Background and Purpose: We performed endovascular recanalization in 6 patients (7 times) with acute vertebrobasilar stenosis and occlusion out of 60 patients who underwent endovascular surgery during a 2-year period from April 2002 to March 2004. Their ages ranged from 56 to 77 years (mean: 68 years). All 6 patients were male. The affected lesions were the vertebral artery (VA) in 2 cases (3 times), the basilar artery (BA) in 3 cases, and the posterior cerebral artery in 1 case.
Methods: The extent of improvement in the National Institutes of Health Stroke Scale (NIHSS), and the rates of improvement in the Glasgow Outcome Scale (GOS) and stenosis were examined.
Results: The outcome was 3 case of Good Recovery (GR), one case of Moderately Disabled (MD), 1 case of Severely Disabled (SD), and 1 case of Dead (D). The stenosis improvement rates ranged from 0 to 80% (mean: 63%). The mean NIHSS improved from 24 before endovascular surgery to 16 after surgery. The 3 severe patients who had an NIHSS of at least 23 before endovascutar surgery revealed a poor prognosis (1 case of D and 2 cases of SD) even after endovascular recanalization at the acute stage.
Conclusion: The present findings suggest that such treatment is not indicated in patients with a high NIHSS. However, endovascular recanalization centered on percutaneous transluminal angioplasty (PTA) is an effective treatment in moderate NIHSS cases. Endovascular recanalization centered on PTA for acute ischemic stroke in the vertebrobasilar system could well provide the effect of improving prognosis.

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Purpose: To study the localization, underlying cause, and prognosis of acute stroke with pure motor monoapresis (PMM). Methods: Patients with motor paresis of only one limb were included consecutively in the present study. We excluded mild dysarthria and vertigo. We determined the stroke location using brain CT and diffusion-weighted images obtained by magnetic resonance imaging. Results: 32 patients among 3, 226 acute stroke patients (0.99%) had PMM, and only 1 case demonstrated intracerebral hemorrhage. Cardiac embolism was the cause of stroke in 21.9%, an artery-to-artery mechanism in 25%, and small artery disease in 40.6%. Most of the ischemic lesions were in the subcortical territory of the middle cerebral artery, the corona radiata, or the centrum semiovale (12/32). 11 of the 32 were in the cortical territories or the watershed region. Although the prognosis for recovery is good, the recurrent stroke risk was 21.9% over a 2.9-year mean followup period.
Conclusion: PMM is a rare symptom in stroke patients and half of the cause is an embolic mechanism.

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To estimate the efficacy of the free radical scavenger edaravone, we administered edaravone (Group A) or sodium ozagrel (Group B) for 14 days in randomly selected patients within 24 hours after the onset of lacunar infarction. The percentage of patients whose NIH Stroke Scale (NIHSS) improved by more than 2 points was 72.7% in Group A and 61.5% in Group B; the difference was not statistically significant. The percentage of patients whose modified Rankin Scale (mRS) was rated at 1 or less upon discharge was 86.4% in Group A and 57.7% in Group B; the difference was statistically significant (p<0.05). The percentage of patients whose NIHSS improved by more than 2 points during the period from 7 days up to 20 days after onset was 40.9% in Group A and 26.9% in Group B. In Group A, the NIHSS tended to improve from 7 days after onset. Edaravone needs continuous administration for more than one week in order to show a therapeutic benefit.

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We report a case of vertebral arterial dissection associated with parent artery occlusion initially manifesting as incident and secondary subarachnoid hemorrhage (SAH). The patient was a 64-year-old man. It had been noted earlier that his right vertebral artery was occluded when he underwent coronary artery bypass grafting 2 years previously. He was transported to our hospital in an unconscious state and with bilateral abducent nerve palsy. CT scans demonstrated SAH in his posterior fossa. Angiograms revealed right vertebral occlusion. We diagnosed SAH due to right vertebral arterial dissection associated with parent artery occlusion based on a series of studies. The said vertebral artery with the occlusion was considered as an incidental vertebral arterial dissection. Earlier, when there is nonhemorrhagic vertebral artery dissection with dilatation, the remaining findings may have the potential for SAH later. Based on the present data, we should consider that nonhemorrhagic vertebral artery dissection with occlusion has the potential for SAH later.

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We report a successful case of percutaneous transarterial clot removal therapy (CRT) for acute embolic internal carotid artery (ICA) occlusion. A 32-year-old woman consuming oral contraceptives and dietary supplement containing ephedrine was admitted to our institution due to left-sided mild hemiparesis. Her magnetic resonance images demonstrated a small infarction of the corona radiata on the right side. An echocardiogram revealed dilated cardiomyopathy complicated by a pedunculated and mobile left ventricular thrombus. The patient received intravenous heparin and oral warfarin immediately after admission, and her symptoms improved rapidly on the 2nd day. However, she suddenly exhibited stupor, motor aphasia, and dense rightsided hemiparesis on the 7th day. Cranial computed tomography (CT) showed neither high density areas nor early CT signs, while emergent cerebral angiography disclosed an occlusion of the left ICA. We assumed that the ICA occlusion was due to recurrent embolism from the left ventricular thrombus and attempted recanalization therapy. After obtaining informed consent from the patient's family, we performed CRT using a basket-type microsnare supported proximal flow blockade with a balloon-guided catheter and additional angioplasty. Immediately after removal of several clots, the left ICA was completely recanalized, although the middle cerebral artery was not recanalized. Her symptoms except for the motor aphasia improved rapidly after the procedure, and her life became completely independent on the 94th day. This case experience suggests that CRT is a potential treatment for patients with acute embolic occlusion of the ICA.

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A 53-year-old man was admitted to our hospital with left hemiparesis of acute onset. Diffusion MRI disclosed cerebral infarction in the right anterior cerebral artery (ACA) territories. Cerebral MRA demonstrated a segmentally irregular artery with a partial double lumen at the A₂ portion of the right ACA. Following antithrombotic therapy and rehabilitation, the patient showed improvement of his symptoms and could perform independent walking in a month. Cerebral angiography revealed double lumen signs at the A2 portion of the right ACA, which confirmed the dissection. The irregularity of the artery on MRA changed to become normalized over time. This case was diagnosed as having acute cerebral infarction caused by dissection of the right ACA. In conclusion, MRA is considered useful to diagnose and follow up dissection. We should employ MRA actively as a noninvasive and significant method of diagnosis when we suspect dissection.

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Dental extractions were performed in 53 patients on warfarin treatment, which was continued at the time of the operation. We examined the incidence of postoperative bleeding according to the INR values. Postoperative minor hemorrhage occurred in 4 cases (7.5%) whose INR values at dental extraction were 2.6, 3.0, 3.5, and 3.8, respectively, while major hemorrhage did not. The incidence of postoperative hemorrhage was 0% in 37 patients with INR<2.5, 2.7% in 37 patients with INR<3.0 while it was 18.6% in 16 patients with INR of 3.0 or more. It appears that dental extraction is safe when the INR is less than 3.0.
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