Radovan Maly

Four cases of venous thromboembolism associated with olanzapine

Aims:  Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available.

Cavotricuspid Isthmus Catheter Ablation Across an Inferior Vena Cava Filter

Patients who suffer from recurrent thromboembolic events often receive an inferior vena cava (IVC) filter. There are few data available regarding treatment of this patient population with catheterization interventions, especially catheter ablation. We report a case of cavotricuspid isthmus catheter ablation across an IVC filter.

Emergent Carotid Thromboendarterectomy for Acute Symptomatic Occlusion of the Extracranial Internal Carotid Artery

Background: Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with an extremely poor prognosis. The best treatment approach in this setting is still unknown. The aim of our study was to evaluate the efficacy, safety, and outcomes of emergent surgical revascularization of acute extracranial ICA occlusion in patients with minor to severe ischemic stroke. Methods: A retrospective analysis was performed using prospectively collected data of consecutive patients who underwent carotid thromboendarterectomy for symptomatic acute ICA occlusion during the period from January 2013 to December 2015. Primary outcomes were disability at 90 days assessed by the modified Rankin Scale (mRS) and neurological deficit at discharge assessed using the National Institute of Health Stroke Scale (NIHSS). Secondary outcomes were the recanalization rate, 30-day overall mortality, and any intracerebral bleeding. Results: During the study period, a total of 6 patients (5 men and 1 woman) with a median age of 64 years (range: 58-84 years) underwent emergent reconstruction for acute symptomatic ICA occlusion within a median of 5.4 hours (range: 2.9-12.0 hours) after symptoms onset. The median presenting NIHSS score was 10.5 points (range: 4-21). Before surgery, 4 patients (66.7%) had been treated by systemic recombinant tissue plasminogen activator lysis. The median time interval between initiation of intravenous thrombolysis and carotid thromboendarterectomy was 117.5 minutes (range: 65-140 minutes). Patency of the ICA was achieved in all patients. On discharge, the median NIHSS score was 2 points (range: 0-11 points). There was no postoperative intracerebral hemorrhage and zero 30-day mortality rate. At 3 months, 5 patients (83.3%) had a good clinical outcome (mRS ≤ 2). Conclusion: Patients presenting with minor to severe ischemic stroke syndromes due to isolated extracranial ICA occlusion may benefit from emergent carotid revascularization. Thorough preoperative neuroimaging is essential to aid in selecting eligible candidates for acute surgical intervention.

Integration of Endovascular Therapy of Ruptured Abdominal and Iliac Aneurysms in the Treatment Algorithm: A Single-Center Experience in a Medium-Volume Vascular Center

Purpose: To evaluate the influence of endovascular therapy of ruptured abdominal or iliac aneurysms on total mortality. Materials and Methods: We analyzed the mortality of 40 patients from 2005 to 2009, when only surgical treatment was available. These results were compared with the period 2010 to 2013, when endovascular aneurysm repair (EVAR) was assessed as the first option in selected patients. Results: During 2005 to 2009, the mortality was 37.5%. From 2010 to 2013, 45 patients were treated with mortality 28.9%. Open repair was performed in 35 (77.8%) patients and EVAR in 10 (22.2%) patients. The 30-day and 1-year mortality rates of the EVAR group were 0% and 20%, respectively, and the total mortality rate was 30% during follow-up (median 11 months, range 1-42 months). The 30-day mortality in the surgical group remained unchanged, at 37.1%, and 1-year and total mortality rates were 45.7% and 51.4%, respectively. Conclusion: Following integration in the treatment algorithm, EVAR decreased total mortality in our center by 8.6%.

Endovascular Treatment of Symptomatic Thoracic Aneurysm Due to Periaortic Lymphoma

An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography–guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.

P03-244 - Cardiometabolic risk in patients with schizophrenia

Introduction Patients with schizophrenia have at least 20 years shorter life spam compared with general population that is primarily caused by their cardiovascular morbidity. Aims The aim of this cross-sectional study was to assess the prevalence of cardiometabolic risk factors in a sample of Czech patients with schizophrenia and related diseases and to predict a risk of premature cardiovascular mortality in this population. Methods We reviewed data from 129 outpatients treated in specialized outpatient clinic for psychoses. The main collected variables included basic physical parameters (height, weight, waist circumference, blood pressure), smoking habits, laboratory data (glucose level, serum lipids levels) and ECG. Finally, we compared the studied group with a matched sample from general population in Czech Republic regarding the cardiovascular risk factors. Results Our results show that the most prevalent risk factors are overweight (70% of patients have BMI over 25), dyslipidaemia (70% of patients) and smoking (43% of patients). According to SCORE diagram, there is a high risk of fatal cardiovascular event in ten years in 10% of the study group. The percentage gets even higher (up to 24%) when the latest European guidelines for cardiovascular disease prevention were used to calculate the risk. Conclusions Our outcomes indicate even higher cardiometabolic morbidity in patients with psychoses than referred in literature.

P03-62 - Markers of thrombogenesis are activated in not-yet treated acute schizophrenia

Objectives Antipsychotic treatment has been repeatedly found to be associated with an increased risk for venous thromboembolism (VTE) in schizophrenia. The aim of the study was to ascertain whether markers of thrombogenesis are increased in psychotic patients who have not yet been treated with antipsychotic medication. Methods We investigated plasma levels of markers indicating activation of coagulation (D-dimers) and platelets (solubile P-selectin, sP-selectin) in a group of nine men and nine women with acute schizophrenia who had not yet been treated with antipsychotics (age 29.8±9.1 years; body mass index 23.3±5.1), and eighteen healthy volunteers matched for age, gender and body mass index. Results D-dimers (median 0.38 vs 0.22 mg/l; P=0.049) as well as sP-selectin (median 195.9 vs 111.9 ng/ml; P=0.008) plasma levels were significantly increased in the group of patients with acute schizophrenia as compared to healthy volunteers. Conclusions The results suggest that at least a part of venous thromboembolic events in patients with schizophrenia may rather be induced by pathogenetic mechanisms related to psychosis than caused by antipsychotic treatment. Finding an exact cause of VTE in schizophrenia is necessary for its efficient treatment and prevention. We are aware of the pilot character of our data, and continue to involve more patients and healthy volunteers into the research.