Shigeru Miyachi

Nagoya University | Meidai

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...

It is considered acceptable to conservatively manage coronary artery bypass grafting patients with carotid artery disease without the need for preoperative corrective carotid revascularization. However, in the present case, rapidly progressive stroke symptoms with penumbra suggested in the arterial spin labeling, carotid artery stenting was perform...

Neuroendovascular catheterization using fluoroscopy poses the problem to operators and staffs of cumulative radiation exposure. To solve this problem, we are developing a remote-controlled master-slave robot. Because a wire-like elongated treatment device is inserted into a blood vessel using a catheter, the robot requires a sensor to detect the in...

[Background] An endoscope can enter the surgical field from a small entrance and provide a wide panoramic view. Conversely, an exoscope has a viewpoint similar to that of a microscope without any confliction of tools, which occurs in endoscopic surgery. Endoscopic surgery is a head-up surgery and entails a free visual axis as well as an endoscope....

Background A method of guiding an intermediate catheter from a new alpha-type guiding catheter placed in the ascending aorta to the carotid artery is evaluated in neuroendovascular treatment in challenging anatomic directions of the guiding catheter, such as the bovine aortic arch and type III aortic arch. Methods The existing 8-Fr guiding cathete...

Yolk sac tumor (YST) is a rare primary brain tumor that occurs almost exclusively in patients under 30 years old. Intracranial germ cell tumors are most frequently located in the pineal and suprasellar region. Medulla oblongata YSTs are particularly rare. Extragonadal YSTs may be difficult to diagnose because of their characteristics, such as the r...

The advantages of neuroendoscopic surgery are the wide viewing angle and the freedom of an axis of view with minimal surgical trauma. With the advent of the exoscope, which has similar advantages to endoscopy, such as a small body and ergonomically superior heads-up surgery, it has become possible to add a field of view that is similar to that of m...

Hemorrhagic isolated dural arteriovenous fistulas (DAVFs) are often challenging to treat. Here, we report a case of the lateral cavernous sinus (CS) DAVF successfully treated by transarterial intravenous coil embolization using a curved multiplanar reconstruction (MPR) image assistance. A 54-year-old man presented with a severe headache and was dia...

The COVID-19 pandemic has demanded a change in learning modalities, which led us to develop a remote personal training system for clinicians performing neuroendovascular procedures. A portable vascular model designed for practicing catheter navigation guidance, thrombus retrieval, and intracranial aneurysm coil embolisation was established. We crea...

Double crush syndrome (DCS) is a clinical condition involving impingement of the spinal and peripheral nerves. DCS of the lower limbs has been recognized; however, no detailed reports have been published. Herein, we report a rare case of the coexistence of L5 radiculopathy and peroneal nerve entrapment neuropathy. The patient suffered from pain in...

Chronic subdural hematoma (CSDH) is considered to be an inflammatory and angiogenic disease. Osteopontin is an extracellular matrix protein. Osteopontin is cleaved by thrombin, resulting in N-half osteopontin, which is more prominent in integrin signal transduction. We examined the expression of N-half osteopontin in the CSDH fluid and the expressi...

Chronic subdural hematoma (CSDH) is considered to be an inflammatory and angiogenic disease. The CSDH outer membrane, which contains inflammatory cells, plays an important role in CSDH development. Osteopontin (OPN) is an extracellular matrix protein that is cleaved by thrombin, generating the N-terminal half of OPN, which is prominently involved i...

Navigating a large-caliber catheter into the intracranial artery may generate a "ledge effect," which disturbs successful neurointervention. Particularly, navigation of a large-lumen aspiration catheter is often required to achieve fast recanalization in acute ischemic stroke cases. Occasionally, the aspirator cannot be passed through the ophthalmi...

Purpose To present results of HYBRID study, whether second generation hydrogel coils (HGC) for the treatment of intracranial aneurysms improves outcomes compared with bare platinum coils. Material and Methods HYBRID study is investigator-initiated, prospective, randomized, multicenter trial with open label treatment, blinded endpoint evaluation in...

Objective: Improved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH. Methods: The authors conducted a nationw...

The purpose of this study was to investigate the in-hospital acute ischemic stroke due to large vessel occlusion (LVO) that developed in another thrombectomy-incapable hospital, treated by mechanical thrombectomy after inter-hospital transfer. In eight other hospital-onset LVO patients, clinical characteristics, treatment results, and the timeline...

Mechanical thrombectomy has been widely used for the treatment of acute ischemic stroke. During this procedure, operators must navigate the microcatheter with a microguidewire (MGW) into vessels that cannot be visualized on fluoroscopy as rapidly as possible. In this study, we developed a modified pigtail-shaped MGW (MPMGW) for security and control...

Background: When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitates the identification of the...

Background: Stent clot retrievers can be used to perform mechanical thrombectomies to treat cases of acute major arterial occlusion. This approach is associated with faster recanalization and better outcomes than internal treatments. The function of the stent retrievers is based on a technique known as confront clot scrambling method (CCSM), which...

Background: When inserting coils under stent deployment, a jailed microcatheter technique is typically applied as a first line approach. However, the trans cell approach might be required to achieve satisfactory complete occlusion. The trans cell approach occasionally ends in failure because the catheter cannot safely follow a proceeding guidewire...

Background Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Jap...

Background: Endovascular embolization of the middle meningeal artery (MMA) is effective for recurrent chronic subdural hematoma (CSDH). CSDH associated with dural metastasis is generally refractory to burr hole surgery and has poor prognosis even if any interventions are applied. To the best of our knowledge, this study is the first to report a ca...

Cerebral infarction related to traumatic vertebral artery (VA) injuries is not common. However, if VA injuries cause ischemic and/or hemorrhage stroke, these subsequent problems can result in severe residual impairment and mortality. Herein, we present five patients with cervical vertebra fractures due to blunt cervical trauma who underwent preoper...

Background: Spinal epidural hematoma associated with epidural metastasis is very rare. Epidural hematoma is unusual in itself, and metastatic epidural tumors do not commonly occur. Case description: A 76-year-old man with a medical history of untreated stage III rectal cancer and chronic obstructive pulmonary disease underwent emergency spine su...

Background: Hemostasis valves are commonly used in neurointerventions. We propose a novel concept for fixing hemostasis valves to the operating table during procedures. Moreover, we report our preliminary in vitro experience using these new devices created using a 3-dimensional printer. Methods: The hemostasis valve holder (HVH) comprises 2 comp...

Complete and secure occlusion of the entire aneurysmal neck remains a problem despite major advances in the treatment of intracranial aneurysms using endovascular coil embolization. Here, we present our initial clinical experience using a novel strategy for endovascular coil embolization involving a microcatheter tip, known as the “Γ (gamma) tip me...

The combination of a flow reversal with two balloons and a filter protection device is one of the safest methods that can be used during carotid artery stenting (CAS). Although major adverse events did not occur under restrict protection, we experienced a case of in-filter thrombus during the procedure. A 68-year-old male presented with temporary r...

A 75-year-old man presented with right-sided hemiplegia and was diagnosed with a left middle cerebral artery occlusion. He underwent endovascular thrombectomy, and a bulge was found. A modified pigtail-shaped microguidewire (MPMGW) proved useful for diagnosis because it allowed differentiation between the occluded artery and a saccular aneurysm as...

Background: When a shaping mandrel is inserted into the tip of a preshaped microcatheter, the existing curve becomes uncertain because the tip is straightened by the inner mandrel. Therefore, we developed a way to perform microcatheter shaping by means of an external cast, which we named "microcatheter shaping cast." Techniques: A shaping mandre...

Objective: The purpose of this study was to investigate the characteristics, time-line, and treatment results of in-hospital acute ischemic stroke due to large vessel occlusion (LVO) treated by mechanical thrombectomy. Methods: The authors investigated 10 patients (six males and four females; mean age 78.6 years, range 65–92) with in-hospital LVO t...

Background: Persistent primitive trigeminal artery (PPTA) is the most common type of fetal carotid-basilar persisting communication in adulthood; however, carotid-cavernous fistulas (CCFs) associated with PPTA are rare. Case description: An 84-year-old woman presented with traumatic CCF associated with PPTA manifesting as vascular bruit. Transar...

In endovascular coil embolization for intracranial aneurysms, as coils are filled in the aneurysm and the stage of procedure is advanced, the force to push forward the coil delivery wire (insertion force) increases. However, the coil insertion force that interventionist's felt at his fingertips does not directly reflect the stress of the aneurysm a...

Background Sinus pericranii (SP) is a rare abnormal connection between the intracranial and extracranial venous drainage pathways through the osseous channels. Herein we present the case of a patient with growing SP, which was successfully treated using endovascular transvenous embolization through external compression with a plastic cup for preven...

Background: The effect of HydroSoft coils on the prevention of recanalization and thrombosis after embolization is unclear. We herein report the results of the single-armed prospective Japanese HydroSoft Registry. Methods: Aneurysms with a diameter of <10 mm that were treated with a ≥50% length of HydroSoft coils were registered. We evaluated th...

After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This...

This study, following Japanese Registry of NeuroEndovascular Treatment 1 and 2 (JR-NET 1 & 2), shows an annual trend of cases including adverse events and clinical outcomes at 30 days after NET. JR-NET3 was registered by 749 cumulative total number of physicians, certified by the Japanese Society of Neuroendovascular Therapy in 166 centers, between...

Purpose: We review our case series of embolization for unruptured aneurysms <5 mm in maximum diameter to clarify the safety and availability of embolization for these aneurysms, for which surgery is not indicated in the present guidelines. Materials and methods: The clinical materials were 499 unruptured aneurysms treated with embolization between...

Background: Robotic technology is rapidly developing in the medical field, particularly contributing to support operative intervention using the da Vinci system during endoscopic surgery. Neuroendovascular intervention robot surgery is preferred when aiming to reduce radiation exposure among surgeons. Methods: We developed a prototype of a suppo...

Lumbar cerebrospinal fluid drainage has been widely performed in patients at the bedside; however, technical failure can occasionally occur as a result of blind maneuvering. Herein, we present the use of rotational fluoroscopic unit-guided lumbar drainage for patients with an unsuccessful initial attempt at bedside. In four of the 24 patients with...

The low-profile visualized intraluminal support device (LVIS) is a braided stent for stent assist coil embolization for intracranial aneurysms. The LVIS stent has a small stent cell design with higher neck coverage than Enterprise VRD/2 and Neuroform EZ/Atlas. The LVIS stent is applied for parent arteries with diameters ranging from 2.0 to 3.0 mm....

We previously reported using a microguidewire with a curved, pigtail-shaped tip as an anchor for navigating a microcatheter. However, we considered that the microcatheter could follow even if the tip of wire did not advance so far distally. The present study assessed the usefulness of a modified version of this pigtail-shaped microguidewire for nav...

This article was first published in JNIS. Cite this article as: Pierot L, Jayaraman MV, Szikora I, et al. Standards of practice in acute ischemic stroke intervention: international recommendations. Journal of NeuroInterventional Surgery. Published Online First: 28 August 2018. doi: 10.1136/neurintsurg-2018-014287.

Background Ehlers-Danlos syndrome (EDS) is a rare genetic connective tissue disorders, but the vascular type (type IV) typically poses the greatest risk to patients. We report a case of multiple cranial artery dissection, which was successfully treated with carotid artery stenting. Case Description A 50-year-old woman presented with recurrent seve...

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as "secondary intracranial hypertension," and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives....

Background: Stent clot retrievers (SRs) can be used to perform mechanical thrombectomy for the treatment of acute major arterial occlusion. Recanalization is faster and outcomes are better with treatment involving these devices than with internal treatment. Although several SRs are available, their clot-capturing abilities are unclear. Therefore,...

Background In endovascular embolisation for an intracranial aneurysm, after framing coil deployment, soft coils (often called filling coils) are usually selected to fill inside the cage of previous coils. Various kinds of filling coils are available, although each coil has its own characteristics. Understanding their differences to ensure proper co...

A 48-year-old female with a symptomatic giant carotid cavernous aneurysm underwent endovascular treatment with multiple Pipeline Flex embolic devices (PED). The delivery catheter had to take a complicated course of multiple turns to cross the aneurysm, and its loop was tied in the aneurysm. When the catheter was to be withdrawn, it was apparent tha...

Conventional coil embolization for large carotid cavernous aneurysms (CCAs) is limited because of inadequate ability to prevent recurrence or reduce mass effects. Although trapping of the parent artery may be the most radical treatment, it also has a risk of ischemic complications due to intracranial perfusion disorders associated with external-int...

Background: The frequency of the occurrence of adverse events associated with carotid artery stenting (CAS) is usually low, but serious adverse events such as cerebral hyperperfusion syndrome (CHS) may occur. Real-time monitoring is ideal for the early detection of adverse events during the surgical procedure. This study aimed to evaluate continuo...

Objective: We encountered a rare case of steal phenomenon via the vertebral artery due to occlusion of the brachiocephalic artery that developed dissecting aneurysm in the right vertebral artery and suffered subarachnoid hemorrhage. Case Presentation: A 68-year-old woman was transported due to headache and disturbance of consciousness. Close examin...

Dural arteriovenous fistula (DAVF) is occasionally associated with venous/sinus stenosis. In some cases, venous congestion and venous hypertension due to venous/sinus stenosis can induce clinical symptoms. The authors report a case of transverse-sigmoid sinus DAVF treated with transvenous embolization and venous/sinus angioplasty and stenting. A 46...

Endovascular thrombectomy is recommended for a persistent ischemic penumbra if recanalization cannot be achieved by the intravenous (IV) administration of recombinant tissue-plasminogen activator (rt-PA) alone. Although endovascular thrombectomy is a powerful treatment for major cerebral artery occlusion, the monitoring of recanalization and reperf...

Background This study aimed to evaluate the detailed location and the number (single or multiple) of cavernous sinus dural arteriovenous fistula (CSDAVF) shunted pouches as well as the relationship between the characteristics of shunted pouch(es) and the treatment outcome of transvenous embolization for CSDAVF. Methods A total of 23 consecutive pa...

Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-ind...

PurposeRecent reports have posed doubts about the effect of preradiosurgical embolization in brain arteriovenous malformation (AVM) because it makes the planning of stereotactic radiosurgery (SRS) difficult and has the risk of recanalization out of the target. We investigated whether the performance and quality of embolization may influence the suc...

Purpose Conventional coil embolization for large carotid cavernous aneurysms (CCAs) has limited utility due to its inability to prevent recurrences and reduce mass effect. Trapping of the parent artery may have a risk of ischemic complications due to intracranial perfusion disorders. We successfully treated 24 patients with large CCAs using a flow...

Treatment of unruptured aneurysms in elderly patients tends to be contraindicated based on the risks and benefits for a limited life expectancy. In such cases, endovascular treatment has been frequently adopted because of its minimal invasiveness. We compared the results of endovascular treatment between non-elderly and elderly patients aged >75 ye...

Introduction In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by the neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that f...

Objective: The authors report a case treated using the Penumbra system for in-stent reocclusion after revascularization with stent for acute intracranial artery occlusion. Case Presentations: The patient was a 37-year-old woman. Endovascular treatment was performed for acute occlusion of the M1 segment of the left middle cerebral artery, and recana...

Objective: The purpose of this study was to compare the clinical outcome of transarterial embolization for isolated sinus type dural arteriovenous fistula (iDAVF) using n-butyl-cyanoacrylate (NBCA) and Onyx. Methods: Seventeen lesions of iDAVF in 17 patients who underwent transarterial embolization between March 2008 and February 2015 were retrospe...

Background: The efficacy for the treatment of large carotid cavernous aneurysms (CCAs) was compared between conventional endovascular treatments, stent-assisted coiling (SAC), parent artery occlusion (PAO), and the flow diverter (FD). Methods: Between January 2001 and December 2015, 49 patients with large, broad-necked, unruptured CCA underwent...

In endovascular coil embolization of intracranial aneurysms, very soft coils, often called “finishing coils,” are usually selected in the final stage of coil embolization. The authors developed a radiolucent coil made of thin nylon thread to evaluate the performance of coils under a situation simulating the course of embolization. The characteristi...

Objective: Permanent therapeutic occlusion of the carotid artery is one of the treatment options for patients with a large/giant internal carotid artery aneurysm or tumor involving the neck or skull base. Balloon test occlusion (BTO) is performed to predict the tolerance of parent artery occlusion (PAO). The authors combined various modalities to i...

Introduction: Higher hospital volumes have been related to better outcomes in previous researches. However, the mechanisms of the volume-outcome relationships in stroke have not been sufficiently figured out. The aim of this study is to uncover the roles of processes in acute phase stroke care among the volume-outcome relationships. Hypothesis: Pro...

Introduction: Evidences of comprehensive stroke center regarding mortality and hospitalization days are insufficient. Hypothesis: To examine temporal changes in mortality and hospitalization days in patients with ischemic and hemorrhagic stroke according to stroke subtype and comprehensive stroke care capabilities in a nationwide hospital cohort in...

Introduction: Organized stroke care is an integrated approach to managing stroke to improve outcomes. However, the effectiveness of organized stroke care on mortality and morbidity remains uncertain. This study aimed to examine whether Organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessmen...

Stenoses of intracranial arteries are common among Asian people, and most of them have been treated with percutaneous transluminal angioplasty (PTA). Due to the frequency of recoil and restenosis in cases with balloon PTA alone, off-label stenting with coronary stent has been often adopted. Actually in our case series, the rate of stenosis was sign...

Low response to antiplatelet drugs is one of the risk factors for ischemic events. We examined the influence of low response to clopidogrel on symptomatic ischemic events and new ischemic MRI lesions with endovascular intracranial aneurysmal coil embolization. Between August 2010 and July 2013, 189 procedures in 181 consecutive patients who underwe...

Bilateral cavernous carotid aneurysms (CCAs) are very rare. A treatment strategy for symptomatic bilateral CCAs has not been established because of their complex pathogenesis. Here we report our treatment strategy and long-term results for 6 cases of symptomatic bilateral CCAs. From January 2007 to December 2013, we treated 6 patients (2 men and 4...

The authors retrospectively reviewed their cases of infectious intracranial aneurysms and discuss results and trends of current treatment modalities including medical, neurosurgical, and endovascular. Twenty patients (10 males and 10 females; mean age 46 years) with 23 infectious aneurysms were treated by various treatment modalities during a 15-ye...

Background Carotid artery stenting (CAS) is minimally invasive but may cause perioperative cerebral infarction associated with distal embolization. We conducted a multicenter prospective observational study on the onset of vascular events after CAS to find out the efficacy and safety of CAS in Japan and to investigate the effects of antiplatelet dr...

The present study retrospectively analyzed the database of the Japanese Registry of Neuroendovascular Therapy 1 and 2 (JR-NET1&2) to determine annual trends, including adverse events and clinical outcomes at 30 days after undergoing neuroendovascular therapy. JR-NET1&2 are surveys that targeted all patients in Japan who underwent neuroendovascular...

Of the patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET), a surveillance study in Japanese, 1133 patients who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2005 to 2009 were investigated. A technical success was achieved in 98.3% of the pat...

Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter techn...

A subgroup analysis of spinal vascular lesions in the Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET2, retrospective registry studies conducted in 2005-2009, was performed to understand the current status of treatment in Japan. Of 201 spinal lesions enrolled, 98 analyzable cases of spinal dural arteriovenous fistula (SDAVF), 43...

This retrospective study constitutes a part of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2. Its purpose is to evaluate the feasibility, safety, and outcome of endovascular embolization for cerebral arteriovenous malformations (AVMs) in Japan. Nine hundred and eighty-seven embolization procedures were registered with JR-NET 1...

We describe an enhanced endovascular procedure for the coiling of broad-necked basilar terminal aneurysms with a combined balloon/stent assist technique. A balloon-assisted catheter is inserted in the origin of one posterior cerebral artery (PCA) and an assisted stent is deployed from the opposite PCA to the basilar artery. A microcatheter for coil...

Background: Carotid artery stenting(CAS)is a common procedure for the treatment of high surgical risk patients with carotid artery stenosis. Recent clinical study failed to show the non-inferiority of CAS to carotid endarterectomy(CEA)because of higher complication rates of CAS. However the result of a multicenter case study in Japan with tailored...

Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the dif...

Background: Stent-assisted coil embolization is useful for wide-necked, large and giant aneurysms, and is effective for avoiding coil herniation. However, the mobility of the microcatheter is often restricted, resulting in deviated or unbalanced coiling. In order to prevent this insufficient coiling, the authors devised a method for microcatheteri...

Background: Acute cervical carotid artery occlusion presents with a severe neurological deficit and is associated with unfavorable outcomes. In this study, the authors report their experience with patients having had acute ischemic stroke due to cervical carotid occlusion, who underwent endovascular intervention. Method: Sixteen acute cervical c...

Delayed rupture of a previously unruptured cerebral aneurysm after uneventful saccular coil packing is rare, particularly when the quality of aneurysm occlusion is appropriate (neck remnant or total occlusion). The present report describes the case of a 70-year-old woman with an incidentally detected, asymptomatic, small basilar tip non-thrombosed...

Dural arteriovenous fistula (DAVF) is classically defined as abnormal arteriovenous connections located within the dural leaflets. Though the exact etiology is still not clear, they are generally accepted as acquired lesions. However, some DAVFs formed as the congenital disorders are called dural arteriovenous malformations and these lesions with a...

There are few reports describing stroke due to the acute occlusion of the vertebral artery (VA) origin successfully treated by endovascularily. The authors report a case of 78-year-old man suffering from stroke owing to acute VA origin occlusion associated with contralateral hypoplastic VA leading to basilar artery (BA) thrombosis. Cerebral angiogr...

Background and Purpose Data on the effectiveness of organized stroke care on mortality of patients with ischemic and hemorrhagic stroke are limited. In this study, we examined whether organized stroke care for all types of stroke influence the stroke in-hospital mortality in the real-world setting. Methods Of the 1381 certified training institution...

Virtual Histology intravascular ultrasound (VH IVUS) volumetric analysis (analysis of the entire plaque responsible for stenosis) has been used for carotid plaque diagnosis. Knowing the carotid plaque characteristics by analyzing the plaque composition only at the minimum lumen site will facilitate plaque diagnosis using VH IVUS. To detect the rela...

IntroductionIsolated bilateral thalamic congestion due to an arteriovenous malformation (AVM) is a rare entity. Few case reports of dural arteriovenous fistula associated with it have been reported in the literature. The association of pial arteriovenous fistula (pial AVF) with thalamic hyperintensities has never been described before. The pial AVF...

Background and purpose: We conducted a large retrospective survey of the clinical results of carotid artery stenting (CAS) for about 10 years performed by neurointerventionists at 43 Japanese institutions. Hence, the historical perspective of CAS in Japan was demonstrated. Methods: Cases were stratified into three separate periods based on the a...

A 30-year-old female developed moyamoya syndrome after gamma knife surgery (GKS) for cerebral arteriovenous malformation (AVM), and was treated with bypass surgery. She suffered from flittering scotoma, right transient hemianopsia, and headache for 1 year. Cerebral angiography revealed a Spetzler-Martin grade III AVM located in the left occipital l...

The authors report a case of intracardiac migration of a ventriculoatrial (VA) shunt catheter and transvenous retrieval of the migrated shunt catheter. A 67-year-old male, who had previously undergone a VA shunt for hydrocephalus after subarachnoid hemorrhage, presented disorientation, memory disturbance and gait disturbance without any cardiopulmo...

Objective: To clarify the frequency of Japanese patients who are resistant to antiplatelet agents, and then clarify correlations between resistance and thromboembolic adverse events in neurointervention. Methods: Blood samples were collected from 163 patients who were taking antiplatelet agents and received neurointervention, with 128 samples co...

Hemodynamics in intracranial aneurysms is thought to play an important role in their growth and rupture. Usual computed fluid dynamics (CFD) based on three-dimensional (3D) computed tomographic (CT) angiography requires a time-consuming process for analysis. Magnetic resonance fluid dynamics (MRFD) based on MR images is a new tool for analyzing flo...

Objective: The advantages of neuroendovascular treatment (NET) include low invasiveness and the ability to be performed under local anesthesia. However, the psychological burden of surgery might be increased because patients remain conscious during the operation. A multi-media digital versatile disc (DVD) showing the neuroendovascular course was cr...

Objective: Straightening of the coil at its proximal end is rare but possible. We report a case of internal carotid aneurysm in which this phenomenon was encountered during parent artery occlusion. Case presentation: A 69-year-old woman underwent endovascular trapping of an unruptured left cavernous internal carotid artery (ICA) aneurysm, 15mm in d...