Hiroyuki Katano

Endovascular stent placement for multiple aneurysms of the extracranial internal carotid artery: technical case report.

A patient with multiple extracranial internal carotid artery aneurysms that caused cerebral infarction was treated by endovascular placement of a metallic stent. Complete disappearance of the aneurysms was angiographically confirmed within 15 weeks. Endovascular observation 6 months after the stent placement revealed that the endoluminal surface was totally covered by normal endothelium. The patient returned to his regular work routine and had no complication or neurological deterioration during the 17-month follow-up period.

Endovascular Stent Placement for Multiple Aneurysms of the Extracranial Internal Carotid Artery

ABSTRACTA PATIENT WITH multiple extracranial internal carotid artery aneurysms that caused cerebral infarction was treated by endovascular placement of a metallic stent. Complete disappearance of the aneurysms was angiographically confirmed within 15 weeks. Endovascular observation 6 months after th

Significance of the Hemorrhagic Site for Recurrent Bleeding: Prespecified Analysis in the Japan Adult Moyamoya Trial

Background and Purpose— The primary results of the Japan Adult Moyamoya Trial revealed the statistically marginal superiority of bypass surgery over medical treatment alone in preventing rebleeding in moyamoya disease. The purpose of this analysis is to test the prespecified subgroup hypothesis that the natural course and surgical effects vary depending on the hemorrhagic site at onset. Methods— The hemorrhagic site, classified as either anterior or posterior, was the only stratifying variable for randomization. Statistical analyses were focused on the assessment of effect modification according to the hemorrhagic site and were based on tests of interaction. Results— Of 42 surgically treated patients, 24 were classified as anterior hemorrhage and 18 as posterior hemorrhage; of 38 medically treated patients, 21 were classified as anterior and 17 as posterior. The hazard ratio of the primary end points (all adverse events) for the surgical group relative to the nonsurgical group was 0.07 (95% confidence interval, 0.01–0.55) for the posterior group, as compared with 1.62 (95% confidence interval, 0.39–6.79) for the anterior group (P=0.013 for interaction). Analysis within the nonsurgical group revealed that the incidence of the primary end point was significantly higher in the posterior group than in the anterior group (17.1% per year versus 3.0% per year; hazard ratio, 5.83; 95% confidence interval, 1.60–21.27). Conclusions— Careful interpretation of the results suggests that patients with posterior hemorrhage are at higher risk of rebleeding and accrue greater benefit from surgery, subject to verification in further studies. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000166.

Perioperative evaluation of carotid endarterectomy by 3D-CT angiography with refined reconstruction: preliminary experience of CEA without conventional angiography.

Three-dimensional CT angiography (3D-CTA) was employed for perioperative evaluation of carotid endarterectomy (CEA) as an alternative to conventional angiography. A total of 62 carotid arteries were examined before and after CEA, 26 with an early 3D-CT system and 36 with multidetector helical CT allowing sophisticated reconstruction by a personal workstation. In addition to patients who had undergone conventional angiography at other institutes, 10 subjects underwent CEA on the basis of 3D-CTA findings alone. The findings provided detailed information with an excellent view of carotid stenoses. Volume rendering images comprehensively visualized lesions and surrounding structures as well as calcifications, which were also well depicted by maximum intensity projection images. Evaluation of the cerebral circulation is one problem that still requires solution, although cerebral vessels were delineated by 3D-CTA. One patient experienced transient hemiparesis, but no significant permanent deficit. We conclude that 3D-CTA is a safe and accurate modality that is a practical alternative to conventional perioperative angiography.

Analysis of Calcium in Carotid Plaques With Agatston Scores for Appropriate Selection of Surgical Intervention

Background and Purpose— The aim of the study was to determine whether the Agatston calcium score might be applied as a useful tool for evaluation of carotid stenosis. Methods— A total of 124 carotid bifurcations were examined with multidetector row CT. Calcium scores were determined according to the method described by Agatston et al. Results— Agatston scores generally appear appropriate for evaluation of calcified plaques. Calcified lesions with bigger differences between mean and peak Hounsfield unit (HU) in single cases accounted for only 34.3% of those with volume scores under 500 mm3, whereas 81.3% (P<0.001) for those sized >500 mm3. Conclusions— The Agatston calcium score is useful in evaluating carotid plaques with calcium. We recommend, however, individual analyses for quality (hardness) and quantity (volume) of each large calcified focus (>500 mm3) by multidetector row CT lesions in order to provide indications for surgical treatment of carotid stenosis, carotid endarterectomy or carotid artery stenting.

Involvement of CD45RO+ T Lymphocyte Infiltration in a Patient with Primary Angiitis of the Central Nervous System Restricted to Small Vessels

Involvement of CD45RO+ T Lymphocyte Infiltration in a Patient with Primary Angiitis of the Central Nervous System Restricted to Small Vessels Tamaki Iwase a, Kosei Ojika a, Shigehisa Mitake a, Eiichi Katada a, Hiroyuki Katano b, Mitsuhito Maseb, Shinichi Yoshida c, Ryuzo Ueda a aSecond Department of Internal Medicine, bDepartment of Neurosurgery and cDepartment of Psychiatry, Nagoya City University Medical School, Aichi, Japan

Differential induction of immediate early gene mRNAs following cryogenic and impact trauma with/without craniotomy in rats

Expression of immediate early gene (IEG) mRNAs following traumatic brain injury in 3 different models-cryogenic injury, impact injury with craniotomy and impact injury without craniotomy-was investigated using in situ hybridization. Cryogenic brain injury resulted in c-fos and c-jun mRNA expression throughout the ipsilateral cortex, piriform cortex and dentate gyrus on the injured side, with peak at 30 min to 1 h post-injury. Impact injury with craniotomy was associated with hybridization signals in the same areas and also in the subcortical white matter or ependyma underlying the impact site at 30 min post-injury. The expression was rather more prolonged than with cryogenic injury. Impact injury without craniotomy induced the expression of both mRNAs throughout the ipsilateral cortex, piriform cortex and dentate gyrus at 30 min post-injury, but this was promptly attenuated by 1 h post-injury, except for bilateral elevation in the dentate gyrus. The present study, thus, demonstrated that regional and temporal expression of IEG mRNAs is influenced by the intensity, quality and manner of application of the insult. Differences in the expression of IEGs may alter the late response gene expression and affect the succeeding events.

Traumatic injury in vitro induces IEG mRNAs in cultured glial cells, suppressed by co-culture with neurons.

Glial changes following traumatic injury to glial monolayers as well as to neuronal-glial co-culture systems in vitro were examined with a focus on the expression of mRNAs coding for the immediate early genes (IEG) c-fos, c-jun and zif/268, demonstrated using in situ hybridization. Glial cells along scratch wound lines extended cytoplasmic processes as early as 10 min post-injury and the whole wound was covered with gliosis by 24 h. For complete restoration in the case of glial cells co-cultured with neurons, this required 48 h. Induction of the three IEG mRNAs was eminent along the edges of scratch wound, peaking at 30-60 min post-injury and subsiding by 3 h. The peak expression of IEG mRNAs was delayed to 1-3 h post-injury and became undetectable at 6 h in neuronal-glial co-cultures. The data suggest that mechanical injury to glial cells causes gliosis and the expression of IEG mRNAs, which are suppressed by co-culture with neurons, indicating some influence of neuronal-glial interactions.

Calcification in carotid atheromatous plaque: delineation by 3D-CT angiography, compared with pathological findings.

Abstract The authors investigated calcification in the carotid plaque of patients with carotid stenosis, using three-dimensional CT angiography (3D-CTA) and comparing the images with findings from pathological inspection. Calcification was clearly visualized using volume rendering (VR) images constructed with a refined workstation as well as maximum intensity projection and multiplanar reconstruction images. Calcification in VR images was classified into bean- and island-like shaped groups, while calcification in microscopic examination was classified into granular, lump and laminar types. Granular type of calcification tended to be found at the intimal side of the plaque, while lump/laminar calcification was preferentially located at the side of the internal elastic fiber. Though carotid endarterectomy successfully removed calcification at both sides, the presence of a granular calcification assembly when massive calcification is observed with 3D-CTA might alert us to the importance of predicting the hardness of plaque in carotid angioplasty and stenting.

Plaque Vulnerability in Internal Carotid Arteries with Positive Remodeling

Background: This study aimed to evaluate the efficacy of assessing positive remodeling for predicting future stroke events in the internal carotid artery. We therefore assessed narrowing of the carotid artery lumen using multidetector-row computer tomography (MDCT) angiography and carotid plaque characteristics using black-blood (BB) magnetic resonance (MR). Methods: We retrospectively selected 17 symptomatic and 11 asymptomatic lesions with luminal narrowing >50%. We compared remodeling parameters of luminal stenosis (remodeling ratio, RR/remodeling index, RI) using MDCT and MR intensities of atherosclerotic plaque contents using the BB technique (relative signal intensity, rSI). We also confirmed the validity of the relationship between MR intensity and atherosclerotic plaque contents by histology. The levels of biological markers related to vessel atherosclerosis were measured. Results: Plaque lesions with positive remodeling in carotid arteries were associated with a significantly higher prevalence of stroke compared with plaques with negative remodeling (p < 0.05). Radiologic and histologic analyses determined that plaques with positive remodeling had higher signal intensities (with respect to their lipid-rich content or to hemorrhage) compared with negative remodeling (correlation coefficients: RI and rSI, r = 0.41, p < 0.05; RR and rSI, r = 0.50, p < 0.05). Levels of biological markers, including high-sensitivity C-reactive protein, hemoglobin A1C, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, were not useful for predicting stroke events. Conclusions: The results of this study suggest that the combined analysis of RR, RI and rSI could potentially help to predict future stroke events.