Publications by authors named "Yoshikazu Yoshino"

Background: Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography.

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Article Synopsis
  • Thromboembolism is a critical concern in patients undergoing endovascular treatment for ruptured cerebral aneurysms, and administering antiplatelet agents like aspirin before the procedure may lower this risk.
  • The study, called ASTOP, is a multicenter, randomized, double-blind trial involving 484 patients, comparing the effects of 200 mg of aspirin versus a placebo prior to treatment.
  • Primary outcomes will focus on measuring thromboembolic complications and ischemic lesions during the procedure, while secondary outcomes will assess cerebral ischemic events, bleeding incidents, and patient functional status after 90 days.
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 Predicting the shape of the occluded middle cerebral artery (MCA) from the contralateral MCA might help catheterization in endovascular mechanical thrombectomy (EMT).  We analyzed magnetic resonance (MR) angiography in 100 consecutive patients who had MR imaging for diseases other than acute ischemic stroke. To assess the symmetricity of MCA, the shape of M1, length of M1, number of M2, number of early branches (EBs), and distance from the top of the internal carotid artery to EB were investigated.

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Article Synopsis
  • The study examines clinical outcomes of two treatment options for distal anterior cerebral artery (DACA) aneurysms: microsurgery and endovascular treatment (EVT).
  • It analyzes data from 166 patients across 16 stroke centers, comparing the efficacy, complications, and recurrence rates of both treatments over a median follow-up of 15.3 months.
  • Findings suggest that while EVT may be a viable alternative to microsurgery, especially for unruptured aneurysms, it shows higher recurrence and retreatment rates, particularly in cases of ruptured aneurysms, highlighting the need for careful monitoring.
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  • - The study aimed to establish a method for predicting vascular access difficulty during mechanical thrombectomy by using a specific measurement called the distance from the sternum to the ascending aorta (S-AAD) from chest CT scans.
  • - Researchers analyzed data from 115 patients who underwent mechanical thrombectomy and found that a shorter S-AAD was significantly correlated with longer guiding times, indicating access difficulty.
  • - The findings suggest that a S-AAD of less than 5 mm is a strong predictor of challenging access, which can help clinicians choose better devices and approaches before the intervention.
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  • The study investigates the effectiveness of hybrid emergency room systems (HERSs) in treating acute ischemic stroke (AIS) by comparing them to conventional emergency care methods.
  • It analyzed data from 83 patients who received endovascular therapy, focusing on treatment timing and neurological outcomes after 30 days.
  • While HERS showed shorter treatment times (door-to-puncture and door-to-recanalization), there was no significant difference in the percentage of patients achieving favorable neurological outcomes between HERS and conventional groups.
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Aim: Assessing the indication for elective neuro-endovascular treatment (EVT) in older patients requires consideration of the impact of systemic comorbidities on their overall reduced life expectancy. The objective of this study was to determine the long-term outcomes of elective neuro-EVT in patients aged ≥80 years, and to investigate the impact of pre-existing cancer on their long-term outcomes.

Methods: Of the patients enrolled in multicenter observational registry, those aged ≥80 years undergoing elective neuro-EVT between 2011 and 2020 were enrolled.

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Background: Postoperative cerebral embolic stroke is a serious complication of pulmonary lobectomy, occurring in 1.1% of patients undergoing lobectomy through video-assisted thoracoscopic surgery (VATS). The mechanism of this complication is thought to be embolic stroke caused by thrombus formed due to stagnation in the pulmonary vein stump after VATS lobectomy.

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A 68-year-old man received hemodialysis (HD) for the treatment of end-stage renal failure for 6 years. Five years prior to carotid artery stenting (CAS), a neck ultrasound performed to screen for carotid atherosclerosis revealed an asymptomatic right internal carotid artery stenosis. One month prior, the stenotic lesion progressed to 74% by cerebral angiography; therefore, CAS was performed.

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A flow-diverter (FD) device is a well-established tool for the treatment of unruptured intracranial aneurysms. Time-of-flight (TOF) MR angiography (MRA) is widely used for postoperative assessment after the treatment with FD; however, it cannot fully visualize intra-aneurysmal and intrastent flow signals due to the magnetic susceptibility from the FD. Recently, the utility of MRA with ultra-short TE (UTE) sequence and arterial spin labeling technique in assessing the therapeutic efficacy of intracranial aneurysms treated with metallic devices has been reported, but long image acquisition time is one of the drawbacks of this method.

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Objective: We report a patient with chronic headache due to idiopathic intracranial hypertension (IIH) associated with transverse sinus (TS) stenosis. The symptom improved after stent placement at the site of stenosis.

Case Presentation: The patient was a 37-year-old woman with progressive headache and diplopia as chief complaints.

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Acute ischemic stroke (AIS) caused by major vessel occlusion has potentially poor outcomes. Early successful recanalization after symptom onset is an important factor for favorable outcomes of AIS. We present the case of a 74-year-old man with AIS who underwent the entire process from diagnosis to thrombolysis and endovascular treatment in a hybrid emergency room (ER) equipped with a multidetector computed tomography (CT) scanner and an angiography suite set-up.

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Many neuroendovascular treatments are supported by real-time anatomical and visual hemodynamic assessments through digital subtraction angiography (DSA). Here we used DSA in a single-center prospective randomized crossover study to assess the intracranial hemodynamics of patients undergoing coiling for cerebral aneurysm (n = 15) during sevoflurane- and propofol-based anesthesia. Color-coded DSA was used to define time to peak density of contrast medium (TTP) at several intravascular regions of interest (ROIs).

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We describe the case of a 75-year-old man with pharyngeal hemorrhage caused by a pseudoaneurysm of the lingual artery after accidentally swallowing his dentures. He developed sudden oral and nasal hemorrhage and was transported to a hospital near his residence. The doctors at the hospital diagnosed the case as epistaxis and treated the symptom with nasal packing.

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Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization.

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Objective: This report presents 12 consecutively managed patients with aneurysmal subarachnoid hemorrhage (SAH) associated with acute subdural hematoma (ASDH) who underwent decompressive craniectomy (DC) with special attention to their clinical characteristics and surgical outcomes.

Methods: We retrospectively reviewed medical charts, radiologic findings, surgical notes, and video records.

Results: Among these 12 patients (mean age 59.

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Hypereosinophilic syndrome (HES) is a rare disorder that can cause ischemic stroke. We present a patient with middle cerebral artery (MCA) occlusion resulting from HES. Transarterial thrombolysis resulted in MCA recanalization and adjuvant therapy may have contributed to stabilization of the underlying HES in our patient.

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Computed tomography (CT) is an important tool for the evaluation of subarachnoid hemorrhages caused by ruptured aneurysms. However, an unusual radiologic presentation of blood can result in the misdiagnosis of the rupture site. We report a case of ruptured right internal carotid-posterior communicating (IC-PC) artery aneurysm with an unusual radiologic presentation of hemorrhage.

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Epstein-Barr virus (EBV) encephalitis is a rare neurological complication, usually only reported in pediatric patients. We present a 20-year-old, previously healthy male who developed hemorrhagic encephalitis caused by EBV. He was admitted to our hospital with a 1-week history of fever, diarrhea, headache, and confusion.

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Purpose: Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy.

Methods: Twelve patients underwent bilateral decompressive craniectomy among 217 individuals who had been treated with decompressive craniectomy with dural expansion from September 1995 to August 2006.

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Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling.

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Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four.

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A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion.

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