Neurologia medico-chirurgica最新文献_第2页

Embosphere Size Selection and Dilution Rate in Preoperative Tumor Embolization of the External Carotid Artery System Using a Small-diameter Catheter. 使用小直径导管进行颈外动脉系统肿瘤术前栓塞时的栓塞圈大小选择和稀释率

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-11-06 DOI: 10.2176/jns-nmc.2024-0059

Takao Hashimoto, Yusuke Arai, Hirofumi Okada, Muneaki Kikuno, Hiroki Sakamoto, Kyosuke Matsunaga, Michihiro Kohno

{"title":"Embosphere Size Selection and Dilution Rate in Preoperative Tumor Embolization of the External Carotid Artery System Using a Small-diameter Catheter.","authors":"Takao Hashimoto, Yusuke Arai, Hirofumi Okada, Muneaki Kikuno, Hiroki Sakamoto, Kyosuke Matsunaga, Michihiro Kohno","doi":"10.2176/jns-nmc.2024-0059","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0059","url":null,"abstract":"The widespread adoption of preoperative embolization in highly vascularized brain tumors often involves the frequent use of Embosphere (Merit Medical Systems, South Jordan, Utah, USA). Nevertheless, inconsistency in size selection and dilution rates across different institutions requires comprehensive examination. This study explored the appropriate size and dilution rate of Embosphere microspheres. To assess catheter occlusion and Embosphere breakage, various dilutions (4-, 10-, 20-, 30-, and 60-fold) of Embosphere 300-500 and 500-700 μm were injected into the catheter in vitro. Results indicated that 20-fold or higher dilutions of Embosphere 300-500 μm and 30-fold or higher dilutions of Embosphere 500-700 μm showed no occlusion of the Excelsior SL-10 microcatheter (Stryker, Fremont, CA, USA) or Embosphere breakage. For embolization, to reduce the risk of Excelsior SL-10 occlusion further, a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm were employed. For 195 blood vessels in 107 patients (84 with meningioma and 23 with schwannoma), embolization was carried out using a 30-fold dilution of Embosphere 300-500 μm when the provocative test was negative and a 60-fold dilution of Embosphere 500-700 μm when the test was positive or when there was a risk of migration into neurotrophic vessels. Contrast-enhanced magnetic resonance imaging after embolization revealed a reduced enhancement effect in 69.1% of cases. Embolization using a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm with an Excelsior SL-10 catheter is safe and satisfactory, which minimizes microcatheter occlusion.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Usefulness of Mechanical Thrombectomy in Patients with Cancer Who Developed Cerebral Infarction. 机械血栓切除术在发生脑梗塞的癌症患者中的实用性

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-11-06 DOI: 10.2176/jns-nmc.2024-0016

Sayaka Terazono, Yuki Sakaeyama, Yutaka Fuchinoue, Masataka Mikai, Shuhei Kubota, Mitsuyoshi Abe, Kosuke Kondo, Nobuo Sugo, Takaaki Nagao, Masaaki Nemoto

{"title":"Usefulness of Mechanical Thrombectomy in Patients with Cancer Who Developed Cerebral Infarction.","authors":"Sayaka Terazono, Yuki Sakaeyama, Yutaka Fuchinoue, Masataka Mikai, Shuhei Kubota, Mitsuyoshi Abe, Kosuke Kondo, Nobuo Sugo, Takaaki Nagao, Masaaki Nemoto","doi":"10.2176/jns-nmc.2024-0016","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0016","url":null,"abstract":"Mechanical thrombectomy (MT) is an established treatment for large vessel occlusion in the acute phase of stroke. However, its efficacy and safety in patients with cancer remain unclear. This study aimed to evaluate the therapeutic effect of MT against large vessel occlusion between patients with and without cancer. A total of 71 patients who underwent MT from August 2014 to November 2021 were included in this study. Patients with cancer and/or a history of cancer (n = 16) were included in the with cancer group and the remaining patients in the without cancer group (n = 55). The frequency of preoperative tissue plasminogen activator administration was significantly lower in the with cancer group (n = 2 [12.5%]) than in the without cancer group (n = 24 [43.6%]). However, there were no significant differences between the two groups in terms of treatment time, pass frequency, thrombolysis in cerebral infarction grade, modified Rankin scale score at 1 week after treatment [mRS (1w) ], modified Rankin scale score at discharge [mRS (ENT) ], modified Rankin scale score at 90 days after treatment [mRS (90 days) ], and length of hospital stay (days). In the multivariate analysis, if the objective variables were mRS (1w) and mRS (90 days), the National Institutes of Health Stroke Scale (NIHSS) and preonset mRS scores were considered significant variables. The presence or absence of cancer was not considered an independent factor of mRS (1w), mRS (ENT), or mRS (90 days). Aggressive treatment may be recommended to patients with cancer and/or a history of cancer who present with a systemic condition that can be managed with MT.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Simultaneous and Consecutive Drainage of Bilateral Chronic Subdural Hematoma: A Randomized Controlled Trial. 同时和连续引流双侧慢性硬膜下血肿：随机对照试验。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-22 DOI: 10.2176/jns-nmc.2024-0084

Omer Akar, Hasan Kamil Sucu, Selin Bozdag

{"title":"Simultaneous and Consecutive Drainage of Bilateral Chronic Subdural Hematoma: A Randomized Controlled Trial.","authors":"Omer Akar, Hasan Kamil Sucu, Selin Bozdag","doi":"10.2176/jns-nmc.2024-0084","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0084","url":null,"abstract":"Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, particularly in elderly individuals. Although most patients present with unilateral CSDH, bilateral involvement is not rare. Furthermore, bilateral CSDHs are associated with rapid deterioration and poorer outcomes because of a higher risk of brain herniation than unilateral hematomas. The most contentious issue is the potential herniation of the medial temporal lobe, which remains on the unevacuated side during the brief interval between right and left procedures. We compared simultaneous burr-hole craniostomy with consecutive burr-hole craniostomy for treating bilateral CSDH and to determine whether consecutive evacuation is riskier in terms of brain stem complications.Over a 6.5-year period, patients with bilateral CSDH who had an indication for operation were allocated into two groups randomly. The first group (n = 18) underwent simultaneous evacuation, and the second group (n = 25) underwent consecutive evacuation. Glasgow Coma Scale and Markwalder grades were recorded during the postoperative period. Patients were followed up during the inpatient period and postoperatively at 1, 3, 6, and 12 months after discharge. Mortality, morbidity, surgical complications, reoperation, and, as a combination of all of these, treatment success rates were compared. Treatment success rates were worse in patients with mixed-density hematomas and in female patients at the end of 12 months, but there was no significant difference between the simultaneous and consecutive evacuation groups at any time. Therefore, the choice of technique can be decided by the surgeon.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Frequency and Prognostic Impact of CDKN2A/B Alteration in Oligodendrogliomas: Systematic Review and Meta-analysis. CDKN2A/B在少突胶质细胞瘤中的发生率和预后影响：系统综述和荟萃分析

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-22 DOI: 10.2176/jns-nmc.2024-0105

Satoshi Nakasu, Shoichi Deguchi, Yoko Nakasu

{"title":"Frequency and Prognostic Impact of CDKN2A/B Alteration in Oligodendrogliomas: Systematic Review and Meta-analysis.","authors":"Satoshi Nakasu, Shoichi Deguchi, Yoko Nakasu","doi":"10.2176/jns-nmc.2024-0105","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0105","url":null,"abstract":"Isocitrate dehydrogenase (IDH) -mutant astrocytomas with homozygous deletion of cyclin-dependent kinase 2A/B (CDKN2A/B-HomoD) are categorized to grade 4 in the new World Health Organization (WHO) classification. However, the clinical implications of CDKN2A/B-HomoD in oligodendrogliomas remain unclear. This study systematically reviewed and meta-analyzed the literature on molecularly defined oligodendrogliomas (mOlig) to find the frequency and prognostic significance of CDKN2A/B gene alterations. Overall survival was worse in patients with CDKN2A/B-HomoD [pooled hazard ratio (pHR) 2.44; 95% confidential interval (CI), 1.59-3.76; P < 0.0001; 7 studies, 1,012 patients] than in those without CDKN2A/B-HomoD. Although the frequency (95% CI) was very low in grade 2 tumors (0.31%; 0.02-0.4) than in grade 3 tumors (9.4%; 6.2-14.0; I2 = 52.0%), pHR of multivariate analyses with covariates of WHO grade and age was still significant (P = 0.017). In contrast, the method in CDKN2A/B evaluation was a significant factor for the heterogeneity in frequency. The pooled frequency of CDKN2A/B-HomoD in grade 3 mOlig by fluorescence in situ hybridization (FISH) (20.3%) was higher than that by other methods (7.3%; P < 0.0006), probably due to the lower threshold for CDKN2A/B-HomoD in FISH studies that was used in this analysis. The frequency (95% CI) of other alterations of the CDKN2A/B gene, i.e., mutation, hemizygous deletion, and promoter methylation, was estimated as 1.48% (0.6-3.5), 15.9% (9.8-24.7), and 20.6% (13.7-29.8), respectively. The clinical significance of these alterations remains unclear due to the immaturity of the investigations.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real-world Data of Antithrombotic Therapy in Neuroendovascular Therapy: Analysis of JR-NET 4. 神经血管内治疗中抗血栓治疗的真实世界数据：分析 JR-NET 4.

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-22 DOI: 10.2176/jns-nmc.2024-0144

Nozomi Sasaki, Yukiko Enomoto, Hiroshi Yamagami, Koji Iihara, Akira Ishii, Hirotoshi Imamura, Nobuyuki Sakai, Chiaki Sakai, Tetsu Satow, Yuji Matsumaru, Shinichi Yoshimura

{"title":"Real-world Data of Antithrombotic Therapy in Neuroendovascular Therapy: Analysis of JR-NET 4.","authors":"Nozomi Sasaki, Yukiko Enomoto, Hiroshi Yamagami, Koji Iihara, Akira Ishii, Hirotoshi Imamura, Nobuyuki Sakai, Chiaki Sakai, Tetsu Satow, Yuji Matsumaru, Shinichi Yoshimura","doi":"10.2176/jns-nmc.2024-0144","DOIUrl":"https://doi.org/10.2176/jns-nmc.2024-0144","url":null,"abstract":"As the number of neuroendovascular therapies in Japan increases, the current trends in periprocedural antithrombotic therapy must be understood.We retrospectively analyzed data on periprocedural antithrombotic therapy in the Japanese Registry of Neuroendovascular Therapy (JR-NET) 4, a nationwide survey carried out in Japan between January 2015 and December 2019. Details on antithrombotic therapy in neuroendovascular therapy for ruptured cerebral aneurysms, unruptured cerebral aneurysms, and percutaneous transluminal angioplasty or stenting were collected from the JR-NET 4 database. These data were analyzed and compared with those from the JR-NET 2 (January 2008 to December 2009) and JR-NET 3 (January 2010 to December 2014). A total of 36,560 cases were analyzed in the JR-NET 4. The frequency of preprocedural dual antiplatelet therapy (DAPT) significantly increased from the JR-NET 2 to 4 (48.1%, 53.4%, and 62.3%, respectively; P < 0.001), whereas the frequency of monotherapy significantly decreased (15.7%, 13.9%, and 8%, respectively; P < 0.001). Postprocedural antiplatelet therapy exhibited similar trends, and postprocedural anticoagulant therapy was discontinued. Particularly, heparin use significantly decreased from the JR-NET 2 to 4 (23.4% vs. 12.7% vs. 7.9%, respectively; P < 0.001). In terms of periprocedural complications, the incidence of ischemic complications increased from the JR-NET 3 to 4 (5.8% vs. 6.2%; P = 0.05). In the JR-NET 4, severe adverse events and hemorrhagic and all complications were significantly more frequent in the preprocedural triple or more therapy group.The rate of postprocedural anticoagulant therapy decreased, whereas that of antiplatelet therapy increased. Overall, in Japan, periprocedural DAPT has become increasingly common.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Moyamoya Periventricular Choroidal Collateral Registry-A Multicenter Cohort Study of Moyamoya Disease with Choroidal Anastomosis: Study Protocol. Moyamoya 室周脉络膜侧支注册--一项关于脉络膜吻合的 Moyamoya 病的多中心队列研究：研究协议。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-15 Epub Date: 2024-09-07 DOI: 10.2176/jns-nmc.2024-0063

Takeshi Funaki, Susumu Miyamoto

引用次数: 0

Prevalence, Radiological, and Pathological Findings of Ossification and Calcification of the Lumbar Spinal Ligamentum Flavum: A Comparative Study with Thoracic Lesions. 腰椎韧带骨化和钙化的发病率、放射学和病理学发现：与胸椎病变的比较研究。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-15 Epub Date: 2024-09-07 DOI: 10.2176/jns-nmc.2024-0074

Takeaki Endo, Keisuke Takai, Takashi Komori, Yasuhiro Nakata

{"title":"Prevalence, Radiological, and Pathological Findings of Ossification and Calcification of the Lumbar Spinal Ligamentum Flavum: A Comparative Study with Thoracic Lesions.","authors":"Takeaki Endo, Keisuke Takai, Takashi Komori, Yasuhiro Nakata","doi":"10.2176/jns-nmc.2024-0074","DOIUrl":"10.2176/jns-nmc.2024-0074","url":null,"abstract":"This study aimed to determine the prevalence of lumbar ligamentum flavum lesions and identify correlations between radiological and pathological findings. We conducted an observational cross-sectional study of 349 patients (lumbar: n = 296, thoracic: n = 39, lumbar and thoracic: n = 14, mean age: 69 ± 12 years, male: 74%) who underwent posterior surgery for thoracolumbar spinal canal stenosis between January 2008 and April 2023 at our hospital.Computed tomography (CT) revealed that the prevalence of ligamentum flavum lesions defined as a high-density area with a CT value of 200 Hounsfield Unit or higher in the lumbar and thoracic spine was 47% (147/310) and 85% (45/53), respectively. CT showed that most patients had radiologically suspected ossification in the lumbar (90%) and thoracic spine (98%) than radiologically suspected calcification. Lumbar lesions were thinner than the thoracic lesions (2.5 vs 3.7 mm, p < 0.01). Pathological examinations were performed in specimens collected from 34 cases (lumbar: n = 13, thoracic: n = 21), and ossification was found in 62% (8/13) and 95% (20/21) of lumbar and thoracic lesions (p = 0.02), respectively. Lastly, ossification was confirmed pathologically in 72% (8/11) and 95% (19/20) of lumbar and thoracic lesions that showed ossification on imaging (p = 0.13), respectively. The literature review revealed that the prevalence of the lumbar ligamentum flavum lesions varied from 1.5 to 35% and the patient population was mostly asymptomatic.Collectively, we found that the prevalence of lumbar ligamentum flavum lesions in symptomatic patients was greater than previously reported. Histologically confirmed ossification was less common in lumbar lesions than in thoracic lesions.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"369-375"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials. 面肌痉挛患者微血管减压后延迟缓解与外侧扩展反应形态之间的相关性--复合运动动作电位的进一步研究

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-15 Epub Date: 2024-09-07 DOI: 10.2176/jns-nmc.2024-0017

Yuki Amano, Bunsho Asayama, Shusaku Noro, Takenori Abe, Masahiro Okuma, Kaori Honjo, Yoshinobu Seo, Hirohiko Nakamura

{"title":"Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials.","authors":"Yuki Amano, Bunsho Asayama, Shusaku Noro, Takenori Abe, Masahiro Okuma, Kaori Honjo, Yoshinobu Seo, Hirohiko Nakamura","doi":"10.2176/jns-nmc.2024-0017","DOIUrl":"10.2176/jns-nmc.2024-0017","url":null,"abstract":"Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported correlation between delayed relief after MVD and polyphasic morphology of the LSR. This study aimed to investigate the morphology of LSR and the course of recovery of the compound motor action potential (CMAP), to better understand the pathophysiology of delayed healing of HFS. Based on the pattern of the initial LSR morphology on temporal and marginal mandibular branches stimulation, patients were divided into two groups: the monophasic and polyphasic groups. The results of MVD surgery and sequential changes in the CMAP were evaluated 1 week, 1 month, 1 year, and final follow-up after the surgery. Significantly higher rates of persistent postoperative HFS were observed in patients with the polyphasic type of initial LSR at 1 week and 1 month after the surgery (P < 0.05, respectively). In the polyphasic group, the amplitude of the CMAP tended to gradually improve with time, while in the monophasic group, the amplitude of the CMAP decreased on the seventh postoperative day, followed by its gradual improvement. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. In the polyphasic group, CMAP recovered earlier and showed less reduction in amplitude, suggesting segmental demyelination, with less damage to peripheral nerves.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"360-368"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Important Notes for Preventing Entrapment of Distal Filter-based Embolic Protection Device in Carotid Artery Stenting. 在颈动脉支架植入术中防止远端滤器型栓塞保护装置被卡住的重要注意事项。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-15 Epub Date: 2024-08-28 DOI: 10.2176/jns-nmc.2024-0013

Juntaro Fujita, Nobuyuki Hirotsune, Yuki Matsuda, Osamu Hamasaki, Shoichi Fukuda, Yoshihiro Okada, Aiko Kobashi, Shohei Nishigaki, Keigo Makino, Yusuke Tomita, Naoya Kidani, Kenichiro Muraoka, Shigeki Nishino

{"title":"Important Notes for Preventing Entrapment of Distal Filter-based Embolic Protection Device in Carotid Artery Stenting.","authors":"Juntaro Fujita, Nobuyuki Hirotsune, Yuki Matsuda, Osamu Hamasaki, Shoichi Fukuda, Yoshihiro Okada, Aiko Kobashi, Shohei Nishigaki, Keigo Makino, Yusuke Tomita, Naoya Kidani, Kenichiro Muraoka, Shigeki Nishino","doi":"10.2176/jns-nmc.2024-0013","DOIUrl":"10.2176/jns-nmc.2024-0013","url":null,"abstract":"Failure to retrieve a distal filter-based embolic protection device (EPD) is a potential complication of carotid artery stenting. This may be caused by trapping of the proximal marker of the EPD within the stent tip marker. Maintaining an adequate distance between the two can prevent this. We examined the behavior of several stent-filter-based EPD combinations, focusing on their propensity to become trapped or disengage in vitro. Four physicians subjectively rated the force required to result in trapping using a 5-point scale. Moreover, the force required to disengage trapped devices was evaluated. The Casper stent-Spider FX EPD combination was difficult to disengage when entrapment occurred, which suggested that this phenomenon tended to occur with this combination. The stent tip marker of the closed-cell stents advanced as they shortened, which may be a unique feature of closed-cell stents. Although trapping is uncommon, it can cause serious complications. To prevent these complications, device characteristics should be well understood before they are used in patients.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"382-386"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coil Embolization for Cerebral Aneurysm Using Low Pulse Rate Fluoroscopy. 使用低脉率荧光透视对脑动脉瘤进行线圈栓塞治疗。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-10-15 Epub Date: 2024-08-28 DOI: 10.2176/jns-nmc.2024-0069

Takeshi Shimizu, Shingo Toyota, Tomoaki Murakami, Maki Kobayashi, Haruhiko Kishima

{"title":"Coil Embolization for Cerebral Aneurysm Using Low Pulse Rate Fluoroscopy.","authors":"Takeshi Shimizu, Shingo Toyota, Tomoaki Murakami, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2024-0069","DOIUrl":"10.2176/jns-nmc.2024-0069","url":null,"abstract":"Although coil embolization is commonly perceived as a minimally invasive procedure, the associated radiation exposure cannot be disregarded. To date, no specific study has investigated radiation exposure during coil embolization. This study aimed to investigate the potential of lowering the pulse rate to decrease radiation exposure during coil embolization while maintaining patient safety. Radiation data and clinical features of 70 patients who underwent coil embolization between 2015 and 2020 were retrospectively analyzed. Since July 2017, the pulse rate was regulated from 7.5 to 4 frames per second (f/s). Statistical analyses were performed to examine the correlation between pulse rate and radiation exposure. Out of the 70 procedures, 30 were performed at the standard pulse rate (7.5 f/s), and 40 were performed at the lower pulse rate (4 f/s). In the lower-pulse-rate group, the absorbed dose to the patient (AK) was 2580.7 (±217) mGy, whereas in the standard-pulse-rate group, it was 4760 (±411.1). Both the dose-area product (DAP) and AK were substantially reduced in the low pulse rate group (p = 0.000002). There was a significant correlation between DAP and AK and pulse rate (p = 0.004, p = 0.0017, respectively). Moreover, there was no significant correlation between pulse rate and perioperative complications. Our findings suggest that using a lower pulse rate (4 f/s) can effectively reduce radiation exposure during coil embolization for cerebral aneurysms while ensuring patient safety.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"353-359"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0