Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in Neuroendovascular Procedures.

 In neuroendovascular treatment, there are many opportunities to guide multiple catheters into the intracranial blood vessels. We report the relationship between two microcatheters according to the guiding order with experimental in vitro studies.  We hypothesize that in a bent blood vessel such as a paraclinoid region of the internal carotid artery, the catheter that was first guided tended to pass through the inside, and the catheter that was guided later tended to pass through the outside.

A Novel Training Method for Endovascular Clot Retrieval Using a Portable Vascular Model and Red Film.

Hands-on training is a crucial part of education in neuroendovascular treatment to ensure safe and rapid acquisition of techniques. However, there is a significant gap between training and actual clinical practice. This study will introduce innovations for more practical thrombus retrieval training that was developed in this process.

Relationship between Shape Retention and X-ray Absorption Value of the Tip of Microcatheters in Neuroendovascular Treatment.

 We noticed that the X-ray absorption value of the tip of each microcatheter used for aneurysm treatment varied from product to product. We hypothesized that the differences were caused by variations in the metal's density braid, which could be related to the ability of the tip to retain its shape.  The X-ray absorption value of each microcatheter tip was measured.

Hairball-Like Migration of "Onyx Threads" into the Draining Vein during Transarterial Embolization of a Dural Arteriovenous Fistula: A Case Report and Experimental Validation.

Transarterial embolization using Onyx is a well-established treatment for dural arteriovenous fistulas (DAVFs). However, complications can arise when Onyx migrates into the venous side, impairing the draining veins. We encountered a case where Onyx, injected through the arterial side, strayed into the jugular vein, forming a hairball-like structure.

Influence of dosing pattern of antipsychotics on treatment outcome of delirium in patients with advanced cancer.

Background: Clinical guidelines recommend antipsychotics for the treatment of delirium; however, there has been no confirmed recommendation regarding their administrating patterns. This study aims to investigate whether different dosing patterns of antipsychotics (single or multiple administrations) influence the outcomes of delirium treatment.

Methods: This is a secondary analysis of a prospective observational study involving patients with advanced cancer and delirium receiving antipsychotics.

Persistent representation of the environment in the hippocampus.

In the hippocampus, environmental changes elicit rearrangement of active neuronal ensembles or remapping of place cells. However, it remains elusive how the brain ensures a consistent representation of a certain environment itself despite salient events occurring there. Here, we longitudinally tracked calcium dynamics of dorsal hippocampal CA1 neurons in mice subjected to contextual fear conditioning and extinction training.

A Novel Approach to Neuroendovascular Treatment Looking Up from the Ascending Aorta Using an Alpha Shape Guiding Catheter.

Background: A method of guiding an intermediate catheter from a new alpha-type guiding catheter placed in the ascending aorta to the carotid artery is evaluated in neuroendovascular treatment in challenging anatomic directions of the guiding catheter, such as the bovine aortic arch and type III aortic arch.

Methods: The existing 8-Fr guiding catheter was given a strong bending shape at the tip to make it an alpha type. The total length of the catheter was 85 cm.

Usefulness of a Curved Multiple Reconstruction Image for Transarterial Intravenous Coil Embolization of a Dural Arteriovenous Fistula of the Sphenobasal Vein: A Case Report.

Hemorrhagic isolated dural arteriovenous fistulas (DAVFs) are often challenging to treat. Here, we report a case of the lateral cavernous sinus (CS) DAVF successfully treated by transarterial intravenous coil embolization using a curved multiplanar reconstruction (MPR) image assistance. A 54-year-old man presented with a severe headache and was diagnosed with subarachnoid hemorrhage caused by CSDAVF.

A novel remote hands-on training for neuroendovascular-based treatment in the era of the COVID-19 pandemic.

The COVID-19 pandemic has demanded a change in learning modalities, which led us to develop a remote personal training system for clinicians performing neuroendovascular procedures. A portable vascular model designed for practicing catheter navigation guidance, thrombus retrieval, and intracranial aneurysm coil embolisation was established. We created an environment that enabled interactive dialogue and communication across long distances using the Internet.

The Impact of Aging on Symptom Prevalence and Management in Terminally ill Patients With Cancer.

Context: With global population aging, the number of older patients with cancer is increasing. However, few data are available on palliative care for these patients.

Objectives: To evaluate differences in symptom prevalence and the need for medical interventions among patients of different ages in a palliative care unit.

Safety and Effectiveness of a Modified ASAP Technique during Mechanical Thrombectomy for Acute Ischemic Stroke: Initial Clinical Experience.

Objectives: For patients with acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best technique for the first attempt at mechanical thrombectomy remains a matter of debate. In this study, we evaluated the efficacy of a modified version of a stent-retrieving into an aspiration catheter with a proximal balloon (ASAP) technique.

Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages.

Purpose: We investigated the age distribution of cerebral saccular aneurysms in various locations to clarify the differences by location and discuss the mechanism of formation.

Materials And Methods: We retrospectively assessed clinical material obtained from 1,252 unruptured aneurysms treated with endovascular embolization between 2004 and 2019. Age, sex, laterality, and size were investigated by the location of aneurysms, classified as cavernous internal carotid artery (ICA), paraclinoid ICA, supraclinoid ICA, anterior communicating artery, anterior cerebral artery, middle cerebral artery, basilar artery complex, and posterior inferior cerebellar artery.

Pull the Trigger Sign: A Novel Method to Identify the Clot Position during Acute Endovascular Thrombectomy.

Objective: Accurately determining the clot position is highly important for immediate recanalization when endovascular mechanical thrombectomy is performed using a stent retriever and aspiration catheter. We describe a new method that facilitates the precise identification of the clot position called pull the trigger sign (PTS).

Case Presentation: Selective angiography was performed through a 0.

Initial Clinical Experience of Using a Newly Designed Preshaped Microguidewire in Acute Endovascular Thrombectomy.

Mechanical thrombectomy has been widely used for the treatment of acute ischemic stroke. During this procedure, operators must navigate the microcatheter with a microguidewire (MGW) into vessels that cannot be visualized on fluoroscopy as rapidly as possible. In this study, we developed a modified pigtail-shaped MGW (MPMGW) for security and controllability.

Novel Technique for Detection of Actual Position of Clot During Endovascular Clot Retrieval: Assessment of Microcatheter Withdrawing Angiography.

Background: When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitates the identification of the precise position of a clot. The negative shadow appearance of the clot on angiography was referred to as the actual crab claw sign.

Experimental Evaluation of Stent Clot Retrieval Using the Confront Clot Scrambling Method with an Equitable Automatic Withdrawal Machine.

Background: Stent clot retrievers can be used to perform mechanical thrombectomies to treat cases of acute major arterial occlusion. This approach is associated with faster recanalization and better outcomes than internal treatments. The function of the stent retrievers is based on a technique known as confront clot scrambling method (CCSM), which usually involves the insertion of two stent retrievers (one from each side) and the simultaneous withdrawal of the retrievers with an equal force.

A Novel Technique for Stent-Assisted Coil Embolization of Intracranial Aneurysms: The Wireless Trans-Cell Approach.

Background: When inserting coils under stent deployment, a jailed microcatheter technique is typically applied as a first line approach. However, the trans cell approach might be required to achieve satisfactory complete occlusion. The trans cell approach occasionally ends in failure because the catheter cannot safely follow a proceeding guidewire into the aneurysm.

Variegatic acid from the edible mushroom Tylopilus ballouii inhibits TNF-α production and PKCβ1 activity in leukemia cells.

Variegatic acid, isolated from Tylopilus ballouii dry fruiting bodies, is an inhibitor of β-hexosaminidase release and tumor necrosis factor (TNF)-α secretion from rat basophilic leukemia (RBL-2H3) cells, with IC values of 10.4 μM and 16.8 μM, respectively.

How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study.

Purpose: Parenteral morphine is widely used for dyspnea of imminently dying cancer patients, but the outcomes to expect over time remain largely unknown. We examined outcomes after the administration of parenteral morphine infusion over 48 h in cancer patients with a poor performance status.

Methods: This was a multicenter prospective observational study.

Efficacy of Endovascular Proximal Occlusion before Direct Reposition Surgery of Blunt Cervical Fracture with Unilateral Vertebral Injury.

Cerebral infarction related to traumatic vertebral artery (VA) injuries is not common. However, if VA injuries cause ischemic and/or hemorrhage stroke, these subsequent problems can result in severe residual impairment and mortality. Herein, we present five patients with cervical vertebra fractures due to blunt cervical trauma who underwent preoperative endovascular therapy.

A Multicenter Cohort Study to Explore Differentiating Factors between Tumor Fever and Infection among Advanced Cancer Patients.

Tumor fever and infection are common febrile etiologies among advanced cancer patients. To date, only few studies have been conducted to differentiate between tumor fever and infections. This study aimed to identify discriminating factors that provide rapid results and are feasible and minimally invasive for discriminating between tumor fever and infection in advanced cancer patients.

Efficacy and Safety of a Modified Pigtail-Shaped Microguidewire during Endovascular Thrombectomy.

A 75-year-old man presented with right-sided hemiplegia and was diagnosed with a left middle cerebral artery occlusion. He underwent endovascular thrombectomy, and a bulge was found. A modified pigtail-shaped microguidewire (MPMGW) proved useful for diagnosis because it allowed differentiation between the occluded artery and a saccular aneurysm as the etiology.

Precautions for using a Filter Protection Device with a Flow Reversal Method during Carotid Artery Stenting: A Case Report on In-Filter Thrombus.

The combination of a flow reversal with two balloons and a filter protection device is one of the safest methods that can be used during carotid artery stenting (CAS). Although major adverse events did not occur under restrict protection, we experienced a case of in-filter thrombus during the procedure. A 68-year-old male presented with temporary right hemiparesis.

A Novel Technique for Microcatheter Additional Shaping During Intracranial Aneurysmal Coil Embolization: Microcatheter Shaping Cast.

Background: When a shaping mandrel is inserted into the tip of a preshaped microcatheter, the existing curve becomes uncertain because the tip is straightened by the inner mandrel. Therefore, we developed a way to perform microcatheter shaping by means of an external cast, which we named "microcatheter shaping cast."

Techniques: A shaping mandrel attached to a microcatheter was used and coiled 4-5 times around a metallic introducer, which was attached using a microguidewire.