Kazuo Minematsu

Thrombolytic Therapy in Acute Ischemic Stroke III

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CHADS2 and CHA2DS2-VASc scores as bleeding risk indices for patients with atrial fibrillation: the Bleeding with Antithrombotic Therapy Study.

The CHADS2 and CHA2DS2-VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS2 and CHA2DS2-VASc scores were assessed based on information at entry. Scores of 0, 1 and ⩾2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA2DS2-VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS2, and 1.44, 1.69 and 2.24% by CHA2DS2-VASc. After multivariate adjustment, the CHADS2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03–3.38 per 1−category increase) and the CHA2DS2-VASc tended to be associated with ischemia (2.18, 0.89–8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS2 and CHA2DS2-VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke.

A Web-Based Stroke Education Application for Older Elementary Schoolchildren Focusing on the FAST Message

It is necessary to identify the symptoms of a transient ischemic attack (TIA) quickly and provide treatment at special medical facilities to prevent stroke. All family members need to learn stroke signs. Specialists are spreading the face, arm, speech, time (FAST) message for identifying typical TIA symptoms to teens as part of stroke education activity in schools. To support these activities, we developed stroke education for older elementary schoolchildren outside of a school environment using information and communication technology. We utilized HTML5 and JavaScript to make a web-based application using on the FAST message. We provided an example of our application program at an event held at the National Cerebral and Cardiovascular Center in Japan, 2014. On average, 83 % of older children answered questions about the FAST message correctly. Our application might be useful as a stroke education support tool.

Brain ischemia and spreading depression in a primate model

In order to investigate the pathophysiology of ischemic stroke, we developed a primate thromboembolic stroke model and examined serial changes in cerebral blood flow (CBF) and cerebral metabolic rate of glucose (CMRglc) using positron emission tomography (PET). In addition, we attempted to elicit spreading depression (SD), which is essential in the evolution of infarcts in small animal models, by chemical stimulation in primates.

Bordering Zone Hyperemia and Glucose Metabolism in Experimental Cerebral Ischemia

Areas of increased blood flow (hyperemia) at the periphery of ischemic foci have been noted in experimental animals [1]. Experiments using 14C-2-deoxyglucose (2-D G) for the measurement of local cerebral glucose utilization (LCGU) have also demonstrated increased uptake of 2-DG in the bordering zone of focal ischemia [2]. The present study was designed to elucidate the relationship between hyperemia and increased 2-DG uptake in gerbils with unilateral common carotid artery (CCA) occlusion.