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1. National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Author

Satoshi Suzuki, Kenji Yamamoto, Hiroaki Tanaka, Hiroshi Ozawa, Yuji Okamoto, Tatsuya Abe, Hidenori Suzuki, Akiko Kada, Shigeki Nishino, Nobuyuki Sakai, Kunihiro Nishimura, Tomoyoshi Oikawa, Takanari Kitazono, Hiroshi Tanaka, Daisuke Onozuka, Akihito Hagihara, Hiroshi Ooyama, Akira Watanabe, Shinichi Yoshimura, Toru Iwama, Hiroki Sato, Satoshi Ushikoshi, Kiyohiro Houkin, Nobuhiro Mikuni, Naoyuki Nakao, Michio Nakamura, Nanako Tamiya, Naofumi Isono, Koji Iihara, Yutaka Yamaguchi, Kuniaki Ogasawara, Osamu Onodera, Yusaku Nakamura, Naoki Hayashi, Akira Takada, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yuji Matsumaru, Ichiro Nakahara, Tomoaki Terada, Kazunari Yoshida, Ai Kurogi, Ataru Nishimura, Yoshiaki Shiokawa, Koichi Arimura, Kaoru Kurisu, Fusao Ikawa, Kenji Ohata, Kyoichi Nomura, Nobuhito Saito, Hiroaki Fujiwara, Susumu Suzuki, Masanori Isobe, Soshiro Ogata, Takeshi Matsuoka, Junichiro Satomi, Takashi Matsumoto, Hiroyuki Nakase, Yasunari Niimi, Manabu Kinoshita, Mamoru Murakami, Masaaki Uno, Junichi Iida, Takashi Matsuoka, Tatsuya Sasaki, Shinichi Wakabayashi, Hiroki Toda, Hideki Sakai, Hajime Ohta, Osamu Yamamura, Hideyuki Ohnishi, Hiroko Oyama, Junichi Ono, Izumi Nagata, Hiroharu Kataoka, Ryota Kurogi, Hajime Arai, Atsuo Yoshino, Tsuyoshi Ohta, Hiroshi Sugimori, Hidehiro Hirabayashi, Hiroyuki Masaoka, Satoshi Yamamoto, Hideki Murakami, Kazuhiko Nozaki, Hiroyuki Matsumoto, Yuichiro Tanaka, Takahisa Mori, Keizo Yasui, Akira Takahashi, Ichiro Suzuki, Sachio Suzuki, TAKASHI YOSHIDA, Masanori Morimoto, Tetsuya Ueba, Hiromu Hadeishi, Masaki Chin, Michihiro Kohno, Hitoshi Fukuda, Toru Nishi, Kazunari Koga, Toshihiko Wakabayashi, Hiroki Ohkuma, Kazuhiro Hongo, Hiroshi Nakane, Kazumi Nitta, Satoshi Utsuki, Toshihiko Iuchi, Nice Ren, Hidefuku Gi, Kensuke Kawai, Masayuki Ishihara, Eiji Kohmura, Yoshihiro Nishiura, Kazutaka Yatsushiro, Kensaku Yoshida, Atsushi Tominaga, Masayuki Sumida, Hidenori Yoshida, Atsushi Sato, Takashi Inoue, Hiroaki Shimizu, Eiichiro Kamatsuka, Makoto Ichinose, Naoya Takeda, Tsuyoshi Inoue, Hidekazu Takahashi, Satoshi Kuroda, Toshiaki Osato, Nobutaka Horie, Isao Date, Yoichiro Hashimoto, Haruhiko Hoshino, Takafumi Shimogawa, Koji Yoshimoto, Teiji Tominaga, Isao Sasaki, Kazuo Kitazawa, Minoru Saitoh, Hitoshi Saito, Minoru Asahi, Makoto Goda, Atsuhito Takemura, Masaaki Shibukawa, Isao Fuwa, Saburo Watanabe, Seiko Kataoka, Koji Takasaki, Kouji Shiga, Kensuke Hayashida, Ryunosuke Uranishi, Chiaki Ito, Kenji Wakui, Takashi Saegusa, Isao Kitahara, Yasushi Ejima, Satoru Hayashi, Kazuyoshi Hattori, Shinji Okita, Toshikazu Ichihashi, Tsugumichi Ichioka, Shinichi Shirakami, Teruo Kimura, Tomonori Kobayashi, Kanehisa Kohno, Kazunori Yamanaka, Akira Morooka, Nozomi Mori, Hideo Kunimine, Masahiro Satoh, Syougo Imae, Hirochiyo Wada, Masanori Kabuto, Katsuyuki Hirakawa, Isao Inoue, Kiyoshi Kazekawa, Masani Nonaka, Kouzou Fukuyama, Shigenari Kin, Kiyoshi Saito, Yoichi Watanabe, Tadashi Arisawa, Kou Takahashi, Tetsuya Tanigawara, Junki Ito, Kei Hisada, Makoto Takeda, Jun Niwa, Mikio Nishiya, Shuji Hayashi, Ichiro Fujishima, Teiji Nakayama, Yoshihiko Watanabe, Koichirou Matsukado, Takamichi Yuguchi, Tadahisa Shono, Hiroyuki Nishimura, Jyunya Hayashi, Keisuke Migita, Kazuhiro Yokoyama, Hirotoshi Ohtaka, Takata Hisashi, Takamitsu Uchizawa, Naoki Shinohara, Mitsunobu Kaijima, Junkoh Yamamoto, Yoshio Sakagami, Hideo Aihara, Takayuki Sakaki, Keishi Fujita, Sumio Kobayashi, Nobuaki Momozaki, Masahito Hara, Akazi Kazunori, Fumitaka Miya, Hisato Minamide, Shinichiro Kurokawa, Syuichi Ishikawa, Naohisa Miura, Shinya Noda, Shoji Mashiyama, Shinji Amano, Takayuki Sugawara, Yukihiko Shimizu, Keiichi Saito, Kazuyuki Miura, Akinori Yabuta, Tatumi Yamanome, Hiroshi Seto, Makoto Hasebe, Hikaru Mizobuchi, Junkoh Sasaki, Shin Tsuruoka, Keiichi Nishimaki, Katsumi Takizawa, Hitoshi Tsugu, Nozomi Suzuki, Takeshi Kohno, Shu Hasegawa, Ken Asakura, Masaki Miyatake, Hiromu Konno, Katsunobu Takenaka, Akira Ikeda, Keizou Yamamoto, Keigo Matsumoto, Satoshi Inoha, Masaki Morisige, Kunihiko Harada, Hirofumi Hiyama, Yasuaki Takeda, Taturou Mori, Takekazu Akiyama, Osamu Okuda, Kazuaki Awamori, Naoki Shirasaki, Kimihiro Yoshino, Atsushi Shindo, Kazuho Hirahara, Shunichi Tanaka, Teruaki Kawano, Kazunori Arita, Hiroaki Sawaura, Yoichi Uozumi, Masahiko Tanaka, Shunsuke Shiraga, Shuji Sato, Mitsutoshi Nakada, Kimihisa Kinoshita, Nakazawa Kazutomo, Yasuhiro Fujimoto, Kunikazu Yoshimura, Masaaki Iwase, Shinichi Yagi, Atsushi Tsuchiya, Junichi Harashina, Sadao Kaneko, Naoto Kuwayama, Junya Hayashi, Masayuki Sasou, Sotaro Higashi, Masakazu Kitahara, Sumio Suda, Amami Kato, Satoshi Magarisawa, Kenji Hashimoto, Hirotoshi Hamaguchi, Tomohiko Satou, Masaru Idei, Haruhisa Tsukamoto, Toshihiro Kumabe, Naoaki Sato, Yasuyuki Toba, Takashi Tominaga, Haruo Yamashita, Toyoaki Shinohara, Kazuyoshi Watanabe, Hidenori Endo, Kenjirou Hujiwara, Toshinori Hasegawa, Hisashi Nitta, Kuroyanagi Takayuki, Nobuhiko Mizutani, Akira Tsunoda, Fumio Suzuki, Tetsuya Morimoto, Takuya Kawai, Mitsuyuki Fujitsuka, Hiromasa Tsuiki, Junichi Kuratsu, Hidemichi Sasayama, Shigehiro Ohmori, Seiko Hasegawa, Kazuhiro Kikuchi, Motohiro Morioka, Masayuki Yokota, Nozomu Murai, Yasumasa Yamamoto, Nobuhito Mori, Minoru Kidooka, Hiroshi Tenjin, Yoshihiro Iwamoto, Hitonori Takaba, Sei Haga, Yoshinori Arai, Toshiyuki Tsukada, Hirohide Karasudani, Masakazu Suga, Kawamoto Yukihiko, Naoto Izumi, Youtarou Takeuchi, Motohiro Arai, Shinji Okumura, Hisashi Tanaka, Yasushi Shibata, Tetsuya Masaoka, Masahiko Kasai, Hitoshi Miyake, Osamu Hamasaki, Misao Nishikawa, Naohiko Kubo, Yosimasa Kinosita, Hiroyuki Kaidu, Tarou Komuro, Hiroaki Shigeta, Yoshikazu Kusano, Shigekazu Takeuchi, Takayuki Matsuo, Yoshiharu Tokunaga, Norimoto Nakahara, Nobukazu Hashimoto, Mitsuhito Mase, Junpei Yoshimoto, Jin Momoji, Kenji Kamiyama, Koji Oka, Hiromichi Koga, Kazuya Morimoto, Tsutomu Kadekaru, Naoki Tokumitsu, Yasuyuki Nagai, Hirokazu Tanno, Takato Kagawa, Masaaki Saiki, Kotaro Ogihara, Junichi Imamura, Katsuhiro Yamashita, Akira Nakamizo, Yoshinari Nakamura, Ei-Ichirou Urasaki, Noriyuki Suzaki, Chiaki Takahashi, Youichirou Namba, Kazuo Hashikawa, Tomonori Yamada, Kazuyuki Kuwayama, Keiichi Sakai, Katsuhiro Kuroda, Hideyuki Kurihara, Masayuki Miyazono, Kosuke Miyahara, Hideaki Takahashi, Akihiko Saito, Igarashi Michitoku, Mitsuo Kouno, Shiro Kobayashi, Shunichi Yoneda, Hiroshi Kusunoki, Hiroji Miyake, Toshio Yokoe, Tatsuya Nakamura, Takayuki Kubodera, Mitsuhiko Hokari, Yasunari Otawara, Cheho Park, Hidemitu Nakagawa, Souichi Obara, Haruki Takahashi, Masafumi Ohtaki, Atsuya Okubo, Katsuhiko Hayashi, Masahisa Kawakami, Yu Takeda, Akihiko Kaga, Ryoichi Hayashi, Koji Tokunaga, Hiroyuki Nakashima, Yasuyuki Miyoshi, Atusi Kimoto, Toshimitsu Uchihara, Tomoaki Nagamine, Masahiro Noha, Hiromichi Sadashima, Toshihiko Kinjo, Osamu Tao, Masayuki Nakajima, Akira Isoshima, Kouichi Kuramoto, Shigeru Daido, Yoshiyasu Iwai, Toshihiko Kuroiwa, Akatsuki Wakayama, Kohsuke Yamashita, Yasunobu Gotou, Kouich Iwatsuki, Yoshida Masahiro, Nobuaki Kobayasi, Yoshimasa Niiya, Syouji Mabuchi, Motohiro Takayama, Kazuo Yamamoto, Junta Moroi, Masato Sugitani, Akio Ookura, Naoko Fujimura, Osamu Nishizaki, Sumio Isimaru, Hiroshi Wanihuchi, Nobukuni Murakami, Hiroto Murata, Naoki Kitagawa, Katsuhiko Kono, Michiya Kubo, Masashi Nakatsukasa, Makoto Inaba, Hidetoshi Ooigawa, Atsuhiro Kojima, Takamitsu Fujimaki, Osamu Fukuda, Yoshikazu Nakajima, Kazuyuki Kouno, Takaaki Yoshida, Reizou Kanemaru, Yohei Kudoh, Toshitaka Nakamura, Masayoshi Takigami, Shogo Nishi, Rokuya Tanikawa, Seisaburo Sakamoto, Makio Kaminogo, Seiichiro Hoshi, Yoshinari Okumura, Shinichi Okabe, Haruhiko Sato, Shiro Miyata, Kotaro Tsumura, Hiroshi Karibe, Noriaki Watabe, Ryuji Nakamura, Norifumi Shimoeda, Tsutomu Hitotsumatsu, Tomoaki Kameda, Hiroshi Ishiguchi, Atsuo Shinoda, Masanobu Hokama, Akinori Yamamura, Takeshi Kondoh, Kenichi Murao, Takafumi Wataya, Seiji Fukazawa, Shinsuke Muraoka, Hirosuke Fujisawa, Tsuneo Shishido, Mayumi Mori, Arai Hiroaki, Shinjitsu Nishimura, Zenichiro Watanabe, Susumu Nakashima, Kazuhito Nakamura, Yukinari Kakizawa, Hiroki Takano, Norihito Shirakawa, Masahiro Kagawa, Eiichiro Mabuchi, Kazusige Maeno, Takayuki Koizumi, Warou Taki, Yusuke Nakagaki, Kazuyuki Tane, Hiromichi Ooishi, Katsuyuki Asaoka, Yoshinori Akiyama, Tadao Kawamura, Atumi Takenobu, Takehisa Tuji, Masami Shimoda, Mitsunori Matsumae, Shinji Noda, Koiti Moroki, Hirofumi Oka, Masahito Agawa, Hajimu Miyake, Masateru Katayama, Shinichi Numazawa, Taketoshi Maehara, Hiroyuki Jimbo, Satoshi Ihara, Koji Matuoka, Oikawa Akihiro, Takahiro Oota, Makoto Noguchi, Takakazu Kawamata, Youichi Hashimoto, Keiichirou Onitsuka, Masahiko Kitano, Jae-Hyun Son, Toru Masuoka, Naoki Koketsu, Keiichi Akatsuka, Masamichi Kurosaki, Miyamori Tadao, Hiroaki Hondo, Kazumasa Yamatani, Hirofumi Oyama, Junji Koyama, Ogura Koichiro, Shinji Yamamoto, Hitoshi Tabata, Kazuya Uemura, Kazuhiko Sato, Hideyuki Yoshida, Takafumi Nishizaki, Hiroshi Egami, Hideo Takeshima, Shogo Ishiuchi, Akira Matsumura, Hiroyuki Kinouchi, Susumu Mekaru, Mikihiko Takeshita, Hitoshi Ozawa, Kiichiro Zenke, Takeshi Matsuyama, Toshikazu Kuwata, Teruyuki Habu, Tomoyoshi Okumura, Seiya Takehara, Rei Kondo, Takashi Kumagai, Keiten So, Sunao Takemura, Sonoda Yukihiko, Manabu Urakawa, Yasuhiro Hamada, Michiyasu Suzuki, Mikito Uchida, Hidehito Koizumi, Masaru Yamada, Takashi Tsuruno, Gen Ishida, Ryouichi Masuda, Makoto Kimura, Shinichirou Ishihara, Masashi Morikawa, Hidetoshi Murata, Katsumi Sakata, Motohiro Nomura, Akihiro Nemoto, Sumio Endou, Nobuo Hirota, Kennji Itou, Hiroaki Minami, and Yoshihumi Teramoto

Subjects
Medicine
Abstract

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

Published
2023
Full Text
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4. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Author

J. Donald Easton, Maria Aunes, Gregory W. Albers, Pierre Amarenco, Sara Bokelund-Singh, Hans Denison, Scott R. Evans, Peter Held, Marianne Jahreskog, Jenny Jonasson, Kazuo Minematsu, Carlos A. Molina, Yongjun Wang, K.S. Lawrence Wong, S. Claiborne Johnston, Sebastiá F. Ameriso, Geoffrey Donnan, Robin Lemmens, Ayrton Massaro, Ekaterina Titianova, Michael D. Hill, Pablo Lavados, David Skoloudik, Joachim Röther, Szegedi Norbert, Giancarlo Agnelli, Natan Bornstein, Norio Tanahashi, Angel Arauz Góngora, Edwin Pretell, Maria Cristina Z. San Jose, Anna Czlonkowska, Ovidiu Bajenaru, Ludmila Stakhovskaya, Miroslav Brozman, Jong-Sung Kim, Nils Wahlgren, Patrik Michel, Tsong Hai Lee, Nijasri Charnnarong Suwanwela, Kursad Kutluk, Sergii Moskovko, Scott Kasner, Daniel Laskowitz, Wayne Clark, Huy Thang Nguyen, Sebastian Ameriso, Sandra Lepera, Marina Romano, David Paulon, Pablo Ioli, Cristina Zurru, Guadalupe Bruera, Lorena Jure, Francisco Klein, Guillermo Povedano, Christopher Levi, Thanh Phan, Romesh Markus, Craig Anderson, Arman Sabet, Stephen Davis, Andrew Lee, Timothy Kleinig, Andrew Wong, Martin Krause, Jim Jannes, Tissa Wijeratne, Dimitri Hemelsoet, André Peeters, Philippe Tack, Peter Vanacker, Patrice Laloux, William Van Landegem, Geert Vanhooren, Philippe Desfontaines, Marc Van Orshoven, Fabio Oliveira, Mauricio Friedrich, Rosane Brondani, Rubens Gagliardi, Soraia Fabio, Marianna Dracoulakis, Rodrigo Bazan, Luiz Marrone, Octavio Pontes Neto, Gisele Silva, Pedro Kowacs, Paraskeva Stamenova, Marin Daskalov, Ivan Staikov, Dimo Baldaranov, Dimitar Maslarov, Hristo Lilovski, Plamen Petkov, Neli Petrova, Radoslav Mavrov, Veska Markova, Valeria Petrova, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Veska Lekova, Dimcho Hristov, Vera Ermenkova, Lyudmil Mateev, Rumeliya Mitkova, Liybomir Haralanov, Rosen Ikonomov, Margarita Mihailova, Ivan Georgiev, Ashfaq Shuaib, Vladimir Hachinski, Jean-Martin Boulanger, Sharan Mann, Ayman Hassan, Ariane Mackey, Bijoy Menon, Jeffrey Minuk, Muzaffar Siddiqui, Marsha Eustace, Lucia Vieira, Daniel Selchen, Michel Beaudry, Grant Stotts, Angel Castro, Kristo Gasic, Rodrigo Rivas, Pablo Sanchez, Andres Roldan, Ingrid Grossmann, Christian Figueroa, Jimei Li, Xiaolin Xu, Huisheng Chen, Xiaohong Li, Yi Yang, Chunsheng Zhang, Baojun Wang, Guanglai Li, Dong Wang, Hong Lin, Yamei Tang, Anding Xu, Yanjiang Wang, Wenke Hong, Zhi Song, Xu Zhang, Xiaoping Jin, Yun Xu, Fuling Yan, Weihong Zheng, Xiaoping Wang, Qiang Dong, Zhongxin Zhao, Baorong Zhang, Wangtao Zhong, Guoqiang Wen, Jun Xu, Guozhong Li, Xueshuang Dong, Xiangyang Tian, Zhaohui Zhang, En Xu, Kaixiang Liu, Jun Chen, Ondrej Skoda, Edvard Ehler, Daniel Vaclavik, Daniel Sanak, Sylva Klimosova, Eva Vitkova, Jan Fiksa, Robert Mikulik, Jiri Neumann, Richard Plny, Didier Leys, Igor Sibon, Jean-Louis Mas, Sonia Alamowitch, Fernando Pico, Hassan Hosseini, Marie-Hélène Mahagne, Emmanuel Touze, Wilfried Vadot, Stéphane Vannier, Norbert Nighoghossian, Yves Samson, Pierre Garnier, Emmanuel Ellie, Benoît Guillon, Serge Timsit, Maurice Giroud, Frédéric Philippeau, Aude Bagan-Triquenot, Valérie Wolff, Nicolas Raposo, Michel Obadia, Severine Debiais, Jérôme Grimaud, Stéphane Illouz, Didier Smadja, Cédric Urbanczyk, Jörg Berrouschot, Christian Weimar, Georg Gahn, Hassan Soda, Sven Klimpe, Darius Nabavi, Jörg Glahn, Martin Köhrmann, Lars Krause, Christoph Terborg, Peter Urban, Thorsten Steiner, Andreas Ferbert, Rainer Dziewas, Günter Seidel, Götz Thomalla, Richard Li, Wing Chi Fong, Raymond Cheung, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, László Németh, Péter Diószeghy, Csaba Óváry, Attila Csányi, Levente Kerényi, Valéria Nagy, Sámuel Komoly, Dániel Bereczki, Sándor Molnár, István Kondákor, David Tanne, Guy Raphaeli, Gregory Telman, Ronen Leker, Yair Lampl, Francesco Corea, Stefano Ricci, Donata Guidetti, Giovanni Malferrari, Simona Marcheselli, Giuseppe Micieli, Andrea Zini, Vincenzo Di Lazzaro, Carlo Gandolfo, Andrea Salmaggi, Rossana Tassi, Maurizia Rasura, Giovanni Orlandi, Giancarlo Comi, Michelangelo Mancuso, Marialuisa Delodovici, Paolo Bovi, Domenico Consoli, Kimiaki Utsugisawa, Tsuneo Fujita, Hideyuki Kurihara, Chikashi Maruki, Takeshi Hayashi, Tsuneaki Ogiichi, Morio Kumagai, Katsunobu Takenaka, Kazunori Toyoda, Kazuhiro Takamatsu, Ryo Ogami, Shigenari Kin, Takeshi Aoki, Katsumi Takizawa, Shigehiro Omori, Takehiko Umezawa, Yasuyuki Toba, Yutaka Nonoyama, Hidemitsu Nakagawa, Takashi Naka, Masanori Morimoto, Shuichi Matsumoto, Tsutomu Hitotsumatsu, Tatsuya Shingaki, Satoshi Okuda, Mamoru Ota, Nobuyuki Sakai, Takeshi Yamada, Jun Niwa, Hitoshi Fujita, Akihito Moriki, Kimihiro Yoshino, Yoshihisa Fukushima, Takahisa Mori, Atsushi Sato, Yoshikazu Kusano, Michiya Kubo, Masashi Yamazaki, Takao Ooasa, Takafumi Nishizaki, Naoki Kitagawa, Masahiro Yasaka, Yasuhiro Manabe, Akira Yoshioka, Masayuki Ishihara, Takato Kagawa, Toshikazu Ichihashi, Hideki Matsuoka, Yasuhiro Ito, Masahiro Yamasaki, Hitonori Takaba, Hisatoshi Saito, Masahiro Sato, Kazumasa Fukuda, Sumio Endo, Minoru Kidooka, Toshitaka Umemura, Yuriko Kikkawa, Shuta Toru, Kentaro Yamada, Hideki Sakai, Jun Asari, Masayuki Ezura, Hisashi Nitta, Keiko Nagano, Jun Ochiai, Keiichi Sakai, Yasutaka Kobayashi, Yasuhiro Yoshii, Hirotomo Miake, Tomohiro Takita, Hidekazu Taniguchi, Kazuhiko Kuroki, Takamitsu Mizota, Kenichi Yamamoto, Hiroshi Nakane, Takeshi Iwanaga, Kei Chiba, Tetsuyuki Yoshimoto, Tsuyoshi Torii, Takeo Kitagawa, Hiroshi Takashima, Naoki Shirasaki, Makoto Dehara, Naomichi Wada, Kensuke Hamada, Noriyuki Kato, Yoshinori Go, Ichiro Izumi, Hirotomo Ninomiya, Junichiro Kumai, Yoshikazu Nakajima, Yasuhiko Kaku, Yukihiro Isayama, Masahiro Kawanishi, Shinya Noda, Kazuhide Yamamoto, Takanori Hazama, Hiroshi Takahashi, Yohei Tanaka, Takashi Hata, Kiyoshi Kazekawa, Eisuke Furui, Hideki Hondo, Nobuyuki Sato, Katsusuke Kusunoki, Kazunori Nanri, Satoshi Abe, Noboru Sasaoka, Takayuki Kuroyanagi, Hisahiko Suzuki, Kouzou Fukuyama, Kimihiro Nakahara, Fernando Gongora, Carlos Cantú Brito, Jorge Villarreal Careaga, Rosalia Vazquez Alfaro, Geronimo Aguayo Leytte, Percy Berrospi, Carlos Chavez, Liliana Rodriguez, Nilton Custodio, Cesar Castañeda, Julio Perez, Maria Cristina San Jose, Alejandro Baroque, Epifania Collantes, Abdias Aquino, Alejandro Díaz, Artemio Roxas, Johnny Lokin, Joel Advincula, Emerito Calderon, Jose Navarro, John Hiyadan, Arturo Surdilla, Danuta Ryglewicz, Grzegorz Krychowiak, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Urszula Fiszer, Beata Papierowska, Justyna Zielińska-Turek, Anetta Lasek-Bal, Ewa Kołodziejska, Anna Kamińska, Bożena Adamkiewicz, Andrzej Tutaj, Dorota Szkopek, Krzysztof Musiatowicz, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Antoni Ferens, Marek Zalisz, Konrad Rejdak, Monika Rudzińska, Cristina Panea, Mihaela Simu, Rodica Balasa, Iulian Cuciureanu, Bogdan Popescu, Monica Sabau, Corina Roman-Filip, Leonid Pimenov, Alla Gekht, Anna Milto, Ivan Shchukin, Vladimir Parfenov, Liudmila Stakhovskaya, Mikhail Arkhipov, Nadezhda Sokolova, Enver Bogdanov, Radiy Esin, Dina Khasanova, Konstantin Golikov, Elena Melnikova, Leonid Zaslavskiy, Igor Voznyuk, Alexander Nazarov, Leila Akhmadeeva, Aida Iakupova, Nikolay Shamalov, Galina Belskaya, Svetlana Chuprina, Olga Denisova, Ekaterina Drozdova, Yuliya Karakulova, Ilya Sholomov, Nikolay Spirin, Elena Vostrikova, Elena Mordvintseva, Vera Grigoryeva, Dmitry Zateyshchikov, Vladimir Gorbachev, Zhanna Chefranova, Mikhail Dudarev, Rostislav Nilk, Alexey Rozhdestvenskiy, Ladislav Gurcik, Miloslav Dvorak, Georgi Krastev, Egon Kurca, Juraj Vyletelka, Jong Sung Kim, Hee-Joon Bae, Yong-Won Kim, Joon-Tae Kim, Jae-Kwan Cha, Hyo Suk Nam, Dae-Il Chang, Yong-Seok Lee, Kyungmi Oh, Sung-Wook Yu, Sung-Il Sohn, Jun Lee, Han Jin Cho, Eung-Gyu Kim, Joung-Ho Rha, Seo Hyun Kim, Carlos Molina Cateriano, Joaquín Serena Leal, José Vivancos Mora, Manuel Rodríguez Yañez, Jaume Roquer González, Francisco Purroy García, Meritxell Gomis Cortina, Jaime Masjuan Vallejo, Juan Arenillas Lara, Tomás Segura Martín, José Antonio Egido Herrero, Jose Ignacio Tembl Ferrairó, Jaime Gállego Culleré, Francisco Moniche Álvarez, Anna Steinberg, Margarita Callander, Ann Charlotte Laska, Lena Bokemark, Thomas Mooe, Tor-Björn Käll, Lennart Welin, Lars Sjöblom, Joakim Hambraeus, Jörg Teichert, Hans Wannberg, Johan Sanner, Bo Ramströmer, Bo Ziedén, Stefan Olsson Hau, Claes Gustafsson, Timo Kahles, Philippe Lyrer, Marcel Arnold, Martin Liesch, Friedrich Medlin, Carlo Cereda, Georg Kägi, Andreas Luft, Emmanuel Carrera, Tsong-Hai Lee, Helen L. Po, Chang-Ming Chern, Li-Ming Lien, Lung Chan, Chung-Hsiang Liu, Shey-Lin Wu, Jiann-Der Lee, Chih-Hung Chen, Huey-Juan Lin, Ruey-Tay Lin, Wei-Hsi Chen, Yu Sun, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Kanokwan Watcharasaksilp, Witoon Jantararotai, Hadiye Sirin, Birsen Ince, Talip Asil, Murat Arsava, Tulay Kurt Incesu, Hulya Tireli, Hayriye Kucukoglu, Fikri Ak, Ali Unal, Serefnur Ozturk, Nevzat Uzuner, Galyna Chmyr, Volodymyr Lebedynets, Vadym Nikonov, Lyudmyla Shulga, Volodymyr Smolanka, Marta Khavunka, Valentyna Yavorska, Nataliya Tomakh, Olexandr Kozyolkin, Galyna Litovaltseva, Maarten Lansberg, Richard Bernstein, David Brown, Jonathan Dissin, Carmelo Graffagnino, Jonathan Harris, William Hicks, Irene Katzan, Jeffrey Kramer, Joshua Willey, Scott Silliman, Sidney Starkman, David Thaler, Margaret Tremwel, Mauricio Concha, Kumar Rajamani, Bhuvaneswari Dandapani, Brian Silver, Nathan Deal, Ira Chang, Ameer Hassan, Steven Rudolph, Kenneth Fischer, Howard Kirshner, William Logan, Sidney Mallenbaum, Hebah Hefzy, Julius Latorre, Steven Levine, Anthony Ciabarra, Rima Dafer, Benjamin Anyanwu, Laurel Cherian, Spozhmy Panezai, Anna Khanna, Jodi Dodds, Michel Torbey, James Gebel, Henry Woo, David Chiu, Xiao Androulakis, William Burgin, Maria Pineda, Engin Yilmaz, Irfan Altafullah, Christine Boutwell, Salvador Cruz-Flores, Biggya Sapkota, Pierre Fayad, Michael Jacoby, Shahid Rafiq, Efrain Salgado, Eugene Lafranchise, Warren Felton, Ramesh Madhavan, Osama Zaidat, Connie Pieper, Ralph Riviello, Aaron Burnett, Michelle Fischer, Nina Gentile, Christopher Calder, Dennis Dietrich, Jonathan Cross, Larry Blankenship, Liliana Montoya, Wendell Grogan, Mark Young, Farrukh Khan, Duane Campbell, Nizar Daboul, Andrey Espinoza, Paul Cullis, Gilberto Concepcion, John Wulff, Haider Afzal, Naseem Jaffrani, William Reiter, Tamjeed Arshad, Timothy Lukovits, James Welker, Fen Lei Chang, Aamir Badruddin, Viken Babikian, Ravi Menon, James Sander, Mellanie Springer, Ashish Nanda, Luis Mas, Raj Rajan, Bruce Silverman, David Huang, David Carpenter, Joni Clark, Marilou Ching, Sunitha Santhakumar, Jeffrey Gould, Vibhav Bansal, Gabriel Vidal, Timothy Mikesell, John Brick, William French, Qaisar Shah, Christine Holmstedt, Nadir Ishag-Osman, John Kostis, Abbas Shehadeh, Pramodkumak Sethi, Asher Imam, Carl Mccomas, Duc Tran, Mehari Gebreyohanns, Brian Wiseman, Maheen Malik, Aron Schwarcz, Dorothea Altschul, John Castaldo, Amer Alshekhlee, Stephen Gancher, Nagesh Krish, Mai Nguyen-Huynh, Margaret Tremwell, Jitendra Sharma, Lance Lee, William Neil, Fazeel Siddiqui, Ali Malek, Charles Romero, Thang Nguyen Huy, Hoa Hoang, Thang Nguyen, Anh Nguyen, Hung Nguyen, Laboratoire de Recherche Vasculaire Translationnelle ( LVTS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), AstraZeneca, National Cerebral and Cardiovascular Center ( NCCC - OSAKA ), Osaka University [Osaka], Department of Neurology ( Dep Neuro - BEIJING ), Tiantan Hospital, University of Melbourne, Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Heidelberg University, Centre hospitalier de Namur, IBM Thomas J. Watson Research Center, IBM, Bulgarian Academy of Sciences, Department of Clinical Neurological Sciences [London, Canada], University of Western Ontario ( UWO ), Servicio de Neurologia ( SANTIAGO - Neurologie ), Universidad de Santiago de Chile [Santiago] ( USACH ) -Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand - Clermont Auvergne ( ICCF ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Universidad de Talca, Shanghai Second Polytechnic University, Northwest Normal University [Lanzhou], Zhongda Hospital, Southeast University [Jiangsu], Cryogenics Laboratory ( CRYOGENICS LABORATORY ), Huazhong University of Science and Technology [Wuhan] ( HUST ) -Wuhan University [China], Centre for Synthetic and Systems Biology, University of Edinburgh-School of Biological Sciences, Duke university [Durham], Fiber Glass, Glass Business and Discovery Center, PPG Industries, National University of Defense Technology [Changsha], School of Oceanography [Seattle], University of Washington [Seattle], Key Laboratory of New Processing Technology for Nonferrous Metals and Materials, Guilin University of Technologie, Laboratoire de Génie Electrique et Ferroélectricité ( LGEF ), Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Université de Bordeaux ( UB ), Service de Pédiatrie, Centre Hospitalier Universitaire de Nice ( CHU Nice ) -Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 ( UPMC ), Centre Hospitalier de Versailles ( CHV ), Service de neurologie, Hôpital Sainte-Anne, Functional Exploration of Nervous, CHU Grenoble, Service de Neurologie [Rennes], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière ( NEMESIS-CRICM ), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière ( CRICM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Français de Mécanique Avancée ( IFMA ), Neurologie - Côte Basque ( NEUROLOGIE ), Hopital, Laboratoire d'Intégration des Systèmes et des Technologies ( LIST ), Université Paris-Saclay-Direction de Recherche Technologique (CEA) ( DRT (CEA) ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) ( GGB ), Institut Brestois Santé Agro Matière ( IBSAM ), Université de Brest ( UBO ) -Université de Brest ( UBO ) -EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), CIC Brest, Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), CHU Strasbourg, Imagerie cérébrale et handicaps neurologiques, Institut des sciences du cerveau de Toulouse. ( ISCT ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Department of Neurology, Asklepios Klinik Altona, Department of Neurology and Stroke Center, Universität Duisburg-Essen [Essen], Department of Neurology, University of Mainz, Vivantes Klinikum Neukölln, University of Erlangen, University Hospital Münster, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] ( UKE ), PROTOMED, Neurology Department, Ichilov Medical Center, Internal and Cardiovascular Medicine - Stroke Unit ( PERUGIA - ICM-SU ), Università degli Studi di Perugia ( UNIPG ), University Hospital San Raffaele Milan, Scientific Institute and University Ospedale San Raffaele, Dipartimento di Scienze Fisiche, della Terra e dell'Ambiente., Università degli Studi di Siena ( UNISI ), Department of Education, Yamagata University, Nippon Medical School, Catalan Institute of Ornithology (ICO), Museu de Ciències Naturals (Zoologia), Wroclaw University of Science and Technology, Department of neurology, Jagiellonian University [Krakow] ( UJ ), LInguistique et DIdactique des Langues Étrangères et Maternelles ( LIDILEM ), Université Stendhal - Grenoble 3-Université Grenoble Alpes ( UGA ), Metacohorts Consortium, GenXpro GmBH, Lausanne University Hospital, Lausanne university hospital, Northeastern University [Boston], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), National Cerebral and Cardiovascular Center (NCCC - OSAKA), Department of Neurology (Dep Neuro - BEIJING), Bulgarian Academy of Sciences (BAS), University of Western Ontario (UWO), Servicio de Neurologia (SANTIAGO - Neurologie), Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Shanghai Polytechnic University (SSPU), Cryogenics Laboratory (CRYOGENICS LABORATORY), Huazhong University of Science and Technology [Wuhan] (HUST)-Wuhan University [China], Centre for Synthetic and Systems Biology (Ssynthsys), University of Edinburgh, Duke University [Durham], National University of Defense Technology [China], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Bordeaux (UB), Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 (UPMC), Centre Hospitalier de Versailles André Mignot (CHV), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière (NEMESIS-CRICM), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Français de Mécanique Avancée (IFMA), Neurologie - Côte Basque (NEUROLOGIE), Centre hospitalier universitaire de Nantes (CHU Nantes), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Internal and Cardiovascular Medicine - Stroke Unit (PERUGIA - ICM-SU), Università degli Studi di Perugia (UNIPG), Università degli Studi di Siena = University of Siena (UNISI), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Universität Duisburg-Essen = University of Duisburg-Essen [Essen], Università degli Studi di Perugia = University of Perugia (UNIPG), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-SIGMA Clermont (SIGMA Clermont), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Jagiellonian University [Krakow] (UJ), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Institut National de la Santé et de la Recherche Médicale (INSERM), Weimar, Christian (Beitragende*r), and Calvez, Ghislaine

Subjects
Male, Risk, Ticagrelor, Adenosine, [SDV]Life Sciences [q-bio], Population, Medizin, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Platelet aggregation inhibitors, Physiology (medical), [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Humans, Myocardial infarction, education, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Aspirin, Ischemic attack, Transient, Female, Ischemic Attack, Transient, Purinergic P2Y Receptor Antagonists, Treatment Outcome, Cardiology and Cardiovascular Medicine, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [ SDV ] Life Sciences [q-bio], Ischemic Attack, business.industry, medicine.disease, Clopidogrel, [SDV] Life Sciences [q-bio], Anesthesia, Platelet aggregation inhibitor, business, 030217 neurology & neurosurgery, TIMI, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01994720.

Published
2017

6. Carotid Artery Stent Placement for Progressing Stroke: Reports of a 3 Cases

Author

Hideki Koyama, Masahiro Ohno, Takahisa Fuse, Ken Kamiya, Toshikazu Ichihashi, and Kenichi Watanabe

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Carotid arteries, Hemodynamics, medicine.disease, Surgery, Stenosis, Stent placement, Hemiparesis, Blood pressure, Angiography, Medicine, cardiovascular diseases, Radiology, medicine.symptom, business, Calcification
Abstract

We successfully performed carotid artery stent placement (CAS) in 3 patients with cervical carotid artery stenosis presenting with progressing stroke. In our presented cases, we used intravascular ultrasonographic virtual histology (IVUS-VH) to evaluate carotid plaque and continuous monitoring of regional cerebral oxygenation by near-infrared spectroscopy to detect early hemodynamic complications. These techniques significantly helped to improve neurological outcome after CAS in patients with progressing stroke. In Case 1, an 80-year-old female presented with progressing right hemiparesis due to severe stenosis of the cervical portion of the left carotid artery. IVUS-VH revealed the plaque as mainly fibrous and partially necrotic and fibrolipidic, and under distal protection, CAS was successfully performed. In Case 2, a 70-year-old male presented with repeated transient loss of consciousness. 3D-CT angiography demonstrated severe stenosis of the cervical portion of the right carotid artery, and under the distal protection, CAS was conducted. During placement of the carotid stent, near infrared spectroscopy revealed a marked change in cerebral oximetry. His blood pressure was carefully controlled for 3 days to avoid hyperperfusion syndrome. In Case 3, a comatose 76-year-old male was admitted to our hospital with right-sided hemiparesis. He had suffered several transient ischemic attacks 6 months previously. Intravenous rt-PA therapy was performed, and his symptoms improved rapidly. 3D-CT angiography demonstrated severe stenosis of the right cervical carotid artery with dense calcified plaque. However, IVUS-VH revealed the plaque as mainly fibrous with partial calcification, and CAS was successfully performed.

Published
2009
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7. Posterior communicating artery aneurysm associated with unilateral aplasia of the internal carotid artery presenting as thalamic hemorrhage: A case report

Author

Tomoyasu Abe, Takahisa Fuse, Toshikazu Ichihashi, Naoki Matsuo, and Hideki Koyama

Subjects
medicine.medical_specialty, business.industry, medicine.artery, medicine, Thalamic hemorrhage, General Medicine, Posterior Communicating Artery Aneurysm, Radiology, Aplasia, Internal carotid artery, business, medicine.disease
Abstract

一側内頸動脈形成不全に伴う後交通動脈動脈瘤は非常に稀である．今回，右内頸動脈形成不全を有し，右後交通動脈に発生した脳動脈瘤が破綻し，脳内出血像を示した症例を経験した．本例は右中大脳動脈が右後交通動脈を介して椎骨脳底動脈系から血流を受けていた．MRI所見から出血は動脈瘤壁外側に存在しており，部分血栓化動脈瘤ではないと判断された．治療法は直達術ではリスクが高いと考え，瘤内塞栓術をダブルカテーテル法で施行した．術後2年を経て，経過良好であるが，今後も慎重な観察が必要と考えている．

Published
2009
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8. Malignant nerve sheath tumor with rhabdomyoblastic differentiation arising from the acoustic nerve

Author

Toshinori Jozaki, Satoshi Baba, Haruyuki Shirasawa, Hiroyuki Muro, Toshikazu Ichihashi, and Matsuyoshi Maeda

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Malignant triton tumor, Autopsy, General Medicine, Anatomy, Vestibulocochlear Nerve, Biology, Cerebellopontine angle, medicine.disease, Pathology and Forensic Medicine, Nerve sheath tumor, Microscopy, Electron, medicine.anatomical_structure, Rhabdomyosarcoma, Eosinophilic, medicine, Humans, Immunohistochemistry, Cranial Nerve Neoplasms, Basal lamina, Desmin
Abstract

A case of a malignant nerve sheath tumor with rhabdomyoblastic differentiation arising from the acoustic nerve in a 38 year old man is reported. At autopsy, the tumor was found to be extensively involved in the right cerebellopontine angle of the brain stem. Histologically, the tumor was composed mainly of spindle-shaped tumor cells proliferating in hypercellular fascicles scattered with pleomorphic cells. The tumor cells were characterized by high mitotic activity and invasive growth. Occasional tumor cells had eosinophilic cytoplasm, which in a few cases was cross-striated. Cytoplasmic interdigitations and a thick basal lamina were confirmed ultrastructurally. Immunohistochemical analysis revealed that some tumor cells were positive for myoglobin and desmin, but weakly positive or negative for S-100 protein. The patient did not have von Recklinghausen's disease.

Published
1993
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9. [Spontaneous extra-cranial vertebral artery dissection accompanied with multiple cerebral infarctions due to re-canalization]

Author

Toshikazu, Ichihashi, Yasuhiro, Matsushita, Yukiko, Tsuji, Hideyuki, Harano, and Hiroshi, Nakagawa

Subjects
Male, Vertebral Artery Dissection, Cerebral Revascularization, Thalamus, Cerebellum, Vertebrobasilar Insufficiency, Humans, Stents, Cerebral Infarction, Middle Aged
Abstract

In this paper we report a case of vertebral artery occlusion caused by spontaneous extra-cranial vertebral artery dissection accompanied with cerebellar and thalamic infarctions due to recanalization. Furthermore, after a nine-week time lapse we performed PTA/stenting. A 62-year-old man with vertigo, dysarthria and nuchal pain without injury was admitted to our hospital. Emergent cerebral angiography revealed an occlusion of the right vertebral artery and the right PICA. The patient's symptoms gradually improved owing to local-fibrinolysis with urokinase for the right PICA via the left vertebral artery. Follow-up angiography (2 weeks later) showed re-canalization and dissection of the right vertebral artery. Treatment for spontaneous extra-cranial vertebral artery dissection is chosen, depending on whether there is co-lateral circulation or not. We obtained a good result using PTA/Stenting in this case of spontaneous extra-cranial vertebral artery dissection within nine weeks after onset.

Published
2003

10. [A case of treatment on traumatic pseudoaneurysm of internal carotid artery occurred epistaxis]

Author

Toshikazu, Ichihashi, Yasuhiro, Matsushita, Yukiko, Tsuji, Hideyuki, Harano, and Hiroshi, Nakagawa

Subjects
Male, Epistaxis, Humans, Middle Aged, Carotid Artery Injuries, Embolization, Therapeutic, Aneurysm, False, Carotid Artery, Internal
Abstract

We reported a case of traumatic pseudoaneurysm of internal carotid artery accompanied by skull base fracture, for which Guglielmi detachable coil(GDC) embolization surgery was very effective for recovery. A 53-year-old man met a traffic accident and was admitted to our hospital with blindness and epistaxis accompanied with shock. Balloon occlusion test showed a positive sign of traumatic pseudoaneurysm of internal carotid artery, and under the diagnosis GDC embolization surgery was performed on six days after the onset. The patient has completely recovered and keeps his wellness untill now after six months from the surgery except for loss of left eye vision. We believe that the endovascular surgery using stents will become the prime modality for treatment of traumatic pseudoaneurysm in the future.

Published
2003

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