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Background: In patients with vertebral artery origin (VAO) stenosis and concomitant stenoses of other cerebral feeding arteries, data on the risk of percutaneous transluminal angioplasty (PTA) alone and with stent placement (PTAS) for VAO stenosis are limited. We aimed to determine how the presence of polystenotic lesions in other cerebral feeding arteries and concomitant carotid artery stenting (CAS) affect the periprocedural risk and long-term effect of PTA/S for atherosclerotic VAO stenosis. Methods: In a retrospective descriptive study, consecutive patients treated with PTA/S for ≥70% VAO stenosis were divided into groups with isolated VAO stenosis and multiple stenoses. We investigated the rate of periprocedural complications in the first 72 h and the risk of restenosis and ischemic stroke (IS)/transient ischemic attack (TIA) during the follow-up period. Results: In a set of 66 patients aged 66.1 ± 9.1 years, polystenotic lesions were present in 56 (84.8%) patients. 21 (31.8%) patients underwent endovascular treatment for stenosis of one or more other arteries in addition to VAO stenosis (15 underwent CAS). During the periprocedural period, no patient suffered from an IS or died, and, in the polystenotic group with concomitant CAS, there was one case of TIA (1.6%). During a mean follow-up period of 36 months, we identified 8 cases (16.3%) of ≥50% asymptomatic VA restenosis, and, in the polystenotic group, 4 (8.9%) cases of IS. Conclusion: The presence of severe polystenotic lesions or concomitant CAS had no adverse effect on the overall low periprocedural risk of PTA/S of VAO stenosis or the risk of restenosis during the follow-up period. [ABSTRACT FROM AUTHOR]

We aimed was to assess the factors influencing therapy choice and clinical outcome after 3–4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3–4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0–1). Multivariate logistic regression analysis was used for statistical evaluation. After 3–4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome. [ABSTRACT FROM AUTHOR]

The authors present an overview of the trend in endovascular procedure rates for ischemic stroke during the last six years. Mechanical thrombectomy (MT) gained the highest level of evidence in 2015 when positive results of several studies comparing the clinical outcome of MT with intravenous thrombolysis using recombinant tissue plasminogen activator were published. MT has become the most frequent endovascular therapeutic procedure on cerebral vessels. In order to provide this therapy, there has been an active geographical system of qualified cerebrovascular centers at two levels in the Czech Republic since 2010. The authors give a survey of possibilities how to increase the effectiveness of the existing system in terms of both quantitative and qualitative aspects. [ABSTRACT FROM AUTHOR]

Real-world data report worse 3-month clinical outcomes in elderly patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). The aim was to identify factors influencing clinical outcome in elderly patients with anterior circulation AIS treated with MT (±intravenous thrombolysis (IVT)). In a retrospective, monocentric study, analysis of prospectively collected data of 138 patients (≥80 years) was performed. IVT was an independent negative predictor (OR 0.356; 95% CI: 0.134–0.942) and female sex an independent positive predictor (OR 4.179, 95% CI: 1.300–13.438) of 3-month good clinical outcome (modified Rankin scale 0–2). Female sex was also an independent negative predictor of 3-month mortality (OR 0.244, 95% CI: 0.100–0.599). Other independent negative predictors of 3-month good clinical outcome were older age, lower pre-stroke self-sufficiency, more severe neurological deficit and longer procedural intervals. Mortality was also independently predicted by longer procedural interval and by the occurrence of symptomatic intracerebral hemorrhage (p < 0.05 in all cases). Our results demonstrated, that in patients aged ≥80 years with anterior circulation AIS undergoing MT (±IVT), IVT reduced the chance of 3-month good clinical outcome and female sex was associated with a greater likelihood of 3-month good clinical outcome and lower probability of 3-month mortality. [ABSTRACT FROM AUTHOR]

Purpose: Spinal selective angiography (SSA) is due to its extension one of the most demanding angiographic studies with high radiation dose. The retrospective study analysed single centre experience with the most frequent indication which was the dural arteriovenous fistula (dAVF) location during last 5 years. Methods: There were 50 SSAs performed in our department between 2014 and 2019. The study included 31 patients with suspection on the dAVF of average age 65.7 years ( ranged from 25 to 90 years). All patients had at least one MR imaging of the spine for peripheral paresis, and/or urinary problems. Indication for the SSA was done by a neurologist, neurosurgeon or interventional neuroradiologist. The SSA were performed from femoral approach in local anesthesia using biplane angiographic machine. Selective injections of the intercostal and lumbal arteries were registered during procedure, to prevent repeating or skipping of some levels. Numbers of angiographic runs, positive finding of dAVF, location of radiculomedullary and radiculopial arteries, and radiaton doses were recorded in each examination. Results: There were 31 patients indicated for suspection of the dAVF out of 50 patients indicated for the SSA. The dAVF was confirmed in 26 (83%) patients. The SSA had 22.3 angiographic runs (ranged 6-37 runs). The dAVF feeders were equally distributed on the right and left side with two maximum peaks. The cranial peak was at the level of T6 a T7, caudal one was at L1. The thoracolumbal dAVFs occurred in patients above the age of 48 years and more often in men than in women (69% versus 31%). The radiculomedullary arteries arised more often on the left side than on the right (69% versus 31%). Discussion: The study revealed that keeping strict angiographic protocol, the dAVF feeders can be proved in 83% patients suspected for thoracolumbal dAVF and origin of the radiculomedullary arteries is localised too. Age, gender, craniocaudal location of the dAVF, and extension of the SSA were studied as well. [ABSTRACT FROM AUTHOR]

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase; p = 0.036, and by 24.56 ± 8.42 min; p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min; p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min; p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min; p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min; p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min; p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms. [ABSTRACT FROM AUTHOR]