Objective: CT-like images and cerebral blood volume (CBV) measurements have become available due to technical improvements in the angiographic C-arm system and workstation. In this study, we evaluated the usefulness of C-arm CBV measurements in patients with acute ischemic stroke.

Methods: The study included 27 consecutive patients admitted for acute ischemic stroke due to major intracranial artery occlusion within 7 hours of onset. Cerebral angiography and C-arm CBV measurements were performed immediately after CT or MRI. The areas with reduced CBV in CBV color maps were classified into infarcted and non-infarcted areas according to CT/MRI images obtained 8–48 hours after onset, and their relationship with CBV was retrospectively evaluated.

Results: The mean CBV values and the relative CBV ratios (ipsilateral/contralateral side) were 1.29 ± 0.51 mL/100 g and 0.41 ± 0.17 in the infarcted area and 3.19 ± 0.17 mL/100 g and 0.8 ± 0.1 in the non-infarcted areas. The CBV values and relative CBV ratios in infarcted areas with hemorrhage (n = 5) were 0.95 ± 0.56 mL/100 g and 0.3 ± 0.17, and significantly lower than in infarcted areas without hemorrhage.

Conclusion: C-arm CBV measurements with an angiography system can be performed readily in a short time and may provide useful information for the treatment of acute ischemic stroke patients.

Objective: There have been few reports on the frequency of atherosclerotic diseases complicating carotid artery stenosis. This study was conducted to clarify the frequency of various atherosclerotic diseases concurrent with carotid artery stenosis that required revascularization.

Methods: Examinations concerning various atherosclerotic diseases were reviewed using clinical records of 152 consecutive patients who underwent carotid artery stenting from January 2012 to October 2016 at our hospital. The patients were also divided into those with systemic atherosclerosis (SA group) and those without SA (non-SA group), and their characteristics were analyzed.

Results: Of the 152 patients, carotid artery stenosis was complicated by other atherosclerotic diseases in 50 (32.9%), of whom 28 (18.4%) had coronary artery disease, 23 (15.1%) had peripheral artery disease, and 3 (2.0%) had renal artery stenosis. In the SA group, the frequencies of diabetes and dyslipidemia were significantly higher, hemoglobin A1c (HbA1c) level was higher, and high-density lipoprotein (HDL) cholesterol level and estimated glomerular filtration rate (eGFR) were lower.

Conclusion: Carotid artery stenosis that required revascularization was frequently complicated by other atherosclerotic diseases. It is considered necessary to treat carotid artery stenosis with the prevention of cardiovascular events.

Objective: Reducing the time to recanalization is important for the treatment of acute ischemic stroke. We changed the treatment protocol to reduce the door-to-puncture time (DTP). In this study, we evaluated the effects of this protocol change on the treatment of ischemic stroke.

Methods: Consecutive 633 patients with acute ischemic stroke were analyzed. We divided the patients into pre-protocol change and post-protocol change (359 pre-protocol changes and 274 post-protocol changes). The percentage of patients with endovascular therapy, DTP, and outcome were retrospectively compared.

Results: After the protocol change, the percentage of patients with endovascular therapy in acute ischemic stroke increased (14.9 vs. 9.4%, p = 0.03), and DTP was significantly reduced (78 vs. 108 minutes, p = 0.003). No difference was observed in the outcome 90 days after the onset.

Conclusion: In patients with acute ischemic stroke suspected to have major artery occlusion, DTP could be shortened by 30 minutes by informing neurointerventionalists before MRI and deciding to perform endovascular treatment and starting the setup angiography suite during MRI. It is considered vital for all members of the staff involved in stroke management to recognize the importance of early recanalization and organize a system for cooperation.

Objective: The hemostatic/coagulation capacity is enhanced in the acute phase of ruptured cerebral aneurysms, and the risk of thromboembolic complications during endovascular surgery is high. We examined the usefulness of antiplatelet drug loading (LD) before acute-phase coil embolization of ruptured cerebral aneurysms.

Methods: The subjects were 117 patients who underwent acute-phase coil embolization of ruptured cerebral aneurysms in our hospital between June 2009 and October 2016. They were divided into three groups (non-administration, clopidogrel LD, and dual LD groups) based on the presence or absence of preoperative antiplatelet drug administration, and the incidence of thromboembolic events (TEEs), influence of combined adjunctive techniques (ATs), and incidence of hemorrhagic events were compared.

Results: In the clopidogrel LD group, there was no significant decrease in the incidence of TEEs in comparison with the non-administration group. However, the incidence of TEEs was significantly lower in the dual LD group. Similarly, combined ATs significantly decreased the incidence of TEEs in the dual LD group. In LD groups, there was no increase in the incidence of hemorrhagic complications.

Conclusion: The results suggest that dual LD decreases the incidence of TEEs. In the future, its effects should be further investigated.

Objective: Recently, the exposure threshold for cataract has been reduced, and interest in lens exposure is deepening. The importance of cone-beam CT (CBCT) is increasing in the field of intracranial endovascular treatment, and opportunities of substituting CT after endovascular treatment with CBCT has also increased. While the exposure by angiography and CT must be considered comprehensively for the management of lens exposure, total dose management and direct comparison are difficult due to the difference in the evaluation methods. Therefore, we compared the direct doses measured at the lens between the modalities.

Methods: We measured the doses at five points (center, upper, lower, left, and right) in an acrylic phantom 16 cm in diameter and simulating the head for the determination of the CT dose index (CTDI) under various conditions of non-helical scanning of area detector CT (ADCT) and CBCT and compared the mean of the five points, which was assumed to be the dose of the whole head, and the upper point, which was assumed to correspond to the lens.

Results: The ratio of the dose by ADCT relative to that by 15-second MIDDLE mode CBCT was 1.1 as the mean of the five sites but was 2.3 at the site corresponding to the lens.

Conclusion: Compared with CT, by which the object is scanned over 360°, the exposure of the lens can be reduced by CBCT because it collects data from an arc of dorsal 200° and does not directly apply X-ray to the lens.

Objective: To evaluate changes related to cerebral endovascular treatment, a C-arm cerebral blood volume (CBV) study was performed before and after treatment. Although conditions related to treatment-administered contrast medium of the pretreatment examination differs from that for post-treatment, no study has investigated the effect on the results. In this study, we examined differences in the results of the C-arm CBV examination before and after treatment in patients who underwent carotid artery stenting (CAS).

Subjects and Methods: Fifteen subjects were included in this study. The time interval until the volume of contrast medium reached a peak in points established at the proximal and distal sites of stenosis on a lateral view of a cervical common carotid artery angiogram before and after treatment was ≤0.5 seconds. For the C-arm CBV study, 25% diluted contrast medium was trans-arterially administered. The first C-arm CBV study was performed before angiography for preoperative assessment, and the second study was performed immediately after the completion of the CAS. The mean CBV value in each vascular territory was calculated, and the change in CBV after treatment was evaluated. In addition, the relative CBV ratio was calculated.

Results: For both the unaffected and affected sides, the CBVs measured in the post-treatment study were high. When evaluating the relative CBV ratio, there were no marked changes after treatment. The value was constant.

Conclusion: The results suggest that a C-arm CBV study is influenced by the contrast medium used during treatment. To apply a C-arm CBV study for pretreatment and post-treatment evaluation, relative evaluation parameters, such as the relative CBV ratio, should be used.

Objective: A case in which carotid artery stenting (CAS) was performed via the femoral artery for stenosis of the left common carotid artery ostium is reported.

Case Presentation: The patient was a 70-year-old man with multiple infarction of the right cerebral hemisphere that presented with a transient decrease in grip strength and numbness of the left hand. Occlusion of the right internal carotid artery and stenosis of the left common carotid artery ostium were demonstrated. CAS was performed using the buddy wire technique and a distal filter protection device for stenosis of the left common carotid artery ostium. The postoperative course was uneventful, and the patient was discharged to home 8 days after surgery.

Conclusion: In CAS for stenotic lesions of the common carotid artery ostium, the concomitant use of the buddy wire technique is useful.

Objective: Two cases in which emergency retrograde stenting were performed for occlusion of the left common carotid artery orifice that occurred during thoracic endovascular aortic repair are reported.

Case Presentations: In males in their 70s with thoracic aortic aneurysm, oxygen saturation dropped in the left cerebrum immediately after deployment of the thoracic aortic stent graft under general anesthesia. The stent graft obstructed the orifice of the left common carotid artery, and recanalization was achieved by direct puncture of the cervical left common carotid artery and placing a balloon expandable stent at the orifice of the left common carotid artery. No postprocedural neurologic deficits were observed.

Conclusion: Retrograde stenting of the orifice of the left common carotid artery is effective for thoracic aortic stent graft migration, and regional cerebral oxygen saturation is an important index. The cases are worth reporting as neurointerventionist may also be required to perform the procedure, which is usually performed by vascular surgeons.