966
481828020012657116
www.iakardiologie.cz48438040010765133201214233274312354380428447495515563613632675690730769
KAZUISTIKA341200012665137200272306365424456524597
/959200012632
CASE1012200012660131190248
REPORT1282200012662120184260325384
The34136001063071103
role46036001063374105137
of61336001063869
intracoronary6983600106155689125166200238274315357397432468
thrombolysisin118236001063071107147201237278310342375392424441482
thrombus-laden168036001063071106147201237278310338368410450482523
coronary221936001063271107148190229265301
artery:253636001063873105137173209223
a2773360010638
case282736001063274108139
report298236001063366101142178209
INTERVENČNÍ341804001071978123168215263308366420478499
A8628040010752
AKUTNÍ936804001075299157202263284
KARDIOLOGIE12418040010745103150211232295337397456477520
/18078040010732
Interv188480400107196794136163207
Akut2111804001075290139167
Kardiol.2297804001074588114162181229249264
2024;23(1):43-492581804001074487128168183227271293333351365409450477523565
/31918040010732
some34062001093582155197
extent;54962001094484114156204231247
however,80862001094996159201241283310323
this11426200109307795128
method1282620010974117144192239287
can158162001094081128
increase172162001092068106132175216249291
the34076001093078122
likelihood4797600109214181124144163211259308358
of85476001095075
plaque94676001095171113162210254
detachment121776001095195123166205253326370419447
and168176001094392141
fragmentation18397600109275597146340900010975119168195238266285333382
of73690001095074
the82590001093078122
remaining96190001092973147188208256275324373
thrombus,134890001093078106153227277325359377
leading173990001092165107157176224273
to340104001093078
distal440104001095272106136179199
embolization6611040010946121171221241261299343371391440489
(5,117210400109267086
20).1280104001094791115130
Furthermore,1433104001094491119151200244273348397426470487
in1942104001092170
our340118001094998126
case,484118001094183117161177
the680118001093078122
use821118001095084128
of968118001094974
balloon1061118001095193113132181229278
angioplasty1358118001094392141160208258278320354383426
along1803118001094463112160209
with340132001096686114163
intracoronary52313200109216997125167206253281329377419447491
thrombolysis1034132001093078106153227277326346387421440474
was15281320010967109142
aimed1691132001094362136180230
at1941132001094371
manipulating3401460010975117165185234283302344372391439488
a8441460010943
partially903146001095193121152171213233252293
lysed121214600109216296140191
thrombus.1418146001093078106153227277325359377
Intracoronary340171001432589125160215269331367429494548583640
Thrombolysis10091710014356122157219318384449475529574598641
Before480188001094891115162190232
coronary723188001094086113160207248275317
stents1052188001093563105152179213
became1276188001095194133174246289
widely1576188001096584133175195235
used,1822188001094982125174190
intracoronary34020200109216997124166205252280327376417445488
thrombolysis841202001093078105153226276324344385419438472
using1325202001095083102150199
plasminogen1537202001095171112146219238286334383427475
activator340216001094483114134176219247295324
was6862160010967110144
used852216001095085129180
in1054216001092170
almost1147216001094363137186221250
all141921600109446484
patients1525216001095295123143187236265300
with1847216001096788116165
various340230001094488116137187236271
types634230001093175127173208
of865230001095176
coronary964230001094190119168218261290335
artery1322230001094473105149178223
disease1568230001095272107152196230276
(31).1867230001092670111129145
The340244001094696142
principle504244001095382102152192212263284329
of856244001095176
thrombolytic955244001093180109158234285335356398430451491
therapy1468244001093180126155198249291
is1782244001092156
that1861244001093080123152
the340258001093078121
use474258001094983127
of613258001094974
streptokinase,69925800109366592136185213260301322370412445489505
alteplase,121725800109436291133183203244278322338
or1568258001094977
tenecteplase165725800109307312116520423427732734027200109216498142
increases504272001092270110138182224258302337
the863272001093079123
conversion1008272001094188138178221250285305353402
of1433272001094974
plasminogen1530272001095172114148222242290339389433482
to340286001093079
active442286001094484116136179223
plasmin,688286001095273116151226247296314
resulting1025286001093075110159179209229278329
in1377286001092171
a14712860010944
cascade1538286001094185120160204255300
that1861286001093080123151
culminates340300001094189109182202251293321364398
in760300001092270
fibrin85230000109274999127147196
lysis.107030000109216397116150168
However,12613000010958107172215257300329342
as1625300001094377
primary172530000109517999173215243288
PCI340314001094797115
with467314001096584112159
stent638314001093563105152179
implantation829314001092192141160201248275317344362409457
has1298314001094989122
become1432314001095094132178251294
routine,1737314001092976123151169216259275
followed34032800109267495114162226269320
by678328001095292
studies789328001093665113162182225259
with1067328001096787115163
disappointing1249328001095170104146196246295315363391410458507
results1775328001092973107154174202237
regarding340342001092973123164192241261309358
excess715342001094586124167201235
bleeding967342001095171115160210229277326
rates,1310342001093072100143177195
intracoronary152234200109216997124167206252281328377419447491
thrombolysis340356001093078106153227277326346387421440474
has830356001095091125
been971356001095195140188
used1175356001094983127177
less136835600109216599133
and1516356001094492142
less167335600109216599133
in1822356001092169
clinical190735600109405979340370001095069108151170
practice523370001095280122161191210249292
(32,828370001092668111127
33).968370001094789110126
In1107370001092170
recent1190370001092972112155204231
years,1434370001094386127155190208
intracoronary165537000109216997125167206253281329340384001095093121165
thrombolysis527384001093079107155230280329350391426445479
has1029384001095092126
regained1178384001092973123165185234278329
popularity15293840010952101152201220263291311340383
as1935384001094377
an340398001094390
adjunctive442398001094392111158206244274293334376
therapy830398001092977120147189238277
for1119398001092673101
primary123239800109507897169210238281
PCI,1524398001094898116134
as1669398001094377
studies1757398001093664111160179222255
using340412001095083103151200
different55341200109517095123167195239287315
thrombolytic882412001092977105153227276325345387418437476
agents1371412001094493136185213248
and1632412001094492141
better1787412001095195124154197226
antiplatelet340426001094391119138188208249277320340384412
regimens765426001092972122141214258307340
have1118426001095091131174
proven1305426001095179126167210258
this157642600109307897130
method17194260010975119147195243293
to340440001093076
be428440001095195
safe535440001093678102146
and693440001094391140
effective.84544000109457097141180210229270313329
In1186440001092270
a12684400010943
pilot132344000109517090137165
study1500440001093664112161202
by1714440001095191
Sezer1817440001094488125168196
et340454001094574
al.,4284540010944638198
41541454001094685
patients640454001095294122141185234261296
undergoing951454001094998147191219268316336384433
primary139945400109517999172214242286
PCI1699454001094899118
were18314540010966110138181
randomized340468001092972120170218292311348392442
to795468001093077
receive885468001092973112155175217260
intracoronary115846800109216997125167206253281329377419447491
streptokinase166246800109356492136186214261302323340482001095092126169
(250,000529482001092669113157174219265311
units)860482001094998117146181202
or1081482001095078
placebo.1178482001095272114153195245294310
An15084820010955103
evaluation1631482001094586128148196238265285333381
two340496001093097144
days502496001095092132166
later68649600109216390133161
showed865496001093684132196239289
a11724960010943
significant1233496001093655104152171196218257300348376
increase1626496001092170109136180222255299
in1943496001092169
coronary340510001094189117166216258287331
flow69451000109264998164
reserve880510001093074109154182228271
and1174510001094493144
a13405100010944
decrease1407510001095196136164209251286331
in1760510001092271
TIMI1853510001094567139160
frame34052400109265496169213
count565524001094086134182209
when7865240010966115158206
compared1004524001094087160209251279322371
with1387524001096686114161
placebo1561524001095170112150192242290
(34).1863524001092668113134149
Subsequently,340538001094593144178223274322367416444464506520
54882538001094792
patients997538001095295123143187237265301
were13205380010967111139183
added1526538001094494144189240
to1788538001093078
the1889538001093079123
cohort340552001094190141191220253
to616552001093079
allow71955200109446585135202
long-term944552001092272122173202232276306382
assessment.1349552001094580115161197232308353404433452
After1824552001095682114159188
six34056600109365595
months,4575660010975123172200248281299
there777566001093078122150194
was9925660010966108142
a11555660010944
smaller12205660010936109151171190234262
infarct150356600109217094137165203233
size175856600109355592135
on1915566001094998
SPECT340580001094591132183229
evaluation591580001094587129149197239267287335384
(22.7%997580001092669113131176245
vs.126458000109447896
32.9%,1382580001094689106150221239
p16435800010952
=17175800010954
0.003)1793580001094663108154198220
and340594001094392141
a5035940010944
higher568594001095070119167211239
LVEF829594001094286129171
(57.2%1022594001092568111119166236
vs.127959400109447895
51.8%,1396594001094687100146216234
p16525940010951
=17255940010954
0.018)1801594001094663108149189211
in340608001092169
the424608001093078122
streptokinase56160800109356492136186214261302323371413447491
group1067608001095078126174223
compared1305608001094087161211253281325375
with1694608001096787115163
placebo,1872608001095171113340622001094083133182198
with558622001096786115163
marked7416220010976117145186229279
reductions1040622001093073123171210241260308357390
in1451622001092169
end-diastolic1541622001094593143170222241283317346393413433471
and340636001094392141
systolic497636001093577111141188208227266
volumes779636001094390110158231275310
on1104636001094998
echocardiography1218636001094584133181220263290340359407457485527576625665
(3).189863600109266990105
In480650001092270
a5726500010943
small6376500010936109151171190
study849650001093665113163204
involving1075650001092169110157177219239287337
341433650001094792
ACS15476500010955103147
patients1716650001095194121141185233261296
with340664001096889118168
the531664001093180126
no-reflow6806640010951101131161206232255305371
phenomenon,10746640010953103149199249325371421471521539
distal1636664001095273108138182202
embolization,186166400109471233406780010951100120139176220248267315364381
or738678001094978
intracoronary83267800109217097125167206253281329378420447491
thrombus1340678001093078106153227277325359
findings171667800109264897146166214263297
at340692001094574
PCI,4376920010949102122141
Kelly601692001095094116136179
et803692001094676
al.90369200109446583
reported1009692001093176128178208240285337
that1369692001093080124153
the1545692001093181126
addition1695692001094496147168197217267318
of340706001095075
intracoronary43770600109216997125168207254283331380422450494
tenecteplase953706001093073122166206237280330351393427471
adjuvant1446706001094494114162204247295323
therapy1791706001093079123151194340720001095294
(mean4577200010926100145188238
dose7187200010952102137183
=9247200010955
10.21002720001094789107155
±11807200010955
5.21258720001094764113
mg)13947200010976127151
proved1568720001095282131173218269
safe1861720001093680106151
and340734001094392141
effective50373400109457199143182213232274317
for842734001092674102
thrombus966734001093078106154228277326360
dissolution1348734001095070104138186206254282302350399
and/or1768734001094492142172216245
improving340748001092194144172220261281329378
flow73774800109264896161
in916748001092169
91%1004748001094687152
of1174748001095074
patients.1267748001095194121141184233261296314
Seventy-six1599748001094488130173221249292319354373413
percent340762001095297126165208258286
of649762001095075
patients747762001095295123143187237265301
in1071762001092170
this116376200109318099134
study1319762001093666115165207
received1549762001093074114158178221264315
GPI18877620010959106126
therapy,340776001093078122150192242282295
with647776001096787115163
major8237760010975116136184212
and1048776001094392141
minor1202776001097594142190219
bleeding1433776001095172115160210229277326
events1772776001094586129178205241
found214062001092674123171221
in237662001092169
one246162001094998142
and261862001094492142
three277562001093078106149194
cases,298462001094183117161195212
respectively321262001092973107156201240271290332375395436
(35).366462001092568111133148
Boscarelli214076001095099134175218247291312333353
et251576001094676
al.26147600109446482
also27197600109446599149
reported289176001093074126176205237281332
that324676001093080123152
in342076001092271
cases351476001094185120165200
of373776001095076
STEMI214090001094488132203223
with238090001096686115163
a2560900010943
high262190001095069118166
thrombus280490001093078106154228277326359
burden318190001095199127176220269
that346790001093078120148
were3632900010966109137181
unsuccessful2140104001095099133181221259302337371397447467
on2629104001095099
MAT,27501040010973128166178
low-dose2951104001092170135162214263297342
intracoronary331510400109217098127169209256285333382425453497
adjuvant2140118001094393113161203245293321
alteplase248211800109446392135185205246280324
therapy2828118001092978121150192241282
(53131118001092668
mg,32211180010975124141
5-min3383118001094674149168216
intervals,3621118001092169971401682140132001094384103137154
maximum23061320010974115155175247294367
302685132001094589
mg)27861320010974122144
significantly2942132001093654102150169193215253295342369388429
reduced3383132001092972121168206248298
the3693132001092977120
TIMI2140146001094566138158
thrombus2321146001093078106155229279328362
grade2706146001095078121171216
and2944146001094392142
increased3108146001092270110138182224258303353
coronary3484146001094088116164214256284328
epicardial2140160001094594114152194221270289330349
outflow.2501160001094997125152174221285299
In2812160001092169
this289316000109307796130
study,3035160001093564111160201214
although326116000109436290138185233282330
alteplase360316000109436290132182214017400109216397141
was23011740010967109142
given2464174001095070112154203
with2688174001096686114162
GPI28711740010958105124
in3015174001092170
half3105174001095092111136
of3262174001094974
the3357174001093078122
patients,3499174001095194122141185233261296314
there2140188001093077120148191
were23431880010965108136178
no2533188001095097
reports2642188001092972122170197228262
of2916188001094974
major30021880010974115135182210
bleeding3224188001095070114157207226273322
events,3558188001094485127175203237254
demonstrating2140202001095195168217265299328356398426445494543
the2698202001093078122
safety2835202001093679103147176219
of3070202001094974
this315920200109307898132
strategy330620200109366593135163206255297
(36).3618202001092669113135150
Bleeding2140227001436186145204271295359425
and25942270014354118184
Ischemic2806227001432669123187246344368422
Risk3257227001436086129179
In2280244001092170
contrast2365244001094087137165193236271300
to2680244001092977
elective2771244001094566110151182202244288
procedures,3073244001095180128168211262311339383418436
primary3523244001095180101174217245290
PCI21402580010949102123
is2287258001092257
associated2369258001094480116166208229272302347399
with2793258001096789119170
higher2987258001095172123174220250
bleeding3261258001095274120167219240291342
rates3628258001093074104149185
because2140272001095195135178226260304
of2458272001094874
the2545272001093078122
need2681272001094993138188
for2883272001092674103
potent29992720010951100129172221249
antithrombotic3261272001094392120139168216244292366416464493513552
and2140286001094393143
antiplatelet2306286001094392121141191212255284328349394423
agents.2752286001094393138187216252270
GPIs,30452860010958106126160179
in3246286001092170
combination3339286001094088163213234283326355375424474
with2140300001096687116165
thrombolytic2320300001092979107156230281331352394426446486
agents,2820300001094493138188216252271
can3105300001094084133
significantly3252300001093656106155175201224264307356385405447
increase37143000010921702140314001094067110152185229
the2382314001092977120
risk251531400109294983123
of2651314001094873
bleeding2737314001095171114158208227275324
events.3074314001094485127175203238256
However,33433140010957105169211252295323336
the3692314001092977121
doses2140328001095199134178213
of2367328001095075
thrombolytic2456328001093079107155230280329350392424444484
agents2954328001094392137186215250
administered3219328001094393167187236256290320364393437487
by3721328001095192
the2140342001092978122
intracoronary227534200109216997125167206253282329378420448492
route2780342001092977125154197
are2990342001094371115
usually3118342001094983131173193212254
much33853420010974122161209
lower3608342001092169133176204
than2140356001092978119168
those2321356001093078126160204
used2539356001094983127177
by2729356001095191
the2834356001092978122
intravenous296935600109216997125167208251299348396430
route.3412356001093077126154197214
Kelly3640356001094891111131172
et2140370001094574
al.222837000109436381
reported2323370001092973123172201232275326
only2663370001094998118159
one2836370001094998143
case2992370001094083117162
of3168370001094974
major32563700010974116137185214
bleeding3484370001095071115160211231279328
(2.9%)214038400109267088132204226
among23823840010943118167216266
342664384001094692
patients2772384001095194123143188237266302
receiving3090384001092973114158178221242291341
intracoronary3447384001092170991271702102582873362140398001095093122168
tenecteplase,2331398001093075125170211243287338360403438483501
which28563980010966116137177227
did3106398001095272123
not32533980010950100129
differ340639800109517298127172202
from3631398001092757106181
the2140412001093079124
rate2278412001093073102145
of2438412001094975
major25284120010975117138187216
bleeding2759412001095172117162213234283333
events3106412001094588131181210246
in3366412001092170
ACS34514120010955104149
cases3614412001094184119164199
in2140426001092170
the2234426001093079124
GRACE23824260010958106163212255
data2661426001095193122166
(3.9%)285042600109267087131203226
(35,3099426001092670113130
37).3253426001094689114130
In3406426001092271
fact,3501426001092670110141160
our3684426001095099128
patient2140440001095195123143188238266
did2424440001095071121
not2562440001095099128
receive2708440001092973114158178221265
GPI29904400010958106126
therapy.3133440001093079124153196246288302
Ischemic228045400109215491138180252271308
risk259945400109294780119
management27294540010973114160201248290362404451478
must32184540010973120152180
be3409454001095093
considered35134540010939841311641822302722140468001092971119
after227046800109436797138165
undergoing2446468001094995143186213260307325372419
a28764680010943
PCI2930468001094796114
procedure.3055468001095178124162203252298325367382
Thrombus3448468001094492119165237285331364
manipulation21404820010975117165185234283302344372391439488
and2648482001094391141
evidence2809482001094586106156200248287330
of3159482001094974
residual3253482001092973107126175223265285
thrombus355848200109297710515322721404960010951100133
after229049600109436899142170
stent2477496001093665108156184
implantation2677496001092195144165206255282325353372420469
in3162496001092169
our3248496001094998126
patients3390496001095194121141185233261296
carry37024960010941832140510001092958102
a22605100010944
high2322510001095070119167
risk250851000109294983123
for2650510001092674102
microvascular2771510001097595134161209250292326365413433474502
obstruction3292510001094999133162190239278308327375424
or3735510001094978
even2140524001094689133182
acute2345524001094585134163207
stent2575524001093666111160189
thrombosis2787524001093080108157233284334369389424
(20).3233524001092671116139155
To3411524001094689
address3523524001094495146175220255290
this2140538001093080100134
issue,229753800109215691139184201
the2521538001093080125
20182669538001094691133174
ESC/EACTS2866538001094590141173218274323370415
guidelines33035380010952101121171216237257306351386
on37125380010950100
myocardial21405520010975114161200242269318337378398
revascularization2550552001092972113155188227275294335363382419462489508556604
recommend3166552001093073112158232304348396445
triple362355200109305877126146189
therapy2140566001093078122150192242282
for2439566001092674102
1–62558566001094687135
months27095660010975124172200248282
in3008566001092169
patients3094566001095193121140184233260296
at3406566001094471
ischemic349456600109215594142186260279318
risk214058000109294983123
due2275580001095198142
to2429580001093077
ACS25185800010955104147
or2677580001095078
other2767580001094977125169197
anatomic2976580001094392133161208281301339
or3328580001094977
procedural3417580001095179127166209259306334376395
characteristics2140594001094189131159202241272315343363398427446486521
that2683594001093079121149
are2854594001094472116
higher2992594001095070119168212240
than3254594001093079121170
the3446594001093079123
risk359159400109305084125
of3738594001094974
bleeding2140608001095171115160210229278327
(Class248160800109267594136169203
IIa;269960800109214183100
LOE28136080010943101145
A)2972608001095579
(38).3065608001092669113135151
With3230608001097697125173
a34186080010943
low3476608001092169133
bleeding36246080010951721151602140622001095171121171
risk233362200109305085126
(PRECISE-DAPT2482622001092672119163214234278321348409461508553
score3058622001093676124152197
=32776220010955
10),3354622001094789112128
warfarin35046220010967110139167211239259308
was21406360010966108142
added2304636001094393142186236
to2562636001092977
DAPT26606360010960111157201
therapy2883636001093078122150192242282
using3186636001095084103151200
aspirin3408636001094377126146174194242
and3671636001094492141
ticagrelor214065000109294886127174201243263310337
and2488650001094390138
was26386500010965106139
discontinued2788650001095069101139185232259278325371414463
immediately3262650001092192164207256274315342383403443
on3716650001094996
the2140664001093078122
fourth2276664001092675123151182230
day2520664001095193132
after266766400109436899142170
the2851664001093078122
results2988664001092972107154174202237
of3239664001095075
angiographic3328664001094392141160208258286328377426446485
evaluation2140678001094586129148196238266285333382
showed2541678001093684132196239290
no2850678001095098
residual2967678001093073107126176224265285
thrombus3271678001093078106154228277326359
with3650678001096686114162
grade2140692001095078120170214
323696920010946
TIMI2431692001094565136157
flow.260369200109274997161175
Conclusion21407170014771137206261292361411442510580
Intracoronary2280734001092272102132176217266296346396440470516
thrombi2820734001093181111160237289310
in3155734001092172
cases3251734001094186121167203
of3479734001095077
STEMI3580734001094692137210233
may21407480010975118158
result2318748001092974109157178207
in2545748001092170
a26347480010944
poorer26977480010952101151180224253
clinical297074800109406181130150190233254
outcome,3243748001095099128167215290335352
apart3615748001094394137166197
from2140762001092758109187
successful2355762001093687129170215252289317369391
PCI27747620010949103124
with2926762001096991122173
normal31277620010951102133211256278
epicardial3433762001094699121163208239291313357379
vascular2140776001094386121161210230273302
flow.245977600109265099164179
Although2655776001095576105154203252302351
there3024776001092978123152197
is3238776001092156
no3311776001095099
gold-standard34277760010951100121171199234264308357394062001095298128181
therapy415662001093182130161207260304
for449562001092778110
intracoronary463962001092274105136181224274306357409455485533
thrombus,520662001093183114165243297349386406
combined394076001094190166217238288334386
pharmacological4351760010951102146175251295335384406456507528569613634
and500976001094494146
mechanical5179760010976122163213257307328368412434
treatment394090001093059103146174249294343372
options4331900010949100129149198248282
are463290001094472117
being476790001095297118167217
explored.500290001094587138160209238282333351
MAT5372900010973127166
is555790001092155
not3940104001095099128
recommended4084104001093074115162237311356406456501552
to4652104001093078
be4747104001095196
performed4859104001095197126154203232307352403
routinely5278104001093078128157177226271292334
in3940118001092168
STEMI4021118001094488131200221
cases,4255118001093981115158192210
but4478118001095098126
may46171180010974116155
be4785118001095094
helpful4892118001094993113162187235255
in5160118001092068
certain5241118001094082110141183202250
cases55041180010939813940132001093681116
at4072132001094372
the4161132001092978123
discretion4301132001095171105146174219248268317367
of4684132001095075
the4776132001093079124
operator49161320010950100146175218247295324
and5256132001094493144
intervention5416132001092170991431723940146001094387137165185234284
team.4239146001093074116191209
Intracoronary4463146001092271100128171211259288337386429458503
thrombolysis4980146001093079108157231282331353395430450485
can5479146001094184133
be3940160001095197
a40521600010943
safe4110160001093680105150
and4275160001094493143
effective4434160001094571100144185216236279323
alternative477216000109446493137166216259288308351394
reperfusion5182160001092973124170199227277312332381430
strategy394017400109366694137166210261303
when42651740010966116161210
the4497174001093079124
MAT46431740010972127165
procedure4830174001095281129170213264313342386
alone5238174001094364113163208
fails546717400109277090111145
to3940188001093077
achieve4031188001094382131151195236280
adequate4324188001094393137188236278306350
coronary4687188001094088116164213255284328
blood5029188001095071120169219
flow526218800109264997161
in5437188001092170
an5520188001094392
IRA3940202001092269126
with4087202001096687116165
a42732020010944
high4338202001095070120169
thrombus4528202001093079107156231281331365
load.4914202001092271114165183
The5118202001094595140
management5279202001097511816720925930439402160010974118166193
of4147216001094873
intracoronary423321600109216996124166205251280327375417445488
thrombus4734216001093077105152225275323356
in5104216001092068
STEMI5185216001094488131201221
cases5419216001094082116159193
continues3940230001094088138166187236284329364
to4327230001093078
be4428230001095196
a45472300010944
challenge4613230001094190132153173218268318362
in4998230001092170
interventional509123000109217099143172217261311339359408458501521
cardiology,3940244001094083112162182231251300351393407
so4361244001093584
a44592440010944
case-by-case4517244001094083118162192243284311353396431476
approach5007244001094393144173221264304353
is5374244001092155
needed54442440010949941393940258001095196147
in4104258001092170
order4191258001095079129174203
to4411258001093078
obtain45062580010950100130173193243
better4766258001095196126157201230
results.5013258001093074109158178207243262
Funding3940285001104696149203228281334
The4080300001094495140
authors4235300001094392122171220250286
received4536300001093074115159180223267318
no4870300001094998
financial498430000109264999142191231252295316
support5315300001093684135186236265297
for3940314001092676106
this4070314001093080101137
article’s4231314001094473106127168189234254287
research,4542314001092975111156200230270320339
authorship,4905314001094493123173223253290340361412430
and/or5360314001094393144176222252
publication.39403280010951101153175196237281310332381432451
Ethics3940355001104679132156198238
Committee41993550011052104181259284316351398447
approval46663550011046100154188240287334358
Our40803700010961110138
institution4233370001092069103133153182230259279327376
exempted4624370001094485128202251280323374
ethical5012370001094474122142181224245
approval.5271370001094392142171219261303323342
Informed3940397001102477107159193271319373
Consent43343970011053104157195244297329
Written40804120010976105126157189234285
informed439041200109217198148178254300352
consent4768412001094089140175221272301
was50954120010966110146
obtained52674120010949101131176197247293345
from3940426001092657106181
the4137426001093079125
patient4278426001095195125145191241270
for4564426001092676106
publication46864260010951101152174195235279309330379430
of5132426001094975
the5223426001093080125
details5364426001095196127171192213248
of3940440001094976
their4035440001093080126147177
medical42314400010975121173194235279301
case4551440001094084120166
and4736440001094394145
any4900440001094494135
accompanying5054440001094484124173249300344394436458508558
images.3940454001092196140191236272292
Identifiable4256454001092274119170199220247271314366388434
patient4714454001095196125146192242272
information501145400109217197147177253296326347397448
has5483454001095094130
been3940468001095197144194
removed.4153468001093075150201243288340359
Author39404950011057109142195247281
contribution4241495001104092145177211235289342375399451504
IGDS4080510001092178137180
and4275510001094391141
RZ4431510001094898
conceived4544510001093987136175218239282325375
the4934510001092978122
idea5071510001092171115157
and5243510001094392141
mainly539951000109741161371853940524001092266
designed4033524001095299136158210262309362
the4422524001093182129
report.4578524001093077130182213247268
RZ48725240010950103
was50025240010967113150
involved5178524001092273117167190235281335
in5539524001092274
patient3940538001095195125146192242272
management42375380010975119169213263309385430481510
of4773538001094976
this4874538001093080101137
case5036538001094185120166
and5228538001094393144
was53985380010966110146
a55695380010943
major39405520010975119140190220
contributor4180552001094089140169199220272322352401431
to4631552001093079
writing4730552001096696118148169219270
the5020552001093080125
manuscript.51655520010975119169219254295325346398428447
RZ39405660010948100
and4058566001094393144
FT4220566001094491
edited4328566001094597118148193245
the4591566001092979125
manuscript47335660010976119169219255296325347398428
for5179566001092676106
publication.530256600109511021531751962372813940580001093051101151170
IGDS4127580001092180140184
and4328580001094393144
FT4488580001094491
contributed4595580001094089140169199220271321351396448
to5059580001093079
artwork5154580001094373105174223253296
editing54665800010945971183940594001093051101152
and4109594001094393145
grammar4271594001095080124199274318348
correction.4636594001094089119149194236268289339389409
IGDS5062594001092180141185
reviewed5264594001092975118140185252297348
the3940608001092978123
article4078608001094271103123163183228
before4321608001095095121170199243
submission.4579608001093584134208228263298318366416434
All502860800109557596
authors5139608001094291120169217247282
have5436608001095092133177
read3940622001092975118170
and4129622001094393145
approved4293622001094394146176226269313365
the4677622001093080126
final4822622001092650100143165
manuscript.50066220010975119169218254295325346398428447
Availability39406490011057102149174198245299324349373406454
of4415649001105181
data45166490011053100132180
and4717649001104598152
materials48906490011076123156203237261308333372
The4080664001094596142
datasets4243664001095195124169204250280317
used4582664001095085131183
are4787664001094373118
available4927664001094385129150172215267289334
from5283664001092657106182
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corresponding3940678001094088117147192227277327377428449498548
author4503678001094392122171220250
on4768678001094999
reasonable4883678001092973116151201251293344366411
request.5309678001092974125174219254285304
Registration3940705001105199153177216250283330362387439492
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research4554705001103280119167214248289342
studies4917705001103771123177201249288
Not40807200010959110139
applicable.4239720001094394146168189230274325347393412
Conflict39407470011053104157184209233275310
of4270747001105181
interest4372747001102376108156189237276310
The4080762001094493137
authors4230762001094390119166214242277
declare4521762001095093133152194222265
that4799762001092977119147
there4959762001092977121149192
is5164762001092155
no5232762001094997
conflict5342762001094087135160182202240271
of3940776001094975
interest.403277600109217199143172216251281300
Acknowledgment4349776001095594136186235300321366417467541586636665
not5031776001095099128
applicable.5176776001094394145166186226269320341386403