302 results on '"Yuji Matsumaru"'
Search Results
52. Application of Three-dimensional Cerebral Angiography for Presurgical Simulation of Cerebral Aneurysm Clipping
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Yoshiro ITO, Masayuki SATO, Yuji MATSUMARU, Aiki MARUSHIMA, Shinya MINAMIMOTO, Tenyu HINO, Mikito HAYAKAWA, Eiichi ISHIKAWA, and Akira MATSUMURA
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- 2022
53. Evaluation of Peak Skin Doses and Lens Doses during Interventional Neuroradiology Using a Direct Measurement System
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Satoru Kawauchi, Koichi Chida, Takashi Moritake, Yusuke Hamada, Shogo Yoda, Hideyuki Sakuma, Wataro Tsuruta, and Yuji Matsumaru
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Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
54. Monitoring and Protection against Radiation Dose to Eyes of Operators Performing Neuroendovascular Procedures: A Nationwide Study in Japan
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Hajime Sakamoto, Takashi Moritake, Lue Sun, Ikuo Kobayashi, Satoru Kawauchi, Toshi Abe, Atsuko Tsukamoto, Yuh Morimoto, Hiroyuki Daida, and Yuji Matsumaru
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Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
55. Middle meningeal artery embolization for pediatric chronic subdural hematoma under anticoagulant therapy with ventricular assist device: a case report
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Yuji Matsumaru, Masayuki Sato, Osamu Yazawa, Taisuke Akimoto, Eiichi Ishikawa, and Yoshiro Ito
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medicine.medical_specialty ,medicine.medical_treatment ,Middle meningeal artery ,Anastomosis ,Hematoma ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Embolization ,Cerebral Hemorrhage ,Intracranial pressure ,Intracerebral hemorrhage ,business.industry ,Anticoagulants ,Infant ,food and beverages ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Meningeal Arteries ,Surgery ,Hematoma, Subdural, Chronic ,Ventricular assist device ,Pediatrics, Perinatology and Child Health ,Female ,Heart-Assist Devices ,Neurology (clinical) ,Neurosurgery ,business - Abstract
Recently, the efficacy of middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) in the elderly has been reported. However, no previous reports of MMA embolization for cSDH in children with ventricular assist devices (VAD) have been published. Here, we report a case of MMA embolization for cSDH in a child with VAD. A 15-month-old female was diagnosed with dilated cardiomyopathy at 7 months old. Soon, a VAD was inserted, and anticoagulant and antiplatelet therapy was started. Bilateral cSDH was observed at 15 months, and, 2 months later, an acute exacerbation of the right cSDH necessitated intracerebral hemorrhage removal. Afterwards, increased intracranial pressure occurred due to a contralateral subdural hematoma but, 4 months after intracerebral hemorrhage removal, CT showed new hemorrhaging in the left cSDH. MMA embolization was then conducted to prevent rebleeding in the hematoma. Selective angiography of the left MMA demonstrated stains of hematoma capsules from the frontal and parietal branches, which were embolized using liquid embolic material. During the procedure, the material migrated into the intracranial vessels via an undetected transdural anastomosis. Postoperatively, no new neurological abnormalities, including hemiparesis, were observed. Two months later, CT showed a decrease in hematoma size. MMA embolization for cSDH in pediatric patients with VAD may be effective, if vigilance is maintained against transdural anastomoses.
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- 2021
56. The effects of antithrombotic therapy on head trauma and its management
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Masayuki Goto, Eichi Ishikawa, Yoji Komatsu, Takao Koiso, Toshitsugu Terakado, and Yuji Matsumaru
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Male ,medicine.medical_specialty ,Vitamin K ,Multivariate analysis ,medicine.drug_class ,Science ,Trauma ,Article ,Group B ,Head trauma ,Hematoma ,Fibrinolytic Agents ,Japan ,Risk Factors ,Internal medicine ,Antithrombotic ,medicine ,Craniocerebral Trauma ,Humans ,Drug safety ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,Multidisciplinary ,business.industry ,Clinical course ,Anticoagulants ,Middle Aged ,Vitamin K antagonist ,medicine.disease ,Intracranial Hemorrhage, Traumatic ,Medicine ,Female ,Tomography, X-Ray Computed ,business ,Platelet Aggregation Inhibitors - Abstract
To examine the effects of antithrombotics for head trauma, 393 consecutive patients were enrolled. The patients were divided into those that were (group A, n = 117) and were not (group B, n = 276) taking antithrombotics, and the groups’ outcomes were compared. To identify factors that affected functional independence in group A, clinical factors were compared between the patients that exhibited mRS of 0–2 and 3–6 at discharge. Furthermore, to assess the optimal time to restart antithrombotics, cases in which rebleeding occurred after antithrombotics were restarted or thromboembolic events occurred were extracted. The ratio of mRS 3–6 and death within 30 days were significantly higher in group A than in group B. Multivariate analysis of group A revealed that being aged ≥ 70, not receiving antiplatelet therapy, and intracranial hematoma enlargement were poor prognostic factors. Five patients in group A experienced ischemic strokes within 30 days. In 3 of these patients, the ischemic strokes occurred before antithrombotics were restarted. Rebleeding occurred in two cases after anticoagulants restarted within 48 hours. Patients taking antithrombotics are at high risk of poor prognosis after head trauma. To prevent thromboembolic events, the active resumption of antithrombotics after 48 hours is desirable if hemostasis has been achieved.
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- 2021
57. Induced Neural Cells from Human Dental Pulp Ameliorate Functional Recovery in a Murine Model of Cerebral Infarction
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Hideaki Matsumura, Eiichi Ishikawa, Aiki Marushima, Akihiro Ohyama, Hiroshi Ishikawa, Yuji Matsumaru, Junko Toyomura, Akira Matsumura, Miho Watanabe, Shohei Takaoka, and Hiroki Bukawa
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Neurogenesis ,Mesenchymal stem cell ,Biology ,Regenerative medicine ,Cell biology ,Transplantation ,Cell therapy ,stomatognathic diseases ,medicine.anatomical_structure ,stomatognathic system ,Dental pulp stem cells ,medicine ,Neuron ,Stem cell - Abstract
Human mesenchymal stem cells are a promising cell source for the treatment of stroke. Their primary mechanism of action occurs via neuroprotective effects by trophic factors, anti-inflammatory effects, and immunomodulation. However, the regeneration of damaged neuronal networks by cell transplantation remains challenging. We hypothesized that cells induced to neural lineages would fit the niche, replace the lesion, and be more effective in improving symptoms compared with stem cells themselves. We investigated the characteristics of induced neural cells from human dental pulp tissue and compared the transplantation effects between these induced neural cells and uninduced dental pulp stem cells. Induced neural cells or dental pulp stem cells were intracerebrally transplanted 5 days after cerebral infarction induced by permanent middle cerebral artery occlusion in immunodeficient mice. Effects on functional recovery were also assessed through behavior testing. We used immunohistochemistry and neuron tracing to analyze the differentiation, axonal extension, and connectivity of transplanted cells to the host’s neural circuit. Transplantation of induced neural cells from human dental pulp ameliorated functional recovery after cerebral infarction compared with dental pulp stem cells. The induced neural cells comprised both neurons and glia and expressed functional voltage, and they were more related to neurogenesis in terms of transcriptomics. Induced neural cells had a higher viability than did dental pulp stem cells in hypoxic culture. We showed that induced neural cells from dental pulp tissue offer a novel therapeutic approach for recovery after cerebral infarction.
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- 2021
58. Ventral Clival Branch of the Ascending Pharyngeal Artery as a Transosseous Feeder of an Arteriovenous Fistula Surrounding the Clival Lesions
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Wataro Tsuruta, Tomokazu Sekine, Daiichiro Ishigami, Shigeta Fujitani, Arisa Tomioka, Yuki Kamiya, Hisayuki Hosoo, Yoshiro Ito, Aiki Marushima, Mikito Hayakawa, and Yuji Matsumaru
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Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Abstract
Arteriovenous fistulas (AVFs) adjacent to the clivus, such as cavernous sinus dural AVFs (CSDAVFs) and condylar AVFs, sometimes have an intraosseous shunted pouch and recruit blood supply from transosseous feeders. Precise analysis of transosseous feeders regarding the clival lesion has not yet been performed. Therefore, this study aimed to clarify the characteristics and identity of transosseous feeders in clival lesions.Patients with CSDAVFs and condylar AVFs, who underwent high-resolution cone-beam computed tomography or three-dimensional rotational angiography in our institute, were included. The frequency, type of branch, penetrating point, and termination of intraosseous feeders were retrospectively evaluated.A total of 31 patients with 36 lesions in CSDAVFs and 8 patients with 8 lesions in condylar AVFs underwent angiography. For CSDAVFs, 38 transosseous feeders were detected in 23 out of 31 patients, including 22 in the pharyngeal branch of the ascending pharyngeal artery (APhA), 6 in the hypoglossal branch of the APhA, 6 in the accessory meningeal artery, 3 in the meningohypophyseal trunk (MHT), and 1 in the anterior branch of the middle meningeal artery. For condylar AVFs, 24 transosseous feeders were detected in all 8 patients, including 11 in the pharyngeal branches of the APhA, 7 in the hypoglossal branch of the APhA, 6 in the segmental artery from the vertebral artery, and 2 in the MHT.Transosseous feeders of AVFs around the clivus, which are frequently seen in AVFs of this area, mainly arise from ventral clival branches and from pharyngeal branches of the APhA.
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- 2022
59. World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Federation Assembly neurointerventional surgery safety checklist
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Michael Chen, Kyle M Fargen, J Mocco, Adnan H Siddiqui, Shigeru Miyachi, Jeyaledchumy Mahadevan, Sirintara Singhara Na Ayudya, Anchalee Churojana, Steve Chryssidis, Laetitia De Villiers, Mohibur Rahman, Subash Kanti Dey, Hongqi Zhang, Donghai Wang, Sergio Petrocelli, Silvia Garbugino, Zsolt Kulcsar, Anne Januel, Naci Kocer, Luigi Manfre, Michihiro Tanaka, Yuji Matsumaru, Sang Hyun Suh, Woong Yoon, Carlos de Freitas, Francisco Mont’Alverne, Hubert Desal, Jildaz Caroff, Wickly Lee, Gopinathan Anil, Rohen Harrichandparsad, David LeFeuvre, Ronit Agid, Darren B Orbach, and Allan Taylor
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of ‘checking off boxes’. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN) decided to construct a checklist for neurointerventional cases based on a review of the literature and insights from an expert panel.
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- 2023
60. Comparison of the Clinical Outcome of Carotid Artery Stenting Between Institutions With a Treatment Strategy Based on Risk Factors and Those With First-Line Treatment
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Yoshiro Ito, Eiichi Ishikawa, Masayuki Sato, Aiki Marushima, Mikito Hayakawa, Kazushi Maruo, Tomoji Takigawa, Noriyuki Kato, Wataro Tsuruta, Kazuya Uemura, and Yuji Matsumaru
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Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Purpose: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recommended based on certain risk factors. The volume of an institution’s treatment experience may be associated with good clinical outcomes. There is a dilemma between the treatment strategy based on risk factors and the experience volume. Therefore, we investigated the clinical outcomes of CAS performed at institutions that selected the treatment strategy based on risk factors and those that performed CAS at the first-line treatment. Materials and Methods: Patients who underwent CAS at 5 institutions were included in this retrospective case-control study. We defined CEA/CAS institutions as those that selected the treatment option based on risk factors, and CAS-first institutions as those that performed CAS as the first-line treatment. We investigated cases of ischemic stroke, hemorrhagic stroke, myocardial infarction, and deaths within 30 days of the intervention between the CEA/CAS- and CAS-first institution groups. One-to-one propensity score matching was performed to compare rates of ischemic and hemorrhagic strokes within 30 days of the intervention. Results: A total of 239 and 302 patients underwent CAS at the CEA/CAS institutions and CAS-first institutions, respectively; ischemic stroke occurred in 12 (5.0%) and 7 patients (2.3%), respectively (p=0.09). No differences in major ischemic strokes (0.8% vs 1.3%; p=0.59), hemorrhagic strokes (0.4% vs 0.3%; p=0.87), or deaths (0.0% vs 0.7%; p=0.21) were observed. Myocardial infarction did not occur in either group. Propensity score analysis showed that ischemic stroke (odds ratio: 1.845, 95% confidence interval: 0.601–5.668, p=0.28) and hemorrhagic stroke (odds ratio: 1.000, 95% confidence interval: 0.0061–16.418, p=1.00) were not significantly associated with either institution group. Conclusions: The CAS-specific treatment strategies for CAS can achieve the same level of outcomes as the treatment strategy based on risk factors. The CAS performed based on risk factors in CEA/CAS institutions and the treatment of more than 30 patients/year/institution in CAS-first institutions were associated with good clinical outcomes.
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- 2022
61. Efficacy and Safety of Prasugrel vs Clopidogrel in Thrombotic Stroke Patients With Risk Factors for Ischemic Stroke Recurrence: A Double-blind, Phase III Study (PRASTRO-III)
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Takanari Kitazono, Masahiro Kamouchi, Yuji Matsumaru, Masato Nakamura, Kazuo Umemura, Hajime Matsuo, Nobuyuki Koyama, Junko Tsutsumi, and Kazumi Kimura
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Biochemistry (medical) ,Internal Medicine ,Cardiology and Cardiovascular Medicine - Abstract
To examine the efficacy and safety of prasugrel vs clopidogrel in thrombotic stroke patients at risk of ischemic stroke.This multicenter, active-controlled, randomized, double-blind, double-dummy, parallel group study enrolled thrombotic stroke patients aged ≥ 50 years at risk of ischemic stroke. Patients received prasugrel (3.75 mg/day) or clopidogrel (75 or 50 mg/day) for 24-48 weeks; other antiplatelet drugs were prohibited. The primary efficacy endpoint was the composite incidence of ischemic stroke, myocardial infarction (MI), and death from other vascular causes from the start to 1 day after treatment completion or discontinuation. Secondary efficacy endpoints included the incidences of ischemic stroke, MI, death from other vascular causes, ischemic stroke and transient ischemic attack, and stroke. Safety endpoints included bleeding events and adverse events (AEs).In the prasugrel (N=118) and clopidogrel (N=112; all received 75 mg) groups, the primary efficacy endpoint composite incidence (95% confidence interval) was 6.8% (3.0%-12.9%) and 7.1% (3.1%-13.6%), respectively. The risk ratio (prasugrel/clopidogrel) was 0.949 (0.369-2.443). Secondary efficacy endpoints followed a similar trend. The combined incidences of life-threatening, major, and clinically relevant bleeding were 5.0% and 3.5% in the prasugrel and clopidogrel groups, respectively. The incidences of all bleeding events and AEs were 19.2% and 24.6% and 76.7% and 82.5% in the prasugrel and clopidogrel groups, respectively. No serious AEs were causally related to prasugrel.We observed a risk reduction of 5% with prasugrel vs clopidogrel, indicating comparable efficacy. There were no major safety issues for prasugrel.
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- 2022
62. Levetiracetam Versus Levetiracetam Plus Sodium Channel Blockers for Postoperative Epileptic Seizure Prevention in Brain Tumor Patients
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Noriyuki, Watanabe, Eiichi, Ishikawa, Narushi, Sugii, Kazuki, Sakakura, Masahide, Matsuda, Hidehiro, Kohzuki, Takao, Tsurubuchi, Yosuke, Masuda, Alexander, Zaboronok, Hiroyoshi, Kino, Mikito, Hayakawa, Shingo, Takano, Yuji, Matsumaru, and Hiroyoshi, Akutsu
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General Engineering - Abstract
Background Brain tumor patients tend to develop postoperative epileptic seizures, which can lead to an unfavorable outcome. Although the incidence of postoperative epileptic seizures and adverse events are improved with the advent of levetiracetam (LEV), postoperative epilepsy occurs at a frequency of 4.6% or higher. In brain tumor patients, the addition of sodium channel blockers (SCBs) to LEV significantly reduces seizures, though confirmed in a non-postoperative study. Thus, the combination of SCBs with LEV might be promising. Objective In this prospective randomized controlled trial we investigated the safety, evaluated by adverse events during one and two weeks after surgery, and the efficacy, evaluated by the incidence of early epilepsy, including non-convulsive status epilepticus (NCSE), of using LEV alone or SCBs added to LEV in patients who underwent craniotomy or biopsy for brain tumors or brain mass lesions. Methods Patients with brain tumors or brain mass lesions undergoing surgical interventions, excluding endoscopic endonasal surgery (EES), with a diagnosis of epilepsy were eligible for this study. Patients are randomized into either Group A or B (B1 or B2) after the informed consents are taken; LEV alone in Group A patients, while LEV and SCBs in Group B patients (GroupB1, intravenous fosphenytoin plus oral lacosamide (LCM) and GroupB2, intravenous LCM plus oral LCM) were administered postoperatively. Fifty-three patients were enrolled during the first two and a half years of the study and four of them were excluded, resulting in the accumulation of 49 patients' data. Results Postoperative epileptic seizures occurred only in three out of 49 patients during the first week (6.1%) and in seven patients within two weeks after surgery (14.3%, including the three patients during the first week). In Group A, epileptic seizures occurred in two out of 26 patients during the first week (7.7%) and in five patients within two weeks (19.2%) after surgery. In Group B, epileptic seizures occurred in one out of 23 patients during the first week (4.3%) and in two patients during the first two weeks (8.7%). Low complication grade of epileptic seizures was observed in Group B rather than in Group A, however, without significant difference (p=0.256). There was no difference in the frequency of adverse effects in each group. Conclusion Although not statistically significant, the incidence of epileptic seizures within one week after surgery was lesser in LEV+SCBs groups than in LEV alone. No hepatic damage or renal function worsening occurred with the addition of LCM, suggesting the safety of LEV+SCBs therapy.
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- 2022
63. Endovascular Stent Grafting for Recurrent Strokes Due to Fragile Innominate Artery Plaque: A Case Report
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Noriyuki Kato, Akira Matsumura, Tomosato Yamazaki, Eiichi Ishikawa, Yuji Matsumaru, Takaaki Ishikawa, and Masataka Sato
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Thorax ,magnetization-prepared rapid acquisition gradient echo ,medicine.medical_specialty ,fragile plaque ,Medical treatment ,medicine.diagnostic_test ,business.industry ,endovascular stent grafting ,medicine.medical_treatment ,innominate artery ,recurrent stroke ,Stent ,Magnetic resonance imaging ,Case Report ,Stent grafting ,equipment and supplies ,Surgery ,medicine.anatomical_structure ,surgical procedures, operative ,Recurrent stroke ,medicine ,Implant ,cardiovascular diseases ,business ,Artery - Abstract
Here we describe a case of recurrent ischemic strokes due to fragile innominate artery plaque successfully treated using endovascular stent grafting. An 80-year-old man presented with a history of recurrent strokes that were refractory to medical treatment. Computed tomography and magnetic resonance images of the thorax revealed a gross intramural plaque in the innominate artery. He was successfully treated using endovascular stent grafting. An AFX stent graft device was used to prevent further embolic strokes. The AFX stent graft has a unique endoskeleton design with a thin-walled expanded polytetrafluoroethylene fabric-known as active sealing structure-attached to the implant. Postoperatively, the patient has experienced no recurrent strokes in over 2 years of follow-up. The stent grafting procedure could be an optimal treatment option for treating fragile innominate artery plaques.
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- 2021
64. Arteriovenous fistula of the clival diploic vein associated with arteriovenous fistula of the posterior condylar canal
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Tomosato Yamazaki, Yuji Matsumaru, Koji Hirata, Masanari Shiigai, Noriyuki Kato, and Susumu Yasuda
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Male ,congenital, hereditary, and neonatal diseases and abnormalities ,Diploic vein ,medicine.medical_specialty ,business.industry ,Angiography, Digital Subtraction ,Arteriovenous fistula ,medicine.disease ,Embolization, Therapeutic ,Meningeal Arteries ,AV shunt ,medicine.anatomical_structure ,Cranial Fossa, Posterior ,stomatognathic system ,Arteriovenous Fistula ,Rare case ,Humans ,Medicine ,cardiovascular diseases ,Radiology ,business ,Aged ,Condylar canal - Abstract
We herein report a rare case of a patient with a clival diploic vein arteriovenous fistula (AVF) associated with a posterior condylar canal AVF and discuss the radiological features of clival diploic vein AVF during decision-making on treatment strategies. A 69-year-old male patient with one-year history of pulsatile tinnitus was evaluated with magnetic resonance angiography, which revealed a dilated venous structure. Digital subtraction angiography revealed AVFs located in the clivus and posterior condylar canal. The clival diploic vein AVF was fed by the right internal maxillary artery and the petrous branch of middle meningeal artery and shed to the posterior condylar canal only through an intraosseous vein in the jugular tubercle. Although a catheter could not be navigated into the venous pouch in the clivus, the AVFs were successfully obliterated by transvenous embolization of the venous pouch in the posterior condylar canal.
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- 2021
65. Effects of case volume and comprehensive stroke center capabilities on patient outcomes of clipping and coiling for subarachnoid hemorrhage
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Yoichiro Hashimoto, Yuji Matsumaru, Hajime Arai, Kuniaki Ogasawara, Koji Iihara, Yuriko Nakaoku, Ai Kurogi, Teiji Tominaga, Akihito Hagihara, Daisuke Onozuka, Susumu Miyamoto, Takanari Kitazono, Nice Ren, Kunihiro Nishimura, Yoshiaki Shiokawa, Ataru Nishimura, Koichi Arimura, Shigeru Miyachi, Akiko Kada, Toru Iwama, Ryota Kurogi, and Nobuyuki Sakai
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Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Databases, Factual ,Aneurysm, Ruptured ,Neurosurgical Procedures ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Surveys and Questionnaires ,medicine ,Humans ,In patient ,Hospital Mortality ,Stroke ,Aged ,Retrospective Studies ,Clipping (audio) ,Case volume ,business.industry ,Absolute risk reduction ,Retrospective cohort study ,General Medicine ,Middle Aged ,Subarachnoid Hemorrhage ,Surgical Instruments ,medicine.disease ,Surgery ,Treatment Outcome ,Quartile ,030220 oncology & carcinogenesis ,Female ,business ,Risk Reduction Behavior ,Hospitals, High-Volume ,030217 neurology & neurosurgery - Abstract
OBJECTIVEImproved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH.METHODSThe authors conducted a nationwide retrospective cohort study in 27,490 SAH patients who underwent clipping or coiling in 621 institutions between 2010 and 2015 and whose data were collected from the Japanese nationwide J-ASPECT Diagnosis Procedure Combination database. The CSC capabilities of each hospital were assessed by use of a validated scoring system based on answers to a previously reported 25-item questionnaire (CSC score 1–25 points). Hospitals were classified into quartiles based on CSC scores and case volumes of clipping or coiling for SAH.RESULTSOverall, the absolute risk reductions associated with high versus low case volumes and high versus low CSC scores were relatively small. Nevertheless, in patients who underwent clipping, a high case volume (> 14 cases/yr) was significantly associated with reduced in-hospital mortality (Q1 as control, Q4 OR 0.71, 95% CI 0.55–0.90) but not with short-term poor outcome. In patients who underwent coiling, a high case volume (> 9 cases/yr) was associated with reduced in-hospital mortality (Q4 OR 0.69, 95% CI 0.53–0.90) and short-term poor outcomes (Q3 [> 5 cases/yr] OR 0.75, 95% CI 0.59–0.96 vs Q4 OR 0.65, 95% CI 0.51–0.82). A high CSC score (> 19 points) was significantly associated with reduced in-hospital mortality for clipping (OR 0.68, 95% CI 0.54–0.86) but not coiling treatment. There was no association between CSC capabilities and short-term poor outcomes.CONCLUSIONSThe effects of case volume and CSC capabilities on in-hospital mortality and short-term functional outcomes in SAH patients differed between patients undergoing clipping and those undergoing coiling. In the modern endovascular era, better outcomes of clipping may be achieved in facilities with high CSC capabilities.
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- 2021
66. Long-term Durability of Coil Embolization for Unruptured Aneurysm after Introduction of the Neck-bridge Stent: Comparison between the Pre-stent Era and the Stent Era
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Hisayuki Hosoo, Masahiro Katsumata, Wataro Tsuruta, Eiichi Ishikawa, Yuji Matsumaru, Akira Matsumura, and Daiichiro Ishigami
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medicine.medical_specialty ,Long term durability ,medicine.medical_treatment ,Context (language use) ,coil embolization ,neck-bridge stent ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,cardiovascular diseases ,Retrospective Studies ,Coil embolization ,business.industry ,Stent ,Intracranial Aneurysm ,equipment and supplies ,Embolization, Therapeutic ,Surgery ,cerebral aneurysm ,Treatment Outcome ,surgical procedures, operative ,Bridge (graph theory) ,Hemorrhagic complication ,Original Article ,Stents ,Unruptured aneurysm ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
More complex aneurysms can be treated by coil embolization with neck-bridge stent assistance. However, concerns about postprocedural ischemic or hemorrhagic complications remain. In this study, we assessed the long-term durability after introduction of neck-bridge stent in the context of coil embolization for unruptured aneurysm by comparing re-treatment and neurological events between the pre-stent and stent eras. Unruptured aneurysms treated by coil embolization between April 2005 and May 2018 were analyzed retrospectively. We divided cases into two groups: the pre-stent era and the stent era. The cumulative rate of re-treatment and neurological events were assessed and compared. During the period, 177 aneurysms were treated in the pre-stent era and 354 aneurysms were treated in the stent era. The median follow-up was 55 months. In the stent era, the dome/neck (D/N) ratio was significantly lower (P
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- 2021
67. Anterior cerebral artery dissection for a patient with ipsilateral aplastic or twig-like middle cerebral artery: An illustrative case report
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Toshitsugu Terakado, Yuji Matsumaru, and Eiichi Ishikawa
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Surgery ,Neurology (clinical) - Abstract
Background: An aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anomaly, which sometimes causes ischemic infarction. Collateral flow from the ipsilateral anterior cerebral artery (ACA) is important for patients with Ap/T-MCA. If ipsilateral ACA stenosis or occlusion occurs, a large infarction with a wider field than the ACA territory could happen. First, mechanical thrombectomy was performed for the right ACA near occlusion caused by arterial dissection with ipsilateral Ap/T-MCA in this case. Second, Wingspan stenting was performed for the right ACA restenosis. Case Description: A 77-year-old female presented to the hospital with the left hemiparesis. We diagnosed a right ACA infarction caused by right ACA occlusion. Digital subtraction angiography showed right Ap/T-MCA and ipsilateral ACA near occlusion. Thrombectomy was performed, and recanalization was achieved with mild ACA stenosis. The lesion was the dissection due to angiographical finding. Two months after treatment, transient left hemiparesis occurred and right ACA stenosis progressed. Computed tomography perfusion showed hypoperfusion of the right hemisphere. Wingspan stenting was performed from the left internal carotid artery through the anterior communicating artery with an intermediate catheter. The patient was discharged without any neurological deficit. Conclusion: We reported the first case of a patient who underwent Wingspan stenting for the right ACA dissection with Ap/T-MCA. Short-term follow-up and aggressive intervention should be considered for collateral pathway dissection with Ap/T-MCA because the symptoms can become serious. The patients with Ap/T-MCA should be cautious about the collateral pathway arterial changes in particular ipsilateral ACA due to the increasing hemodynamic stress.
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- 2023
68. Short- versus long-term Dual AntiPlatelet Therapy for Stent-Assisted treatment of CErebral aneurysm (DAPTS ACE): a multicenter, open-label, randomized clinical trial
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Tomohiko Ozaki, Hiroshi Yamagami, Masafumi Morimoto, Taketo Hatano, Hidenori Oishi, Koichi Haraguchi, Shinichi Yoshimura, Kenji Sugiu, Koji Iihara, Yuji Matsumaru, Yasushi Matsumoto, Tetsu Satow, Mikito Hayakawa, Chiaki Sakai, Susumu Miyamoto, Kazuo Kitagawa, Takashi Daimon, Tatsuo Kagimura, and Nobuyuki Sakai
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Surgery ,Neurology (clinical) ,General Medicine - Abstract
BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) after stent-assisted coil embolization (SACE) for cerebral aneurysm remains uncertain. This randomized trial of short- versus long-term Dual AntiPlatelet Therapy for Stent-Assisted treatment of CErebral aneurysm (DAPTS ACE) aimed to clarify whether long-term DAPT can reduce the occurrence of ischemic stroke in patients with cerebral aneurysms treated by SACE compared with short-term DAPT.MethodsPatients treated for cerebral aneurysm with SACE were enrolled from 17 hospitals in Japan. Patients were enrolled within 30 days after SACE and assigned in a 1:1 ratio to receive long-term (12 months) or short-term (3 months) DAPT with aspirin and clopidogrel. Randomization was performed centrally through a web-based system. The primary outcome was the time to ischemic stroke event during 3 to 12 months after SACE. This trial was registered with the Japan Registry of Clinical Trials (jRCTs051180141).ResultsA total of 142 patients were recruited from November 4, 2016 to January 7, 2019. Among them, 65 and 68 patients assigned to the long- and short-term DAPT groups, respectively, were included in the full analysis set. Ischemic stroke occurred in no patients in the long-term DAPT group and in one patient in the short-term DAPT group. The incidence rate did not differ between the groups (0.0 vs 2.1/100 person-years; log rank test, P=0.33).ConclusionsIn this multicenter randomized controlled trial, there was not a statistically significant difference in the rate of ischemic strokes between long- and short-term DAPT.
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- 2023
69. National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study
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Ryota Kurogi, Akiko Kada, Kuniaki Ogasawara, Kunihiro Nishimura, Takanari Kitazono, Toru Iwama, Yuji Matsumaru, Nobuyuki Sakai, Yoshiaki Shiokawa, Shigeru Miyachi, Satoshi Kuroda, Hiroaki Shimizu, Shinichi Yoshimura, Toshiaki Osato, Nobutaka Horie, Izumi Nagata, Kazuhiko Nozaki, Isao Date, Yoichiro Hashimoto, Haruhiko Hoshino, Hiroyuki Nakase, Hiroharu Kataoka, Tsuyoshi Ohta, Hitoshi Fukuda, Nanako Tamiya, AI Kurogi, Nice Ren, Ataru Nishimura, Koichi Arimura, Takafumi Shimogawa, Koji Yoshimoto, Daisuke Onozuka, Soshiro Ogata, Akihito Hagihara, Nobuhito Saito, Hajime Arai, Susumu Miyamoto, Teiji Tominaga, and Koji Iihara
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General Medicine - Abstract
ObjectivesTo examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.DesignRetrospective study.SettingSix hundred and thirty-one primary care institutions in Japan.ParticipantsForty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measuresAnnual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).ResultsIn the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.ConclusionsThe 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.
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- 2023
70. Image quality improvements for brain soft tissue in neuro-endovascular treatments: A novel dual-axis 'butterfly' trajectory for optimized Cone-Beam CT
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Hisayuki Hosoo, Yoshiro Ito, Aiki Marushima, Mikito Hayakawa, Tomohiko Masumoto, Eiichi Ishikawa, and Yuji Matsumaru
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Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2023
71. Traumatic dissection of the anterior cerebral artery secondary to a rugby related impact: A case report with emphasis on the usefulness of T1-VISTA
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Junzo Nakao, Hisayuki Hosoo, Ai Muroi, Toshihide Takahashi, Aiki Marushima, Eiichi Ishikawa, and Yuji Matsumaru
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Surgery ,Neurology (clinical) - Abstract
Background: Cerebrovascular injuries (CVIs) are not usually considered in the differential diagnosis of sport-related head injuries (SRHIs). We encountered a rugby player with traumatic dissection of the anterior cerebral artery (ACA) after impact on the forehead. Head magnetic resonance imaging (MRI) with T1-volume isotropic turbo spin-echo acquisition (VISTA) was used to diagnose the patient. Case Description: The patient was a 21-year-old man. During a rugby tackle, his forehead collided with the forehead of an opponent. He did not have a headache or disturbance of consciousness immediately after the SRHI. On the 2nd day of illness, he had transient weakness of the left lower limb several times. On the 3rd day of illness, he visited our hospital. MRI revealed occlusion of the right ACA and acute infarction of the right medial frontal lobe. T1-VISTA revealed intramural hematoma of the occluded artery. He was diagnosed with acute cerebral infarction due to dissection of the ACA and was followed up for vascular changes with T1-VISTA. The vessel had recanalized and the size of the intramural hematoma had decreased 1 and 3 months after the SRHI, respectively. Conclusion: Accurate detection of morphological changes in cerebral arteries is important for the diagnosis of intracranial vascular injuries. When paralysis or sensory deficits occur after SRHIs, it is difficult to differentiate between concussion from CVI. Athletes with red-flag symptoms after SRHIs should not merely be suspected to have concussion; they should be considered for imaging studies.
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- 2023
72. The Relationships between Anatomical Factors and Treatment Procedures for the Endovascular Treatment of Anterior Communicating Artery Aneurysms
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Go Ikeda, Toshitsugu Terakado, Yuji Matsumaru, Yasunobu Nakai, and Kazuya Uemura
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Anterior Communicating Artery Aneurysm ,Anterior communicating artery ,medicine.medical_specialty ,business.industry ,medicine.artery ,medicine ,Neurology (clinical) ,Endovascular treatment ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2021
73. Delayed Occlusion of the Anterior Choroidal Artery Following Flow Diverter Stent Deployment for Unruptured Aneurysm: A Case Report and Literature Review
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Yuji Matsumaru, Eiichi Ishikawa, Wataro Tsuruta, Hisayuki Hosoo, Takayuki Hara, and Shogo Dofuku
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side branch arising from aneurysm sac ,Flow diverter stent ,medicine.medical_specialty ,business.industry ,Case Report ,anterior choroidal artery ,Surgery ,Anterior choroidal artery ,flow diverter stent ,Occlusion ,cardiovascular system ,Medicine ,Unruptured aneurysm ,cardiovascular diseases ,business - Abstract
Flow diverter stent has been a promising device for intracranial aneurysm treatment. For treating aneurysms located in the anterior circulation, critical branches may be covered by flow diverter stent. The occlusion incidence of these branches has been reported, and even if branch vessel occlusions occur, associated neurological deficits are extremely rare. We present a 55-year-old woman who had a large saccular aneurysm at the right internal carotid artery (ICA). A developed fetal-type posterior communicating artery (PCOM) originated from the sac. We administered flow diverter stent deployment with coil insertion following surgical anastomosis of the superficial temporal artery to the posterior cerebral artery (STA-PCA) with ligation of the origin of the PCOM. On the seventh morning following the intervention, ischemic complication developed due to anterior choroidal artery occlusion jailed by the flow diverter stent. The occlusion of anterior choroidal artery covered by flow diverter stent is extremely rare. However, if the branch arises from the aneurysm sac, occlusion can transpire and induce serious complication. The most probable cause of occlusion in this case was that the orifice was jailed apart from the stent strut because the branch originated from the sac rather than the neck. Furthermore, the progression rate of intra-aneurysm thrombus formation is also an important factor affecting the side branch occlusion.
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- 2021
74. The Japan Neurosurgical Database: Statistics Update 2018 and 2019
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Teiji Tominaga, Yoshiaki Shiokawa, Haruhiko Kishima, Nobuhiro Mikuni, Yukihiko Fujii, Toshihiko Wakabayashi, Kazuhiko Nozaki, Kaoru Kurisu, Hiroyuki Nakase, Isao Date, Kenji Ohata, Ryo Nishikawa, Yuji Matsumaru, Nobuyuki Sakai, Kiyohiro Houkin, Yoshitaka Narita, Phyo Kim, Susumu Miyamoto, Takakazu Kawamata, Tooru Inoue, Keisuke Maruyama, Michiyasu Suzuki, Koji Iihara, Nobuhito Saito, Akio Morita, Hajime Arai, Kuniaki Ogasawara, Hiroyuki Kinouchi, Hiroaki Sakamoto, Keisuke Ueki, Jun C. Takahashi, Toru Iwama, Eiji Kohmura, and Koji Yoshimoto
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medicine.medical_specialty ,medicine.medical_treatment ,Patient demographics ,registry ,computer.software_genre ,Neurosurgical Procedures ,Radiosurgery ,Aneurysm ,Japan ,Chronic subdural hematoma ,national database ,quality of care ,Health care ,Statistics ,Humans ,Medicine ,Special Topic ,neurosurgery ,Endovascular treatment ,Database ,business.industry ,Intracranial Aneurysm ,medicine.disease ,Stroke ,Tissue Plasminogen Activator ,Cohort ,Surgery ,Neurology (clinical) ,Neurosurgery ,business ,computer ,performance measure - Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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- 2021
75. Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note
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Aiki Marushima, Tomoki Koide, Tenyu Hino, Eiichi Ishikawa, Mikito Hayakawa, Masayuki Sato, Yuji Matsumaru, and Yoshiro Ito
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congenital, hereditary, and neonatal diseases and abnormalities ,buddy wire technique ,medicine.medical_specialty ,integumentary system ,carotid artery stenting ,business.industry ,Carotid arteries ,Technical note ,equipment and supplies ,medicine.disease ,Tortuous carotid artery ,tortuous ,Stenosis ,dissection ,proximal balloon guiding ,Internal medicine ,Technical Note ,medicine ,Cardiology ,cardiovascular diseases ,business - Abstract
In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the “snake hunt technique” because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.
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- 2021
76. Peri-mesencephalic subarachnoid hemorrhage due to venous aneurysm associated cerebellar arteriovenous malformation: a case report
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Koji Hirata, Masanari Shiigai, Kazuya Uemura, Yuji Matsumaru, and Eiichi Ishikawa
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Neurology (clinical) ,General Medicine - Published
- 2022
77. Simultaneous intracerebral and subarachnoid hemorrhages caused by multiple infectious intracranial aneurysms treated endovascularly and by microsurgical clipping: illustrative case
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Ken, Akimoto, Kiyoyuki, Yanaka, Kazuhiro, Nakamura, Hayato, Takeda, Minami, Saura, Maya, Takada, Hisayuki, Hosoo, Yuji, Matsumaru, and Eiichi, Ishikawa
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cardiovascular system ,cardiovascular diseases ,General Medicine - Abstract
BACKGROUND Infected intracranial aneurysms are relatively rare but tend to occur in multiple locations. Establishing an optimal treatment strategy for multiple ruptured aneurysms is often challenging, especially when simultaneous ruptures occur in different locations. We report a case of simultaneous intracerebral and subarachnoid hemorrhages caused by the rupture of multiple infected intracranial aneurysms. OBSERVATIONS A 23-year-old male with a 2-week history of chronic fever presented with sudden onset of severe headache and visual disturbance. Computed tomography showed intracerebral hemorrhage in the right occipital lobe and subarachnoid hemorrhage in the area of the left Sylvian fissure. Further investigation documented Staphylococcus bacteremia, verrucae on the mitral valve, and aneurysms arising from the right posterior cerebral artery (PCA) and the left middle cerebral artery (MCA). A larger aneurysm arising from the PCA was successfully occluded endovascularly, but subsequent endovascular occlusion of the MCA aneurysm was unsuccessful because some important branches were observed extending from the aneurysm. The left MCA aneurysm was then obliterated by angioplastic clipping via left pterional craniotomy. The patient showed a favorable neurological recovery after treatment. LESSONS In such complex cases of infectious aneurysms, the method and timing of treatment need to be carefully determined based on the medical condition.
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- 2022
78. Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment.
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Kaesmacher, Johannes, Mujanovic, Adnan, Treurniet, Kilian, Kappelhof, Manon, Meinel, Thomas R., Pengfei Yang, Jianmin Liu, Yongwei Zhang, Wenjie Zi, Qingwu Yang, Nogueira, Raul G., Kazumi Kimura, Yuji Matsumaru, Kentaro Suzuki, Yan, Bernard, Mitchell, Peter J., Zhongrong Miao, Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., and Gralla, Jan
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STROKE treatment ,HEALTH facilities ,NEUROLOGISTS ,CLINICAL trials ,CONFIDENCE intervals ,HUMAN comfort ,UNCERTAINTY ,THROMBOLYTIC therapy ,PATIENTS ,HOSPITAL admission & discharge ,SURVEYS ,FUNCTIONAL assessment ,DECISION making ,DESCRIPTIVE statistics ,ENDOVASCULAR surgery ,MEDICAL practice ,ODDS ratio ,TISSUE plasminogen activator - Abstract
Background Most trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non- inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown. Objective To characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers. Methods A web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results. Results There were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1-5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67). Conclusion Physicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT. [ABSTRACT FROM AUTHOR]
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- 2023
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79. Ruptured Mycotic Cerebral Aneurysm Secondary to Disseminated Nocardiosis
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Kyoji Tsuda, Yuji Matsumaru, Eiichi Ishikawa, Akira Matsumura, Wataro Tsuruta, Masayuki Goto, Aiki Marushima, and Tomoji Takigawa
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Pathology ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Immunosuppressed host ,Case Report ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,law ,medicine ,cardiovascular diseases ,nocardiosis ,medicine.diagnostic_test ,biology ,business.industry ,Nocardiosis ,Nocardia ,General Medicine ,Digital subtraction angiography ,Mycotic aneurysm ,medicine.disease ,biology.organism_classification ,Gram staining ,ruptured mycotic cerebral aneurysm ,Infective endocarditis ,cardiovascular system ,business ,030217 neurology & neurosurgery - Abstract
We report a case of a ruptured mycotic cerebral aneurysm caused by Nocardia infection. A 22-year-old immunocompromised woman with adult-onset Still's disease developed a subarachnoid hemorrhage (SAH). Digital subtraction angiography revealed a small aneurysm at the M2-3 bifurcation of the right middle cerebral artery. Cardiac ultrasonography showed vegetation at the posterior cardiac wall, suspecting infective endocarditis (IE). Gram-positive filamentous bacteria were observed in the necrotic tissue surrounding the aneurysm obtained during trapping surgery. Long-term blood culture showed that the cause of her cerebral mycotic aneurysm was nocardiosis. A mycotic ruptured cerebral aneurysm is an important cause of SAH in immunocompromised patients. Early diagnosis of IE, detection of gram-positive rods by Gram staining, and long-term culture to identify the bacteria is crucial in diagnosing nocardiosis.
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- 2020
80. Predictors of intracranial hemorrhage in acute ischemic stroke after endovascular thrombectomy
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Takahiro Ota, Masaya Enomoto, Teruyuki Hirano, Tatsuo Amano, Yuji Matsumaru, Yoshiaki Shiokawa, Keigo Shigeta, and Masayuki Ueda
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Male ,medicine.medical_specialty ,Postoperative Complications ,Risk Factors ,Internal medicine ,Diabetes Mellitus ,Humans ,Medicine ,Clinical significance ,cardiovascular diseases ,Acute ischemic stroke ,Stroke ,Device Removal ,Aged ,Ischemic Stroke ,Retrospective Studies ,Thrombectomy ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Subarachnoid Hemorrhage ,medicine.disease ,Cardiology ,Female ,Stents ,business ,Intracranial Hemorrhages - Abstract
Background Limited data are available regarding the predictors, clinical relevance, and bleeding rate by surgical devices of intracranial hemorrhage after endovascular thrombectomy. This is partially explained by the difference in the classification and definition of hemorrhage among studies. The purpose of this study was to identify the predictors of hemorrhagic transformation and isolated subarachnoid hemorrhage after endovascular thrombectomy. Methods This was a retrospective, multicenter observational cohort study of consecutive patients who underwent endovascular thrombectomy between January 2015 and December 2018. Univariate and logistic regression analyses were performed to determine the predictors, the impact on clinical outcomes, and the bleeding rate by surgical devices of hemorrhagic transformation and isolated subarachnoid hemorrhage. Results Among 610 eligible patients, hemorrhagic transformations occurred in 93 (15.2%). Fourteen patients (2.3%) were classified as having symptomatic intracranial hemorrhage. Isolated subarachnoid hemorrhage was found in 60 (9.8%) patients. In the logistic regression analyses, diabetes mellitus (odds ratio: 1.92; 95% confidence interval: 1.06–3.49) was associated with hemorrhagic transformation, and the number of device passes (odds ratio: 1.33; 95% confidence interval: 1.11–1.59) was associated with isolated subarachnoid hemorrhage. Both hemorrhagic transformation and isolated subarachnoid hemorrhage were associated with poor 90-day functional outcomes. There was a significant correlation between treatment with stent retrievers and isolated subarachnoid hemorrhage. Conclusions Patients with diabetes mellitus were vulnerable to hemorrhagic transformation, whereas those who underwent several attempts of thrombectomy were susceptible to isolated subarachnoid hemorrhage. Both hemorrhage types worsened the functional outcome. Treatment with the stent retriever was significantly associated with postprocedural isolated subarachnoid hemorrhage.
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- 2020
81. Clinical Outcome of Patients With Large Vessel Occlusion and Low National Institutes of Health Stroke Scale Scores
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Takuya Saito, Ryo Itabashi, Yukako Yazawa, Kazutaka Uchida, Hiroshi Yamagami, Nobuyuki Sakai, Takeshi Morimoto, Shinichi Yoshimura, Ryosuke Doijiri, Yukiko Enomoto, Masayuki Ezura, Norihito Fukawa, Eisuke Furui, Akira Handa, Koichi Haraguchi, Taketo Hatano, Makoto Hayase, Nagayasu Hiyama, Koji Iihara, Norio Ikeda, Keisuke Imai, Hideyuki Ishihara, Yuki Kamiya, Chisaku Kanbayashi, Kazumi Kimura, Kazuo Kitagawa, Yoshihiro Kiura, Junya Kobayashi, Takao Kojima, Ryushi Kondo, Naoya Kuwayama, Yuji Matsumaru, Keigo Matsumoto, Yoshihisa Matsumoto, Kazuo Minematsu, Masafumi Morimoto, Kohei Nii, Kuniaki Ogasawara, Hiroyuki Ohnishi, Hajime Ohta, Takahiro Ohta, Yasushi Okada, Toshiyuki Onda, Manabu Sakaguchi, Shigeyuki Sakamoto, Makoto Sasaki, Junichiro Satomi, Masunari Shibata, Atsushi Shindo, Masataka Takeuchi, Norio Tanahashi, Naoki Toma, Kazunori Toyoda, Tomoyuki Tsumoto, Wataro Tsuruta, Naoyuki Uchiyama, Yoshiki Yagita, Taro Yamashita, Daisuke Yamamoto, Ikuya Yamaura, Takaaki Yamazaki, and Hiroaki Yasuda
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Male ,medicine.medical_specialty ,Multivariate analysis ,Brain Ischemia ,Modified Rankin Scale ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Stroke ,Aged ,Advanced and Specialized Nursing ,Stroke scale ,business.industry ,Clinical Studies as Topic ,Endovascular Procedures ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Intracranial Embolism ,National Institutes of Health (U.S.) ,Tissue Plasminogen Activator ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Plasminogen activator ,Large vessel occlusion - Abstract
Background and Purpose— The treatment and prognosis of acute large vessel occlusion with mild symptoms have not been sufficiently studied. The present study aimed to investigate the clinical or radiological predictors of clinical outcome in patients with stroke with mild symptoms due to acute large vessel occlusion. Methods— Of 2420 patients with acute large vessel occlusion in the RESCUE-Japan Registry 2 (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Registry 2), a multicenter prospective registry in Japan, patients with modified Rankin Scale scores of 0 to 2 before onset and initial National Institutes of Health Stroke Scale (NIHSS) scores of 0 to 5 were examined in post hoc analysis. We examined the clinical and radiological characteristics associated with a favorable outcome (modified Rankin Scale score, 0–2 at 90 days) using multivariate analysis, as well as the factors associated with a favorable outcome in patients treated with endovascular therapy. Results— We analyzed 272 patients (median age, 73 years; median NIHSS score on admission, 3). Eighty-six (31.6%) patients were treated with intravenous recombinant tissue-type plasminogen activator, 54 (19.9%) underwent endovascular therapy, and 208 (76.5%) showed a favorable outcome. In multivariate analysis, age P Conclusions— Younger age, lower initial NIHSS score, intravenous recombinant tissue-type plasminogen activator, and absence of hyperglycemia were independently associated with a favorable outcome in patients with acute large vessel occlusion with low NIHSS scores. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.
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- 2020
82. Futile complete recanalization: patients characteristics and its time course
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Hiroshi Yamagami, Masayuki Ezura, Kazumi Kimura, Kazunori Toyoda, Kazutaka Uchida, Takeshi Morimoto, Kenichi Todo, Kazuo Kitagawa, Yuji Matsumaru, Manabu Sakaguchi, Takaya Kitano, Eisuke Furui, Norio Tanahashi, Hajime Nakamura, Haruhiko Kishima, Shinichi Yoshimura, Hideki Mochizuki, Kazuo Minematsu, Nobuyuki Sakai, Makoto Sasaki, and Yasushi Okada
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Male ,medicine.medical_specialty ,Time Factors ,Science ,MEDLINE ,Cardiology ,Patient characteristics ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Internal medicine ,Occlusion ,medicine ,Humans ,Prospective Studies ,Stroke ,Aged ,Thrombectomy ,Aged, 80 and over ,Multidisciplinary ,business.industry ,Endovascular Procedures ,medicine.disease ,Mechanical thrombectomy ,Cerebrovascular Disorders ,Treatment Outcome ,Baseline characteristics ,Cerebrovascular Circulation ,Time course ,Reperfusion ,Medicine ,Female ,business ,030217 neurology & neurosurgery - Abstract
As the goal of mechanical thrombectomy is shifting toward mTICI-3 rather than mTICI-2b, we sought to clarify the limitation of the effect of mTICI-3. A post-hoc analysis of a registry of large-vessel occlusion stroke from 46 centers was conducted. Among 2,420 registered patients, 725 patients with anterior circulation occlusion who achieved successful reperfusion were analyzed. We compared outcomes between patients with mTICI-3 and mTICI-2b, and investigated how the effect of mTICI-3 changed according to baseline characteristics and time course. The proportion of patients with favorable outcomes (mRS 0–2 at day 90) was higher among patients with mTICI-3 compared to those with mTICI-2b (adjusted OR, 2.10; 95% CI, 1.49–2.97). There was no heterogeneity in the effect of mTICI-3 with respect to age, neurological deficit, alteplase use, occluded vessels, or infarct size. mTICI-3 was associated with favorable outcomes when the puncture-to-reperfusion time was
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- 2020
83. Prediction of the Cerebral Hyperperfusion Phenomenon after Carotid Endarterectomy Using a Transit Time Flowmeter
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Eiichi Ishikawa, Hideaki Matsumura, Yuji Matsumaru, Yoshiro Ito, Yasunobu Nakai, Akira Matsumura, Yoji Komatsu, and Kazuya Uemura
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Male ,medicine.medical_treatment ,cerebral blood flow ,Carotid endarterectomy ,Single-photon emission computed tomography ,Pulse Wave Analysis ,Flow measurement ,030218 nuclear medicine & medical imaging ,transit time flowmeter ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine.artery ,medicine ,Humans ,Carotid Stenosis ,Asymmetry Index ,Endarterectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Tomography, Emission-Computed, Single-Photon ,Endarterectomy, Carotid ,Blood Volume ,medicine.diagnostic_test ,business.industry ,Area under the curve ,Brain ,Middle Aged ,Carotid Arteries ,Cerebral blood flow ,ROC Curve ,Regional Blood Flow ,Surgery ,Female ,Original Article ,Neurology (clinical) ,Internal carotid artery ,Nuclear medicine ,business ,carotid endarterectomy ,hyperperfusion ,030217 neurology & neurosurgery - Abstract
The purpose of this study was to investigate the relationship between the cerebral hyperperfusion phenomenon (CHP) and carotid artery flow volume as measured by a transit time flowmeter during carotid endarterectomy (CEA). We retrospectively investigated 74 patients who underwent both transit time flowmetry and single photon emission computed tomography (SPECT). The flow volumes of the internal carotid artery (ICA) before and after the endarterectomy were recorded during surgery as the pre- and the post-ICA (mL/min), respectively. We defined the difference between the pre- and the post-ICA as the ΔIC (mL/min). Two independent board-certified neurosurgeons analyzed the asymmetry index (affected side/contralateral side) of regional qualitative cerebral blood flow before and after the CEA respectively. We defined the CHP as an excessive increase in this asymmetry index between preoperative and postoperative SPECT. The CHP was observed in five of the 74 patients (6.8%). The pre-ICA of the CHP cases was significantly lower than that of the non-CHP cases (in mL/min, median 29 vs. 97; P = 0.01). The ΔIC of the CHP cases was significantly higher than that of the non-CHP cases (in mL/min, median 154 vs. 50; P = 0.002). The cut-off value of the ΔIC was 81 mL/min (sensitivity 100%, specificity 78.3%, area under the curve 0.912). The findings of this study suggest that the ΔIC is associated with the CHP. The transit time flowmeter is useful to predict the CHP during surgery.
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- 2020
84. Anterior Cranial Fossa Dural Arteriovenous Fistula with Pial Arterial Supply
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Akira Matsumura, Eiichi Ishikawa, Daisuke Watanabe, Yuji Matsumaru, Kiyoyuki Yanaka, Akinari Yamano, Kazuhiro Nakamura, Kuniyuki Onuma, and Masayuki Sato
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medicine.medical_specialty ,Arteriovenous fistula ,Case Report ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,combined therapy ,Dural arteriovenous fistulas ,medicine.artery ,medicine ,Anterior cerebral artery ,Vein ,dural arteriovenous fistula ,Anterior cranial fossa ,medicine.diagnostic_test ,integumentary system ,business.industry ,General Medicine ,medicine.disease ,Tentorium ,Surgery ,Orbitofrontal artery ,medicine.anatomical_structure ,nervous system ,Angiography ,cardiovascular system ,pial supply ,business ,030217 neurology & neurosurgery ,circulatory and respiratory physiology - Abstract
Anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) are mainly fed by the ethmoidal arteries and sometimes have pial arterial feeders. DAVFs with pial arterial supply in ACF are extremely rare because most of the reported cases of DAVFs with pial arterial supply are located at the transverse sigmoid sinus and tentorium. A 68-year-old male presented with dizziness. Angiography showed cortical venous reflex (CVR) through an ACF DAVF fed by both bilateral ethmoidal arteries and by the right orbitofrontal artery as a pial feeder. The ethmoidal feeders were disconnected by craniotomy. The pial arterial feeder from the anterior cerebral artery was not found during surgery, and disconnection of the draining vein was not performed. CVR showed a significant reduction after the surgery. After 2 years of follow-up, angiography revealed an increased shunt flow from the pial feeder. Endovascular treatment using n-butyl-2-cyanoacrylate was performed, resulting in the complete occlusion of the fistula. DAVFs with pial supply are reported to carry a high risk of perioperative complications because of the restriction of the venous outflow and retrograde thrombosis of the pial artery. Endovascular pial feeder occlusion after surgical dural arterial feeder disconnection might achieve a safe and effective outcome. With close follow-up, the recurrence of increased shunt flow may be an appropriate timing for additional treatment. This rare condition may offer a new insight into the mechanisms of pial feeder development.
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- 2020
85. Combined Endoscopic Endonasal and Bilateral Subfrontal Approach for a Nonfunctioning Pituitary Adenoma Associated with an Internal Carotid Artery–Superior Hypophyseal Artery Aneurysm
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Takuma Hara, Hiroyoshi Kino, Akira Matsumura, Hidetaka Miyamoto, Yuji Matsumaru, Yoshiro Ito, Hiroyoshi Akutsu, Shuho Tanaka, and Eiichi Ishikawa
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medicine.medical_specialty ,Supine position ,medicine.diagnostic_test ,Endoscopic endonasal surgery ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Superior Hypophyseal Artery ,Clipping (medicine) ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Pituitary adenoma ,030220 oncology & carcinogenesis ,medicine.artery ,cardiovascular system ,medicine ,Surgery ,cardiovascular diseases ,Neurology (clinical) ,Radiology ,Internal carotid artery ,business ,030217 neurology & neurosurgery - Abstract
Background An aneurysm embedded in a pituitary adenoma is rare, and treatment for both the aneurysm and pituitary adenoma is complex and controversial. Case Description A 53-year-old woman presented with a visual field defect. Magnetic resonance imaging showed a pituitary adenoma and coexistence of an aneurysm located at the orifice of the superior hypophyseal artery (SHA) from the internal carotid artery (ICA). The aneurysm was embedded in the pituitary adenoma; therefore, obliteration of the aneurysm was needed prior to tumor removal to prevent intraoperative rupture of the aneurysm. Although endovascular coil embolization was tried first, it was not successful. A combined endoscopic endonasal approach and transcranial approach was performed for simultaneous tumor removal and aneurysm clipping. A bilateral subfrontal approach was selected for aneurysm clipping because, using this approach, the parent artery was safely controlled from the ipsilateral trajectory, whereas exposure and clipping of the aneurysm were easily done from the contralateral trajectory. Additionally, the supine head position without rotation is comfortable for endoscopic endonasal surgery. The tumor was totally removed, and the aneurysm was safely and completely obliterated with a clip. The patient's postoperative course was uneventful, and her visual disturbance improved. Conclusions A combined endoscopic endonasal and bilateral subfrontal approach is effective for a pituitary adenoma associated with an ICA-SHA aneurysm.
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- 2020
86. Retrograde three-dimensional rotational angiography: A novel method for the detection of plaque protrusion during carotid artery stenting under continuous distal balloon protection
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Eiichi Ishikawa, Masahiro Katsumata, Hisayuki Hosoo, Yuji Matsumaru, Akira Matsumura, Yusuke Hamada, Daiichiro Ishigami, and Wataro Tsuruta
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Male ,medicine.medical_specialty ,Carotid arteries ,Contrast Media ,Balloon ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Ischemia ,medicine ,Humans ,Carotid Stenosis ,Aged ,Retrospective Studies ,business.industry ,Anticoagulants ,Three dimensional rotational angiography ,Embolization, Therapeutic ,Plaque, Atherosclerotic ,Cerebral Angiography ,Female ,Stents ,Radiology ,business ,Angioplasty, Balloon ,030217 neurology & neurosurgery - Abstract
Background To prevent ischemic complications during carotid artery stenting, accurate detection of plaque protrusion and appropriate additional treatment are essential. Here, we introduce a novel method for the detection of plaque protrusion under distal balloon protection using three-dimensional rotation angiography—“retrograde 3DRA.” We evaluated the safety and efficacy of this method. Materials and methods We retrospectively analyzed 28 consecutive carotid artery stenting procedures under distal balloon protection at our hospital between July 2017 and August 2019. The first line of protection was dual balloon protection (proximal and distal balloon). After stent deployment, balloon dilatation, and subsequent blood aspiration, 3DRA was performed with the injection of diluted contrast medium from the aspiration catheter positioned just proximal to the distal protection balloon. The stent lumen was analyzed by obtaining the reconstruction maximum intensity projection image. Results Among the 28 cases, all cases could be assessed for in-stent plaque protrusion using “retrograde 3DRA.” We were able to evaluate the stent lumen clearly. There were three cases (10.7%) in which plaque protrusion could be confirmed. Since additional balloon dilatation was performed for all protrusion cases under continuing balloon protection, no ischemic complications occurred. Conclusion Retrograde 3DRA could be safe and useful for the detection of plaque protrusions and to avoid ischemic complication for tolerable cases of internal carotid artery transient balloon protection.
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- 2020
87. Analysis of Puncture Site-related Complications in Japanese Registry of Neuroendovascular Therapy (JR-NET)3
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Masayuki Sato, Yuji Matsumaru, and Nobuyuki Sakai
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endovascular treatment ,Male ,medicine.medical_specialty ,Percutaneous ,Carotid arteries ,Subgroup analysis ,Punctures ,Transluminal Angioplasty ,puncture-site related complication ,nationwide survey ,Postoperative Complications ,Japan ,Risk Factors ,Humans ,Medicine ,Registries ,Endovascular treatment ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Open surgery ,Endovascular Procedures ,Retrospective cohort study ,Middle Aged ,Surgery ,Neuroendoscopy ,Original Article ,Female ,Neurology (clinical) ,business - Abstract
A subgroup analysis of puncture site-related complications listed in the Japanese Registry of NeuroEndovascular Therapy 3, based on retrospective studies, was performed. Puncture site-related complications occurred in 315 (0.73%, average age: 65.2) of 36,708 patients out of all 43,303 registered cases. Carotid artery stenting (CAS, 95 patients, 1.1%, P
- Published
- 2020
88. A Patient with a Distal Medial Lenticulostriate Artery Aneurysm and Intraventricular Hemorrhage Treated by Endovascular Treatment
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Akira Matsumura, Masayuki Sato, Yuji Matsumaru, Kazuhiro Nakamura, Akinari Yamano, Eiichi Ishikawa, Kiyoyuki Yanaka, and Kuniyuki Onuma
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medicine.medical_specialty ,Intraventricular hemorrhage ,Aneurysm ,business.industry ,medicine ,Neurology (clinical) ,Endovascular treatment ,Cardiology and Cardiovascular Medicine ,medicine.disease ,Medial Lenticulostriate Artery ,business ,Endovascular therapy ,Surgery - Published
- 2020
89. Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment
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Johannes Kaesmacher, Adnan Mujanovic, Kilian Treurniet, Manon Kappelhof, Thomas R Meinel, Pengfei Yang, Jianmin Liu, Yongwei Zhang, Wenjie Zi, Qingwu Yang, Raul G Nogueira, Kazumi Kimura, Yuji Matsumaru, Kentaro Suzuki, Bernard Yan, Peter J Mitchell, Zhongrong Miao, Yvo B W E M Roos, Charles B L M Majoie, Jan Gralla, Jeffrey L Saver, Urs Fischer, Radiology and Nuclear Medicine, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, ANS - Neurovascular Disorders, ACS - Microcirculation, and ACS - Atherosclerosis & ischemic syndromes
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thrombolysis ,Endovascular Procedures ,Clinical Trials and Supportive Activities ,Uncertainty ,610 Medicine & health ,General Medicine ,stroke ,Brain Ischemia ,Treatment Outcome ,Fibrinolytic Agents ,Clinical Research ,thrombectomy ,Humans ,Surgery ,Thrombolytic Therapy ,Neurology (clinical) - Abstract
BackgroundMost trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non-inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown.ObjectiveTo characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers.MethodsA web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results.ResultsThere were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1–5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67).ConclusionPhysicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.
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- 2022
90. Effectiveness of Near-Infrared Spectroscopy (NIRO-200NX, Pulse Mode) for Risk Management in Carotid Artery Stenting
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Yoshiro Ito, Aiki Marushima, Tomoji Takigawa, Yoshiaki Inoue, Tenyu Hino, Wataro Tsuruta, Toshitsugu Terakado, Yasuaki Koyama, Eiichi Ishikawa, Yuji Matsumaru, Mikito Hayakawa, Akira Matsumura, and Masayuki Sato
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Male ,medicine.medical_specialty ,Carotid arteries ,Balloon ,Brain Ischemia ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Monitoring, Intraoperative ,Internal medicine ,Humans ,Medicine ,Carotid Stenosis ,Monitoring methods ,Intraoperative Complications ,Aged ,Aged, 80 and over ,Tomography, Emission-Computed, Single-Photon ,Spectroscopy, Near-Infrared ,medicine.diagnostic_test ,business.industry ,Perioperative ,medicine.disease ,Stenosis ,Tissue oxygenation index ,Cerebrovascular Circulation ,030220 oncology & carcinogenesis ,Cardiology ,Female ,Stents ,Surgery ,Neurology (clinical) ,Hypotension ,Pulse mode ,business ,Angioplasty, Balloon ,030217 neurology & neurosurgery ,Emission computed tomography - Abstract
Background Near-infrared spectroscopy (NIRS) is an alternative monitoring method during carotid artery stenting (CAS). NIRS has been reported to be effective in emergency care; however, it is unknown whether it can predict intraoperative ischemic intolerance and cerebral hyperperfusion during CAS. Perioperative ischemic intolerance and cerebral hyperperfusion are potential events during CAS for carotid artery stenosis. We evaluated whether perioperative monitoring of the tissue oxygenation index (TOI) using NIRS with the NIRO system can predict the occurrence of ischemic intolerance and cerebral hyperperfusion. Methods The TOI of 27 patients was measured during CAS. The relationship between the TOI and ischemic intolerance or cerebral hyperperfusion was analyzed, and the cutoff TOI was calculated to predict their occurrence. Results Ischemic intolerance occurred in 5 patients during balloon protection. The TOI in the presence of ischemic intolerance was significantly lower than that without ischemic intolerance. The cutoff TOI to detect ischemic intolerance was 50% and that of the TOI change rate before and after balloon protection was 80%. The ischemic symptoms in all patients had resolved immediately after balloon deflation. The cerebral hyperperfusion phenomenon was detected using single-photon emission computed tomography in 4 patients. These patients showed a transient increase in the TOI immediately after CAS; however, none of these patients showed symptomatic cerebral hyperperfusion phenomenon. The cutoff TOI to detect cerebral hyperperfusion was 109% compared with the TOI before CAS. Conclusion Monitoring of the TOI using the NIRO system could be useful for the detection of ischemic intolerance and cerebral hyperperfusion during CAS and to prevent perioperative adverse events.
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- 2019
91. Randomized Clinical Trial of Endovascular Therapy for Acute Large Vessel Occlusion with Large Ischemic Core (RESCUE-Japan LIMIT): Rationale and Study Protocol
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Shinichi YOSHIMURA, Kazutaka UCHIDA, Nobuyuki SAKAI, Hiroshi YAMAGAMI, Manabu INOUE, Kazunori TOYODA, Yuji MATSUMARU, Yasushi MATSUMOTO, Kazumi KIMURA, Reiichi ISHIKURA, and Takeshi MORIMOTO
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Stroke ,Treatment Outcome ,Japan ,Endovascular Procedures ,Humans ,Surgery ,Neurology (clinical) ,Brain Ischemia - Abstract
Endovascular therapy is strongly recommended for acute cerebral large vessel occlusion (LVO) with an Alberta stroke program early computed tomography score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of endovascular therapy for patients with a large ischemic core with an ASPECTS ≤5 (0-5) was not established. A multicenter, randomized, open-label, parallel-group trial was conducted to investigate the superiority of endovascular therapy over medical therapy without endovascular therapy for a large ischemic core with ASPECTS (3-5). Patients were randomly assigned to receive endovascular therapy or without endovascular therapy at a ratio of 1:1. The primary outcome was a moderate functional outcome, defined as a modified Rankin scale (mRS; scores ranging from 0 [no symptoms] to 6 [death]) ≤3 after 90 days. The secondary outcomes were defined as ordinal mRS, good functional outcome (mRS ≤2), excellent functional outcome (mRS ≤1), mRS shift analysis after 90 days, and early improvement of neurological findings at 48 hours. A total sample size of 200 was estimated to provide a power of 0.9 with a two-sided alpha of 0.05, for the primary outcome, considering a 15% dropout rate. This randomized clinical trial reported the applicability of endovascular therapy in patients with acute cerebral LVO with a large ischemic core.
- Published
- 2021
92. Relationship between platelet aggregation and stroke risk after percutaneous coronary intervention: a PENDULUM analysis
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Yuji Matsumaru, Takanari Kitazono, Kazushige Kadota, Koichi Nakao, Yoshihisa Nakagawa, Junya Shite, Hiroyoshi Yokoi, Ken Kozuma, Kengo Tanabe, Takashi Akasaka, Toshiro Shinke, Takafumi Ueno, Atsushi Hirayama, Shiro Uemura, Takeshi Kuroda, Atsushi Takita, Atsushi Harada, Raisuke Iijima, Yoshitaka Murakami, Shigeru Saito, and Masato Nakamura
- Subjects
Blood Platelets ,Stroke ,Percutaneous Coronary Intervention ,Treatment Outcome ,Platelet Aggregation ,Platelet Function Tests ,Humans ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Platelet Aggregation Inhibitors ,Ischemic Stroke - Abstract
In patients undergoing percutaneous coronary intervention (PCI) with a stent, high on-treatment platelet reactivity may be associated with an increased risk of stroke. This post hoc analysis of the PENDULUM registry compared the risk of post-PCI stroke according to on-treatment P2Y12 reaction unit (PRU) values. Patients aged ≥ 20 years who underwent PCI were stratified by baseline PRU (at 12 and 48 h post-PCI) as either high (HPR, > 208), optimal (OPR, > 85 to ≤ 208), or low on-treatment platelet reactivity (LPR, ≤ 85). The incidences of non-fatal ischemic and non-ischemic stroke through to 12 months post-PCI were recorded. Almost all enrolled patients (6102/6267 [97.4%]) had a risk factor for ischemic stroke, and most were receiving dual antiplatelet therapy. Of the 5906 patients with PRU data (HPR, n = 2227; OPR, n = 3002; LPR, n = 677), 47 had a non-fatal stroke post-PCI (cumulative incidence: 0.68%, ischemic; 0.18%, non-ischemic stroke). Patients with a non-fatal ischemic stroke event had statistically significantly higher post-PCI PRU values versus those without an event (P = 0.037). The incidence of non-fatal non-ischemic stroke was not related to PRU value. When the patients were stratified by PRU ≤ 153 versus > 153 at 12–48 h post-PCI, a significant difference was observed in the cumulative incidence of non-fatal stroke at 12 months (P = 0.044). We found that patients with ischemic stroke tended to have higher PRU values at 12–48 h after PCI versus those without ischemic stroke.Clinical trial registration: UMIN000020332.
- Published
- 2021
93. Inducing substances for chondrogenic differentiation of dental pulp stem cells in the conditioned medium of a novel chordoma cell line
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Hiroyoshi Kino, Hiroyoshi Akutsu, Hiroshi Ishikawa, Shingo Takano, Shohei Takaoka, Junko Toyomura, Takuma Hara, Eiichi Ishikawa, Yuji Matsumaru, Hiroki Bukawa, and Akira Matsumura
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Cancer Research ,Culture Media, Conditioned ,Stem Cells ,Chordoma ,Humans ,Cell Differentiation ,Cell Biology ,Dental Pulp ,Cell Line - Abstract
We successfully established a chordoma cell line, designated TSK-CHO1, derived from the clival chordoma. Currently, there is only one skull base chordoma cell line, UM-chor1, freely available to researchers. The established TSK-CHO1 cells were neoplastic, exhibited pleomorphic features, and secreted brachyury, as revealed by immunocytochemical staining or ELISA of conditioned medium (CM). Cells also secreted SOX9, which enhanced brachyury production. The CM of TSK-CHO1 cells promoted the production of hyaluronic acid and type II collagen during differentiation of human dental pulp stem cells (DPSCs) into fibrocartilage cells. Culture of DPSC pellets in a growth medium supplemented with 10% CM of TSK-CHO1 cells for 2 weeks resulted in the induction of fibrocartilage tissue under normoxic conditions. Brachyury produced by TSK-CHO1 cells promoted the production of collagen type II, peculiar to cartilage, in a dose-dependent manner. The newly established skull base chordoma cell line, TSK-CHO1, is expected to be used for elucidating the pathogenesis of skull base chordoma and for investigating the mechanism underlying the production of fibrocartilage.
- Published
- 2021
94. Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case
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Atsushi Tsukada, Kazuhiro Nakamura, Yuji Matsumaru, Maya Takada, Kiyoyuki Yanaka, Nobuyuki Takahashi, Eiichi Ishikawa, Masayuki Sato, and Kuniyuki Onuma
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medicine.medical_specialty ,Palsy ,business.industry ,Cavernous sinus ,Medicine ,Arteriovenous fistula ,Arteriovenous malformation ,General Medicine ,business ,medicine.disease ,Abducens nerve ,Surgery - Abstract
BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.
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- 2021
95. Carotid artery stenosis concomitant with severe aortic stenosis treated by combination of staged angioplasty and transcatheter aortic valve implantation: A case report
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Ryosuke Shintoku, Mikito Hayakawa, Tomoya Hoshi, Sho Okune, Takato Hiramine, Toshihide Takahashi, Hisayuki Hosoo, Yoshiro Ito, Aiki Marushima, Eiichi Ishikawa, and Yuji Matsumaru
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Surgery ,Neurology (clinical) - Abstract
Background: When severe aortic stenosis (AS) is concomitant with carotid stenosis, carotid artery stenting (CAS) will become a high-risk procedure because baroreceptor reflex-induced bradycardia and hypotension may cause irreversible circulatory collapse. When carotid stenosis-related misery perfusion is present, the risk of cerebral hyperperfusion syndrome increases after carotid revascularization. We report a case of severe carotid disease concomitant with severe AS successfully treated by a combination of staged angioplasty (SAP) and transcatheter aortic valve implantation (TAVI). Case Description: An 86-year-old man presented with transient deterioration of mental status and sluggish responsiveness continuous from the previous day. Magnetic resonance imaging of the brain revealed a right putaminal infarction, occlusion of the right internal carotid artery (ICA), and severe stenosis of the left ICA. Severe AS was diagnosed and single-photon emission computed tomography showed misery perfusion at the bilateral ICA territories. We performed a staged treatment consisting of SAP for the left carotid stenosis and TAVI. A first-stage carotid angioplasty was performed, followed by TAVI 2 weeks later and second-stage CAS 1 week after that. There were no apparent periprocedural complications throughout the clinical course. Conclusion: Combining SAP and TAVI may be an effective treatment option for severe carotid stenosis with misery perfusion concomitant with severe AS.
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- 2022
96. Transplanted neural lineage cells derived from dental pulp stem cells promote peripheral nerve regeneration
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Shohei Takaoka, Fumihiko Uchida, Hiroshi Ishikawa, Junko Toyomura, Akihiro Ohyama, Miho Watanabe, Hideaki Matsumura, Aiki Marushima, Seiichiro Iizumi, Satoshi Fukuzawa, Naomi Ishibashi-Kanno, Kenji Yamagata, Toru Yanagawa, Yuji Matsumaru, and Hiroki Bukawa
- Subjects
Neurons ,Cancer Research ,Neural Stem Cells ,Animals ,Endothelial Cells ,Cell Differentiation ,Cell Biology ,Dental Pulp ,Nerve Regeneration ,Rats - Abstract
Cell therapy for peripheral nerve injury is a promising strategy as regenerative medicine that restores neurological function. However, challenges remain in producing suitable and sufficient amounts of autologous cells for promoting nerve regeneration. This study aimed to identify the characteristics of neural lineage cells (NLCs) differentiated from dental pulp stem cells (DPSCs) and reveal their effect on functional recovery and nerve regeneration after cell transplantation into an immunodeficient rat using a nerve guide conduit. Here we report a protocol of neural induction in monolayer culture and characterize NLCs in vitro. Furthermore, NLCs were transplanted into an immunodeficient rat model with a 10-mm sciatic nerve defect, and cell survival and differentiation were investigated in vivo. Outcomes of nerve regeneration were also assessed using the remyelinated axon numbers, myelin sheath thickness, electrophysiological activities, and gastrocnemius muscle mass. NLCs comprised neuronal, astrocyte, oligodendrocyte, and neural crest lineage cells. NLCs enhanced the activities of endothelial cells, Schwann cells, and neurons in a paracrine-dependent manner in vitro. At 2 weeks post-transplantation, numerous transplanted NLCs differentiated into platelet-derived growth factor receptor alpha (PDGFRα) + oligodendrocyte progenitor cells (OPCs) and a few PDGFRα + /p75 neurotrophin receptor + Schwann cell-like cells derived from OPCs were observed. At 12 weeks post-transplantation, human Schwann cell-like cells survived, and axon growth, remyelination, electrophysiological activities, and muscle atrophy were improved. This study demonstrates the broad application of our protocol of neural induction of DPSCs and portrays the efficacy of transplantation of NLCs derived from human DPSCs as a promising strategy for peripheral nerve regeneration.
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- 2021
97. Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database
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Haruhisa Fukuda, Hisayuki Hosoo, Takashi Yamamoto, Yuji Matsumaru, Yoriko Kato, Daisuke Sato, Wataro Tsuruta, and Masahiro Katsumata
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Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Cost effectiveness ,medicine.medical_treatment ,Cohort Studies ,Aneurysm ,Japan ,Aneurysm treatment ,Humans ,Medicine ,Embolization ,Aged ,Retrospective Studies ,business.industry ,Proportional hazards model ,Endovascular Procedures ,Hazard ratio ,Intracranial Aneurysm ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Retreatment ,Female ,National database ,Neurology (clinical) ,Health Expenditures ,business - Abstract
Background Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives. Objective To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan. Methods We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models. Results The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with ≥10 coils and ≥9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with ≥10 coils and SAC group with ≥10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively. Conclusion In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils.
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- 2019
98. Distribution and current problems of acute endovascular therapy for large artery occlusion from a two-year national survey in Japan
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Toshinori Takagi, Bijoy K Menon, Nobuyuki Sakai, Mohammed A. Almekhlafi, Koji Iihara, Jessalyn K. Holodinsky, Shinichi Yoshimura, Yuji Matsumaru, Michael D. Hill, Masaru Hirohata, Hidenori Oishi, Noreen Kamal, Hiroshi Yamagami, Yasushi Matsumoto, and Mayank Goyal
- Subjects
medicine.medical_specialty ,Time Factors ,business.industry ,Endovascular Procedures ,Large artery occlusion ,Endovascular therapy ,Hospitals ,Clinical Practice ,Cerebrovascular Disorders ,Japan ,Neurology ,Surveys and Questionnaires ,medicine ,Humans ,Distribution (pharmacology) ,Radiology ,Endovascular treatment ,business ,Societies, Medical ,Acute stroke ,Large vessel occlusion - Abstract
BackgroundEndovascular treatment is recommended in clinical practice in Japan. However, its utilization and comprehensiveness are less well described.AimsTo report endovascular treatment utilization and overall geographical coverage in Japan and to analyze regional differences in the number of endovascular treatments, specialists, and endovascular treatment-capable hospitals.MethodsA national survey of members of the Japanese Society for NeuroEndovascular Therapy (JSNET) was conducted in 2017 and 2018. The total number of endovascular treatment cases per year was estimated, and the number of endovascular treatment cases per 100,000 people was calculated using the 2015 census. The distribution of treatment hospitals and JSNET specialists was mapped and the population coverage rate was determined.ResultsThe total number of endovascular treatment cases in Japan increased by 34.5% from 2016 (7702) to 2017 (10,360). The number of endovascular treatment-capable hospitals in Japan increased from 597 in 2016 to 693 in 2017, with an average annual caseload of 14.9 in 2017. The number of JSNET specialists per hospital decreased from 1.81 in 2016 to 1.76 in 2017 because of the increase in endovascular treatment-capable hospitals. Only 50 (7.2%) hospitals had > 40 endovascular treatment cases annually. The majority (97.7%) of the Japanese population lives within a 60-min drive of any endovascular treatment-capable hospital. However, only 70.4% live within a 60-min drive of a high-volume center (>40 cases annually).ConclusionsUtilization of endovascular treatment in Japan is increasing; however, the number of cases per hospital remains low, as is the number of specialists per endovascular treatment-capable hospital. Increased number of specialists and centralization of endovascular treatment services may improve patient outcomes.
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- 2019
99. ESTIMATION OF PATIENT LENS DOSE ASSOCIATED WITH C-ARM CONE-BEAM COMPUTED TOMOGRAPHY USAGE DURING INTERVENTIONAL NEURORADIOLOGY
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Koichi Chida, Lue Sun, Shogo Yoda, Hideyuki Sakuma, Yusuke Hamada, Satoru Kawauchi, Masayuki Sato, Yuji Matsumaru, Wataro Tsuruta, and Takashi Moritake
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Cone beam computed tomography ,Right lens ,Computed tomography ,Dose distribution ,Radiology, Interventional ,Radiation Dosage ,Imaging phantom ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,stomatognathic system ,law ,Lens, Crystalline ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Interventional neuroradiology ,Radiation ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Public Health, Environmental and Occupational Health ,General Medicine ,Cone-Beam Computed Tomography ,equipment and supplies ,Lens (optics) ,030220 oncology & carcinogenesis ,Tomography ,Nuclear medicine ,business ,Head - Abstract
The purpose of this study was to investigate the dose distribution and lens doses associated with C-arm cone-beam computed tomography (CBCT), using a head phantom, and to estimate the contribution ratio of C-arm CBCT to each patient’s lens dose during interventional neuroradiology (‘lens dose ratio’) in 109 clinical cases. In the phantom study, the peak skin doses and respective right and left lens doses of C-arm CBCT were as follows: 63.0 ± 1.9 mGy, 19.7 ± 1.4 mGy and 21.9 ± 0.8 mGy in whole brain C-arm CBCT and 39.2 ± 1.4 mGy, 4.7 ± 0.9 mGy and 3.6 ± 0.3 mGy in high-resolution C-arm CBCT. In the clinical study, the lens dose ratios were 25.4 ± 8.7% in the right lens and 19.1 ± 9.8% in the left lens. This study shows that, on average, ~25% of patients’ total lens dose was contributed by C-arm CBCT.
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- 2019
100. Widening Time Disparities between Two Paradigms: Tama-REgistry of Acute Endovascular Thrombectomy
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Teruyuki Hirano, Yoshiaki Shiokawa, Masayuki Ueda, Takahiro Ota, Tatsuo Amano, Yuji Matsumaru, and Keigo Shigeta
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Male ,medicine.medical_specialty ,Time Factors ,Registry study ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Retrospective analysis ,Humans ,Medicine ,In patient ,Registries ,Healthcare Disparities ,Tokyo ,Acute ischemic stroke ,Aged ,Retrospective Studies ,Thrombectomy ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Process Assessment, Health Care ,Rehabilitation ,Middle Aged ,Stroke ,Mechanical thrombectomy ,Transportation of Patients ,Treatment Outcome ,Emergency medicine ,Time course ,Female ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
The Tama-REgistry of Acute endovascular Thrombectomy (TREAT) is a multicenter registry of endovascular thrombectomy in the Tama area of Tokyo. The objective of this study was to confirm the real-world status of 2 paradigms of transportation.This was a retrospective analysis of data from TREAT. Patients were divided into 2 groups and 2 periods: directly admitted to an endovascular thrombectomy-capable center (ECC; group D)/secondary transfer from a non-ECC (group S), and the first period/the second period. Transfer distance, workflow metrics, and clinical outcomes were analyzed.A total of 326 patients, including 264 in group D and 62 in group S, were analyzed. The median distance from the onset-to-ECC was 3.62km for group D and 7.87km for group S (P.001). The median onset-to-needle (OTN) time was longer for group S (168 minutes) than group D (138 minutes; P = .006). The median onset-to-reperfusion (OTR) time was significantly shorter for group D (247 minutes) than for group S (304 minutes; P = .029). With respect to the 2 periods, there was no significant difference in onset-to-puncture time between the 2 groups in the first period (207 minutes versus 243.5 minutes, respectively, P = .50), while there was one in the second period (164 minutes versus 246.5 minutes, respectively, P = .02).This region-wide registry study showed longer OTN and OTR times, with no improvement of the time course over time in patients transported via non-ECCs. These results should be used to create a regional medical policy for the management of acute ischemic stroke.
- Published
- 2019
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