Publications by authors named "Muneaki Kikuno"
Article Synopsis
- Preoperative embolization for vestibular schwannomas has unclear efficacy, but this study focuses on using only external carotid artery (ECA) feeding arteries to minimize complications associated with other artery embolization.
- The analysis included 15 patients from a larger group of 805 who underwent tumor removal, showing a significant average tumor volume reduction of 15.3% after ECA embolization.
- Results indicate that embolization of ECA feeding arteries is an effective method for reducing tumor size and potentially lowering blood loss during surgery, with measurable effects observed within just a few days post-procedure.
Article Synopsis
- * Various dilutions were tested in vitro, revealing that 20-fold or higher dilutions of Embosphere 300-500 μm and 30-fold or higher dilutions of Embosphere 500-700 μm resulted in no catheter occlusion or microsphere breakage.
- * In clinical practice with 107 patients, using a 30-fold dilution for 300-500 μm and a 60-fold dilution for 500-700 μm proved to be effective and safe, showing reduced enhancement in MRI for 69
Overview and Future Direction of Embolic Stroke of Undetermined Source from the Insights of CHALLENGE ESUS/CS Registry.
J Atheroscler Thromb
December 2024
Article Synopsis
- * The CHALLENGE ESUS/CS registry, involving 455 patients in Japan, is revealing important details about the origins and mechanisms of embolic strokes through transesophageal echocardiography (TEE).
- * This review covers the diagnosis and management of embolic stroke of undetermined source (ESUS) and CS, incorporating key findings from the CHALLENGE registry to highlight future directions in research and treatment.
Article Synopsis
- * He experienced a hyperacute embolism in his left middle cerebral artery, leading to a mechanical thrombectomy, where the emboli were determined to be MPNST tumor cells.
- * Tragically, he passed away 15 days into his hospitalization due to respiratory failure caused by lung metastasis from the MPNST, marking the first known case of spontaneous cerebral embolism from MPNST in an NF-1 patient.
High-risk patent foramen ovale and elderly in cryptogenic stroke.
J Stroke Cerebrovasc Dis
November 2023
Background: High-risk patent foramen ovale (PFO) could be pathological in cryptogenic stroke (CS), but its clinical characteristics have not been fully studied, especially in elderly patients.
Methods: Patients with CS were enrolled in the CHALLENGE ESUS/CS registry, a multicenter registry of CS patients undergoing transesophageal echocardiography. Clinical characteristics were compared among three groups: high-risk PFO group, large shunt PFO (≥25 microbubbles) or PFO with atrial septal aneurysm (ASA); right-to-left shunt (RLS) group, RLS including PFO with <25 microbubbles or without ASA; and no-RLS group.
Aim: Various embolic sources and pathogenetic mechanisms underlie cryptogenic stroke (CS). We investigated the association of etiological diversity with short-term outcomes in patients with CS using a modified atherosclerosis (A), small-vessel disease (S), cardiac pathology (C), other causes (O), and dissection (D) (ASCOD) system.
Methods: Patients with CS who underwent transesophageal echocardiography were registered in this multicenter, observational study.
Background Cerebrovascular diseases are common comorbidities in patients with cancer. Although active cancer causes ischemic stroke by multiple pathological conditions, including thromboembolism attributable to Trousseau syndrome, the relationship between stroke and inactive cancer is poorly known. The aim of this study was to elucidate the different underlying pathogeneses of cryptogenic stroke in active and inactive patients with cancer, with detailed investigation by transesophageal echocardiography.
View Article and Find Full Text PDFObjective: Some cardiac abnormalities could be a substrate for potential embolic source in cryptogenic stroke (CS). We evaluated whether cardiac and echocardiographic markers were associated with CS in patients with incidental patent foramen ovale (PFO) as defined using the Risk of Paradoxical Embolism (RoPE) score.
Materials And Methods: Among 677 patients enrolled in a multicenter observational CS registry, 300 patients (44%) had PFOs detected by transesophageal echocardiography.
Article Synopsis
- Insertable cardiac monitoring (ICM) is enhancing the ability to detect atrial fibrillation (AF) in patients who have suffered a cryptogenic stroke during hospitalization.
- In a study involving 677 patients, researchers found that 64 developed AF, with an important distinction made between early detection (within 4 days) and late detection (after 4 days).
- Factors such as spontaneous echo contrast (SEC) were linked to early AF detection, while larger infarctions were associated with later AF detection, highlighting their potential as indicators for recommending ICM use.
We present a case of a patient who survived carotid blowout syndrome(CBS)due to covered stent placement, but bled again 34 days later. A 67-year-old man with laryngeal cancer experienced cardiac arrest due to carotid blowout a day after he underwent the balloon occlusion test and abnormal feeder embolization of the tumor. After quick resuscitation, he was treated with endovascular therapy using a covered stent, since he had insufficient cerebral ischemic tolerance.
View Article and Find Full Text PDFArticle Synopsis
- This study investigated the effectiveness of 7-day Holter monitoring in detecting covert atrial fibrillation (AF) in patients who recently experienced an embolic stroke of undetermined source (ESUS).
- A total of 206 ESUS patients underwent Holter monitoring, revealing a 6.8% detection rate of AF, with specific biomarkers correlating with higher detection rates.
- Key predictive biomarkers included serum brain natriuretic peptide levels and counts of atrial premature contractions, both of which were consistently associated with AF detection in both the primary and validation cohorts.
Article Synopsis
- - The study investigated the role of atrial septal aneurysm (ASA) in patients experiencing cryptogenic stroke to better understand their clinical characteristics and recurrence rates during hospitalization.
- - In a multicenter observational registry with 671 patients, ASA was found in 14% of cases; these patients were generally older and had a lower prevalence of diabetes, along with a higher incidence of right-to-left shunts and in-hospital stroke recurrence.
- - The findings suggest that ASA is a significant factor in cryptogenic strokes, potentially linked to increased chances of stroke recurrence during hospitalization, highlighting the need for more focus on ASA in clinical evaluations.
Background: Cryptogenic stroke encompasses diverse emboligenic mechanisms and pathogeneses. Cerebral microbleeds (CMBs) occur differently among stroke subtypes. The association of CMBs with cryptogenic stroke is essentially unknown.
View Article and Find Full Text PDFBackground And Aims: Current trends have suggested covert atrial fibrillation as a mechanism of cryptogenic stroke. However, etiological heterogeneity regarding the underlying embolic sources remains a critical issue in cryptogenic stroke.
Methods: CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for Embolic Stroke of Undetermined Source/Cryptogenic Stroke) is a multicenter observational registry of cryptogenic stroke patients admitted to participating hospitals, who underwent transesophageal echocardiography between April 2014 and December 2016.
A 31-year-old man with Duchenne muscular dystrophy was admitted to our center, having infarctions in bilateral cerebral hemispheres and an occluded right middle cerebral artery. His right middle cerebral artery was spontaneous recanalization on the next day, and thrombus in the left ventricle vanished on the eighth day after giving warfarin.
View Article and Find Full Text PDFArticle Synopsis
- A 74-year-old man with a history of heart issues and a previous stroke was admitted with speech difficulties and was found to have an acute ischemic stroke in the cerebellum and left occipital lobe.
- He was initially treated with warfarin and heparin due to a thrombus in his left atrial appendage, but the therapy was switched to apixaban when the thrombus increased in size.
- Following a hemorrhagic stroke on day 17, he continued treatment with warfarin until the thrombus resolved, and a thoracoscopic left atrial appendectomy was performed to prevent future strokes, with no recurrence since then.
Article Synopsis
- Pneumonia is a common complication after stroke, and a study compared its incidence and risk factors between two hospitals: one in Japan and one in Indonesia.
- The study involved 210 patients, with findings showing a significantly higher incidence of stroke-associated pneumonia (SAP) at the Indonesian hospital (22.9%) compared to the Japanese hospital (12.4%).
- Key risk factors for developing SAP included dysphagia and severe neurological deficits, which were significant in both hospitals' analyses.