COVID-19 during Early Phase of Autologous Stem Cell Transplantation.

We present one of few cases of COVID-19 occurrence during the early phase of autologous hematopoietic stem cell transplantation. We observed an interesting correlation between the patient's rapid clinical deterioration and myeloid reconstitution that cannot be assigned to engraftment syndrome. Our report emphasizes the need to investigate whether timely steroid therapy upon neutrophil engraftment in the setting of COVID-19 could limit the extent of lung injury and prevent ARDS. Furthermore, we discuss a significant issue of possible prolonged incubation of the virus in heavily pretreated hematological patients.

[Endovascular treatment of extracranial internal carotid artery aneurysm]. / Wewnatrznaczyniowe leczenie zewnatrzczaszkowego tetniaka tetnicy szyjnej wewnetrznej.

Aneurysms within internal carotid artery in extracranial segment occur very rarely. The treatment of choice is surgery, which is difficult and poses a risk of serious complications. The introduction of endovascular techniques opened new possibilities of treatment. The case of internal carotid artery aneurysm treated with self-expandable stent, covered with fabric PTFE was introduced. The total exclusion of aneurysm from the circulation was obtained.

[Endovascular treatment of iatrogenic subclavian artery injury]. / Leczenie metoda wewnatrznaczyniowa jatrogennego uszkodzenia tetnicy podobojczykowej.

Iatrogenic subclavian artery inju. ries occur rarely but they can cause life threatening consequences. A case of a mistakenly placed catheter into right subclavian artery was introduced. Little invasive endovascular treatment was used. The catheter was removed simultaneously dressing the wound with the stent covered with fabric PTFE. Total tightness of the vessel was obtained.

[Catheter-directed thrombolytic treatment with high doses of rtPA of a lower limb ischemia complicated by peripheral embolism]. / Celowane leczenie trombolityczne za pomoca duzych dawek rtPA ostrego niedokrwienia konczyny dolnej z powiklaniem w postaci zatorowosci obwodowej.

Catheter-directed thrombolytic treatment in an alternative method of treatment compared to the surgery of acute lower limbs ischemia. A case of acute lower limb ischemia due to occlusion of the vascular by-pass treated with guided thrombolysis with the use of a high doses of rtPA administered in a short period of time. Restoration of patency (revascularization) was achieved, and simultaneously complication in the form of peripheral embolism was found. After performing angioplasty of arteries occluded with embolism, total vascular revascularization and finally a very good clinical result were achieved.

[Treatment of recurrent splenic artery aneurysm with covered stents]. / Leczenie nawrotowego tetniaka tetnicy sledzionowej stentem pokrywanym.

Aneurysms of the visceral arteries occur the most frequently in splenic artery. They can be managed surgically or endovascularly. The endovascular techniques include embolization with coils, glue or covered stent. The case of recurrent splenic artery aneurysm treated with self-expandable stent covered with fabric PTFE is presented. The total exclusion of the aneurysm from the circulation was obtained.

Percutaneous endovascular recanalization of iliac artery.

BACKGROUND: The method of percutaneous, endovascular recanalization of the iliac artery in patients with occluded common and external iliac arteries was used. MATERIAL/METHODS: In 58 patients (mean age 59 years), percutaneous endovascular recanalization of 40 common and 18 external iliac arteries was performed. In 2 cases the common superficial femoral artery was also occluded. The average length of occlusion was 6.2 cm. The time since the onset of occlusion symptoms was 1 to 12 months. The recanalization was performed by passing with hydrophilic guidewire and catheter through the occlusion,and then performing balloon angioplasty. In case of unsatisfying results, a stent was placed. Intra-arterial thrombolysis was not provisionally applied in any case. RESULTS: 56 arteries were recanalized, 2 intravascular procedures were not successful. 7 cases of complications occurred: 3 of peripheral embolia, 1 occlusion of internal iliac artery, 3 hematomas at the puncture site; none of them required surgical intervention. CONCLUSIONS: Percutaneous endovascular recanalization is an efficient method of treatment in occlusion of iliac arteries.

Does use of hydrophilic guidewires significantly improve technical success rates of peripheral PTA?

BACKGROUND: To determine whether the use of hydrophilic guidewires has increased the technical success rate of peripheral percutaneous transluminal angioplasty (PTA). MATERIAL/METHODS: We performed 125 procedures and analyzed the technical success rates of PTA using the conventional guidewire first and then if needed, the hydrophilic guidewire for iliac and SFA stenoses or occlusions. Angioplasty was performed on 25 stenosed, 25 occluded iliac arteries and 25 stenosed, 50 occluded femoral arteries. The result was defined as technical success when the lesion was crossed by a guidewire and balloon, then it was dilated with restoration of vessel lumen and less than 30% residual stenosis and the rise in ABI values was at least 0.15 after 24 hours. RESULTS: The technical success rate after PTA of stenosed iliac arteries was achieved in 96% (24/25) using conventional wires and 100% using hydrophilic guidewire; in iliac occlusions, the rates were 60% (15/25) and 96%, respectively; in femoral stenosis - 84% (21/25) and 100%; in occlusions in the first group: lesions <10 cm -64% (16/25) and 96%, in the second group: lesions >10 cm -48% (12/25) and 88%. In the iliac group, there was no significant difference in the success of iliac stenosis PTA. However, there were significant changes in the success rates of PTA performed for SFA stenosis and iliac and SFA occlusions. CONCLUSIONS: In summary, we report an overall improvement and high technical success rate for peripherial PTA. The use of hydrophilic guidewires made significant difference to the technical success rate of PTA, especially in occlusion and more complicated lesions.

Computer-assisted characterisation of a carotid plaque.

BACKGROUND: The aim of this study was to attempt an objective assessment of carotid plaque echogenicity by means of computer-aided technique and to determine the association between the echogenicity and the incidence of brain infarctions. MATERIAL/METHODS: 54 carotid plaques causing internal carotid artery stenosis within the range of 60 - 99% constituted the material for our studies. The images of the plaques obtained by means of USG were transferred to and saved on the computer. Using image analysis software, a histogram of each plaque was obtained. The grey scale median (GSM range 0 - 255) for each histogram, which was used as a measure of the plaque echogenicity, was determined. The value of GSM was assessed in patients who suffered from brain infarctions in the area of the stenosed artery and in patients without infarctions. RESULTS: The grey scale median associated with cerebral infarction was nearly two times lower in comparison with GSM of plaques found in patients without infarction. Among 30 plaques with GSM >35,only 5.5%were connected with brain infarction ,and 27.8%of the 24 plaques with GSM <35 were associated with brain infarction.No correlation with cerebral infarction was found for 50%of the plaques with GSM >35 and 16.7%of the plaques with GSM <35. CONCLUSIONS: The use of computer-aided method allows assessment of carotid plaque echogenicity and can be used for clinical studies aimed at evaluation of the correlation between carotid plaque type and a risk of ischemic stroke.