Background: The multicenter prospective registry of Japan (RESCUE-Japan Registry) was performed to clarify the clinical impact of endovascular treatment (EVT) on acute stroke due to large vessel occlusion. Methods: Patients admitted within 24 h after onset were prospectively registered from July, 2010 to June, 2011. The efficacy of rescue EVT for intravenous intravenous tissue plasminogen activator (IV-tPA)-failed patients was analyzed. Results: Among a total of 1,454 patients registered from 84 medical centers, 1,442 patients (633 women, 899 men) with 3 months outcome were analyzed. Mean age was 74.0 years, and mean arrival time was 233.4 min after onset, and mean NIHSS was 15.5 points. As the revascularization treatment within 3 h, IV-tPA was performed in 51%, EVT in 16% and their combination in 17%. In the patients treated with IV-tPA (n=194), significant recanalization (TICI 2B and 3) was obtained in 29-39% in MCA, but less than 15% in ICA on cerebral angiogram performed 1 to 3 h after IV-tPA (Fig1). Rescue EVT after IV-tPA was performed in 129 patients (17%), and increased significant recanalization (17% to 68%) (Fig.2) and favorable outcome (mRS:0-2) in the ICA (22% vs 48%, p=0.007) (Fig. 3), but not symptomatic intracranial hemorrhage (6.1% vs 4.1%) (p=0.35). Conclusions: This registry suggested the efficacy of rescue EVT in IV-tPA failed patients, especially with ICA occlusion.
The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone.This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups.A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes.Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.
Objective —The growth factor progranulin (PGRN) is a widely expressed protein with various biological functions, and it is known to have an anti-inflammatory effect. The aim of this study was to investigate the possible ameliorative effects of PGRN against cerebral ischemia-reperfusion (I/R) injury. Methods —In vivo ischemic stroke was induced in 4-week-old male ddY mice by 2 h of middle cerebral artery occlusion (MCAO) followed by 22 h of reperfusion. The following 4 experimental protocols were devised: (1) to determine the expression level of PGRN in the I/R brain (n = 4 per group); (2) to establish the dose-response effects of intracerebroventricularly administered recombinant PGRN (r-PGRN; 0.1 to 1.0 ng) on cerebral I/R injury (n = 6 to 8 per group); (3) to establish the therapeutic time window of r-PGRN treatment (n = 8 to 9 per group); and (4) to investigate the effects of r-PGRN treatment on the expression of inflammatory cytokines in the I/R brain (n = 5 per group). Results —We found that the expression level of PGRN was significantly reduced in the I/R brain (P < 0.01, vs. Sham; t test). The administration of 1.0 ng of r-PGRN at 2 h after MCAO resulted in a reduction in the infarct volume and brain swelling at 24 h after MCAO (P < 0.01, vs. Vehicle, in each; Dunnett test), and this led to an improvement in neurological scores (P < 0.05; Wilcoxon signed-rank test). Delayed administration of r-PGRN at 6 h after MCAO did not reduce the infarct volume, but significantly reduced brain swelling (P < 0.05; t test). We also confirmed that r-PGRN administration significantly reduced the phosphorylation of NF-κB and expression of MMP-9 in the I/R brain (P < 0.05, vs. Vehicle, in each; t test). Conclusion —r-PGRN treatment exerts ameliorative effects on experimental ischemic stroke, and these effects are due to the prevention of harmful inflammatory reactions following cerebral I/R. This study suggests the feasibility of r-PGRN administration as a novel therapeutic strategy for treatment in the acute phase of ischemic stroke.
Intraluminal thrombus in the carotid artery is often misdiagnosed because clinical imaging, such as angiography and duplex ultrasonography, fails to accurately identify it. Recently, it was reported that optical coherence tomography (OCT), a new imaging modality, can visualize intravascular thrombus in the coronary artery.An 83-year old male was admitted due to newly developed motor weakness of the left hand. Diffusion weighted magnetic resonance imaging showed multiple high intensity spots in the territory of the right middle cerebral artery, and magnetic resonance angiography revealed significant stenosis at the origin of the right internal carotid artery. Because of an apparent change in plaque shape on the angiogram just before carotid artery stenting, further examinations such as intravascular ultrasonography (IVUS) and OCT were performed.After IVUS examination, both the common carotid and external carotid arteries were occluded by an occlusion balloon system prepared for carotid artery stenting. Then the stenotic site was imaged by OCT from the distal section at 1 mm/sec using a built-in pull-back system with continuous injection of saline through the guiding catheter to remove blood from the field of view. Since intraluminal thrombus was clearly demonstrated by an OCT, carotid endarterectomy was performed instead of stenting, and thrombus was confirmed by surgical specimen.OCT may provide useful information for diagnosis of an intraluminal thrombus in the carotid artery, which is important for the appropriate selection of therapeutic strategy.
Background: One disadvantage of carotid artery stenting (CAS) is a high incidence of distal embolism (DE) during or after the procedure. Also, irregular plaque protrusion (PP) after stent placement has been suggested as one of the major causes of post procedural ischemic complications. The aim of this study was to evaluate the relationship between unstable plaque identified on black-blood magnetic resonance imaging (BB-MRI) and the occurrence of irregular PP after CAS using optical frequency domain imaging (OFDI). Materials and Methods: We enrolled 41 patients who underwent CAS with OFDI image acquisition. We measured signal intensity ratios (SIR) from T1 weighted images of all carotid plaques. The plaque with high SIR is considered as unstable plaque with intraplaque hemorrhage (IPH) according to previously published criteria. Cross-sectional OFDI images were evaluated at every 0.125-mm intervals within the stented segments, and assessed the relationships among the occurrence of irregular PP (I-PP), smooth PP (S-PP) or non-PP, and SIR measured by MRI. Results: PP and I-PP were detected in 34 cases (83%) and in 20 cases (49%), respectively. There were two minor strokes in the I-PP group. There was a positive correlation between PP volume and SIR (r=0.47, p<0.01). The SIR was significantly higher in the I-PP group than the S-PP or non-PP groups [I-PP vs. S-PP or non-PP: 1.67 (IQR: 1.39-1.9) vs. 1.36 (IQR: 1.25-1.62), p<0.01]. From analysis of receiver operating characteristic curves, a SIR of 1.57 on BB-MRI was the most reliable cutoff values for predicting I-PP. In multivariate logistic regression analysis, the independent predictor of I-PP was SIR (p=0.012) even after adjusted by plaque volume. Conclusions: Quantitative tissue characterization of carotid plaques using BB-MRI was useful to predict I-PP. These data suggest that identification of carotid plaque components such as IPH by BB-MRI before CAS may improve the clinical outcome of this procedure.
For the rotating optical head of an optical tape recorder, whose optics are divided into a fixed part and a rotating part, and whose beam is controlled with a lens in the fixed part, the focusing operation causes a change of both the diameter of the incident beam to an objective lens and the optical magnification. Therefore, we developed an optical system which does not cause these changes and confirmed stable focused-spot characteristics for a ±60 µm displacement of the recording medium by carrying out recording experiments.
Objective: Antiplatelet drugs are frequently used to prevent ischemic complications of endovascular therapy, but patients who showed poor responses to these drugs have been reported. We have adjusted antiplatelet drugs based on platelet aggregation activity before endovascular therapy. The objective of this study was to investigate the association between platelet aggregation test-based modification of antiplatelet drugs and perioperative complications.
