Publications by authors named "Yoshimura Shinichi"
Objective: Studies have demonstrated the effectiveness of hydrogel-coated coils (HGCs) to achieve the composite endpoint of decreased recanalization rates and greater safety. Herein, the authors aimed to assess the true ability of second-generation HGCs to prevent recanalization.
Methods: This randomized controlled study, the HYBRID (Hydrocoil Versus Bare Platinum Coil in Recanalization Imaging Data) trial, comparing HGCs with bare platinum coils (BPCs), was conducted in 43 Japanese institutions.
Article Synopsis
- Re-occlusion and thrombus formation after mechanical thrombectomy in stroke patients can lead to worse outcomes, but early antiplatelet therapy (APT) may help prevent these issues.
- Current guidelines recommend waiting to use APT after intravenous thrombolysis, which complicates treatment for large vessel occlusion strokes.
- A study of 164 patients in Japan suggests that starting APT early post-thrombolysis is safe, with no significant differences in hemorrhagic events or mortality compared to those who started APT later or not at all.
Article Synopsis
- The study examines treatment strategies for unruptured large/giant paraclinoid aneurysms in Japan, focusing on methods like coiling, clipping, parent artery occlusion (PAO), and flow diverters (FDs).
- Coiling was the most commonly used method for large aneurysms, while PAO was preferred for giant ones; all treatments showed high occlusion rates but had varying complications.
- The findings suggest that while all methods are effective, FDs emerge as the best option due to their high occlusion rate and lower complication and retreatment risks.
Article Synopsis
- The study investigated the effect of administering P2Y inhibitors during endovascular treatment (EVT) in patients with anterior circulation thrombosis due to acute ischemic stroke.
- Out of 242 patients analyzed, those who received P2Y inhibitors had a significantly higher rate of carotid artery stenting and better functional outcomes after 90 days compared to those who did not.
- The results showed that patients treated with P2Y inhibitors had an adjusted odds ratio of 6.65 for better outcomes, suggesting a strong positive association with the use of these medications.
Article Synopsis
- Transplantation of injury/ischemia-induced stem cells (iSCs) from post-stroke human brains has been shown to improve neurological functions in stroke-affected mice, although their effectiveness compared to mesenchymal stem cells (MSCs) remains uncertain.
- In experiments, both h-iSCs and h-MSCs were transplanted into mice, with results indicating that while both types activated neural stem/progenitor cells (NSPCs), h-iSCs led to greater improvements in a variety of behavioral tasks.
- Further analysis revealed that interactions between NSPCs and h-iSCs promoted the transdifferentiation toward functional neurons more effectively than interactions with h-MSCs, suggesting h-iSCs may
Background: Restenosis after carotid artery stenting (CAS) is associated with the risk of developing ischemic stroke. We aimed to evaluate the inhibitory effect of cilostazol addition on in-stent restenosis (ISR) in patients treated with CAS.
Methods: In a randomized, open-label, blind-end point trial, patients with symptomatic and asymptomatic carotid artery stenosis and scheduled for CAS were randomly assigned to adding cilostazol (50 or 100 mg, twice per day) on other antiplatelets from 3 days before CAS or not adding cilostazol.
Article Synopsis
- * A randomized trial in China involved 269 patients who were assigned to start antiplatelet therapy early (3 days post-surgery) or late (30 days post-surgery) to evaluate safety and effectiveness on major cardiovascular events.
- * The study, which involved patients mostly around 60 years old, aimed to measure occurrences of new major ischaemic events and intracranial bleeding within 90 days after surgery, and is officially registered under ClinicalTrials.gov number NCT04820972.
Background: Although endovascular therapy (EVT) is effective for large ischemic region strokes, the impact of hyperglycemia remains unclear.
Methods And Results: We analyzed data from the RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism-Japan Large Ischemic Core) trial, which randomized stroke patients with Alberta Stroke Program Early Computed Tomography Score of 3 to 5 to EVT versus medical management. Outcomes were compared among patients with normoglycemia (<140 mg/dL), moderate hyperglycemia (≥140, <180 mg/dL), and severe hyperglycemia (≥180 mg/dL) on admission.
Background: The duration of mechanical thrombectomy (MT) is a negative predictor of outcomes in acute ischemic stroke (AIS), yet the precise mechanisms are unclear. We investigated whether the placement of large-bore catheters intracranially reduces blood flow to the ischemic penumbra and diminishes the efficacy of MT.
Methods: We investigated the impact of different catheter sizes on flow through the intracranial circulation using an in vitro model.
Objectives: This study aimed to examine nationwide trends in acute stroke endovascular thrombectomy (EVT) following five pivotal trials in 2015 that established it as the 'standard of care'.
Methods: The Japanese Registry of NeuroEndovascular Therapy 4 was a nationwide retrospective study registering consecutive patients who underwent neurointervention by specialists certified by the Japanese Society for Neuroendovascular Therapy at 166 centers from January 2015 to December 2019. We extracted patients who underwent EVT, and analyzed the annual trends in baseline characteristics, revascularization procedures and outcomes.
O6-methylguanine DNA methyltransferase promoter methylation is an important clinical biomarker of newly diagnosed glioblastoma. Previous radiological studies using dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion have aimed to predict methylation status non-invasively in gliomas with radiological characteristics. The possibility of predicting methylation status using DSC-MRI perfusion with a radiological approach remains controversial.
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- Researchers aimed to create and validate a prediction score for futile recanalization (FR) in patients with low Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) who underwent endovascular thrombectomy (EVT) for large vessel occlusions (LVO).
- The study analyzed data from 219 patients with anterior circulation LVO and identified key predictors of FR, resulting in the development of the SNAP score, which considers factors like the site of occlusion and patient age.
- The SNAP score successfully predicted FR with an area under the curve of 0.79 in both training and validation cohorts, indicating its potential usefulness for guiding expectations in patients undergoing EVT for severe strokes.
Article Synopsis
- The study examines trends in antithrombotic therapy during neuroendovascular procedures in Japan, analyzing data from the JR-NET 4 registry covering 36,560 cases from 2015 to 2019.
- It found that the use of dual antiplatelet therapy (DAPT) significantly increased over the years, while monotherapy decreased; postprocedural anticoagulant therapy was notably discontinued.
- Additionally, complications related to ischemic events rose slightly, and the occurrence of severe adverse events was higher in patients receiving more extensive preprocedural therapy.
Article Synopsis
- This study evaluated the safety and effectiveness of the Versi Retriever for mechanical thrombectomy in patients suffering from acute ischemic stroke (AIS) at 10 hospitals in Japan.
- It involved 58 patients, showing that 62% achieved a good recovery (mRS 0-2) after 90 days, and 100% had successful blood flow restoration.
- The procedure had an 8% mortality rate within 90 days and a significant occurrence of intracranial hemorrhage, indicating that while effective, some risks are involved.
Article Synopsis
- The study compared outcomes and safety in patients aged ≥75 years versus those aged <75 years undergoing stent-assisted treatment for unruptured cerebral aneurysms, focusing on antiplatelet therapy.
- Among 632 patients, the primary outcomes (thromboembolic events, bleeding, or death) showed no significant differences between the two age groups, with similar rates of events over time.
- The findings suggest that age alone should not be a strict criterion against stent-assisted treatment for unruptured aneurysms.
We report a case with paretic focal hand dystonia, which at first glance was diagnosed as writer's cramp, with poor performance only when playing the guitar and writing but with increased muscle tension around the elbow rather than in the fingers and hands. The muscle tension was around the elbow and the pallidothalamic tract (PTT) was selected as the proximal muscle target with less permanent complications. During the operation, the PTT test electrical stimulation was impaired only for guitar playing, but not for other hand movements.
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- Endovascular therapy (EVT) is effective for treating acute large vessel occlusion (LVO), but some patients do not achieve successful recanalization, prompting this study.
- The research analyzed data from the RESCUE-Japan Registry 2, comparing outcomes of patients who had unsuccessful EVT to those who received no EVT, focusing on recovery and complications.
- Results indicated that patients with unsuccessful EVT had poorer recovery scores, increased mortality rates, and more frequent symptomatic intracranial hemorrhages compared to the no EVT group.
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.
Introduction: Spinal cord injury (SCI) leads to severe disabilities and remains a significant social and economic challenge. Despite advances in medical research, there are still no effective treatments for SCI. Human amnion-derived mesenchymal stem cells (hAMSCs) have shown potential due to their anti-inflammatory and neuroprotective effects.
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- Endovascular treatment (EVT) shows promise for addressing extracranial vertebral artery (VA) stenosis, but optimal procedures and efficacy are still unclear.
- A study analyzed data from 308 patients in Japan who underwent EVT, focusing on procedural success and outcomes at 30 days post-treatment.
- Results indicated a high procedural success rate (98%) and functional independence (80%) without significant differences based on type of treatment used, highlighting EVT's potential but also the need for additional research.
Background: A higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT techniques after a failed first pass on procedural and clinical outcomes.
Methods: This multicenter international study, conducted between January 2013 and December 2022, included patients undergoing EVT for anterior circulation LVO (internal carotid artery or M1 segments) with failed first pass recanalization.
Background And Objectives: This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset.
Methods: A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included.
Background Meige syndrome is a segmental dystonia affecting the head and neck, with bilateral blepharospasm as the primary symptom. First-line treatment typically involves Botox injections. For cases resistant to this treatment, bilateral deep brain stimulation of the globus pallidus internus (GPi) is considered.
View Article and Find Full Text PDFBackground And Objectives: Endovascular treatment (EVT) for medium vessel occlusion (MeVO) raises concern about hemorrhagic complications; however, its clinical impact has not been elucidated. Therefore, we investigated the association between intracranial hemorrhage (ICH) after EVT for MeVO and functional outcomes.
Methods: We conducted a post hoc analysis of the Japan Registry of NeuroEndovascular Therapy 4, a nationwide registry in Japan from 2015 to 2019 including 13 479 patients who underwent EVT for acute ischemic stroke.
Background: The benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT).
Methods: We included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score ≤ 2A).