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Article: Superficial temporal artery access for carotid artery stenting: A case report.

Csavajda, Ádám / Nardai, Sándor / Bertrand, Olivier F / Ruzsa, Zoltán

2023 Volume 11, Issue 2, Page(s) e6947

Abstract: Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66-year-old man who presented with critical right internal ... ...

Abstract	Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66-year-old man who presented with critical right internal carotid artery (ICA) stenosis after previous hospitalization due to stroke. In addition to arteria lusoria, the patient had known bilateral femoral amputation, occlusion of the left ICA and significant three-vessel coronary artery disease. After unsuccessful common carotid artery (CCA) cannulation from the right distal radial artery access, we successfully performed the diagnostic angiography and the planned right ICA-CCA intervention using superficial temporal artery (STA) puncture. We showed that STA access can be used as an alternative and additional access site for diagnostic carotid artery angiography and intervention when standard access sites alone are insufficient.
Language	English
Publishing date	2023-02-13
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.6947
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Article ; Online: Successful endovascular treatment of simultaneous acute ischaemic stroke and hyperacute ST-elevation myocardial infarction: the first case report of a single-operator cardio-cerebral intervention.

Nardai, Sándor / Vorobcsuk, András / Nagy, Ferenc / Vajda, Zsolt

European heart journal. Case reports

2021 Volume 5, Issue 11, Page(s) ytab419

Abstract: Background: The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published ...

Abstract	Background: The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published endovascular treatment of synchronous heart and brain infarctions delivered by a single operator with excellent clinical outcome. Case summary: A 67-year-old female patient was directly transported to the emergency room of a comprehensive stroke centre with acute onset global aphasia and right hemiplegia. The onset to admission time exceeded the 4.5-h time window of systemic thrombolysis. Head computed tomography (CT) excluded extensive early extensive brain damage, CT angiography documented left middle cerebral artery occlusion and mechanical thrombectomy was indicated. Extensive anterior ST elevation was detected on the transport monitor while waiting for in-hospital transfer. The two simultaneously evolving pathologies were handled in a single endovascular procedure that took less than 60 min by a dual-trained interventional cardiologist/neurointerventional surgeon. The patient recovered without any major cardiac or neurologic sequela. Discussion: Interventional cardiologists, professionally trained through a neurointerventional fellowship programme to perform endovascular stroke interventions according to the latest multi-society position paper, could not only complement stroke teams lacking manpower, but their unique experience could also help the patients suffering from the most devastating forms of cardio-cerebral infarctions.
Language	English
Publishing date	2021-10-14
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytab419
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Article ; Online: Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure.

Molnár, Andrea Ágnes / Ábrahám, Pál / Merkely, Béla / Nardai, Sándor

Journal of visualized experiments : JoVE

2022 , Issue 180

Abstract: Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure, for intraoperative guidance ... ...

Abstract	Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure, for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.
MeSH term(s)	Cardiac Catheterization ; Echocardiography/methods ; Echocardiography, Transesophageal/methods ; Foramen Ovale, Patent/diagnostic imaging ; Foramen Ovale, Patent/surgery ; Heart Atria/diagnostic imaging ; Heart Atria/surgery ; Heart Septal Defects, Atrial/diagnostic imaging ; Heart Septal Defects, Atrial/surgery ; Humans ; Patient Selection ; Treatment Outcome
Language	English
Publishing date	2022-02-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/61240
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Article: Echocardiographic evaluation of atrial communications before transcatheter closure

Molnár, Andrea Ágnes / Ábrahám, Pál / Merkely, Béla / Nardai, Sándor

Journal of visualized experiments. 2022 Feb. 08, , no. 180

2022

Abstract	Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure, for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.
Keywords	aneurysm ; echocardiography ; microbubbles ; patients
Language	English
Dates of publication	2022-0208
Size	p. e61240.
Publishing place	Journal of Visualized Experiments
Document type	Article
ZDB-ID	2259946-0
ISSN	1940-087X
ISSN	1940-087X
DOI	10.3791/61240
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Article ; Online: Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis.

Pomozi, Enikő / Nagy, Rita / Fehérvári, Péter / Hegyi, Péter / Kiss, Boldizsár / Dembrovszky, Fanni / Kosztin, Annamária / Nardai, Sándor / Zima, Endre / Szeberin, Zoltán

Journal of cardiovascular development and disease

2023 Volume 10, Issue 2

Abstract: The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist ...

Abstract	The best method of anticoagulation for patients with peripheral artery disease (PAD) is still a topic of interest for physicians. We conducted a meta-analysis to compare the effects of direct oral anticoagulants (DOACs) with those of vitamin-K-antagonist (VKA) anticoagulants in patients with peripheral artery disease. Five databases (Medline (via PubMed), EMBASE, Scopus, Web of Science, and CENTRAL) were searched systematically for studies comparing the effects of the two types of anticoagulants in patients with PAD, with an emphasis on lower-limb outcomes, cardiovascular events, and mortality. In PAD patients with concomitant non-valvular atrial fibrillation (NVAF), the use of DOACs significantly reduced the risk of major adverse limb events (HR = 0.58, 95% CI, 0.39-0.86,
Language	English
Publishing date	2023-02-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd10020065
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Article ; Online: Stent-Graft Treatment of a Giant Asymptomatic Extracranial Vertebral Artery Aneurysm: Case Report and Literature Review.

Pataki, Ákos / Nguyen, Dat T / Nagy, Zsuzsa / Nardai, Sándor / Nemes, Balázs

Annals of vascular surgery

2021 Volume 79, Page(s) 442.e1–442.e6

Abstract: With the widespread appliance of endovascular techniques, a plethora of options is available in the treatment of extracranial vertebral artery aneurysms. If the vertebral artery can be sacrificed, embolization with coiling, liquid injection, or parent ... ...

Abstract	With the widespread appliance of endovascular techniques, a plethora of options is available in the treatment of extracranial vertebral artery aneurysms. If the vertebral artery can be sacrificed, embolization with coiling, liquid injection, or parent artery exclusion can be done. We hereby present a case of a 74-year-old male patient presenting with an asymptomatic atherosclerotic giant extracranial vertebral artery aneurysm in the V1 segment of the vertebral artery, successfully treated with balloon expandable stent-graft deployment. No neurologic symptoms occurred, and the stent-graft was patent with no signs of endoleak at 24 months follow-up with computed tomography angiography.
MeSH term(s)	Aged ; Aneurysm/diagnostic imaging ; Aneurysm/surgery ; Asymptomatic Diseases ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/instrumentation ; Endovascular Procedures/instrumentation ; Humans ; Male ; Stents ; Treatment Outcome ; Vertebral Artery/diagnostic imaging ; Vertebral Artery/surgery
Language	English
Publishing date	2021-10-14
Publishing country	Netherlands
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2021.08.023
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Article: Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment.

Safouris, Apostolos / Psychogios, Klearchos / Palaiodimou, Lina / Orosz, Peter / Magoufis, George / Kargiotis, Odysseas / Theodorou, Aikaterini / Karapanayiotides, Theodore / Spiliopoulos, Stavros / Nardai, Sándor / Sarraj, Amrou / Nguyen, Thanh N / Yaghi, Shadi / Walter, Silke / Sacco, Simona / Turc, Guillaume / Tsivgoulis, Georgios

Journal of stroke

2024 Volume 26, Issue 1, Page(s) 13–25

Abstract: Cardioembolic stroke is a major cause of morbidity, with a high risk of recurrence, and anticoagulation represents the mainstay of secondary stroke prevention in most patients. The implementation of endovascular treatment in routine clinical practice ... ...

Abstract	Cardioembolic stroke is a major cause of morbidity, with a high risk of recurrence, and anticoagulation represents the mainstay of secondary stroke prevention in most patients. The implementation of endovascular treatment in routine clinical practice complicates the decision to initiate anticoagulation, especially in patients with early hemorrhagic transformation who are considered at higher risk of hematoma expansion. Late hemorrhagic transformation in the days and weeks following stroke remains a potentially serious complication for which we still do not have any established clinical or radiological prediction tools. The optimal time to initiate therapy is challenging to define since delaying effective secondary prevention treatment exposes patients to the risk of recurrent embolism. Consequently, there is clinical equipoise to define and individualize the optimal timepoint to initiate anticoagulation combining the lowest risk of hemorrhagic transformation and ischemic recurrence in cardioembolic stroke patients. In this narrative review, we will highlight and critically outline recent observational and randomized relevant evidence in different subtypes of cardioembolic stroke with a special focus on anticoagulation initiation following endovascular treatment. We will refer mainly to the commonest cause of cardioembolism, non-valvular atrial fibrillation, and examine the possible risk and benefit of anticoagulation before, during, and shortly after the acute phase of stroke. Other indications of anticoagulation after ischemic stroke will be briefly discussed. We provide a synthesis of available data to help clinicians individualize the timing of initiation of oral anticoagulation based on the presence and extent of hemorrhagic transformation as well as stroke severity.
Language	English
Publishing date	2024-01-30
Publishing country	Korea (South)
Document type	Journal Article ; Review
ZDB-ID	2814366-8
ISSN	2287-6405 ; 2287-6391
ISSN (online)	2287-6405
ISSN	2287-6391
DOI	10.5853/jos.2023.01578
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Article ; Online: Treatment of In-stent Restenosis of the Internal Carotid Artery Using Drug-eluting Balloons.

Marton, Annamária / Blényesi, Eszter / Török, Katalin / Balogh, Gábor / Gubucz, István / Nardai, Sándor / Lenzsér, Gábor / Nagy, Csaba / Bajzik, Gábor / Tollár, József / Repa, Imre / Nagy, Ferenc / Vajda, Zsolt

Clinical neuroradiology

2023 Volume 34, Issue 1, Page(s) 147–154

Abstract: Purpose: In-stent restenosis (ISR) following internal carotid artery (ICA) stenting is relatively common with an estimated incidence of 5%. Treatment options include repeat angioplasty with conventional or drug-eluting balloons (DEB), repeat stent ... ...

Abstract	Purpose: In-stent restenosis (ISR) following internal carotid artery (ICA) stenting is relatively common with an estimated incidence of 5%. Treatment options include repeat angioplasty with conventional or drug-eluting balloons (DEB), repeat stent angioplasty and surgical intervention. Application of DEB in ISR of the coronary and peripheral arteries is an established method; however, data on DEB treatment of ICA ISR are sparse. In this work, results from a retrospective cohort of 45 patients harboring 46 ICA ISR lesions treated with DEB angioplasty are presented. Methods: Clinical, procedural and imaging data from DEB angioplasty treatment of 46 high-grade ICA ISR lesions in 45 patients, performed between 2013 and 2021 were collected. A single type of DEB (Elutax, Aachen Resonance, Aachen, Germany) was used in all procedures. Imaging follow-up was performed by regular Doppler ultrasound (DUS), verified by computed tomography angiography (CTA) in cases suspicious for a recurrent ISR. Results: Technical success was 100%. Intraprocedural and postprocedural complications were not encountered. Clinical follow-up was obtained in all patients. Recurrent stroke in the affected territory was not encountered. A recurrent ISR following DEB treatment was confirmed by DUS and CTA in 4/46 (8.7%) of the lesions and were retreated with DEB. A third recurrent ISR occurred in a single case (2%) and following a second DEB retreatment there were no signs of a fourth recurrence after 36 months follow-up. Conclusion: The use of DEB angioplasty is a safe and effective treatment of ICA ISR lesions, yielding significantly better results compared to other modalities. Randomized multicenter studies are warranted.
MeSH term(s)	Humans ; Carotid Artery, Internal/diagnostic imaging ; Retrospective Studies ; Coronary Restenosis/etiology ; Coronary Restenosis/therapy ; Drug-Eluting Stents/adverse effects ; Stents/adverse effects ; Constriction, Pathologic ; Treatment Outcome
Language	English
Publishing date	2023-09-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2234662-4
ISSN	1869-1447 ; 0939-7116 ; 1869-1439
ISSN (online)	1869-1447
ISSN	0939-7116 ; 1869-1439
DOI	10.1007/s00062-023-01343-6
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Article: Living with a Brain AVM: A Quality of Life Assessment.

Orosz, Péter / Vadász, Ágnes / Veres, Dániel Sándor / Berentei, Zsolt / Gubucz, István / Nardai, Sándor / Kis, Balázs / Szikora, István

Acta neurochirurgica. Supplement

2021 Volume 132, Page(s) 71–76

Abstract: Background and purpose: Brain arteriovenous malformations (AVM) are uncommon vascular lesions with the risk of hemorrhage, epileptic seizures, neurological deficits, and headache. Comparing the risks of the natural history and that of preventive ... ...

Abstract	Background and purpose: Brain arteriovenous malformations (AVM) are uncommon vascular lesions with the risk of hemorrhage, epileptic seizures, neurological deficits, and headache. Comparing the risks of the natural history and that of preventive treatment, a recent study has found observation more beneficial than treatment for unruptured AVMs. This study, however, did not consider the long-term impact of carrying a brain AVM on everyday activities. In this study we analyzed the Quality Of Life (QOL) of patients with untreated AVMs, a measure increasingly used in clinical trials to asses this kind of impact. Methods: We enrolled 36 patients with unruptured, untreated brain AVM from our hospital database and measured their QOL retrospectively using the EQ-5D-5L questionnaire. As a control group we used the results of the Research Report, a nationwide study based on the quality of life of 5534 healthy Hungarians in 2002. Due to the low number of cases, statistical analysis could not be made. Results: Headache proved to be the most common AVM-related sign in our cohort (40%, n = 17), with a female predominance; neurological deficit was detected in 33% (n = 14), while epileptic seizures occurred in 26% (n = 11), more commonly affecting male subjects. Anxiety and discomfort seemed to be the most prevalent influencing factors on QOL, especially in the youngest age group (18-34 years). Female subjects showed a greater dependence than men in all age groups, though males had a more significant impairment in their usual activities. Older patients were affected more significantly in their self-care and usual activities compared with the younger population. Conclusions: Untreated AVMs have a significant negative impact on patients carrying unruptured brain AVMs, as proved by QOL assessment. Beside neurological deficits, this impact should also be considered in the therapeutic decision.
MeSH term(s)	Brain ; Female ; Humans ; Infant, Newborn ; Intracranial Arteriovenous Malformations/epidemiology ; Intracranial Arteriovenous Malformations/surgery ; Male ; Quality of Life ; Radiosurgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-05-08
Publishing country	Austria
Document type	Journal Article
ISSN	0065-1419
ISSN	0065-1419
DOI	10.1007/978-3-030-63453-7_10
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Article ; Online: Coronary stent implantation for acute basilar artery occlusion with underlying stenosis.

Nardai, Sándor / Kis, Balázs / Gubucz, István / Berentei, Zsolt / Vajda, Zsolt / Orosz, Péter / Nagy, András / Óváry, Csaba / Nagy, Zoltán / Szikora, István

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

2020 Volume 16, Issue 12, Page(s) e1021–e1028

Abstract: Aims: Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS).: Methods and results: ... ...

Abstract	Aims: Our aim was to study the effectiveness of coronary stent implantation during the endovascular treatment (EVT) of acute basilar artery occlusion (BAO) with occlusion-underlying intracranial atherosclerotic stenosis (ICAS). Methods and results: We retrospectively analysed 91 consecutive BAO patients who underwent EVT between February 2014 and January 2019 in a single, high-volume neurointerventional centre. We studied the effect of immediate coronary stent implantation on the clinical outcome of BAO with occlusion-underlying stenosis. BAO patients with underlying ICAS (n=41) were characterised by longer symptom-onset-to-reperfusion times (231 min vs 173 min, p=0.0020), lower TICI 2b-3 reperfusion rates (65.85% vs 90.00%, p=0.0084), and higher overall mortality (HR 2.021, p=0.0417) compared to the BAO cases without ICAS (n=50). The patients undergoing stenting (n=18) had lower residual basilar artery (BA) stenosis (14.7% vs 81.0%, p<0.0001), higher chance for functional recovery (OR 7.6, p=0.0250) and higher chance of survival (HR 4.163, p=0.0026) compared to the BAO-ICAS cases treated without coronary stents (n=21). Conclusions: The immediate treatment of the occlusion-underlying stenosis with coronary stents and dual antiplatelet therapy (DAPT) in BAO was associated with improved overall survival and better functional outcomes.
MeSH term(s)	Basilar Artery/diagnostic imaging ; Basilar Artery/surgery ; Constriction, Pathologic ; Endovascular Procedures ; Humans ; Retrospective Studies ; Stents ; Stroke ; Thrombectomy ; Treatment Outcome ; Vertebrobasilar Insufficiency/complications ; Vertebrobasilar Insufficiency/diagnostic imaging ; Vertebrobasilar Insufficiency/surgery
Language	English
Publishing date	2020-12-18
Publishing country	France
Document type	Journal Article
ZDB-ID	2457174-X
ISSN	1969-6213 ; 1774-024X
ISSN (online)	1969-6213
ISSN	1774-024X
DOI	10.4244/EIJ-D-19-00519
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