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Therapeutic use of ultrasound in patients with cerebrovascular diseases.
Kuliha, Martin ; Školoudík, David (advisor) ; Beneš, Vladimír (referee) ; Tomek, Aleš (referee)
Background: Sonolysis is an important factor in therapeutic use of ultrasound in patients with cerebrovascular diseases, it is ultrasound induced lysis of thrombus or embolus. The aim of this work was to asses safety and efficacy of therapeutic ultrasound effect (sonolysis) in acute stroke patients and in patients undergoing carotid artery intervention. First partial aim of this work was to confirm the safety and efficacy of endovascular sonolysis by using the EkoSonic Endovascular System in subjects with acute ischemic stroke. Second partial aim of this work was to test the clinical efficacy of sonolysis for reducing the risk of incidence of new brain ischaemic lesions detected on brain magnetic resonance imaging in patients undergoing elective CEA or CAS for severe internal carotid stenosis. In addition, we assessed the effects of sonolysis on cognitive function, morbidity, and mortality at 30 days post-surgery. Methods: Patients with acute ischemic stroke and occlusion of the middle cerebral artery or basilar artery were enrolled consecutively to the prospective study tested safety and efficacy of endovascular sonolysis using the EkoSonic Endovascular System (EKOS) in patients with acute stroke. The control group (44 MCA and 12 BA occlusions) was selected from historical controls. EkoSonic...
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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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