Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54–122) vs. 147 (116–242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications.

Background and Objectives: Carotid intima–media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today, we are talking about a new paradigm—cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, an unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Background: Iatrogenic cerebral amyloid angiopathy (iCAA) is a subform of cerebral amyloid angiopathy caused by exposure to amyloid β. The aim of this study was to assess cerebrospinal fluid amyloid and τ concentrations in iCAA in comparison with sporadic cerebral amyloid angiopathy (sCAA), Alzheimer disease (AD), and controls. Methods: We conducted a systematic literature review to identify patients with iCAA with published cerebrospinal fluid marker concentrations. We then analyzed the cerebrospinal fluid concentrations of amyloid β40, amyloid β42, total τ, and phosphorylated τ 181, comparing them with the corresponding data of patients with sCAA, AD, and controls from our previous work. Results: The study included 25 patients with iCAA (age, 44±11 years), 31 patients with sCAA (age, 75±5 years), 28 patients with AD (age, 71±8 years) and 30 controls (age, 72±8 years) from 9 case descriptions and 1 cohort study. Amyloid β40 concentrations did not differ significantly between iCAA and the other groups. Amyloid β42 concentration was significantly higher in controls than iCAA and the other groups. The amyloid β42/40 ratio was higher in iCAA than in AD and higher in controls than sCAA and AD. Total τ concentrations were lower in controls than iCAA but did not differ significantly between iCAA, sCAA, and AD. Phosphorylated τ concentrations were not significantly different in iCAA compared with controls, significantly higher in sCAA, and highest in AD. Conclusions: The observation that phosphorylated τ concentrations in iCAA are not different from controls led us to the hypothesis that iCAA is characterized by amyloid plaque formation largely without concomitant phosphorylated τ aggregation, which is well compatible with most published pathologic studies.

Introduction: Early identification of stroke aetiology, hemodynamic monitoring and detection of complications represent key challenges for vascular neurologists. Stroke-point-of-care ultrasound (Stroke-POCUS) has emerged as a structured framework for integrating multimodal bedside ultrasound into stroke management. Patients and methods: Stroke-POCUS involves the comprehensive bedside use of various ultrasound modalities, including cervical and transcranial ultrasound, orbital ultrasound, echocardiography, venous system ultrasound, lung ultrasound, abdominal ultrasound and interventional ultrasound. These modalities are applied in an integrated manner to assess stroke patients in the acute setting, aiming to support diagnosis, etiological investigation, detection of complications and monitoring of treatment response, as an adjunct, not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive ultrasound examination. Results: The integration of multiple ultrasound modalities within Stroke-POCUS enables clinicians to obtain rapid, noninvasive answers to well-defined clinical questions at the patient’s bedside and in real time. This capability is particularly critical for patients requiring expedited diagnostics prior to urgent treatment initiation, for clinically unstable patients in whom intrahospital transport carries an increased risk of complications, as well as for assessing potential underlying causes, identifying secondary complications and monitoring treatment efficacy. Discussion and conclusion: Stroke-POCUS represents a comprehensive bedside imaging strategy that enhances the evaluation and management of stroke patients. By integrating multiple ultrasound techniques, it provides a more holistic view of stroke pathophysiology, complications and treatment monitoring, potentially improving clinical decision-making and individualised patient care.