トクシマ ダイガク ビョウイン ノウソッチュウ センター デノ ナイケイドウミャク キュウセイ ヘイソク ニ タイスル チリョウ センリャク

Objective : Strokes related to acute internal carotid artery （ICA） occlusion are associated with extremely poor prognosis. Recently, some studies have reported that the prognosis has been getting better by treating with intra-arterial endovascular therapy. We sought to evaluate clinical outcomes in patients with acute ischemic stroke attributable to ICA occlusion treated with intraarterial endovascular therapy or otherwise. Methods : We reviewed ４４ patients who underwent treatment with intra-arterial endovascular therapy or otherwise in our stroke care unit （SCU） from January, ２０１１ to May, ２０１４. We compared the prognosis of patients in the ２ treatment groups （endovascular group, n＝２３ vs nonendovascular group, n＝２１）. Results : The rate of good prognosis （modified Rankin Score of ≦２） was significantly higher in the endovascular group than non-endovascular group （１７．４％ vs０％，p＝０．０４５）. The rate of patients who had extreme improvements of National Institutes of Health Stroke Scale （NIHSS） ≧８ was higher in the endovascular group than non-endovascular group （３０．４％ vs１４．３％）. Concerning the improvement of NIHSS ≧８, recombinant tissue-type plasminogen activator （rt-PA） or the left side ICA occlusion were associated significantly （p＝０．０１９, p＝０．０４２, respectively）. Although the hypothesis that endovascular therapy could contribute to extreme improvements of NIHSS wasn’t proved （p＝０．２０２）, there was one case that NIHSS was dramatically improved from ２２ to ０ by endovascular therapy. Conclusions : Intra-arterial endovascular therapy of ICA occlusion might result in improved clinical outcomes for indicated cases

Blocking COX-2 induces apoptosis and inhibits cell proliferation via the Akt/survivin- and Akt/ID3 pathway in low-grade-glioma

Approximately half of surgically-treated patients with low-grade-glioma (LGG) suffer recurrence or metastasis. Currently there is no effective drug treatment. While the selective COX-2 inhibitor celecoxib showed anti-neoplastic activity against several malignant tumors, its effects against LGG remain to be elucidated. Ours is the first report that the expression level of COX-2 in brain tissue samples from patients with LGG and in LGG cell lines is higher than in the non-neoplastic region and in normal brain cells. We found that celecoxib attenuated LGG cell proliferation in a dose-dependent manner. It inhibited the generation of prostaglandin E2 and induced apoptosis and cell-cycle arrest. We also show that celecoxib hampered the activation of the Akt/survivin- and the Akt/ID3 pathway in LGGs. These findings suggest that celecoxib may have a promising therapeutic potential and that the early treatment of LGG patients with the drug may be beneficial

MEDICAL TREATMENT OF UNRUPTURED CEREBRAL ANEURYSMS

Background: Currently there are no pharmacological therapies for patients with unruptured cerebral aneurysms. Elsewhere we showed that the mineralocorticoid receptor antagonist eplerenone prevented the formation of cerebral aneurysms in our ovariectomized hypertensive aneurysm rat model. The current pilot study evaluated whether it can be used to prevent the growth and rupture of cerebral aneurysms in hypertensive patients. Methods: Between August 2011 and May 2014, we enrolled 82 patients with 90 aneurysms in an open-label uncontrolled clinical trial. All provided prior informed consent for inclusion in this study, and all were treated with eplerenone (25-100 mg/d). The primary end points of our study were the rupture and enlargement of the cerebral aneurysms. Results: Of the 82 patients, 80 (88 unruptured aneurysms) were followed for a mean of 21.3 months (153.4 aneurysm-years); 12 patients (15.0%) permanently discontinued taking the drug. One month after the start of eplerenone administration and throughout the follow-up period, eplerenone kept the blood pressure within the normal range. Most notably, no aneurysms smaller than 9 mm ruptured or enlarged. However, of 2 large thrombosed aneurysms, 1 enlarged and the other ruptured. The overall annual rupture rate was .65%; it was 13.16% for aneurysms larger than 10 mm; the overall annual rate for reaching the primary end points was 1.30%. Conclusion: Our observations suggest that eplerenone may help to prevent the growth and rupture of unruptured cerebral aneurysms smaller than 9 mm. To assess its potential long-term clinical benefits, large clinical trials are needed

膠芽腫においてAd-DKK3の抗腫瘍効果はWnt蛋白と受容体の相互作用の阻害によりもたらされる

Field log book of Mike Gagner, labeled WM-7, 4/14/04, WM-7, 06/26/04, and WM-7, 8/20/04 of project 1418.01 PHABSIM site

Arterial spin labeling灌流画像で得られる血管内高信号は内頚動脈の閉塞部位を予測する

Introduction Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Methods Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Results Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1–C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3–C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1–C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. Conclusion High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site

Urgent Carotid Artery Stenting

As the safety and effectiveness of urgent carotid artery stenting (CAS) for neurologically progressing patients remain controversial, we retrospectively analyzed the outcome of urgent CAS based on the patients’ pathophysiological condition and neuroimaging findings. We divided 71 patients who underwent CAS within 14 days of stroke onset into two groups. Group 1 (n = 35) was comprised of patients with progressing neurologic signs and a reversible ischemic penumbra on magnetic resonance images (MRI). They were treated by urgent CAS. Group 2 (n = 36) was neurologically stable and underwent prophylactic CAS. In all patients we recorded the National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale (mRS). Urgent CAS resulted in significant improvement in the NIHSS score, when compared before and after CAS in group 1 (5.3 ± 4.3, P < 0.01). The rate of good outcomes (mRS 0-2 at 3 months post-CAS) was 48.6% in group 1, and 75% in group 2. The cumulative incidence of ipsilateral stroke between 31 days and 1 year was 5.9% in group 1, and 0% in group 2. The procedural complication rate was similar in both groups (group 1: 5.7%, n = 2; group 2: 5.6%, n = 2). No patient suffered a symptomatic intracerebral hemorrhage. When the pathophysiological status and neuroimaging findings are used to determine patient eligibility for urgent CAS, this treatment improve neurologic outcome and can be performed as safely as prophylactic CAS in our cohort of patients with acute ischemic stroke

Post-ischemic hyperperfusion after clipping of a ruptured internal carotid-posterior communicating artery aneurysm under suction decompression

A 64-year-old woman presenting with subarachnoid hemorrhage (World Federation of Neurosurgeons grade IV) from the rupture of a right large internal carotid-posterior communicating artery aneurysm suffered neuronal damage associated with post-ischemic hyperperfusion after neck clipping of the aneurysm under suction decompression. She did not completely recover consciousness after the operation. Diffusion-weighted imaging (DWI) performed on the first postoperative day showed subtle cortical hyperintensity in the parietal lobe. Arterial spin-labeling (ASL) and 123I-iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) demonstrated hyperperfusion in the right temporo-parietal lobes. Delayed 123I-iomazenil (123I-IMZ) SPECT images showed a reduced IMZ uptake in the right temporo-parietal lobe corresponding to the hyperperfusion area on ASL images. DWI repeated on postoperative day 3 revealed progression of a hyperintensity lesion in the right parietal lobe. Blood pressure control and the use of a free radical scavenger relieved her symptoms. One month later, the area of reduced IMZ uptake was further expanded. Our findings suggest that post-ischemic hyperperfusion after suction decompression may result in neuronal damage demonstrated on 123I-IMZ SPECT images