Carotid plaque characteristics on magnetic resonance plaque imaging following long-term cilostazol therapy.

BACKGROUND: Cilostazol is an antiplatelet agent that can induce the regression of atherosclerosis. However, its long-term effects on plaque involution of the cervical carotid arteries remain unknown. Thus, we aimed to evaluate the effect of long-term cilostazol administration on carotid plaques using quantitative magnetic resonance (MR) plaque imaging. METHODS: Sixteen consecutive patients with carotid stenosis were examined using T1-weighted MR plaque imaging at baseline, 6 months, and 12 months after initiation of 200 mg per day of cilostazol. We calculated the contrast ratio of the carotid plaque against the sternocleidomastoid muscle and percent areas of the intraplaque fibrous tissue, lipid/necrosis, and hemorrhage components using automated software. We also measured the volume and echogenicity of the plaques using 3-dimensional ultrasonography. RESULTS: The contrast ratio of the carotid plaque significantly decreased during the cilostazol administration (median 1.07, 1.04, and 1.00 at baseline, 6 months, and 12 months, respectively; P = .03). Furthermore, the area of the fibrous components significantly increased (73.9%, 80.3%, and 85.7%, respectively; P = .03) and that of the lipid/necrotic components significantly decreased (25.2%, 19.2%, and 14.3%, respectively; P = .04). There were no substantial changes in plaque volume or echogenicity on ultrasonography. CONCLUSIONS: Signal alterations on MR plaque imaging indicated the increase of fibrous components and the decrease of lipid/necrotic components in the carotid plaque during the cilostazol therapy.

Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis.

Background Long-term benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been established in patients with intracranial arterial stenosis. We compared the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin in patients with intracranial arterial stenosis, who were recruited to the Cilostazol Stroke Prevention Study for Antiplatelet Combination trial, a randomized controlled trial in high-risk Japanese patients with ischemic stroke. Methods and Results We compared the vascular and hemorrhagic events between DAPT and SAPT in patients with ischemic stroke and symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery. Patients were placed in two groups: 275 were assigned to receive DAPT and 272 patients SAPT. The risks of ischemic stroke (hazard ratio [HR], 0.47; 95% CI, 0.23-0.95); and composite of stroke, myocardial infarction, and vascular death (HR, 0.48; 95% CI, 0.26-0.91) were lower in DAPT than SAPT, whereas the risk of severe or life-threatening bleeding (HR, 0.72; 95% CI, 0.12-4.30) did not differ between the 2 treatment groups. Conclusions DAPT using cilostazol was superior to SAPT with clopidogrel or aspirin for the prevention of recurrent stroke and vascular events without increasing bleeding risk among patients with intracranial arterial stenosis after stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01995370.

[Role of the liaison officer in disaster countermeasures implemented by the Japanese Society of Neurology: Hope for the best and prepare for the worst].

Disaster countermeasures have been implemented by the Japanese Society of Neurology based on the experience of support to the areas affected by the Great East Japan Earthquake on March 11, 2011. The countermeasures activity began at the end of 2011. We, the Committee for Measures Against Disaster, officially started work in 2014. We developed a support network to urgently deal with patients with intractable neurological disease at the time of disaster and strengthen disaster measures, including effective disaster countermeasure training. During the 2016 Kumamoto earthquake, we realized the need to prepare for natural disasters, leading to a state of emergency, at normal times. A list of vulnerable people should be prepared and the individual support plan for disaster should be confirmed during normal times. Furthermore, during disaster, livelihood support is required for patients with intractable neurological disease living in evacuation centers in affected areas. Therefore, we compiled and published the book, titled "The manual of disaster countermeasures," in 2017. The Committee for Measures Against Disaster in the Japanese Society of Neurology has appointed a liaison officer for patients with intractable neurological disease in each prefecture. The liaison's role of is gathering and disseminating information on the disaster-hit areas, arranging medical support, and coordinating health activities, when natural disasters occur. It is hoped that the liaison officer will play an active role both at normal times and during disaster, even unforeseen ones. Although we hope for the best, we aim to be prepared for the worst.

[Postgraduate education program in neurology at Iwate Medical University].

The major goal of the program is to provide residents with the opportunity to gain the knowledge, attitudes, and skills to enable them to provide exemplary health care to people with neurological disease. The program will facilitate learning through an atmosphere of collegiality and mutual respect that fosters active communication between residents and faculty. We will stress the pursuit of excellence in clinical neurology and encourage the development of a deeper interest in the academic aspects of the discipline. We will endeavor to create a level of excitement that will stimulate our residents to seek further education and pursue careers in academic neurology. Our program aims to serve both the present and future requirements of our patients and our discipline. The program consists of 24 months of internal medicine and other clinical rotations; 12 months of clinical and basic neuroscience research including neurophysiology, neurochemistry, neuroradiology, neuro-rehabilitation and neurogenetics; 24 months of clinical neurology including the primary care of inpatients on the neurology ward, the assessment of emergency department, and neurological consultation; and 12 months of residency as a senior neurology resident consultant in inpatient and outpatient settings with responsibility for teaching and supervising junior residents.