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Abstract Background Following failure of standard systemic chemotherapy, the role of hepatic transarterial therapy for colorectal hepatic metastasis continues to evolve as the experience with this technique matures. The aim of this study to gain a better understanding of the value of drug eluting bead therapy when administered to patients with unresectable colorectal hepatic metastasis. Methods This was an open-label, multi-center, single arm study, of unresectable colorectal hepatic metastasis patients who had failed standard therapy from 10/2006-10/2008. Patients received repeat embolizations with Irinotecan loaded beads(max 100 mg per embolization) per treating physician's discretion. Results Fifty-five patients underwent 99 treatments using Irinotecan drug eluting beads. The median number of total treatments per patient was 2(range of 1-5). Median length of hospital stay was 23 hours(range 23 hours - 10 days). There were 30(30%) sessions associated with adverse reactions during or after the treatment. The median disease free and overall survival from the time of first treatment was 247 days and 343 days. Six patients(10%) were downstaged from their original disease status. Of these, four were treated with surgery and two with RFA. Neither number of liver lesions, size of liver lesions or extent of liver replacement(25%) were predictors of overall survival. Only the presence of extrahepatic disease(p = 0,001), extent of prior chemotherapy (failed 1st and 2nd line vs > 2 line failure)(p = 0,007) were predictors of overall survival in multivariate analysis. Conclusion Chemoembolization using Irinotecan loaded beads was safe and effective in the treatment of patients as demonstrated by a minimal complication rate and acceptable tumor response.

Vein of Galen aneurysmal malformation is a rare life threatening congenital malformation of cerebral vessels. Size and type of malformation has a major influence on clinical manifestations especially on hemodynamics. In the neonatal period the most common type is choroidal which causes heart failure in the newborn shortly after birth or even prenatally. Patients need multidisciplinary approach. Causal therapy belongs to the hands of interventional radiologists. Thanks to these methods and highly specialized care in neonatal intensive care units the mortality of these patients is no longer 100% as in the 20th century. Nevertheless, it is still a disease with high mortality and morbidity. The article is supplemented with a short overview of our patients from the last 12 years. [ABSTRACT FROM AUTHOR]

Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Czecho-Slovak Pediatrics / Česko-Slovenská Pediatrie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Given the paucity of high-quality safety/efficacy data on acute stroke therapies in patients with premorbid disability, they risk being routinely excluded from such therapies. We examined utilization of endovascular thrombectomy (EVT), associated workflow, and poststroke outcomes among patients with vs without premorbid disability., Methods: We used national registry data on thrombolysis/EVT for the Czech Republic from 1 January 2016 to 31 December 2020. Premorbid disability was defined as prestroke modified Rankin Scale score (mRS) ≥3. We compared proportions of patients with vs without premorbid disability who received EVT and examined workflow times. We compared ΔmRS-change in mRS from prestroke to 3 months-in patients with vs without premorbid disability, in addition to intracerebral hemorrhage (ICH), mortality, and discharge NIHSS (National Institutes of Health Stroke Scale score), adjusting for age, sex, baseline NIHSS, and comorbidities, and verified using propensity score weighting (PSW) and matching for differences in treatment assignment. We stratified by age group (<65, 65-74, 75-84, ≥85 years) to explore outcome heterogeneity with vs without premorbid disability., Results: Among 22,405 patients with ischemic stroke who received thrombolysis/EVT/both, 1,712 (7.6%) had prestroke mRS ≥ 3. Patients with prestroke disability were less likely to receive EVT vs those without (10.1% vs 20.7%, aOR: 0.30, 95% CI 0.24-0.36). When treated, they had longer door-to-arterial puncture times (median: 75 minutes, IQR: 58-100 vs 54, IQR: 27-77, adjusted difference: 12.5, 95% CI 2.68-22.3). Patients with prestroke disability receiving thrombolysis/EVT/both had worse ΔmRS (adjusted rate ratio, aIRR on PSW: 1.57, 95% CI 1.43-1.72), rates of 3-month mRS 5-6, discharge NIHSS, and mortality (aOR-PSW [mortality]: 2.54, 95% CI 1.92-3.34), while ICH did not significantly differ. 32.1% of patients with prestroke disability receiving thrombolysis/EVT/both successfully returned to prestroke state, but this proportion ranged from 19.6% for those older than 85 years to 66.0% for those younger than 65 years. Regardless of premorbid disability, EVT was associated with better outcomes including lower ΔmRS (aIRR-PSW: 0.87, 95% CI 0.83-0.91) and mortality, with no interaction of treatment effect by premorbid disability status (e.g., mortality p interaction = 0.73). EVT recipients with premorbid disability did not differ significantly for several outcomes including ΔmRS (aIRR: 0.99, 95% CI 0.84-1.17) but were more likely to have 3-month mRS 5-6 (70.1% vs 39.5% without premorbid disability, aOR: 1.85, 95% CI 1.12-3.04)., Discussion: Patients with premorbid disability were less likely to receive EVT, had slower treatment times, and had worse outcomes compared with patients without premorbid disability. However, regardless of premorbid disability, patients fared better with EVT vs medical management and one-third with prestroke disability returned to their prestroke status., Competing Interests: O. Volny and R. Mikulik report a financial support from the STROCZECH research infrastructure within the CZECRIN Large Research Infrastructure (No. LM2023049), funded by the state budget of the Czech Republic. O. Volny reports a research support from the University Ostrava—The Rector's Award 2022 for young academic researchers aged younger than 35 and The Quality assurance frameworks for health services and patient safety based on systematic support for data-driven and informed decision-making relevant to published work. M.D. Hill reports research funding from the NoNO Inc., Medtronic LLC, Boehringer-Ingelheim Canada, and Biogen Inc.—all outside the scope of the published work. A. Ganesh reports salary support from the Heart and Stroke Foundation of Canada New Investigator Award relevant to the published work. He also reports membership in the editorial boards of Stroke, Neurology, and Neurology Clinical Practice; consulting fees and honoraria from Atheneum, AlphaSights, MD Analytics, Figure 1, MyMedicalPanel, Creative Research Designs, CTC Communications Corp, Alexion, Biogen, and Servier Canada; research support from Alberta Innovates, the Alzheimer Society of Canada, Campus Alberta Neuroscience, Brain Canada, the Canadian Cardiovascular Society, Panmure House, the Government of Canada INOVAIT and New Frontiers in Research Fund programs, and the Canadian Institutes of Health Research; stock/stock options from SnapDx and Let's Get Proof (Collavidence Inc); and a patent application for a system for patient monitoring and cuff-based therapies—all outside the scope of the published work. The other authors report no disclosures relevant to this manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp., (© 2024 American Academy of Neurology.)

Background: Critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. CLI is associated with high rates of morbidity and mortality with high risk of limb amputation. In the absence of appropriate autologous grafts, unsuitability of prosthetic bypasses, and endovascular methods, fresh cold-stored venous allografts is an option. Endovascular interventional methods are essential methods for maintaining primary and secondary patency., Methods: A single-centre retrospective analysis of 82 surgical revascularizations using allogeneic vascular grafts and rescue endovascular techniques restoring and maintaining the patency of these allogeneic revascularizations in the period between July 2005 and July 2021., Results: We have performed 82 allogeneic revascularizations in 75 patients (52 reconstructions in men/63.4%/, 30 reconstructions in women/36.6%/). The median age of patients was 68 years (49 min, 87 max). We subsequently had to intervene a total of 26 bypasses. We intervened in 30 acute occluded allogeneic bypass grafts and 9 failing stenotic bypass grafts. We performed 52 angiographies. The success rate of rescue endovascular procedures in primary allogeneic reconstruction with distal anastomosis to the popliteal artery is statistically significant (P < 0.02) compared to procedures with distal anastomosis to the tibial and pedal bed. The cumulative patency (primary at time) of allogeneic reconstructions in our group was 89% after 1 month, 51.9% after 12 months, 24.2% after 3 years, 9.8% after 5 years. Limb salvage was 72.6% in 1 year, 53% in 3 years, 36.5% in 5 years, respectively., Conclusions: Cold-stored venous allografts may be used for performing below-the-knee revascularization for CLI with acceptable results, despite the poor long-term patency. Rescue endovascular techniques are an essential method for restoring or maintaining the patency of these reconstructions. These techniques have a high success rate and no other alternative., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically.  EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.

A retrospective analysis of our group of patients, efficacy, safety and the results of endovascular treatment of descending thoracic aorta by using stentgraft implantation in polytraumatized patients. In the period between 6/2006 and 2/2020, in the processing of data, we analysed retrospectively patients with polytrauma diagnosed with thoracic aortic rupture or transection (TAT) and treated with multiple injuries. Clinical characteristics, complications, pathological features, and hospital follow-up data were retrieved from our group. In our group of 28 polytraumatized patients referred to our Trauma Centre with current TAT, all 28 patients with such a thoracic aortic injury were treated by using thoracic stentgraft implantation. In our group of patients, the average Injury Severity Score (ISS) was 22 for women (min 19, max 27) and 26 for men (min 17, max 41), respectively. We reached 100% technical implantation success rate with our patients. In our group, we had 30-day mortality of 10.7% (3 patients) and the in-hospital mortality was 17.8% (5 patients). Surviving patients had calculated ISS score of 25 (min 17, max 41); dead patients had an ISS score of 28 (min 19, max 34) - p≤0.05. Endovascular treatment of TAT, as a minimally invasive and effective procedure with rapid bleeding control, may increase survival chances for severely compromised polytraumatized patients in the context of multiple-organ damage and the need for a major cardio-vascular surgery.

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.

Background: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique., Patients and Methods: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique., Results: The immediate success rate of the treatment was 98 %. In follow-up intervals of six weeks, six months, one year, and two years, the anatomical success rates of embolization (recanalization of no more than 5 cm of the junction) were 98, 96, 94, and 94 %, respectively. At identical intervals the venous insufficiency was scored according to the Aberdeen Varicose Vein Questionnaire and the American Venous Clinical Severity Score. In both cases, improvement was demonstrated over the two-year follow-up, with a 0.5 % significance level. Specific clinical signs of venous insufficiency were also evaluated, such as pain, oedema, clearance of varicose veins, and healing of venous ulceration. One severe complication - a pulmonary embolism - was reported, without consequences., Conclusions: We demonstrated that treating insufficient saphenous veins with modified histoacryl application brought a relief from symptoms of venous insufficiency and that the efficiency of this technique is comparable to commonly used methods.

Upper gastrointestinal bleeding is a serious and potentially life-threatening abdominal emergency. An important diagnostic goal is to determine the cause and localize the bleeding site(s), which is crucial for choosing an appropriate therapy and consequently also for the long-term result. Our case report presents a patient with recurrent upper gastrointestinal bleeding where even repeated endoscopic, surgical and endovascular interventions were not sufficient to determinate the cause of bleeding and to save the patient´s life.Key words: portal hypertension hepatic cirrhosis variceal bleeding ulcerative bleeding.

Delayed bleeding is a potential complication of pancreatoduodenectomy. Its treatment is either endovascular or surgical (stentgraft, embolization). Our case report presents a patient with bleeding from the hepatic artery pseudoaneurysm within a period of 3 months after pancreatoduodenectomy for common bile duct carcinoma, resolved using a stent graft.

Iatrogenic injuries to blood vessels in joint replacement surgery are rare events that occur as few per thousand. However, their sequelae are serious. The patient may either bleed to death, because vascular injury is not obvious and therefore difficult to diagnose, or lose the limb due to ischaemia. The highest risk of vascular injury is associated with repeat surgery and loosening of the acetabular component. We distinguish sharp and blunt force injuries. The former are caused by implants, sharp instruments, bone fragments or bone cement debris. The latter arise from stretching over a part of implanted material. Bleeding can be inapparent or apparent. Inapparent bleeding is difficult to diagnose and is recognized from the dynamics of blood losses. Haemodynamic instability or, in a worse case, even hypovolaemic shock may be the only signs of bleeding. Occlusion of an artery is manifested by limb ischaemia. The seriousness and progression of ischaemia depends on the rate of arterial occlusion, potential pathways for collateral circulation and the degree of atherosclerotic vascular disease. The patient with conduction anaesthesia does not feel pain and therefore the diagnosis must primarily be based on arterial pulsation in the limb and its skin colour. A pseudoaneurysm can develop due to a partially weakened vascular wall and its rupture is a life-threatening complication. Its presence is recognized as a pulsating mass in the groin. An arterio- venous fistula which arises from traumatic communication between the two vessels may lead to cardiac failure. The diagnosis is based on examination by sonography and digital subtraction angiography. The results of CT angiography and MR angiography are difficult to evaluate because of the presence of metal implants. In apparent bleeding it is sometimes difficult to locate the source. It is recommended to perform digital compression and gain access to the vessels from the extraperitoneal approach. When an expanding haematoma or ischaemia is present, the artery can be treated by surgical exploration or percutaneous transluminal angioplasty. A possibility of vascular injury should be taken into account particularly in revision arthroplasty. To check blood flow in the limb before surgery is advisable. If the procedure entails a significant risk of post-operative complications, a vascular surgeon should be available. In the case of acute intra-operative bleeding, the source should be localised as soon as possible, the site compressed and an expert assistance called in. When the source is not obvious, it should not be attempted to apply vascular clamps or clips at random; this may do even more damage to the vessel.

Tympanojugular paragangliomas are benign and slow growing lesions of the lateral skull base. Due to their localization and vascularity, they represent a surgical challenge. Treatment modalities include preoperative embolization of feeding vessels and tumour itself, surgical removal and irradiation. In our group, 16 patients with large tympanojugular paragangliomas have been operated in the period of 10 years. Surgical radicality has been achieved in 62.5%, in the rest of patients the tumour remnants were either irradiated with a Leksell gamma knife, or left without treatment in a wait-end-rescan approach. According to the benign character of the tumour, radicality is not always the highest goal, since a radical removal may be compromised by a high postoperative morbidity.

Background: Arosion of peripancreatic arteries in acute or chronic pancreatitis is a rare cause of bleeding into gastrointestinal tract--hemosuccus pancreaticus. Aim of the paper is to show the diagnostic and therapeutic options in this serious clinical stage., Methods and Results: We report a case of a patient with chronic pancreatitis who developed acute bleeding into the gastrointestinal tract due to the perforation of a pseudoaneurysm into pancreatic pseudocyst in the area of the pancreatic body. The diagnosis of hemosuccus pancreaticus, established by endoscopy and postcontrast CT examination, was confirmed by angiography. We stopped the acute bleeding from pseudoaneurysm, unusually well supplied by both gastric arteries by embolization of both arteries with metallic coils., Conclusions: Angiography plays an irreplaceable role in patients with hemosuccus pancreaticus. Our case demonstrates bleeding from pseudoaneurysm supplied by both gastric arteries, whose embolization produced an immediate hemostasis and improvment the patient's condition.

In treating acute cholecystitis in patients with a high operative risk, the general rule is to treat conservatively, with surgery indicated in those patients where this therapy is insufficient. Cholecystotomy is one alternative method of treatment. Due to its disadvantages, it belongs to one of the most seldomly used surgical procedures. These drawbacks, however, may be curtailed by using a percutaneous cholecystotomy (PC) done under CT or US navigation. The authors here recount their experiences of treating acute cholecystitis with PC in two case studies, relating difficulties in indication, technical performance, and complications of the procedure. In accordance with scientific literature, we consider PC an effective treatment method with minimal complications.

Stem cell transplants into spinal cord lesions may help to improve regeneration and spinal cord function. Clinical studies are necessary for transferring preclinical findings from animal experiments to humans. We investigated the transplantation of unmanipulated autologous bone marrow in patients with transversal spinal cord injury (SCI) with respect to safety, therapeutic time window, implantation strategy, method of administration, and functional improvement. We report data from 20 patients with complete SCI who received transplants 10 to 467 days postinjury. The follow-up examinations were done at 3, 6, and 12 months after implantation by two independent neurologists using standard neurological classification of SCI, including the ASIA protocol, the Frankel score, the recording of motor and somatosensory evoked potentials, and MRI evaluation of lesion size. We compared intra-arterial (via catheterization of a. vertebralis) versus intravenous administration of all mononuclear cells in groups of acute (10-30 days post-SCI, n=7) and chronic patients (2-17 months postinjury, n=13). Improvement in motor and/or sensory functions was observed within 3 months in 5 of 6 patients with intra-arterial application, in 5 of 7 acute, and in 1 of 13 chronic patients. Our case study shows that the implantation of autologous bone marrow cells appears to be safe, as there have been no complications following implantation to date (11 patients followed up for more than 2 years), but longer follow-ups are required to determine that implantation is definitively safe. Also, we cannot yet confirm that the observed beneficial effects were due to the cell therapy. However, the outcomes following transplantation in acute patients, and in one chronic patient who was in stable condition for several months prior to cell implantation, are promising. It is evident that transplantation within a therapeutic window of 3-4 weeks following injury will play an important role in any type of stem cell SCI treatment. Trials involving a larger population of patients and different cell types are needed before further conclusions can be drawn.

During the period from January 2000 to November 2001 the authors performed in 98 patients 129 drainages of pathological fluid collections. In all instances the drainages were performed under CT control. In 80 patients the drain was placed in the area of the pleural cavity, in 47 in the area of the peritoneal cavity and in three patients the localization was different. For drainage they used catheters of the pigtail type size from 8F to 24 F, depending on the extent of the pathological collection, its depth, and nature of the drained contents. In 119 cases Seldinger's method was used, in 10 the tandem troacar method of placement of drainage catheters. The placement of the drainage catheter under CT control is a safe and effective method for removal of pathological fluid collection. In the authors' group successful drainage was proved in 71 of 84 (84.5%) patients followed up on a long-term basis.