著者

Mayank Goyal Leon A. Rinkel Johanna M. Ospel

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.17, no.11, pp.263-271, 2023 (Released:2023-11-20)

参考文献数

54

被引用文献数

1

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Endovascular treatment (EVT) has revolutionized the management of acute ischemic stroke (AIS), but almost half of patients undergoing EVT do not achieve a good outcome. Adjunctive therapies have been proposed to improve the outcomes of EVT in AIS. This review aims to summarize the current evidence on the use of adjunctive therapies in EVT for AIS, including antithrombotic agents, intra-arterial thrombolytics, cerebroprotective agents, normobaric oxygen, and hypothermia. Several adjunctive therapies have shown promise in improving the outcomes of EVT in AIS, but phase 3 clinical trials are needed to establish clinical efficacy. We summarize the advantages and disadvantages of adjunctive EVT treatments and outline the challenges that each of these therapies will face before being adopted in clinical practice.

著者

Yoichi Morofuji Minoru Morikawa Nobutaka Horie Yuki Matsunaga Tsuyoshi Izumo Takayuki Matsuo

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.ra.2023-0023, (Released:2023-09-05)

参考文献数

41

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The clinical manifestations of dural arteriovenous fistulas (dAVFs) are highly variable and dependent on the hemodynamic properties and location of the fistula. The locations of the fistula are numerous and include the cavernous sinus, transverse–sigmoid sinus, superior sagittal sinus, inferior and superior petrosal sinuses, anterior condylar confluence, tentorium, anterior cranial fossa, middle fossa, foramen magnum, cranio-cervical junction, convexity, and spinal cord. These dAVFs can be divided into two types, “sinus type” and “non-sinus type,” based on their communication with dural shunts and cerebral veins. The sinus type involves direct communication between the arterial dural branch and one dural sinus, sometimes leading to recruitment of cortical veins. On the other hand, the non-sinus type is embedded into the dura, with the drainage always involving a cerebral vein and no communication with any sinus. Treatment options for these types of dAVFs differ; sinus-type dAVFs require normally sinus obliteration and occlusion of recruited veins, while non-sinus-type dAVFs require embolization of the drainage vein. Accurately classifying the type of fistula, sinus type or non-sinus type, is critical for developing a proper treatment plan. This review describes clinical characteristics and treatment of those non-sinus-type dAVFs involving unusual locations with illustrative cases.

著者

Yoshikazu Matsuda Tomoaki Terada Yu Sakamoto Minako Kubo Arisa Umesaki Yuko Tanaka Hiroaki Matsumoto Hiroo Yamaga Tomoyuki Tsumoto Tohru Mizutani

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0032, (Released:2023-07-22)

参考文献数

14

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Objective: Recently, the occlusion rate of transarterial embolization (TAE) for intracranial non-sinus-type dural arteriovenous fistulas (NSDAVFs) has improved after ONYX was introduced. Additionally, when TAE for NSDAVF is unsuccessful, transvenous embolization (TVE) has become available as an alternative treatment. We investigated the factor for the favorable occlusion rate of endovascular treatment for NSDAVF at our institutions.Methods: Two hundred and twenty-seven patients with intracranial dural arteriovenous fistulas (DAVFs) were treated at our institutions between September 2014 and October 2022. The patients diagnosed with NSDAVF in all DAVFs who underwent endovascular treatment were included. The clinical characteristics, angiographical outcomes, and clinical outcomes of patients who underwent endovascular treatment were evaluated.Results: Thirty-eight patients had intracranial NSDAVF (tentorial: 23 cases, parasagittal-convexity: 7, anterior cranial fossa: 6, middle cranial fossa: 2). Our participants’ mean age was 64.8 ± 11.3 years, and 31 (81.6%) of them were males. Patients’ symptoms were as follows: asymptomatic (24), hemorrhage (10), tinnitus (3), and trigeminal neuralgia (1). TAE and TVE were performed on 35 and 3 patients, respectively. The rate of immediate angiographical occlusion was 84.2% (32/38). The follow-up angiographical occlusion rate in 6 months was 88.5% (31/35). Complications occurred in three cases. There was no morbidity or mortality after 30 days.Conclusion: TAE using the combination of the new microcatheter and microguidewire and TVE in the case of difficult or failed TAE for NSDAVF could achieve high success rates and safety.

著者

Ryo Hiramatsu Ryokichi Yagi Masahiro Kameda Naosuke Nonoguchi Motomasa Furuse Shinji Kawabata Hiroyuki Ohnishi Shigeru Miyachi Masahiko Wanibuchi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0027, (Released:2023-08-15)

参考文献数

25

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Objective: This study aimed to report the outcome of an endovascular treatment with a pipeline embolization device (PED) at a single center. We also examined the predictive factors for an incomplete occlusion after the PED placement.Methods: The subjects were 94 patients with 109 aneurysms who underwent the PED placement at our single center from June 2015 to September 2022. As treatment outcomes, we investigated the PED placement success rate, perioperative morbidity and mortality, postoperative cranial nerve improvement rate, and the classification of angiographic result at 6 months after the PED placement. Furthermore, the predictors of an incomplete occlusion were investigated in detail.Results: One hundred nine aneurysms locations were: C1 (9), C2 (30), C3 (15), C4 (53), and C5 (2) in the internal carotid artery segments. Perioperative morbidity, including the asymptomatic ones, occurred in 10 cases (10.6%). Among these 10 cases, the modified Rankin Scale (mRS) improved to preoperative mRS after 90 days in 9 cases except 1 case. On the other hand, no perioperative mortality was observed. The postoperative cranial nerve improvement rate was 84.4%, and 61.7% of patients had a complete occlusion in the follow-up angiography, 6 months after the PED placement. Predictive factors for an incomplete occlusion after the PED placement were the elderly aged 70 years or older (P-value = 0.0214), the elderly aged 75 years or older (P-value = 0.0009), and the use of anticoagulants (P-value = 0.0388) in an univariate analysis. Further, the multivariate analysis revealed that the elderly aged 75 years or older was a predictive factor of an incomplete occlusion in this study.Conclusion: We summarized the outcomes of the PED treatment at our single center. In this study, the elderly aged 75 years or older was a predictive factor of an incomplete occlusion after the PED placement.

著者

Shin Hirota Satoru Takahashi Masataka Yoshimura Sakyo Hirai Takamaro Takei Asumi Orihara Hirotaka Sagawa Hikaru Wakabayashi Shoko Fuji Shinji Yamamoto Kazutaka Sumita

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0041, (Released:2023-09-01)

参考文献数

20

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Objective: Basilar artery occlusion (BAO) secondary to traumatic vertebral artery (VA) dissection caused by vertebral fracture is a rare cause of acute ischemic stroke, and optimal management, such as antithrombotic agents, surgical fixation, and parent artery occlusion (PAO), has been controversial. We report a case in which mechanical thrombectomy and PAO were performed for a BAO due to right VA dissection caused by a transverse foramen fracture of the axis vertebra.Case Presentation: A patient in her 80s suffered from a backward fall, and a neck CT revealed a fracture and dislocation of the right lateral mass of the axis and a compressed transverse foramen. The patient was instructed to admit and to remain in bed rest; however, she suddenly lost consciousness the following day. The CTA revealed right VA occlusion and BAO; therefore, the patient underwent mechanical thrombectomy and the BAO was successfully reperfused but the VA stenotic dissection remained. PAO of the right VA was performed on the fifth day after the accident to prevent BAO recurrence.Conclusion: Mechanical thrombectomy is an effective treatment for BAO caused by VA dissection, and PAO may contribute to the prevention of stroke recurrence.

著者

Yasuhiko Nariai Tomoji Takigawa Akio Hyodo Kensuke Suzuki

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0011, (Released:2023-05-26)

参考文献数

24

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Objective: The flow diverter (FD) is a promising device. Apart from two main complications, hemorrhagic and ischemic ones, stent migration is reportedly an unusual complication. In particular, distal migration of the FD has rarely been reported. We report a case of asymptomatic acute distal migration of the flow-redirection endoluminal device (FRED).Case Presentation: A 50-year-old woman was incidentally diagnosed with an unruptured right internal carotid–ophthalmic artery aneurysm with a maximum diameter of 8.0 mm, and she subsequently underwent endovascular treatment with FRED. Based on the vessel diameter (3.8 mm proximal and 3.6 mm distal to the aneurysm), a 4.0-mm-diameter and 18-mm-long FRED was deployed without postoperative complications. However, on MRA 12 months after treatment, the aneurysm was not occluded; angiography showed distal migration of the FRED. The postoperative MRA and skull X-ray images were retrospectively reviewed to determine the period of the migration. The skull X-ray images and the signal loss area due to the FRED on MRA 1 day after the treatment had already demonstrated the migration of the FRED. In the second treatment, a 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion up to the proximal part of the carotid siphon. Prompt identification of distal migration of the FD without neurologic signs could be challenging.Conclusion: It is important to follow up meticulously with MRA and skull X-ray images after FD treatment for detecting stent migrations as early as possible.

著者

Ichiro Nakagawa Masashi Kotsugi Shohei Yokoyama Ryosuke Maeoka Tomoya Okamoto Hiromitsu Sasaki Kenta Nakase Ai Okamoto Yudai Morisaki

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.ra.2023-0018, (Released:2023-05-26)

参考文献数

50

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Anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF) is a rare lesion among cerebral DAVFs. This lesion shows significant bleeding risk because of the angioarchitecture, involving direct leptomeningeal retrograde venous drainage, as a nonsinus-type DAVF. Over the years, direct surgery has been considered the primary treatment for ACF DAVF, offering favorable clinical outcomes compared to a low complete obliteration rate with endovascular treatment and the relatively high risk of blindness due to central retinal artery occlusion with transophthalmic artery embolization. In recent years, however, significant improvements in DSA and 3D reconstruction imaging quality have allowed a much more precise understanding of the angioarchitecture of the shunt and vascular access route. In addition, advances in endovascular devices, including catheters and embolic materials, have facilitated microcatheter navigation into more distal vessels and more reliable closure of the fistulous point. Supported by such technological innovations, endovascular approaches to the treatment of ACF DAVF have been becoming successful first-line treatments. This article reviews the evolution of treatment strategies and the current status of endovascular treatment for ACF DAVF, with a particular focus on transarterial embolization.

著者

Yoshitaka Yamaguchi Tatsuro Takada Kazuki Uchida Kei Miyata Kota Kurisu Tomohiro Okuyama Fumiki Tomeoka Minoru Ajiki Masaaki Hokari Katsuyuki Asaoka

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0003, (Released:2023-04-19)

参考文献数

20

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Objective: Recent studies evaluating plaque protrusion at carotid artery stenting (CAS) using optical coherence tomography showed not a few cases of plaque protrusion when using double-layer micromesh stents. We report a case of symptomatic internal carotid artery (ICA) stenosis with at-risk unstable plaques in which CAS was successfully performed using a stent-in-stent technique by the combined use of a closed-cell stent and a dual-layer micromesh stent.Case Presentation: An 87-year-old Japanese man with dysarthria and right hemiparesis was diagnosed with atheromatous cerebral embolism caused by severe left ICA stenosis on MRI and DSA. MRI with T1-weighted black blood methods showed high intensities in the plaques of the left ICA, suggesting unstable plaque characteristics with intraplaque hemorrhage components. On day 20, CAS was performed. After the pre-stent dilation under proximal and distal protection, a Carotid WALLSTENT was placed to cover the stenotic lesion. Then, a CASPER Rx was placed from the proximal left ICA to the common carotid artery to cover the Carotid WALLSTENT. Although visible plaque debris was recognized in the aspirated blood, the debris became invisible after aspiration of 1300 mL. Postoperative angiography showed enough dilation of the left ICA, with no plaque protrusion or acute stent thrombosis. The patient had an uneventful postoperative course and was discharged without any neurological sequelae.Conclusion: The present case suggests that the combined stent-in-stent technique using a closed-cell stent and a micromesh stent can be considered as one of the treatment strategies for preventing plaque protrusion and procedural ischemic complications in patients with high-risk carotid plaques.

著者

Hideaki Shigematsu Kazuma Yokota Akihiro Hirayama Takatoshi Sorimachi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.17, no.3, pp.88-92, 2023 (Released:2023-03-20)

参考文献数

7

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Objective: A few cases of postsurgical iatrogenic arteriovenous shunts have been reported, with the arterial blood flow directly entering the pial veins. Herein, we reported a patient with a dural artery–pial vein shunt found 1 year after aneurysmal clipping.Case Presentation: A 64-year-old male presented with generalized convulsion 1 year after cerebral aneurysmal clipping. A CT showed intracerebral hemorrhage in the temporo-occipital cortex and a dural artery–pial vein shunt in proximity to the previous craniotomy center. The arterial blood flow from the deep temporal artery, the middle meningeal artery, and the anterior auricular branch of the superficial temporal artery shunted into the superficial middle cerebral vein, with evident cortical venous reflux. Embolization was performed with n-butyl-2-cyanoacrylate and completely occluded the shunt. The patient was discharged without neurological deficits.Conclusion: Endovascular liquid embolization may be an effective treatment for iatrogenic dural artery–pial vein shunt.

著者

Hideaki Shigematsu Kazuma Yokota Akihiro Hirayama Takatoshi Sorimachi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2022-0058, (Released:2023-02-14)

参考文献数

7

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Objective: A few cases of postsurgical iatrogenic arteriovenous shunts have been reported, with the arterial blood flow directly entering the pial veins. Herein, we reported a patient with a dural artery–pial vein shunt found 1 year after aneurysmal clipping.Case Presentation: A 64-year-old male presented with generalized convulsion 1 year after cerebral aneurysmal clipping. A CT showed intracerebral hemorrhage in the temporo-occipital cortex and a dural artery–pial vein shunt in proximity to the previous craniotomy center. The arterial blood flow from the deep temporal artery, the middle meningeal artery, and the anterior auricular branch of the superficial temporal artery shunted into the superficial middle cerebral vein, with evident cortical venous reflux. Embolization was performed with n-butyl-2-cyanoacrylate and completely occluded the shunt. The patient was discharged without neurological deficits.Conclusion: Endovascular liquid embolization may be an effective treatment for iatrogenic dural artery–pial vein shunt.

著者

Jun Shinoda Saeko Ichimura Ryuichi Kanai Takamasa Majima Shumpei Azami Kouji Inoue Toshitaka Shirai

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0031, (Released:2022-12-14)

参考文献数

19

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Objective: Protected code stroke has been widely introduced in the emergency medical system for acute stroke in the current coronavirus disease 2019 (COVID-19) pandemic. This study aims to confirm the effects of protected code stroke formulated by the Japan Stroke Society (JSS-PCS) on the quality and outcomes of reperfusion therapy for acute ischemic stroke (AIS), followed by evaluating its validity.Methods: The subjects were 109 consecutive patients with AIS who underwent reperfusion therapy between January 2016 and July 2021, excluding in-hospital onset cases. Patients were classified according to the treatment date into the pre-COVID-19 (n = 82) and the with-COVID-19 (n = 27) groups. JSS-PCS was applied to all patients in the latter group. Statistical comparisons were made between groups on time indicators for initial treatment (onset-to-door time, door-to-imaging time [DTI], door-to-needle time [DTN], door-to-puncture time [DTP], door-to-reperfusion time, and puncture-to-reperfusion time [PTR]). The time indicator transition over the entire period was also evaluated by subgroup analysis. Subsequently, the outcomes at discharge were statistically compared between the two periods, followed by a subgroup comparison. Finally, univariate and multivariate analyses examined whether the application of JSS-PCS affected clinical outcomes.Results: Slight delays were revealed in DTI, DTN, DTP, and PTR in the with-COVID-19 group with no statistical significance. The time indicators were delayed once entering the period of the COVID-19 pandemic and then shortened again. The outcomes at discharge tended to worsen slightly in the with-COVID-19 group with no significance. Subgroup analysis depicted a transient deterioration of outcomes early in the pandemic. Applying JSS-PCS did not significantly affect clinical outcomes in univariate and multivariate analyses.Conclusion: Regarding reperfusion therapy at our facility, the introduction and application of JSS-PCS during the COVID-19 pandemic significantly affected neither time indicators nor outcomes. Infection control should be a top priority in the first medical practice for AIS in today’s world, where COVID-19 shows no signs of termination.

著者

Masashi Ito Takashi Izumi Masahiro Nishihori Tasuku Imai Yousuke Tamari Tetsuya Tsukada Mamoru Ishida Asuka Kropp Toshihiko Wakabayashi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.11, no.12, pp.615-618, 2017 (Released:2017-12-20)

参考文献数

12

被引用文献数

1 2

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Objective: We encountered a patient with lateral medullary infarction during transarterial embolization of the posterior meningeal artery (PMA). We reviewed the anatomic characteristics/imaging findings of this disorder.Case Presentation: A 69-year-old male. Cerebral infarction involving the lateral medulla occurred during transarterial embolization of a dural arteriovenous fistula. It was considered to be a complication related to occlusion of a lateral medulla-penetrating vessel on microcatheter/guidewire operations in the PMA. When examining images in detail, the blood vessel could be confirmed using DSA and 3D angiography.Conclusion: When performing embolization, the presence of a brainstem-penetrating vessel originating from the PMA must be considered.

著者

Jiro Aoyama Hiroto Iha Mariko Ishikawa Hirotaka Sagawa Sakyo Hirai Kyohei Fujita Shoko Fujii Kazutaka Sumita

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0052, (Released:2023-11-18)

参考文献数

20

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Objective: Cerebral venous sinus thrombosis (CVST) is one of the rare and severe complications of coronavirus disease 2019 (COVID-19) vaccines. CVST has also been reported to develop into dural arteriovenous fistula; however, there were no reports of dural arteriovenous fistula associated with COVID-19 vaccine-induced cerebral venous sinus thrombosis. Here, we describe a rare case of a transverse–sigmoid sinus dural arteriovenous fistula followed by CVST due to COVID-19 vaccination.Case Presentation: A 70-year-old patient presented with headache five days after receiving a second dose of COVID-19 vaccine. MRI showed a CVST in the superior sagittal sinus, left transverse sinus, and left sigmoid sinus. His headache improved after the administration of anticoagulant therapy. Six months later, a similar headache recurred, and cerebral angiography demonstrated a dural arteriovenous fistula in the left transverse sigmoid sinus and convexity dural arteriovenous fistulas in the left parietal cortex. The patient was treated twice with two sessions of transarterial embolization, and the shunts were completely occluded. His symptoms improved, and he was discharged with a modified Rankin Scale score of 0.Conclusion: Dural arteriovenous fistula can develop after CVST in association with COVID-19 vaccination.

著者

Taro Yanagawa Aoto Shibata Shinya Tabata Shunsuke Ikeda Toshiki Ikeda

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0055, (Released:2023-10-24)

参考文献数

9

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Objective: The trans-cell technique in stent-assisted coil embolization is a common treatment method for intracranial aneurysm. However, despite the frequency of its use, reports discussing its complications and their management are few. We describe a case of stent and microguidewire entanglement, which could not be removed, during treatment using the trans-cell technique. We discuss the mechanism of the entanglement and its management.Case Presentation: A woman in her 40s was found to have an unruptured cerebral aneurysm with a maximum diameter of 5.9 mm located in the paraclinodal anterior process of the left internal carotid artery during a close examination of a headache. The aneurysm had an irregular shape and wide neck. Stent-assisted coil embolization was planned. Initially, the coil was embolized using a jailing technique, but the microcatheter was pushed out of the aneurysm during embolization. Thus, we attempted to switch to a trans-cell technique. However, during the process, the stent and microguidewire became entangled and could not be removed. Finally, when the stent slipped off, the entanglement was resolved and the microguidewire was retrieved. Fortunately, the patient was discharged home without postoperative complications.Conclusion: Once a stent and a microguidewire become entangled, safely releasing them is difficult. Thus, it is important to avoid this scenario from occurring.

著者

Shinya Yoshii Satoshi Fujita Yu Hiramoto Morito Hayashi Satoshi Iwabuchi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0046, (Released:2023-11-22)

参考文献数

21

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Objective: Since the efficacy of mechanical thrombectomy (MT) for acute cerebral infarction due to large vessel occlusion has been proven, the time available for treatment has gradually increased. Currently, under certain conditions, treatment is indicated up to 24 h from onset. Based on neurological signs and imaging diagnosis, Stroke Treatment Guideline 2021 recommends initiation of MT within 6–24 h from onset. Herein, we retrospectively investigated the relationship between cerebral perfusion imaging evaluation and prognosis in patients with acute cerebral infarction due to large or median vessel occlusion.Methods: Fifty-one patients diagnosed with acute cerebral infarction due to large or median vessel occlusions in anterior circulation between November 2019 and December 2021 were divided into medical care and reconstructive therapy (including tissue plasminogen activator [t-PA] therapy and MT) groups. The primary outcome was changes in the National Institutes of Health Stroke Scale (NIHSS) at admission and 1 week after onset. Patients in the medical care group were divided into those whose NIHSS did not worsen and those whose NIHSS worsened. Those in the reconstructive therapy group were divided into those whose NIHSS improved and those whose NIHSS did not improve. We evaluated the relationship between improvement factors in acute neurological symptoms and penumbral and core volumes from computed tomography perfusion performed at admission.Results: Of 45 eligible patients, 10 received medical care without t-PA or MT and 35 underwent reconstructive therapy, including t-PA and MT. Among the 10 patients in the medical care group, 3 had worsening symptoms and 7 did not. The mean and median (interquartile range [IQR]) penumbra volumes were significantly higher in patients with worsening symptoms than in those without. The receiver operating characteristic (ROC) curve showed a threshold value of 28.6 mL with an area under the curve (AUC) of 0.952. Among the 35 patients in the reconstructive therapy group, symptoms improved for 29 but did not improve for 6. The mean and median (IQR) core volumes were significantly higher in patients whose symptoms did not improve than in those whose symptoms improved. The ROC curve showed a threshold value of 25 mL and an AUC of 0.632.Conclusion: Evaluation of penumbra volumes could detect cases with worsening symptoms in cases where medical care was performed, and evaluation of core volumes may detect cases with non-improved symptoms in cases that received reconstructive therapy.

著者

Hiroshi Ikawa Shigetaka Okamoto Naoki Shinohara Saya Ozaki Toshiaki Kusuhara

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.tn.2023-0031, (Released:2023-08-08)

参考文献数

13

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Objective: This is a report on the usefulness of 3D fusion imaging with susceptibility-weighted imaging (SWI) as preoperative imaging for mechanical thrombectomy (MT) for acute ischemic stroke (AIS).Case Presentations: Among 17 cases of patients who underwent MT in AIS between March 2021 and April 2022, 14 patients who underwent MRI with SWI (shortened SWI for stroke) and 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution were targeted in the study. Three cases with motion artifacts due to body movement were excluded from the images. After imaging, 3D fusion images were constructed to visualize thrombi and occluded vessels. SWI for stroke obtained thrombus information in 11 of the 14 cases (78.5%) and 3D images of the thrombi could be created in all 11 cases. 3D fusion images could be created in nine of the 14 cases (64.2%).Conclusion: 3D fusion images, using SWI for stroke, can visualize thrombi and occluded vessels and may be effectively used as preoperative images for MT.

著者

Katsunori Asai Masaaki Taniguchi Hajime Nakamura Akihiro Tateishi Naoki Irizato Hiroto Okubata Shogo Fukuya Kazuhiro Yoshimura Kazumi Yamamoto Haruhiko Kishima Akatsuki Wakayama

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0008, (Released:2023-06-02)

参考文献数

20

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Objective: Intracranial atherosclerosis disease (ICAD) is one of the most common causes of acute ischemic stroke. In endovascular treatment (EVT) for acute large vessel occlusion stroke-related ICAD, reocclusion of the recanalized artery due to in situ thrombosis is problematic. In this study, the safety and efficacy of prasugrel administration to avoid reocclusion of emergent EVT for ICAD was investigated.Methods: All consecutive emergent EVTs for ICAD between September 2019 and December 2022 were included in this study. The procedures were divided into two groups as receiving periprocedural prasugrel (PSG group) or not (non-PSG group). Target vessel patency on follow-up, postprocedural intracranial hemorrhage (ICH), and clinical outcome were compared between PSG and non-PSG groups.Results: A total of 27 procedures were included in this analysis. Nineteen target vessels were patent on follow-up and eight were non-patent. Fifteen patients received prasugrel (18.75 mg: 11 cases, 11.25 mg: 4 cases), and twelve patients did not receive prasugrel. The target vessel patency rate was better in the PSG group vs. non-PSG group (100% vs. 33.3%, respectively; p = 0.0002). The postprocedural ICH rate was not different between the groups (PSG: 40.0% vs. non-PSG: 25.0%; p = 0.68), and all ICHs were asymptomatic. Good clinical outcome (modified Rankin Scale score of 0 to 3 at discharge) was more frequent in the PSG group than that in the non-PSG group (66.7% vs. 16.7%, respectively; p = 0.019).Conclusion: Prasugrel administration was significantly associated with target vessel patency and good clinical outcome after emergent EVT for ICAD without increasing the symptomatic ICH rate. Prasugrel administration might be safe and effective to avoid reocclusion during and after emergent EVT for ICAD.

著者

Eitaro Okumura Sho Onodera Hiroyuki Jimbo

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0009, (Released:2023-07-07)

参考文献数

14

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Objective: CASPER Rx stent (Terumo, Tokyo, Japan) is one of the dual-layer micromesh stents for carotid artery stenosis. Although it is expected to be safe and efficacious even for vulnerable plaque, we report a case of in-stent occlusion 2 weeks after stenting with CASPER Rx stent.Case Presentation: The patient was a 78-year-old man with a symptomatic, severely stenosed lesion of the cervical internal carotid artery (ICA). He had an unstable plaque and underwent carotid artery stenting with the CASPER Rx stent. There were no problems with the procedure or the patient’s subsequent course, and he was discharged home 1 week after the procedure. However, on postoperative day 14, the patient had a transit ischemic attack and imaging showed acute occlusion due to thrombus in the stent and in the distal part of the ICA. Mechanical thrombectomy was performed and good recanalization was achieved, but postoperative cerebral infarction was observed and the patient was transferred to other hospital with modified Rankin Scale 2.Conclusion: We experienced a case of in-stent occlusion 2 weeks after stenting with the CASPER Rx stent.

著者

Tomoaki Murakami Shingo Toyota Motohide Takahara Kazuhiro Touhara Tatsuya Hagioka Yuhei Hoshikuma Takamune Achiha Takeshi Shimizu Maki Kobayashi Haruhiko Kishima

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2023-0020, (Released:2023-07-04)

参考文献数

18

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Objective: Extracranial internal carotid artery aneurysms (ECAAs) are rare. We herein describe a case of overlapped stenting with two double-layer micromesh stents for a giant ECAA.Case Presentation: A 73-year-old man presented to our hospital with an enlarged right posterior cervical mass. A right internal carotid artery (ICA) angiogram revealed a giant aneurysm of 50 × 60 mm. We chose a carotid double-layer micromesh stent for stenting. With the patient under general anesthesia, the first double-layer micromesh stent (CASPER Rx, 10 × 30 mm; Terumo, Tokyo, Japan) was deployed between the ICA distal to the aneurysm and the common carotid artery (CCA). The second stent was also deployed from a site more proximal than the first one. Ten coils were then placed from a microcatheter that had been placed in the aneurysm. A right CCA angiogram after the procedure revealed a flow-diversion effect for the aneurysm. The patient was discharged with no complications. At the 6-month follow-up angiogram, blood flow into the aneurysm had completely disappeared.Conclusion: A flow-diversion effect using overlapped double-layer micromesh stents can result in thrombosis and healing of giant ECAAs.

著者

Yuhei Ito Takao Kojima Toru Kobayashi Naoki Sato Yutaka Konno Keiko Oda Masazumi Fujii

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0005, (Released:2023-05-10)

参考文献数

10

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Objective: Most large-vessel occlusions (LVOs) amenable to acute recanalization occur in the internal carotid or middle cerebral artery. However, few LVOs with a multivessel disease can be difficult to treat. This study aimed to determine the outcomes of mechanical thrombectomy in patients with both anterior and middle cerebral artery occlusions.Methods: We retrospectively collected data for patients who had undergone mechanical thrombectomy since January 2016 at Fukushima Medical University and its affiliated institutions (10 institutions). Patients with occluded vessels in the anterior and middle cerebral arteries were selected, and patient background, treatment course, and outcomes were reviewed.Results: A total of 341 mechanical thrombectomies were performed during the study period. Seven patients had occlusions involving both anterior and middle cerebral arteries. In these seven patients, the median time from onset to imaging, imaging to puncture, and puncture to recanalization was 106, 60, and 74 min, respectively. Only one patient (14%) had a modified Rankin Scale of 0–2 at 90 days.Conclusion: Comorbid anterior cerebral artery occlusion may worsen the outcome of patients with middle cerebral artery occlusion.