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Consoli A, Cancelliere NM, Charbonnier G, Nishi H, Vanek I, Marotta TR, Spears J, Pereira VM. Novel, braided, self-expandable stent designed for the treatment of pulsatile tinnitus caused by intracranial venous stenosis: first-in-human experience and long-term outcomes. J Neurointerv Surg 2024:jnis-2024-021458. [PMID: 38697807 DOI: 10.1136/jnis-2024-021458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Pulsatile tinnitus (PT) can be a disabling clinical condition, which may be caused by a sigmoid/transverse sinus stenosis (STSS). Intracranial venous stenting with off-label carotid or peripheral venous stents has been used successfully to treat this condition. We present the results of a cohort of patients presenting with PT treated with a novel, dedicated, braided stent for the endovascular treatment of STSS. METHODS Twelve patients presenting with PT and associated STSS were treated at our institution (December 2022-June 2023). All clinical and procedural variables were prospectively collected. We used the Tinnitus Function Index (TFI) and the Tinnitus Handicap Inventory (THI) scores to assess the impact of PT on quality of life before and after the treatment (mean follow-up: 10.3 months). RESULTS Twelve women (mean age: 44±16.5 years) presenting with PT and STSS were treated. Mean pretreatment TFI/THI scores were 78.8/77. The BosStent was successfully deployed in all patients. We experienced no intraprocedural/postoperative complications. Intra-stent angioplasty was performed in three cases. All patients reported a complete resolution of PT symptoms within 1 month and remained stable and PT-free at the last follow-up (mean posttreatment TFI/THI score: 7.1/5, p<0001). CONCLUSIONS The BosStent was successfully used in a cohort of patients with PT without any intraprocedural complications. All the patients experienced a complete resolution of PT symptoms after 1 month, which was stable during the follow-up period. Further studies with larger populations will be necessary to investigate the safety and effectiveness of this novel stent for the treatment of PT with STSS.
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Affiliation(s)
- Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch Department of Therapeutic and Interventional Neuroradiology, Suresnes, France
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Neurology, Hôpital Jean Minjoz, Besancon, France
| | - Hidehisa Nishi
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Irene Vanek
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Interventional Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Vitor M Pereira
- RADIS Lab, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Diestro JDB, Fahed R, Omar AT, Hawkes C, Hendriks EJ, Enriquez C, Eesa M, Stotts G, Lee H, Nagendra S, Poppe A, Ducroux C, Lim T, Narvacan K, Rizzuto M, Alfalahi A, Nishi H, Sarma P, Itsekson Hayosh Z, Ignacio K, Boisseau W, Pimenta Ribeiro Pontes Almeida E, Benomar A, Almekhlafi MA, Milot G, Deshmukh A, Kishore K, Tampieri D, Wang J, Srivastava A, Roy D, Carpani F, Kashani N, Candale-Radu C, Singh N, Bres Bullrich M, Sarmiento R, Muir RT, Parra-Fariñas C, Reiter S, Deschaintre Y, Singh RJ, Bodani V, Katsanos A, Agid R, Zafar A, Pereira VM, Spears J, Marotta TR, Djiadeu P, Sharma S, Farrokhyar F. Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study. J Neurointerv Surg 2024:jnis-2023-021429. [PMID: 38453461 DOI: 10.1136/jnis-2023-021429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke. OBJECTIVE T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography. METHODS We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG). RESULTS The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81-1) for 71.4% (20/28) of raters in both groups. CONCLUSIONS Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fahed
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Abdelsimar Tan Omar
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christine Hawkes
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eef J Hendriks
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Clare Enriquez
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Muneer Eesa
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Grant Stotts
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Hubert Lee
- Division of Neurointerventional Neuroradiology, Division of Neurosurgery, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shashank Nagendra
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandre Poppe
- Department of Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Célina Ducroux
- Division Neurology, Department of Medicine, The Ottawa Hospital - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy Lim
- Division of Diagnostic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karl Narvacan
- Department of Medical Imaging, St Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Michael Rizzuto
- Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Afra Alfalahi
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Koseikai Takeda hospital, Kyoto, Japan
| | - Pragyan Sarma
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Ze'ev Itsekson Hayosh
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Ignacio
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William Boisseau
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Anass Benomar
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada
| | - Genvieve Milot
- Department of Surgery (Neurosurgery), Centre Hospitalier de Quebec, Université Laval, Laval, Quebec, Canada
| | - Aviraj Deshmukh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Kislay Kishore
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Jeffrey Wang
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Abhilekh Srivastava
- Division of Neurology, Department of Medicine, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Roy
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montréal, Quebec, Canada
| | - Federico Carpani
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nima Kashani
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Claudia Candale-Radu
- Division of Neurology, Department of Internal Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nishita Singh
- Division of Neurology, Department of Internal Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert Sarmiento
- Division of Neurology, Department of Medicine, Vancouver General Hospital- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan T Muir
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Parra-Fariñas
- Divisions of Neuroradiology & Neurointervention, Department of Diagnostic & Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Reiter
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, Quebec, Canada
| | - Ravinder-Jeet Singh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Vivek Bodani
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aristeidis Katsanos
- Division of Neurology, Department of Medicine, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ronit Agid
- Division of Interventional Neuroradiology, Joint Department of Medical Imaging (JDMI), Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Atif Zafar
- Divison of Neurology, Department of Medicine, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Li Ka Shing Knowledge Insitute, St. Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital- Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Consoli A, Nishi H, Diouf A, Charbonnier G, Araújo A, Marotta TR. Endovascular treatment of wide-neck bifurcation aneurysms: the eCLIPs device. J Neurointerv Surg 2024; 16:229. [PMID: 38171614 DOI: 10.1136/jnis-2023-020442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/21/2023] [Indexed: 01/05/2024]
Abstract
The endovascular clip system device, eCLIPs (eVasc, Vancouver, British Columbia, Canada), was introduced almost a decade ago for the treatment of wide-neck bifurcation aneurysms,1-3 which represent a challenge for both endovascular and surgical approaches. Several techniques and devices (intrasaccular or intra-arterial) have been introduced and are currently available in order to improve the technical and clinical outcomes of aneurysm embolization. Flow diversion and flow disruption have shown controversial results in this subtype of aneurysm. In this video we present the use of the eCLIPs device to treat a ruptured, wide-neck aneurysm of the top of the basilar artery. The decisional approach, technical details, and the different steps of the endovascular treatment are described. The final part of the video is dedicated to the characteristics of the device for re-endothelialization4 and flow diversion (video 1).5 neurintsurg;16/3/229/V1F1V1Video 1 .
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Affiliation(s)
- Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch Department of Therapeutic and Interventional Neuroradiology, Suresnes, France
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Department of Neurosurgery, Division of Surgery, St Michael's Hospital Neurosurgery Service, Toronto, Ontario, Canada
| | - Ange Diouf
- Department of Medical Imaging, St Michael's Hospital Medical Imaging Department, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Interventional Neuroradiology, Besançon Regional University Hospital Center, Besancon, Bourgogne-Franche-Comté, France
| | - André Araújo
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Thomas R Marotta
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Interventional Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
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Nishi H, Cancelliere NM, Rustici A, Charbonnier G, Chan V, Spears J, Marotta TR, Mendes Pereira V. Deep learning-based cerebral aneurysm segmentation and morphological analysis with three-dimensional rotational angiography. J Neurointerv Surg 2024; 16:197-203. [PMID: 37192786 DOI: 10.1136/jnis-2023-020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The morphological assessment of cerebral aneurysms based on cerebral angiography is an essential step when planning strategy and device selection in endovascular treatment, but manual evaluation by human raters only has moderate interrater/intrarater reliability. METHODS We collected data for 889 cerebral angiograms from consecutive patients with suspected cerebral aneurysms at our institution from January 2017 to October 2021. The automatic morphological analysis model was developed on the derivation cohort dataset consisting of 388 scans with 437 aneurysms, and the performance of the model was tested on the validation cohort dataset consisting of 96 scans with 124 aneurysms. Five clinically important parameters were automatically calculated by the model: aneurysm volume, maximum aneurysm size, neck size, aneurysm height, and aspect ratio. RESULTS On the validation cohort dataset the average aneurysm size was 7.9±4.6 mm. The proposed model displayed high segmentation accuracy with a mean Dice similarity index of 0.87 (median 0.93). All the morphological parameters were significantly correlated with the reference standard (all P<0.0001; Pearson correlation analysis). The difference in the maximum aneurysm size between the model prediction and reference standard was 0.5±0.7 mm (mean±SD). The difference in neck size between the model prediction and reference standard was 0.8±1.7 mm (mean±SD). CONCLUSION The automatic aneurysm analysis model based on angiography data exhibited high accuracy for evaluating the morphological characteristics of cerebral aneurysms.
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Affiliation(s)
- Hidehisa Nishi
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicole M Cancelliere
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ariana Rustici
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa Chan
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Julian Spears
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Department of Surgery, Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS Lab, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Benalia VHC, Cortez GM, Mounayer C, Saatci I, Cekirge HS, Kocer N, Islak C, Dabus G, Brinjikji W, Baltacioglu F, Pereira VM, Nishi H, Siddiqui AH, Monteiro A, Lopes DK, Aghaebrahim A, Sauvageau E, Hanel RA. Safety and Efficacy of Flow Diverters for Treatment of Unruptured Anterior Communicating Artery Aneurysms: Retrospective Multicenter Study. J Neurointerv Surg 2023; 15:1181-1186. [PMID: 37845019 DOI: 10.1136/jnis-2023-020673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The anterior communicating artery (AComm) region is the most common site of intracranial aneurysms, with increased rupture risk compared with other locations. Overall, flow diverters present as a safe and efficacious treatment for intracranial aneurysms, but there is paucity of data for their use in the treatment of unruptured AComm aneurysms. We present the largest multicentric analysis evaluating the outcomes of flow diverters in AComm aneurysm treatment. METHODS Databases from 10 centers were retrospectively reviewed for unruptured AComm aneurysms treated with flow diverters. Demographics, clinical presentation, radiographic characteristics, procedural complications, and outcomes were assessed. RESULTS A total of 144 patients harboring 147 AComm aneurysms were treated between January 2012 and December 2021. Seventy-four were women (51.4%) and median age was 60 (IQR 50-67) years. All were unruptured AComm aneurysms. Half of the cohort had similar anterior cerebral artery sizes (51.4%). The most common morphology was saccular (94.6%), with a branch involvement in 32.7% of cases. Median vessel diameter was 2.4 mm, and the Pipeline Flex was the most prevalent device (32.7%). Median follow-up time was 17 months, with complete occlusion in 86.4% at the last follow-up. Functional independence (modified Rankin Scale score 0-2) was reported in 95.1%. Intraprocedural complications occurred in 5.6%, and postoperative complications were noted in 9.7% of cases. Combined major complication and mortality rate was 2.1%. CONCLUSIONS Our study suggests that flow diverters are a useful treatment for AComm aneurysms. Mid-term results indicated favorable aneurysm occlusion with a good safety profile. Additional prospective studies with longer follow-up periods and independent adjudication are warranted to better assess these results.
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Affiliation(s)
- Victor H C Benalia
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Charbel Mounayer
- Interventional Neuroradiology Department, University Hospital Centre of Limoges, Limoges, France
| | - Isil Saatci
- Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey
| | - H Saruhan Cekirge
- Interventional Neuroradiology Department, Koru Health Group, Ankara, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Fatih, Istanbul, Turkey
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Neuroscience Institute and Miami Cardiac and Vascular Institute-Baptist Hospital, Miami, Florida, USA
| | - Waleed Brinjikji
- Department of Neurosurgery and Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Feyyaz Baltacioglu
- Department of Radiology, Division of Interventional Radiology/Neuroradiology, VKV Amerikan Hastanesi, Istanbul, Turkey
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Andre Monteiro
- Departments of Neurosurgery and Radiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Demetrius K Lopes
- Neurosurgery, Brain and Spine Institute-Advocate Aurora Health, Chicago, Illinois, USA
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
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Cancelliere NM, van Nijnatten F, Hummel E, Withagen P, van de Haar P, Nishi H, Agid R, Nicholson P, Hallacoglu B, van Vlimmeren M, Pereira VM. Motion artifact correction for cone beam CT stroke imaging: a prospective series. J Neurointerv Surg 2023; 15:e223-e228. [PMID: 36564201 DOI: 10.1136/jnis-2021-018201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Imaging assessment for acute ischemic stroke (AIS) patients in the angiosuite using cone beam CT (CBCT) has created increased interest since endovascular treatment became the first line therapy for proximal vessel occlusions. One of the main challenges of CBCT imaging in AIS patients is degraded image quality due to motion artifacts. This study aims to evaluate the prevalence of motion artifacts in CBCT stroke imaging and the effectiveness of a novel motion artifact correction algorithm for image quality improvement. METHODS Patients presenting with acute stroke symptoms and considered for endovascular treatment were included in the study. CBCT scans were performed using the angiosuite X-ray system. All CBCT scans were post-processed using a motion artifact correction algorithm. Motion artifacts were scored before and after processing using a 4-point scale. RESULTS We prospectively included 310 CBCT scans from acute stroke patients. 51% (n=159/310) of scans had motion artifacts, with 24% being moderate to severe. The post-processing algorithm improved motion artifacts in 91% of scans with motion (n=144/159), restoring clinical diagnostic capability in 34%. Overall, 76% of the scans were sufficient for clinical decision-making before correction, which improved to 93% (n=289/310) after post-processing with our algorithm. CONCLUSIONS Our results demonstrate that CBCT motion artifacts are significantly reduced using a novel post-processing algorithm, which improved brain CBCT image quality and diagnostic assessment for stroke. This is an important step on the road towards a direct-to-angio approach for endovascular thrombectomy (EVT) treatment.
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Affiliation(s)
- Nicole M Cancelliere
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
| | - Fred van Nijnatten
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Eric Hummel
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Paul Withagen
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Peter van de Haar
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | - Hidehisa Nishi
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ronit Agid
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Bertan Hallacoglu
- Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
| | | | - Vitor M Pereira
- Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
- RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
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Nishi H, Ishii A, Tsuji H, Fuchigami T, Sasaki N, Tachibana A, Ito H, Miyamoto S. Automatic Ischemic Core Estimation Based on Noncontrast-Enhanced Computed Tomography. Stroke 2023. [PMID: 37264917 DOI: 10.1161/strokeaha.123.042689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Evaluating the extent of ischemic change is an important step in deciding whether to use thrombolysis or mechanical thrombectomy, but the current standard method, Alberta Stroke Program Early CT Score, is semiquantitative and has low consistency among raters. We aim to create and test a fully automated machine learning-based ischemic core segmentation model using only noncontrast-enhanced computed tomography images. METHODS In this multicenter retrospective study, patients with anterior circulation acute ischemic stroke who received both computed tomography (CT) and magnetic resonance imaging before thrombolysis or recanalization treatment between 2013 and 2019 were included. On CT, the ischemic core was manually delineated using the diffusion-weighted image and apparent diffusion coefficient maps. A deep learning-based ischemic core segmentation model (DL model) was developed using data from 3 institutions (n=272), and the model performance was validated using data from 3 institutions (n=106 Results: The median time ).between CT and magnetic resonance imaging in the validation cohort was 18 min. The DL model calculated ischemic core volume was significantly correlated with the reference standard (intraclass correlation coefficient, 0.90, P<0.01). Both the early time window (≤4.5 hours from onset; intraclass correlation coefficient, 0.90, P<0.01) and the late time window (>4.5 hours from onset; intraclass correlation coefficient, 0.93, P<0.01) had significant correlations. The median difference in ivolume between the model and the reference standard was 4.7 mL (interquartile range, 0.8-12.4 mL). The DL model performed well in distinguishing large ischemic cores (>70 mL), with a sensitivity of 84.2%, specificity of 97.7%, and area under the curve of 0.91. CONCLUSIONS The deep learning-based ischemic core segmentation model, which was based on noncontrast-enhanced CT, demonstrated high accuracy in assessing ischemic core volume in patients with anterior circulation acute ischemic stroke.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (H.N., A.I., H.T., N.S., S.M.)
- RADIS Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada (H.N.)
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (H.N., A.I., H.T., N.S., S.M.)
| | - Hirofumi Tsuji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (H.N., A.I., H.T., N.S., S.M.)
| | | | - Natsuhi Sasaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (H.N., A.I., H.T., N.S., S.M.)
| | | | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (H.N., A.I., H.T., N.S., S.M.)
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10
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Sasaki N, Ishii A, Yagi S, Nishi H, Akiyama R, Okawa M, Abekura Y, Tsuji H, Sakurai S, Miyamoto S. Bioresorbable Poly (L-Lactic Acid) Flow Diverter Versus Cobalt-Chromium Flow Diverter: In Vitro and In Vivo Analysis. Stroke 2023; 54:1627-1635. [PMID: 37139818 DOI: 10.1161/strokeaha.122.042043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Permanent metallic flow diverter (FD) implantation for treatment of intracranial aneurysms requires antiplatelet therapy for an unclear duration and restricts postprocedural endovascular access. Bioresorbable FDs are being developed as a solution to these issues, but the biological reactions and phenomena induced by bioresorbable FDs have not been compared with those of metallic FDs. METHODS We have developed a bioresorbable poly (L-lactic acid) FD (PLLA-FD) and compared it with an FD composed of cobalt-chromium and platinum-tungsten (CoCr-FD). FD mechanical performance and in vitro degradation of the PLLA-FD were evaluated. For in vivo testing in a rabbit aneurysm model, FDs were implanted at the aneurysm site and the abdominal aorta in the PLLA-FD group (n=21) and CoCr-FD group (n=15). Aneurysm occlusion rate, branch patency, and thrombus formation within the FD were evaluated at 3, 6, and 12 months. Local inflammation and neointima structure were also evaluated. RESULTS Mean strut, porosity, and pore density for the PLLA-FD were 41.7 μm, 60%, and 20 pores per mm2, respectively. The proportion of aneurysms exhibiting a neck remnant or complete occlusion did not significantly differ between the groups; however, the complete occlusion rate was significantly higher in the PLLA-FD group (48% versus 13%; P=0.0399). Branch occlusion and thrombus formation within the FD were not observed in either group. In the PLLA-FD group, CD68 immunoreactivity was significantly higher, but neointimal thickness decreased over time and did not significantly differ from that of the CoCr-FD at 12 months. Collagen fibers significantly predominated over elastic fibers in the neointima in the PLLA-FD group. The opposite was observed in the CoCr-FD group. CONCLUSIONS The PLLA-FD was as effective as the CoCr-FD in this study and is feasible for aneurysm treatment. No morphological or pathological problems were observed with PLLA-FD over a 1-year period.
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Affiliation(s)
- Natsuhi Sasaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Shinichi Yagi
- Department of Biobased Materials Science, Kyoto Institute of Technology, Japan (S.Y., S.S.)
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
- RADIS Lab, Research in Cerebral Vascular Diseases, Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada (H.N.)
| | - Ryo Akiyama
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Yu Abekura
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Hirofumi Tsuji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
| | - Shinichi Sakurai
- Department of Biobased Materials Science, Kyoto Institute of Technology, Japan (S.Y., S.S.)
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (N.S., A.I., H.N., R.A., M.O., Y.A., H.T., S.M.)
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11
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Benalia V, Cortez G, Mounayer C, Saatci I, Cekirge S, Koçer N, Islak C, Dabus G, Brinjikji W, Baltacıoğlu F, Pereira VM, Nishi H, Siddiqui A, Lopes DK, Aghaebrahim A, Sauvageau E, Hanel RA. 315 Use of Flow Diverter in the Treatment of Anterior Communicating Artery Aneurysms: A Multicenter Experience (FEAR ME study). Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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12
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Kitamura G, Nankaku M, Kikuchi T, Nishi H, Tanaka H, Nishikawa T, Yonezawa H, Kajimoto T, Kawano T, Ohtagaki A, Mashimoto E, Miyamoto S, Ikeguchi R, Matsuda S. Effect of gait distance during robot training on walking independence after acute brain injury. Assist Technol 2023:1-6. [PMID: 36441850 DOI: 10.1080/10400435.2022.2151664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to determine whether the distance of gait training using a hybrid assistive limb (HAL) is related to the improvement of walking independence in patients with acute brain injury. This was an exploratory, observational study. Thirty patients having hemiplegia (functional ambulation category, FAC score ≤2) with acute stroke or after brain tumor surgery were included. Patients performed 4 sessions of gait training using HAL (60 min/session), 1-3 sessions/week, combined with conventional physical therapy. The gait distance achieved in the four training sessions using HAL was measured. FAC score was measured before and after intervention. Patients were divided into groups A, B, and C, for FAC score improvements of 0, 1, and ≥2, respectively. Gait distance was compared among groups using one-way analysis of variance. Gait distance in group C was significantly longer than that ingroup A [mean (standard deviation): 2527 (1725) m vs. 608 (542) m]. This study suggested that the gait distance achieved during training using the HAL may be a clinical indicator of the effectiveness of the HAL on gait training in patients with acute brain injury.Clinical trial registration number: UMIN000012764 R000014756.
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Affiliation(s)
- Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Toru Nishikawa
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Honami Yonezawa
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Taishi Kajimoto
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ayumi Ohtagaki
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Eriko Mashimoto
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishi H, tsuji H, Ishii A, Fuchigami T, Tachibana A, Ito H, Miyamoto S. Abstract TP98: Deep Learning-based Automatic Ischemic Core Estimation Based On Non-contrastenhanced Computed Tomography. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background/Purpose:
With the spread of thrombus retrieval procedures, the demand for immediate diagnosis and severity assessment of ischemic stroke is increasing, but current standard method using ASPECTS is semi-quantitative, and has low consistency among physicians. We develop and validate the fully automatic machine learning-based ischemic core segmentation model based only on non-contrast-enhanced computed tomography (NCCT).
Materials and Methods:
This multicenter retrospective study included patients with anterior circulation acute ischemic stroke who received both CT and MRI before thrombolysis or recanalization treatment between 2013 to 2019. The ischemic core on CT was manually delineated referencing the DWI and ADC map. A deep learning-based ischemic core segmentation model was developed using the derivation cohort data from 3 institutions (n=313), and the model performance was validated on the external validation cohort data from 3 institutions (n=106).
Results:
On the validation cohort, the median time between CT and MRI was 18 min. The ischemic core volume calculated by the DL model was significantly correlated with the reference standard (Pearson r=0.91, p<.001). The correlation was significant both in early time window (<4.5hr from onset; Pearson r=0.91, p<.0.01) and the late time window (>4.5hr from onset; Pearson r=0.93, p<0.01). The median difference between model and reference standard was 4.7 mL (IQR, 0.8-12.4 mL). The DL model displayed high accuracy on discriminating large ischemic core (>70mL) with a sensitivity of 84.2%, specificity of 97.7%, and AUC of 0.91.
Conclusions:
A segmentation model of cerebral ischemic core volume of the anterior circulation based on NCCT using deep learning showed good correlation with the correct labels generated with reference to MRI.
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Hamatani Y, Nishi H, Iguchi M, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Fukuda S, Akao M. Machine Learning Risk Prediction for Incident Heart Failure in Patients With Atrial Fibrillation. JACC Asia 2022; 2:706-716. [PMID: 36444329 PMCID: PMC9700042 DOI: 10.1016/j.jacasi.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus is placed on the risk stratification for, and prevention of, incident HF in patients with AF. OBJECTIVES This study aimed to construct and validate a machine learning (ML) prediction model for HF hospitalization in patients with AF. METHODS The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. We divided the data set of the registry into derivation (n = 2,383) and validation (n = 2,011) cohorts. An ML model was built to predict the incidence of HF hospitalization using the derivation cohort, and predictive ability was examined using the validation cohort. RESULTS HF hospitalization occurred in 606 patients (14%) during a median follow-up period of 4.4 years in the entire registry. Data of transthoracic echocardiography and biomarkers were frequently nominated as important predictive variables across all 6 ML models. The ML model based on a random forest algorithm using 7 variables (age, history of HF, creatinine clearance, cardiothoracic ratio on x-ray, left ventricular [LV] ejection fraction, LV end-systolic diameter, and LV asynergy) had high prediction performance (area under the receiver operating characteristics curve [AUC]: 0.75) and was significantly superior to the Framingham HF risk model (AUC: 0.67; P < 0.001). Based on Kaplan-Meier curves, the ML model could stratify the risk of HF hospitalization during the follow-up period (log-rank; P < 0.001). CONCLUSIONS The ML model revealed important predictors and helped us to stratify the risk of HF, providing opportunities for the prevention of HF in patients with AF.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hidehisa Nishi
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Canada
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masahiro Esato
- Department of Arrhythmia, Ogaki Tokushukai Hospital, Gifu, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Tominaga A, Wada K, Okazaki K, Nishi H, Terayama Y, Kodama Y, Kato Y. Effect of the duration of previous osteoporosis treatment on the effect of romosozumab treatment. Osteoporos Int 2022; 33:1265-1273. [PMID: 35059774 DOI: 10.1007/s00198-021-06261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/02/2021] [Indexed: 01/19/2023]
Abstract
UNLABELLED The effect of romosozumab is affected by previous osteoporosis treatment. Here we showed that the duration of the previous treatment just before romosozumab affects the therapeutic effect of romosozumab. Using denosumab and oral bisphosphonates for more than 1 year attenuates the effect of romosozumab. INTRODUCTION As an anti-sclerostin antibody, romosozumab suppresses bone resorption and stimulates bone formation. We investigated whether the effectiveness of 12 months of romosozumab treatment depended on the duration of previous treatment with teriparatide, denosumab, or oral bisphosphonates. METHODS In total, 259 osteoporosis patients received subcutaneous injections of romosozumab (210 mg) every 4 weeks during 2019 and 2020. This study was designed as a pre-post comparison. The end points were the percent changes of bone mineral density (BMD) after 12 months of romosozumab treatment. The patients were divided into seven groups depending on the type and duration of previous treatment before starting romosozumab as follows: non-previous treatment group, change from teriparatide used for 1 year or less/more than 1 year, change from denosumab used for 1 year or less/more than 1 year, and change from oral bisphosphonates used for 1 year or less/more than 1 year. RESULTS The effects of previous treatment with teriparatide on the effectiveness of 12-month romosozumab did not clearly depend on the duration of treatment (p > 0.05). In contrast, the effects of previous treatments with denosumab or oral bisphosphonates on the effectiveness of 12-month romosozumab depended on the previous treatment duration, which was reflected by the differences in percent change of the spine BMD (both p < 0.05), however, there were no significant differences in the percent change of the total hip BMD (both p > 0.05). CONCLUSION The duration of the previous treatment affected the effectiveness of romosozumab. Using denosumab and oral bisphosphonate for more than 1 year attenuated the effect of romosozumab.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan.
| | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Terayama
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Kodama
- Ohara Clinic, 2-23-19 Ohara Setagaya-ku, Tokyo, Japan
| | - Y Kato
- Kita Shinagawa 3rd Hospital, 3-3-7 Kitashinagawa Shinagawa-ku, Tokyo, Japan
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Nishi H, Oishi N, Ogawa H, Natsue K, Doi K, Kawakami O, Aoki T, Fukuda S, Akao M, Tsukahara T. Predicting cerebral infarction in patients with atrial fibrillation using machine learning: The Fushimi AF registry. J Cereb Blood Flow Metab 2022; 42:746-756. [PMID: 34851764 PMCID: PMC9254038 DOI: 10.1177/0271678x211063802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The CHADS2 and CHA2DS2-VASc scores are widely used to assess ischemic risk in the patients with atrial fibrillation (AF). However, the discrimination performance of these scores is limited. Using the data from a community-based prospective cohort study, we sought to construct a machine learning-based prediction model for cerebral infarction in patients with AF, and to compare its performance with the existing scores. All consecutive patients with AF treated at 81 study institutions from March 2011 to May 2017 were enrolled (n = 4396). The whole dataset was divided into a derivation cohort (n = 1005) and validation cohort (n = 752) after excluding the patients with valvular AF and anticoagulation therapy. Using the derivation cohort dataset, a machine learning model based on gradient boosting tree algorithm (ML) was built to predict cerebral infarction. In the validation cohort, the receiver operating characteristic area under the curve of the ML model was higher than those of the existing models according to the Hanley and McNeil method: ML, 0.72 (95%CI, 0.66-0.79); CHADS2, 0.61 (95%CI, 0.53-0.69); CHA2DS2-VASc, 0.62 (95%CI, 0.54-0.70). As a conclusion, machine learning algorithm have the potential to perform better than the CHADS2 and CHA2DS2-VASc scores for predicting cerebral infarction in patients with non-valvular AF.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Oishi
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kishida Natsue
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kento Doi
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Osamu Kawakami
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tomokazu Aoki
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Matsumoto S, Nakahara I, Yasuda A, Okita S, Aoki M, Ishii A, Okawa M, Nishi H, Yamada K, Kubo M, Ishihara T, KOYAMA H, Kira J. Abstract 147: Reducing The Workflow Times For Reperfusion Therapy For Acute Ischemic Stroke By Using A Task Management Mobile Application For Stroke Care. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Since the effectiveness of reperfusion therapy for acute ischemic stroke (AIS) is highly time-dependent, stroke centers are required to carry out quality management (QM) of AIS care and provide treatment promptly. For many hospitals, however, QM are not easy. We have developed a mobile application named Task Calc. Stroke (TCS) to support the hospital's QM while supporting the staffs task processing. This study aims to evaluate the impact of using TCS on the workflow times of reperfusion therapy and clinical outcomes.
Methods:
We conducted a prospective cohort study at 4 Japanese comprehensive stroke centers for 33 months from June 2018 to December 2020. Patients treated with intravenous tissue plasminogen activator (IV-t PA) / mechanical thrombectomy (MT) were enrolled. The research team visited each facility and trained how to use TCS for AIS care. Each facility begun using TCS after training. We divided the study period into three stages as follows: 1) Pre-intervention stage, 2) Training stage, and 3) Using TCS stage and examined the workflow times such as door-to-needle time (D2N) for IV-tPA and door-to-puncture time (D2P) for MT and clinical outcomes (at discharge modified Rankin Scale score (mRS)).
Results:
During the study period, 333 cases (165 pre-intervention stage, 80 training stage, and 88 using TCS stage) underwent reperfusion therapy, 250 received IV-tPA, and 156 received MT. For D2N, the geometric mean decreased significantly from 57.7 minutes to 51.3 minutes in the training stage compared to the pre-intervention stage (Exp (β) 0.816: 95% CI 0.691-0.963, P=0.016) and further decreased to 49.7 minutes in the using TCS stage (Exp(β) 0.759: 95% CI 0.65-0. 888, P=0.001). For D2P, it slightly increased from 91.1 to 95.8 minutes in the training stage (Exp(β) 0.939: 95%CI 0.75-01.175, P=0.578), and significantly decreased to 84.2 minutes in the using TCS stage (Exp(β) 0.675: 95%CI 0. 524-0.87, P=0.003). The severity of disability tended to decrease across the mRS range (adjusted common odds ratio, 0.49; 95% CI, 0.22-1.11; P = 0.088) in the TCS using stage.
Conclusions:
TCS care support hospital's QM to reduce the workflow times of reperfusion therapy and tends to improve clinical outcomes.
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Affiliation(s)
- Shoji Matsumoto
- Comprehensive Strokology, Fujita Health Univ Sch of Medicine, Toyoake, Aichi, Japan
| | - Ichiro Nakahara
- Comprehensive Strokology, Fujita Health Univ Sch of Medicine, Toyoake, Aichi, Japan
| | - Ayuko Yasuda
- Quality and Safety in Healthcare, Fujita Health Univ Sch of Medicine, Toyoake, Aichi, Japan
| | - Shinpei Okita
- Comprehensive Strokology, Fujita Health Univ Sch of Medicine, Toyoake, Aichi, Japan
| | - Michiru Aoki
- Comprehensive Strokology, Fujita Health Univ Sch of Medicine, Toyoake, Aichi, Japan
| | | | | | | | | | | | | | - Hiroshi KOYAMA
- Graduate Sch of Industrial Technology, Advanced Institute of Industrial Technology,, Shinagawa, Tokyo, Japan
| | - Junichi Kira
- Translational Neuroscience Cntr, International Univ of Health and Welfare, Fukuoka, Japan
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Tominaga A, Wada K, Okazaki K, Nishi H, Terayama Y, Kato Y. Early clinical effects, safety, and predictors of the effects of romosozumab treatment in osteoporosis patients: one-year study. Osteoporos Int 2021; 32:1999-2009. [PMID: 33770201 PMCID: PMC7996128 DOI: 10.1007/s00198-021-05925-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/11/2021] [Indexed: 01/06/2023]
Abstract
UNLABELLED Romosozumab is an effective treatment for spine osteoporosis because it reduces the incidence of new fractures and significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications. INTRODUCTION Romosozumab appeared as a new osteoporosis medication in Japan in 2019. It is an anti-sclerostin antibody, which increases bone formation and suppresses bone resorption. The aim of our study was to elucidate the clinical effects, safety, and predictors of the effects of one-year romosozumab treatment. METHODS This study was an observational study designed as a pre-post study in 262 patients. Romosozumab (210 mg) was administered subcutaneously once every 4 weeks during 12 months. We focused on incidence of new fractures, safety, bone mineral density (BMD) at the spine and total hip, and bone metabolism markers. RESULTS There were five cases of new fractures during one-year romosozumab treatment. There were no fatal adverse events. Percent changes from baseline in the spine and total hip BMD after 12 months of romosozumab treatment were 10.67% and 2.04%, respectively. Romosozumab had better effects in cases of severe osteoporosis with low spine BMD, high TRACP-5b, and high iP1NP at the start of romosozumab treatment. The percent change in the spine BMD at 12 months was significantly lower in the group transitioning from bisphosphonates than in the group not previously treated with other anti-osteoporosis medications. CONCLUSION Romosozumab is an effective treatment for spine osteoporosis because it significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan.
| | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho Shinjuku-ku, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Terayama
- Hasuda Hospital, 1662-1 Negane Hasudashi, Saitama, Japan
| | - Y Kato
- Kita Shinagawa 3rd Hospital, 3-3-7 Kitashinagawa Shinagawa-ku, Tokyo, Japan
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Tanaka H, Nankaku M, Kikuchi T, Nishi H, Nishikawa T, Yonezawa H, Kitamura G, Takagi Y, Miyamoto S, Ikeguchi R, Matsuda S. Effects of periodic robot rehabilitation using the Hybrid Assistive Limb for a year on gait function in chronic stroke patients. J Clin Neurosci 2021; 92:17-21. [PMID: 34509247 DOI: 10.1016/j.jocn.2021.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
Using a robot for gait training in stroke patients has attracted attention for the last several decades. Previous studies reported positive effects of robot rehabilitation on gait function in the short term. However, the long-term effects of robot rehabilitation for stroke patients are still unclear. The purpose of the present study was to investigate the long-term effects of periodic gait training using the Hybrid Assistive Limb (HAL) on gait function in chronic stroke patients. Seven chronic stroke patients performed 8 gait training sessions using the HAL 3 times every few months. The maximal 10-m walk test and the 2-minute walking distance (2MWD) were measured before the first intervention and after the first, second, and third interventions. Gait speed, stride length, and cadence were calculated from the 10-m walk test. Repeated one-way analysis of variance showed a significant main effect on evaluation time of gait speed (F = 7.69, p < 0.01), 2MWD (F = 7.52, p < 0.01), stride length (F = 5.24, p < 0.01), and cadence (F = 8.43, p < 0.01). The effect sizes after the first, second, and third interventions compared to pre-intervention in gait speed (d = 0.39, 0.52, and 0.59) and 2MWD (d = 0.35, 0.46, and 0.57) showed a gradual improvement of gait function at every intervention. The results of the present study showed that gait function of chronic stroke patients improved over a year with periodic gait training using the HAL every few months.
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Affiliation(s)
- Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Toru Nishikawa
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Honami Yonezawa
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Tanaka K, Matsumoto S, Ainiding G, Nakahara I, Nishi H, Hashimoto T, Ohta T, Sadamasa N, Ishibashi R, Gomi M, Saka M, Miyata H, Watanabe S, Okata T, Sonoda K, Koge J, Iinuma KM, Furuta K, Nagata I, Matsuo K, Matsushita T, Isobe N, Yamasaki R, Kira JI. PON1 Q192R is associated with high platelet reactivity with clopidogrel in patients undergoing elective neurointervention: A prospective single-center cohort study. PLoS One 2021; 16:e0254067. [PMID: 34351918 PMCID: PMC8341610 DOI: 10.1371/journal.pone.0254067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose The impact of the paraoxonase-1 (PON1) polymorphism, Q192R, on platelet inhibition in response to clopidogrel remains controversial. We aimed to investigate the association between carrier status of PON1 Q192R and high platelet reactivity (HPR) with clopidogrel in patients undergoing elective neurointervention. Methods Post-clopidogrel platelet reactivity was measured using a VerifyNow® P2Y12 assay in P2Y12 reaction units (PRU) for consecutive patients before the treatment. Genotype testing was performed for PON1 Q192R and CYP2C19*2 and *3 (no function alleles), and *17. PRU was corrected on the basis of hematocrit. We investigated associations between factors including carrying ≥1 PON1 192R allele and HPR defined as original and corrected PRU ≥208. Results Of 475 patients (232 men, median age, 68 years), HPR by original and corrected PRU was observed in 259 and 199 patients (54.5% and 41.9%), respectively. Carriers of ≥1 PON1 192R allele more frequently had HPR by original and corrected PRU compared with non-carriers (91.5% vs 85.2%, P = 0.031 and 92.5% vs 85.9%, P = 0.026, respectively). In multivariate analyses, carrying ≥1 PON1 192R allele was associated with HPR by original (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.03–3.76) and corrected PRU (OR 2.34, 95% CI 1.21–4.74) after adjustment for age, sex, treatment with antihypertensive medications, hematocrit, platelet count, total cholesterol, and carrying ≥1 CYP2C19 no function allele. Conclusions Carrying ≥1 PON1 192R allele is associated with HPR by original and corrected PRU with clopidogrel in patients undergoing elective neurointervention, although alternative results related to other genetic polymorphisms cannot be excluded.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Gulibahaer Ainiding
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tetsuya Hashimoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Makoto Saka
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Takuya Okata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazutaka Sonoda
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Junpei Koge
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kyoko M. Iinuma
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Konosuke Furuta
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Keitaro Matsuo
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Takuya Matsushita
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Jun-ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
- * E-mail:
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Fukuda M, Seki Y, Ezato K, Yokoyama K, Nishi H, Suzuki S, Hirai T. Performance evaluation of tungsten for ITER divertor toward mass production. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kusama K, Fukushima Y, Yoshida K, Sakakibara H, Tsubata N, Yoshie M, Kojima J, Nishi H, Tamura K. Endometrial epithelial-mesenchymal transition (EMT) by menstruation-related inflammatory factors during hypoxia. Mol Hum Reprod 2021; 27:6275231. [PMID: 33983443 DOI: 10.1093/molehr/gaab036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is characterised by inflammation and fibrotic changes. Our previous study using a mouse model showed that proinflammatory factors present in peritoneal haemorrhage exacerbated inflammation in endometriosis-like grafts, at least in part through the activation of prostaglandin (PG) E2 receptor and protease-activated receptor (PAR). In addition, hypoxia is a well-known inducer of fibrosis that may be associated with epithelial-mesenchymal transition (EMT). However, the complex molecular interactions between hypoxia and proinflammatory menstruation-related factors, PGE2 and thrombin, a PAR1 agonist, on EMT in endometriosis have not been fully characterised. To explore the effects of hypoxia and proinflammatory factors on EMT-like changes in endometrial cells, we determined the effects of PGE2 and thrombin (P/T) on EMT marker expression and cell migration in three dimensional cultured human endometrial epithelial cells (EECs) and endometrial stromal cells (ESCs). Treatment of EECs with P/T under hypoxia stimulated cell migration, increased the expression of mesenchymal N-cadherin, vimentin and C-X-C chemokine receptor type 4 (CXCR4), and reduced the expression of epithelial E-cadherin. Furthermore, treatment with C-X-C motif chemokine ligand 12 (CXCL12), a ligand for CXCR4, increased EMT marker expression and cell migration. In ESCs, P/T or oestrogen treatment under hypoxic conditions increased the expression and secretion of CXCL12. Taken together, our data show that hypoxic and proinflammatory stimuli induce EMT, cell migration and inflammation in EECs, which was increased by CXCL12 derived from ESCs. These data imply that inflammatory mediators in retrograde menstrual fluid contribute to ectopic endometrial EMT and migration in the presence of peritoneal hypoxia.
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Affiliation(s)
- K Kusama
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - Y Fukushima
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - K Yoshida
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - H Sakakibara
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - N Tsubata
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - M Yoshie
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - J Kojima
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - H Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - K Tamura
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
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Ogawa H, An Y, Nishi H, Fukuda S, Ishigami K, Ikeda S, Doi K, Ide Y, Hamatani Y, Fujino A, Ishii M, Iguchi M, Masunaga N, Esato M, Tsuji H, Wada H, Hasegawa K, Abe M, Tsukahara T, Lip GYH, Akao M. Characteristics and clinical outcomes in atrial fibrillation patients classified using cluster analysis: the Fushimi AF Registry. Europace 2021; 23:1369-1379. [PMID: 33930126 DOI: 10.1093/europace/euab079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The risk of adverse events in atrial fibrillation (AF) patients was commonly stratified by risk factors or clinical risk scores. Risk factors often do not occur in isolation and are often found in multimorbidity 'clusters' which may have prognostic implications. We aimed to perform cluster analysis in a cohort of AF patients and to assess the outcomes and prognostic implications of the identified comorbidity cluster phenotypes. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. Hierarchical cluster analysis was performed on 4304 patients (mean age: 73.6 years, female; 40.3%, mean CHA2DS2-VASc score 3.37 ± 1.69), using 42 baseline clinical characteristics. On hierarchical cluster analysis, AF patients could be categorized into six statistically driven comorbidity clusters: (i) younger ages (mean age: 48.3 years) with low prevalence of risk factors and comorbidities (n = 209); (ii) elderly (mean age: 74.0 years) with low prevalence of risk factors and comorbidities (n = 1301); (iii) those with high prevalence of atherosclerotic risk factors, but without atherosclerotic disease (n = 1411); (iv) those with atherosclerotic comorbidities (n = 440); (v) those with history of any-cause stroke (n = 681); and (vi) the very elderly (mean age: 83.4 years) (n = 262). Rates of all-cause mortality and major adverse cardiovascular or neurological events can be stratified by these six identified clusters (log-rank test; P < 0.001 and P < 0.001, respectively). CONCLUSIONS We identified six clinically relevant phenotypes of AF patients on cluster analysis. These phenotypes can be associated with various types of comorbidities and associated with the incidence of clinical outcomes. CLINICAL TRIAL REGISTRATION INFORMATION https://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000005834.
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Affiliation(s)
- Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yoshimori An
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kenjiro Ishigami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Syuhei Ikeda
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Kosuke Doi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yuya Ide
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Akiko Fujino
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Nobutoyo Masunaga
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masahiro Esato
- Department of Cardiology, Heart Rhythm Section, Ogaki Tokushukai Hospital, Gifu, Japan
| | | | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Tominaga A, Wada K, Kato Y, Nishi H, Terayama Y, Okazaki K. Early clinical effects, safety, and appropriate selection of bone markers in romosozumab treatment for osteoporosis patients: a 6-month study. Osteoporos Int 2021; 32:653-661. [PMID: 32979066 DOI: 10.1007/s00198-020-05639-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/11/2020] [Indexed: 01/22/2023]
Abstract
UNLABELLED Our 6-month study showed the usefulness of romosozumab for preventing fractures and its safety. It was effective in patients with low baseline spine BMD, high TRACP-5b, and high iP1NP. Percent change from baseline of TRACP-5b and iP1NP after 1 month correlated with that from baseline of BMD after four to 6-month treatment. INTRODUCTION Romosozumab appeared as a new osteoporosis medication in Japan in 2019. It is an anti-sclerostin antibody which increases bone formation and suppresses bone resorption. In this study, we analyzed the actual clinical effects, adverse effects, and the optimal way to evaluate the treatment. METHODS Romosozumab was administered as subcutaneous injection of 210 mg once every 4 weeks. We conducted pre-post study in 185 patients treated for 6 months. We focused on the incidence of new vertebral fractures, safety, bone mineral density (BMD) at the spine and total hip, and bone metabolism markers. We evaluated BMD before romosozumab treatment and after 4 to 6 months and performed the serum analysis before romosozumab treatment, after 1, 3, and 6 months. RESULTS There was no new fracture during treatment, and there was no fatal adverse event including cardiovascular disease. Since percent changes from baseline of the spine and total hip BMD were 6.34% and 1.53% after 4- to 6-month treatment, the treatment was effective for spine osteoporosis. Tartrate-resistant acid phosphatase 5b (TRACP-5b) and intact type I procollagen N-terminal propeptide (iP1NP) had significant changes during romosozumab treatment (p < 0.05). Percent change from baseline of TRACP-5b and iP1NP after 1 month correlated with percent change from baseline of BMD after 4 to 6 months of treatment. CONCLUSION Romosozumab is effective in preventing fractures and useful for increasing the spine BMD. Also, romosozumab is relatively safe to use. It is especially effective in patients with low baseline spine BMD, high TRACP-5b, and high iP1NP.
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Affiliation(s)
- A Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - K Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Y Kato
- Kita Shinagawa 3rd Hospital, Tokyo, Japan
| | - H Nishi
- Hasuda Hospital, Saitama, Japan
| | | | - K Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Higashihara T, Nishi H, Takemura K, Nangaku M. POS-263 β2-adrenergic receptor agonist averts indoxyl sulfate-induced skeletal muscle atrophy and oxidative stress in mice. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Nishi H, Oishi N, Ishii A, Ono I, Ogura T, Sunohara T, Chihara H, Fukumitsu R, Okawa M, Yamana N, Imamura H, Sadamasa N, Hatano T, Nakahara I, Sakai N, Miyamoto S. Deep Learning–Derived High-Level Neuroimaging Features Predict Clinical Outcomes for Large Vessel Occlusion. Stroke 2020; 51:1484-1492. [DOI: 10.1161/strokeaha.119.028101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
For patients with large vessel occlusion, neuroimaging biomarkers that evaluate the changes in brain tissue are important for determining the indications for mechanical thrombectomy. In this study, we applied deep learning to derive imaging features from pretreatment diffusion-weighted image data and evaluated the ability of these features in predicting clinical outcomes for patients with large vessel occlusion.
Methods—
This multicenter retrospective study included patients with anterior circulation large vessel occlusion treated with mechanical thrombectomy between 2013 and 2018. We designed a 2-output deep learning model based on convolutional neural networks (the convolutional neural network model). This model employed encoder-decoder architecture for the ischemic lesion segmentation, which automatically extracted high-level feature maps in its middle layers, and used its information to predict the clinical outcome. Its performance was internally validated with 5-fold cross-validation, externally validated, and the results compared with those from the standard neuroimaging biomarkers Alberta Stroke Program Early CT Score and ischemic core volume. The prediction target was a good clinical outcome, defined as a modified Rankin Scale score at 90-day follow-up of 0 to 2.
Results—
The derivation cohort included 250 patients, and the validation cohort included 74 patients. The convolutional neural network model showed the highest area under the receiver operating characteristic curve: 0.81±0.06 compared with 0.63±0.05 and 0.64±0.05 for the Alberta Stroke Program Early CT Score and ischemic core volume models, respectively. In the external validation, the area under the curve for the convolutional neural network model was significantly superior to those for the other 2 models.
Conclusions—
Compared with the standard neuroimaging biomarkers, our deep learning model derived a greater amount of prognostic information from pretreatment neuroimaging data. Although a confirmatory prospective evaluation is needed, the high-level imaging features derived by deep learning may offer an effective prognostic imaging biomarker.
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Affiliation(s)
- Hidehisa Nishi
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Naoya Oishi
- Medical Innovation Center (N.O.), Kyoto University Graduate School of Medicine, Japan
| | - Akira Ishii
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Isao Ono
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | - Takenori Ogura
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C.)
| | - Tadashi Sunohara
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Hideo Chihara
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C.)
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Masakazu Okawa
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
| | | | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N.S.)
| | | | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan (I.N.)
| | - Nobuyuki Sakai
- Department of Neurosurgery, Koseikai Takeda Hospital, Kyoto, Japan (N.S.)
| | - Susumu Miyamoto
- From the Department of Neurosurgery (H.N., A.I., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Japan
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27
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Ikeda H, Ishii A, Sano K, Chihara H, Arai D, Abekura Y, Nishi H, Ono M, Saji H, Miyamoto S. Activatable Fluorescence Imaging of Macrophages in Cerebral Aneurysms Using Iron Oxide Nanoparticles Conjugated With Indocyanine Green. Front Neurosci 2020; 14:370. [PMID: 32390794 PMCID: PMC7189773 DOI: 10.3389/fnins.2020.00370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose Chronic inflammation is involved in the formation and enlargement of cerebral aneurysms (CAs), with macrophages playing a key role in the process. The present study evaluated visualization of macrophages present in CAs using an activatable fluorescent probe (IONP-ICG) comprising an iron oxide nanoparticles (IONPs) conjugated with indocyanine green (ICG). Methods IONP-ICG was intravenously administered to 15-week-old CA model rats (n = 8), and ex vivo near-infrared fluorescence (NIRF) imaging and histological assessment of exposed CAs and cerebral arteries were performed 48 h later. Similar evaluations were performed in the control group, which included CA model rats given IONPs or ICG (n = 8 each). Results ICG-derived NIRF signals were detected in three IONP-ICG group rats but not in IONP or ICG control groups. Among the three rats that exhibited signals, NIRF signal accumulation was observed in the CA of two rats and at the site of hemodynamic stress in the left posterior cerebral artery in one rat. Histologically, NIRF signals correlated strongly with macrophage localization. A total of 13 CAs formed in the IONP-ICG group. The number of macrophages in the CA wall was significantly greater in the two CAs that exhibited NIRF signals compared to the remaining 11 CAs that did not (P = 0.037). Moreover, all 11 CAs that did not exhibit NIRF signals were iron-negative, while the two CAs that exhibited NIRF signals were both iron-positive (P = 0.013). Conclusion NIRF imaging using an activatable IONP-ICG probe is feasible for detecting the macrophage-rich regions in CAs and the cerebral artery wall, which is considered an early lesion in the process of CA formation.
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Affiliation(s)
- Hiroyuki Ikeda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Patho-Functional Bioanalysis, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Sano
- Department of Patho-Functional Bioanalysis, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan.,Laboratory of Biophysical Chemistry, Kobe Pharmaceutical University, Kobe, Japan
| | - Hideo Chihara
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Abekura
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Ono
- Department of Patho-Functional Bioanalysis, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Hideo Saji
- Department of Patho-Functional Bioanalysis, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishi H, Hosomi N, Ohta K, Aoki S, Nakamori M, Nezu T, Shigeishi H, Shintani T, Obayashi T, Ishikawa K, Kinoshita N, Shiga Y, Sugiyama M, Ohge H, Maruyama H, Kawaguchi H, Kurihara H. Serum immunoglobulin G antibody titer to Fusobacterium nucleatum is associated with unfavorable outcome after stroke. Clin Exp Immunol 2020; 200:302-309. [PMID: 32155293 DOI: 10.1111/cei.13430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
Stroke can be a cause of death, while in non-fatal cases it is a common cause of various disabilities resulting from associated brain damage. However, whether a specific periodontal pathogen is associated with increased risk of unfavorable outcome after stroke remains unknown. We examined risk factors for unfavorable outcome following stroke occurrence, including serum antibody titers to periodontal pathogens. The enrolled cohort included 534 patients who had experienced an acute stroke, who were divided into favorable (n = 337) and unfavorable (n = 197) outcome groups according to modified ranking scale (mRS) score determined at 3 months after onset (favorable = score 0 or 1; unfavorable = score 2-6). The associations of risk factors with unfavorable outcome, including serum titers of IgG antibodies to 16 periodontal pathogens, were examined. Logistic regression analysis showed that the initial National Institutes of Health stroke scale score [odds ratio (OR) = 1·24, 95% confidence interval (CI) = 1·18-1·31, P < 0·001] and C-reactive protein (OR = 1·29, 95% CI = 1·10-1·51, P = 0·002) were independently associated with unfavorable outcome after stroke. Following adjustment with those, detection of the antibody for Fusobacterium nucleatum ATCC 10953 in serum remained an independent predictor of unfavorable outcome (OR = 3·12, 95% CI = 1·55-6·29, P = 0·002). Determination of the antibody titer to F. nucleatum ATCC 10953 in serum may be useful as a predictor of unfavorable outcome after stroke.
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Affiliation(s)
- H Nishi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - N Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan.,Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - K Ohta
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - S Aoki
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - M Nakamori
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - T Nezu
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Shigeishi
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Shintani
- Center of Oral Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - T Obayashi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - K Ishikawa
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - N Kinoshita
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Shiga
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - M Sugiyama
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - H Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Kawaguchi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - H Kurihara
- Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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29
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Nishi H, Ishii A, Nakahara I, Matsumoto S, Sadamasa N, Kai Y, Ishibashi R, Yamamoto M, Morita S, Nagata I. Different learning curves between stent retrieval and a direct aspiration first-pass technique for acute ischemic stroke. J Neurosurg 2019; 129:1456-1463. [PMID: 29303452 DOI: 10.3171/2017.6.jns17872] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVEThe clinical outcomes of a direct aspiration first-pass technique (ADAPT) and stent retriever (SR) have been reported to be similar in several observational studies. In this study, procedural and clinical outcomes with ADAPT and SR for the treatment of acute ischemic stroke with large artery occlusion were compared in different time periods.METHODSIn each specific time period, SR and ADAPT were used as the first-line treatment approach for acute ischemic stroke patients with large artery occlusion at the authors' institution. Baseline characteristics, procedural variables, and functional outcome at 90 days were compared between patients treated with SR and those treated with ADAPT. These 2 groups were divided into 3 sequential subgroups to assess the learning curve effects of the endovascular team and individual operators on the procedural variables of each treatment strategy.RESULTSOverall, 89 patients were treated. In the SR group, the recanalization rate was higher (84% vs 65%; p = 0.01) and the procedure time was shorter than in the ADAPT group (median 42 minutes vs 76 minutes, p = 0.04). On the subgroup analysis of the learning curve, the SR group showed more rapid improvement in procedure time than the ADAPT group (p = 0.01 for the team; p < 0.01 for individual operators).CONCLUSIONSIn this initial experience, a higher recanalization rate and shorter procedure time were achieved with SR than with ADAPT. A high recanalization rate with SR was possible with relatively less clinical experience, whereas procedure time dramatically decreased with experience. These observed effects on the learning curve might be useful when choosing the method for initial endovascular treatment of acute ischemic stroke at relatively small stroke centers.
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Affiliation(s)
- Hidehisa Nishi
- Departments of1Neurosurgery and.,Departments of2Neurosurgery and
| | - Akira Ishii
- Departments of1Neurosurgery and.,3Department of Neurosurgery, Kyoto University Hospital, Kyoto
| | - Ichiro Nakahara
- 4Department of Comprehensive Strokology, Fujita Health University Medical School, Aichi; and
| | | | | | | | - Ryota Ishibashi
- Departments of1Neurosurgery and.,6Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Michio Yamamoto
- 7Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto
| | - Satoshi Morita
- 7Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto
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Nishi H, Ishii A, Ono I, Abekura Y, Ikeda H, Arai D, Yamao Y, Okawa M, Kikuchi T, Nakakura A, Miyamoto S. Biodegradable Flow Diverter for the Treatment of Intracranial Aneurysms: A Pilot Study Using a Rabbit Aneurysm Model. J Am Heart Assoc 2019; 8:e014074. [PMID: 31583935 PMCID: PMC6818033 DOI: 10.1161/jaha.119.014074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Herein, we report an in vivo study of a biodegradable flow diverter (BDFD) for aneurysm occlusion. Conceptually, BDFDs induce a temporal flow‐diverting effect and provide a vascular scaffold for neointimal formation at the neck of the aneurysm until occlusion. This offers several potential advantages, including a reduced risk of remote ischemic complications and more treatment options in case of device failure to occlude the aneurysm. Methods and Results A BDFD consisting of 48 poly‐l‐lactic acid wires with radiopaque markers at both ends was prepared. An in vitro degradation test of the BDFD was performed. Thirty‐six BDFDs were implanted in a rabbit aneurysm model. Digital angiography, optical coherence tomography, histopathology, and scanning electron microscopy were performed after 1, 3, and 6 months, and 1 year. The in vitro degradation test showed that the BDFD was almost degraded in 1.5 years. In the in vivo experiment, aneurysm occlusion rates were 0% at 1 month, 20% at 3 months, 50% at 6 months, and 33% at 1 year. Optical coherence tomography showed that luminal area stenosis was the highest at 3 months (16%) and decreased afterward. Immunohistochemical analysis showed that more than half of the luminal surface area was covered by endothelial cells at 1 month. Device fragmentation was not observed in any lesions. Conclusions This first in vivo study of a BDFD shows the feasibility of using BDFDs for treating aneurysms; however, a longer follow‐up is required for comprehensive evaluation of the biological and mechanical behavior peculiar to biodegradable devices.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Akira Ishii
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Isao Ono
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yu Abekura
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan.,Department of Neurosurgery Fukui Red Cross Hospital Fukui Japan
| | - Daisuke Arai
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan.,Department of Neurosurgery Shizuoka General Hospital Shizuoka Japan
| | - Yukihiro Yamao
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masakazu Okawa
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics Kyoto University Graduate School of Medicine Kyoto Japan
| | - Susumu Miyamoto
- Department of Neurosurgery Kyoto University Graduate School of Medicine Kyoto Japan
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31
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Nishi H, Oishi N, Ishii A, Ono I, Ogura T, Sunohara T, Chihara H, Fukumitsu R, Okawa M, Yamana N, Imamura H, Sadamasa N, Hatano T, Nakahara I, Sakai N, Miyamoto S. Predicting Clinical Outcomes of Large Vessel Occlusion Before Mechanical Thrombectomy Using Machine Learning. Stroke 2019; 50:2379-2388. [PMID: 31409267 DOI: 10.1161/strokeaha.119.025411] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The clinical course of acute ischemic stroke with large vessel occlusion (LVO) is a multifactorial process with various prognostic factors. We aimed to model this process with machine learning and predict the long-term clinical outcome of LVO before endovascular treatment and to compare our method with previously developed pretreatment scoring methods. Methods- The derivation cohort included 387 LVO patients, and the external validation cohort included 115 LVO patients with anterior circulation who were treated with mechanical thrombectomy. The statistical model with logistic regression without regularization and machine learning algorithms, such as regularized logistic regression, linear support vector machine, and random forest, were used to predict good clinical outcome (modified Rankin Scale score of 0-2 at 90 days) with standard and multiple pretreatment clinical variables. Five previously reported pretreatment scoring methods (the Pittsburgh Response to Endovascular Therapy score, the Stroke Prognostication Using Age and National Institutes of Health Stroke Scale index, the Totaled Health Risks in Vascular Events score, the Houston Intra-Arterial Therapy score, and the Houston Intra-Arterial Therapy 2 score) were compared with these models for the area under the receiver operating characteristic curve. Results- The area under the receiver operating characteristic curve of random forest, which was the worst among the machine learning algorithms, was significantly higher than those of the standard statistical model and the best model among the previously reported pretreatment scoring methods in the derivation (the area under the receiver operating characteristic curve were 0.85±0.07 for random forest, 0.78±0.08 for logistic regression without regularization, and 0.77±0.09 for Stroke Prognostication using Age and National Institutes of Health Stroke Scale) and validation cohorts (the area under the receiver operating characteristic curve were 0.87±0.01 for random forest, 0.56±0.07 for logistic regression without regularization, and 0.83±0.00 for Pittsburgh Response to Endovascular Therapy). Conclusions- Machine learning methods with multiple pretreatment clinical variables can predict clinical outcomes of patients with anterior circulation LVO who undergo mechanical thrombectomy more accurately than previously developed pretreatment scoring methods.
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Affiliation(s)
- Hidehisa Nishi
- Form the Department of Neurosurgery (H.N., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Oishi
- Medical Innovation Center (N.O.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Ishii
- Department of Neurology (A.I.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Isao Ono
- Form the Department of Neurosurgery (H.N., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takenori Ogura
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C., T.H.)
| | - Tadashi Sunohara
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N. Sakai)
| | - Hideo Chihara
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C., T.H.)
| | - Ryu Fukumitsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N. Sakai)
| | - Masakazu Okawa
- Form the Department of Neurosurgery (H.N., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norikazu Yamana
- Department of Neurosurgery, Koseikai Takeda Hospital, Kyoto, Japan (N.Y., N. Sadamasa)
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N. Sakai)
| | - Nobutake Sadamasa
- Department of Neurosurgery, Koseikai Takeda Hospital, Kyoto, Japan (N.Y., N. Sadamasa)
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan (T.O., H.C., T.H.)
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan (I.N.)
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan (T.S., R.F., H.I., N. Sakai)
| | - Susumu Miyamoto
- Form the Department of Neurosurgery (H.N., I.O., M.O., S.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan
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Tanaka H, Nankaku M, Nishikawa T, Yonezawa H, Mori H, Kikuchi T, Nishi H, Takagi Y, Miyamoto S, Ikeguchi R, Matsuda S. A follow-up study of the effect of training using the Hybrid Assistive Limb on Gait ability in chronic stroke patients. Top Stroke Rehabil 2019; 26:491-496. [PMID: 31318323 DOI: 10.1080/10749357.2019.1640001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Recently, use of the Hybrid Assistive Limb (HAL) that is effective for improvement of gait ability in chronic stroke patients has been reported. However, how long the effects are maintained remains unknown. The purpose of the present study was to investigate whether the effect of gait training using the HAL on gait ability was maintained for 3 months after the intervention. Methods: A longitudinal, observational study with an intervention for a single group that adhered to the STROBE guidelines was performed. Nine chronic stroke patients were enrolled in this study. The patients performed gait training sessions using the HAL, 2-5 sessions/week for 3 weeks. Gait speed, stride length, cadence, and 2-minute walk distance (2MWD) were measured before and after intervention and at 3-month follow-up. The clinical trial registration number of this study is UMIN000012764 R000014756. Results: Compared to the initial status, gait speed (p = .02), stride length (p = .03), cadence (p = .01), and 2MWD (p < .05) were significantly increased immediately after the intervention. Moreover, gait speed (p < .01), cadence (p = .03), and 2MWD (p = .02) remained significantly higher 3 months after the intervention. There were no significant changes in all outcome measures between after intervention and at 3-month follow-up. Conclusions: This study showed that gait training using the HAL resulted in significant improvement of gait ability after the intervention and the effect was maintained for 3 months after the training.
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Affiliation(s)
- Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan
| | - Toru Nishikawa
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan
| | - Honami Yonezawa
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan
| | - Hiroki Mori
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Medicine , Tokushima , Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan.,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital , Kyoto , Japan.,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine , Kyoto , Japan
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INOUE R, Nishi H, Nangaku M. SUN-226 PRESCRIPTION VARIATION OF DRUGS FOR CHRONIC KIDNEY DISEASE AMONG PREFECTURES IN JAPAN. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Tanaka H, Nankaku M, Nishikawa T, Hosoe T, Yonezawa H, Mori H, Kikuchi T, Nishi H, Takagi Y, Miyamoto S, Ikeguchi R, Matsuda S. Spatiotemporal gait characteristic changes with gait training using the hybrid assistive limb for chronic stroke patients. Gait Posture 2019; 71:205-210. [PMID: 31078010 DOI: 10.1016/j.gaitpost.2019.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/20/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Robotic rehabilitation has been attracting attention as a means to carry out "intensive", "repetitive", "task-specific", gait training. The newly developed robotic device, the Hybrid Assistive Limb (HAL), is thought to have the possibility of having an excellent effect on gait speed improvement over the conventional automatic programed assist robot. The purpose of this study was to investigate the spatiotemporal characteristics related to gait speed improvement using the HAL in chronic stroke patients. RESEARCH QUESTION To investigate the effects of robotic gait training on gait speed and gait parameters. METHODS An observational study with an intervention for single group was used. Intervention was conducted in University Hospital. Eleven chronic stroke patients were enrolled in this study. The patients performed 8 gait training sessions using the HAL, 2-5 sessions/week for 3 weeks. Gait speed, stride length, cadence, time of gait cycle (double-limb stance phases and single-limb stance phases) and time asymmetry index were measured before and after intervention. RESULTS After intervention, gait speed, stride length, and cadence were significantly improved (Effect size = 0.39, 0.29, and 0.29), the affected initial double-limb stance phase was significantly shortened (from 15.8 ± 3.46%-13.3 ± 4.20%, p = .01), and the affected single-limb stance phase was significantly lengthened (from 21.8±7.02%-24.5±7.95%, p < .01). The time asymmetry index showed a tendency to improve after intervention (from 22.9±11.8-17.6±9.62, p = .06). There was a significant correlation between gait speed and the stride length increase rate (r = .72, p = .01). SIGNIFICANCE This study showed that increasing stride length with lengthening of the affected single-stance phase by gait training using the HAL improved gait speed in chronic stroke patients. However, the actual contributions on HAL cannot be separated from gait training because this study is an observational research without a control group.
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Affiliation(s)
- Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Japan.
| | | | | | - Takuya Hosoe
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | | | - Hiroki Mori
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Medicine, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Japan
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Nishi H, Oishi N, Ishii A, Chihara H, Ogura T, Ishibashi R, Ando M, Sadamasa N, Ohta T, Kai Y, Yamao Y, Okawa M, Kikuchi T, Hatano T, Nakahara I, Miyamoto S. Abstract TP83: Predicting Clinical Outcomes of Acute Ischemic Stroke Due to Large Vessel Occlusion: The Approach to Utilize High-dimensional Neuroimaging Data With Deep Learning. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Although the clinical outcomes of acute ischemic strokes associated with large vessel occlusion have substantially improved by mechanical thrombectomy, the good clinical outcomes were achieved only in 40-50% of the treated patients. In the clinical practice, neuroimaging information is usually interpreted into scalar data, such as ASPECTS or lesion volume. The detection of prognostic factor might lead to the patient selection appropriate for intervention.
Hypothesis:
We hypothesize that more appropriate information could be directly deduced from high-dimensional neuroimaging data using deep learning algorithm.
Methods:
All patients with anterior circulation ischemic stroke treated with mechanical thrombectomy at our institution between December 2013 and December 2017 were included. The purpose of each model was designed to predict good clinical outcome, which was determined as modified Rankin Scale 0 to 2 at the 90-day follow-up. The “low-dimensional” model used logistic regressions with DWI-ASPECTS (ASPECTS model) or infarct volume (Lesion volume model), both features were derived from on-arrival diffusion weighted image (DWI). The “high-dimensional” model used 3D convolutional neural network (3D-CNN). The input to the 3D-CNN model was the whole DWI volume data. All models were evaluated and compared for the accuracy with 5-fold cross validation.
Results and Conclusions:
One hundred sixty-six patients were included for the analysis. The 3D-CNN model showed the highest accuracy 0.70±0.05 (mean±SD), compared with 0.59±0.07 of ASPECTS model and 0.53±0.05 of Lesion volume model, and was signify better than the other two models (p=0.008 with ANOVA). Although this was a preliminary analysis with limited number of patients, it is suggested that deep learning model can retrieve more valuable information from neuroimaging data than conventional low-dimensional neuroimaging factors.
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Arai D, Ishii A, Ikeda H, Abekura Y, Nishi H, Miyamoto S, Tabata Y. Development of a stent capable of the controlled release of basic fibroblast growth factor and argatroban to treat cerebral aneurysms: In vitro experiment and evaluation in a rabbit aneurysm model. J Biomed Mater Res B Appl Biomater 2019; 107:2185-2194. [PMID: 30653829 DOI: 10.1002/jbm.b.34314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 12/14/2018] [Accepted: 12/23/2018] [Indexed: 11/09/2022]
Abstract
An ideal stent to treat cerebral aneurysms should have an antithrombotic effect on the inner stent blood-facing side and a tissue organization effect on the outer aneurysmal side of the stent. The objective of this study is to evaluate the feasibility of a drug containing stent in the in vivo treatment of cerebral aneurysms. Argatroban, an antithrombotic drug, is encapsulated in biodegradable poly (d,l-lactide-co-glycolide) (PLGA) microspheres for the controlled release with an in vitro study conducted to evaluate the drug release and anticoagulation behavior of released drug. Basic fibroblast growth factor (bFGF), an organization drug, is released from gelatin hydrogels. The stents are coated with gelatin hydrogels incorporating bFGF and PLGA microspheres containing argatroban, and applied to the carotid artery aneurysm of an elastase-induced rabbit model. Most of the aneurysm cavity is occupied by loose connective tissues in the group treated with drug-coated stents, whereas extensive massive hematomas are observed in the group treated with drug-free stents. The occurrence rate of in-stent thrombus is small in the drug-coated stents. The stent incorporating bFGF and PLGA microspheres containing argatroban is an effective device for cerebral aneurysm treatment. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2185-2194, 2019.
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Affiliation(s)
- Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Laboratory of Biomaterials, Institution for Frontier Life and Medicine Sciences, Kyoto University, Kyoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yu Abekura
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuhiko Tabata
- Laboratory of Biomaterials, Institution for Frontier Life and Medicine Sciences, Kyoto University, Kyoto, Japan
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Ohara J, Yamao Y, Ishii A, Shimizu H, Kikuchi T, Takenobu Y, Komatsu K, Ikeda H, Inada T, Nishi H, Abekura Y, Miyamoto S. [Possible Segmental Arterial Mediolysis Associated with Intraperitoneal Hemorrhage in the Acute Stage of Subarachnoid Hemorrhage:A Case Report]. No Shinkei Geka 2019; 47:97-103. [PMID: 30696797 DOI: 10.11477/mf.1436203902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Segmental arterial mediolysis(SAM)is a rare non-inflammatory and non-atherosclerotic arteriopathy associated with the occurrence of multiple aneurysms such as intracranial and intraperitoneal aneurysms. We report a case of intraperitoneal hemorrhage that occurred during the acute stage of subarachnoid hemorrhage(SAH). An 82-year-old woman presented with a sudden onset of loss of consciousness with a diagnosis of SAH. Digital subtraction angiography demonstrated two consecutive vertebral artery-posterior inferior cerebellar artery aneurysms. The larger aneurysm, which seemed to be ruptured, was successfully treated by coil embolization. On the 9th day after the onset of SAH, she developed aphasia secondary to the cerebral vasospasm. After selective intra-arterial infusion of fasudil hydrochloride, she was observed to maintain elevated systolic blood pressure. Her aphasia improved; however, on the 14th day, she suddenly developed hemorrhagic shock. An abdominal computed tomography scan demonstrated intraperitoneal hemorrhage secondary to a ruptured fusiform aneurysm of the right gastroepiploic artery. The lesion was successfully treated by coil embolization, although she became bedridden. Although a histopathological examination was not performed, her clinical, radiological, and serological presentation met the criteria of the clinical diagnosis of SAM. Elevated systolic blood pressure and excessive release of catecholamines in the acute stage of SAH might have caused the intraperitoneal hemorrhage. Non-saccular ruptured intracranial aneurysms should be considered among the differential diagnoses of SAM. In such cases, identifying and monitoring intraperitoneal aneurysms might be useful for earlier diagnosis and treatment of SAM, especially in the acute stage after SAH.
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Affiliation(s)
- Jiro Ohara
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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Nishi H, Ishii A, Satow T, Iihara K, Sakai N. Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3. Neurol Med Chir (Tokyo) 2018; 59:1-9. [PMID: 30531152 PMCID: PMC6350003 DOI: 10.2176/nmc.st.2018-0190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02-5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07-221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University
| | - Akira Ishii
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Nobuyuki Sakai
- Department of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation.,Department of Neurosurgery, Kobe City Medical Center General Hospital
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Ikeda H, Ishii A, Sano K, Chihara H, Arai D, Abekura Y, Nishi H, Ono M, Saji H, Miyamoto S. Activatable fluorescence imaging of macrophages in atherosclerotic plaques using iron oxide nanoparticles conjugated with indocyanine green. Atherosclerosis 2018; 275:1-10. [DOI: 10.1016/j.atherosclerosis.2018.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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Tanaka H, Nankaku M, Nishikawa T, Hosoe T, Yonezawa H, Mori H, Kikuchi T, Nishi H, Miyamoto S, Ikeguchi R, Matsuda S. Effects of gait training with using HAL® on gait functions of chronic stroke patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Koge J, Matsumoto S, Nakahara I, Ishii A, Hatano T, Sadamasa N, Kai Y, Ando M, Saka M, Chihara H, Takita W, Tokunaga K, Kamata T, Nishi H, Hashimoto T, Tsujimoto A, Kira J, Nagata I. Reduction in stroke alert response time for patients with in-hospital stroke using a standardized protocol. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ohta T, Nakahara I, Matsumoto S, Ishibashi R, Miyata H, Nishi H, Watanabe S, Nagata I. Prediction of Cerebral Hyperperfusion After Carotid Artery Stenting by Cerebral Angiography and Single-Photon Emission Computed Tomography Without Acetazolamide Challenge. Neurosurgery 2017; 81:512-519. [DOI: 10.1093/neuros/nyx041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/17/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi Prefecture, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake City, Aichi Prefecture, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan
| | - Sadayoshi Watanabe
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake City, Aichi Prefecture, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan
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Takase KI, Matsumoto S, Nishi H, Nakahara I. A case of superior sagittal sinus intracranial dural arteriovenous fistula mimicking corticobasal syndrome. J Neurol Sci 2017; 376:91-92. [PMID: 28431635 DOI: 10.1016/j.jns.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/19/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Kei-Ichiro Takase
- Department of Neurology, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, Japan.
| | - Shoji Matsumoto
- Department of Neurology, Kokura Memorial Hospital, 3-3-2-1, Asano, Kokura-kita-ku, Kitakyushu, Fukuoka, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University Medical School, 1-98, Dengaku-ga-Kubo, Kutsukake-cho, Toyoake, Aichi, Japan
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Ohta K, Naruse T, Ishida Y, Shigeishi H, Nakagawa T, Fukui A, Nishi H, Sasaki K, Ogawa I, Takechi M. TNF-α-induced IL-6 and MMP-9 expression in immortalized ameloblastoma cell line established by hTERT. Oral Dis 2016; 23:199-209. [PMID: 27868311 DOI: 10.1111/odi.12594] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ameloblastoma (AM) shows locally invasive behaviour. However, biological investigations regarding regulation of gene expression associated with AM pathological features are difficult to perform, because AM cells can be passaged for a few generations due to senescence. We report a newly established immortalized AM cell line, AMB cells, by transfection with human telomerase reverse transcriptase (hTERT). Furthermore, we examined whether TNF-α modulates bone resorption-related genes, IL-6 and MMP-9 in cooperation with TGF-β or IFN-γ. MATERIALS AND METHODS Following transfection of an hTERT expression vector into AM cells using a non-viral method, the effects of cytokines on the expressions of IL-6 and MMP-9 mRNA were examined using real-time PCR. TNF-α-induced NF-κB activity was examined by western blotting and transcription factor assays. RESULTS AMB cells continued to grow for more than 100 population doublings. Stimulation with TNF-α increased IL-6 and MMP-9 mRNA expressions, as well as NF-κB activation. Furthermore, TGF-β and IFN-γ dramatically increased TNF-α-mediated expressions of MMP-9 and IL-6 mRNA, respectively, while those responses were suppressed by NF-κB inhibitor. CONCLUSION We established an immortalized AM cell line by hTERT transfection. TNF-α-mediated regulation of MMP-9 and IL-6 via NF-κB may play an important role in the pathological behaviour of AMs, such as bone resorption.
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Affiliation(s)
- K Ohta
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - T Naruse
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Ishida
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - H Shigeishi
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - T Nakagawa
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - A Fukui
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - H Nishi
- Department General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - K Sasaki
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - I Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - M Takechi
- Department of Oral and Maxillofacial Surgery, Division of Cervico-Gnathostmatology, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Nakayama D, Nishi H, Kato R, Sagawa Y, Terauchi F, Isaka K. Biweekly administration of docetaxel and carboplatin for advanced or recurrent endometrial and ovarian carcinomas. EUR J GYNAECOL ONCOL 2016; 37:488-492. [PMID: 29894072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine efficacy and safety of biweekly administration of docetaxel and carboplatin for advanced or recurrent en- dometrial and ovarian carcinomas. MATERIAL AND METHODS The recommended doses were determined in the phase I study. In the phase II feasibility study, the primary end-point was safety, and the secondary end-point was response rate and progression-free survival (PFS). RESULTS The recommended doses of docetaxel and carboplatin were determined to be 45 mg/n(2) and AUC 3.0, respectively, in phase I study. In phase II feasibility study, no treatment-related death was observed. Most non-hematotoxicity cases were mild or moderate. Grade 4 neutropenia was confirmed in 13 patients (31.0%), whereas all cases showed tolerability with 2.6 days delay of anticancer drugs administration in both groups. Response rate was 55.0% in the ovarian carcinoma group, and average PFS was 8.7 months. In the endometrial carcinoma group, response rate was 50.0% and average PFS was 32.0 months. CONCLUSION The present results showed that biweekly administration of docetaxel and carboplatin for advanced and recurrent endometrial and ovarian carcinomas results in acceptable side effects, response rate, and PFS.
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Nishi H, Izumoto S, Nakamura K, Nakai H, Sato T. Dextran and dextrin as chiral selectors in capillary zone electrophoresis. Chromatographia 2016. [DOI: 10.1007/bf02267693] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nishi H, Nakahara I, Matsumoto S, Hashimoto T, Ohta T, Sadamasa N, Ishibashi R, Gomi M, Saka M, Miyata H, Watanabe S, Okata T, Sonoda K, Kouge J, Ishii A, Nagata I, Kira JI. Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy. J Neurointerv Surg 2015; 8:949-53. [PMID: 26297788 DOI: 10.1136/neurintsurg-2015-011844] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 08/05/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy. METHODS From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications. RESULTS A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications. CONCLUSIONS The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuya Hashimoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Science Center, Kochi, Japan
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Makoto Saka
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | | | - Takuya Okata
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazutaka Sonoda
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Junpei Kouge
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Fukushima Y, Nakahara I, Ohta T, Matsumoto S, Ishibashi R, Gomi M, Miyata H, Nishi H, Watanabe S. Rare complication characterized by late-onset transient neurological symptoms without hyperperfusion after carotid artery stenting: A report of three cases. Interv Neuroradiol 2015; 21:72-9. [PMID: 25934779 DOI: 10.15274/inr-2014-10099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We experienced a rare complication after carotid artery stenting (CAS) characterized by transient neurological symptoms with no evidence of distal emboli or hyperperfusion. Using neuroimaging, we investigated the pathogenesis of the complication that occurred after CAS in three patients who developed neurological symptoms over a period of ten hours after CAS and improved within two days. None of the three patients showed signs of fresh infarctions on diffusion-weighted imaging or hyperperfusion on single-photon emission computed tomography. However, high signal intensity was observed in the leptomeningeal zone of the cerebral hemisphere on the stent side in all three patients and in the leptomeningeal zone of the contralateral anterior cerebral artery territory in one patient. These areas were assessed using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging without gadolinium administration. The high signal intensity in the leptomeningeal zone disappeared as the symptoms improved. Based on the transient nature of the neurological disorders and the normalization of FLAIR imaging findings in these patients, the pathogenesis of this complication might have been vasogenic edema due to vasoparalysis of the local vessels caused by the hemodynamic changes occurring after CAS.
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Affiliation(s)
- Yutaka Fukushima
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Ichiro Nakahara
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
| | - Sadayoshi Watanabe
- Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan
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Fukushima Y, Nakahara I, Ohta T, Matsumoto S, Ishibashi R, Gomi M, Miyata H, Nishi H, Watanabe S. Rare complication characterized by late-onset transient neurological symptoms without hyperperfusion after carotid artery stenting: A report of three cases. Interv Neuroradiol 2015. [DOI: 10.1177/inr-2014-10099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ohta T, Nakahara I, Ishibashi R, Matsumoto S, Gomi M, Miyata H, Nishi H, Watanabe S, Nagata I. The maze-making and solving technique for coil embolization of large and giant aneurysms. AJNR Am J Neuroradiol 2014; 36:744-50. [PMID: 25542878 DOI: 10.3174/ajnr.a4198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/23/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite major progress in treating aneurysms by coil embolization, the complete occlusion of aneurysms of >10 mm in diameter (large/giant aneurysms) remains challenging. We present a novel endovascular treatment method for large and giant cerebral aneurysms called the "maze-making and solving" technique and compare the short-term follow-up results of this technique with those of conventional coil embolization. MATERIALS AND METHODS Eight patients (65 ± 11.5 years of age, 7 women) with large/giant unruptured nonthrombosed cerebral aneurysm (mean largest aneurysm dimension, 19 ± 4.4 mm) were treated by the maze-making and solving technique, a combination of the double-catheter technique and various assisted techniques. The coil-packing attenuation, postoperative courses, and recurrence rate of this maze group were compared with 30 previous cases (conventional group, 65.4 ± 13.0 years of age; 22 women; mean largest aneurysm dimension, 13.4 ± 3.8 mm). RESULTS Four maze group cases were Raymond class 1; and 4 were class 2 as indicated by immediate postsurgical angiography. No perioperative deaths or major strokes occurred. Mean packing attenuation of the maze group was significantly higher than that of the conventional group (37.4 ± 5.9% versus 26.2 ± 5.6%). Follow-up angiography performed at 11.3 ± 5.4 months revealed no recurrence in the maze group compared with 39.2% in the conventional group. CONCLUSIONS The maze-making and solving technique achieves high coil-packing attenuation for efficient embolization of large and giant cerebral aneurysms with a low risk of recurrence.
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Affiliation(s)
- T Ohta
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
| | - I Nakahara
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - R Ishibashi
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - S Matsumoto
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - M Gomi
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - H Miyata
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - H Nishi
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - S Watanabe
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - I Nagata
- From the Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
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