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2010 Volume 19 Issue 8 Pages
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Article type: Cover
2010 Volume 19 Issue 8 Pages
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
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2010 Volume 19 Issue 8 Pages
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
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Shinichi Yoshimura, Yuji Matsumaru
Article type: Article
2010 Volume 19 Issue 8 Pages
575-
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Izumi Nagata
Article type: Article
2010 Volume 19 Issue 8 Pages
576-579
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Many guidelines recommend CEA for patients with symptomatic moderate or severe carotid artery stenosis, and for patients with asymptomatic severe stenosis after controlled randomized studies. However, sex and age sould also be considered in each case. In high risk patients for CEA, CAS may be selected. In recent years, stroke risk for medically treated patients has decreased. Therefore, medical treatment may be first choice for those patients with asymptomatic carotid stenosis and for CEA high risk patients.
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Kuniaki Ogasawara
Article type: Article
2010 Volume 19 Issue 8 Pages
580-587
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Cerebral ischemic events due to generation of emboli from the surgical site and cerebral hyperperfusion syndrome are complications during or after carotid endarterectomy (CEA) or carotid artery stenting (CAS). Cerebral hyperperfusion syndrome results in postoperative cognitive impairment as well as intracerebral hemorrhage. Risk factors for development of these cerebrovascular complications include impaired cerebral hemodynamics that can be detected using brain perfusion single-photon emission computed tomography, perfusion-weighted magnetic resonance imaging or perfusion-weighted computed tomography. Considering the numbers and incidences of microemboli during procedures and intracranial hemorrhage due to hyperperfusion, patients with impaired cerebral hemodynamics should undergo CEA.
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Shigeru Miyachi, Takashi Izumi, Noriaki Matsubara, Tsuyoshi Ichikawa, ...
Article type: Article
2010 Volume 19 Issue 8 Pages
588-593
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Carotid artery stenting (CAS) has been approved as a safe and effective method of treating carotid stenosis. The Japanese post-marketing study (J-CASES-PMS) revealed a low rate of major adverse events after CAS similar to that found in other international clinical trials. This favorable result might be due to precise adherence to the guidelines and the training system. However, structural issues with the filter device, which is the only approved protection method, have caused some pitfalls. In particular, ischemic complications are quite frequent among patients with no-flow phenomenon and with minute or liquid-like debris passing through the filter mesh. These complications are closely associated with the quality and volume of plaque. To evaluate the plaque image and to design the safest strategy including a balloon or multiple combined protection methods is a critically important preoperative process. Although all European clinical trials with or without filter protection have finally disclosed disadvantageous results for CAS, improvements in the appropriate protection strategy in Japan should be reviewed since the time of off-label use.
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Koji Iihara, Tomohito Hishikawa, Kimitoshi Sato, Naoaki Yamada, Hatsue ...
Article type: Article
2010 Volume 19 Issue 8 Pages
594-601
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Critical decision-making regarding the mode and timing of surgical treatment is mandatory for proper management of occlusive cerebrovascular diseases, especially in Japan's aging society. Recently, in addition to B-mode duplex ultrasound, various modes of plaque characterization such as magnetic resonance imaging (MRI) and positron emission tomography (PET) have been introduced to clinical practice mainly for carotid stenosis. At present, understanding of plaque vulnerability as well as degree of stenosis is important for critical judgement of surgical treatment. Here the recent progress of the various plaque characterization techniques is reviewed in relation to their clinical significance and future perspective.
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Akinori Kondo
Article type: Article
2010 Volume 19 Issue 8 Pages
602-604
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Akifumi Izumihara
Article type: Article
2010 Volume 19 Issue 8 Pages
605-615
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Epidemiological studies of periodicity, clustering, and meteorological association in relation to the onset of subarachnoid hemorrhage (SAH) have already been reported for populations in the temperate and subarctic latitudes. The purpose of the present study was to analyze epidemiological, especially environmental data for patients with SAH in the Yaeyama Islands, an isolated subtropical region of Japan. A total of 94 patients (31 males and 63 females, mean age 57.3 years) were diagnosed as having SAH during a 13-year period from 1989 to 2002. The age- and sex-adjusted annual incidence rate of SAH was 17.4 per 100,000 person-years. In comparison with other Japanese studies, the present demographic data indicated a stronger predominance of females, a relative younger age at onset, and an average annual incidence rate. Periodic patterns of SAH onset showed a seasonal peak in fall, a monthly peak in August, a weekly peak on Monday, a daily large peak in the evening, a daily small peak in the morning, and a daily trough in the period from midnight to dawn. The incidence of SAH for the 3 days before and after the day when a typhoon went nearest within 300km from the Ishigaki Island was about 1.8 times as high as but those days. SAH occurred more frequently during daily living or labor activities. Periodicity in the onset of SAH and its association with the approach of typhoons were demonstrated more clearly in patients with no or light stress at onset.
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[in Japanese]
Article type: Article
2010 Volume 19 Issue 8 Pages
615-
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Masaaki Uno, Hiroyuki Toi, Shunji Matsubara, Toshitaka Fujihara, Kimih ...
Article type: Article
2010 Volume 19 Issue 8 Pages
616-622
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We determined microsurgical techniques for treating previously coiled aneurysms and report the outcomes. Twelve symptomatic patients with incomplete or recurrent aneurysms were managed microsurgically. The necks of five incomplete coiled aneurysms were clipped (mean time to microsurgery, 35.5 days), and one was treated with bypass surgery. One of the patients who underwent neck clipping had bleeding during dissection of the aneurysm. Six patients who had recurrent aneurysms underwent microsurgery at a mean of 778 days after initial complete embolization. Two fully recovered from transient ischemic symptoms that occurred after microsurgery and the coil became extruded in one other patient. The necks of the aneurysms were clipped in five of these patients and the aneurysm was wrapped in one. Direct clipping is the preferred microsurgical treatment for coiled aneurysms. The necks of such aneurysms should be carefully clipped according to the timing of the surgery and the status of the aneurysm.
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[in Japanese]
Article type: Article
2010 Volume 19 Issue 8 Pages
622-
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Yuki Yamada, Toshihiko Kinjo, Takamasa Kayama
Article type: Article
2010 Volume 19 Issue 8 Pages
623-629
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We report a case of multiple aneurysms arising from an abnormal vessel connecting to the bilateral distal posterior inferior cerebellar artery (PICA communicating artery). A 71-year-old man presented with sudden onset of consciousness disturbance and respiratory failure. On admission, his level of consciousness was 200 in JCS, 4 in GCS (E1V1M2). Computed tomography (CT) without contrast material showed a subarachnoid hemorrhage with massive intraventricular hematoma predominantly in the fourth ventricle. Three-dimensional CT angiogram (3D-CTA) revealed 3 aneurysms at the distal PICA. After 2 weeks of management with a respirator, the patient recovered gradually. Sequential 3D-CTA disclosed enlargement of the aneurysms. The patient underwent suboccipital craniotomy. The right PICA was followed distally to identify two aneurysms at the communicating artery and an aneurysm at the cortical segment of the left PICA. The first aneurysm was clipped and the two distal aneurysms were resected. Pathological findings of the aneurysms were compatible with berry aneurysms. Postoperative course was uneventful with gradual improvement without development of hydrocephalus. The patient was transferred to a rehabilitation hospital. There have been only 4 reports on PICA communicating artery aneurysms in the literature. Our case is the 5th such case of a PICA communicating artery aneurysm and the second case involving multiple aneurysms. The occluded left vertebral artery might induce hemodynamic stress to develop this type of aneurysms.
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[in Japanese]
Article type: Article
2010 Volume 19 Issue 8 Pages
630-
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
631-636
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
637-638
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
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2010 Volume 19 Issue 8 Pages
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
639-640
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
641-645
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
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Article type: Appendix
2010 Volume 19 Issue 8 Pages
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Article type: Cover
2010 Volume 19 Issue 8 Pages
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