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Structural and hemodynamic characteristics of atherosclerotic plaques in carotid arteries with relation to endovascular manipulation during carotid artery stenting.
Špaček, Miloslav ; Zemánek, David (advisor) ; Malík, Jan (referee) ; Pařenica, Jiří (referee)
Atherosclerotic diseases including stroke are the leading causes of morbidity, mortality as well as disability in industrialized countries. Carotid endarterectomy was long considered the stan- dard approach for the treatment of atherosclerotic carotid disease, one of major causes of stroke. Over time, carotid artery stenting (CAS) has evolved as an alternative approach and is considered equivalent to surgical treatment in selected patients. Particularly in the last years, CAS has gained attention with the increasing knowledge regarding atherosclerotic plaque and cerebrovascular flow. In our study, we focused on patients undergoing CAS and evaluated structural and hemodynamic characteristics of atherosclerotic plaques together with relation to endovascular manipulation. The major part of the study includes transcranial doppler ultrasound evaluation which is able to detect flow in major cerebral arteries as well as to detect microembolizations of atherosclerotic particles during CAS. In eligible patients, we investigated the usefulness of cerebrovascular reserve (CVR) testing to predict severe hemodynamic changes in ipsilateral middle cerebral artery induced by temporary carotid occlusion during proximally protected CAS. CVR was tested by means of a breath-holding test and ophthalmic artery flow...
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Percutaneous transluminal angioplasty of extracranial carotid arteries in comparison with the operating solution stenoses
VESELÁ, Lenka
My bachelor thesis "Percutaneous Transluminal Angioplasty of Intracranial Carotid Arteries Compared with Surgical Treatment of Stenoses" is divided into two parts.Theoretical part, is based on analysis of available sources containing publications and articles concerning with anatomy, radiological technologies, angelology, neurosurgery and neurology.The treatment is interdisciplinary.The choice of correct treatment plan is important. We must take account of patient's overall condition with his comorbidities and anticipated life expectancy. There is also discussed cerebrovascular reserve which has to be considered. It is worth mentioning that in the Nemocnice České Budějovice, a. s. České Budějovice Hospital is in collaboration with the University Illinois Center in Chicago a NOVA examination done.Patients with exhausted cerebrovascular reserve and patients with symptomatic stenoses are indicated to intervetional treatment (percutaneous transluminal angioplasty) or surgical (carotic endartectomy).My bachelor thesis was created with two objectives. The first one was comparison of economic aspects of the individual treatment methods.After analysis of the accessible materials were approximately quantified expenses on each method using DRG system. Results show that interventional procedure is more expensive. It is caused by costs of disposable intervetional radiology instrumentation. At surgical method are used cheaper instruments.Second objective was comparison of individual procedures performance in relation to resocialization. It was compared the hospitalization period and the period for which it is possible to return to work. It is necessary to compare similar patients, i.d. patients with no complications after angioplasty and patients with no complications after endarterectomy. Results show that duration of hospitalization is comparable.Time after which is patient able to return to work is very individual. The time depends on type and content of the work. It could be said that after interventional procedure is minimal traumatization and painfulness, so that patients can return back without complications into work soon after discharge. In the conclusion, it has to be said that quantification of expenses was not optimal. Professional community in cooperation with National Reference Centre tries to redress methodology for reporting and subsequent payment performances by insurance companies.On the subject of comparing carotid stenting and endarterectomy in terms of appropriate indications, safety performance and profit performance of the patient, there were several studies. One also takes place contemporary. There was not proved that one of the treatment modalities were clearly better.
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