Impact of immediate general anesthesia in the emergency room on prevention of rebleeding after subarachnoid hemorrhage.

BACKGROUND: Aneurysm rebleeding is fatal in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether immediate general anesthesia (iGA) management in the emergency room, upon arrival, prevents rebleeding after admission and reduces mortality following aSAH. METHODS: The clinical data of 3033 patients with World Federation of Neurosurgical Societies (WFNS) grade 1, 2, or 3 aSAH from the Nagasaki SAH Registry Study between 2001 and 2018 were retrospectively analyzed. iGA was defined as sedation and analgesia using intravenous anesthetics and opioids combined with intubation induction. We calculated crude and adjusted odds ratios to evaluate the associations between iGA and the risk of rebleeding/death using multivariable logistic regression models with fully conditional specification for multiple imputations. In the analysis of the relationship between iGA and death, we excluded patients with aSAH who died within 3 days after the onset of symptoms. RESULTS: Of the 3033 patients with aSAH who met the eligibility criteria, 175 patients (5.8%) received iGA (mean age, 62.4 years; 49 were male). Heart disease, WFNS grade, and lack of iGA were independently associated with rebleeding in the multivariable analysis with multiple imputations. Among the 3033 patients, 15 were excluded due to death within 3 days after the onset of symptoms. After excluding these cases, our analysis revealed that age, diabetes mellitus, history of cerebrovascular disease, WFNS grade, Fisher grade, lack of iGA, rebleeding, postoperative rebleeding, no shunt operation, and symptomatic spasm were independently associated with mortality. CONCLUSIONS: Management by iGA was associated with a 0.28-fold decrease in the risks of both rebleeding and mortality in patients with aSAH, even after adjusting for the patient's history of diseases, comorbidities, and aSAH status. Thus, iGA can be a treatment for the prevention of rebleeding before aneurysmal obliteration treatment.

Real-world use of enzalutamide in men with nonmetastatic castration-resistant prostate cancer in Japan.

BACKGROUND: The purpose of the study is to evaluate real-world effectiveness and safety of enzalutamide in men with nonmetastatic castration-resistant prostate cancer (nmCRPC) in Japan. METHODS: This was a retrospective evaluation of medical records from men in Japan who started enzalutamide treatment from November 1, 2014, to March 31, 2018, and received androgen deprivation therapy throughout. The primary endpoint was time to prostate-specific antigen (PSA) progression. Secondary endpoints included PSA response rate, time to first use of new antineoplastic therapy, time to first use of cytotoxic chemotherapy, and enzalutamide treatment duration. An exploratory analysis of metastasis-free survival (MFS) was also performed. Adverse events (AEs) were analyzed to assess safety. RESULTS: Based on data from medical records of 205 men in Japan, median time to PSA progression was 27 months (95% confidence interval [CI] 19-not reached [NR]), with 82.5% and 52.0% of men achieving PSA response rates of ≥ 50% and ≥ 90%, respectively. Median time to first use of new antineoplastic therapy was 36 months (95% CI 27-NR) and median enzalutamide treatment duration was 13 months (interquartile range: 7-24). Median time to first use of cytotoxic chemotherapy was NR (95% CI 41-NR). Median MFS was 29 months (95% CI 23-35). In total, 51.7% of men experienced AEs, with malaise (18.5%), decreased appetite (10.7%), and nausea (4.9%) the most frequently reported. CONCLUSIONS: This is the first study to demonstrate the real-world effectiveness and safety of enzalutamide in men with nmCRPC in Japan, further informing healthcare providers about available treatment options for this patient population.

A Spontaneous Extracranial Internal Carotid Artery Dissection with Autosomal Dominant Polycystic Kidney Disease: A Case Report and Literature Review.

Background and Objectives: Non-cystic manifestation of autosomal dominant polycystic kidney disease (ADPKD) is an important risk factor for cerebral aneurysms. In this report, we describe a rare spontaneous internal carotid artery (ICA) dissection in a patient with ADPKD. Observations: A 38-year-old woman with a history of ADPKD and acute myocardial infarction due to coronary artery dissection experienced severe spontaneous pain on the left side of her neck. Magnetic resonance imaging (MRI) revealed a severe left ICA stenosis localized at its origin. Carotid plaque MRI showed that the stenotic lesion was due to a subacute intramural hematoma. Close follow-up by an imaging study was performed under the diagnosis of spontaneous extracranial ICA dissection, and spontaneous regression of the intramural hematoma was observed uneventfully. Conclusions: When patients with a history of ADPKD present with severe neck pain, it is crucial to consider the possibility of a spontaneous ICA dissection. A carotid plaque MRI is beneficial in the differential diagnosis. Conservative management may benefit patients without ischemic symptoms.

Characteristics of aneurysmal subarachnoid hemorrhage associated with rheumatic disease.

Spontaneous subarachnoid hemorrhage (SAH) occurs due to intracranial aneurysm rupture in most cases. Rheumatic disease may cause vessel wall inflammation, which can increase the risk of rupture. However, the characteristics of SAH with rheumatic disease are unknown. This study aimed to evaluate SAH features in patients with rheumatic disease. We retrospectively analyzed clinical data of 5066 patients from the Nagasaki SAH Registry Study who had been diagnosed with aneurysmal SAH between 2001 and 2018. We evaluated the SAH characteristics in patients with rheumatic disease using multivariable logistic regression analysis. In total, 102 patients (2.0%, 11 men and 91 women, median age 69.0 [57.0-75.5]) had rheumatic disease. In these patients, univariate logistic regression analysis showed that sex, hypertension, family history of SAH, smoking history, World Federation of Neurosurgical Societies grade on admission, aneurysm size, multiple aneurysms, treatment, and symptomatic spasms were associated with SAH. Multivariable logistic regression analysis showed that characteristics independently associated with SAH in rheumatic disease were female sex (odds ratio [OR] 3.38; 95% confidence interval [CI] 1.81-6.93, P < 0.001), hypertension (OR 0.60; 95% CI 0.40-0.90, P = 0.012), family history of SAH (OR 0.18; 95% CI 0.01-0.80, P = 0.020), small ruptured aneurysms (OR 1.50; 95% CI 1.02-2.24, P = 0.048), and multiple aneurysms (OR 1.69; 95% CI 1.09-2.58, P = 0.021) in comparison with SAH without rheumatic disease. In conclusion, SAH in patients with rheumatic disease was characterized by small multiple aneurysms, regardless of the low incidence of hypertension and family history of SAH.

Correction to: Intra-Arterial Transplantation of Low-Dose Stem Cells Provides Functional Recovery Without Adverse Effects After Stroke.

The original version of this article unfortunately contained an error in affiliation of Yuhtaka Fukuda.

A long side chain imidazolium-based graft-type anion-exchange membrane: novel electrolyte and alkaline-durable properties and structural elucidation using SANS contrast variation.

Newly designed styrylimidazolium-based grafted anion-exchange membranes (StIm-AEMs), in which imidazolium ionic groups are attached to styrene at the far side from the graft chains, were prepared by radiation-induced graft polymerization of p-(2-imidazoliumyl) styrene onto poly(ethylene-co-tetrafluoloethylene) (ETFE) films, followed by N-alkylation and ion-exchange reactions. StIm-AEM having an ion exchange capacity (IEC) of 0.54 mmol g-1 with a grafting degree (GD) of ∼18%, possesses practical conductivity (>50 mS cm-1) even with a very low water uptake (∼10%) and high stability over 600 h in a 1 M KOH solution at 80 °C. There exists a critical IEC (IECc) in the range of 0.7-0.8 mmol g-1 over which the membrane showed high water uptake, which resulted in pronounced susceptibility to hydrolysis. Using small-angle neutron scattering technique with a contrast variation method, we found the hydrophilic phase in StIm-AEMs with IECs lower and higher than IECc shows "reverse-micelles" with water domains dispersed in the polymer matrix and "micelles" with graft polymer aggregates dispersed in the water matrix, respectively. The further analysis of micelle structures using the hard-sphere liquid model and Porod limit analysis reveals that the interfacial structures of ionic groups are essential for the electrochemical properties and durability of StIm-AEMs. In addition, StIm-AEM with an IEC of 0.95 mmol g-1 and the maximum power density of 80 mW cm-2 in the hydrazine hydrate fuel cell test, exhibited long-term durability under constant current (8.0 mA) up to 455 h, which, thus far, is the best durability at 80 °C for platinum-free alkaline-type liquid fuel cells.

Arterial Spin Labeling Magnetic Resonance Imaging Can Identify the Occlusion Site and Collateral Perfusion in Patients with Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography.

BACKGROUND AND OBJECTIVES: Determining the occlusion site and collateral blood flow is important in acute ischemic stroke. The purpose of the current study was to test whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) could be used to identify the occlusion site and collateral perfusion, using digital subtraction angiography (DSA) as a gold standard. METHOD: Data from 521 consecutive patients who presented with acute ischemic stroke at our institution from January 2012 to September 2014 were retrospectively reviewed. Image data were included in this study if: (1) the patient presented symptoms of acute ischemic stroke; (2) MRI was performed within 24 h of symptom onset; and (3) DSA following MRI was performed (n = 32 patients). We defined proximal intra-arterial sign (IAS) on ASL as enlarged circular or linear bright hyperintense signal within the occluded artery and distal IAS as enlarged circular or linear bright hyperintense signals within arteries inside or surrounding the affected region. The presence or absence of the proximal IAS and distal IAS were assessed, along with their inter-rater agreement and consistency with the presence of occlusion site and collateral flow on DSA images. RESULTS: The sensitivity and specificity for identifying occlusion site with ASL were 82.8 and 100%, respectively. Those for identifying collateral flow with ASL were 96.7 and 50%, respectively. The inter-rater reliability was excellent for proximal IAS (κ = 0.92; 95% CI 0.76-1.00) and substantial for distal IAS detection (κ = 0.78; 95% CI 0.38-1.00). CONCLUSIONS: Proximal IAS and distal IAS on ASL imaging can provide important diagnostic clues for the detection of arterial occlusion sites and collateral perfusion in patients with acute ischemic stroke.

Reverse relationships of water uptake and alkaline durability with hydrophilicity of imidazolium-based grafted anion-exchange membranes.

We found unprecedented reverse relationships in anion-exchange membranes (AEMs) for Pt-free alkaline fuel cell systems, i.e., the increase in hydrophobicity increased water uptake and susceptibility to hydrolysis. AEMs with graft copolymers that composed of anion-conducting 2-methyl-N-vinylimidazolium (Im) and hydrophobic styrene (St) units were employed. We characterized two new structures in these AEMs using a small-angle neutron scattering with a contrast variation method. (1) The distribution of graft polymers in conducting (ion channel) or non-conducting (hydrophobic amorphous poly(ethylene-co-tetrafluoroethylene) (ETFE)) phase was evaluated in a quantitative manner. High fraction in conducting layer for AEMs having high grafting degrees was found using the proposed structural model of "conducting/non-conducting two-phase system". (2) Assuming a hard-sphere fluid model, we found AEMs having high St contents and low alkaline durability possessed nanophase-separated water puddles with diameters of 3-4 nm. The AEM having a low St content and the best alkaline durability did not show evident nanophase separation. The above hierarchical structures elucidate the unexpected reverse relationships that the AEM having highly hydrophobic graft polymers was subjected to the morphological transition to give water puddles at nanoscale. The imidazolium groups that were located at the boundary between graft polymers and water puddles should be susceptible to hydrolysis.

[A Case of Cerebellum Abscess due to Fusobacterium nucleatum that Developed Because of Poor Dental Hygiene].

We report a case of cerebellum abscess due to Fusobacterium nucleatum(F. nucleatum) in a 60-year-old man. He was admitted to our hospital complaining of headache and dizziness. On admission, he was lucid with the following vital data:blood pressure, 136/89 mmHg;heart rate, 65 beats/min;body temperature, 37.0℃;and oxygen saturation, 100%. He had a moderate headache and could not walk straight. In general, there were no abnormal findings except for his poor dental hygiene. Laboratory findings revealed elevated white blood cell counts(10,900/mm3)and brain MRI revealed a mass shadow that was suspected to be an abscess in the left side of his cerebellum. Elective surgery was scheduled. However, consciousness of disorder was observed on the second hospital day and the size of mass shadow extended;hence, emergent drainage under craniotomy was performed. The diagnosis was cerebellum abscess, and F. nucleatum, which is a normal flora in the oral cavity, was isolated in his cerebellum abscess. After the surgery, his hospital course was positive under the treatment of antibiotics for F. nucleatum. The route of bacterial infection entry was unclear;however, it will be considered that abscesses in the central nervous system occur because of poor dental hygiene.

Imidazolium-based anion exchange membranes for alkaline anion fuel cells: (2) elucidation of the ionic structure and its impact on conducting properties.

In our previous study (Soft Matter, 2016, 12, 1567), the relationship between the morphology and properties of graft-type imidazolium-based anion exchange membranes (AEMs) was revealed, in that the semi-crystalline features of the polymer matrix maintain its mechanical properties and the formation of interconnected hydrophilic domains promotes the membrane conductivity. Here, we report a novel ionic structure of the same graft-type AEMs with different grafting degrees, analyzed using a small-angle X-ray scattering method under different relative humidity (RH) conditions. The characteristic "ionomer peak" with a corresponding correlation distance of approximately 1.0 nm was observed at RH < 80%. This distance is much smaller than the literature-reported mean distance between two ionic clusters, but close to the Bjerrum length of water. Since the representative number of water molecules per cation, nw, was small, we proposed that dissociated ion-pairs are distributed in the hydrophilic domains (ion-channels). At RH < 80%, ion-channels are disconnected, however in liquid water, they are well-connected as evidenced by the sharp increase in nw. The disconnected ion-channels even under relatively high RH conditions should be a substantial factor for the low power generation efficiency of AEM-type fuel cells.

Efficacy and safety of ipragliflozin as add-on therapy to insulin in Japanese patients with type 2 diabetes mellitus (IOLITE): a multi-centre, randomized, placebo-controlled, double-blind study.

AIMS: To examine the efficacy and safety of add-on ipragliflozin in Japanese patients with type 2 diabetes in the early stage of insulin therapy. METHODS: Patients treated with insulin (bolus component <30% of total daily dose) with/without a dipeptidyl peptidase-4 (DPP-4) inhibitor were randomized to receive placebo (n = 87) or ipragliflozin (n = 175) for 16 weeks. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline. Secondary endpoints included changes in fasting plasma glucose (FPG) and metabolic hormones. Safety endpoints were also examined. RESULTS: The changes in HbA1c were 0.27% and -0.79% (2.9 and -8.7 mmol/mol) in the placebo and ipragliflozin groups, respectively (baseline: 8.62% vs 8.67% [70.8 vs 71.2 mmol/mol]), corresponding to an adjusted mean difference of -1.07% (95% confidence interval -1.24, -0.91) or -11.7 mmol/mol (-13.5, -9.9), p < .001. Ipragliflozin reduced FPG and serum C-peptide levels and body weight (all p < .001), and increased serum adiponectin levels (p = .022). There was a statistically significant interaction for use/non-use of a DPP-4 inhibitor × treatment group for the change in HbA1c (p = .042). Hypoglycaemia was the only treatment-related adverse event reported in >5% of patients (14.9% vs 29.1%). Events consistent with urinary tract infection (placebo 1.1% vs ipragliflozin 2.3%) or genital infection (0.0% and 4.0%, respectively) occurred in <5% of patients. CONCLUSION: Ipragliflozin was well tolerated and effective in insulin-treated patients, especially when used with a DPP-4 inhibitor.

Imidazolium-based anion exchange membranes for alkaline anion fuel cells: elucidation of the morphology and the interplay between the morphology and properties.

We investigated the morphology and swelling behavior of a new graft-type of anion exchange membrane (AEM) containing 2-methylimidazolium groups by using a contrast variation small angle neutron scattering (SANS) technique. These AEMs were prepared by radiation-induced grafting of 2-methyl-1-vinylimidazole and styrene into poly(ethylene-co-tetrafluoroethylene) (ETFE) films and subsequent N-alkylation with methyliodide, and possessed both high alkaline durability and high conductivity. Our results showed that the crystalline lamellar and crystallite structures originating from the pristine ETFE films were more or less conserved in these AEMs, but the lamellar d-spacing in both dry and wet membranes was enlarged, indicating an expansion of the amorphous lamellae due to the graft chains introduced in the grafting process and the water incorporated in the swelling process. For the first time, the swelling behavior of the AEMs was studied quantitatively in various water mixtures of water and deuterated water with different volume ratios (contrast variation method), and the morphology of these membranes was elucidated by three phases: phase (1) crystalline ETFE domains, which offer good mechanical properties; phase (2) hydrophobic amorphous domains, which are made up of amorphous ETFE chains and offer a matrix to create conducting regions; phase (3) interconnected hydrated domains, which are composed of the entire graft chains and water and play a key role in promoting the conductivity.

Point-by-point parent artery/sinus obliteration using detachable, pushable, 0.035-inch coils.

BACKGROUND: Parent artery occlusion for intractable aneurysms or sinus packing for dural arteriovenous fistulas (DAVFs) is sometimes difficult and requires many expensive coils to accomplish complete occlusion. To help solve these problems, we reviewed our experience using 0.035-inch coil (0.035 coil; Boston Scientific, San Leandro, CA, USA), which has been used in cardiovascular and abdominal lesions. METHODS: These 0.035 coils were preferably used in addition to the detachable and fibered coils for patients with intractable aneurysms, traumatic vessel blowout, and DAVF. Our strategy was as follows: (1) detachable coils were deployed first for the ideal anchoring of the coils; (2) small fibered coils were additionally deployed to stabilize the coil mass; (3) 0.035 coils were deployed to complete the occlusion. RESULTS: From January 2012 to December 2013, seven consecutive patients were treated by endovascular embolization with 0.035 coils. Reasons for intervention were parent artery occlusion for carotid blowout (n = 1), internal carotid artery aneurysm (n = 2), traumatic vertebral artery injury (n = 2), vertebral AVF (n = 1), and transverse sinus-sigmoid sinus DAVF (n = 1). In our cases, a mean of 20.1 ± 8.5 coils per vessel were placed, and mean total coil length was 258.4 ± 91.5 cm per vessel. All procedures were safely performed and complete occlusions achieved. CONCLUSIONS: From our initial experience and treatment results, we believe endovascular parent artery occlusion or sinus packing with 0.035 coils to be useful in terms of reducing the number and expense of coils and also accomplishing immediate occlusion.

Intra-arterial transplantation of low-dose stem cells provides functional recovery without adverse effects after stroke.

Cell transplantation therapy for cerebral infarction has emerged as a promising treatment to reduce brain damage and enhance functional recovery. We previously reported that intra-arterial delivery of bone marrow mesenchymal stem cells (MSCs) enables superselective cell administration to the infarct area and results in significant functional recovery after ischemic stroke in a rat model. However, to reduce the risk of embolism caused by the transplanted cells, an optimal cell number should be determined. At 24 h after middle cerebral artery occlusion and reperfusion, we administered human MSCs (low dose: 1 × 10(4) cells; high dose: 1 × 10(6) cells) and then assessed functional recovery, inflammatory responses, cell distribution, and mortality. Rats treated with high- or low-dose MSCs showed behavioral recovery. At day 8 post-stroke, microglial activation was suppressed significantly, and interleukin (IL)-1ß and IL-12p70 were reduced in both groups. Although high-dose MSCs were more widely distributed in the cortex and striatum of rats, the degree of intravascular cell aggregation and mortality was significantly higher in the high-dose group. In conclusion, selective intra-arterial transplantation of low-dose MSCs has anti-inflammatory effects and reduces the adverse effects of embolic complication, resulting in sufficient functional recovery of the affected brain.

Follow-up after undersized dilatation of targeted lesions in carotid artery stenting.

BACKGROUND AND PURPOSE: We assessed whether intentional undersized dilatation of targeted lesions during carotid artery stenting (CAS) carried a higher risk of in-stent restenosis (ISR) and correlation to subsequent ischemic stroke in qualifying arteries in the follow-up period. METHODS: Consecutive patients undergoing CAS between April 2003 and May 2010 were retrospectively reviewed. The use of a filter device as a distal embolic protection device (EPD) was first approved by Japanese governmental health insurance in April 2008; previously, transient balloon occlusion was used off-label. Until March 2008 (Group A), the target diameter of balloon dilatation was 80-100% of the normal vessel diameter just distal to the stenotic lesion. Moderately undersized dilatation (70-80% of the normal vessel diameter) using the distal EPD was adopted in April 2008 (Group B) in an attempt to reduce the amount of released plaque debris. RESULTS: We analyzed 132 CAS procedures (125 patients) in Group A and 53 CAS procedures (52 patients) in Group B. The mean follow-up period was 35.4 months (35.3 months in Group A and 36.0 months in Group B). Eight lesions (4.3%; 7 in Group A and 1 in Group B) developed ISR. None of the patients had symptomatic ISR, and ISR did not increase in Group B (odds ratio, 0.34; 95% confidence interval, 0.04-2.86; p = 0.32). CONCLUSIONS: Undersized dilatation of targeted lesions did not increase the risk of developing ISR, and we suggest it as a viable treatment option to prevent ischemic events during CAS.

"Double-trick" visual and chemical mimicry by the juvenile orchid mantis hymenopus coronatus used in predation of the oriental honeybee apis cerana.

It has long been hypothesized that the flower-like appearance of the juvenile orchid mantis is used as visual camouflage to capture flower-visiting insects, although it is doubtful whether such morphological resemblance alone could increase their success in hunting. We confirmed that juvenile female orchid mantes often succeed in capturing oriental honeybees, while adult females often fail. Since most of the honeybees approached the juveniles from the front, we hypothesized that juvenile orchid mantes might attract honeybees by emitting some volatile chemical cues. Gas chromatography-mass spectrometry analyses revealed that the mantes' mandibular adducts contained 3-hydroxyoctanoic acid (3HOA) and 10-hydroxy-(E)-2-decenoic acid (10HDA), both of which are also features of the pheromone communication of the oriental honeybee. We also successfully detected 3HOA emitted in the head space air only at the time when the juvenile mantes were attempting to capture their prey. Field bioassay showed that the Oriental Honeybee predominantly preferred to visit dummies impregnated with a mixture of the appropriate amounts and ratios of 3HOA and 10HDA. We therefore conclude that the juvenile mantes utilize these as allelochemicals to trick and attract oriental honeybees.

Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter.

OBJECTIVE: Carotid artery stenting (CAS) is a well-accepted treatment for atherosclerotic stenosis of carotid arteries. Since the occurrence of distal embolization with CAS is still a major concern embolus protection devices (EPD) are usually employed during the procedure. We examined two types of embolus protection filters (Angioguard XP (AG); Filterwire EZ (FW)) and evaluated the function. Thus, the filter was examined postoperatively and the cause of intraoperative flow impairment was evaluated. MATERIALS AND METHODS: CAS was performed for 54 patients with carotid artery stenosis (55 lesions: 25 AG; 27 FW; 3 others). After completing CAS the filter membrane was stained with hematoxylin-eosin (HE) solution and removed from the filter strut. Once mounted on a glass slide the filter was evaluated under a microscope. The area occupied with debris was measured and the relationship to intraoperative flow impairment was evaluated. Furthermore, the relationship between perioperative ischemic complications and intraoperative flow impairment was statistically analyzed. RESULTS: Microscopic observation of the slide revealed the pore density of the FW was 1.5 times higher than that of the AG and the filter area of the FW was 2.5 times wider than than the AG. HE staining facilitated characterization of the debris composition. The area occupied with debris was significantly more in the AG (0.241 ± 0.13 cm(2)) than in the FW (0.129 ± 0.093 cm(2)). Thus, fibrin was significantly more precipitated in the AG. Flow impairment occurred in 6 AG cases (24.0 %) and 4 FW cases (14.8 %). It was induced by filter obstruction in the AG and by vasospasms in the FW. Three cases treated with AG (12.0 %) were complicated with cerebral infarction and all of them were related to flow impairment. One FW case (3.7 %) was complicated with cerebral infarction in presence of preserved flow throughout the intervention. CONCLUSION: Filter function is different according to each design. The cause of flow impairment was attributable to filter obstruction in the AG group and to vasospasms in the FW group. Filter obstruction tends to result in cerebral infarction.

[Carotid blowout syndrome treated by parent artery occlusion using pushable coils: a case report].

OBJECTIVE: Here we report a case of carotid blowout syndrome (CBS) treated with parent artery occlusion using pushable coils. CASE PRESENTATION: A 68-year-old man with a history of surgery and chemoradiation therapy for esophageal cancer 9 years prior presented with a massive hemorrhage from a skin defect in the neck. Angiography revealed encasement of the right common carotid artery by radiation necrosis, and CBS was diagnosed. We performed emergent endovascular treatment, and the right common carotid artery was occluded using pushable coils and a detachable coil. The patient's postoperative course was uneventful. However, he died of esophageal cancer recurrence 6 months later. CONCLUSION: Pushable coils were useful for occluding the parent artery in this case of CBS.

[Carotid artery stenting with proximal and distal protection for radiation-induced carotid stenosis: a case report].

Here we report a case of radiation-induced carotid stenosis treated with carotid artery stenting and proximal and distal protection. A 62-year-old man with a history of radiation therapy for cervical malignant lymphoma at 31 years of age was diagnosed with left radiation-induced carotid stenosis. Angiography revealed left common carotid artery severe stenosis, and T1-weighted magnetic resonance imaging showed plaque hyperintensity. He was treated with carotid artery stenting and proximal and distal protection. Postoperative carotid ultrasonography showed moderate dilatation of the left common carotid artery and his postoperative course was uneventful. Carotid artery stenting and proximal and distal protection for radiation-induced carotid stenosis may be an effective treatment.