The role of neurologist in acute ischemic stroke

Aleš Tomek

Cor Vasa 2016, 58(2):e181-e182 | DOI: 10.1016/j.crvasa.2016.02.008  

More than one third of cardiovascular mortality globally is caused by cerebrovascular diseases. Although the ischemic stroke shares the same risk factors as other subtypes of cardiovascular diseases, the clinical picture and treatment is distinct and different. The rapid development of treatment modalities of ischemic stroke merits a new subspecialty of neurology - cerebrovascular neurology. The practice of this emerging subspecialty requires an interdisciplinary approach that incorporates the knowledge of relevant aspects of basic science, clinical neurology, vascular neurosurgery, internal medicine, cardiology, diagnostic and interventional radiology,...

Acute stroke intervention: The heart of the matter

L. Nelson Hopkins

Cor Vasa 2016, 58(2):e183-e184 | DOI: 10.1016/j.crvasa.2016.02.014  

Why special issue of Cor et Vasa dedicated to stroke?

Michael Aschermann

Cor Vasa 2016, 58(2):e185-e186 | DOI: 10.1016/j.crvasa.2016.03.003  

How many years it will take to implement the new stroke guidelines for the benefit of all suitable patients with acute ischemic stroke in Europe?

Petr Widimský

Cor Vasa 2016, 58(2):e212-e214 | DOI: 10.1016/j.crvasa.2016.03.004  

Time for brain

Ivan Vulev

Cor Vasa 2016, 58(2):e233 | DOI: 10.1016/j.crvasa.2016.02.010  

Stent or balloon: How to treat proximal internal carotid artery occlusion in the acute phase of ischemic stroke? Results of a short survey

Petr Widimský, Boris Kožnar, Mark Abelson, Peter Blaško, Peter Lanzer, Mikael Mazighi, Martijn Meuwissen, Václav Procházka, Horst Sievert, Joost de Vries, L. Nelson Hopkins

Cor Vasa 2016, 58(2):e204-e206 | DOI: 10.1016/j.crvasa.2016.02.006  

This short survey presents authors views on three questions related to endovascular treatment of acute ischemic stroke patients with critical stenosis of proximal internal carotid artery either alone or combined with a more distal intracranial artery occlusion. Approximately 15% of patients with acute stroke undergoing interventional treatment present with this condition. The interventional strategy varies from balloon dilatation followed by mechanical thrombectomy to carotid stenting preceeded or followed by mechanical thrombectomy. Antithrombotic treatment also varies from immediate dual antiplatelet therapy to therapy postponed after control CT...

The importance of time: Time delays in acute stroke

Giuseppe Marchese, Bohumír Procházka, Petr Widimský

Cor Vasa 2016, 58(2):e225-e232 | DOI: 10.1016/j.crvasa.2016.03.002  

Background: Endovascular treatment (EVT) of severe acute ischemic stroke (AIS) determined by large vessel occlusion (LVO) is effective and safe. Debate still goes on especially about time importance and utilization of advanced penumbra imaging at the expense of losing valuable minutes.Methods: We did a meta-analysis focused on time of randomized clinical trials (RCTs) that started to use methodically the new-tech stent retrievers. The chosen time interval was onset-groin time (from last seen well to sheath insertion in the cathlab). Primary outcome was good functional outcome (mRS of 0-2) at 90 days, secondary outcomes were mortality at 90 days...

Simultaneous coronary and carotid revascularisation

Jiří Ničovský, Jiří Ondrášek, Pavel Piler, Robert Wágner, Tomáš Ostřížek, Vladimír Horváth, Petr Němec

Cor Vasa 2016, 58(2):e234-e237 | DOI: 10.1016/j.crvasa.2016.01.005  

Introduction: Coronary artery disease is the most frequent cardiovascular disease at all. Combination of coronary and carotid artery disease due to multisystem atherosclerosis is an indicator of impaired prognosis. Patients with existing coronary artery disease who undergo carotid endarterectomy (CEA) are at high risk of developing perioperative myocardial infarction. There is also increased risk of perioperative stroke in patients with severe carotid artery stenosis who undergo coronary artery bypass grafting (CABG). There is possibility to perform simultaneous CEA/CABG in selected cases to prevent these severe complications.Materials and methods:...

Impact of different perioperative intraluminal shunt insertion methods on final patient outcomes after carotid endarterectomy in a sample of 250 patients

Pavel Haninec, Filip Šámal, Tomáš Peisker, Richard Brzezny

Cor Vasa 2016, 58(2):e238-e241 | DOI: 10.1016/j.crvasa.2016.02.004  

Background and purpose: Carotid endarterectomy (CEA) is a common and effective surgical method of stroke prevention. The procedure is performed under general anesthesia and is usually accompanied by simultaneous intraoperative somatosensory evoked potential (SEP) monitoring. If a more than 50% decrease in N20/P25 SEP wave amplitude in 3 or more recordings occurs during surgery, a shunt is inserted. Shunt surgery is associated with higher risk of vessel wall injury and possible central embolization. In an effort to minimize the number of shunted patients, we modified shunt insertion timing criteria according to intraoperative SEP changes and reviewed...

The key messages from 2015 North American (US and Canada) Guidelines for the Early Management of Patients With Acute Ischemic Stroke: Focus on endovascular treatment

Petr Widimský

Cor Vasa 2016, 58(2):e187-e192 | DOI: 10.1016/j.crvasa.2015.11.009  

Recently published randomized trials collected large evidence supporting endovascular interventions as the most effective treatment of acute ischemic stroke. The first two scientific societies (one in the US, another in Canada) reflected this evidence into new guidelines. The key messages along with the personal view of the author are presented in this manuscript.

Mechanical thrombectomy: Stent retrievers vs. aspiration catheters

Andrew A. Fanous, Adnan H. Siddiqui

Cor Vasa 2016, 58(2):e193-e203 | DOI: 10.1016/j.crvasa.2016.01.004  

Mechanical thrombectomy, in conjunction with systemic thrombolysis, is currently the standard of care for the treatment of acute ischemic stroke. Mechanical thrombectomy extends the therapeutic window up to at least 8 hours from the time of symptom onset and is more efficient than systemic thrombolytic agents in removing clots resistant to enzymatic degradation. It is also a viable option for patients with various contraindications against the use of systemic thrombolysis. Treatment of patients with acute ischemic strokes using mechanical thrombectomy devices has yielded both higher rates of revascularization as well as superior clinical outcomes when...

The selections of acute stroke patients for catheter based intervention

Talip Asil, Tugce Ozdemir Gultekin

Cor Vasa 2016, 58(2):e207-e211 | DOI: 10.1016/j.crvasa.2016.02.002  

Administration of intravenous thrombolytic agents within the first 4.5 h after initial presentation has been used as a reliable therapy for many years in patients with acute ischemic stroke. However, more efficient therapeutic strategies are warranted due to high complication and low treatment success rate with thrombolytic agents, particularly in patients with proximal arterial occlusion. After the completion of the most recent randomized controlled trials, endovascular treatments in conjunction with intravenous thrombolytic agents have been regarded as an integral part of management in this condition. Endovascular treatments with retrievable stents...

Role of CT perfusion in acute stroke management

Stephan A. Munich, Hakeem J. Shakir, Kenneth V. Snyder

Cor Vasa 2016, 58(2):e215-e224 | DOI: 10.1016/j.crvasa.2016.01.008  

Acute ischemic stroke is a leading cause of adult disability worldwide. Modern endovascular treatment for acute ischemic stroke is predicated on advanced imaging modalities and the identification of salvageable tissue. Unlike noncontrast computed tomographic (CT) imaging or traditional magnetic resonance imaging, CT perfusion (CTP) imaging offers an active view of cerebrovascular physiology with multiple parameters involved. Though limited by the different equipment and analytic software used to quantitatively assess the extent of ischemia and penumbra, CTP imaging nevertheless serves as an excellent tool for neurointerventionists. The rapidity by...

Cardiac surgery interventions for stroke prevention in patients with atrial fibrillation

Petr Budera, Zbyněk Straka

Cor Vasa 2016, 58(2):e242-e249 | DOI: 10.1016/j.crvasa.2016.01.015  

Atrial fibrillation (AF) is the most frequent cause of stroke. Surgical ablation of AF presents a rapidly evolving area in cardiac surgery. Concomitant procedures and operations for stand-alone AF have been considered safe and effective in sinus rhythm restoration. Their clinical effect in stroke prevention, as well as the effect of elimination of the left atrial appendage, is less clear. In this article we summarize current cardiac surgery procedures for AF treatment and LAA elimination with special regard to their efficacy in stroke prevention.

Percutaneous closure of left atrial appendage for stroke prevention

Petr Neužil, Tomáš Mráz, Jan Petrů, Pavel Hála, Martin Mates, Petr Kmoníček, Milena Prokopová, Vivek Y. Reddy

Cor Vasa 2016, 58(2):e250-e260 | DOI: 10.1016/j.crvasa.2016.02.007  

Transcatheter left atrial appendage closure (LAAC) is an alternative therapy for stroke prevention in atrial fibrillation (AF) patients. There are increasing data supporting this ''local'' prevention of thromboembolism in the patients with high-risk CHA2DS2-VASc score. LAAC might be a very important alternative in patients with limitations/contraindication to the anticoagulation therapy. Two main randomized clinical trials data indicated the utility and safety of WATCHMAN LAAC device for stroke prevention in patients with AF as a non-inferior treatment strategy. Despite overall effectiveness showed for all currently used mechanical occluders (prospective,...

The role of echocardiography in patients after ischemic stroke

Martin Hutyra, Luděk Pavlů, Daniel Šaňák, Jan Přeček, Martin Köcher, Zbyněk Tüdös, Tomáš Skála, Ondřej Moravec, David Vindiš, Miloš Táborský

Cor Vasa 2016, 58(2):e261-e272 | DOI: 10.1016/j.crvasa.2016.02.003  

Therapy of acute phase of ischemic central vascular accident is focused on immediate actions to suppress the severity of damage with the earliest possible initiation of reperfusion strategy together with initiation and maintenance of adequate therapy to prevent further cerebral reinfarctions. The key factor for adequate and effective secondary prevention is elucidation of the etiology of ischemic central vascular accident because the risk of brain reinfarction is the highest in the first weeks after the primary event. The exclusion of potential cardiac or vascular sources of embolization into the cerebrovascular system is essential in choosing adequate...

Carotid ultrasound in primary and secondary prevention of stroke

Alena Lorenzová

Cor Vasa 2016, 58(2):e273-e278 | DOI: 10.1016/j.crvasa.2016.02.012  

Imaging methods play an important role in management of patients with acute stroke or chronic cerebrovascular disease. Carotid ultrasound is a widely used method, thanks to its noninvasivity and wide accessibility. This review article deals with indications for carotid ultrasound examination in primary and secondary prevention. It presents current criteria for carotid stenosis assessment: calculation of the percentage of the stenosis, velocity criteria and the morphology of the plaque. Also accuracy of the method is analysed. In conclusion, carotid ultrasound is a reliable diagnostic tool that has an important role in the diagnosis and grading of the...

The role of arterial hypertension in the primary prevention of stroke

Jiří Widimský

Cor Vasa 2016, 58(2):e279-e286 | DOI: 10.1016/j.crvasa.2015.11.005  

Hypertension belongs to the most important modifiable risk factors of cerebrovascular diseases and stroke. Home or 24-hour ambulatory blood pressure measurement (ABPM) are preferable measurements of blood pressure. Nonpharmacologic treatment should include smoking abstinence, overweight reduction, restriction of alcohol intake and moderate consumption of salt.Evidence based clinical studies have convincingly proved that drug therapy decreases the incidence of cerebrovascular diseases and stroke by 40-60%. Systolic blood pressure is more important than diastolic blood pressure in the elderly patients, in whom the majority of cerebrovascular diseases...

A case of successful interventional treatment in acute basilar artery occlusion

Ivo Petrov, Marko Klissurski, Sevim Halibryam, Galina Georgieva-Kozarova, Vesela Stoynova

Cor Vasa 2016, 58(2):e287-e291 | DOI: 10.1016/j.crvasa.2016.01.014  

We describe a case of successful recanalisation and favorite clinical outcome of a patient with acute basilar artery occlusion (BAO) and interventional treatment (IT). A 67-year old patient presented in a comatose state, with quadriplegia, and decerebrate posturing. His initial Glasgow-Liege Coma Scale (GLCS) score was 11, Institutes of Health Stroke Scale (NIHSS) 24, and modified Rankin Scale (mRS) 5. Non-contrast CT was performed before IT. Due to suspicion of BAO, an immediate cerebral angiography was performed. It demonstrated BAO in the middle and distal segment. Intra-arterial catheter based treatment was performed including balloon angioplasty...

Zamyšlení nad knihou prof. MUDr. J. Kautznera, CSc., a doc. V. Melenovského, Ph.D., Srdeční selhání (Mladá fronta, 2015) a recenzí prof. MUDr. J. Petráška, DrSc.

MUDr. Pavel Jerie

Cor Vasa 2016, 58(2):307  

Zápis ze schůze výboru ČKS konané 20. října 2015 v kanceláři ČKS v Praze

L. Klímová, M. Táborský, T. Bracková

Cor Vasa 2016, 58(2):309-311  

Jan Václavík: Obtížně léčitelná hypertenze

Prof. MUDr. Jan Petrášek, DrSc.

Cor Vasa 2016, 58(2):305  

MUDr. Karel Roztočil, CSc., předseda České angiologické společnosti, se v březnu 2016 dožil 75 let

MUDr. Jiří Spáčil, CSc., MUDr. Alena Broulíková, CSc.

Cor Vasa 2016, 58(2):304  

Editorial Board

Editorial board

Cor Vasa 2016, 58(2):i | DOI: 10.1016/S0010-8650(16)30025-X