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OBJECTIVES: Distal anterior cerebral artery (DACA) aneurysms account for 1%-9% of all intracranial aneurysms. Microsurgical treatment is generally preferred for DACA aneurysms; however, it presents challenges owing to the anatomical complexities. Advances in neuro-interventional techniques have yielded promising results. This study aims to compare the clinical outcomes of DACA aneurysms treated with microsurgery and endovascular treatment (EVT) to elucidate the efficacy of EVT. MATERIALS AND METHODS: A multicenter observational registry comprising 16 stroke centers was utilized for this study. Data was retrospectively and prospectively analyzed from 166 patients with DACA aneurysms in our database, which included 4,552 consecutive patients with ruptured or unruptured intracranial aneurysms who underwent microsurgical or endovascular treatment between January 2013 and December 2021. RESULTS: Surgical clipping was performed in 115 patients, and 51 underwent coil embolization. The median follow-up duration was 15.3 months. No significant differences were observed in patient characteristics between the two treatment modalities. There were no differences in complication-related morbidity between the microsurgical treatment and EVT groups in either unruptured (10.5% vs. 9.1%, p=1.00) or ruptured aneurysms (5.2% vs. 6.9%, p=0.66). Coil embolization resulted in higher recurrence and retreatment rates than surgical clipping did, especially for ruptured aneurysms (2.6% vs. 27.6%, p<0.01). CONCLUSIONS: Endovascular treatment is an alternative to microsurgery for DACA aneurysms especially in unruptured cases or the patients who have difficulty undergoing craniotomy due to their general condition, albeit with considerations for higher recurrence and retreatment rates, particularly in ruptured cases. Close follow-up is crucial for the effective management of these challenges. Further studies are needed to refine the treatment strategies for DACA aneurysms.
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OBJECTIVE: Effective thrombectomies in the posterior circulation remain controversial. Previous reports have demonstrated the superiority of contact aspiration in anterior circulation. Aspiration catheters and stent retrievers are often used alone on a global scale, while combined techniques are commonly used in Japan. This study evaluated the effect of first-line contact aspiration with other strategies for the treatment of basilar artery occlusion. METHODS: The primary outcome was the frequency of the first-pass effect, and the secondary outcome was the time from puncture to the first-pass effect. A multicenter observational registry including 16 Japanese stroke centers was used. Between December 2013 and February 2021, enrolled patients underwent endovascular thrombectomy for basilar artery occlusion. The efficacy of contact aspiration compared to other methods (including stent retrievers and combined techniques) was evaluated. RESULTS: Eighty-four patients were included, all of whom had achieved effective recanalization. Twenty-six patients were treated with contact aspiration, 13 with combined technique, and 45 with stent retrievers. The two groups: contact aspiration and non-contact aspiration, had different backgrounds. Both had similar frequencies of effective recanalization and first-pass effects. The contact aspiration group experienced better functional outcomes without statistical significance, while this strategy was significantly associated with a shorter puncture-to-recanalization time (38 vs. 55â¯minutes, P=0.036). In particular, in the 55 patients with the first-pass effect, multivariate Cox proportional hazard analysis showed that contact aspiration was significantly associated with a shorter time from puncture to first-pass effect, independent of age and etiology of large-artery atherosclerosis (hazard ratio 2.02, 95% confidence intervals 1.10-3.69, P=0.023). CONCLUSION: This study suggested that contact aspiration for basilar artery occlusion may shorten the puncture-to-first-pass effect, compared to stent retrievers and combined techniques.
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Procedimentos Endovasculares , Trombectomia , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Trombectomia/métodos , Procedimentos Endovasculares/métodos , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Punções/métodos , Idoso de 80 Anos ou mais , Sistema de Registros , Tempo para o Tratamento , Artéria Basilar/cirurgia , Stents , Sucção/métodosRESUMO
BACKGROUND AND OBJECTIVES: Although intraprocedural rupture (IPR) is rare, it is a devastating complication of endovascular treatment (EVT) for intracranial aneurysms. Very few studies have been conducted on IPR, and the safety and efficacy of management techniques of IPR have not been investigated. METHODS: Patients who experienced IPR during EVT between 2013 and 2022 were enrolled from a multicenter observational registry. We examined the safety and efficacy of the management of IPR using imaging markers, including increased hemorrhage and ischemic lesions, which were evaluated using postoperative computed tomography and diffusion-weighted imaging, respectively. RESULTS: Of the 3269 EVTs for intracranial aneurysms, 74 patients who experienced IPR (2.26%) were analyzed. Fifty-five patients (3.36%) experienced IPR among 1636 EVT cases for ruptured aneurysms. Multivariate analysis revealed that increased hemorrhage was significantly associated with poor outcomes (odds ratio [OR], 6.37 [95% CI, 1.00-40.51], P = .050), whereas ischemic lesions were not. Regarding management techniques of IPR, antihypertensive medication use was significantly associated with increased hemorrhage (OR, 14.16 [95% CI, 2.35-85.34], P = .004). Heparin reversal was an independent factor for ischemic lesions (OR, 8.92 [95% CI, 1.54-51.58], P = .014). CONCLUSION: Although the setting of IPR may be miscellaneous, and optimal management varies depending on individual cases, heparin reversal might be associated with ischemic complications, and its role in the successful hemostasis in IPR during EVT for ruptured aneurysms remains unclear.
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PURPOSE: We aimed to investigate the impact of baseline infarct area and collateral status (CS), which are imaging predictors of clinical outcome following stroke, after endovascular treatment (EVT) in MRI-selected patients with acute basilar artery occlusion (BAO). METHODS: Patients with acute BAO who underwent EVT within 24 h after stroke from December 2013 to February 2021 were included in this retrospective, multicenter, observational study. The baseline infarct area was evaluated by the posterior circulation of Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) using diffuse-weighted imaging (DWI), and CS was assessed by measuring the computed tomography angiography of the basilar artery (BATMAN) score and the posterior circulation collateral score (PC-CS) using magnetic resonance angiography (MRA). A Good outcome was defined as a modified Rankin scale score ≤ 3 at 3 months. For each imaging predictor, a multivariate logistic regression analysis was performed to evaluate its impact on good outcomes. RESULTS: A total of 86 patients were analyzed, and 37 (43.0%) had a good outcome. The latter showed significantly higher pc-ASPECTS than those without good outcomes. In multivariate analyses, a pc-ASPECTS ≥ 7 was significantly associated with good outcomes (OR, 2.98 [95% CI, 1.10-8.13], P = 0.032), while PC-CS ≥ 4 (OR, 2.49 [95% CI, 0.92-6.74], P = 0.073) and BATMAN score ≥ 5 (OR, 1.51 [95% CI, 0.58-3.98], P = 0.401) were not. CONCLUSIONS: In MRI-selected patients with acute BAO, pc-ASPECTS on DWI was an independent predictor of clinical outcomes after EVT, while the MRA-based CS assessments were not.
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Arteriopatias Oclusivas , Procedimentos Endovasculares , Acidente Vascular Cerebral , Insuficiência Vertebrobasilar , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Procedimentos Endovasculares/métodos , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Arteriopatias Oclusivas/etiologia , Trombectomia/métodos , Infarto , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND AND PURPOSE: To measure the magnitude of the effect of the infarct location measured using the posterior circulation Alberta Stroke Program Early Computed Tomographic Score (pc-ASPECTS) on the functional outcome at 90 days in patients with basilar artery (BA) occlusion undergoing endovascular therapy (EVT). METHODS: Of the acute ischemic stroke patients undergoing EVT for acute posterior circulation large vessel occlusion enrolled in the multicenter observational registry from December 2013 to February 2021, patients with BA occlusion were included. A favorable outcome was defined as achieving a modified Rankin Scale score of 0-3 at 90 days. The effect of pc-ASPECTS including the distribution on favorable outcomes was evaluated. RESULTS: One hundred patients were analyzed. Fifty-one patients (51%) achieved favorable outcome. Patients achieving a favorable outcome were younger, had a lower National Institutes of Health Stroke Scale score before EVT, and had a higher pc-ASPECTS before EVT than those not achieving a favorable outcome. Multivariable logistic analysis showed a significant association between higher pc-ASPECTS and a favorable outcome (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.02-1.52; P = 0.028). Considering the infarct location, bilateral cerebellar infarction was significantly associated with a lower frequency of favorable outcomes than those without cerebellar infarction (OR 0.16; 95% CI 0.04-0.51; P = 0.002). CONCLUSIONS: A higher pc-ASPECTS before EVT could be a predictor of a favorable outcome after EVT for BA occlusion. In particular, the presence of bilateral cerebellar infarction before EVT was significantly associated with a lower likelihood of a favorable outcome.
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Arteriopatias Oclusivas , Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Artéria Basilar , Resultado do Tratamento , AVC Isquêmico/etiologia , Procedimentos Endovasculares/efeitos adversos , Isquemia Encefálica/etiologia , Acidente Vascular Cerebral/etiologia , Arteriopatias Oclusivas/etiologia , Infarto/etiologiaRESUMO
Cerebral venous thrombosis (CVT) is a rare complication of ulcerative colitis (UC) that is potentially fatal once it occurs. This report describes a case of CVT that led to a diagnosis of UC. A 48-year-old woman was diagnosed with CVT due to paresthesia and weakness and was hospitalized for treatment. She developed bloody diarrhea on admission and was further diagnosed with UC based on endoscopic and pathologic findings. Treatment of UC with steroids and sulfasalazine was administered immediately. Her condition improved significantly within several days following treatment. After discharge, the patient experienced no recurrence of either CVT or UC flare-up over the last five years. This report describes CVT as an initial presentation of UC. This is also the first report of a long-term follow-up following successful treatment of CVT with concomitant UC.
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Objective: Stanford type A acute aortic dissection (AAD) is associated with carotid artery dissections (CADs). We report two cases of carotid artery stenting (CAS) for symptomatic CAD after ascending aortic replacement (AAR) for AAD. Case Presentation: Case 1: A 51-year-old man with AAD was transferred to our institute. He had no notable paralysis symptoms on initial presentation. However, after AAR for AAD was performed, left paralysis developed within a few hours. Emergency angiography revealed right CAD and pseudo-occlusion. CAS was performed successfully using intravascular ultrasound (IVUS). He was transferred to a rehabilitation hospital with a modified Rankin Scale (mRS) score of 2.Case 2: A 55-year-old man underwent AAR for AAD, but asymptomatic left CAD remained. Two weeks after the operation, he presented with slight signs of aphasia. Aspirin was prescribed and follow-up was performed, but his symptoms did not improve. He underwent magnetic resonance imaging in our department, which revealed acute cerebral infarction on the left pars opercularis and an artery-to-artery embolism from CAD. CAS was performed via the retrograde approach with direct puncture of the normal left common carotid artery using IVUS. He was discharged with no complications and a mRS score of 1. Conclusion: IVUS can be useful for CAS to confirm the true lumen and extension of long CAD lesions developing from AAD.
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Primary aldosteronism (PA) has been recognized as a relatively benign form of hypertension associated with a low incidence of vascular complications. Recent reports, however, indicate that cerebrovascular accidents are common in PA. We report a case of multiple aneurysms with PA in a middle-aged woman who presented with subarachnoid hemorrhage. A 47-year-old woman with a history of untreated hypertension was referred to our hospital for subarachnoid hemorrhage. Cerebral angiography showed multiple small aneurysms. The initial intervention was aneurysm clipping for a ruptured aneurysm at the bifurcation of the right middle cerebral artery. Despite medication, she continued to suffer from uncontrolled hypertension and hypokalemia. She was diagnosed with PA on the basis of elevated plasma aldosterone, suppressed plasma rennin, and a right adrenal tumor detected by abdominal CT scanning. She underwent several more neck clippings for the remaining aneurysms (unruptured), followed by a total right adrenectomy. Histological examination revealed an adrenal adenoma. After the operation, her blood pressure returned to normal without any vasodepressors. Recent studies have demonstrated that hyperaldosteronism might have direct vasculo-toxic actions, including remodeling, fibrosis, and proliferation. Cerebrovascular accidents caused by PA are reported to have high rates of mortality and recurrence when the PA is overlooked or untreated. Physicians must be alert to the possibility of PA in patients with hypertension and persistent hypokalemia, especially in those who are young or middle-aged. We also recommend screening for intracranial aneurysms by low-invasive magnetic resonance angiography.
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Aneurisma Roto/etiologia , Aneurisma Roto/cirurgia , Hiperaldosteronismo/complicações , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/etiologia , Adenoma/complicações , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos VascularesRESUMO
BACKGROUND Cerebral venous thrombosis (CVT) is a rare but fatal complication of hyperthyroidism that is induced by the hypercoagulable state of thyrotoxicosis. Although it is frequently difficult to diagnose CVT promptly, it is important to consider it in the differential diagnosis when a hyperthyroid patient presents with atypical neurologic symptoms. CASE REPORT A 49-year-old Japanese female with unremarkable medical history came in with thyroid storm and multiple progressive ischemic stroke identified at another hospital. Treatment for thyroid storm with beta-blocker, glucocorticoid, and potassium iodide-iodine was started and MR venography was performed on hospital day 3 for further evaluation of her progressive ischemic stroke. The MRI showed CVT, and anticoagulation therapy, in addition to the anti-thyroid agents, was initiated. The patient's thyroid function was successfully stabilized by hospital day 10 and further progression of CVT was prevented. CONCLUSIONS Physicians should consider CVT when a patient presents with atypical course of stroke or with atypical MRI findings such as high intensity area in apparent diffusion coefficient (ADC) mapping. Not only is an early diagnosis and initiation of anticoagulation important, but identifying and treating the underlying disease is essential to avoid the progression of CVT.
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Isquemia Encefálica/etiologia , Hipertireoidismo/complicações , Trombose Intracraniana/etiologia , Veias Jugulares , Trombose do Seio Lateral , Acidente Vascular Cerebral/etiologia , Crise Tireóidea/etiologia , Trombose Venosa/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Heparina/uso terapêutico , Humanos , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/tratamento farmacológico , Pessoa de Meia-Idade , Iodeto de Potássio/uso terapêutico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Crise Tireóidea/diagnóstico , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológicoRESUMO
OBJECTIVES: To determine the relationship between lifestyle and hemorheology among young people, a study was conducted among healthy university students. Because few investigations have been reported on the relationship between lifestyle factors and hemorheology by gender in young people, we analyzed the effects of lifestyle on hemorheology by administering an assessment questionnaire and by measuring whole blood passage time using MC-FAN (Micro Channel array Flow ANalyzer) and hematological and blood biochemical variables for female and male university students. METHODS: The study was conducted with 40 healthy nonathlete subjects (20 females aged 19.9+/-1.3 years and 20 healthy males aged 20.6+/-1.4 years) who volunteered to participate in the study. The smoking, alcohol drinking, eating, and other habits of the subjects were investigated using a questionnaire. Blood was obtained to determine whole blood passage time and hematological and blood biochemical variables. RESULTS: The mean value of whole blood passage time was significantly shorter in females (43.4+/-5.2 sec/100 microl) than in males (58.2+/-13.6 sec/100 microl). The mean values of RBC, Hb, Ht, MCHC, Alb, TG, Cr, UA, K, Ca, Fe, AST and ALT were significantly lower in females than in males, and the mean value of HDL-C was significantly higher in females than in males. In females, Spearman's correlation coefficient showed a positive correlation between whole blood passage time and RBC, and a negative correlation between whole blood passage time and TG It also showed a positive correlation between whole blood passage time and Plt, and a negative correlation between whole blood passage time and Alb in males. Among the lifestyle factors, the mean value of whole blood passage time in females who consumed salt lightly was significantly longer than that in females who consumed salt moderately. The mean value of whole blood passage time in males who liked sweets was significantly longer than that in males who were neutral to sweets. CONCLUSIONS: The present study showed that whole blood passage time is shorter in females than in males for young people. This conforms to the pattern shown in previous studies which investigated blood passage time among the elderly and people in their prime of life. It is conceivable that females have a higher fluidity than males in all age brackets. Regarding the effects of lifestyle on hemorheology, the present study suggests that several lifestyle factors are related to whole blood passage time and their effects differ according to gender.