1. Long-term adverse effects of neck radiotherapy in childhood on the carotid arteries in survivors of hodgkin lymphomaMatjaž Popit, Marjan Zaletel, Bojana Žvan, Lorna Zadravec-Zaletel, 2023, original scientific article Abstract: Abstract: Introduction: Survivors of Hodgkin lymphoma are recognized to have an increased risk of stroke and carotid artery disease owing to neck irradiation (RT). However, it remains unclear whether the vascular modifications induced by the treatment of Hodgkin lymphoma during childhood persist over the long term. Methods: Our matched study involved 79 survivors of Hodgkin lymphoma in childhood who received neck RT and 57 healthy controls. Parameters of arterial stiffness (AS), intima-media thickness (IMT), and flow-mediated dilation (FMD) of carotid arteries were assessed using ultrasound. Results: Our patient cohort demonstrated a significant increase in AS compared to controls (p < 0.05), though no such disparity was observed for FMD (p = 0.111). Neck RT intensified AS (B = 0.037, p = 0.000), while anthracyclines attenuated it (B = −0.803, p = 0.000). Multivariate analysis revealed a positive correlation between neck RT (p < 0.001) and AS. However, we found no significant association between neck RT and FMD (p = 0.277). We identified a substantial positive correlation between the dose of neck RT and AS. Conclusions: Vascular changes in survivors of childhood Hodgkin lymphoma after neck RT seem to be long-term. Therefore, these patients may have an increased risk of stroke. We suggest refinement of international guidelines according to our results.
Keywords: Hodgkin lymphoma, childhood, neck radiotherapy
Published in DiRROS: 06.08.2026; Views: 55; Downloads: 37
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2. Long-term echocardiographic features after percutaneous closure of patent foramen ovaleMaja Rojko, Nataša Černič Šuligoj, Bojana Žvan, Marjeta Zorc, Saibal Kar, Marko Noč, 2026, original scientific article Abstract: Background: There is a lack of studies systematically addressing long-term echocardiographic features after patent foramen ovale (PFO) closure. Thus, the present study investigated long-term echocardiographic features after percutaneous closure of PFO. Methods: This was a single-centre observational study based on the institutional registry of consecutive patients undergoing PFO closure. Clinical and echocardiographic features during the follow-up were investigated. Results: Between 2006 and 2023, 355 consecutive patients underwent PFO closure following transitory ischaemic attack (TIA) or cerebrovascular insult (CVI). Echocardiography immediately after the procedure and at 6 months was performed in 306 (86%) patients, who had repeat examinations at either between 1 and 5 years (median 1.32 years), between 5 and 10 years (median 7.10 years) or after 10 years (median 11.64 years). The percentage of patients with complete closure (no bubbles during the Valsalva manoeuvre) increased from 64% after the procedure to 80% at 6 months (p<0.05), and ranged between 77% and 81% thereafter (NS). Functional closure (≤10 bubbles) was observed in 93% of patients after the procedure and remained between 94% and 97% thereafter (NS). Except for decreased immediate complete closure (60% versus 83%; p<0.001), there was no difference between the Amplatzer PFO occluder and alternative devices. Among the 15 patients with greater than moderate residual shunt, reasons for the shunt were determined in 73% of patients and included leakage at the level of device, fenestration/atrial septal defect and pulmonary arteriovenous malformation. There was no late device embolisation, thrombus formation or pericardial effusion. Clinical follow-up revealed recurrent TIA and CVI rates of 0.11 and 0.06 per 100 patient-years, respectively. Conclusion: We demonstrated high (>90%) and persistent functional PFO closure beyond 10 years, independent of closure device. There was no late device embolisation, thrombus formation or pericardial effusion. Favourable echocardiographic features were associated with very low rates of recurrent TIA or CVI.
Keywords: patent foramen ovale closure, residual shunt, echocardiography
Published in DiRROS: 01.06.2026; Views: 313; Downloads: 211
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3. Cerebral hyperperfusion syndrome after carotid angioplastyZoran Miloševič, Bojana Žvan, Marjan Zaletel, Miloš Šurlan, 2002, published scientific conference contribution Abstract: Background. Cerebral hyperperfusion syndrome after carotid endarterectomy is an uncommon but well-de- fined entity. There are only few reports of "hyperperfusion injury" following carotid angioplasty. Case report. We report an unstable arterial hypertension and high grade carotid stenosis in a 58-year-old, right-handed woman. After a stroke in the territory of middle cerebral artery carotid angioplasty was per- formed in the patient. Among riskfactors, the long lasting arterial hypertension was the most pronounced. Immediately after the procedure, the patient was stable without any additionalneurologic deficit. The sec- ond day, the patient had an epileptic seizure and CT revealed a small haemorrhage in the left frontal lobe. Conclusions. The combination of a high grade carotid stenosis and unstable arterial pressure is probably an important prognostic factor in the pathogenesis of hyperperfusion syndrome.
Published in DiRROS: 31.01.2024; Views: 2294; Downloads: 422
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4. Carotid angioplasty with cerebral protectionZoran Miloševič, Bojana Žvan, Marjan Zaletel, Miloš Šurlan, 2002, original scientific article Abstract: Background. Carotid endarterectomy (CF.A) is widely used in the management of high-rade carotid stenosis: It is a surgical procedure requiring general anaesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It may develop complications, such as stroke, death, cranial nerve palsies, wound haematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in patients with cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distalinternal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anaesthesiaand causes lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distalimmobilisation of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intmal hyperplasia. CAS is a relatively new procedure; therefore, it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. Patients and methods. In Slovenia, we have also started with carotid angioplasty by the study: Slovenian Carotid Angioplasty Study (SCAS). We performed CAS in 17 patients (12 males and 5 females) aged from 69 to 82 years. All patients were symptomatic with stenosisgreater than 70 %. 10 patients suffered transient ischemic attacks, 4 patients minor strokes and 3 patients amaurosis fugax. (Abstract truncated at 2000 characters)
Published in DiRROS: 31.01.2024; Views: 2497; Downloads: 403
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