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Carotid Artery Stenosis
Svoboda, Norbert ; Beneš, Vladimír (advisor) ; Peisker, Tomáš (referee) ; Herzig, Roman (referee)
The basis of the doctoral thesis consists of three studies focused on the diagnosis of carotid stenosis. The first study examines the histological structure of carotid plaques and their relationship to clinical manifestations. The study included 269 patients with 280 analyzed plaques. Multiple logistic regression demonstrated a significant association between symptomatic stenosis and foam cells (OR=1.9, p=0.03) as well as plaque thrombosis (OR=3.5, p=0.02). A significant correlation was also found between symptomatic plaque and unstable plaque according to the comprehensive AHA plaque classification (OR=1.8, p=0.03).The second study addresses the accuracy of carotid stenosis diagnosis using digital subtraction angiography (DSA). Carotid stenosis was measured on DSA and histologically processed plaques obtained during carotid endarterectomy in 644 patients. The study did not establish a correlation between the findings on the histological plaque and DSA (correlation coefficient of 0.22 for ECST and 0.20 for NASCET). The last study focuses on the analysis of the biomarker of oxidative stress (malondialdehyde, MDA) as a predictor of unstable carotid plaques. The study involved 35 patients. Patients with asymptomatic carotid stenosis and those who experienced amaurosis fugax had significantly lower...
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Possibilities of aggregometry in antiplatelet prevention of strokes. Relationship between reduced aggregation and stroke risk prevention.
Chýlová, Miroslava ; Kalvach, Pavel (advisor) ; Tomek, Aleš (referee) ; Herzig, Roman (referee)
Background. This dissertation offers an overview of knowledge about platelets, the principle of platelet aggregation, its reduction by antiplatelet drugs and anticoagulation, methods of measuring platelet aggregation and views on resistance to acetylsalicylic acid. The effectiveness of ASA (acetylsalicylic acid) in prevention of vascular events is usually derived indirectly from comparison of individuals taking placebo and not from the results of aggregometric methods. The purpose of our work was 1) to assess the effect of different doses and different routes of ASA administration on platelet aggregation, 2) to compare results of two different aggregometry methods and 3) to assess the effect of anticoagulation treatment on platelet aggregation in patients with chronic ischemic heart disease. Methods. The first study group consisted of 22 healthy individuals and 30 patients with documented ischemic stroke. Platelet aggregation was measured before ASA application and then after different doses and different routes of ASA administration. In the second study the group consisted of 30 patients with documented ischemic stroke who were taking orally 100mg ASA daily. We compared platelet aggregation measured by VerifyNow and by light transmission aggregometry (LTA) using different agonists. In the third...
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Sonolysis in Risk Reduction of Symptomatic and Silent Brain Infarctions during Coronary Angioplasty and Stenting
Viszlayová, Daša ; Herzig, Roman (advisor) ; Nosáľ, Vladimír (referee) ; Škoda, Ondřej (referee)
Background: Cerebral complications of coronary catheterizations are transient ischemic attack (TIA) and stroke. Silent stroke (SCI) does not cause acute neurological dysfunction. It might cause many disorders including dementia. Sonolysis is therapeutic method. Sonolysis should be the method for reducing the risk of symptomatic and asymptomatic brain ischemic lesions in patients undergoing elective coronary angioplasty or stenting. Aims: To analyse patients with cardiac disease indicated for elective coronary catheterization: 1) Assess the incidence of acute/subacute SCI on brain magnetic resonance (MR) imaging; 2) Investigate factors influencing the frequency and type of microembolic signals (MES) detected using transcranial Doppler (TCD) in patients undergoing elective coronary intervention, and to correlate the frequency and type of MES with detection of new brain ischemic lesions using MR. Examine changes in cognitive function at 30 days post procedure in relation to pretreatment scores; 3) Test the clinical efficacy and safety of perioperative sonolysis in patients undergoing elective coronary catheterization. Methods: 1) 144 patients were enrolled to the study. Brain MR was performed before cardiac intervention. The presence of acute and subacute SCI was evaluated, SCI volume was measured and risk...
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