No abstract available.
Ischemic Attack, Transient* ; Magnetic Resonance Imaging* ; Stroke, Lacunar*

No abstract available.
Embolism, Air*

No abstract available.
Central Nervous System Vascular Malformations* ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve*

Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high demands of quality outcomes, the need for digital therapeutics is gradually increasing in the clinical field. We conducted review of the implications of digital therapeutics in the treatment of neurological deficits for stroke patients. The implications of digital therapeutics have been discussed in four domains: cognition, speech and aphasia, motor, and vision. It was evident that different forms of digital therapeutics such as online platforms, virtual reality trainings, and iPad applications have been investigated in many trials to test its feasibility in clinical use. Although digital therapeutics may deliver high-quality solutions to healthcare services, the medicalization of digital therapeutics is accompanied with many limitations. Clinically validated digital therapeutics should be developed to prove its efficacy in stroke rehabilitation.
Aphasia ; Aphasia, Broca ; Cognition ; Delivery of Health Care ; Hemianopsia ; Hemiplegia ; Humans ; Medicalization ; Neurologic Manifestations ; Rehabilitation ; Stroke

OBJECTIVE: We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke.METHODS: We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them.RESULTS: The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ≥11 or National Institutes of Health Stroke Scale ≤1 at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ≤2) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group.CONCLUSION: The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.
Academies and Institutes ; Brain Ischemia ; Catheters ; Cerebral Infarction ; Humans ; National Institutes of Health (U.S.) ; Reperfusion ; Retrospective Studies ; Stents ; Stroke ; Thrombectomy ; Thrombosis

In the absence of hypertension, hypertrophic cardiomyopathy is the most common cause of left ventricular hypertrophy (LVH). However, it has been reported that up to 3% of males with unexplained LVH have Fabry disease, an X-linked disorder of glycophospholipid metabolism that is due to a deficiency in the lysosomal enzyme alpha-galactosidase A (alpha-Gal A). A 44-year-old man was admitted to our hospital with palpitations. He had a history of chronic renal failure diagnosed at age 33 followed by kidney transplantation performed at our institution 2 years later, as well as long-standing hypohidrosis. His medications included prednisolone (5 mg daily), mycophenolate mofetil (1,000 mg, bid), and cyclosporine (150 mg, bid). On hospital day two, an echocardiogram demonstrated increased left ventricular wall thickness (septal wall thickness of 28 mm, posterior wall thickness of 20 mm). Diastolic dysfunction was noted on transmitral flow patterns and tissue Doppler imaging. The patient was found to have low plasma alpha-Gal A activity. A previously reported H46R missense mutation was detected in his alpha-Gal A gene and the patient was subsequently diagnosed with Fabry disease.
Adult ; alpha-Galactosidase ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Cyclosporine ; Fabry Disease ; Genes, vif ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Hypohidrosis ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mutation, Missense ; Mycophenolic Acid ; Plasma ; Prednisolone

BACKGROUND: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. METHODS: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under ‘Drip-and-Ship’ or ‘Ship-and-Drip’ paradigm were selected. RESULTS: During the observation period, 225 patients were treated under ‘Drip-and-Ship’ or ‘Ship-and-Drip’ paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P < 0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. CONCLUSION: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.
Brain ; Emergencies ; Humans ; Punctures ; Retrospective Studies ; Stroke ; Thrombectomy ; Transportation

BACKGROUND AND OBJECTIVES: The GFX stent is a flexible, balloon-expansible stent made of sinusoidal element of stainless steel. The adjunct high-pressure balloon dilatations after stenting were usually recommended in routine stenting procedure. The aim of this study was 1) to evaluate the immediate and long-term clinical and angiographic outcomes and 2) to investigate the necessity of high-pressure balloon during GFX stenting. MATERIAL AND METHODS: One hundred seventy two consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: 1) stent size of a final stent-to-artery ratio of 1:1 (inflation pressure > 10 atm, usually 12-14 atm: high pressure group) and 2) stent size of 0.5 mm bigger than reference vessel (inflation pressure 10 atm, usually 9 atm: low pressure group). The adjunct high-pressure balloon dilatations were done only in cases of suboptimal results. RESULTS: The adjunct high-pressure balloon dilatation were required under angiographic guidance in 11 of 83 lesions (13%) in high pressure group and 7 of 105 lesions (7%) in low pressure group (p=0.203). Procedural success rate was 100%. There were no significant differences of in-hospital and long-term clinical events between 2 group. The overall angiographic restenosis rate was 17.7%: 18.4% in high pressure group and 17.1% in low pressure group (p=0.991). CONCLUSION: GFX stent is a safe and effective device with high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantations.
Angioplasty ; Coronary Artery Disease ; Dilatation* ; Humans ; Stainless Steel ; Stents*

Polyarteritis nodosa (PAN) is a multi systemic disease, occasionally described as limited forms of the disease. Localized form of PAN is usually associated with better prognosis. We describe unusual two cases of patients who has suffered from sudden onset of low extremity pain by localized forms of polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the suspected muscle. Acute necrotizing arteritis with myopathy has been revealed by muscle biopsy. The symptom of the patient has been improved soon after corticosteroid administration. Muscle biopsy of symptomatic muscles or MRI-directed biopsies can be useful to diagnose this case as PAN with localized myopathies.
Biopsy ; Extremities ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscles ; Muscular Diseases ; Polyarteritis Nodosa* ; Prognosis

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.
Catheterization ; Catheters ; Compliance* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Exercise Tolerance ; Heart* ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Multivariate Analysis ; Tricuspid Valve Insufficiency