Cerebrovascular Diseases Extra最新文献

{"title":"The Challenging Clinical Management of Patients with Cranial Dural Arteriovenous Fistula and Secondary Parkinson's Syndrome: Pathophysiology and Treatment Options.","authors":"Julia Velz,&nbsp;Zsolt Kulcsar,&nbsp;Fabian Büchele,&nbsp;Heiko Richter,&nbsp;Luca Regli","doi":"10.1159/000510597","DOIUrl":"https://doi.org/10.1159/000510597","url":null,"abstract":"<p><p>Cranial dural arteriovenous fistula (cDAVF) may rarely lead to parkinsonism and rapid cognitive decline. Dysfunction of the extrapyramidal system and the thalamus, due to venous congestion of the Galenic system with subsequent parenchymal edema, is likely to represent an important pathophysiological mechanism. Here, we report a case of a 57-year-old man with a cDAVF of the straight sinus (Borden type III; DES-Zurich bridging vein shunt [BVS] type with direct, exclusive, and strained leptomeningeal venous drainage [LVD]) and subsequent edema of both thalami, the internal capsule, the hippocampi, the pallidum, and the mesencephalon. Several attempts at venous embolization were unsuccessful, and the neurological condition of the patient further deteriorated with progressive parkinsonism and intermittent episodes of loss of consciousness (KPS 30). A suboccipital mini-craniotomy was performed and the culminal vein was disconnected from the medial tentorial sinus, achieving an immediate fistula occlusion. Three-month follow-up MRI revealed complete regression of the edema. Clinically, parkinsonism remitted completely, allowing for tapering of dopaminergic medication. His cognition markedly improved in further course. The purpose of this report is to highlight the importance of rapid and complete cDAVF occlusion to reverse venous hypertension and prevent progressive clinical impairment. The review of the literature underlines the high morbidity and mortality of these patients. Microsurgical disconnection of the fistula plays an important role in the management of these patients and, surprisingly, has not been reported so far.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"124-138"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000510597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38621951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort.","authors":"Santiago Fernández Menéndez,&nbsp;Eduardo Murias Quintana,&nbsp;Pedro Vega Valdés,&nbsp;Edison Morales Deza,&nbsp;Elena López-Cancio,&nbsp;Lorena Benavente Fernández,&nbsp;Montserrat González Delgado,&nbsp;Maria Rico-Santos,&nbsp;Sergio Calleja Puerta,&nbsp;Davinia Larrosa Campo","doi":"10.1159/000507919","DOIUrl":"https://doi.org/10.1159/000507919","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischemic strokes with tandem occlusions, which represent 10-20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management.</p><p><strong>Objective: </strong>We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports.</p><p><strong>Methods: </strong>From a prospective registry we analyzed data of 99 consecutive patients (males: 77.7%, mean age ± SD: 67.5 ± 9.5 years) with stroke due to tandem occlusions who underwent treatment with emergent carotid stenting and intracranial mechanical thrombectomy. Successful recanalization was defined as a TICI score of 2b-3 and a good functional outcome was defined as a modified Rankin scale score ≤2 at 90 days. Symptomatic intracranial hemorrhage (sICH) was considered when associated with worsening on the National Institutes of Health Stroke Scale (≥4 points).</p><p><strong>Results: </strong>A successful recanalization rate was achieved in 87.8 and 48.5% of the patients had a good functional outcome. sICH and mortality rates were 12.1 and 20.2%, respectively, and 21.2% of the patients received combined treatment with intravenous thrombolysis, which did not affect neither the prognosis nor the recanalization or sICH rates. The time from symptom onset to recanalization and the degree of recanalization were the main factors associated with prognosis and the occurrence of sICH.</p><p><strong>Conclusions: </strong>Our results suggest that endovascular treatment with emergent carotid stenting and intracranial thrombectomy in patients with acute stroke due to tandem occlusions is an effective and safe procedure.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 2","pages":"50-58"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000507919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38082014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Cerebrovascular Diseases Decreased after the Great East Japan Earthquake and Tsunami of 2011.","authors":"Shinichi Omama,&nbsp;Nobukazu Komoribayashi,&nbsp;Yoshihiro Inoue,&nbsp;Tomohiko Mase,&nbsp;Kuniaki Ogasawara,&nbsp;Yasuhiro Ishibashi,&nbsp;Masaki Ohsawa,&nbsp;Toshiyuki Onoda,&nbsp;Kazuyoshi Itai,&nbsp;Kozo Tanno,&nbsp;Kiyomi Sakata","doi":"10.1159/000509869","DOIUrl":"https://doi.org/10.1159/000509869","url":null,"abstract":"<p><strong>Background: </strong>A temporary increase in the occurrence of cerebrovascular diseases (CVDs) after the Great East Japan Earthquake and Tsunami of 2011 was reported; however, no studies have been conducted to investigate long-term effects. We assessed the long-term impact of the disaster on the incidence of CVDs.</p><p><strong>Methods: </strong>Incidence data for CVDs from 2008 to 2017 were acquired from the population-based Stroke Registry with an inventory survey of Iwate Prefecture, Japan. Part of the coastal area in Iwate Prefecture was mildly flooded and the other part was severely flooded. Age-adjusted incidence rates of CVDs (according to the Japanese standard population) were calculated for each area. The relative risk (RR) of incidence based on the years before the disaster (2008-2010), adjusted by stratified age groups, was calculated for the year of the disaster (2011), and the years after the disaster (2012-2017) in each area.</p><p><strong>Results: </strong>The age-adjusted incidence rates gradually decreased in all areas, with the exception of a temporary increase among men who lived on the coast the year the disaster occurred. The adjusted RR in the disaster year were not significant in any area and those of the postdisaster years were 0.91 (95% CI 0.87-0.96) for all inland men, 0.93 (0.89-0.97) for all inland women, 0.85 (0.78-0.93) for all coastal men, 0.87 (0.81-0.94) for all coastal women, 0.88 (0.80-0.98) for men at mildly flooded coast, 0.82 (0.75-0.89) for women at mildly flooded coast, 0.79 (0.68-0.91) for men at severely flooded coast, and 0.98 (0.86-1.11) for women at severely flooded coast.</p><p><strong>Conclusions: </strong>The occurrence of CVDs in the flooded coastal areas did not increase in the year of the Great East Japan Earthquake and Tsunami; furthermore, it decreased for men according to the severity of flood damage in the subsequent years; this can be attributed to supportive activities for the tsunami victims and the migration of the population.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"105-115"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000509869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38467610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement of Intraoperative Graft Flow Predicts Radiological Hyperperfusion during Bypass Surgery in Patients with Moyamoya Disease.","authors":"Akikazu Nakamura,&nbsp;Akitsugu Kawashima,&nbsp;Shunsuke Nomura,&nbsp;Takakazu Kawamata","doi":"10.1159/000508827","DOIUrl":"https://doi.org/10.1159/000508827","url":null,"abstract":"<p><strong>Introduction: </strong>Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF.</p><p><strong>Objective: </strong>The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD.</p><p><strong>Methods: </strong>This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed.</p><p><strong>Results: </strong>Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p < 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p < 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675-0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685-0.875), respectively.</p><p><strong>Conclusions: </strong>Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 2","pages":"66-75"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000508827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38206233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors of Silent Brain Infarction in Patients with Aortic Stenosis.","authors":"Ayaka Ito,&nbsp;Shinichi Iwata,&nbsp;Soichiro Tamura,&nbsp;Andrew T Kim,&nbsp;Shinichi Nonin,&nbsp;Sera Ishikawa,&nbsp;Asahiro Ito,&nbsp;Yasuhiro Izumiya,&nbsp;Takato Abe,&nbsp;Toshihiko Shibata,&nbsp;Minoru Yoshiyama","doi":"10.1159/000510438","DOIUrl":"https://doi.org/10.1159/000510438","url":null,"abstract":"<p><strong>Introduction: </strong>Silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke in the general population. Although aortic stenosis (AS) is also known to be associated with an increased risk of future symptomatic stroke, little is known regarding the prevalence and risk factors for SBI in patients with AS.</p><p><strong>Methods: </strong>The study population comprised 83 patients with severe AS with no history of stroke or transient ischemic attack and paralysis or sensory impairment (mean age 75 ± 7 years). All patients underwent brain magnetic resonance imaging to screen for SBI and multidetector-row computed tomography to quantify the aortic valve calcification (AVC) volume. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial (LA) abnormalities, such as LA enlargement, spontaneous echo contrast, or abnormal LA appendage emptying velocity (<20 cm/s), and complex plaques in the aortic arch.</p><p><strong>Results: </strong>SBI was detected in 38 patients (46%). Multiple logistic regression analysis indicated that CHA2DS2-VASc score and estimated glomerular filtration rate (eGFR) were independently associated with SBI (p < 0.05), whereas LA abnormalities and AVC volume were not. When patients were divided into 4 groups according to CHA2DS2-VASc score and eGFR, the group with a higher CHA2DS2-VASc score (≥4) and a lower eGFR (<60 mL/min/1.73 m2) had a greater risk of SBI than the other groups (p < 0.05).</p><p><strong>Conclusion: </strong>These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA2DS2-VASc score and eGFR are useful for risk stratification.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"10 3","pages":"116-123"},"PeriodicalIF":1.9,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000510438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38467611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active Cancer and Elevated D-Dimer Are Risk Factors for In-Hospital Ischemic Stroke","authors":"Izumi Yamaguchi, Y. Kanematsu, Kenji Shimada, M. Korai, Takeshi Miyamoto, E. Shikata, Tadashi Yamaguchi, N. Yamamoto, Yuki Yamamoto, K. Kitazato, Y. Okayama, Y. Takagi","doi":"10.1159/000504163","DOIUrl":"https://doi.org/10.1159/000504163","url":null,"abstract":"Background and Purpose: Little attention has been paid to the pathogenesis of in-hospital stroke, despite poor outcomes and a longer time from stroke onset to treatment. We studied the pathophysiology and biomarkers for detecting patients who progress to in-hospital ischemic stroke (IHS). Methods: Seventy-nine patients with IHS were sequentially recruited in the period 2011–2017. Their characteristics, care, and outcomes were compared with 933 patients who had an out-of-hospital ischemic stroke (OHS) using a prospectively collected database of the Tokushima University Stroke Registry. Results: Active cancer and coronary artery disease were more prevalent in patients with IHS than in those with OHS (53.2 and 27.8% vs. 2.0 and 10.9%, respectively; p < 0.001), the median onset-to-evaluation time was longer (300 vs. 240 min; p = 0.015), and the undetermined etiology was significantly higher (36.7 vs. 2.4%; p < 0.001). Although there was no significant difference in stroke severity at onset between the groups, patients with IHS had higher modified Rankin Scale (mRS) scores (3–6) at discharge (67.1 vs. 50.3%; p = 0.004) and rates of death during hospitalization (16.5 vs. 2.9%; p < 0.001). D-dimer (5.8 vs. 0.8 µg/mL; p < 0.001) and fibrinogen (532 vs. 430 mg/dL; p = 0.014) plasma levels at the time of onset were significantly higher in patients with IHS after propensity score matching. Multivariate logistic regression analysis revealed that active cancer (odds ratio [OR] 2.30; 95% confidence interval [CI] 1.26–4.20), prestroke mRS scores 3–5 (OR 6.78; 95% CI 3.96–11.61), female sex (OR 1.57; 95% CI 1.19–2.08), and age ≥75 years (OR 2.36; 95% CI 1.80–3.08) were associated with poor outcomes. Conclusions: Patients with IHS had poorer outcomes than those with OHS because of a higher prevalence of active cancer and functional dependence before stroke onset. Elevated plasma levels of D-dimer and fibrinogen, especially with active cancer, can help identify patients who are at a higher risk of progression to IHS.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"129 - 138"},"PeriodicalIF":1.9,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000504163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45026610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infarct Patterns in Patients with Atherosclerotic Vertebrobasilar Disease in Relation to Hemodynamics","authors":"J. Schaafsma, F. Silver, S. Kasner, L. Caplan, Linda Rose-Finnell, F. Charbel, D. Pandey, S. Amin‐Hanjani","doi":"10.1159/000503091","DOIUrl":"https://doi.org/10.1159/000503091","url":null,"abstract":"Introduction: Distal territory blood flow is independently associated with subsequent strokes in symptomatic vertebrobasilar atherosclerotic disease. We aimed to assess infarct patterns in relation to hemodynamic status in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. Methods: Distal territory blood flow was measured using quantitative magnetic resonance angiography (MRA) in 72 patients with symptomatic atherosclerotic vertebrobasilar disease, and then dichotomized into normal (n = 54) and low (n = 18) flow. Patients were followed longitudinally on standard medical management. Two observers blinded to flow status independently reviewed the imaging performed at the time of subsequent strokes, in order to adjudicate the likely mechanism based on infarct patterns. The frequency of stroke mechanisms was qualitatively compared based on flow status. Results: During a median follow-up period of 23 months, 10/72 patients had a subsequent stroke; 5 of these had low distal flow. Infarct patterns were adjudicated to be consistent with hemodynamic (n = 2), embolic (n = 4), and junctional plaque/perforator (n = 4) infarcts. Hemodynamic infarcts were seen in 40% (2/5) low-flow patients, in comparison to 0% (0/5) normal-flow patients. Conclusion: In contrast to normal-flow patients, those with low distal flow seem to be uniquely susceptible to hemodynamic infarctions, although other patterns of infarction can also be seen in these hemodynamically impaired patients.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"123 - 128"},"PeriodicalIF":1.9,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48647749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern Recognition to Identify Stroke in the Cognitive Profile: Secondary Analyses of a Prospective Cohort Study","authors":"S. Clouston, Yun Zhang, Dylan M. Smith","doi":"10.1159/000503002","DOIUrl":"https://doi.org/10.1159/000503002","url":null,"abstract":"Background: Stroke can produce subtle changes in the brain that may produce symptoms that are too small to lead to a diagnosis. Noting that a lack of diagnosis may bias research estimates, the current study sought to examine the utility of pattern recognition relying on serial assessments of cognition to objectively identify stroke-like patterns of cognitive decline (pattern-detected stroke, p-stroke). Methods: Secondary data analysis was conducted using participants with no reported history of stroke in the Health and Retirement Study, a large (n = 16,113) epidemiological study of cognitive aging among respondents aged 50 years and older that measured episodic memory consistently biennially between 1996 and 2014. Analyses were limited to participants with at least 4 serial measures of episodic memory. Occurrence and date of p-stroke events were identified utilizing pattern recognition to identify stepwise declines in cognition consistent with stroke. Descriptive statistics included the percentage of the population with p-stroke, the mean change in episodic memory resulting in stroke-positive testing, and the mean time between p-stroke and first major diagnosed stroke. Statistical analyses comparing cases of p-stroke with reported major stroke relied on the area under the receiver-operating curve (AUC). Longitudinal modeling was utilized to examine rates of change in those with/without major stroke after adjusting for demographics. Results: The pattern recognition protocol identified 7,499 p-strokes that went unreported. On average, individuals with p-stroke declined in episodic memory by 1.986 (SD = 0.023) words at the inferred time of stroke. The resulting pattern recognition protocol was able to identify self-reported major stroke (AUC = 0.58, 95% CI = 0.57–0.59, p < 0.001). In those with a reported major stroke, p-stroke events were detectable on average 4.963 (4.650–5.275) years (p < 0.001) before diagnosis was first reported. The incidence of p-stroke was 40.23/1,000 (95% CI = 39.40–41.08) person-years. After adjusting for sex, age was associated with the incidence of p-stroke and major stroke at similar rates. Conclusions: This is the first study to propose utilizing pattern recognition to identify the incidence and timing of p-stroke. Further work is warranted examining the clinical utility of pattern recognition in identifying p-stroke in longitudinal cognitive profiles.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"114 - 122"},"PeriodicalIF":1.9,"publicationDate":"2019-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44704970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Unsuccessful Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke","authors":"Toshiaki Goda, N. Oyama, T. Kitano, Takanori Iwamoto, Shinji Yamashita, Hiroki Takai, S. Matsubara, M. Uno, Y. Yagita","doi":"10.1159/000503001","DOIUrl":"https://doi.org/10.1159/000503001","url":null,"abstract":"Introduction: Mechanical thrombectomy (MT) for acute ischemic stroke has become a standard therapy, and the recanalization rate has significantly improved. However, some cases of unsuccessful recanalization still occur. We aimed to clarify patient factors associated with unsuccessful recanalization after MT for acute ischemic stroke. Methods: This was a single-center, retrospective study of 119 consecutive patients with anterior circulation acute ischemic stroke who underwent MT at our hospital between April 2015 and March 2019. Successful recanalization after MT was defined as modified Treatment in Cerebral Ischemia (mTICI) grade 2b or 3, and unsuccessful recanalization was defined as mTICI grades 0–2a. Several factors were analyzed to assess their effect on recanalization rates. Results: Successful recanalization was achieved in 88 patients (73.9%). The univariate analysis showed that female sex (38.6 vs. 67.7%, p = 0.007), a history of hypertension (53.4 vs. 83.9%, p = 0.003), and a longer time from groin puncture to recanalization (median 75 vs. 124 min, p < 0.001) were significantly associated with unsuccessful recanalization. The multivariate analysis confirmed that female sex (OR 3.18; 95% CI 1.12–9.02, p = 0.030), a history of hypertension (OR 4.84; 95% CI 1.32–17.8, p = 0.018), M2–3 occlusion (OR 4.26; 95% CI 1.36–13.3, p = 0.013), and the time from groin puncture to recanalization (per 10-min increase, OR 1.22; 95% CI 1.09–1.37, p < 0.001) were independently associated with unsuccessful recanalization. Conclusion: Female sex and a history of hypertension might be predictors of unsuccessful recanalization after MT for anterior circulation acute ischemic stroke. Further studies are needed to fully evaluate predictors of recanalization.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"107 - 113"},"PeriodicalIF":1.9,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000503001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45978316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source","authors":"Yuichiro Ohya, M. Osaki, S. Fujimoto, Juro Jinnouchi, T. Matsuki, Satomi Mezuki, M. Kumamoto, M. Kanazawa, Naoki Tagawa, T. Ago, T. Kitazono, S. Arakawa","doi":"10.1159/000502713","DOIUrl":"https://doi.org/10.1159/000502713","url":null,"abstract":"Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":"9 1","pages":"98 - 106"},"PeriodicalIF":1.9,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000502713","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43363375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}