Cerebrospinal fluid enhancement on fluid attenuated inversion recovery images after carotid artery stenting with neuroprotective balloon occlusions: Hemodynamic instability and blood-brain barrier disruption
Ogami R.,Mazda Hospital |
Nakahara T.,Mazda Hospital |
Hamasaki O.,Shimane Prefectural Central Hospital |
Araki H.,Mazda Hospital |
Kurisu K.,Hiroshima University
CardioVascular and Interventional Radiology | Year: 2011
Purpose A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. Methods Nineteen patients\-5 acute-phase and 14 scheduled\-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined. Results CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. Conclusions Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications. © 2010 Springer Science+Business Media, LLC.
Onari Y.,Mazda Hospital |
Haruta Y.,Hiroshima University |
Mukaida K.,Tadanoumi Branch Hospital |
Kondoh K.,Tadanoumi Branch Hospital
Japanese Journal of Allergology | Year: 2012
Background and Aims: Tulobuterol patch (Tulo) is often used for treatment of elder patient with asthma in Japan. However, there is no evidence either ICS plus Tulo or ICS/LABA combination is better for elder patient Methods: Elder patients with asthma (aged ≥ 70, n= 17) who had treated with budesonide (BUD) 400 μg/day plus Tulo 2mg/day, were randomly assigned either to change control medication to budesonide/formoterol combination (BUD/FM) 320/9μg/day or to keep BUD plus Tulo treatment for 12 weeks. Results: At week 4 and week 12, the BUD/FM group showed significant increase in lung function (FEV1, % FEV1) and mini AQLQ score compared with the BUD plus Tulo group. The BUD/FM group also showed decrease in Tumor Necrosis Factor-alpha level in exhaled breath condensate at week 12. No adverse event was observed in both groups. Conclusion: In elder patients with asthma, treatment with BUD/FM does not have any clinical disadvantage and may provide better efficacy in lung function, QOL, and possibly anti-inflammation compared with BUD plus Tulo treatment. ©2012 Japanese Society of Allergology.
Okada T.,Hiroshima University |
Yamamoto H.,Hiroshima University |
Okimoto T.,Hiroshima University |
Okimoto T.,Cardiovascular Center |
And 9 more authors.
Circulation Journal | Year: 2011
Background: Angiotensin II receptor blockers (ARB) have been shown to reduce cardiovascular events in patients at risk. The effect of valsartan on outcomes after percutaneous coronary interventions (PCI) with bare-metal stents (BMS) was investigated. Methods and Results: The prospective, randomized study included 191 patients at 5 participating institutions, who were randomly assigned to either a 40-80 mg valsartan add-on or non-ARB treatment. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, and target lesion revascularization (TLR) at 18 months. Enrollment was stopped when the use of drug-eluting stents has been expanded in Japan. No significant differences existed between the groups in terms of primary endpoint (18.9% vs. 24.8%; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.61-1.14; P=0.26). In the valsartan group, as compared with the non-ARB group, the secondary endpoint of TLR was significantly reduced at a median follow-up 4.4 years; the rate of TLR was from 27.8% to 14.5% (HR, 0.69; 95%CI, 0.49-0.96; P=0.024). Conclusions: Valsartan treatment was not superior to non-ARB treatment in reducing the primary endpoint after PCI at 18 months. The pre-specified secondary endpoint of TLR was lower in the valsartan group, but this needs to be proved statistically with an adequate study sampling.
Takahashi S.,Hiroshima University |
Takasaki T.,Hiroshima University |
Tadehara F.,Mazda Hospital |
Taguchi T.,Hiroshima University |
And 4 more authors.
Heart Surgery Forum | Year: 2014
An 86-year-old woman presented with chest pain and discomfort. Echocardiography revealed severe aortic valve stenosis and asymmetric septal hypertrophy. Aortic valve replacement and myectomy were performed using a curved knife. The blade was U-shaped in cross-section, and was curved upward along the long axis. Hypertrophic septal myocardium was removed along the long axis of the left ventricle (LV), and a groove for blood flow was constructed. The patient was discharged uneventfully without recurrence of her chest discomfort. Our result suggested that a curved knife is a reasonable option for transaortic septal myectomy in patients with obstructive LV hypertrophy. © 2014 Forum Multimedia Publishing, LLC.
Nagaoki Y.,Hiroshima University |
Nagaoki Y.,Higashihiroshima Medical Center |
Imamura M.,Hiroshima University |
Kawakami Y.,Hiroshima University |
And 55 more authors.
Hepatology Research | Year: 2014
Aim: The predictive value of the recently identified interferon-λ (IFNL)4 polymorphism on the outcome of telaprevir (TVR), pegylated interferon (PEG IFN) plus ribavirin (RBV) combination therapy for chronic hepatitis C is unknown. Methods: We assessed predictive factors for sustained virological response (SVR) for TVR, PEG IFN plus RBV combination therapy in 283 genotype 1 chronic hepatitis C patients. IFNL4 polymorphism ss469415590 was analyzed by Invader assay. Results: SVR rates for patients with IFNL4 TT/TT genotype were significantly higher than for those with the IFNL4 TT/ΔG or ΔG/ΔG genotypes (93% and 59%, respectively, P<0.0001). In a multivariate regression analysis, prior treatment history (treatment-naïve patients or patients who relapsed during prior treatment) (odds ratio [OR], 2.385; P=0.028), rapid virological response (OR, 6.800; P<0.0001) and ss469415590 TT/TT genotype (OR, 8.064; P<0.0001) were identified as significant independent predictors for SVR. In patients with IFNL4 TT/ΔG or ΔG/ΔG genotypes, SVR rates for non-RVR patients were significantly lower than RVR patients (22% and 75%, respectively, P<0.0001). Conclusion: Analysis of IFNL4 polymorphism is a valuable predictor in patients receiving TVR triple therapy. © 2014 The Japan Society of Hepatology.