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1. Efficacy of pretreatment with the free radical scavenger, edaravone, for prevention of cerebral hyperperfusion after carotid artery stenting: A single-center randomized controlled trial

Author

Takenobu Kunieda, Kosuke Miyake, Hiroki Sakamoto, Masataka Nakamura, Yusuke Yakushiji, and Hirofumi Kusaka

Subjects
Carotid stenosis, Cerebral hyperperfusion syndrome, Free radicals, Single-photon emission computed tomography, Surgery, RD1-811, Neurology. Diseases of the nervous system, RC346-429
Abstract

Objective: Optimal therapy to avoid cerebral hyperperfusion (CHP) after carotid artery stenting (CAS) is yet to be established. The purpose of this study was to determine whether pretreatment with a free radical scavenger, edaravone, could prevent CHP after CAS. Methods: A prospective, randomized, controlled, single-center trial was conducted between April 2011 and January 2018. Eligible patients were those who underwent CAS. Subjects were randomly assigned to receive (edaravone group) or not receive (control group) administration of edaravone before stent deployment. The primary outcome was occurrence of CHP immediately (within 1 h) after CAS. Cerebral blood flow (CBF) was assessed in the middle cerebral artery (MCA) region and the cerebellar hemisphere using single-photon emission computed tomography (SPECT) before and immediately after CAS. The asymmetry index (AI) (%) was defined as CBF in the affected MCA region divided by CBF in the unaffected MCA region × 100. CHP was defined as AI > 120% immediately after CAS. Results: The trial was stopped ahead of schedule due to poor recruitment. Among 52 participants, 51 completed the trial (edaravone group, n = 25; control group, n = 26). CHP occurred in 2/25 patients (8%) in the edaravone group and in 1/26 patients (4%) in the control group, with no significant difference between the groups (P = 0.610). Conclusion: Pretreatment with edaravone appeared not to be associated with reduction in the occurrence of CHP immediately after CAS.

Published
2021
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2. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

Author

Satoshi Yamada, Thomas G Devlin, David S Liebeskind, Michael D Hill, Tudor G Jovin, Jordi Blasco, Raul G Nogueira, John Thornton, Romain Bourcier, Robert Fahed, Michel Piotin, Salvatore Mangiafico, Maxim Mokin, Shadi Yaghi, Diogo C Haussen, Eytan Raz, Italo Linfante, Vitor Mendes Pereira, Monika Killer-Oberpfalzer, Alhamza R Al-Bayati, Patrick Nicholson, Georgios Tsivgoulis, Vanessa Chalumeau, Lissa Peeling, Xianjin Shang, Hao Zhang, Ajit S Puri, Osama O Zaidat, Santiago Ortega-Gutierrez, Dheeraj Gandhi, Gregory Walker, Kenichi Todo, Ameer E Hassan, Michael Chen, Nobuyuki Sakai, William J Mack, Simon Nagel, Pascal Jabbour, Michael Kelly, Don Frei, Hong Gee Roh, Fawaz Al-Mufti, Emma Griffin, Thanh N Nguyen, Alicia C Castonguay, Roberta Novakovic, Mohamad Abdalkader, Mario Martínez-Galdámez, Toshiyuki Fujinaka, Ken Wong, Daisuke Watanabe, Rishi Gupta, Sunil A Sheth, Melanie Walker, Hiroshi Yamagami, Brendan Steinfort, Alex Brehm, Johanna T Fifi, Nobuyuki Ohara, Yuichi Murayama, Ajay K Wakhloo, Wenguo Huang, Gianmarco Bernava, Paolo Machi, Nabeel Herial, Teddy Y Wu, Anna Luisa Kühn, Markus Möhlenbruch, James E Siegler, Stephan A Mayer, Takuya Kanamaru, André Beer-Furlan, Dileep Yavagal, Charles Matouk, Yuji Matsumaru, Pedro Lylyk, Allan Taylor, Leonardo Renieri, Pablo M Lavados, Verónica V Olavarría, Malveeka Sharma, Marios Psychogios, Laura Mechtouff, Vasu Saini, Jun Luo, Barbara Voetsch, Mudassir Farooqui, Ossama Y Mansour, Viktor Szeder, Jean Raymond, Muhammad M Qureshi, Michael Frankel, Zhongming Qiu, Omer F Eker, Fabricio Oliveira Lima, Francisco Mont'Alverne, Wazim Izzath, Mahmoud Mohammaden, David Ozretic, Saima Ahmad, Umair Rashid, Syed Irteza Hussain, Seby John, Jose Antonio Fiorot, Rodrigo Rivera, Nadia Hammami, Anna M Cervantes-Arslanian, Hormuzdiyar H Dasenbrock, Huynh Le Vu, Viet Quy Nguyen, Steven Hetts, Romain Guile, Atilla Ozcan Ozdemir, Ozlem Aykac, Chandril Chugh, Pascale Lavoie, Randall Edgell, Vikram Huded, Dong Hun Shin, Pedro SC Magalhaes, Raghid Kikano, Amal Abou-Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena A Cora, Rotem Sivan-Hoffmann, Roberto Crosa, Hosam Al-Jehani, Victor S Lopez Rivera, Achmad Fidaus Sani, Daniel G Abud, Octavio M Pontes-Neto, Brijesh P Mehta, Naoto Kimura, Mamoru Murakami, Jin Soo Lee, Ji Man Hong, Eiji Hagashi, Steve M Cordina, Juan F Arenillas, Alejandro Rodriguez Vasquez, Luisa Fonseca, M Luis Silva, Simon John, Matthew Tenser, Tatemi Todaka, Miki Fujimura, Jun Deguchi, Yuri Sugiura, Hiroshi Tokimura, Rakesh Khatri, Hugh Stephen Winters, Johnny Wong, Mohamed Teleb, Jeremy Payne, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Masaaki Uno, Yohei Takenobu, Ryuhei Kono, Masafumi Morimoto, Junichi Iida, Saif Bushnaq, Jawad Kirmani, Ruchir Shah, Lee Birnbaum, Anchalee Churojana, Hesham E Masoud, Carlos Ynigo Lopez, Alice Ma, Amal Al Hashmi, Mollie McDermott, Alex Chebl, Odysseas Kargiotis, Jane G Morris, Clifford J Eskey, Jesse Thon, Leticia Rebello, Dorothea Altschul, Oriana Cornett, Varsha Singh, Jeyaraj Pandian, Anirudh Kulkarni, Yuki Yamamoto, Gisele Sampaio Silva, Serdar Geyik, Jasmine Johann, Sumeet Multani, Artem Kaliaev, Kazutaka Sonoda, Hiroyuki Hashimoto, Adel Alhazzani, David Y Chung, and Zhengzhou Yuan

Subjects
Neurology. Diseases of the nervous system, RC346-429
Abstract

Background During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.Methods We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.Findings There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, p

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3. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Author

Nguyen, Thanh N, Qureshi, Muhammad M, Klein, Piers, Yamagami, Hiroshi, Abdalkader, Mohamad, Mikulik, Robert, Sathya, Anvitha, Mansour, Ossama Yassin, Czlonkowska, Anna, Hannah, Lo, Field, Thalia S, Charidimou, Andreas, Banerjee, Soma, Yaghi, Shadi, Siegler, James E, Sedova, Petra, Kwan, Joseph, de Sousa, Diana Aguiar, Demeestere, Jelle, Inoa, Violiza, Omran, Setareh Salehi, Zhang, Liqun, Michel, Patrik, Strambo, Davide, Marto, João Pedro, Nogueira, Raul G, Kristoffersen, Espen Saxhaug, Tsivgoulis, Georgios, Lereis, Virginia Pujol, Alice, Ma, Enzinger, Christian, Gattringer, Thomas, Rahman, Aminur, Bonnet, Thomas, Ligot, Noémie, De Raedt, Sylvie, Lemmens, Robin, Vanacker, Peter, Vandervorst, Fenne, Conforto, Adriana Bastos, Hidalgo, Raquel C T, Mora Cuervo, Daissy Liliana, de Oliveira Neves, Luciana, Lameirinhas da Silva, Isabelle, Martíns, Rodrigo Targa, Rebello, Letícia C, Santiago, Igor Bessa, Sadelarova, Teodora, Kalpachki, Rosen, Alexiev, Filip, Cora, Elena Adela, Kelly, Michael E, Peeling, Lissa, Pikula, Aleksandra, Chen, Hui-Sheng, Chen, Yimin, Yang, Shuiquan, Roje Bedekovic, Marina, Čabal, Martin, Tenora, Dusan, Fibrich, Petr, Dušek, Pavel, Hlaváčová, Helena, Hrabanovska, Emanuela, Jurák, Lubomír, Kadlčíková, Jana, Karpowicz, Igor, Klečka, Lukáš, Kovář, Martin, Neumann, Jiří, Paloušková, Hana, Reiser, Martin, Rohan, Vladimir, Šimůnek, Libor, Skoda, Ondreij, Škorňa, Miroslav, Šrámek, Martin, Drenck, Nicolas, Sobh, Khalid, Lesaine, Emilie, Sabben, Candice, Reiner, Peggy, Rouanet, Francois, Strbian, Daniel, Boskamp, Stefan, Mbroh, Joshua, Nagel, Simon, Rosenkranz, Michael, Poli, Sven, Thomalla, Götz, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Kargiotis, Odysseas, Palaiodimou, Lina, Barrientos Guerra, José Dominguo, Huded, Vikram, Nagendra, Shashank, Prajapati, Chintan, Sylaja, P N, Sani, Achmad Firdaus, Ghoreishi, Abdoreza, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Hashemilar, Mazyar, Sabetay, Sergiu Ionut, Rahal, Fadi, Acampa, Maurizio, Adami, Alessandro, Longoni, Marco, Ornello, Raffaele, Renieri, Leonardo, Romoli, Michele, Sacco, Simona, Salmaggi, Andrea, Sangalli, Davide, Zini, Andrea, Sakai, Kenichiro, Fukuda, Hiroki, Fujita, Kyohei, Imamura, Hirotoshi, Kosuke, Miyake, Sakaguchi, Manabu, Sonoda, Kazutaka, Matsumaru, Yuji, Ohara, Nobuyuki, Shindo, Seigo, Takenobu, Yohei, Yoshimoto, Takeshi, Toyoda, Kazunori, Uwatoko, Takeshi, Sakai, Nobuyuki, Yamamoto, Nobuaki, Yamamoto, Ryoo, Yazawa, Yukako, Sugiura, Yuri, Baek, Jang-Hyun, Lee, Si Baek, Seo, Kwon-Duk, Sohn, Sung-Il, Lee, Jin Soo, Arsovska, Anita Ante, Chieh, Chan Yong, Wan Zaidi, Wan Asyraf, Wan Yahya, Wan Nur Nafisah, Gongora-Rivera, Fernando, Martinez-Marino, Manuel, Infante-Valenzuela, Adrian, Dippel, Diederik, van Dam-Nolen, Dianne H K, Teddy Y, Wu, Punter, Martin, Adebayo, Tajudeen Temitayo, Bello, Abiodun H, Sunmonu, Taofiki Ajao, Wahab, Kolawole Wasiu, Sundseth, Antje, Al Hashmi, Amal M, Ahmad, Saima, Rashid, Umair, Rodriguez-Kadota, Liliana, Vences, Miguel Ángel, Yalung, Patrick Matic, Jon Stewart Hao, Dy, Brola, Waldemar, Dębiec, Aleksander, Dorobek, Malgorzata, Karlinski, Michal Adam, Labuz-Roszak, Beata M, Lasek-Bal, Anetta, Sienkiewicz-Jarosz, Halina, Staszewski, Jacek, Sobolewski, Piotr, Wiącek, Marcin, Zielinska-Turek, Justyna, Araújo, André Pinho, Rocha, Mariana, Castro, Pedro, Ferreira, Patricia, Nunes, Ana Paiva, Fonseca, Luísa, Pinho E Melo, Teresa, Rodrigues, Miguel, Silva, M Luis, Ciopleias, Bogdan, Dimitriade, Adela, Falup-Pecurariu, Cristian, Hamid, May Adel, Venketasubramanian, Narayanaswamy, Krastev, Georgi, Haring, Jozef, Ayo-Martin, Oscar, Hernandez-Fernandez, Francisco, Blasco, Jordi, Rodríguez-Vázquez, Alejandro, Cruz-Culebras, Antonio, Moniche, Francisco, Montaner, Joan, Perez-Sanchez, Soledad, García Sánchez, María Jesús, Guillán Rodríguez, Marta, Bernava, Gianmarco, Bolognese, Manuel, Carrera, Emmanuel, Churojana, Anchalee, Aykac, Ozlem, Özdemir, Atilla Özcan, Bajrami, Arsida, Senadim, Songul, Hussain, Syed I, John, Seby, Krishnan, Kailash, Lenthall, Robert, Asif, Kaiz S, Below, Kristine, Biller, Jose, Chen, Michael, Chebl, Alex, Colasurdo, Marco, Czap, Alexandra, de Havenon, Adam H, Dharmadhikari, Sushrut, Eskey, Clifford J, Farooqui, Mudassir, Feske, Steven K, Goyal, Nitin, Grimmett, Kasey B, Guzik, Amy K, Haussen, Diogo C, Hovingh, Majesta, Jillela, Dinesh, Kan, Peter T, Khatri, Rakesh, Khoury, Naim N, Kiley, Nicole L, Kolikonda, Murali K, Lara, Stephanie, Grace, Li, Linfante, Italo, Loochtan, Aaron I, Lopez, Carlos D, Lycan, Sarah, Male, Shailesh S, Nahab, Fadi, Maali, Laith, Masoud, Hesham E, Min, Jiangyong, Orgeta-Gutierrez, Santiago, Mohamed, Ghada A, Mohammaden, Mahmoud, Nalleballe, Krishna, Radaideh, Yazan, Ramakrishnan, Pankajavalli, Rayo-Taranto, Bliss, Rojas-Soto, Diana M, Ruland, Sean, Simpkins, Alexis N, Sheth, Sunil A, Starosciak, Amy K, Tarlov, Nicholas E, Taylor, Robert A, Voetsch, Barbara, Zhang, Linda, Duong, Hai Quang, Dao, Viet-Phuong, Huynh Vu, Le, Pham, Thong Nhu, Ton, Mai Duy, Tran, Anh Duc, Zaidat, Osama O, Machi, Paolo, Dirren, Elisabeth, Rodríguez Fernández, Claudio, Escartín López, Jorge, Fernández Ferro, Jose Carlos, Mohammadzadeh, Niloofar, Suryadevara, Neil C, de la Cruz Fernández, Beatriz, Bessa, Filipe, Jancar, Nina, Brady, Megan, Scozzari, Dawn, SVIN COVID-19 Global COVID Stroke Registry, Neurology, Radiology & Nuclear Medicine, Society of Vascular and Interventional Neurology, Nguyen, Thanh N., Nogueira, Raul G., Clinical sciences, Neuroprotection & Neuromodulation, Biology, Neurologian yksikkö, HUS Neurocenter, and Helsinki University Hospital Area

Subjects
Stroke, Vaccine-induced immune thrombotic thrombocytopenia, SDG 3 - Good Health and Well-being, Cerebral venous thrombosis, SARS-CoV-2, 3112 Neurosciences, COVID-19, Mortality, Neurology (clinical), Cardiology and Cardiovascular Medicine, 3124 Neurology and psychiatry
Abstract

[Background and Purpose] Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., [Methods] We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., [Results] There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P, [Conclusions] During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT., The study was funded by the Society of Vascular and Interventional Neurology research pilot grant.

Published
2022

4. Gait evaluation in stroke hemiplegic patients using short physical performance battery

Author

Shota Itoh, Takahiro Ogino, Kenji Kawakami, Kosuke Miyake, Honoka Iyoda, Hidenori Imaizumi, Misaki Nakajima, Haruna Kitahara, and Shigeru Sonoda

Subjects
Stroke, Cross-Sectional Studies, Rehabilitation, Stroke Rehabilitation, Humans, Surgery, Hemiplegia, Neurology (clinical), Physical Functional Performance, Cardiology and Cardiovascular Medicine, Gait
Abstract

Falls can occur daily in stroke patients and appropriate independence assessments for fall prevention are required. Although previous studies evaluated the short physical performance battery (SPPB) in stroke patients, the relationship between SPPB and fall prediction and walking independence remains unclear. Therefore, we aimed to verify whether SPPB is a predictor of walking independence.The present study included 105 hemiplegic stroke patients who were admitted to the rehabilitation ward and gave consent to participate. Cross-sectional physical function and functional independence measure cognitive (FIM-C) evaluation were conducted in hemiplegic stroke patients. Logistic regression analysis using the increasing variable method (likelihood ratio) was performed to extract factors for walking independence. Cutoff values were calculated for the extracted items using the receiver operating-characteristic (ROC) curve.Among 86 participants included in the final analysis, 36 were independent walkers and 50 were dependent walkers. In the logistic regression analysis, SPPB and FIM-C were extracted as factors for walking independence. The cutoff value was 7 [area under the curve (AUC), 0.94; sensitivity, 0.83; specificity, 0.73)] for SPPB and 32 (AUC, 0.83; sensitivity, 0.69; specificity, 0.57) for FIM-C in ROC analysis CONCLUSIONS: SPPB and FIM-C were extracted as factors for walking independence. Although SPPB alone cannot determine independent walking, combined assessment of SPPB with cognitive function may enable more accurate determination of walking independence.

Published
2022

5. Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

Author

Ajit S. Puri, Allan Taylor, Huynh Le Vu, Tatemi Todaka, Teddy Y. Wu, Octavio M. Pontes-Neto, Eytan Raz, Pedro Lylyk, Jasmine Johann, Roberta Novakovic, Hormuzdiyar H. Dasenbrock, Francisco Mont’Alverne, Nobuyuki Sakai, Melanie Walker, Hugh Stephen Winters, Ossama Mansour, Yohei Takenobu, Gregory Walker, Miki Fujimura, Saif Bushnaq, Odysseas Kargiotis, Nabeel Herial, Markus A Möhlenbruch, Malveeka Sharma, Hiroshi Tokimura, Maxim Mokin, Jean Raymond, Michael D. Hill, Amal Abou-Hamden, Leonardo Renieri, Serdar Geyik, Yuri Sugiura, Luisa Fonseca, Roberto Crosa, Fabricio O Lima, Ameer E Hassan, Viet Quy Nguyen, Jane G. Morris, Steven W. Hetts, Jawad F. Kirmani, Matthew S. Tenser, Muhammad M. Qureshi, Gianmarco Bernava, Mahmoud H Mohammaden, Verónica V. Olavarría, Jun Deguchi, André Beer-Furlan, Steve M. Cordina, Hiroshi Yamagami, Mohamad Abdalkader, Toshiyuki Fujinaka, Clifford J. Eskey, Rotem Sivan-Hoffmann, Hao Zhang, Anirudh Kulkarni, Brendan Steinfort, Özlem Aykaç, Barbara Voetsch, Alex Brehm, Italo Linfante, Wenguo Huang, Omer Eker, M. Luis Silva, Pascal Jabbour, Lissa Peeling, Mollie McDermott, Pascale Lavoie, Kazutaka Sonoda, Thomas Devlin, Alicia C. Castonguay, Jin Soo Lee, Diogo C Haussen, Dileep R. Yavagal, Thanh N. Nguyen, Umair Rashid, Vasu Saini, Raghid Kikano, Hiroyuki Hashimoto, Masaaki Uno, Saima Ahmad, Artem Kaliaev, Eiji Hagashi, Ajay K. Wakhloo, Romain Bourcier, Ryoo Yamamoto, Jesse M. Thon, Georgios Tsivgoulis, Dorothea Altschul, Achmad Fidaus Sani, Satoshi Yamada, Varsha Singh, David S Liebeskind, Tatsuo Amano, Anchalee Churojana, Juan F. Arenillas, Junichi Iida, Charles C. Matouk, Nobuyuki Ohara, Osama O. Zaidat, Mario Martínez-Galdámez, Chandril Chugh, Don Frei, Vanessa Chalumeau, Brijesh P Mehta, Marios Psychogios, Anna Luisa Kühn, Leticia C Rebello, Xianjin Shang, Hosam Al-Jehani, Hiroki Fukuda, Hong Gee Roh, Gisele Sampaio Silva, Rakesh Khatri, Kenichi Todo, Amal Al Hashmi, Alex Bou Chebl, Sunil A Sheth, Zhongming Qiu, Oriana Cornett, Zhengzhou Yuan, Wazim Izzath, Hesham Masoud, Rodrigo Rivera, Michel Piotin, Vikram Huded, Mamoru Murakami, Mohamed Teleb, Viktor Szeder, Ruchir Shah, Dheeraj Gandhi, John Thornton, Michael Chen, Vitor Mendes Pereira, Nadia Hammami, Alice Ma, Anna M. Cervantes-Arslanian, James E. Siegler, Seby John, Carlos Ynigo Lopez, Mudassir Farooqui, David Ozretić, Takuya Kanamaru, Romain Guile, Daisuke Watanabe, Kosuke Miyake, Alejandro Rodriguez Vasquez, Patrick Nicholson, Yuki Yamamoto, William J. Mack, Naoto Kimura, Simon Mathew John, Robert Fahed, Yuji Matsumaru, David Y. Chung, Rishi Gupta, Ryuhei Kono, Michael Frankel, Victor S. Lopez Rivera, Johanna T. Fifi, Raul G Nogueira, Paolo Machi, Tudor G. Jovin, Jordi Blasco, Emma Griffin, Salvatore Mangiafico, Masafumi Morimoto, Jun Luo, Santiago Ortega-Gutierrez, Monika Killer-Oberpfalzer, Daniel Giansante Abud, Syed I. Hussain, Fawaz Al-Mufti, Yusuke Sugimura, Atilla Özcan Özdemir, Stephan A. Mayer, Sumeet Multani, Adel Alhazzani, Alhamza R Al-Bayati, Michael Kelly, Lee A Birnbaum, Shadi Yaghi, Jeyaraj D Pandian, Ji Man Hong, Junsuke Shimbo, Johnny Ho-Yin Wong, Elena A. Cora, Laura Mechtouff, Pedro S.C. Magalhães, Pablo M. Lavados, Yuichi Murayama, Dong Hun Shin, Simon Nagel, Ken Wong, Jose Antonio Fiorot, Jeremy Payne, Randall C. Edgell, Adrienne Weeks, CarMeN, laboratoire, Department of Neurology [Boston], Harvard Medical School [Boston] (HMS)-Massachusetts General Hospital [Boston], Emory University School of Medicine, Emory University [Atlanta, GA], Boston University School of Medicine (BUSM), Boston University [Boston] (BU), National Hospital Organization Osaka National Hospital [Japon] (NHO Osaka National Hospital), Alexandria University [Alexandrie], Boston Medical Center [Boston, MA, USA] (BMC), Xinqiao Hospital [Chongqing, China] (XH), University of Cape Town, La Sagrada Familia Clinic/Clínica La Sagrada Familia [Buenos Aires, Argentina] (LSFC), Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Hospital General de Fortaleza [Fortaleza, Brazil] (HGF), Nottingham University Hospitals NHS Trust [UK], Kobe City Medical Center General Hospital [Kobe, Hyogo, Japan] (KCMCGH), Azienda Ospedaliero-Universitaria Careggi [Firenze, Toscana, Italy] (AOUC), University Hospital Centre Zagreb, Partenaires INRAE, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neuroradiologie [CHU de Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cleveland Clinic Abu Dhabi [Abou Dabi, Émirats arabes unis], Hôpital de Beaumont [Dublin, Ireland] (HB), Hospital-Estadual Central [Vitoria, Brazil] (HEC), Instituto de NeuroCirugía Asenjo, Institut national de neurologie Mongi-Ben Hamida [Tunis], Hue Central Hospital [Thua Thien Hue, Vietnam] (HCH), University of California [San Francisco] (UC San Francisco), University of California (UC), Centre hospitalier universitaire de Nantes (CHU Nantes), Washington University School of Medicine (WUSM), University of Washington [Seattle], Englewood Hospital and Medical Center [Englewood], Jefferson (Philadelphia University + Thomas Jefferson University), Westchester Medical Center [Valhalla, New York, USA] (WMC), Eskisehir Osmangazi University, University of Maryland School of Medicine, University of Maryland System, MAX Superspecialty Hospital [Saket, New Delhi, India] (MSH), Yale School of Medicine [New Haven, Connecticut] (YSM), Université Laval [Québec] (ULaval), Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Rush University Medical Center [Chicago], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), University of Toronto, NH Mazumdar Shah Medical Center [Bangalore, India] (NHMSMC), IMS Tokyo-Katsushika General Hospital [Tokyo, Japan], Gachon University [Seongnam, Korea] (GU), Hospital Municipal Sao Jose [Joinville, Santa Catarina, Brazil] (HMSJ), Lau Medical Center [Beirut, Lebanon] (LMC), University of Iowa [Iowa City], Royal Adelaide Hospital [Adelaide Australia], Kyorin University [Tokyo, Japan], Yokohama Brain and Spine Center [Yokohama, Japan] (YBSC), Dalhousie University [Halifax], Rambam Health Care Campus [Haifa, Israel], Centro Endovascular Neurologico Medica Uruguaya [Montevideo, Uruguay] (CENMU), Heidelberg University Hospital [Heidelberg], Imam Abdulrahman bin Faisal University [Alkhobar, Saudi Arabia] (IAFU), McGovern Medical School [Houston, TX, USA] (McGMS), The University of Texas Health Science Center at Houston (UTHealth), Cooper Medical School of Rowan University [Camden] (CMSRU), Airlangga University [Jawa Timur, Indonesia] (AU), University of Massachusetts Medical School [Worcester] (UMASS), University of Massachusetts System (UMASS), Geneva University Hospitals and Geneva University, Universidade de São Paulo = University of São Paulo (USP), Beth Israel Lahey Health [Burlington, MA, USA] (BILH), New York University School of Medicine (NYU Grossman School of Medicine), Memorial Neuroscience Institute [Pembroke Pines, FL, USA] (MNI), Iwate Prefectural Central Hospital [Morioka, Iwate, Japan] (IPCH), Japanese Red Cross Musashino Hospital [Tokyo], Ajou University, University of Ottawa [Ottawa], Saga-ken Medical Centre Koseikan [Saga, Japan] (SMCK), University of South Alabama, Konkuk University [Seoul], Royal Free Hospital [London, UK], Hospital Clinico Universitario de Valladolid [Castilla y León, Spain] (HCUV), Universidad de Valladolid [Valladolid] (UVa), Instituto de Ciencia de Materiales de Aragón [Saragoza, España] (ICMA-CSIC), University of Zaragoza - Universidad de Zaragoza [Zaragoza], Hospital Clínic de Barcelona [Catalonia, Spain], Centro Hospitalar Universitário de São João [Porto], Christchurch Hospital [Christchurch, New Zealand] (CH), University Hospital Basel [Basel], University of Southern California (USC), Kohnan Hospital - Sendai [Miyagi, Japan], University of Texas Southwestern Medical Center [Dallas], Nara City Hospital [Nara, Japan] (NCH), Toyonaka Municipal Hospital [Osaka, Japan] (TMH), Kagoshima City Hospita [Kagoshima, Japan] (KCH), Texas Tech University System [Lubbock, TX, USA] (TTUS), University of Saskatchewan [Saskatoon] (U of S), National Institute of Information and Communications Technology [Tokyo, Japan] (NICT), Royal Prince Alfred Hospital [Camperdown, Australia] (RPAH), Banner Desert Medical Center [Mesa, AZ, USA] (BDMC), Japanese Red Cross Matsue Hospital [Shimane, Japan] (JRCMH), Shiroyama Hospital [Osaka, Japan] (SH), Niigata City General Hospital [Niigata, Japan] (NCGH), Sugimura Hospital [Kumamoto, Japan] (SH), Kawasaki Medical School [Kurashiki, Japan] (KMS), Osaka Red Cross Hospital [Osaka, Japan] (ORCH), Université de Tsukuba = University of Tsukuba, Saiseikai Central Hospital [Tokyo, Japan] (SCH), Kinikyo Chuo Hospital - Sapporo [Hokkaido, Japan] (KCHS), NTT Medical Center Tokyo [Tokyo, Japan] (NTTMCT), Yokohama Shintoshi Neurosurgical Hospital [Yokohama, Japan]. (YSNH), Osaka General Medical Center [Osaka, Japan] (OGMC), University of Miami Leonard M. Miller School of Medicine (UMMSM), Bon Secours Mercy Health System [Toledo, OH, USA] (BSMHS), Maoming City Hospital [Guandong, China] (MCH), Miami Cardiac & Vascular Institute [Miami, FL, USA] (MC&VI), Hackensack University Medical Center [Hackensack], David Geffen School of Medicine [Los Angeles], University of California [Los Angeles] (UCLA), University of California (UC)-University of California (UC), University of Tennessee [Chattanooga] (UTC), The University of Texas at San Antonio (UTSA), Mianyang 404 Hospital [Sichuan, China] (M404H), Siriraj Hosital - Mahidol University [Bangkok, Thailand] (SHMU), SUNY Upstate Medical University, State University of New York (SUNY), Royal North Shore Hospital (RNSH), The University of Texas Rio Grande Valley [Harlingen, TX, USA] (UTRGV), Khoula Hospital [Muscat, Oman] (Ministry of Health - KH), University of Michigan [Ann Arbor], University of Michigan System, University of South Florida [Tampa] (USF), Henry Ford Health System [Detroit, MI, USA] (HFHS), Metropolitan Hospital [Piraeus, Greece] (MH), National and Kapodistrian University of Athens (NKUA), Maine Medical Center, Dartmouth Hitchcock Medical Center [Lebanon, NH, USA] (DHMC), Centro Universitário Feevale (BRAZIL), The Valley Hospital [Ridgewood, NJ, USA] (TVH), St Joseph's University Medical Center [Paterson, NJ, USA] (StJUMC), Christian Medical College and Hospital Ludhiana [Punjab, India] (CMCHL), Universidad del Desarrollo, University Graduate School of Medicine [Osaka, Japan], Tokushima University, Universidade Federal de São Paulo, Istanbul Aydin University [İstanbul, Turkey] (IAU), Swedish Medical Center [Englewood, CO, USA] (SMC), Bayhealth Medical Center [Dover, DE, USA] (BMC), Saiseikai Fukuoka General Hospital [Fukuoka, Japan] (SFGH), Osaka Rosai Hospital - Sakai [Osaka, Japan] (ORHS), King Saud University [Riyadh] (KSU), Mount Sinai Health System, University of Calgary, Huzhou University [Zhejiang], The Affiliated Hospital of Southwest Medical University - Luzhou [Sichuan, China] (TAHSMUL), Yijishan Hospital of Wannan Medical College [Wuhu, Anhui, China] (YHWMC), University of Toledo, WellStar Health System [Marietta, GA, USA] (WHS), Institut National de la Recherche Scientifique [Québec] (INRS), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN), University of California [San Francisco] (UCSF), University of California, Yale University School of Medicine, University of São Paulo (USP), and University of California-University of California

Subjects
[SDV]Life Sciences [q-bio], COVID-19, Subarachnoid Hemorrhage* / diagnostic imaging, 030204 cardiovascular system & hematology, Intracranial Aneurysm* / therapy, lcsh:RC346-429, 0302 clinical medicine, Pandemic, Myocardial infarction, Prospective Studies, Stroke, Original Research, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Intracranial Aneurysm* / diagnostic imaging, Cardiology, Subarachnoid haemorrhage, haemorrhage, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Subgroup analysis, subarachnoid, Intracranial Aneurysm* / epidemiology, 03 medical and health sciences, Aneurysm, Internal medicine, medicine, Humans, coil, cardiovascular diseases, Pandemics, lcsh:Neurology. Diseases of the nervous system, Retrospective Studies, business.industry, SARS-CoV-2, Intracranial Aneurysm, Subarachnoid Hemorrhage, medicine.disease, infection, nervous system diseases, Mechanical thrombectomy, Cross-Sectional Studies, aneurysm, Neurology (clinical), Subarachnoid Hemorrhage* / epidemiology, business, 030217 neurology & neurosurgery
Abstract

BackgroundDuring the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study’s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.MethodsWe conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March–31 May 2020. The prior 1-year control period (1 March–31 May 2019) was obtained to account for seasonal variation.FindingsThere was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI −24.3% to −20.7%, pInterpretationThere was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Published
2021

6. Efficacy of pretreatment with the free radical scavenger, edaravone, for prevention of cerebral hyperperfusion after carotid artery stenting: A single-center randomized controlled trial

Author

Hirofumi Kusaka, Kosuke Miyake, Masataka Nakamura, Yusuke Yakushiji, Hiroki Sakamoto, and Takenobu Kunieda

Subjects
Carotid arteries, lcsh:Surgery, Free radicals, Cerebral hyperperfusion syndrome, Single Center, lcsh:RC346-429, 030218 nuclear medicine & medical imaging, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, medicine.artery, Carotid stenosis, Edaravone, Medicine, lcsh:Neurology. Diseases of the nervous system, business.industry, Significant difference, lcsh:RD1-811, Free radical scavenger, Single-photon emission computed tomography, Cerebral blood flow, chemistry, Anesthesia, Middle cerebral artery, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Objective Optimal therapy to avoid cerebral hyperperfusion (CHP) after carotid artery stenting (CAS) is yet to be established. The purpose of this study was to determine whether pretreatment with a free radical scavenger, edaravone, could prevent CHP after CAS. Methods A prospective, randomized, controlled, single-center trial was conducted between April 2011 and January 2018. Eligible patients were those who underwent CAS. Subjects were randomly assigned to receive (edaravone group) or not receive (control group) administration of edaravone before stent deployment. The primary outcome was occurrence of CHP immediately (within 1 h) after CAS. Cerebral blood flow (CBF) was assessed in the middle cerebral artery (MCA) region and the cerebellar hemisphere using single-photon emission computed tomography (SPECT) before and immediately after CAS. The asymmetry index (AI) (%) was defined as CBF in the affected MCA region divided by CBF in the unaffected MCA region × 100. CHP was defined as AI > 120% immediately after CAS. Results The trial was stopped ahead of schedule due to poor recruitment. Among 52 participants, 51 completed the trial (edaravone group, n = 25; control group, n = 26). CHP occurred in 2/25 patients (8%) in the edaravone group and in 1/26 patients (4%) in the control group, with no significant difference between the groups (P = 0.610). Conclusion Pretreatment with edaravone appeared not to be associated with reduction in the occurrence of CHP immediately after CAS.

Published
2021

7. Use of Simple Neck Extension to Improve Guiding Catheter Accessibility in Tortuous Cervical Internal Carotid Artery for Endovascular Embolization of Intracranial Aneurysm: A Technical Note

Author

Megumu Takata, Kosuke Miyake, Hitoshi Fukuda, Kenichi Murao, and Masanori Kinosada

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Catheterization, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine.artery, Occlusion, Humans, Medicine, Embolization, Aged, Coil embolization, business.industry, Endovascular Procedures, Balloon catheter, Intracranial Aneurysm, Technical note, Middle Aged, Surgical Instruments, medicine.disease, Embolization, Therapeutic, Surgery, Guiding catheter, Female, Neurology (clinical), Radiology, Internal carotid artery, business, Carotid Artery, Internal, Neck, 030217 neurology & neurosurgery
Abstract

Background In endovascular embolization of intracranial aneurysms, a tortuous cervical internal carotid artery can limit guiding catheter access to a sufficiently high position. Although intermediate distal access catheters can go beyond the tortuous segment of internal carotid arteries, they may increase the risk of procedure-related complications, require significantly complex technical procedures, and limit the use of adjunctive techniques. Using simple neck extension alone, we successfully improved guiding catheter access in 2 patients. Methods Through a provocative test, we confirmed suitability of manual neck extension in 2 patients with severe posterior curvature of a tortuous internal carotid artery. Intraoperatively, we manually extended the neck and stretched the curvatures. We guided a 6F guiding catheter superiorly and performed coil embolization with an occlusion balloon catheter in 1 case and with the balloon-assisted neck remodeling technique in 1 case. Results Coil embolization was completed without any adverse events in both cases. Conclusions The simple neck extension technique successfully improved accessibility of the guiding catheter. As the need for safe and highly skilled intervention increases, our technique may be useful because it can reduce procedure-related complications and allow balloon-assisted techniques.

Published
2017

8. Leptomeningeal Collaterals Strongly Correlate with Reduced Cerebrovascular Reactivity Measured by Acetazolamide-challenged Single-photon Emission Computed Tomography Using a Stereotactic Extraction Estimation Analysis in Patients with Unilateral Internal Carotid Artery Stenosis

Author

Hirofumi Kusaka, Kengo Fujita, Masataka Nakamura, Satoshi Kaneko, Takenobu Kunieda, Yuko Iwasaki, Hiroki Sakamoto, Shin Iida, Kosuke Miyake, and Satoshi Morise

Subjects
Male, Middle Cerebral Artery, medicine.medical_specialty, cerebral blood flow, Constriction, Pathologic, 030204 cardiovascular system & hematology, Single-photon emission computed tomography, QSPECT/DTARG, 03 medical and health sciences, Imaging, Three-Dimensional, 0302 clinical medicine, medicine.artery, Internal medicine, Internal Medicine, medicine, Humans, Carotid Stenosis, Aged, Retrospective Studies, Aged, 80 and over, Tomography, Emission-Computed, Single-Photon, SEE-JET, medicine.diagnostic_test, business.industry, Brain, General Medicine, Middle Aged, medicine.disease, vasomotor reactivity, Cerebral Angiography, Acetazolamide, Stenosis, Cerebral blood flow, Cerebrovascular Circulation, Middle cerebral artery, Cardiology, Original Article, Female, business, 030217 neurology & neurosurgery, Emission computed tomography, Cerebral angiography, medicine.drug, Circle of Willis
Abstract

Objective To assess the correlation between the angiographic appearance of cerebral collateral pathways or the degree of internal carotid artery stenosis (ICAS) and reduced cerebrovascular reactivity (CVR) estimated by single-photon emission computed tomography (SPECT) image analysis in patients with unilateral ICAS. Methods A retrospective analysis was performed in 42 patients with unilateral ICAS who underwent cerebral angiography and acetazolamide-challenged SPECT of the brain. Cerebral blood flow quantitation was performed using the quantitative SPECT/dual-table autoradiography method. The CVR in the middle cerebral artery (MCA) territory was evaluated using the stereotactic extraction estimation based on the Japanese extracranial-intracranial bypass trial (SEE-JET) program and classified as reduced (

Published
2017

9. Abstract TP523: A Randomized Controlled Trial Evaluating the Effectiveness of Pretreatment With the Free Radical Scavenger, Edaravone, Before Carotid Artery Stenting

Author

Kosuke Miyake, Takenobu Kunieda, Masataka Nakamura, Satoshi Kaneko, Hirofumi Kusaka, and Hiroki Sakamoto

Subjects
Advanced and Specialized Nursing, Carotid revascularization, medicine.medical_specialty, business.industry, Carotid arteries, Hemodynamics, Free radical scavenger, law.invention, chemistry.chemical_compound, nervous system, chemistry, Randomized controlled trial, law, Internal medicine, Cardiology, medicine, Edaravone, In patient, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract

Objective: Cerebral hyperperfusion syndrome (CHS) is likely to occur after carotid revascularization in patients with severe hemodynamic failure. It is important to control cerebral hyperperfusion phenomenon (CHP) to prevent the development of CHS. To determine whether pretreatment with the free radical scavenger, edaravone, could prevent the onset of CHP after carotid artery stenting (CAS). Methods: Patients with severe carotid artery stenosis were randomized to receive either pretreatment with edaravone immediately before CAS or the common CAS procedure. Cerebral blood flow (CBF) was assessed in the affected middle cerebral artery (MCA) region and in the ipsilateral cerebellum using single-photon emission computed tomography (SPECT) of the brain before and immediately after CAS. Cerebrovascular reactivity (CVR) in the MCA region was also evaluated using the stereotactic extraction estimation based on the Japanese extracranial-intracranial bypass trial (SEE-JET) program and classified as reduced when it was Results: Of the 52 patients recruited in this study, 26 were assigned to the pretreatment with edaravone group and 26 were assigned to the treatment as the usual group. Eleven patients showed reduced CVR. CHP occurred in 0 of 6 patients in the edaravone group and in 4 of 5 patients in the usual group (0% vs. 80%, p=0.0152). However, there was no significant difference in the overall patient population between the two groups. Conclusion: Pretreatment with edaravone could reduce the incidence of CHP after CAS in patients with reduced CVR.

Published
2019

10. Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage

Author

Kosuke Miyake, Kenichi Murao, Takenobu Kunieda, and Hitoshi Fukuda

Subjects
Adult, Male, medicine.medical_specialty, Fistula, Arteriovenous fistula, Cranial Sinuses, Balloon, Neurosurgical Procedures, Jugular vein, Medicine, Humans, Sinus (anatomy), Sigmoid sinus, Central Nervous System Vascular Malformations, business.industry, Rehabilitation, Endovascular Procedures, Middle Aged, medicine.disease, Cortical Vein, Surgery, medicine.anatomical_structure, Treatment Outcome, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, Superior sagittal sinus
Abstract

Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.

Published
2013

13. Melatonin receptor agonists for treating delirium in elderly patients with acute stroke

Author

Kenichi Murao, Tsuyoshi Ohta, Koichiro Takemoto, and Kosuke Miyake

Subjects
Male, medicine.medical_treatment, Ramelteon, Receptors, Melatonin, Melatonin receptor, mental disorders, Insomnia, medicine, Humans, Melatonin receptor agonist, Stroke, Acute stroke, Aged, Aged, 80 and over, Rehabilitation, business.industry, Delirium, Middle Aged, medicine.disease, Prognosis, humanities, nervous system diseases, Treatment Outcome, Indenes, Anesthesia, Surgery, Female, Neurology (clinical), medicine.symptom, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Background Delirium is considered to worsen life prognosis in elderly patients with stroke. We examined the effects of the melatonin receptor agonist ramelteon for treating delirium in elderly stroke patients with insomnia in comparison to the other drugs. Methods Elderly patients with delirium and insomnia after acute stroke who were treated with ramelteon (7 patients; mean age 76 years) and the other drugs (21 patients; mean age 77.3 years) between July 2011 and March 2012 at our hospital were retrospectively examined. Results All patients treated with ramelteon had a significant improvement within a week and were started on early and aggressive rehabilitation. No patient experienced oversedation, neurologic deterioration, or any other worsening effect associated with ramelteon treatment. Conclusions Melatonin receptor agonists may be effective for the treatment of delirium in elderly patients with acute stroke.

Published
2012

14. Nurse Scheduling by Using Cooperative GA with Efficient Mutation and Mountain-Climbing Operators

Author

Makoto Ohki, Akio Morimoto, and Kosuke Miyake

Subjects
Mathematical optimization, Schedule, Operator (computer programming), business.industry, Computer science, Nurse scheduling problem, Genetic algorithm, Mutation (genetic algorithm), Crossover, Artificial intelligence, business, Scheduling (computing), Task (project management)
Abstract

This paper proposes an effective algorithm to solve a nurse scheduling problem by using genetic algorithm (GA). In hospitals, nurses are assigned to any section such as the internal medicine department or the pediatrics department. In generally, 15-30 nurses belong to a section. A clinical director of the department has to make a duty schedule of all nurses of the department every month. It is very complex task to create the nurse schedule. To improve this problem, we propose an effective algorithm to create and optimize the nurse schedule. Our algorithm is based on the cooperative GA. In conventional ways using the cooperative GA for the nurse scheduling, a crossover operator is only applied to optimize the schedule, because it keeps validity between chromosomes. As the first proposal of this paper, we apply a new mutation operator to the cooperative GA, which does not fail validity of the schedule. Although the cooperative GA with the crossover and mutation operators optimizes the nurse schedule better than the conventional GA, the optimization mostly stagnates at the middle game or the endgame. We consider that this stagnation is caused that the optimization is caught in a local minimum area of a solution space. To escape from the local minimum and to find better solution, we apply a mountain-climbing operator to the cooperative GA. Effectiveness of these two new operators are shown by practical experiments.

Published
2006

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