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Article: Safety and Efficacy of Low-Dose Eptifibatide for Tandem Occlusions in Acute Ischemic Stroke.

Latacz, Paweł / Popiela, Tadeusz / Brzegowy, Paweł / Lasocha, Bartłomiej / Kwiecień, Krzysztof / Simka, Marian

2024 Volume 16, Issue 1, Page(s) 253–262

Abstract: Objectives: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a ... ...

Abstract	Objectives: The optimal treatment strategy for ischemic stroke in patients presenting with tandem occlusions of the internal carotid artery remains controversial. Several studies have demonstrated better clinical outcomes after eptifibatide, which is a short half-life antiplatelet agent. This retrospective analysis focused on the safety and efficacy of low-dose eptifibatide administration in stroke patients with tandem lesions. Methods: We evaluated the results of endovascular treatment in 148 stroke patients with tandem lesions. Patients in whom balloon angioplasty alone resulted in satisfactory cerebral flow did not receive eptifibatide (33 patients); others received this drug together with stent implantation (115 patients). Eptifibatide was given as an intravenous bolus of 180 μg/kg and then in a modified low dose of 1 μg/kg/min for 24 hours. Results: There were no statistically significant differences between both groups regarding 30-day mortality, frequency of thrombotic events, or hemorrhagic complications. An analysis of clinical status at 30-day follow-up revealed that the administration of eptifibatide was associated with a statistically significant better outcome: a higher rate of either no neurological symptoms or only mild symptoms (4 NIHSS points maximally). Conclusions: The administration of eptifibatide in stroke patients presenting with tandem lesions is relatively safe. Moreover, treatment with this drug can improve clinical outcomes in these challenging patients.
Language	English
Publishing date	2024-02-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2514727-4
ISSN	2035-8377 ; 2035-8385
ISSN (online)	2035-8377
ISSN	2035-8385
DOI	10.3390/neurolint16010017
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Article: Dual energy computed tomography in differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with ischaemic stroke treated with thrombectomy.

Chrzan, Robert / Łasocha, Bartłomiej / Brzegowy, Paweł / Popiela, Tadeusz

Neurologia i neurochirurgia polska

2022 Volume 56, Issue 1, Page(s) 68–74

Abstract: Introduction: The aim of this study was to assess the value of dual energy computed tomography (DECT) in the differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with acute ischaemic stroke treated with ... ...

Abstract	Introduction: The aim of this study was to assess the value of dual energy computed tomography (DECT) in the differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. Material and methods: The group analysed consisted of 66 hyperdense areas in 64 patients with acute ischaemic stroke treated with mechanical thrombectomy and controlled in DECT performed within the first 24 hours after thrombectomy. In every area both qualitative and quantitative analysis of iodine and water material density (MD) maps was performed for the differentiation of iodine and blood, as well as CT density analysis. Results: 66.7% of hyperdense areas were classified as iodine, 18.2% as iodine + blood, and 15.1% as blood. The density of iodine was significantly higher in the iodine (median 9.64 100ug/cm3) group compared to the blood (median 3.97 100ug/cm3) and iodine + blood (median 7.57 100ug/cm3) groups. The density of water was significantly higher in the blood (median 1,051.50 mg/cm3) and iodine + blood (median 1,038.00 mg/cm3) groups compared to the iodine (median 1,021.00 mg/cm3) group. Conclusions: DECT with iodine-water material decomposition maps is a valuable tool in the differentiation of prolonged staining of iodine contrast agent from secondary brain haemorrhage in patients with acute ischaemic stroke treated with mechanical thrombectomy. The value of 6 100ug/cm3 (0.6 mg/cm3) seems a good threshold in quantitative differentiation of iodine from blood on iodine (water) MD maps. The value of 1,030 mg/cm3 seems a good threshold in quantitative differentiation of iodine from blood on water (iodine) MD maps.
MeSH term(s)	Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Contrast Media ; Humans ; Intracranial Hemorrhages/etiology ; Iodine/analysis ; Ischemic Stroke ; Staining and Labeling ; Stroke/complications ; Stroke/diagnostic imaging ; Stroke/surgery ; Thrombectomy ; Tomography, X-Ray Computed/methods
Chemical Substances	Contrast Media ; Iodine (9679TC07X4)
Language	English
Publishing date	2022-01-05
Publishing country	Poland
Document type	Journal Article
ZDB-ID	415519-1
ISSN	1897-4260 ; 0028-3843
ISSN (online)	1897-4260
ISSN	0028-3843
DOI	10.5603/PJNNS.a2022.0005
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Article ; Online: Results of Angioplasty With Double-Layer Mesh Stent and Protection Systems of the Extra- and Intracranial Dissection of Cephalic Arteries.

Latacz, Pawel / Lasocha, Bartlomiej / Pawel, Brzegowy / Tadeusz, Popiela / Marian, Simka

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2022 Volume 30, Issue 1, Page(s) 66–74

Abstract: Purpose: Although a majority of cervical artery dissections can be managed conservatively, patients presenting with cerebral embolization or significant stenosis require a more aggressive approach. However, complications associated with endovascular ... ...

Abstract	Purpose: Although a majority of cervical artery dissections can be managed conservatively, patients presenting with cerebral embolization or significant stenosis require a more aggressive approach. However, complications associated with endovascular repair are quite frequent and optimal interventional technique still remains to be established. Materials and methods: The aim of this post hoc survey was to analyze results of endovascular treatments for symptomatic dissections of the internal carotid and vertebral arteries, which were performed under protection and with the use of double-layer mesh stents. During endovascular procedure catheters, stents and protection systems were tailored according to the angioarchitecture of dissection, particularly to its location, length and coexisting stenotic or aneurysmatic lesions. We evaluated retrospectively midterm and late results of endovascular treatment of 25 patients presenting with symptomatic dissection of cervical arteries, including 11 patients with dissections of intracranial segments of the internal carotid artery. Follow-ups were scheduled 1, 3 and 6 after the procedure, and then every 6 months. Control computed tomography (CT) or digital subtraction angiography (DSA) arteriographies were performed 1-6 months and 12 months after endovascular repair. Results: There were no periprocedural major adverse events. All patients completed the 12-month follow-up. There were neither fatalities nor new neurologic adverse events at the 30-day follow-up, and no such adverse events during long-term follow-up. At 12-month follow-up, in all patients, angiographies revealed patent stents, full coverage of lesions by stents and complete thrombotic closure of the pseudoaneurysms. Conclusions: A tailored endovascular management of symptomatic dissection of cervical arteries is safe and efficient, also in a long run.
MeSH term(s)	Humans ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome ; Stents ; Angioplasty ; Carotid Artery, Internal/diagnostic imaging
Language	English
Publishing date	2022-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028211068767
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Zs.A 4547: Show issues

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Article ; Online: The influence of embolization of internal carotid artery aneurysms on arterial tortuosity: a prospective cohort study.

Krzyżewski, Roger M / Kliś, Kornelia M / Kwinta, Borys M / Stachura, Krzysztof / Popiela, Tadeusz J / Brzegowy, Paweł / Łasocha, Bartłomiej / Urbanik, Andrzej / Grodzicki, Tomasz / Milczarek, Olga / Gąsowski, Jerzy

Journal of vascular and interventional radiology : JVIR

2024

Abstract: Purpose: To compare quantitative tortuosity descriptors of Internal Carotid Artery (ICA) on aneurysmal and non-aneurysmal side before and after embolization of aneurysm and to determine possible factors associated with its change.: Material and ... ...

Abstract	Purpose: To compare quantitative tortuosity descriptors of Internal Carotid Artery (ICA) on aneurysmal and non-aneurysmal side before and after embolization of aneurysm and to determine possible factors associated with its change. Material and methods: An analysis of 52 patients with intracranial aneurysm, treated with endovascular procedure, was performed. Based on their Digital Subtraction Angiography images, obtained prior to the procedure and after first follow-up examination, tortuosity of ICA, both on the side of embolization and on the other side was analysed. For each patient tortuosity descriptors were calculated: Relative Length, Sum of Angle Metrics, Triangular Index, Product of Angle Distance, and Inflection Count Metric. To represent changes in tortuosity, for each descriptor delta value (Δ) was defined as value of the descriptor prior to embolization - value of the descriptor on follow-up examination. Results: In the follow-up We found no statistically significant changes in tortuosity on non-embolized side. On the embolized side SOAM (2.89±0.92 vs. 2.38±0.94;p<0.001), PAD (5.01±1.83 vs. 3.95±1.72 ;p<0.001) and ICM (12.18±4.55 vs. 9.76±4.04 vs.;p = 0.006) was significantly higher after embolization than before embolization. Mean ΔRelative Length (-0.02 [-0.045--0.002] vs. -0.01 [-0.02-0.003];p - 0.003),ΔProduct of Angle Distance (0.84 [0.30 - 1.82] vs. 0.10 [-0.001 - 1.10];p<0.001) and ΔInflection Count Metric (2.05 [0.42 - 3.50] vs. 0.27 [0.02 - 2.16];p = 0.004) were significantly higher on the embolized side. Conclusion: Following study showed that embolization may increase the tortuosity of ICA.
Language	English
Publishing date	2024-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2024.04.012
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Zs.A 3720: Show issues

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Article ; Online: Immediate mechanical thrombectomy with DynaCT evaluation after percutaneous coronary intervention complicated by acute ischemic stroke.

Tokarek, Tomasz / Dykla, Dominika / Popiela, Tadeusz / Łasocha, Bartłomiej / Bartuś, Stanisław / Rzeszutko, Łukasz

Kardiologia polska

2021 Volume 79, Issue 9, Page(s) 1038–1039

MeSH term(s)	Brain Ischemia/diagnostic imaging ; Humans ; Ischemic Stroke ; Percutaneous Coronary Intervention/adverse effects ; Stroke/etiology ; Thrombectomy ; Treatment Outcome
Language	English
Publishing date	2021-06-24
Publishing country	Poland
Document type	Journal Article
ZDB-ID	411492-9
ISSN	1897-4279 ; 0022-9032
ISSN (online)	1897-4279
ISSN	0022-9032
DOI	10.33963/KP.a2021.0043
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Zs.B 598: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity.

Krzyżewski, Roger M / Kliś, Kornelia M / Kwinta, Borys M / Łasocha, Bartłomiej / Brzegowy, Paweł / Popiela, Tadeusz J / Gąsowski, Jerzy

World neurosurgery

2022 Volume 166, Page(s) e84–e92

Abstract: Objective: Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture.: ... ...

Abstract	Objective: Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. Methods: We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). Results: A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. Conclusions: Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.
MeSH term(s)	Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/diagnostic imaging ; Arteries/abnormalities ; Carotid Artery Diseases/complications ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery, Internal/diagnostic imaging ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnostic imaging ; Joint Instability ; Retrospective Studies ; Skin Diseases, Genetic ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/etiology ; Vascular Malformations
Language	English
Publishing date	2022-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.06.101
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Article: Ineffective endovascular treatment of a giant internal carotid artery aneurysm.

Brzegowy, Paweł / Chukwu, Ositadima / Ciuk, Katarzyna / Urbanik, Andrzej / Popiela, Tadeusz / Kwinta, Borys / Łasocha, Bartłomiej

Polish journal of radiology

2020 Volume 85, Page(s) e323–e327

Abstract: Purpose: Despite a growing range of therapeutic possibilities, including various intravascular methods, treating cerebral aneurysms can be still a therapeutic challenge. A growing number of patients previously treated with older techniques require ... ...

Abstract	Purpose: Despite a growing range of therapeutic possibilities, including various intravascular methods, treating cerebral aneurysms can be still a therapeutic challenge. A growing number of patients previously treated with older techniques require additional therapy. Treatment options as well as their efficiency may be influenced by previous procedures. Case report: We report a rare case of a giant treatment-resistant aneurysm in a 65-year-old woman. The aneurysm was first diagnosed due to visual disturbances in the right eye. Computed tomography angiography showed large (20 × 18 mm) wide neck aneurysm of the right internal carotid artery. The patient was subsequently treated with several methods including coiling with regular stent implantation, two flow diverter stent implantations, and hybrid neurosurgery. Full occlusion was not achieved after any of those procedures. After the last procedure (hybrid neurosurgery) the patient, in vegetative state, was transferred to the intensive care unit and then to the Health and Care Centre. Conclusions: Discussion focuses on endovascular treatment options after failure of previous treatment such as "stent in stent" technique. We conclude that three subsequent stent implantations are technically possible; however, subsequent procedures are associated with technical difficulties and their effectiveness is questionable. Ventriculoperitoneal shunt may influence the outcome of flow diversion therapy.
Language	English
Publishing date	2020-06-27
Publishing country	Poland
Document type	Case Reports
ZDB-ID	2675143-4
ISSN	1899-0967 ; 1733-134X
ISSN (online)	1899-0967
ISSN	1733-134X
DOI	10.5114/pjr.2020.96979
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Article: Real-World Comparison of Human and Software Image Assessment in Acute Ischemic Stroke Patients' Qualification for Reperfusion Treatment.

Lasocha, Bartlomiej / Pulyk, Roman / Brzegowy, Pawel / Latacz, Pawel / Slowik, Agnieszka / Popiela, Tadeusz J

Journal of clinical medicine

2020 Volume 9, Issue 11

Abstract: Our aim was to compare human and computer accuracy in reading medical images of acute stroke patients. We analyzed data of patients who underwent assessment of Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion (CTP) via Rapid Processing of ...

Abstract	Our aim was to compare human and computer accuracy in reading medical images of acute stroke patients. We analyzed data of patients who underwent assessment of Alberta Stroke Program Early CT Score (ASPECTS) and CT Perfusion (CTP) via Rapid Processing of Perfusion and Diffusion (RAPID) software RAPID ASPECTS, and RAPID CTP), compared to radiologist reports and manual measurements. We compared volumes calculated by RAPID CTP software with those selected by scanner-equipped software (GE). For reference, follow-up images were manually assessed in accordance with the Alberta Stroke Program Early CT Score (ASPECTS) territories retrospectively. Although exact ASPECTS score agreement between the automatic and manual methods, and between each method and follow-up, was poor, crossing of the threshold for reperfusion therapy was characterized by an 80% match. CT perfusion analyses yielded only slight agreement (kappa = 0.193) in the qualification of patients for therapy. Either automatic or manual scoring methods of non-contrast images imply similar clinical decisions in real-world circumstances. However, volume measurements performed by fully automatic and manually assisted systems are not comparable. Thresholds devised and validated for computer algorithms are not compatible with measurements performed manually using other software and should not be applied to setups other than those with which they were developed.
Language	English
Publishing date	2020-10-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm9113383
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Article ; Online: Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis.

Krupa, Kamil / Brzegowy, Paweł / Kucybała, Iwona / Łasocha, Bartłomiej / Urbanik, Andrzej / Popiela, Tadeusz J

Clinical imaging

2020 Volume 70, Page(s) 81–88

Abstract: Background: The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms.: Material and methods: Major electronic medical databases were thoroughly searched to ... ...

Abstract	Background: The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms. Material and methods: Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted. Results: A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%. Conclusions: The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.
MeSH term(s)	Aneurysm, Ruptured ; Embolization, Therapeutic/adverse effects ; Endovascular Procedures ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy ; Retrospective Studies ; Stents ; Treatment Outcome
Language	English
Publishing date	2020-10-24
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1028123-x
ISSN	1873-4499 ; 0899-7071
ISSN (online)	1873-4499
ISSN	0899-7071
DOI	10.1016/j.clinimag.2020.10.025
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Zs.A 1469: Show issues

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Article ; Online: Association of Arterial Tortuosity with Hemodynamic Parameters-A Computational Fluid Dynamics Study.

Kliś, Kornelia M / Wójtowicz, Dominika / Kwinta, Borys M / Stachura, Krzysztof / Popiela, Tadeusz J / Frączek, Maciej J / Łasocha, Bartłomiej / Gąsowski, Jerzy / Milczarek, Olga / Krzyżewski, Roger M

World neurosurgery

2023 Volume 180, Page(s) e69–e76

Abstract: Background: Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial ... ...

Abstract	Background: Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. Methods: We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1-3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). Results: We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = -0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = -0.333; P < 0.01), TAWSSG (R = -0.473 P < 0.01), OSI (R = -0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = -0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = -0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01). Conclusions: Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs.
MeSH term(s)	Humans ; Intracranial Aneurysm ; Hydrodynamics ; Models, Cardiovascular ; Hemodynamics ; Arteries ; Stress, Mechanical ; Computer Simulation
Language	English
Publishing date	2023-08-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2023.07.152
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