Case report: Usefulness of angioscopy in determining antiplatelet drug reduction after carotid artery stenting

We report a case in which neointima was confirmed by angioscopy and antiplatelet drug administration was reduced 2 months after carotid artery stenting (CAS). A patient in their 80s was scheduled to undergo resection for renal cancer; however, he also had right cervical internal carotid artery stenosis. Because this was a risk for general anesthesia, CAS was performed after first starting dual antiplatelet therapy. Urologically, early reduction of antiplatelet drugs was necessary for a nephrectomy. Although no obvious neointima could be identified on ultrasound 2 months after CAS, thin neointima was observed using angioscopy. Based on the above results, we reduced the antiplatelet drug administration, and then the nephrectomy was performed. Ultimately, no cerebral infarction occurred in the perioperative or postoperative periods. Angioscopy allows for visual confirmation of thin neointima. If sufficient neointima can be confirmed, antiplatelet drug reduction can be performed more safely and reliably

Solitary fibrous tumor/hemangiopericytoma expanding the superior and inferior cerebellar tentorium: A case report

Background: A rare case of a solitary fibrous tumor/hemangiopericytoma (SFT/HPC) expanding the superior and inferior cerebellar tentorium is described. Case description: A 28-year-old male presented with convulsions. Magnetic resonance imaging revealed a tumor around the right cerebellar tentorium. The tumor was completely removed after embolization of the feeding arteries, and the pathological diagnosis was World Health Organization grade III SFT/HPC. The patient's postoperative course was uneventful, and there was no recurrence or extracranial metastasis at 1.5 years following the operation. Conclusions: It was possible to fully remove the SFT/HPC tumor; however, strict observation of the whole body is needed because of the possibility of recurrence and extracranial metastasis

本態性振戦に対するMRIガイド下集束超音波視床破壊術の臨床転帰に影響する因子は何か。

Objective: Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel and useful treatment for essential tremor (ET); however, the factors impacting treatment outcome are unknown. The authors conducted this study to determine the factors affecting the outcome of MRgFUS. Methods: From May 2016 through August 2017, 15 patients with ET were admitted to Ohnishi Neurological Center and treated with MRgFUS. To determine the factors impacting treatment outcome, the authors retrospectively studied correlations between the Clinical Rating Scale for Tremor (CRST) improvement rate and age, disease duration, baseline CRST score, skull density ratio (SDR), skull volume, maximum delivered energy, or maximum temperature. Results: The mean CRST score was 18.5 ± 5.8 at baseline and 4.6 ± 5.7 at 1 year. The rate of improvement in the CRST score was 80% ± 22%. Younger age and lower baseline CRST score were correlated with a higher CRST improvement rate (p = 0.025 and 0.007, respectively). To obtain a CRST improvement rate ≥ 50%, a maximum temperature ≥ 55°C was necessary. There was no correlation between SDR and CRST improvement rate (p = 0.658). A lower SDR and higher skull volume required significantly higher maximum delivered energy (p = 0.014 and 0.016, respectively). A higher maximum temperature was associated with a significantly larger lesion volume (p = 0.026). Conclusions: Younger age and lower baseline CRST score were favorable outcome factors. It is important to assess predictive factors when applying MRgFUS.博士（医学）・乙第1468号・令和2年9月30日©AANS 2020, except where prohibited by US copyright law.発行元の規定により、本文の登録不可。本文は以下のURLを参照 "http://dx.doi.org/10.3171/2020.2.JNS192814"（※全文閲覧は学内限定

Efficacy of Angioscopy for the Detection of Mobile Carotid Artery Lesions

Case presentation A 78‐year‐old man with a mobile lesion was diagnosed with thrombus using carotid ultrasonography, but the lesion was not completely resolved with dual antiplatelet and anticoagulation therapy. Direct visualization by angioscopy showed a white mobile plaque. The carotid artery was stented with a double‐layered stent, as the plaque persisted despite continuing the medical treatment and was linked to an increased risk of cerebral embolism. The plaque was attached to the arterial wall, and it subsequently disappeared. The patient recovered well and no further emboli were observed. Conclusions Angioscopy is effective for identifying lesions under direct vision. The characteristics and dynamics of plaques may be viewed via angioscopy, which aids in making treatment‐related decisions, particularly in the case of carotid artery plaques