Difficult 6F Guiding Sheath Removal Using the Transradial Artery Approach: A Case Report.

Objective: Recently, the use of the radial artery approach for neuroendovascular treatment has become more frequent. The main advantage of this approach is that there is a low complication risk. However, in the aforementioned case, the 6F guiding sheath proved difficult to remove from the radial artery.

Cerebrospinal Fluid CSF Flow Artifacts are Associated with Brain Pulsation in Patients with Severe Carotid Artery Stenoses.

Objective: We investigated the factors associated with cerebrospinal fluid (CSF) flow artifacts on fluid-attenuated inversion recovery imaging in patients with carotid artery (CA) stenosis.

Methods: Each CSF artifact grade was defined by comparing the highest intensity in a given region of interest (ROI) to those in reference ROIs, as follows: higher than the intensity of normal white matter in the centrum semiovale = 2 points; equal to or less than the white matter, and higher than CSF = 1 point; and equal to CSF = 0. CSF flow scores in eight sites were measured and added to the total score (0 -16).

Safety of Apixaban Monotherapy for Non-Valvular Atrial Fibrillation-Related Acute Stroke with Intra-/Extracranial Artery Stenosis.

Introduction: We investigated whether apixaban is safe for the prevention of further adverse events in non-valvular atrial fibrillation (NVAF) patients with intra-/extracranial artery stenosis (Stenosis group) compared with acute large vessel occlusion without intra-/extracranial artery stenosis (No stenosis group). We also examined whether combination therapy using apixaban and antiplatelet is safe.

Methods: ALVO (Apixaban on clinical outcome of patients with Large Vessel Occlusion [LVO] or stenosis) was a historical and prospective multicenter registry at 38 centers in Japan.

Asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery stenoses.

Background And Purpose: Small vessel diseases (SVDs) are often asymptomatic. However, SVDs significantly influence the prognosis in patients with large vessel diseases (LVDs). We investigated asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery (CA) stenoses, compared to peoples without a past history of neurological disorders, including strokes.

Reperfusion Therapy Brings Apixaban Administration Forward in Patients with Nonvalvular Arterial Fibrillation with Anterior Circulation Large Vessel Occlusion or Stenosis.

Objective: The initiation of anticoagulant administration after large vessel occlusion (LVO) or stenosis with nonvalvular arterial fibrillation (NAVF) is controversial. We evaluate the timing of anticoagulation and its relationship with clinical factors.

Methods: We enrolled 595 anterior circulation LVO or stenosis with NAVF cases from 38 stroke centers.

Elongated Internal Carotid Arteries in Patients with Severe Carotid Artery Stenosis.

Objective: This study aimed to investigate the risk factors and asymptomatic cerebrovascular diseases associated with elongated internal carotid arteries (ICAs) and the relationship between ICA elongation and severe carotid artery (CA) stenosis.

Methods: We evaluated risk factors for stroke and magnetic resonance imaging (MRI) findings in patients with severe CA stenosis compared with people without neurological disorders who underwent brain screening (controls). On magnetic resonance angiography (MRA) images, we measured the longest distance, defined as the ICA distance, from the most distant anterior wall of the cervical ICA at the site of bending or kinking to the line between the origin of the external CA and the anterior protrusion of the ICA near the petrosal bone.

Virtual test occlusion for assessing ischemic tolerance using computational fluid dynamics.

Background: Ischemic tolerance has been evaluated by the balloon test occlusion (BTO) for cerebral aneurysms and tumors that might require parent artery occlusion during surgery. However, because of its invasiveness, a non-invasive evaluation method is needed. In this study, we assessed the possibility of virtual test occlusion using computational fluid dynamics (CFD) as a non-invasive alternative to BTO for evaluating ischemic tolerance.

Effect of prior antiplatelet therapy on large vessel occlusion in patients with non-valvular atrial fibrillation newly initiated on apixaban.

Introduction: We evaluated the effect of prior antiplatelet therapy on large vessel occlusion (LVO) in patients with non-valvular atrial fibrillation (NVAF) newly initiated on apixaban.

Methods: Patients with acute LVO with acute stroke due to NVAF or stenosis with NVAF started on apixaban within 14 days of onset were enrolled. We compared incidence of major bleeding, cerebral hemorrhage, ischemic events, cerebral infarction, and all-cause mortality between patients with and without prior antiplatelet therapy for acute LVO.

Usefulness of Preoperative Simulation Using a Stereolithographic 3D Printer in Cerebral Aneurysm Coil Embolization.

Objective: We present a preoperative simulation of cerebral aneurysm coil embolization using a hollow model of cerebral blood vessels created by a stereolithography (SLA) 3D printer.

Case Presentation: The patient was a 66-year-old woman. During follow-up, coil embolization was planned for an expanding paraclinoid aneurysm.

Safety of Early Administration of Apixaban on Clinical Outcomes in Patients with Acute Large Vessel Occlusion.

Early administration of direct oral anticoagulants in patients with acute large vessel occlusion (LVO) and nonvalvular atrial fibrillation (NVAF) is a concern, as endovascular therapy (EVT) became highly utilized. We conducted a historical and prospective multicenter registry at 38 centers in Japan from July 2016 to February 2018. Patients aged ≥ 20 years with NVAF and acute LVO or stenosis who received apixaban within 14 days from onset were included.

[Development of Deep Venous Thrombosis Shortly after Neurological Surgery].

Little is known about the incidence and characteristics of deep venous thrombosis(DVT)developing shortly after neurological surgery. Lower extremity venous ultrasound scanning was performed before and after surgery, and retrospective data of 157 surgical cases, including endovascular surgery(42.0%), craniotomy(28.

Cerebral aneurysm neck diameter is an independent predictor of progressive occlusion after stent-assisted coiling.

Background: Some intracranial aneurysms treated by stent-assisted coiling (SAC) with incomplete occlusion undergo progressive occlusion (PO) during follow-up period. We analyzed the predictors for the occurrence of PO.

Methods: Among 74 cerebral aneurysms treated by SAC using the Enterprise or Neuroform stents from 2010 to 2015, we included 43 aneurysms with occlusion grade of neck remnant (NR, n = 36) or residual aneurysm (RA, n = 7) at the post-procedure.

Double balloon protection during carotid artery stenting for vulnerable carotid stenosis reduces the incidence of new brain lesions.

Background: The use of distal filter protection alone is associated with a high risk of ischemic complications when vulnerable carotid stenosis is treated by carotid artery stenting (CAS). Double balloon protection, a combination of distal balloon protection and proximal balloon occlusion, can be utilized. We assessed the outcome and complications of the double balloon protection method for vulnerable carotid stenosis.

Design of Synthetic Polymer Nanoparticles That Facilitate Resolubilization and Refolding of Aggregated Positively Charged Lysozyme.

Designed polymer hydrogel nanoparticles (NPs) capable of facilitating resolubilization and refolding of an aggregated protein, positively charged lysozyme, are prepared. NPs designed to interact strongly with denatured lysozyme and relatively weakly with native lysozyme, facilitated resolubilization and refolding of aggregated lysozyme. Such NPs could be prepared by copolymerizing optimized combinations and populations of functional monomers.

[Fundamental study of the energy subtraction process using a monochromatic image for computed tomography angiography after coil embolization of a cerebral aneurysm].

Coil-embolized cerebral aneurysms are difficult to evaluate using computed tomography (CT) angiography (CTA) due to artifacts caused by the coil devices. This study was conducted to assess the practicality of energy subtraction processing using monochromatic images obtained using CTA after coil embolization of a cerebral aneurysm. In this study, the changes in the CT value of the contrast agent and the coil were analyzed not only at varying monochromatic energy levels but also by energy subtraction processing.

[Strategy for the treatment of large-giant aneurysms in the cavernous portion of the internal carotid artery].

The treatment of a large-giant aneurysm in the cavernous portion of an internal carotid artery(ICA)requires occlusion of the ICA, with or without extracranial-intracranial(EC-IC)bypass surgery. Although a balloon occlusion test(BOT)is used to determine the need for bypass surgery and select the bypass type, the criteria are not well established. In this study, we retrospectively analyzed 10 consecutive patients(11 sides)with cavernous large and giant aneurysms treated during the past 8 years.

[Angiographic analysis of variations and anomalous origin of the anterior choroidal artery and posterior communicating artery].

Object: The anterior choroidal artery (AchoA) is a very important artery for neurosurgeons and neuroendovascular surgeons. In fact the AchoA not only supplies the ventricles but also has important branches to the diencephalon, mesencephalon and cerebrum and also supplies motor and visual pathways. Review of the cerebrovascular embryology explains this variability in the anatomy of the developing AchoA and posterior communicating artery (PcomA)- posterior cerebral artery (PCA) distributions.

Intravenous administration of mesenchymal stem cells derived from bone marrow after contusive spinal cord injury improves functional outcome.

Transplantation of mesenchymal stem cells (MSCs) derived from bone marrow has been shown to improve functional outcome in spinal cord injury (SCI). Systemic delivery of MSCs results in therapeutic benefits in a number of experimental central nervous system disorders. In the present study we intravenously administered rat MSCs derived from bone marrow at various time points after induction of a severe contusive SCI in rat to study their therapeutic effects.

Quantitative analysis of adverse events in neurosurgery.

Objective: : It is well recognized that the occurrence rate of adverse events related to surgical procedures is considerably high in neurosurgery compared with other specialties. The purpose of this study was to quantitatively determine the occurrence rate of adverse events related to surgery and endovascular intervention in neurosurgery.

Methods: A conference on adverse events related to treatments (morbidity and mortality conference) has been held every month for the past 2 years in our department.

Susceptibility-weighted magnetic resonance imaging for the detection of cerebral microhemorrhage in patients with traumatic brain injury.

The sensitivity of susceptibility-weighted magnetic resonance (MR) imaging was compared with conventional MR sequences, including T(2)*-weighted imaging, and computed tomography for the detection of cerebral hemorrhages in 15 patients with head injury. Susceptibility-weighted imaging detected a mean of 76+/-52 (total 1132) hypointense spotty lesions, compared to a mean of 21+/-19 (total 316) detected by T(2)*-weighted imaging (p<0.0001, paired t-test).

Reversible hyperintense lesion after balloon occlusion test.

We report a unique case of a reversible high signal intensity lesion observed on a magnetic resonance (MR) image accompanied by transient neurological deficits related to a balloon occlusion test. This abnormality was considered to be vasogenic edema caused by the disruption of the blood-brain barrier (BBB) due to a long history of uncontrolled hypertension and transient ischemia induced by the balloon occlusion test.

Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms.

Background: Clipping a paraclinoid aneurysm is difficult if the patient has a visual disturbance. Visual function sometimes deteriorates postoperatively for patients with a large aneurysm. In this study, we report the long-term follow-up of patients with visual impairments attributed to optic nerve compression when paraclinoid aneurysms are surgically treated.

Transorbital intracranial penetrating injury from impaling on an earpick.

An inebriated 86-year-old man impaled himself on a wooden earpick that penetrated through the superior orbital fissure into the prepontine cistern. The patient underwent surgery immediately by a lateral suboccipital approach, and the earpick was pulled out through the wound with control of hemorrhage from the cavernous sinus. He survived this event with no neurologic deficits apart from complete ipsilateral ophthalmoplegia and ptosis.