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

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

No abstract available.
Embolism, Air*

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: Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (> or =60 mL/min/1.73 m2) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin. SUBJECTS AND METHODS: Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, 50.1+/-10.4 years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR > or =90 mL/min/1.73 m2 (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/1.73 m2 (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU. RESULTS: Group 1 had the lowest hfPWV (964.6+/-145.4; group 2, 1013.5+/-168.9; group 3, 1058.2+/-238.0; group 4, 1065.8+/-162.9 cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048). CONCLUSION: Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.
Arterial Pressure ; Body Mass Index ; Cardiovascular Diseases ; Diet ; Glomerular Filtration Rate ; Heart Rate ; Humans ; Hypertension ; Pulse Wave Analysis ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Vascular Stiffness

BACKGROUND: The adequate intravascular ultrasound (IVUS) criteria for stent optimization have not been determined in long coronary stenting. We evaluated the predictors of angiographic restenosis and compared that according to stent lumen cross-sectional area (CSA) and stent length between short (stent length < 20 mm) and long (> or =20 mm) coronary stenting. METHODS: IVUS-guided coronary stenting was successfully performed in 285 consecutive patients with 304 native coronary lesions. Six-month follow-up angiogram was performed in 236 patients (82.8%) with 246 lesions (80.9%). Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. RESULTS: The overall angiographic restenosis rate was 22.8% (56/246)(short stent 17.6% vs long stent 32.2%, p=0.009). Using multivariate logistic regression analysis, the independent predictors of angiographic restenosis were the IVUS stent lumen CSA (odd ratio=1.51, 95% CI 1.18-1.92, p=0.001) and stent length (odd ratio=0.95, 95% CI 0.91-1.00, p=0.039). The angiographic restenosis rate was 54.8% in stent lumen CSA & 5.0 mm2 (short stent 37.5% vs long stent 73.3%, p=0.049), 27.4% between 5.0 and 7.0 mm2 (short stent 24.1% vs long stent 31.7%, p=0.409), 10.5% between 7.0 and 9.0 mm2 (short stent 10.0% vs long stent 12.5%, p=0.772), and 11.4% in stent lumen CSA > or =9.0 mm2 (short stent 10.4% vs long stent 13.3%, p=0.767)(p=0.001). CONCLUSIONS: Compared with short coronary stenting, long coronary stenting is effective treatment modality to cover long lesions with comparable long-term clinical outcomes in cases of stent lumen CSA > or =7.0 mm2. Regardless of the stent length, the most important factor determining the angiographic restenosis was the IVUS stent lumen CSA in relatively large coronary artery lesions.
Coronary Artery Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Logistic Models ; Stents* ; Ultrasonography*

BACKGROUND: The chronic stent recoil of Palmaz-Schatz stent was minimal. However, the chronic stent recoil of other types of stents has not been determined. We evaluated the chronic stent recoil of different design of stents. METHODS: Serial (after stent implantation and follow-up) intravascular ultrasound images using automatic transducer pullback devices were obtained in 70 native coronary artery lesions: slotted-tube design of Palmaz-Schatz stent 30 and NIR 10, sinusoidal ring design of GFX 20, and coil design of CrossFlex 10. Measurements of stent cross-sectional area (CSA) (4 image slices in Palmaz-Schatz stent and 7 image slices in GFX, NIR and CrossFlex) using computerized planimetry were performed. Stent CSA post-stenting and follow-up was compared to evaluate the chronic stent recoil of different designs of stent. The chronic stent recoil (%) was defined as (post-intervention-follow-up) stent CSAx100/post-intervention stent CSA. RESULTS: The changes of stent CSA between post-intervention and follow-up period were minimal in NIR stent, Palmaz-Schatz and GFX. However, there was significant reduction of stent CSA in CrossFlex stent. Compared with other types of stents, the changes of stent CSA were significantly larger in CrossFlex stent (p=0.001). The chronic stent recoil was significantly larger in CrossFlex stent than in other types of stents (4.0+/-6.0% vs 0.7+/-5.8% in GFX stent, 0.4+/-5.0% in Palmaz-Schatz and 0.3+/-3.0% in NIR, p=0.001, respectively). There were no significant differences of chronic stent recoil among GFX, NIR and Palmaz-Schatz stent. CONCLUSIONS: The chronic stent recoil was minimal in slotted-tube and sinusoidal ring designs of stent. However, there was significant chronic stent recoil in coil design of stent.
Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Stents* ; Transducers ; Ultrasonography*