Intraarterial colforsin may improve the outcome of patients with aneurysmal subarachnoid hemorrhage: a retrospective study.

OBJECTIVE: Papaverine hydrochloride (PPV) has been widely used for pharmacologic angioplasty to dilate spastic vessels after aneurysmal subarachnoid hemorrhage (SAH). Colforsin daropate hydrochloride (CDH) has also recently been reported to be useful for reversal of cerebral vasospasm (CV). In this study, we compared the impacts of intraarterial PPV and CDH on the outcomes of SAH patients. METHODS: A consecutive series of SAH patients were retrospectively analyzed. Ninety-eight and 133 patients were included in the study during 1998-1999 (group A) and 2003-2005 (group B), respectively. PPV or CDH was the only agent used for pharmacologic angioplasty in groups A and B, respectively. Good outcome was defined as a modified Rankin scale score ≤ 2 at discharge. RESULTS: The percentages of patients without CV who had good outcomes were similar in groups A (78%) and B (81%, P = 0.91). However, the percentage of patients with CV with a good outcome was significantly higher in group B (66%) than in group A (34%, P = 0.032). Logistic regression revealed that age ≤ 65 years (P = 0.0001), World Federation of Neurological Surgeons (WFNS) grade ≤ 2 (P < 0.0001), CV (P = 0.0001), and group B (P = 0.0069) were independent causative factors for good outcome in the overall patient population. Age ≤ 65 (P = 0.0002) and WFNS grade ≤ 2 (P < 0.0001) were independent causative factors for good outcome in patients without CV, whereas only group B (P = 0.0089) was an independent factor for good outcome in patients with CV. CONCLUSION: CDH appears to be associated with a better outcome in patients with SAH.

Intra-arterial colforsin daropate for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Cerebral vasospasm (CV) remains a major cause of mortality and morbidity in patients with subarachnoid hemorrhage (SAH). Here, we examined the effectiveness and safety of intra-arterial injection of colforsin daropate hydrochloride (CDH). METHODS: A consecutive series of 29 patients with angiographically confirmed CV received intra-arterial CDH (IAC) therapy. Angiographic changes in spastic vessels and the cerebral circulation time (CCT) were assessed before and after IAC treatment, together with the change in clinical status. RESULTS: IAC treatment was performed in 53 procedures in 29 patients. Angiographic improvement was observed following all procedures (100%), and clinical improvement was observed following 36 of 42 procedures (86%) in symptomatic cases. CCT improved significantly. At the 3-month follow-up, 19 patients (66%) showed good recovery or moderate disability on the Glasgow Outcome Scale. Major adverse effects were headache and increased heart rate. CONCLUSIONS: IAC treatment was effective and safe for the treatment of CV after SAH.

Efficacy of the free radical scavenger, edaravone, for motor palsy of acute lacunar infarction.

OBJECTIVE: Free radicals are important in causing neural cell injury during cerebral infarction. Although there was a randomized, placebo-controlled, double-blind study at multiple centers in Japan showing the efficacy of the free radical scavenger, edaravone, in acute cerebral infarction, to date the clinical studies are few. This study investigated the effect of edaravone on the outcome of patients with acute lacunar infarction. METHODS: We retrospectively evaluated 124 consecutive patients with first-ever acute lacunar infarctions who were admitted to our hospital within 24 hours after the onset between January 2004 and June 2007. Of these, 59 patients received both edaravone and conventional therapy (edaravone group), and the other 65 underwent conventional therapy only (non-edaravone group). There was no significant difference in patients' baseline characteristics in the two groups. The clinical outcome was assessed by the National Institutes of Health Stroke Scale (NIHSS). RESULTS: The reduction of NIHSS scale during hospitalization (1.5+/-1.0 vs. 1.0+/-1.1; p = 0.007), especially that of the motor palsy scale (1.0+/-1.0 vs. 0.5+/-1.0; p = 0.006) was significantly larger, and the percentage of patients with a favorable outcome (NIHSS at discharge < or =1) (91.5% vs. 78.5%; p = 0.044) was significantly better in the edaravone group. CONCLUSION: Edaravone improves the outcomes of patients with acute lacunar infarction, especially motor palsy, without regard to the conventional therapy performed concomitantly.

[Lacunar infarction in brain tumor patients: chronic stage complication after radiation therapy].

The authors reported two relatively young adults with lacunar infarction that took place many years after radiation therapy. The first case was that of a 41-year-old male presenting with a slight decrease in consciousness and right hemiparesis of sudden occurrence. MRI revealed a lacunar infarction in the left internal capsule. This patient had received radiation therapy and chemotherapy for a right basal ganglia germinoma when he was 24 years old. The tumor completely disappeared and he was able to return to work. The second case was a 24-year-old female presenting with dysesthesia in the right upper extremity and nausea of sudden occurrence. MRI disclosed a lacunar infarct in the right corona radiata. The patient had received radiation therapy for a suprasellar tumor when she was 11 years old. The tumor considerably decreased in size and the patient conducted normal social life thereafter. MRI showed a lacunar infarction in the right corona radiata. Review of the literature was made and the possibility of radiation therapy as a causative factor of the lacunar infarction in relatively young adults was discussed.

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models.

INTRODUCTION: Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire. METHODS: This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8 mm long and 3.5 mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system. RESULTS: A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30 minutes. CONCLUSION: This new clot-retrieving wire could be useful for mechanical clot extraction in stroke.

Endovascular treatment for dural arteriovenous fistula of the anterior condylar vein with unusual venous drainage: report of two cases.

We report 2 patients with dural arteriovenous fistula of the anterior condylar vein in which the patients presented with rare clinical symptoms related to unusual venous drainage patterns. The first patient had progressive myelopathy and showed venous drainage into the anterior spinal vein. The second had ocular signs and showed retrograde drainage into the superior ophthalmic vein. Complete cure was attained by transarterial glue injection in the first patient and transvenous coil embolization in the latter.

A case of intracranial arteriovenous fistula in an infant with neurofibromatosis type 1.

INTRODUCTION: Reported cases of arteriovenous fistula (AVF) with neurofibromatosis type1 (NF1) are rare. CASE REPORT: In this paper we report the first case of intracranial AVF in an NF1 infant who developed heart failure. Endovascular treatment using coils successfully obliterated the AVF. The mechanism underlying the AVF in this case was believed to be a congenital mesenchymal abnormality of the intracranial vessels. DISCUSSION: The mechanism underlying the development of heart failure in this case is also discussed.