Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (−9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT −16.09%, TTP −7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT −14.65%, TTP −7.46%) sides. PS decreased by almost half: ipsilateral −48.11%, contralateral −45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.

PurposeThe purpose of the study was to assess the responses of pial artery pulsation (cc-TQ) and subarachnoid width (sas-TQ) to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV), cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak response (TTP).MethodsFifteen patients with carotid artery stenosis ≥90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS).ResultsBased on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0%±8.1% vs. +15.3%±4.4% and +26.3%±6.6% vs. +14.3%±5.1%; contralateral: +26.8%±7.0% vs. +17.6%±5.6% and +20.0%±7.3% vs. +10.0%±3.7%, respectively), cc-TQ was significantly higher only on the ipsilateral side (+37.3%±9.3% vs. +26.6%±8.6%) and the decrease in sas-TQ was less pronounced on the ipsilateral side (−0.7%±1.5% vs. −10.2%±1.5%), in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP.ConclusionsThe ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

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Patients with cancer have a high risk of developing cancer-associated thrombosis (CAT). Current guidelines suggest preferential use of low molecular weight heparins (LMWH) in CAT. The real-world data show that compliance with recommended LMWH therapy in cancer patients is low. Many patients discontinue injectable anticoagulants prematurely, in some cases even after a month, despite a high recurrence rate in this population. In recent years an increasing number of cancer patients are treated with direct oral anticoagulants, mainly rivaroxaban. Recent data confirming the safety and efficacy of rivaroxaban are starting to emerge and support the growing trend of using direct oral anticoagulants in cancer patients. If positive results of the recently completed SELECT-D trial are confirmed in the upcoming trials and registries of CALLISTO project, the guidelines for the treatment of CAT will have to be revised in favour of DOAC use in cancer-associated thrombosis.

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IntroductionAtherosclerosis is the most common cause of chronic lower limb ischaemia. Many factors that have a crucial influence on the development of the disease, its course and prognosis have been identified. The risk factors seem to be subject to interventions due to their susceptibility to changes. It is important to increase the engagement of doctors and nurses performing the screening oriented on risk factors, medical consultation regarding giving up smoking, changing the diet and undertaking physical activity. Therefore, knowledge of the patients’ health situation allows introduction of optimal treatment in this group of patients.Material and methodsThe study group consisted of 119 patients with peripheral artery atherosclerosis, who underwent surgical and endovascular repair. The diagnostic survey method was used in this study. The socio-demographic and clinical data were collected using an originally developed questionnaire. The statistical analysis was performed using the data analysis software system Statistica, version 10.0, by StatSoft Inc. (2011) and an Excel spreadsheet. The statistical significance was set at p < 0.05 for all calculations.ResultsThere were statistically significant differences between the analysed groups with regard to severity of ischaemia (p = 0.0001), intermittent claudication (p = 0.0001), rest pain (p = 0.0001), ulceration (p = 0.0031), smoking (p = 0.0075) and comorbidities (percutaneous coronary interventions p = 0.0299; ischaemic stroke p = 0.0235).ConclusionsThere are significantly more patients with more advanced disease and ex-smokers in the surgically treated group. There are significantly more patients with a history of ischaemic stroke, surgical coronary interventions and current smokers in the endovascular group.

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Purpose: This study investigated the 2-year safety and effectiveness of the PQ Bypass DETOUR system as a percutaneous femoropopliteal bypass. Materials and Methods: Seventy-eight patients with 82 long-segment femoropopliteal lesions were enrolled in this prospective, single-arm, multicenter study. The DETOUR system deployed Torus stent grafts directed through a transvenous route. Eligible patients included those with lesions of >10 cm and average of 371±55 mm. Key safety endpoints included major adverse events (MAEs) and symptomatic deep venous thrombosis in the target limb. Effectiveness endpoints included primary patency defined as freedom from ≥50% stenosis, occlusion, or clinically-driven target vessel revascularization (CD-TVR), primary assisted, and secondary patency. Results: Chronic total occlusions and severe calcium occurred in 96% and 67% of lesions, respectively. Core laboratory-assessed total lesion length averaged 371±51 mm with a mean occlusion length of 159±88 mm. The rates of technical and procedural success were 96%, with satisfactory delivery and deployment of the device without in-hospital MAEs in 79/82 limbs. The MAE rate was 22.0%, with 3 unrelated deaths (4%), 12 CD-TVRs (16%), and 1 major amputation (1%). Deep venous thrombosis developed in 2.8% of target limbs, and there were no reported pulmonary emboli. Primary, assisted primary, and secondary patency rates by the Kaplan–Meier analysis were 79±5%, 79±5%, and 86±4%, respectively. Conclusions: The PQ Bypass DETOUR system is a safe and effective percutaneous alternative to femoropopliteal open bypass with favorable results through 2 years. The DETOUR system provides a durable alternative to conventional endovascular modalities and open surgery for patients with long, severely calcified, or occluded femoropopliteal lesions.