Efficacy and safety of adrenomedullin for acute ischemic stroke (AMFIS): a phase 2, randomized, double-blinded, placebo-controlled, clinical trial.

Background: Adrenomedullin has angiogenic and vasoprotective effects in acute ischemic stroke (AIS). This investigator-initiated trial aimed to evaluate the safety, efficacy, and optimal administration of adrenomedullin in treating AIS.

Methods: In this single-center, multi-cohort, double-blinded, randomized, placebo-controlled, Phase II trial, patients with AIS received pulsed adrenomedullin (9 ng/kg/min for 8 h daily over 7 days) or placebo in the first-half cohort, and continuous-pulsed adrenomedullin (9 ng/kg/min for 72 h during the first 3 days and 8 h daily between Day 4-7) or placebo in the second-half cohort.

Randomized Controlled Trial of Cilostazol Addition for In-Stent Restenosis After Carotid Artery Stenting.

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.

Ophthalmic Artery Feeders in Meningioma Reduce the Effectiveness of Transarterial Embolization With n-Butyl Cyanoacrylate.

Background: N-butyl cyanoacrylate (n-BCA) is often used for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture.

A Case of an Intraosseous Arteriovenous Fistula at the Squamous Part of the Occipital Bone with Spontaneous Occlusion of Diploic Venous Drainage.

Objective: An intraosseous arteriovenous fistula (AVF) is a rare fistula with an intracranial shunted pouch. A case of an intraosseous AVF at the squamous part of the occipital bone with spontaneous occlusion of diploic venous drainage is described.

Case Presentation: The patient, a Japanese woman in her 80s, presented with headaches at the back of the head and a history of multiple unruptured cerebral aneurysms but no recent head trauma.

A Case of Multiple Intracranial Hemorrhages due to a Ruptured Neoplastic Cerebral Aneurysm Secondary to Metastasis of Poorly Differentiated Parotid Gland Carcinoma.

Neoplastic cerebral aneurysms (NCAs) are rare. This study reported a case of an NCA secondary to a poorly differentiated carcinoma of the parotid gland. An 84-year-old Japanese woman undergoing treatment for parotid gland cancer was admitted to our hospital with headache and progressive loss of consciousness.

The Usefulness of the 3.1-mm-diameter 4K Rigid Endoscope for Intracerebral Hematoma Evacuation.

The indication for surgical intervention in spontaneous intracerebral hemorrhage remains controversial. Although many clinical trials have failed to demonstrate its efficacy over medical treatment, less invasive endoscopic treatment is expected to demonstrate its superiority. A novel endoscopic system for hematoma removal consisting of a 3.

A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle.

Objective: The risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms.

Methods: We retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021.

Safety and Efficacy of Prasugrel Administration in Emergent Endovascular Treatment for Intracranial Atherosclerotic Disease.

Objective: Intracranial atherosclerosis disease (ICAD) is one of the most common causes of acute ischemic stroke. In endovascular treatment (EVT) for acute large vessel occlusion stroke-related ICAD, reocclusion of the recanalized artery due to in situ thrombosis is problematic. In this study, the safety and efficacy of prasugrel administration to avoid reocclusion of emergent EVT for ICAD was investigated.

Truncal dystonia with isolated middle cerebral artery ischemia: A case report of revascularization therapy for dystonia.

Background: Dystonia is a rare movement disorder with some cases being difficult to treat. Although dystonia can occur as a symptom of moyamoya disease, few studies have reported truncal dystonia occurring with middle cerebral artery (MCA) stenosis. Here, we report a case of truncal dystonia with MCA occlusion.

Dysbiosis of Gut Microbiome Is Associated With Rupture of Cerebral Aneurysms.

Background And Purpose: Environmental factors are important with respect to the rupture of cerebral aneurysms. However, the relationship between the gut microbiome, an environmental factor, and aneurysm rupture is unclear. Therefore, we compared the gut microbiome in patients with unruptured intracranial aneurysms (UIAs) and ruptured aneurysms (RAs) to identify the specific bacteria causing the rupture of cerebral aneurysms.

Newly Identified Hemodynamic Parameter to Predict Thin-Walled Regions of Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics Analysis.

Background: The thin-walled regions (TIWRs) of intracranial aneurysms have a high risk of rupture during surgical manipulation. They have been reported to be predicted by wall shear stress and pressure (PS) based on computational fluid dynamics analysis, although this remains controversial. In this study, we investigated whether the oscillatory shear index (OSI) can predict TIWRs.

Efficacy of endovascular intratumoral embolization for meningioma: assessment using dynamic susceptibility contrast-enhanced perfusion-weighted imaging.

Background: In preoperative embolization for intracranial meningioma, endovascular intratumoral embolization is considered to be more effective for the reduction of tumorous vascularity than proximal feeder occlusion. In this study, we aimed to reveal different efficacies for reducing tumor blood flow in meningiomas by comparing endovascular intratumoral embolization and proximal feeder occlusion using dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI).

Methods: 28 consecutive patients were included.

Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy.

Aims: To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM).

Methods And Results: We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR' patterns in ≥2 contiguous leads representing the anterior (V1-V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments.

Successful Mechanical Thrombectomy for Subocclusive Thrombus at the Origin of Lenticulostriate Artery.

Optimal treatment of patients with intracranial subocclusive thrombus remains unclear. Such a rare case successfully managed with endovascular mechanical thrombectomy is presented. A 71-year-old man experienced a sudden onset of dysarthria and motor deficits.

Prognosis and Clinical Characteristics of Dilated Cardiomyopathy With Family History via Pedigree Analysis.

Background: The clinical characteristics and prognostic outcomes of dilated cardiomyopathy (DCM) with a familial history (FHx) via pedigree analysis are unclear.

Methods and results: We conducted a prospective observational study of 514 consecutive Japanese patients with DCM. FHx was defined as the presence of DCM in ≥1 family member within 2-degrees relative based on pedigree analysis.

Intra-arterial infusion of fasudil hydrochloride to treat post-traumatic cerebral vasospasm.

Background: The effect of intra-arterial infusion of fasudil hydrochloride in patients with post-traumatic cerebral vasospasm remains unclear. Here we report a case of intra-arterial infusion of fasudil hydrochloride for post-traumatic cerebral vasospasm.

Case Presentation: A 47-year-old man was transferred to our hospital with a fractured skull and traumatic subarachnoid hemorrhage.

Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms.

Background And Purpose: The appropriate period of follow-up examinations after endovascular embolization for cerebral aneurysms using time-of-flight MR angiography is not well-known. We retrospectively investigated long-term results after endovascular embolization for unruptured cerebral aneurysms and evaluated the periods from embolization to recanalization and retreatment.

Materials And Methods: Between April 2006 and March 2011, one hundred forty-eight unruptured aneurysms were treated with endovascular coil embolization.

Carotid artery stenting for patients with occipital-vertebral anastomosis.

Background And Purpose: We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery-vertebral artery anastomosis.

Methods: Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery-vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery.