Petra Cimflová

• MD
• Medical Doctor at St. Ann's University Hospital Brno

Background: A third of endovascularly treated stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after...

Introduction Despite recent advances in endovascular therapy, up to half of acute ischemic stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) after intervention. However, many of these patients will achieve complete delayed reperfusion at the 24h follow‐up, which is linked to good clinical outc...

Background We evaluated the association of reperfusion quality and different patterns of achieved reperfusion with clinical and radiological outcomes in the ESCAPE NA1 trial. Methods Data are from the ESCAPE-NA1 trial. Good clinical outcome [90-day modified Rankin Scale (mRS) 0–2], excellent outcome (90-day mRS0–1), isolated subarachnoid hemorrhag...

Background Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-...

Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. We identified all patients admitted with spontaneous ICH to hospitals with a cer...

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1–2% o...

Background and objective Subpleural located pulmonary nodules are perioperatively invisible to the surgeon. Their precise identification is conventionally possible by palpation, but often at the cost of performing a thoracotomy. The aim of the study was to evaluate the success rate and feasibility of the pre-operative CT-guided marking subpleural l...

The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology. Although BAO accounts for only 1-2% o...

Background and Purpose Numerous studies have shown longer pre-hospital and in-hospital workflow times and poorer outcomes in women after acute ischemic stroke (AIS) in general and after endovascular treatment (EVT) in particular. We investigated sex differences in acute stroke care of EVT patients over 5 years in a comprehensive Canadian provincial...

Background Incomplete reperfusion (IR) after mechanical thrombectomy (MT) can be a consequence of residual occlusion, no-reflow phenomenon, or collateral counterpressure. Data on the impact of these phenomena on clinical outcome are limited. Methods Patients from the ESCAPE-NA1 trial with IR (expanded Thrombolysis In Cerebral Infarction (eTICI) 2b...

Introduction: Despite improvements in device technology, only one-third of stroke patients undergoing endovascular thrombectomy (EVT) achieve first-pass effect (FPE). We investigated the effect of arterial tortuosity and thrombus characteristics on the relationship between first-line EVT strategy and angiographic outcomes. Patients and methods:...

Background The presence of diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was used to determine eligibility for intravenous thrombolysis in clinical trials. However, due to the restricted availability of MRI and the ambiguity of image assessment, it is not widely implemented in clinical practice. Methods...

Background and purpose: Identifying the presence and extent of intracranial thrombi is crucial in selecting patients with acute ischemic stroke for treatment. This article aims to develop an automated approach to quantify thrombus on NCCT and CTA in patients with stroke. Materials and methods: A total of 499 patients with large-vessel occlusion...

Background: Infarct in a new territory (INT) is a known complication of endovascular stroke therapy. We assessed the incidence of INT, outcomes after INT, and the impact of concurrent treatments with intravenous thrombolysis and nerinetide. Methods: Data are from ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide [NA-1] in Subjects Undergoing E...

Background and Purpose: First pass effect (FPE), or effective reperfusion with a single pass of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), is strongly associated with good functional outcome (mRS≤2) and can aid in optimal device selection for EVT. We aim to investigate the arterial tortuosity from great vessel origin to the in...

Background: Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. Methods: Patients with thin-slice (≤2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (...

First-pass Effect(FPE) for Endovascular Therapy(EVT) is associated with good clinical outcome (mRS2) of patients with Acute Ischaemic Stroke (AIS). A rapid and accurate prediction of FPE before EVT can help neurointerventionists plan the procedure and avoid delays in restoration of cerebral blood flow. However, there are rare studies focused on FPE...

Background First‐pass effect (FPE), that is, achieving reperfusion with a single thrombectomy device pass, is associated with better clinical outcomes in patients with acute stroke. FPE is therefore increasingly used as a marker of device and procedural efficacy. We aimed to evaluate the ability of thrombus‐based radiomics models to predict FPE in...

Introduction: Distal embolization (DE) is a common complication of endovascular treatment (EVT). We aimed to investigate the association of radiological thrombus characteristics and treatment details with distal embolization (DE). Methods: Patients with thin-slice (≤2.5 mm) baseline non-contrast CT and CT-angiography from the ESCAPE-NA1 trial (Eff...

Introduction It remains unclear whether incomplete reperfusion caused by multiple small occlusions or slow flow after mechanical thrombectomy (MT) results in infarction on follow-up imaging.¹ Aim We investigated whether small peripheral thrombi or slow flow was associated with infarction on follow-up scan. Methods Patients from the ESCAPE-NA1 tri...

Introduction The degree of mTICI 2b reperfusion varies from 51%-89% in acute stroke patients treated with mechanical thrombectomy(MT)¹. Incomplete reperfusion could be due to either focal occlusion (residual thrombus, fragmented/migrated thrombus) or slow flow². With advancing endovascular techniques, residual distal/medium vessel occlusions can be...

Background Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging and specific endovascular tools are needed to safely and effectively recanalize these relatively small and fragile vessels. We aimed to gain insight into availability and desired qualities of endovascular devices used in MeVO stro...

Background Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging and specific endovascular tools are needed to safely and effectively recanalize these relatively small and fragile vessels. We aimed to gain insight into availability and desired qualities of endovascular devices used in MeVO stro...

PurposeInfarct lesion volume (ILV) may serve as an imaging biomarker for clinical outcomes in the early post-treatment stage in patients with acute ischemic stroke. The aim of this study was to evaluate the inter- and intra-rater reliability of manual segmentation of ILV on follow-up non-contrast CT (NCCT) scans.Methods Fifty patients from the Prov...

Purpose CT angiography (CTA) is the imaging standard for large vessel occlusion (LVO) detection in patients with acute ischemic stroke. StrokeSENS LVO is an automated tool that utilizes a machine learning algorithm to identify anterior large vessel occlusions (LVO) on CTA. The aim of this study was to test the algorithm’s performance in LVO detecti...

PurposeMedium vessel occlusions (MeVOs) can be challenging to detect on imaging. Multiphase computed tomography angiography (mCTA) has been shown to improve large vessel occlusion (LVO) detection and endovascular treatment (EVT) selection. The aims of this study were to determine if mCTA-derived tissue maps can (1) accurately detect MeVOs and (2) p...

Purpose: To validate the performance of a 3D convolutional neural network (CNN) based algorithm i.e. Stroke SENS LVO, in automatically detecting the presence of large vessel occlusions (LVO) on computed tomography angiography (CTA) images of the head. Method: A total of 400 studies (217 LVO, 183 non-LVO) were used in the analysis. The LVO group inc...

Introduction: First-pass effect (FPE), i.e., achieving reperfusion with a single thrombectomy device pass, is associated with better clinical outcomes in patients with acute stroke. FPE is therefore increasingly being used as a marker of device and procedural efficacy. We evaluated the ability of thrombus-based radiomics models to predict FPE in pa...

Background Successful reperfusion determines the treatment effect of endovascular thrombectomy. We evaluated stent-retriever characteristics and their relation to reperfusion in the ESCAPE-NA1 trial. Methods Independent re-scoring of reperfusion grade for each attempt was conducted. The following characteristics were evaluated: stent-retriever len...

Background and purposeEndovascular treatment (EVT) is a powerful treatment for large vessel occlusion (LVO) stroke if reperfusion can be achieved, while in cases with failed reperfusion, EVT may cause harm, as procedure-related complications may occur. We hypothesized that EVT with failed recanalization does not result in worse outcomes compared to...

Identifying the presence and extent of early ischemic changes (EIC) on Non-Contrast Computed Tomography (NCCT) is key to diagnosing and making time-sensitive treatment decisions in patients that present with Acute Ischemic Stroke (AIS). Segmenting EIC on NCCT is however a challenging task. In this study, we investigated a 3D CNN based on nnU-Net, a...

Background: Thrombus embolization during endovascular treatment (EVT) occurs in up to 9% of cases, making secondary medium-vessel occlusions (MeVOs) of particular interest to neurointerventionalists. We sought to gain insight into the current EVT approaches for secondary MeVO stroke in an international case-based survey as there are currently no cl...

Background: There are no recommendations regarding endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to primary medium vessel occlusion (MeVO). The aim of this study was to examine the willingness to perform EVT among stroke physicians in patients with mild, yet personally-disabling deficits due to MeVO. Methods: In an...

Background and purpose: Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-bas...

Introduction: The optimal anaesthesia approach for endovascular treatment (EVT) in acute ischaemic stroke is currently unknown. In stroke due to medium vessel occlusions (MeVO), the occluded vessels are particularly small and more difficult to access, especially in restless or uncooperative patients. In these patients, general anaesthesia (GA) may...

Background: Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging. Devices and tools are rapidly evolving. We aimed to gain insight into preferences and global perspectives on the usage of endovascular tools in treating MeVOs. Methods: We conducted an international survey with seven scenarios o...

Background: Multiphase CTA (mCTA) is an established tool for endovascular treatment decision-making and outcome prediction in acute ischemic stroke, but its interpretation requires some degree of experience. We aimed to determine whether mCTA-based prediction of clinical outcome and final infarct volume can be improved by assessing collateral stat...

Background and purpose: Patients with acute ischemic stroke due to medium vessel occlusion (MeVO) make up a substantial part of the acute stroke population, though guidelines currently do not recommend endovascular treatment (EVT) for them. A growing body of evidence suggests that EVT is effective in MeVOs, including observational data but no rand...

Background and purpose: There is a paucity of evidence regarding the safety of endovascular treatment for patients with acute ischemic stroke due to primary medium-vessel occlusion. The aim of this study was to examine the willingness among stroke physicians to perform endovascular treatment in patients with mild-yet-disabling deficits due to medi...

Background Medium-vessel occlusions (MeVOs) account for 25%-40% of all acute ischemic stroke (AIS) cases. With peri-procedural embolization occurring in up to 9% of all EVT cases, secondary MeVOs are of particular interest to neurointerventionalists. There is currently no reliable evidence regarding whether EVT is safe and effective for MeVO stroke...

Background Medium-vessel occlusions (MeVOs) are the second most frequent cause of acute ischemic stroke (AIS) and patients often have poor clinical outcome if treated with best medical management alone. Alteplase recanalization rates have been shown to range from 21-43% in primary (de-novo occurring) MeVOs, indicating a need for a more effective th...

There are limited data on endovascular treatment (EVT) for anterior cerebral artery (ACA) occlusions. This review focuses on aspects related to ACA EVT: ACA anatomy, clinical and imaging findings, prognosis of ACA stroke, and ACA thrombectomy techniques. The ACA anatomy, and the regions supplied by the ACA, are highly variable; frequent anatomical...

Background Intravenous alteplase is currently the only evidence-based treatment for medium-vessel occlusion stroke (MeVO; M2/3, A2/3, and P2/3 vessel segment occlusions), but due to its limited efficacy, endovascular treatment (EVT) is increasingly performed in these patients. In this case-based survey study, we examined the influence of intravenou...

Background The effect of infarct pattern on functional outcome in acute ischemic stroke is incompletely understood. Purpose To investigate the association of qualitative and quantitative infarct variables at 24-hour follow-up noncontrast CT and diffusion-weighted MRI with 90-day clinical outcome. Materials and Methods The Safety and Efficacy of Ner...

Background: We aimed to explore the preference of stroke physicians to treat patients with primary medium vessel occlusion (MeVO) stroke with immediate endovascular treatment (EVT) in an international cross-sectional survey, as there is no clear guideline recommendation for EVT in these patients. Methods: In the survey MeVO-Finding Rationales an...

Background: The optimal treatment and prognosis for stroke patients with tandem cervical carotid occlusion are unclear. We analyzed outcomes and treatment strategies of tandem occlusion patients in the ESCAPE-NA1 trial. Methods: ESCAPE-NA1 was a multicenter international randomized trial of nerinetide versus placebo in 1105 patients with acute i...

Introduction: Fusiform dilatation of the internal carotid artery (ICA) is reported as a possible complication of craniopharyngioma resection in childhood. Here, the authors describe such a complication in an adult patient who presented with acute symptomatic thrombosis 7 months after surgery. Materials and methods: A 45-year-old woman presented...

BACKGROUND AND PURPOSE Manual segmentation of infarct volume on follow‐up MRI diffusion‐weighted imaging (MRI‐DWI) is considered the gold standard but is prone to rater variability. We assess the variability of manual segmentations of MRI‐DWI infarct volume. METHODS Consecutive patients (May 2018 to May 2019) with the anterior circulation stroke a...

Introduction: Emboli in new territory (ENT) are known potential complication of endovascular thrombectomy. We explored their incidence and predictors in ESCAPE-NA-1 trial. Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ische...

Background: The optimal treatment for stroke patients with tandem cervical carotid occlusion is debated. We analyzed the treatment strategies and outcomes of tandem occlusion patients in the ESCAPE NA1 trial. Methods: ESCAPE NA1 was a multicenter international randomized trial of nerinetide vs. placebo in patients with acute ischemic stroke who und...

Background: We evaluated clinical outcome in relation to the degree of reperfusion in ESCAPE-NA1 trial. Methods: ESCAPE-NA1 was a multicenter, international randomized trial assessing the efficacy of nerinetide in ischemic stroke patients who underwent EVT within 12h from onset. Independent clinical outcome [90-days modified Rankin Scale (mRS) 0-2]...

Purpose: In this post-hoc analysis of the ESCAPE-NA1 trial, we investigated the prevalence of deep grey matter infarcts and their influence on clinical outcome. Methods: Infarcts on 24 hour follow up imaging (non contrast head CT or diffusion-weighted MRI) were categorized as predominantly deep grey matter infarcts (caudate and/or lentiform nucleus...

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic strok...

Background: We evaluated technical aspects of stent retriever use and its relation to reperfusion in ESCAPE NA1 trial. Methods: ESCAPE-NA1 was a multicenter, international randomized trial assessing the efficacy of nerinetide in ischemic stroke patients who underwent EVT within 12h from onset. The following stent retriever characteristics were eval...

Purpose: We assessed whether balloon guide catheter (BGC) use during endovascular thrombectomy (EVT) influences procedural and clinical outcomes in the ESCAPE-NA1 trial. Methods: ESCAPE-NA1 was an international multicenter trial that randomized large vessel occlusion stroke patients who underwent endovascular thrombectomy (EVT) to receive Nerinetid...

Background: The degree of cortical venous opacification could reflect the degree of ischemia in tandem occlusions strokes. We assessed the association between asymmetric cortical vein opacification and outcome among patients with acute ischemic stroke and tandem occlusion. Methods: ESCAPE NA1 was a multicenter randomized-controlled trial comparing...

Background: Time from imaging to establishing reperfusion is a major influencer of clinical outcomes and over the years thrombectomy techniques have evolved rapidly. This has led to improvements in achieving fast and complete reperfusion. We analyzed the impact of various intra-procedural techniques and tools on the speed of reperfusion and correla...

Purpose: We investigated the prevalence and prognostic impact on outcome of any intracranial hemorrhage, hemorrhage morphology, type and volume in acute ischemic stroke patients undergoing mechanical thrombectomy. Methods: Prevalence of intracranial hemorrhage, hemorrhage type, morphology and volume was determined on 24h follow-up imaging (non cont...

International survey to assess treatment aross multiple scenarios of patients presenting with MeVO.

Background Indications for flow diversion stent (FDS) treatment are expanding. However, there is still a lack of evidence for the long-term outcome in distally located aneurysms in the M2 segment of the middle cerebral artery (MCA) and beyond. Methods Consecutive subjects (from June 2013 to August 2020) with MCA aneurysms in the M2 segment or beyo...

Background: Endovascular thrombectomy (EVT) is highly effective for acute ischemic stroke with large vessel occlusion (LVO) and moderate to severe neurologic deficits. Objective: To undertake an effectiveness and safety analysis of EVT in patients with LVO and NIHSS ≤6 using datasets of multicentre and multinational nature. Methods: We pooled pat...

Purpose The aim of the study was to compare the assessment of ischemic changes by expert reading and available automated software for non-contrast CT (NCCT) and CT perfusion on baseline multimodal imaging and demonstrate the accuracy for the final infarct prediction. Methods Early ischemic changes were measured by ASPECTS on the baseline neuroimag...

Background and Purpose The prognosis of medium vessel occlusions (MeVOs), that is, M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery occlusions, is generally better compared with large vessel occlusions, since brain ischemia is less extensive. However, in some MeVO patients, infarcts are seen outside the...

Background Preventing errors and complications in neurointervention is crucial, particularly in the treatment of unruptured intracranial aneurysms (UIAs), where the natural history is generally benign, and the margin of treatment benefit small. We aimed to investigate how neurointerventionalists perceive the importance and frequency of errors and t...

Background: In randomized clinical trials, mechanical thrombectomy (MT) was proved to be a highly effective treatment of acute ischemic stroke which improved clinical outcomes. Some of the trials used automated computed tomography perfusion (CTP) analysis for selection of participants. We present a single-center experience with CTP selection and co...

Background: In randomized clinical trials (RCTs) mechanical thrombectomy (MT) was proved to be a highly effective and safe treatment in acute ischemic stroke. Its efficacy and safety in routine practice needs to be documented. Methods: Available nationwide 2016 data for the Czech Republic (CR) from SITS-TBY registry of patients with terminal intern...

Background – Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis. Methods – Available nationwide data for the CR from the year 2016 from th...

Background: Neuroanatomic substrates responsible for development of poststroke spasticity are still poorly understood. The study is focused on identification of brain regions within the territory of the middle cerebral artery associated with spasticity development. Methods: This is a single-center prospective cohort study of first documented anteri...

Introduction: Mechanical thrombectomy (MT) has been established as a standard of care in acute ischaemic stroke. We systematically evaluated all stroke centres conducting MT i. The Czech Republic. Methods: An online questionnaire based. The International Multi-Society Consensus Document was distributed to all such centres to monitor al. The procedu...

Introduction: Mechanical thrombectomy (MT) has been established as a standard of care in acute ischaemic stroke. We systematically evaluated all stroke centres conducting MT in the Czech Republic. Methods: An online questionnaire based on the International Multi-Society Consensus Document was distributed to all such centres to monitor all the proce...

Main research question was whether the structural stroke neuroimaging has any predictive value for post-stroke spasticity development. So far there is still limited evidence in terms of lesion location and its extent in association with spasticity development based on widely-used neuroimaging methods (computed tomography/CT and magnetic resonance i...

Modified Thrombolysis In Cerebral Infarction (mTICI) is currently a standard for reporting angiographic results of mechanical thrombectomy in acute ischemic stroke. This scale has also been used in all recently published positive endovascular trials3. However, it describes only the territory behind the occlusion. We aimed to devise a score represen...

Using the TICI 2c category in clinical practice is feasible. Patients with the near complete reperfusion should be scored in the separate category. It seems to be beneficial and clinically relevant to assess the modified TICI score by consensus of stroke treating specialists (stroke neurologist and neurointerventionalist/neuroradiologist). Our find...

Background and purpose: Using an extended CT perfusion acquisition (150s), we sought to determine the association between perfusion parameters and malignant edema after ischemic stroke. Methods: Patients (from prospective study PROVE-IT, NCT02184936) with terminal internal carotid artery ± proximal middle cerebral occlusion were involved. CTA was a...

Background and purpose – Thrombolysis in Cerebral Infarction (TICI) with 2b/3 (>50% of occluded territory/complete reperfusion) has been regarded as a successful angiographic outcome. To account for near-perfect angiographic results, the category TICI 2c (near complete reperfusion) has been introduced. Since the degree of inter-rater reliability fo...

Objectives: CT angiography (CTA) is recommended as a standard of stroke imaging. We investigated accuracy and precision of standard or single-phase CTA as compared with novel technique or multiphase CTA in clot detection in the middle cerebral artery. Methods: Twenty single-phase CTA and twenty multiphase CTA with prevailing M2 occlusion were asses...

Background: CT angiography (CTA) is recommended as standard of stroke imaging. We investigated accuracy and precision of standard single-phase CTA as compared to novel technique – multi-phase CTA in intracranial clot/s detection in the territory of middle cerebral artery (MCA). Methods: Forty patients (20 single-phase and 20 multiphase CTA) were se...

Background: We explore the role of dural sinus morphology, leptomeningeal collaterals, and clot localization in the development of malignant brain edema in acute ischemic stroke in anterior circulation. Methods: This is a single-center retrospective study of consecutive stroke patients with acute occlusion (middle cerebral artery M1 ± intracrani...

We explore the predictive value of CT perfusion parameters (permeability surface area, cerebral blood fl ow, cerebral blood volume) and multiphase CT angiography (clot localization, leptomeningeal collaterals and dural sinuses morphology) in the development of malignant brain oedema in patients with acute proximal occlusion of the middle cerebral a...

Introduction: Reliable early stroke prognostication has important implications for goals of care planning, treatment guidance, and disposition planning. At present, prediction of patient long term functional outcomes remains challenging. Hypothesis: Infarct volumes on early non-contrast CT may be a useful tool in predicting long term stroke functio...

Small non-coding molecules of ribonucleic acid are Important regulators of gene expression and translation. One group of non-coding RNAs is represented by microRNA-22-24 nucleotides long RNA molecules with effects on regulation of proteins synthesis. Many of them are tissue or organ specific (e.g. miR-206 in striated muscles or miR-122 in hepatocyt...

Cardiovascular diseases are major causes of morbidity and mortality in developed countries. Cerebrovascular diseases, especially stroke, represent major burden of disability and economy impact. Major advances in primary and secondary prevention and therapy are needed in order to tackle this public health problem. Our better understanding of pathoph...

Epilepsy, a central nervous system disorder causing recurrent unprovoked seizures, remains a severe medical problem with a profound social impact on quality of life. The prevalence in population is 0.5-1%. Epilepsy is associated with various brain lesions such as developmental and metabolic disorders, some tumours, vascular malformations, postinfec...