OBJECTIVE: Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. METHODS: Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. RESULTS: The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome (mRS≤2) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001). CONCLUSION: Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.
Cerebral Infarction ; Follow-Up Studies ; Humans ; Intracranial Embolism ; Mechanical Thrombolysis ; Stents* ; Stroke* ; Thrombectomy* ; Thrombosis

PURPOSE: In 1998, Longo introduced a novel operative technique for hemorrhoids. That technique uses a prolapse and hemorrhoid (PPH) stapler. His results showed minimal pain, short hospital stay, and rapid return to normal social life. However, a higher height of staple line yields less postoperative pain, but more residual piles, and vice versa. This study was designed to find the optimal height of the staple line for a PPH hemorrhoidopexy. METHODS: A total of 65 consecutive patients scheduled for a PPH hemorrhoidopexy on grade II or higher internal hemorrhoids were included in this study. The hemorrhoidopexy was performed as in the literature. A purse-string suture was made 5 cm from the anal verge. Remaining piles were excised immediately after the firing of the PPH stapler. Patients were divided into 2 groups. In group A, the staple line was located above 2 cm proximal to the dentate line, and in group B, it was located below 2 cm proximal to the dentate line. RESULTS: The mean subjective pain score of group A was 2.00, and that of group B was 1.98 (P=0.898). The mean hospital stay of group A was 2.5 days, and that of group B was 2.7 days (P=0.431). Group A returned to normal life in a mean of 7.1 days whereas group B returned to normal life in a mean of 6.8 days (P=0.474). Complications included 6 cases of voiding difficulty, 3 cases of heavy sensation in anus, 1 case of temporary fecal incontinence, and 1 case of anal pain caused by long-standing residual staples. CONCLUSION: No meaningful relationship was found to exist between the staple line height and either pain or the number of days to return to normal life. However, the incidence of residual piles was lower in cases with a low staple line height. Therefore, the level of the staple line should be lower than it is for a conventional Longo procedure.
Anal Canal ; Fecal Incontinence ; Fires ; Hemorrhoids ; Humans ; Incidence ; Length of Stay ; Pain, Postoperative ; Prolapse ; Sensation ; Sutures

OBJECTIVE: Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI. METHODS: We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups. RESULTS: During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups. CONCLUSION: Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.
Brain Injuries* ; Cerebral Hemorrhage ; Contusions ; Decompressive Craniectomy* ; Hematoma, Subdural ; Hemorrhage ; Humans ; Platelet Aggregation Inhibitors ; Postoperative Hemorrhage ; Reoperation ; Retrospective Studies

PURPOSE: To assess the added prognostic value of the morphologic characteristics of intracranial arteries in the risk modeling of a future non-cardioembolic stroke. MATERIALS AND METHODS: This retrospective study included 86 patients without acute ischemic stroke who first underwent magnetic resonance imaging (MRI) including the time-of-flight magnetic resonance angiography (TOF-MRA) at 3T. Diffusion-weighted imaging (DWI) was performed for the follow-up imaging of these patients > 120 days after the initial MRI. The TOF-MRA result was used to analyze three morphological characteristics: dilatation, stenosis, and tortuosity. The presence of acute ischemic stroke was assessed using the follow-up DWI data. We built two prognostic models: model 1 includes the conventional stroke-risk factors, while model 2 includes the conventional risk factors and the morphologic characteristics of the intracranial arteries. We used the likelihood-ratio test to compare these two models. The models' performances were evaluated using Harrell's concordance index. RESULTS: Fourteen patients suffered non-cardioembolic strokes. The performances of the two models differed significantly regarding the future-risk modeling of the non-cardioembolic stroke (p = 0.031). The Harrell's concordance index of model 2 (0.78 ± 0.05) exceeded that of model 1 (0.72 ± 0.07). CONCLUSION In addition to the conventional stroke-risk factors, the morphologic characteristics of the intracranial arteries were useful in the modeling of the future risk of the non-cardioembolic ischemic stroke.