著者

Naoyuki Takashima Hisatomi Arima Yoshikuni Kita Takako Fujii Sachiko Tanaka-Mizuno Satoshi Shitara Akihiro Kitamura Katsuyuki Miura Kazuhiko Nozaki on behalf of the Shiga Stroke and Heart Attack Registry Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0024, (Released:2020-04-29)

参考文献数

30

被引用文献数

6

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Background:Despite many effective strategies for the prevention of recurrent stroke, individuals who survive an initial stroke have been shown to be at high risk of recurrent stroke. The aim of this study was to investigate the current status of stroke recurrence after first-ever stroke using a population-based stroke registry in Japan.Methods and Results:As part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based stroke registry study that covers approximately 1.4 million residents of Shiga Prefecture, Japan. A total of 1,883 first-ever stroke survivors at 28 days was registered in 2011 and followed-up until the end of 2013. Recurrence was defined as any type of stroke after 28 days from the onset of an index event. Two-year cumulative recurrence rates were estimated using cumulative incidence function methods. Over a mean 2.1-year follow-up period, 120 patients experienced recurrent stroke and 389 patients died without recurrence. The 2-year cumulative recurrence rate was higher in patients with index ischemic stroke (6.8%) than in those with index hemorrhagic stroke (3.8%).Conclusions:Two-year cumulative recurrence rate after first-ever stroke remained high, particularly among patients with ischemic stroke, in the present population-based registry study in a real-world setting in Japan. Further intensive secondary prevention strategies are required for these high-risk individuals.

著者

Yukihiro GOTO Takuro INOUE Satoshi SHITARA Hideki OKA Shinji NOZUCHI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0367, (Released:2023-07-10)

参考文献数

32

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Since the publication of guidelines for managing idiopathic normal pressure hydrocephalus (iNPH) in 2004, an increasing number of patients with iNPH have been undergoing shunt surgery in Japan. However, shunt surgeries for iNPH can be challenging because the procedures are performed on elderly patients. General anesthesia-related risks, such as postoperative pneumonia or delirium, are higher in the elderly. To decrease these risks, we applied spinal anesthesia on a lumboperitoneal shunt (LPS). Herein, we analyzed our methods focusing on the postoperative outcomes. We retrospectively analyzed 79 patients who underwent LPS at our institution with more than one year of follow-up. The patients were divided into two groups based on the anesthetic approach, that is, 1) general anesthesia and 2) spinal anesthesia, and were examined in terms of postoperative complications, delirium, and postoperative hospital stay. In the general anesthesia group, two patients had respiratory complications after the surgery. The postoperative delirium score using the intensive care delirium screening checklist (ICDSC) was 0 (2) (median [interquartile range]), and the length of postoperative hospital stay was 11 (4) days. In the spinal anesthesia group, no patients had respiratory complications. The postoperative mean ICDSC was 0 (1), and the length of postoperative hospital stay was 10 (3) days. Although there was no significant difference regarding postoperative delirium existed, LPS under spinal anesthesia decreased respiratory complications and significantly shortened the postoperative hospital stay. LPS under spinal anesthesia could be an alternative to general anesthesia in elderly patients with iNPH and possibly lessen the general anesthesia-related risks.

著者

Satoshi Shitara Yoshinori Akiyama

出版者

特定非営利活動法人 日本脳神経血管内治療学会

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.10, no.1, pp.19-24, 2016 (Released:2016-03-31)

参考文献数

18

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Objective: Antiplatelet therapy is essential in neuroendovascular therapy to avoid periprocedural thromboembolic events. The purpose of our study was to evaluate the relationship between platelet aggregation analysis by VerifyNow assay system (Accumetrics, San Diego, CA, USA) and thromboembolic complications.Methods: Seventy-two neuroendovascular procedures were performed between March 2013 and February 2015 in this institution. There were 41 males (56.9%) and their mean age was 69.9 years. Meanwhile, there were 31 females (43.0%) and their mean age was 62.7 years. In all cases, clopidogrel (CLP) was used as one of the periprocedural antiplatelet therapy. All patients were measured CLP response as P2Y12 Reaction Units (PRU) value using VerifyNow assay system (Accumetrics, San Diego, CA, USA) with the whole blood sample collected from the long sheath located at the femoral artery. All patients received diffusion-weighted image (DWI) on MRI at 1–4 days after the procedure. The occurrence of thromboembolic events was recorded and the relationship between CLP response and DWI hyper-intensity area (HIA) positive was analyzed. Appropriate cut-off value to predict thromboembolic events was examined. Results: Symptomatic thromboembolic complications occured in three patients (4.1%), and each PRU value was all over 226. CLP hypo-responder in our study recognized 46 patients (63.8%) as cut-off PRU value set 208. As the result of cut-off value defined as CLP hypo-responder, with regard to PRU more than 208, a significant difference appear in DWI HIA positive or negative, but with regard to PRU more than 230, a significant difference is not recognized.Conclusion: In our study, CLP response measured by VerifyNow assay system is well correlated with the periprocedural thromboembolic events in neuroendovascular procedure. The cut-off value of PRU in neuroendovascular therapy is not still defined, but CLP hypo-responder defined PRU value more than 208 might be meaningful in neuroendovascular therapy performed to Japanese. We should make the custom-made periprocedural anti-platelet therapy according to personal response.