Pub Date : 2019-01-01DOI: 10.5797/JNET.CR.2018-0014
K. Maeda, T. Ochi, Yoshiaki Goto, K. Arisawa, Shouhei Nanbu
Objective: We report a patient with hyperperfusion-related cerebral hemorrhage after neuroendovascular treatment for symptomatic vertebral artery stenosis. Case Presentation: The patient was a 75-year-old male, who presented with repeated attacks of vertigo. He was diagnosed with vertebral-basilar insufficiency. Subsequently, medical treatment involving the administration of an antiplatelet drug was performed, but brainstem infarction developed. Cerebral angiography showed occlusion of the left vertebral artery and stenosis at the origin and intracranial area of the right vertebral artery. Cerebral blood flow scintigraphy revealed a reduction in cerebellar blood flow as well as the site of infarction. The patient was considered to be resistant to medical treatment, and angioplasty was performed at two stenotic sites of the left vertebral artery. Despite strict blood pressure control, brainstem hemorrhage occurred 4 hours after surgery. The postoperative cerebral blood flow scintigraphy findings suggested hyperperfusion-related hemorrhage. Conclusion: For endovascular treatment of vertebral artery stenosis with cerebral blood flow failure, postoperative hyperperfusion-related cerebral hemorrhage may not be prevented by blood pressure control alone. Therapeutic strategies, such as a staged angioplasty, should be established based on cerebral blood flow examination findings.
{"title":"A Patient with Hyperperfusion-related Cerebral Hemorrhage after Neuroendovascular Treatment for Vertebral Artery Stenosis","authors":"K. Maeda, T. Ochi, Yoshiaki Goto, K. Arisawa, Shouhei Nanbu","doi":"10.5797/JNET.CR.2018-0014","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0014","url":null,"abstract":"Objective: We report a patient with hyperperfusion-related cerebral hemorrhage after neuroendovascular treatment for symptomatic vertebral artery stenosis. Case Presentation: The patient was a 75-year-old male, who presented with repeated attacks of vertigo. He was diagnosed with vertebral-basilar insufficiency. Subsequently, medical treatment involving the administration of an antiplatelet drug was performed, but brainstem infarction developed. Cerebral angiography showed occlusion of the left vertebral artery and stenosis at the origin and intracranial area of the right vertebral artery. Cerebral blood flow scintigraphy revealed a reduction in cerebellar blood flow as well as the site of infarction. The patient was considered to be resistant to medical treatment, and angioplasty was performed at two stenotic sites of the left vertebral artery. Despite strict blood pressure control, brainstem hemorrhage occurred 4 hours after surgery. The postoperative cerebral blood flow scintigraphy findings suggested hyperperfusion-related hemorrhage. Conclusion: For endovascular treatment of vertebral artery stenosis with cerebral blood flow failure, postoperative hyperperfusion-related cerebral hemorrhage may not be prevented by blood pressure control alone. Therapeutic strategies, such as a staged angioplasty, should be established based on cerebral blood flow examination findings.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/JNET.CR.2018-0109
Y. Funakoshi, T. Hatano, M. Ando, H. Chihara, W. Takita, K. Tokunaga, Takuro Hashikawa, T. Kamata, Eiji Higashi, I. Nagata
Objective: The fl ow diverter (FD) was developed as a new approach for treating aneurysms. However, FD embolization requires high technical skills and is challenging when the access to the aneurysm is diffi cult and when suffi cient force cannot be transmitted to the catheter because of severe vascular tortuosity. For FD embolization, when a transfemoral approach is too diffi cult, we perform direct puncture of the common carotid artery (CCA) under direct visualization by making a small incision. Herein, we report our experience using this approach. Case Presentation: We present a case of an 80-year-old woman with an unruptured aneurysm on the right internal carotid artery (ICA) treated by FD embolization in conjunction with coil embolization. We considered that access to the aneurysm would be challenging, with limited catheter maneuverability because of severe tortuosity of the bilateral femoral arteries and the region from the right CCA to the ICA. Thus, we decided to access the aneurysm by direct puncture of the right CCA. The aneurysm was easily accessed using this approach, and a stable procedure was completed by placing a sheath with a detachable hemostasis valve and then switching the hemostasis valve to a Y-connector on the sheath. As good catheter control was obtained despite the vascular tortuosity, the Pipeline Flex could be deployed and placed at the appropriate position. Conclusion: Direct puncture of the CCA under direct visualization for FD embolization is useful when access to the aneurysm is challenging and when catheter maneuverability decreases because of severe tortuosity.
{"title":"Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report","authors":"Y. Funakoshi, T. Hatano, M. Ando, H. Chihara, W. Takita, K. Tokunaga, Takuro Hashikawa, T. Kamata, Eiji Higashi, I. Nagata","doi":"10.5797/JNET.CR.2018-0109","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0109","url":null,"abstract":"Objective: The fl ow diverter (FD) was developed as a new approach for treating aneurysms. However, FD embolization requires high technical skills and is challenging when the access to the aneurysm is diffi cult and when suffi cient force cannot be transmitted to the catheter because of severe vascular tortuosity. For FD embolization, when a transfemoral approach is too diffi cult, we perform direct puncture of the common carotid artery (CCA) under direct visualization by making a small incision. Herein, we report our experience using this approach. Case Presentation: We present a case of an 80-year-old woman with an unruptured aneurysm on the right internal carotid artery (ICA) treated by FD embolization in conjunction with coil embolization. We considered that access to the aneurysm would be challenging, with limited catheter maneuverability because of severe tortuosity of the bilateral femoral arteries and the region from the right CCA to the ICA. Thus, we decided to access the aneurysm by direct puncture of the right CCA. The aneurysm was easily accessed using this approach, and a stable procedure was completed by placing a sheath with a detachable hemostasis valve and then switching the hemostasis valve to a Y-connector on the sheath. As good catheter control was obtained despite the vascular tortuosity, the Pipeline Flex could be deployed and placed at the appropriate position. Conclusion: Direct puncture of the CCA under direct visualization for FD embolization is useful when access to the aneurysm is challenging and when catheter maneuverability decreases because of severe tortuosity.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/JNET.CR.2018-0103
Hajime Yabuzaki, T. Terada, H. Ikeda, M. Kawamo, A. Wada, S. Nakayama, Tomomi Yoshiyama, Eisuke Hirose, Yuuta Kawauchi, Y. Yamaguchi
Objective: The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation: A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion: In this patient, double overinflated balloon protection was effective for maintaining the torcula.
{"title":"A Case of Transverse-sigmoid Sinus Dural Arteriovenous Fistula Treated by Transarterial and Transvenous Embolization via the Balloon Microcatheter with Overinflated Balloon Protection of the Torcula","authors":"Hajime Yabuzaki, T. Terada, H. Ikeda, M. Kawamo, A. Wada, S. Nakayama, Tomomi Yoshiyama, Eisuke Hirose, Yuuta Kawauchi, Y. Yamaguchi","doi":"10.5797/JNET.CR.2018-0103","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0103","url":null,"abstract":"Objective: The objectives of treating dural arteriovenous fistula (dAVF) are to achieve complete occlusion of the arteriovenous (AV) shunt and restoration of anterograde venous flow. We report a patient with complex dAVF who was managed by double overinflated balloon protection of the torcula and percutaneous transluminal angioplasty (PTA) for the occluded venous sinus. Case Presentation: A 62-year-old woman was admitted with gradually worsening nausea and vomiting, as well as progressive memory disturbance and left hemiparesis. Head MRI/MRA demonstrated a dAVF involving the region from the right sigmoid sinus (SS) to transverse sinus (TS) along with occlusion of the left TS and right proximal SS. There was associated dilatation of the right TS, torcula, and superior sagittal sinus (SSS). The intracranial venous circulation was impaired, with venous reflux draining into the deep cerebral veins as well as the cortical veins. Transarterial embolization (TAE) and transvenous embolization (TVE) were performed with double overinflated balloon protection of the torcula, and shunt flow was completely abolished. The occluded sinus was recanalized by PTA. Her symptoms gradually improved after treatment. Conclusion: In this patient, double overinflated balloon protection was effective for maintaining the torcula.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/jnet.cr.2019-0032
T. Yano, I. Sasaki, Kanako Kiyohara, M. Kawanishi
Objective: We report a case of stent fracture caused by an elongated styloid process, a form of Eagle syndrome. Case Presentation: A 58-year-old man presented with sudden right hemisensation disturbance and aphasia. MRI revealed multiple acute cerebral infarction in the left parietal and insula cortex. MRA revealed a left-sided internal carotid artery (ICA) occlusion distal to the carotid bifurcation. Digital subtraction angiography (DSA) revealed a left-sided ICA dissection distal to the carotid bifurcation. We performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis in cerebral infarction (TICI) grade III was achieved. We performed DSA 3 months after an operation, it showed stent fracture and aneurysmal formation in the stent fractured department. From CT findings, the carotid artery dissection and stent fracture appeared to be triggered by the elongated styloid process. We performed stent-assisted coil embolization. After conducting percutaneous transluminal angioplasty (PTA) at high pressure after coil embolization, the elongated styloid process was fractured, and accepted a shift to the outside of the stent contact department. The patient was discharged without medical problems, and no recurrence was observed for 2 months after the surgery. Conclusion: We experienced a rare case of ICA dissection and carotid stent fracture from Eagle syndrome. Eagle syndrome is an important disease to consider in the differential diagnosis of extracranial carotid artery dissection.
{"title":"Carotid Stent Fracture due to Eagle Syndrome after Endovascular Stenting for the Treatment of Acute Ischemic Stroke Caused by Internal Carotid Artery Dissection: Case Report","authors":"T. Yano, I. Sasaki, Kanako Kiyohara, M. Kawanishi","doi":"10.5797/jnet.cr.2019-0032","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0032","url":null,"abstract":"Objective: We report a case of stent fracture caused by an elongated styloid process, a form of Eagle syndrome. Case Presentation: A 58-year-old man presented with sudden right hemisensation disturbance and aphasia. MRI revealed multiple acute cerebral infarction in the left parietal and insula cortex. MRA revealed a left-sided internal carotid artery (ICA) occlusion distal to the carotid bifurcation. Digital subtraction angiography (DSA) revealed a left-sided ICA dissection distal to the carotid bifurcation. We performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis in cerebral infarction (TICI) grade III was achieved. We performed DSA 3 months after an operation, it showed stent fracture and aneurysmal formation in the stent fractured department. From CT findings, the carotid artery dissection and stent fracture appeared to be triggered by the elongated styloid process. We performed stent-assisted coil embolization. After conducting percutaneous transluminal angioplasty (PTA) at high pressure after coil embolization, the elongated styloid process was fractured, and accepted a shift to the outside of the stent contact department. The patient was discharged without medical problems, and no recurrence was observed for 2 months after the surgery. Conclusion: We experienced a rare case of ICA dissection and carotid stent fracture from Eagle syndrome. Eagle syndrome is an important disease to consider in the differential diagnosis of extracranial carotid artery dissection.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/jnet.oa.2018-0021
T. Kinoshita, Yusuke Egashira, Naoya Imai, Y. Enomoto, N. Nakayama, H. Yano, S. Yoshimura, T. Iwama
Objective: Preoperative transarterial feeder embolization (TAE) may contribute to the safe surgical removal of hyper vascular tumors such as cerebellar hemangioblastomas (CHBs). We examined the usefulness of preoperative TAE of CHBs in our series. Methods: We retrospectively analyzed the results of treatment in seven patients with CHBs who had undergone preoperative TAE and subsequent surgery in our hospital between 2005 and 2015 (four males and three females, mean age: 45 years). Results: The embolized feeders consisted of the posterior inferior cerebellar artery in five patients, superior cerebellar artery (SCA) in one patient, and occipital artery (OA) in one patient. The embolic materials consisted of polyvinyl alcohol (PVA) in two patients, nbutyl2cyanoacrylate (NBCA) in four patients, and the combination of PVA and NBCA in one patient. Surgery was performed 1–4 days after embolization. The mean volume of intraoperative blood loss was 593 mL. In all patients, total surgical removal of the tumor was possible in the absence of nonautologous blood transfusion. Furthermore, embolic blood vessels could be identified during surgery in all patients, contributing to intraoperative orientation. Periprocedural complication related to TAE, cerebellar infarction related to embolicmaterial migration into a normal blood vessel occurred in one patient (13%). Conclusion: The results suggest that preoperative TAE of CHBs using NBCA contributes to a decrease in the volume of intraoperative blood loss, intraoperative orientation, and safe surgical removal of CHBs.
{"title":"Usefulness of Preoperative Transarterial Feeder Embolization of Cerebellar Hemangioblastomas","authors":"T. Kinoshita, Yusuke Egashira, Naoya Imai, Y. Enomoto, N. Nakayama, H. Yano, S. Yoshimura, T. Iwama","doi":"10.5797/jnet.oa.2018-0021","DOIUrl":"https://doi.org/10.5797/jnet.oa.2018-0021","url":null,"abstract":"Objective: Preoperative transarterial feeder embolization (TAE) may contribute to the safe surgical removal of hyper vascular tumors such as cerebellar hemangioblastomas (CHBs). We examined the usefulness of preoperative TAE of CHBs in our series. Methods: We retrospectively analyzed the results of treatment in seven patients with CHBs who had undergone preoperative TAE and subsequent surgery in our hospital between 2005 and 2015 (four males and three females, mean age: 45 years). Results: The embolized feeders consisted of the posterior inferior cerebellar artery in five patients, superior cerebellar artery (SCA) in one patient, and occipital artery (OA) in one patient. The embolic materials consisted of polyvinyl alcohol (PVA) in two patients, nbutyl2cyanoacrylate (NBCA) in four patients, and the combination of PVA and NBCA in one patient. Surgery was performed 1–4 days after embolization. The mean volume of intraoperative blood loss was 593 mL. In all patients, total surgical removal of the tumor was possible in the absence of nonautologous blood transfusion. Furthermore, embolic blood vessels could be identified during surgery in all patients, contributing to intraoperative orientation. Periprocedural complication related to TAE, cerebellar infarction related to embolicmaterial migration into a normal blood vessel occurred in one patient (13%). Conclusion: The results suggest that preoperative TAE of CHBs using NBCA contributes to a decrease in the volume of intraoperative blood loss, intraoperative orientation, and safe surgical removal of CHBs.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.oa.2018-0021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/jnet.oa.2019-0023
Kentaro Shimoda, K. Kamiya, T. Kano, M. Furuichi, A. Yoshino
Objective: It is still controversial whether coiling or clipping has a lower incidence of cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH). In this study, we compared angiographic vasospasm (AV), symptomatic vasospasm (SV), and the outcome of both procedures for ruptured cerebral aneurysms. Methods: From 2007 to 2018, 127 patients were coiled and 127 were clipped for ruptured cerebral aneurysms. We retrospectively reviewed AV, SV, and the outcome of both procedures. Results: The incidence of AV was 32 (25%) patients for coiling and 59 (46%) patients for clipping. SV occurred in eight (6%) patients for coiling and 19 (15%) patients for clipping, and was significantly less in the coiling group. A favorable outcome (modified Rankin scale [mRS] 0-2 on discharge) was in 71 (56%) patients for coiling and 77 (61%) patients for clipping, and there was no significant difference between the two groups. Conclusion: The incidence of SV was significantly less in the coiling group for ruptured cerebral aneurysms. Even if SV occurred following aneurysmal SAH, early therapeutic intervention may prevent deterioration of the outcome.
{"title":"Cerebral Vasospasm and Patient Outcome after Coiling or Clipping for Intracranial Aneurysmal Subarachnoid Hemorrhage","authors":"Kentaro Shimoda, K. Kamiya, T. Kano, M. Furuichi, A. Yoshino","doi":"10.5797/jnet.oa.2019-0023","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0023","url":null,"abstract":"Objective: It is still controversial whether coiling or clipping has a lower incidence of cerebral vasospasm following an aneurysmal subarachnoid hemorrhage (SAH). In this study, we compared angiographic vasospasm (AV), symptomatic vasospasm (SV), and the outcome of both procedures for ruptured cerebral aneurysms. Methods: From 2007 to 2018, 127 patients were coiled and 127 were clipped for ruptured cerebral aneurysms. We retrospectively reviewed AV, SV, and the outcome of both procedures. Results: The incidence of AV was 32 (25%) patients for coiling and 59 (46%) patients for clipping. SV occurred in eight (6%) patients for coiling and 19 (15%) patients for clipping, and was significantly less in the coiling group. A favorable outcome (modified Rankin scale [mRS] 0-2 on discharge) was in 71 (56%) patients for coiling and 77 (61%) patients for clipping, and there was no significant difference between the two groups. Conclusion: The incidence of SV was significantly less in the coiling group for ruptured cerebral aneurysms. Even if SV occurred following aneurysmal SAH, early therapeutic intervention may prevent deterioration of the outcome.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.oa.2019-0023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/jnet.oa.2019-0073
Manoj Bohara, Y. Nishimuta, Y. Sadamura, Dan Kawahara, Soichiro Komasaku, Masanao Mori, M. Yamada, H. Tokimura, K. Yoshimoto
Background: Early recognition of stroke symptoms, pre-notification to the hospital, and rapid transport of the patients has been associated with faster intervention and better outcomes. We studied the impact of continuous monthly educational intervention to the emergency medical services (EMS) members on the therapeutic time till mechanical thrombectomy in acute ischemic stroke. Methods: Our hospital manages Doctor Heli (DH) and Doctor Car (DC). Since April 2017, continuous monthly educational sessions on stroke care have been conducted involving the EMS doctors and paramedics, using the modalities like lectures and focus group discussions. We evaluated the change in performance time indicators prior to and after the initiation of this educational intervention. Results: In all, 10 patients underwent mechanical thrombectomy for acute ischemic stroke before and 36 patients underwent the procedure after the initiation of educational intervention program. The number of EMS-transported patients (by DH and DC) out of the total patients who underwent mechanical thrombectomy increased from 20% to 42% after the initiation of the educational intervention. The median time interval of onset to door (O2D) decreased from 109.5 to 71 minutes and that of door to recanalization (D2R) decreased from 164 to 88 minutes following the educational intervention. Other performance time indicators were also notably reduced. This improvement of time indicators was observed gradually and annually. Conclusion: This study showed that the continuous monthly education on stroke care to EMS members notably increased the number of EMS-transported patients as well as improved the performance time indicators till treatment in acute ischemic stroke.
{"title":"Continuous Educational Interventions Help Emergency Medical Services Effectively Reduce the Therapeutic Time in Acute Ischemic Stroke","authors":"Manoj Bohara, Y. Nishimuta, Y. Sadamura, Dan Kawahara, Soichiro Komasaku, Masanao Mori, M. Yamada, H. Tokimura, K. Yoshimoto","doi":"10.5797/jnet.oa.2019-0073","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0073","url":null,"abstract":"Background: Early recognition of stroke symptoms, pre-notification to the hospital, and rapid transport of the patients has been associated with faster intervention and better outcomes. We studied the impact of continuous monthly educational intervention to the emergency medical services (EMS) members on the therapeutic time till mechanical thrombectomy in acute ischemic stroke. Methods: Our hospital manages Doctor Heli (DH) and Doctor Car (DC). Since April 2017, continuous monthly educational sessions on stroke care have been conducted involving the EMS doctors and paramedics, using the modalities like lectures and focus group discussions. We evaluated the change in performance time indicators prior to and after the initiation of this educational intervention. Results: In all, 10 patients underwent mechanical thrombectomy for acute ischemic stroke before and 36 patients underwent the procedure after the initiation of educational intervention program. The number of EMS-transported patients (by DH and DC) out of the total patients who underwent mechanical thrombectomy increased from 20% to 42% after the initiation of the educational intervention. The median time interval of onset to door (O2D) decreased from 109.5 to 71 minutes and that of door to recanalization (D2R) decreased from 164 to 88 minutes following the educational intervention. Other performance time indicators were also notably reduced. This improvement of time indicators was observed gradually and annually. Conclusion: This study showed that the continuous monthly education on stroke care to EMS members notably increased the number of EMS-transported patients as well as improved the performance time indicators till treatment in acute ischemic stroke.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/jnet.oa.2019-0031
Keisuke Sato, Yasushi Ito, H. Hasegawa, Tsutomu Kobayashi, H. Aoki, Shinya Jinguji, Y. Fujii
Objective: We show our experiences with the use of a 6Fr Cerulean DD6 (Medikit, Tokyo, Japan) catheter and represent the availability of DD6. Methods: Between May 2017 and October 2018, we performed 19 neurointerventional procedures for 17 patients of anterior circulation aneurysms and two neurointerventional procedures for two patients of posterior circulation aneurysms. We validated the results of the procedures with DD6 such as the techniques of coil embolization, the positions of DD6, the related complications, the kickbacks of DD6, and so on. Results: In all cases, we succeeded with the placement of DD6 and there were no related complications and kickbacks of DD6. The positions of DD6 were C3 in six cases, C4 in 8, C5 in 5, V3 in 1, and V4 in 1. Of all procedures, 12 were performed with the balloon assist technique, 5 were with the stent assist technique, and 4 were with the simple technique. Conclusion: Utilizing DD6, the access difficulty of cervical vessels is apparently reduced and the maneuvers of microcatheters can be made much safer and more reliable for neurointerventional procedures.
{"title":"Verification of the Availability of Cerulean DD6","authors":"Keisuke Sato, Yasushi Ito, H. Hasegawa, Tsutomu Kobayashi, H. Aoki, Shinya Jinguji, Y. Fujii","doi":"10.5797/jnet.oa.2019-0031","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0031","url":null,"abstract":"Objective: We show our experiences with the use of a 6Fr Cerulean DD6 (Medikit, Tokyo, Japan) catheter and represent the availability of DD6. Methods: Between May 2017 and October 2018, we performed 19 neurointerventional procedures for 17 patients of anterior circulation aneurysms and two neurointerventional procedures for two patients of posterior circulation aneurysms. We validated the results of the procedures with DD6 such as the techniques of coil embolization, the positions of DD6, the related complications, the kickbacks of DD6, and so on. Results: In all cases, we succeeded with the placement of DD6 and there were no related complications and kickbacks of DD6. The positions of DD6 were C3 in six cases, C4 in 8, C5 in 5, V3 in 1, and V4 in 1. Of all procedures, 12 were performed with the balloon assist technique, 5 were with the stent assist technique, and 4 were with the simple technique. Conclusion: Utilizing DD6, the access difficulty of cervical vessels is apparently reduced and the maneuvers of microcatheters can be made much safer and more reliable for neurointerventional procedures.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/JNET.CR.2018-0076
Osamu Ishikawa, K. Tsutsumi, M. Shojima, Gakushi Yoshikawa, A. Saito, Sho Tsunoda, Katsuya Sato, Takaki Omura, N. Saito
Objective: We report a patient in whom a devised stent-assisted internal trapping was effective to eliminate the mass effect of a symptomatic giant vertebral artery (VA) aneurysm. Case Presentation: A 63-year-old female. Detailed examination of gait disorder showed a brainstem-compressing, nonthrombotic, giant, fusiform aneurysm at an area distal to the posterior inferior cerebellar artery (PICA) bifurcation of the left VA. Endovascular internal trapping was planned, but the exacerbation of mass effects related to the coils inserted into the aneurysm cavity was concerned. Thus, before the usual internal trapping procedure, a self-expanding stent was deployed across the aneurysm to limit the coils in the stent during the internal trapping procedure. Six months later, the aneurysm decreased markedly in size with a complete relief of neurological symptom. Conclusion: Our devised stent-assisted internal trapping method, coiling-in bridging-stent technique, was successful to exclude a symptomatic giant VA aneurysm from the circulation with a minimum amount of coil in the aneurysm cavity. With this method, marked decrease in size could be expected since coils would not interfere with the shrinkage of the aneurysm. This method would be useful in giant cerebral aneurysms which need endovascular internal trapping.
{"title":"Internal Trapping of a Symptomatic Unruptured Giant Vertebral Artery Aneurysm Using the Coiling-in-bridging-stent Technique: A Case Report","authors":"Osamu Ishikawa, K. Tsutsumi, M. Shojima, Gakushi Yoshikawa, A. Saito, Sho Tsunoda, Katsuya Sato, Takaki Omura, N. Saito","doi":"10.5797/JNET.CR.2018-0076","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0076","url":null,"abstract":"Objective: We report a patient in whom a devised stent-assisted internal trapping was effective to eliminate the mass effect of a symptomatic giant vertebral artery (VA) aneurysm. Case Presentation: A 63-year-old female. Detailed examination of gait disorder showed a brainstem-compressing, nonthrombotic, giant, fusiform aneurysm at an area distal to the posterior inferior cerebellar artery (PICA) bifurcation of the left VA. Endovascular internal trapping was planned, but the exacerbation of mass effects related to the coils inserted into the aneurysm cavity was concerned. Thus, before the usual internal trapping procedure, a self-expanding stent was deployed across the aneurysm to limit the coils in the stent during the internal trapping procedure. Six months later, the aneurysm decreased markedly in size with a complete relief of neurological symptom. Conclusion: Our devised stent-assisted internal trapping method, coiling-in bridging-stent technique, was successful to exclude a symptomatic giant VA aneurysm from the circulation with a minimum amount of coil in the aneurysm cavity. With this method, marked decrease in size could be expected since coils would not interfere with the shrinkage of the aneurysm. This method would be useful in giant cerebral aneurysms which need endovascular internal trapping.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.5797/JNET.OA.2018-0078
T. Kanamaru, S. Yoshimura, Toshinori Takagi, Mikiya Beppu, K. Kimura
Objective: Antiplatelet drugs are frequently used to prevent ischemic complications of endovascular therapy, but patients who showed poor responses to these drugs have been reported. We have adjusted antiplatelet drugs based on platelet aggregation activity before endovascular therapy. The objective of this study was to investigate the association between platelet aggregation test-based modification of antiplatelet drugs and perioperative complications. Methods: In this study, we enrolled 146 patients who received elective endovascular therapy between October 2015 and December 2016. All patients received administration of aspirin 100 mg and clopidogrel 75 mg from 2 weeks before endovascular therapy and platelet aggregation activity was measured 1–2 days before the procedure. Cilostazol was additionally administered to patients who poorly responded to aspirin, or the drug was switched to prasugrel in patients who poorly responded to clopidogrel. Thereafter, platelet aggregation activity was re-tested on the following morning. Results: On the initial test, 52 (35.6%) and 57 (39.0%) patients showed poor responses to aspirin and clopidogrel, respectively, and these rates were higher than those previously reported. After antiplatelet drug modification, 31 (21.2%) and 20 (13.7%) patients showed poor responses to aspirin and clopidogrel, respectively, showing significant decreases (p = 0.012 and <0.0001, respectively). Perioperative ischemic complication developed in five patients (3.4%), being lower than that (4.6%) previously reported. Conclusion: The rate of patients with poor responses to antiplatelet drugs on the platelet aggregation test was higher than those previously reported, but their responses were improved by drug modification. Platelet aggregation test-based drug modification may be effective to prevent perioperative complications and further investigation is necessary.
{"title":"Preliminary Experience of Preoperative Modification of Platelet Aggregation","authors":"T. Kanamaru, S. Yoshimura, Toshinori Takagi, Mikiya Beppu, K. Kimura","doi":"10.5797/JNET.OA.2018-0078","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0078","url":null,"abstract":"Objective: Antiplatelet drugs are frequently used to prevent ischemic complications of endovascular therapy, but patients who showed poor responses to these drugs have been reported. We have adjusted antiplatelet drugs based on platelet aggregation activity before endovascular therapy. The objective of this study was to investigate the association between platelet aggregation test-based modification of antiplatelet drugs and perioperative complications. Methods: In this study, we enrolled 146 patients who received elective endovascular therapy between October 2015 and December 2016. All patients received administration of aspirin 100 mg and clopidogrel 75 mg from 2 weeks before endovascular therapy and platelet aggregation activity was measured 1–2 days before the procedure. Cilostazol was additionally administered to patients who poorly responded to aspirin, or the drug was switched to prasugrel in patients who poorly responded to clopidogrel. Thereafter, platelet aggregation activity was re-tested on the following morning. Results: On the initial test, 52 (35.6%) and 57 (39.0%) patients showed poor responses to aspirin and clopidogrel, respectively, and these rates were higher than those previously reported. After antiplatelet drug modification, 31 (21.2%) and 20 (13.7%) patients showed poor responses to aspirin and clopidogrel, respectively, showing significant decreases (p = 0.012 and <0.0001, respectively). Perioperative ischemic complication developed in five patients (3.4%), being lower than that (4.6%) previously reported. Conclusion: The rate of patients with poor responses to antiplatelet drugs on the platelet aggregation test was higher than those previously reported, but their responses were improved by drug modification. Platelet aggregation test-based drug modification may be effective to prevent perioperative complications and further investigation is necessary.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：