, TICI, acute ischemic stroke, confidence interval, internal carotid artery, intracranial arterial occlusion, intravenous thrombolysis, mRS, middle cerebral artery, modified Rankin scale, odds ratio, recombinant tissue plasminogen activator, rt-PA, thrombolysis in cerebral infarction,
• MeSH
• arteriální okluzní nemoci komplikace   diagnostické zobrazování   chirurgie   MeSH
• cévní mozková příhoda diagnostické zobrazování   etiologie   chirurgie   MeSH
• cévní protézy MeSH
• dospělí MeSH
• intrakraniální arteriální nemoci komplikace   diagnostické zobrazování   chirurgie   MeSH
• ischemie mozku komplikace   diagnostické zobrazování   chirurgie   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza přístrojové vybavení   metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• radiografie MeSH
• revaskularizace mozku přístrojové vybavení   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

The concept of functional revascularization based on proving ischemia has been strongly recommended in the practical guidelines of both European and Czech Societies of Cardiology. In daily practice, application of this concept decreases the rate of coronary interventions. Though the best clinical evidence has been provided in patients with chronic coronary syndromes, recent data strongly advocate its usage also in patients with acute coronary syndromes. Invasive pressure-derived indices: hyperemic FFRmyo (fractional flow reserve of myocardium) and resting iFR (instantaneous wave-free ratio) require an interventional procedure by wiring the diseased vessel. FFRmyo 0.80 and iFR 0.89 mean functionally significant coronary disease mostly indicated for revascularization. Besides that, there are several non-invasive functional tests that may be used for detecting ischemia: perfusion scintigraphy, cardiovascular magnetic resonance, positron emission tomography and recently developed FFRCT or quantitative flow ratio (QFR). In routine practice, the concept of functional revascularization avoids unneccessary coronary interventions and, in case of functionally non-significant disease/stenoses, the patients may be treated conservatively with a very good prognosis. Currently, the „functionally complete revascularization“, instead of the anatomic one, might become the goal of our treatment as the all-in-one concept in the cathetrization laboratory.

• Klíčová slova
• FFR, cathetrization, coronary stenosis, functional myocardial revascularization, hemodynamic significant, iFR, ischemia, revascularization,
• MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární angiografie MeSH
• koronární cévy MeSH
• koronární stenóza * MeSH
• lidé MeSH
• nemoci koronárních tepen * MeSH
• prediktivní hodnota testů MeSH
• revaskularizace myokardu MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH