Neurologia medico-chirurgica最新文献_第4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 : 2025-01-15 Epub 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":"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":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807688/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Outcomes of Carotid Artery Stenting for Carotid Artery Stenosis in Maintenance Hemodialysis Patients. 颈动脉支架植入术治疗维持性血液透析患者颈动脉狭窄的临床效果。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2025-01-15 Epub Date: 2024-11-25 DOI: 10.2176/jns-nmc.2024-0193

Shuki Okuhara, Tomoaki Murakami, Shingo Toyota, Kosei Okochi, Koichi Nakashima, Kazuhiro Tohara, Shuhei Yamada, Takamune Achiha, Maki Kobayashi, Haruhiko Kishima

{"title":"Clinical Outcomes of Carotid Artery Stenting for Carotid Artery Stenosis in Maintenance Hemodialysis Patients.","authors":"Shuki Okuhara, Tomoaki Murakami, Shingo Toyota, Kosei Okochi, Koichi Nakashima, Kazuhiro Tohara, Shuhei Yamada, Takamune Achiha, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2024-0193","DOIUrl":"10.2176/jns-nmc.2024-0193","url":null,"abstract":"Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"37-44"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710622","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

Safety and Selection Criteria of Single-joint Hybrid Assistive Limb for Upper Limb Paralysis After Stroke: A Phase I Trial. 单关节混合辅助肢体治疗中风后上肢瘫痪的安全性和选择标准：一期试验

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2025-01-15 Epub Date: 2024-11-25 DOI: 10.2176/jns-nmc.2024-0137

Hiroshi Ohmae, Taku Matsuda, Maki Fujimoto, Yuka Nakanowatari, Megumi Yamada, Nori Sato, Kimiko Umemura, Ryoma Morigaki, Tetsuya Matsuura, Yasushi Takagi

{"title":"Safety and Selection Criteria of Single-joint Hybrid Assistive Limb for Upper Limb Paralysis After Stroke: A Phase I Trial.","authors":"Hiroshi Ohmae, Taku Matsuda, Maki Fujimoto, Yuka Nakanowatari, Megumi Yamada, Nori Sato, Kimiko Umemura, Ryoma Morigaki, Tetsuya Matsuura, Yasushi Takagi","doi":"10.2176/jns-nmc.2024-0137","DOIUrl":"10.2176/jns-nmc.2024-0137","url":null,"abstract":"Robotic rehabilitation is a high-intensity intervention for upper limb paralysis after a stroke. This study explored the safety and feasibility of using a single-joint hybrid assistive limb (HAL-SJ) exoskeletal device for upper limb paralysis in patients with acute stroke. In total, 11 patients with stroke (6 with moderate paralysis and 5 with severe paralysis) were enrolled between October 2021 and October 2023 in a stroke care unit. The patients underwent HAL training 3 times a week for 6 sessions. No serious adverse events related to HAL-SJ occurred, and participants demonstrated significant improvements in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) (pre- vs. post-intervention; p < 0.05). The minimal clinically important difference (MCID) for FMA-UE was surpassed in 5 patients (83.3%) with moderate paralysis and 2 (40.0%) with severe paralysis. Regarding ARAT, 4 patients (66.7%) with moderate paralysis exceeded the MCID, whereas none (0.0%) with severe paralysis did. These findings suggest that HAL-SJ is both safe and feasible, particularly for individuals with moderate paralysis.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"15-21"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710636","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

Impact of Clazosentan on Vasospasm Reduction and Functional Recovery after Aneurysmal Subarachnoid Hemorrhage. 克拉唑生坦对动脉瘤性蛛网膜下腔出血后血管痉挛缓解和功能恢复的影响

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2025-01-15 Epub Date: 2024-11-25 DOI: 10.2176/jns-nmc.2024-0204

Sosho Kajiwara, Takayuki Kawano, Yu Hasegawa, Yukihiko Nakamura, Kiyohiko Sakata, Jin Kikuchi, Masaru Hirohata, Motohiro Morioka

{"title":"Impact of Clazosentan on Vasospasm Reduction and Functional Recovery after Aneurysmal Subarachnoid Hemorrhage.","authors":"Sosho Kajiwara, Takayuki Kawano, Yu Hasegawa, Yukihiko Nakamura, Kiyohiko Sakata, Jin Kikuchi, Masaru Hirohata, Motohiro Morioka","doi":"10.2176/jns-nmc.2024-0204","DOIUrl":"10.2176/jns-nmc.2024-0204","url":null,"abstract":"In every hospital in Japan, until 2022, the primary treatment for preventing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) involved a combination of ozagrel sodium (Oz), fasudil hydrochloride (Fs), cilostazol, and statins. However, with the approval of clazosentan in January 2022, it has been used as a first-choice drug more frequently. Despite this shift, limited evidence exists regarding the use of clazosentan as the first choice for DCI prevention. In this study, we analyzed the efficacy and outcomes of these two treatments in aSAH patients. Patients treated with Oz+Fs were enrolled between January 2014 and March 2022. In April 2022, clazosentan was prescribed to prevent DCI. Clinical data were collected, and propensity-score matching was conducted based on the clazosentan group. The primary endpoint was the functional outcome at discharge and 6-12 months after admission; the secondary endpoints were the incidence of cerebral vasospasm (CV) and DCI. In this study, 221 patients were included, and 27 were selected from both groups after matching. The incidence of CV was significantly lower in the clazosentan group (11.1% vs. 55.6%, p<0.01), and the incidence of DCI tended to be lower in the clazosentan group (3.7% vs. 25.9%, p=0.05). No significant difference was observed in the primary endpoint of functional outcome at discharge; however, a significant improvement in functional outcome was observed in the clazosentan group at 6 months (96.3% vs. 70.4%, p<0.05). Clazosentan significantly reduced the incidence of CV and improved functional outcomes in patients with aSAH compared to Oz+Fs.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"29-36"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710632","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

Validity of E-PASS Score for Evaluating Perioperative Minor Complications Associated with Carotid Endarterectomy. 评估颈动脉内膜剥脱术围手术期轻微并发症的 E-PASS 评分的有效性

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2025-01-15 Epub Date: 2024-11-25 DOI: 10.2176/jns-nmc.2024-0035

Yutaka Morishima, Masahito Kawabori, Yoichi M Ito, Masayuki Gekka, Koji Furukawa, Yoshimasa Niiya, Miki Fujimura

{"title":"Validity of E-PASS Score for Evaluating Perioperative Minor Complications Associated with Carotid Endarterectomy.","authors":"Yutaka Morishima, Masahito Kawabori, Yoichi M Ito, Masayuki Gekka, Koji Furukawa, Yoshimasa Niiya, Miki Fujimura","doi":"10.2176/jns-nmc.2024-0035","DOIUrl":"10.2176/jns-nmc.2024-0035","url":null,"abstract":"Carotid endarterectomy (CEA) is conducted to reduce the risk of cerebral infarction; therefore, a low complication rate is highly required. To predict long-term morbidity and mortality, various scoring systems have been considered; nonetheless, a model that can be utilized to estimate nonmajor temporary complications and minor complications is currently lacking. To evaluate the occurrence rate of perioperative complications in various surgical domains, the E-PASS (Estimation of Physiological Ability and Surgical Stress) score is employed. This study was carried out to investigate the utility of the E-PASS score as a predictive factor for the risk of minor complications in patients undergoing CEA. The retrospective analysis was performed for 104 consecutive series of CEA procedures carried out at Otaru Municipal Hospital. The correlation between E-PASS and the rate of minor complications was examined. Sensitivity and specificity were used to construct a receiver operating characteristic curve, and the area under the curve (AUC) was calculated for accuracy. Postoperative minor complications occurred in eight cases (7.7%), including six vagal nerve injuries and two pneumonia cases. Three categorical data-preoperative risk score, surgical stress scores, and comprehensive risk score (CRS) -showed a good relationship with the postoperative minor complication. Among them, CRS presented the highest sensitivity and specificity, as indicated by an AUC of 0.68. The CRS cutoff value was calculated as -0.068, with a 1.7% postoperative minor complication rate for those lower than -0.068 and 14.0% for those higher than -0.068. The E-PASS score was effective for evaluating and predicting postoperative minor complications in patients with CEA procedures.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"9-14"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710645","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

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 : 2024-12-15 Epub 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":"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":"419-427"},"PeriodicalIF":2.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729258/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relevance of Lumbar Subcutaneous Edema and Local Lordosis. 腰部皮下水肿与局部后凸的相关性

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-12-15 Epub Date: 2024-11-06 DOI: 10.2176/jns-nmc.2024-0187

Kazuma Doi, Toshiyuki Okazaki, Kazunori Shibamoto, Satoshi Tani, Junichi Mizuno

{"title":"Relevance of Lumbar Subcutaneous Edema and Local Lordosis.","authors":"Kazuma Doi, Toshiyuki Okazaki, Kazunori Shibamoto, Satoshi Tani, Junichi Mizuno","doi":"10.2176/jns-nmc.2024-0187","DOIUrl":"10.2176/jns-nmc.2024-0187","url":null,"abstract":"Lumbar subcutaneous edema (LSE) is sometimes found within the deep subcutaneous or perifascial tissue on magnetic resonance imaging (MRI) via short-tau inversion recovery or fat-suppressed T2-weighted imaging. It is more likely to occur in older patients and those with obesity. However, no studies have focused on the association between LSE and local alignment. Therefore, the present study aimed to elucidate such an association. This retrospective study included 111 adult symptomatic patients who underwent lumbar plain MRI in a single institution. Patient demographics and the radiographical characteristics of the LSE and non-LSE groups were analyzed. LSE was detected in 30 (27.0%) patients. The L1-S1 angle was significantly lower in the LSE group (P = 0.033), whereas the sacral slope was not different between the groups (P > 0.05). As previously reported, the patients in the LSE group were older (P < 0.001) and had lower body weight (P = 0.015). This study demonstrates that older age and age-related hypolordosis were associated with a significantly higher frequency of LSE.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"451-454"},"PeriodicalIF":2.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591237","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

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 : 2024-12-15 Epub 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":"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":"442-450"},"PeriodicalIF":2.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729257/pdf/","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":"OA","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 : 2024-12-15 Epub 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":"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":"434-441"},"PeriodicalIF":2.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729255/pdf/","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":"OA","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 : 2024-12-15 Epub 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":"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":"428-433"},"PeriodicalIF":2.4,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729256/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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