PURPOSE: A chronically-occluded stent during a pelvic vein recanalization attempt was crossed extraluminally to create a new channel to bypass the affected segment after conventional methods failed. CASE REPORT: A 55-year-old male patient presented with recurrent acute deep vein thrombosis superimposed on a chronically-occluded older stent type 25 years after primary endovascular treatment. During the procedure, we used an unusual technique with extraluminal parallel stent insertion. Another recurrence 2.5 years later was treated with pharmacomechanical thrombectomy and stenting. CONCLUSION: Recanalization of venous stent occlusions often requires advanced techniques. The presented technique could be considered as an alternative approach in difficult cases. However, the level of reproducibility is currently unknown due to the lack of further data.Clinical ImpactVenous obstruction can manifest with chronic symptoms that affect daily activities and might cause severe disability. Advanced endovascular recanalization techniques have potential to improve quality of life in cases where other methods failed.

• Klíčová slova
• May-Thurner syndrome, chronic venous occlusion, deep vein thrombosis, recanalization, stent, thrombolysis,
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. METHODS: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. RESULTS: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0-2) was achieved in 28 (84.8%), 3 patients died (9.1%). CONCLUSIONS: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four(12.1%) could be positively affected. SIGNIFICANCE: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.

• Klíčová slova
• Intraoperative monitoring, Ischemic stroke, Selective shunting, Somatosensory evoked potentials, Urgent recanalization,
• MeSH
• arteria carotis interna chirurgie   MeSH
• intraoperační neurofyziologická monitorace * MeSH
• ischemie mozku * prevence a kontrola   MeSH
• lidé MeSH
• nemoci arterie carotis * chirurgie   MeSH
• prospektivní studie MeSH
• somatosenzorické evokované potenciály fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Radial artery occlusion complicates transradial access, limiting future access and precluding bypass grafting and dialysis. Distal radial access offers a promising solution by allowing retrograde recanalization of occluded radial arteries. OBJECTIVES: The authors sought to evaluate multicenter outcomes of radial artery recanalization though distal radial access (DRA), focusing on its safety, efficacy, and reproducibility, while identifying procedural strategies to optimize patency. METHODS: This international registry included 110 patients with radial artery occlusion from 7 centers. Operators with substantial DRA experience (>200 procedures) performed retrograde recanalization through DRA in the anatomical snuffbox using mainly a drilling or knuckling technique to cross the occlusion and dotter dilation ("dotterization") or balloon angioplasty to dilate it. Outcomes included procedural success and radial artery patency at 31 (30-32) days. RESULTS: Procedural success was achieved in 94% of cases (95% CI: 88%-97%), with acute complications managed conservatively. Radial artery patency at 30 days was 80% (95% CI: 72%-86%). Multivariable analysis identified sheathless approach as the only significant predictor of patency (OR: 3.07; 95% CI: 1.10-8.59), whereas use of sheaths >6-F (OR: 0.15; 95% CI: 0.02-0.97) and balloon >2.25 mm (OR: 0.10; 95% CI: 0.01-0.92) were associated with decreased patency. CONCLUSIONS: Recanalization of occluded radial arteries through DRA is a safe, effective, and reproducible procedure with the primary benefit to maintaining the safest vascular access option. A dotterization technique using sheaths ≤6-F or, even better, a sheathless approach should be preferred as it appears to be associated with improved patency at 30 days.

• Klíčová slova
• distal radial access, radial artery occlusion, retrograde recanalization, sheathless, transradial access,
• MeSH
• arteria radialis * patofyziologie   diagnostické zobrazování   MeSH
• arteriální okluzní nemoci * patofyziologie   terapie   diagnostické zobrazování   etiologie   diagnóza   MeSH
• balónková angioplastika * škodlivé účinky   metody   MeSH
• časové faktory MeSH
• dialýza ledvin * MeSH
• lidé středního věku MeSH
• lidé MeSH
• periferní katetrizace * škodlivé účinky   metody   MeSH
• průchodnost cév * MeSH
• punkce MeSH
• registrace MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza 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
• pozorovací studie MeSH

OBJECTIVE: Changes in the N20/P25 amplitude of somatosensory evoked potentials (SEP) of the median nerve have been found to correlate with those in cortical regional cerebral blood flow (rCBF). Our study presents the use of median nerve SEP amplitude in predicting the clinical outcome of urgent surgical internal carotid artery (ICA) recanalization. METHODS: A total of 27 patients suffering an acute ischemic stroke (AIS) with extracranial ICA occlusion within 24 h were prospectively recruited. The primary preoperative endpoints included the SEP amplitude absolute value (SEP-amp) and the SEP amplitude side-to-side ratio (SEP-ratio). Clinical outcome at 3 months postoperatively was assessed using the modified Rankin scale (mRS-3M). RESULTS: The positive predictive values (PPVs) for SEP-amp and SEP-ratio were 95.5% and 100%, respectively, with the negative predictive values (NPVs) being 60.0% and 100%, respectively. The SEP-ratio correlated fully with mRS-3M. CONCLUSION: The median SEP side-to-side N20/P25 amplitude ratio seems to be a very strong positive and negative predictor of the clinical outcome of urgent recanalization of an extracranial ICA occlusion. SIGNIFICANCE: The results suggest that cortical evoked activity may help in selection patient for surgical recanalization and predict clinical recovery after an acute ischemic stroke.

• Klíčová slova
• Amplitude ratio, Evoked neuronal activity, Ischemic stroke, Outcome prediction, Somatosensory evoked potentials, Urgent recanalization,
• MeSH
• arteria carotis interna patofyziologie   chirurgie   MeSH
• ischemická cévní mozková příhoda diagnóza   chirurgie   MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• somatosenzorické evokované potenciály * MeSH
• výkony cévní chirurgie škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: To compare the association of different measures of intracranial thrombus permeability on non-contrast computerized tomography (NCCT) and computed tomography angiography (CTA) with recanalization with or without intravenous alteplase. METHODS: Patients with anterior circulation occlusion from the INTERRSeCT study were included. Thrombus permeability was measured on non-contrast CT and CTA using the following methods: [1] automated method, mean attenuation increase on co-registered thin (< 2.5 mm) CTA/NCCT; [2] semi-automated method, maximum attenuation increase on non-registered CTA/NCCT (ΔHUmax); [3] manual method, maximum attenuation on CTA (HUmax); and [4] visual method, residual flow grade. Primary outcome was recanalization with intravenous alteplase on the revised AOL scale (2b/3). Regression models were compared using C-statistic, Akaike (AIC), and Bayesian information criterion (BIC). RESULTS: Four hundred eighty patients were included in this analysis. Statistical models using methods 2, 3, and 4 were similar in their ability to discriminate recanalizers from non-recanalizers (C-statistic 0.667, 0.683, and 0.634, respectively); method 3 had the least information loss (AIC = 483.8; BIC = 492.2). A HUmax ≥ 89 measured with method 3 provided optimal sensitivity and specificity in discriminating recanalizers from non-recanalizers [recanalization 55.4% (95%CI 46.2-64.6) when HUmax > 89 vs. 16.8% (95%CI 13.0-20.6) when HUmax ≤ 89]. In sensitivity analyses restricted to patients with co-registered CTA/NCCT (n = 88), methods 1-4 predicted recanalization similarly (C-statistic 0.641, 0.688, 0.640, 0.648, respectively) with Method 2 having the least information loss (AIC 104.8, BIC 109.8). CONCLUSION: Simple methods that measure thrombus permeability are as reliable as complex image processing methods in discriminating recanalizers from non-recanalizers.

• Klíčová slova
• Acute ischemic stroke, CTA, NCCT, Recanalization therapies, Thrombus permeability,
• MeSH
• Bayesova věta MeSH
• CT angiografie metody   MeSH
• fibrinolytika terapeutické užití   MeSH
• intrakraniální trombóza diagnostické zobrazování   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie metody   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   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
• srovnávací studie MeSH
• Názvy látek
• fibrinolytika MeSH
• tkáňový aktivátor plazminogenu MeSH

BACKGROUND AND PURPOSE: Although onset-to-treatment time is associated with early clinical recovery in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA), the effect of the timing of tPA-induced recanalization on functional outcomes remains debatable. METHODS: We conducted a multicenter, prospective observational cohort study to determine whether early (within 1-hour from tPA-bolus) complete or partial recanalization assessed during 2-hour real-time transcranial Doppler monitoring is associated with improved outcomes in patients with proximal occlusions. Outcome events included dramatic clinical recovery (DCR) within 2 and 24-hours from tPA-bolus, 3-month mortality, favorable functional outcome (FFO) and functional independence (FI) defined as modified Rankin Scale (mRS) scores of 0-1 and 0-2 respectively. RESULTS: We enrolled 480 AIS patients (mean age 66±15 years, 60% men, baseline National Institutes of Health Stroke Scale score 15). Patients with early recanalization (53%) had significantly (P<0.001) higher rates of DCR at 2-hour (54% vs. 10%) and 24-hour (63% vs. 22%), 3-month FFO (67% vs. 28%) and FI (81% vs. 39%). Three-month mortality rates (6% vs. 17%) and distribution of 3-month mRS scores were significantly lower in the early recanalization group. After adjusting for potential confounders, early recanalization was independently associated with higher odds of 3-month FFO (odds ratio [OR], 6.19; 95% confidence interval [CI], 3.88 to 9.88) and lower likelihood of 3-month mortality (OR, 0.34; 95% CI, 0.17 to 0.67). Onset to treatment time correlated to the elapsed time between tPA-bolus and recanalization (unstandardized linear regression coefficient, 0.13; 95% CI, 0.06 to 0.19). CONCLUSIONS: Earlier tPA treatment after stroke onset is associated with faster tPA-induced recanalization. Earlier onset-to-recanalization time. RESULTS: in improved functional recovery and survival in AIS patients with proximal intracranial occlusions.

• Klíčová slova
• Outcomes, Reperfusion, Stroke, Thrombolysis,
• Publikační typ
• časopisecké články MeSH

The interventional management of stroke may consist of the use of angioplasty, stenting or mechanical thrombus removal technique. For this purpose several retrieval devices are being used. Recently the new alternative device - EkoSonicSV has been introduced, which is particularly suitable for recanalization of the occluded basilar artery (BA). Here we are presenting a complete recanalization of BA using this device in two patients with stroke over a short period of time together with the intra-arterial use of recombinant tissue plasminogen activator and application of intravascular ultrasound.

• MeSH
• cévní mozková příhoda etiologie   terapie   MeSH
• design vybavení MeSH
• digitální subtrakční angiografie MeSH
• endovaskulární výkony přístrojové vybavení   MeSH
• fibrinolytika aplikace a dávkování   MeSH
• intraarteriální infuze MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozková angiografie MeSH
• tkáňový aktivátor plazminogenu aplikace a dávkování   MeSH
• trombolytická terapie přístrojové vybavení   MeSH
• ultrazvuková terapie přístrojové vybavení   MeSH
• vertebrobazilární insuficience komplikace   diagnostické zobrazování   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• fibrinolytika MeSH
• tkáňový aktivátor plazminogenu MeSH

PURPOSE: To demonstrate the feasibility of irreversible electroporation (IRE) for treating biliary metal stent occlusion in an experimental liver model. METHODS AND MATERIALS: IRE was performed using an expandable tubular IRE-catheter placed in nitinol stents in the porcine liver. A 3-electrode IRE-catheter was connected to an IRE-generator and one hundred 100μs pulses of constant voltage (300, 650, 1000, and 1300 V) were applied. Stent occlusion was simulated by insertion of liver tissue both ex vivo (n = 94) and in vivo in 3 pigs (n = 14). Three scenarios of the relationship between the stent, electrodes, and inserted tissue (double contact, single contact, and stent mesh contact) were studied. Electric current was measured and resistance and power calculated. Pigs were sacrificed 72 h post-procedure. Harvested samples (14 experimental, 13 controls) underwent histopathological analysis. RESULTS: IRE application was feasible at 300 and 650 V for the single and double contact setup in both ex vivo and in vivo studies. Significant differences in calculated resistance between double contact and single contact settings were observed (ex-vivo p ˂ 0.0001, in-vivo p = 0.02; Mann-Whitney). A mild temperature increase of the surrounding liver parenchyma was noted with increasing voltage (0.9-5.9 °C for 300-1000 V). The extent of necrotic changes in experimental samples in vivo correlated with the measured electric current (r2 = 0.39, p = 0.01). No complications were observed during or after the in-vivo procedure. CONCLUSION: Endoluminal IRE using an expandable tubular catheter in simulated metal stent occlusion is feasible. The relationship of active catheter electrodes to stent ingrowth tissue can be estimated based on resistance values.

• Klíčová slova
• Irreversible electroporation, experimental model, metal stent occlusion, metal stent recanalization, thermocamera,
• MeSH
• ablace * MeSH
• elektroporace * MeSH
• katétry MeSH
• prasata MeSH
• stenty MeSH
• teoretické modely MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND AND PURPOSE: Recanalization is the important outcome measure for acute stroke therapy. Several methods of recanalization assessment are used in clinical practice, but few studies have addressed their reliability. We, therefore, sought to assess interobserver reliability of the diagnosis of intracranial artery recanalization following intervention by using TIMI criteria. MATERIALS AND METHODS: The digital angiography scans of all patients with acute ischemic stroke during 2009 undergoing DSA and endovascular procedures at Ostrava University Hospital were assessed in the study. Images were retrospectively evaluated for intracranial artery recanalization on the TIMI scale by 2 experienced neuroradiologists who were blinded to clinical findings and to each other. RESULTS: The angiography scans of 43 patients (16 females; age, 70.5 ± 14 years; median baseline NIHSS score, 15 [IQR, 11-18]) were retrospectively evaluated in our study. At 3 months, 27% of patients had mRS scores ≤ 2 and mortality was 18%. Two radiologists diagnosed TIMI grades as follows: TIMI 0, 16%, and 16%; TIMI 1, 21%, and 8%; TIMI 2a, 32% and 29%; TIMI 2b, 13% and 16%; TIMI 3, 18, and 31%. Interobserver agreement for recanalization was weighted κ = 0.4 (95% CI, 0.2-0.6). CONCLUSIONS: The diagnosis of recanalization after interventional procedures was found to have poor interobserver agreement between 2 experienced neuroradiologists. TIMI criteria, therefore, do not permit reliable comparison of the efficacy of recanalization therapy among different studies.

• MeSH
• cévní mozková příhoda diagnostické zobrazování   etiologie   chirurgie   MeSH
• ischemie mozku komplikace   diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• mozková angiografie metody   MeSH
• odchylka pozorovatele MeSH
• prognóza MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• revaskularizace mozku metody   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• vylepšení rentgenového snímku metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Collaterals improve recanalization in acute ischemic stroke patients treated with intravenous thrombolysis, but the mechanisms are poorly understood. To investigate it, an in vitro flow model of the middle cerebral artery was developed with or without collaterals. An occlusion was achieved using human blood clots. Recanalization time, thrombolysis (clot length decrease and red blood cell (RBC) release), pressure gradient across the clot and clot compaction were measured. Results showed that with or without collateral alteplase-treated RBC dominant clots showed recanalization time 98±23 min vs 130±35 min (difference 32 min, 95% CI -6-58 min), relative clot reduction 31.8±14.9% vs 30.3±13.2% (difference 1.5%, 95% CI 10.4-13.4%) and RBC release 0.30±0.07 vs 0.27±0.09 (difference 0.03, 95% CI 0.04-0.10). Similar results were observed with fibrin-dominant clots. In RBC dominant clots, the presence vs absence of collateral caused different pressure gradients across the clot 0.41±0.09 vs 0.70±0.09 mmHg (difference 0.29 mmHg, 95% CI -0.17-0.41 mmHg), and caused the reduction of initial clot compaction by 5%. These findings align with observations in patients, where collaterals shortened recanalization time. However, collaterals did not increase thrombolysis. Instead, they decreased the pressure gradient across the clot, resulting in less clot compaction and easier distal displacement of the clot.

• MeSH
• arteria cerebri media účinky léků   patofyziologie   diagnostické zobrazování   MeSH
• erytrocyty účinky léků   MeSH
• fibrinolytika terapeutické užití   farmakologie   MeSH
• ischemická cévní mozková příhoda * farmakoterapie   patofyziologie   MeSH
• kolaterální oběh * účinky léků   MeSH
• lidé MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   farmakologie   MeSH
• trombolytická terapie metody   MeSH
• trombóza farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• fibrinolytika MeSH
• tkáňový aktivátor plazminogenu MeSH