14 results on '"Rintaro Tachi"'
Search Results
2. Proposed predictors of the need for retreatment after coil embolization of unruptured cerebral aneurysms with major or minor recanalization: Analysis of a single center’s experience
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Michiyasu Fuga, Toshihide Tanaka, Koreaki Irie, Ikki Kajiwara, Rintaro Tachi, Akihiko Teshigawara, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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Long term ,Meyer grade ,Neurovision ,Risk factor ,Spherical shape ,Volume embolization ratio ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: Various risk factors for recanalization after coil embolization have been reported, but the indications for retreatment of recanalized aneurysms have not been determined.The aim of this study was to identify risk factors indicating the need for retreating recanalization during long-term follow-up (approximately 1 year). Methods: A total of 172 unruptured saccular aneurysms in 155 patients treated by initial coil embolization between February 2012 and July 2019 were retrospectively analyzed. Intraluminal thrombosed aneurysms, aneurysms treated with stent assistance, and aneurysms followed without digital subtraction angiography (DSA) were excluded. Recanalization was identified in 31 aneurysms. Recanalized aneurysms (Meyer grade ≥2) were defined as major recanalization (MA); those that worsened to Meyer grade 1 were defined as minor recanalization (MI). Age, sex, aneurysm location, shape, five morphological variables (neck, height, width, dome-to-neck ratio, aspect ratio), aneurysm volume, endovascular technique, immediate Meyer grade, and volume embolization ratio (VER) were compared between MI (n = 18) and MA (n = 13). Predictors of MA were determined using logistic regression and receiver operating characteristic (ROC) curve analyses. Results: On multivariate logistic regression analysis, spherical shape (odds ratio (OR) 11.9; 95% confidence interval (CI) 1.28–111) and VER (OR 1.92; 95% CI 1.13–3.28) were independent predictors of MA. On ROC curve analysis, the optimal cut-off value for the VER was 20.8% (sensitivity, 76.9%; specificity, 77.8%). Conclusions: Lower VER and non-spherical shape appear to be independent risk factors for progression to MA in recanalized aneurysms, and packing with a VER >20.8% is expected to prevent progression to MA.
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- 2021
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3. Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center’s experience
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Michiyasu, Fuga, Toshihide, Tanaka, Koreaki, Irie, Ikki, Kajiwara, Rintaro, Tachi, Akihiko, Teshigawara, Toshihiro, Ishibashi, Yuzuru, Hasegawa, and Yuichi, Murayama
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Treatment Outcome ,Neurology ,Risk Factors ,Physiology (medical) ,Humans ,Intracranial Aneurysm ,Surgery ,Neurology (clinical) ,General Medicine ,Embolization, Therapeutic ,Cerebral Angiography ,Follow-Up Studies ,Retrospective Studies - Abstract
In coil embolization of cerebral aneurysms, inadequate packing is known to increase the probability of recanalization. Even tightly embolized aneurysms may be recanalized, but predictive factors for recanalization have not been fully investigated. This retrospective study aimed to identify risk factors for recanalization of treated aneurysms with a volume embolization ratio (VER) ≥ 25%. A total of 301 unruptured aneurysms in 248 patients who underwent coil embolization between March 2012 and January 2021 were analyzed. Cases involving dissecting aneurysm, intraluminal thrombosis, parent artery occlusion, intraoperative rupture, re-treatment, rupture the day after surgery, postoperative coil migration, and postoperative parent artery occlusion were excluded due to the inaccuracy of VER. A total of 105 aneurysms (34.9%) treated with VER ≥ 25% were extracted. Clinical features (age, sex, medical history, family history), anatomical features (shape, location, aneurysm size, inflow angle, and volume), procedural features (stent-assisted, Raymond-Roy occlusion classification [RROC] immediately after treatment, re-treatment rate), and follow-up period were compared between Recanalization and Non-recanalization groups. Predictors of recanalization were determined using logistic regression and receiver operating characteristic (ROC) curve analyses. Eleven aneurysms were recanalized. In multivariate analysis, RROC class 3 (odds ratio [OR] 11.0; 95% confidence interval [CI] 2.03-59.4) and aneurysm volume (OR 1.005; 95%CI 1.001-1.008) were independent predictors of recanalization. ROC curve analysis showed optimal cutoff values for aneurysm volume of 69.5 mm
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- 2022
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4. Characteristics of Unruptured Intracranial Aneurysms with Delayed Rupture Following Coil Embolization: Case Series and Review of the Literature
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Rintaro Tachi, Michiyasu Fuga, Toshihide Tanaka, Akihiko Teshigawara, Ikki Kajiwara, Koreaki Irie, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
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5. Compartment syndrome associated with vascular avulsion caused by transradial access in neurointervention for unruptured intracranial aneurysm: illustrative case
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Michiyasu Fuga, Toshihide Tanaka, Rintaro Tachi, Kyoichi Tomoto, Shun Okawa, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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General Medicine - Abstract
BACKGROUND Transradial access (TRA) has a lower risk of access-site complications than transfemoral access but can cause major puncture-site complications, including acute compartment syndrome (ACS). OBSERVATIONS The authors report a case of ACS associated with radial artery avulsion after coil embolization via TRA for an unruptured intracranial aneurysm. An 83-year-old woman underwent embolization via TRA for an unruptured basilar tip aneurysm. Following embolization, strong resistance was felt during removal of the guiding sheath due to vasospasm of the radial artery. One hour after neurointervention via TRA, the patient complained of severe pain in the right forearm, with motor and sensory disturbance of the first 3 fingers. The patient was diagnosed with ACS causing diffuse swelling and tenderness over the entire right forearm due to elevated intracompartmental pressure. The patient was successfully treated by decompressive fasciotomy of the forearm and carpal tunnel release for neurolysis of the median nerve. LESSONS TRA operators should be aware that radial artery spasm and the brachioradial artery pose a risk of vascular avulsion and resultant ACS and warrant precautionary measures. Prompt diagnosis and treatment are essential because ACS can be treated without the sequelae of motor or sensory disturbance if properly addressed.
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- 2023
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6. Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms
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Michiyasu Fuga, Toshihide Tanaka, Rintaro Tachi, Kyoichi Tomoto, Shun Okawa, Akihiko Teshigawara, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,General Medicine - Abstract
Purpose The transradial approach (TRA) in neuroendovascular treatment is known to have a lower risk of complications than the transfemoral approach (TFA). However, little research has focused on assessments of efficacy and risk of complications in the treatment of intracranial aneurysms. This study aimed to compare the efficacy and complications of TRA and TFA in coil embolization of unruptured intracranial aneurysms (UIAs) at our institution. Methods Consecutive patients who underwent endovascular surgery via TRA or TFA at a single institution from 1 April 2019, to 28 February 2022, were retrospectively analyzed. Patients were classified into TRA and TFA groups and assessed using propensity-adjusted analysis for outcomes including fluoroscopy time, volume embolization ratio (VER), and complications. Results A total of 163 consecutive UIAs were treated with coil embolization during the 35-months study period. The incidence of minor access site complications (ASCs) was significantly higher with TFA (20%, 25/126) than with TRA (2.7%, 1/37; p = 0.01). Propensity-adjusted analysis (matched for age, sex, aneurysm volume, embolization technique, and sheath size) revealed that TRA was associated with a lower risk of minor ASCs (odds ratio, 0.085; 95% confidence interval 0.0094–0.78; p = 0.029). However, TRA did not differ significantly from TFA with respect to fluoroscopy time, VER, major ASCs, and non-ASCs. Conclusions Coil embolization for UIAs via TRA can reduce risk of minor ASCs without increasing the risk of non-ASCs compared with conventional TFA, and can achieve comparable results in term of efficacy and fluoroscopy time.
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- 2022
7. Successful Endovascular Trapping for Symptomatic Thrombosed Giant Unruptured Aneurysms of the V1 and V2 Segments of the Vertebral Artery: Case Report and Literature Review
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Toshihiro Ishibashi, Yuichi Murayama, Michiyasu Fuga, Yuzuru Hasegawa, Rintaro Tachi, Ryo Nogami, Akihiko Teshigawara, and Toshihide Tanaka
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endovascular treatment ,extracranial vertebral artery aneurysm ,medicine.medical_specialty ,business.industry ,Vertebral artery ,Case Report ,trapping ,thrombosed ,medicine.artery ,giant ,cardiovascular system ,Medicine ,cardiovascular diseases ,Radiology ,business - Abstract
A thrombosed giant aneurysm of the V1 and V2 segments of the vertebral artery (VA) is rare. Therefore, there is controversy regarding its optimal treatment. A case of a symptomatic giant VA aneurysm located in the V1 to V2 segments on the left treated successfully by endovascular trapping of the VA is reported. A 68-year-old woman presented with swelling in the left anterior neck. Computed tomography angiography (CTA) showed a giant aneurysm measuring 47 × 58 × 47 mm3 in the left neck. Ten days after her first visit, she presented with sudden onset of left anterior neck pain. Repeated CTA showed a partial thrombus in the aneurysm. Angiography showed two thrombosed giant aneurysms located in the V1 to V2 segments of the left VA. After endovascular trapping for the aneurysms, the anterior neck pain resolved and the aneurysm gradually shrank. This case demonstrates that endovascular surgery is better than open surgery because it is less invasive. When performing endovascular treatment, trapping will be an alternative strategy for a symptomatic giant thrombotic aneurysm of the V1 and V2 segments of the VA if the patient can tolerate ischemia.
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- 2021
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8. Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms
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Michiyasu Fuga, Toshihide Tanaka, Rintaro Tachi, Kyoichi Tomoto, Ryoto Wachi, Akihiko Teshigawara, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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Rehabilitation ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Methods for assessing platelet function in patients with neurovascular disease remain controversial and poorly studied. This study aimed to assess associations between thromboelastography 6s (TEG6s) measurements and postoperative ischemic complications in patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization.Eighty-four patients with UIAs taking a combined aspirin and clopidogrel protocol were retrospectively reviewed from January 2021 to May 2022. Blood samples were obtained for TEG6s to assess platelet function on the day of coil embolization. To identify acute ischemic complications, diffusion-weighted imaging (DWI) was performed within 24 h after coil embolization. Multivariate logistic regression analysis was conducted to identify potential risk factors for postoperative positive DWI (DWI (+)) lesions.Forty-three of the 84 patients (51%) with DWI (+) lesions were identified. Compared with patients without DWI (+) lesions, Adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MAMA
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- 2023
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9. Delayed Tentorial Subdural Hematoma Caused by Traumatic Posterior Cerebral Artery Aneurysm: A Case Report and Literature Review
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Michiyasu Fuga, Yuichi Murayama, Ryo Nogami, Toshihide Tanaka, Rintaro Tachi, Toshihiro Ishibashi, Yuzuru Hasegawa, and Akihiko Teshigawara
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Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,macromolecular substances ,Posterior cerebral artery ,Aneurysm, Ruptured ,Aneurysm ,Hematoma ,medicine.artery ,Brain Injuries, Traumatic ,medicine ,Humans ,Hematoma, Subdural, Acute ,Cerebellar tentorium ,cardiovascular diseases ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Head injury ,Endovascular Procedures ,Intracranial Aneurysm ,General Medicine ,Articles ,Subarachnoid Hemorrhage ,medicine.disease ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Cerebral Angiography ,Hematoma, Subdural ,Angiography ,Radiology ,business - Abstract
Patient: Male, 42-year-old Final Diagnosis: Traumatic posterior cerebral artery aneurysm Symptoms: Deterioration of mental status and disorientation Medication: — Clinical Procedure: Parent artery occlusion by endovascular approach Specialty: Neurosurgery Objective: Unusual clinical course Background: Subdural hematoma (SDH) caused by traumatic intracranial aneurysm (TICA) is rare. TICAs are known to rupture easily, resulting in a high morbidity and mortality rate. Therefore, accurate diagnosis and treatment are crucial for preserving life. We describe a case of delayed SDH in the setting of posterior cerebral artery (PCA) aneurysm. Case Report: A 42-year-old man presented with sustained head injury from a traffic accident, and was being followed-up conservatively for traumatic SDH and subarachnoid hemorrhage. Three weeks after the head trauma, the patient developed a sudden deterioration of mental status and disorientation. Computed tomography revealed de novo SDH at the cerebellar tentorium. Computed tomography angiography and magnetic resonance imaging demonstrated TICA in the PCA. The patient was diagnosed with SDH due to a ruptured PCA aneurysm at the quadrigeminal segment. To avoid SDH growth due to re-rupture of the aneurysm, parent artery occlusion was subsequently performed with no complications. The patient was discharged home 2 months after endovascular treatment, with moderate disability. Follow-up angiography 2 years after the operation showed no recanalization, and the patient had returned to work. Conclusions: TICA in the PCA can cause tentorial SDH with or without the presence of subarachnoid hemorrhage. Routine cerebrovascular assessment is crucial for head trauma with hematoma adjacent to the cerebellar tentorium. Parent artery occlusion via an endovascular procedure is an alternative treatment for TICA in the PCA that is less invasive than other approaches.
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- 2021
10. Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms.
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Michiyasu Fuga, Toshihide Tanaka, Rintaro Tachi, Kyoichi Tomoto, Ryoto Wachi, Akihiko Teshigawara, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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Background: The transradial approach (TRA) is less invasive than the transfemoral approach (TFA), but the higher conversion rate represents a drawback. Among target vessels, the left internal carotid artery (ICA) is particularly difficult to deliver the guiding catheter to through TRA. The purpose of this study was thus to explore anatomical and clinical features objectively predictive of the difficulty of delivering a guiding catheter into the left ICA via TRA. Methods: Among 78 consecutive patients who underwent coil embolization for unruptured intracranial aneurysms through TRA in a single institution between March 1, 2021, and August 31, 2022, all 29 patients (37%) who underwent delivery of the guiding catheter into the left ICA were retrospectively analyzed. Clinical and anatomical features were analyzed to assess correlations with difficulty in guiding the catheter into the left ICA. Results: Of the 29 aneurysms requiring guidance of a catheter into the left ICA, 9 aneurysms (31%) required conversion from TRA to TFA. More acute innominate-left common carotid artery (CCA) angle (P < 0.001) and older age (P = 0.015) were associated with a higher conversion rate to TFA. Receiver operating characteristic analysis revealed that optimal cutoff values for the innominate-left CCA angle and age to distinguish between nonconversion and conversion to TFA were 16° (area under the curve [AUC], 0.93; 95% confidence interval [CI], 0.83-1.00) and 74 years (AUC, 0.79; 95% CI, 0.61-0.96), respectively. Conclusion: A more acute innominate-left CCA angle and older age appear associated with difficulty delivering the guiding catheter into the left ICA for neurointervention through TRA. [ABSTRACT FROM AUTHOR]
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- 2023
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11. A novel 3-Fr guiding sheath for transradial access in aneurysm embolization: Technical note
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Michiyasu Fuga, Toshihide Tanaka, Rintaro Tachi, Ryoto Wachi, Akihiko Teshigawara, Toshihiro Ishibashi, Yuzuru Hasegawa, and Yuichi Murayama
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General Medicine - Abstract
Neurointervention via transradial access (TRA) is challenging when the radial artery is narrow. We performed aneurysm embolization via TRA using a novel 3-Fr guiding sheath (GS) (Axcelguide; Medikit, Tokyo, Japan) with an outer diameter of only 1.76 mm for patients with a radial artery of inner diameter less than 2 mm, and described the whole procedure and pitfalls as a technical note. Here, we present two patients with radial arteries less than 2 mm. One patient had a narrow neck intracranial aneurysm at the bifurcation of the left vertebral artery and posterior inferior cerebellar artery, which was embolized with the primary coiling technique. The other was a patient with a wide-necked extracranial aneurysm in the cavernous portion of the right internal carotid artery, which was embolized with the transcell technique with stent. We utilized a 3-Fr GS, distal access catheter, and a 0.0165-inch microcatheter for coil embolization. All aneurysms were completely occluded, without neurological or puncture site-related complications including subcutaneous hematoma, radial artery occlusion, and vasospasm. This report provides the first description of neurointervention using a 3-Fr GS. The 3-Fr GS contributed to successful completion of TRA aneurysm embolization without neurological or puncture site-related complications in patients with radial arteries narrower than 2 mm. The 3-Fr GS may be useful to accomplish aneurysmal embolization via TRA even in patients with a small radial artery.
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- 2022
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12. [Technical 'Tips' for Epidural Tenting Using DuraGensup®/supfor Surgical Management of Large Dural Defects:A Technical Note]
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Yosuke, Nakayama, Toshihide, Tanaka, Akihiko, Teshigawara, Ryo, Nogami, Rintaro, Tachi, Michiyasu, Fuga, Satoru, Tochigi, Yuzuru, Hasegawa, and Yuichi, Murayama
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Male ,Japan ,Skull ,Meningeal Neoplasms ,Humans ,Dura Mater ,Neoplasm Recurrence, Local ,Aged - Abstract
DuraGensup®/sup, an absorbable, engineered collagen-based artificial graft was introduced in Japan in September 2019 for cranial, transsphenoidal, and spinal surgeries. In addition to its efficacy and safety profile, owing to sutureless dural repair, DuraGensup®/supis widely accepted by neurosurgeons. Direct tenting with DuraGensup®/supis occasionally required in patients with large dural defects, particularly in cases of tumors adherent to the dura. To overcome this limitation, we introduced a surgical technique for epidural tenting using DuraGensup®/sup. A 78-year-old man with a history of alexia underwent craniotomy for resection of a left temporal lobe metastatic tumor. We completely removed the recurrent tumor, which was strongly adherent to the dura in the middle cranial fossa. A layer of DuraGensup®/supwas used as a subdural underlay beneath the autologous dura to close the wide dural defect. To avoid postoperative epidural fluid collection, we retracted the DuraGensup®/supfrom the epidural aspect and interposed several pieces of muscle, which were sutured on the subdural aspect to ensure that the muscle pieces securely plugged the dural defect. We placed an additional overlay of DuraGensup®/supalong the autologous dura. The patient's postoperative course was uneventful without cerebrospinal fluid leakage, tension pneumocephalus, or wound infection. Reoperations for tumor resection, particularly surgical procedures for refractory meningiomas and malignant tumors cause increasing fragility and wide defects of the dura. DuraGensup®/supplacement enables sutureless closure and is less time-consuming. Our technique of epidural direct tenting with DuraGensup®/supusing muscle pieces sutured on the subdural aspect could be useful in patients with significantly large dural defects and can prevent postoperative epidural fluid collection to ensure complete dural sealing.
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- 2020
13. Relapsing polychondritis‐associated limbic encephalitis preceding the emergence of systemic inflammation
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Risa Maekawa, Miho Kawabe, Tatsuro Mutoh, Sayuri Shima, Rintaro Tachi, Takuto Hideyama, Yukiko Kishida, Yasushi Shiio, and Masato Yagi
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030203 arthritis & rheumatology ,Pathology ,medicine.medical_specialty ,business.industry ,Limbic encephalitis ,medicine.disease ,Systemic inflammation ,03 medical and health sciences ,0302 clinical medicine ,Neurology ,Immunology ,medicine ,Fdg pet ct ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Relapsing polychondritis - Published
- 2016
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14. Abstract WP59: Intraoperative Cbv Measurement for the Treatment of Ischemic Stroke
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Ayako Ikemura, Issei Kan, Chihebeddine Dahmani, Shogo Kaku, Ichiro Yuki, Yuichi Murayama, Toshihiro Ishibashi, Yukiko Abe, Rintaro Tachi, and Kengo Nishimura
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Internal medicine ,Ischemic stroke ,Cardiology ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Introduction: Prediction of ischemic core during the thrombectomy procedure can contribute to the treatment strategy. To evaluate if the Cone Beam CT CBV (CBCT-CBV) can predict the image findings of post procedure MRI, retrospective analysis was performed. Methods: A total of 14 ischemic stroke cases with major vessel occlusion underwent CBCT-CBV. A 4 French diagnostic catheter, which was placed in the guiding catheter, was positioned at the ascending aorta. Utilizing 6 seconds acquisition (6Sec Dyna PBV Neuro, Siemens Healthcare), 30% diluted contrast was injected with the speed of 6ml/sec. The reconstruction of the images with CBV color mapping was created immediately after the acquisition. The pre and post procedure CBCT-CBV data was compared with the corresponding MRI images and the results were retrospectively analyzed. Results: Of the 14 cases who showed major vessel occlusion, 6 underwent both pre and post CBCT-CBV. Location of the occluded vessels were internal carotid artery (ICA) (4 cases), middle cerebral artery (9 cases) and 1 basilar artery. No case showed increased CBV. Five cases showed a significant reduction of regional CBV (mean reduction; 72.65%) at the end of the procedure. All these cases showed DWI high regions in the post procedure MRI matched with the area of CBCT-CBV reduction (100%). Of the 6 cases who underwent both pre and post procedure CBCT-CBV, 3 showed decreased CBV in the pre-procedure CBV. After the recanalization of the occluded vessels, the regional CBV was normalized to the level of contra lateral side in every case. Conclusions: Intra-operative CBCT-CBV showed recovery of the reduced CBV after the recanalization in some cases. The area of reduced CBV at the end of procedure was matched with the DWI positive region in the post-procedure MRI (100%). Intra-operative CBCT-CBV may contribute to the prediction of post-operative ischemic core.
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- 2017
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