A5043643761- Acute Ischemic Stroke Management
- Cerebrovascular and Carotid Artery Diseases
- Atrial Fibrillation Management and Outcomes
- Intracerebral and Subarachnoid Hemorrhage Research
- Venous Thromboembolism Diagnosis and Management
- Antiplatelet Therapy and Cardiovascular Diseases
- Traumatic Brain Injury and Neurovascular Disturbances
- Stroke Rehabilitation and Recovery
- Cardiac Imaging and Diagnostics
- Advanced MRI Techniques and Applications
- Intracranial Aneurysms: Treatment and Complications
- Cerebrovascular and genetic disorders
- Advanced Neuroimaging Techniques and Applications
- Neurological Disease Mechanisms and Treatments
- Blood Pressure and Hypertension Studies
- Neurological Disorders and Treatments
- Cardiovascular and Diving-Related Complications
- Cardiac tumors and thrombi
- Neurological and metabolic disorders
- Blood Coagulation and Thrombosis Mechanisms
- Moyamoya disease diagnosis and treatment
- Parkinson's Disease Mechanisms and Treatments
- Spinal Hematomas and Complications
- Autoimmune Neurological Disorders and Treatments
- Cell Adhesion Molecules Research
Kyoto first Red Cross hospital
2016-2025
Red Cross Hospital
2015-2025
Krankenhaus vom Roten Kreuz
2015-2025
Japanese Red Cross Society Kyoto Daini Hospital
2014-2024
Korea National Institute of Health
2024
Hudson Institute
2024
John Wiley & Sons (United States)
2024
Kyoto Prefectural University of Medicine
2000-2018
McMaster University
2018
National Cerebral and Cardiovascular Center
2004-2016
Diffusion-weighted imaging (DWI) is commonly used to assess irreversibly infarcted tissue but its accuracy challenged by reports of diffusion lesion reversal (DLR). We investigated the frequency and implications for mismatch classification DLR using from EPITHET (Echoplanar Imaging Thrombolytic Evaluation Trial) DEFUSE (Diffusion Perfusion Understanding Stroke Evolution) studies. In 119 patients (83 treated with IV plasminogen activator), follow-up images were coregistered acute lesions...
Large clinical trials are lack of data on non-vitamin K antagonist oral anticoagulants for acute stroke patients.To evaluate the choice at hospital discharge in patients with nonvalvular atrial fibrillation and clarify underlying characteristics potentially affecting that using multicenter Stroke Acute Management Urgent Risk-factor Assessment Improvement-NVAF registry (ClinicalTrials.gov NCT01581502).The study included 1192 ischemic stroke/transient attack (527 women, 77·7 ± 9·9 years old)...
Background and Purpose- We assessed whether lower-dose alteplase at 0.6 mg/kg is efficacious safe for acute fluid-attenuated inversion recovery-negative stroke with unknown time of onset. Methods- This was an investigator-initiated, multicenter, randomized, open-label, blinded-end point trial. Patients met the standard indication criteria intravenous thrombolysis other than a last-known-well >4.5 hours (eg, wake-up stroke). were randomly assigned (1:1) to receive or medical treatment if...
The "1-3-6-12-day rule" for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient attack recommends timings that may be later than used clinical practice. We investigated more practical optimal timing of DOAC initiation according to severity. combined data prospective registries Japan, Stroke Acute Management Urgent Risk-factor Assessment and Improvement-nonvalvular (September 2011 March 2014) RELAXED (February...
The use of diffusion-weighted imaging (DWI) to define irreversibly damaged infarct core is challenged by data suggesting potential partial reversal DWI abnormalities. However, previous studies have not considered involution. We investigated the prevalence lesion in EPITHET Trial.EPITHET randomized patients 3-6 hours from onset acute ischemic stroke tissue plasminogen activator (tPA) or placebo. Pretreatment and day 90 T2-weighted images were coregistered. Apparent was defined as incorporated...
the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a prospective, randomized, double-blinded, placebo-controlled, phase II trial of alteplase between 3 and 6 hours after stroke onset. The primary outcome infarct growth attenuation on MRI with in mismatch patients negative when volumes were assessed volumetrically, without coregistration, which underestimates volumes. We hypothesized that assessing extent by coregistration perfusion diffusion maps may more accurately allow...
Aims This study was performed to determine the short-term risk-benefit profiles of patients treated with oral anticoagulation for acute ischemic stroke or transient attack using a multicenter, prospective registry. Methods A total 1137 (645 men, 77 ± 10 years old) stroke/transient taking warfarin (662 patients) non-vitamin K antagonist anticoagulants (dabigatran in 205, rivaroxaban 245, apixaban 25 nonvalvular atrial fibrillation who completed three-month follow-up survey were studied....
To prospectively evaluate the course of sensory fibers through supratentorial brain with diffusion-tensor-based tractography.This study was approved by institutional review board. Informed consent obtained. Seven healthy volunteers (five men, two women; age range, 20-55 years) underwent 1.5-T magnetic resonance imaging. Diffusion-tensor images isotropic voxels (2 x 2 mm) were obtained using a single-shot echo-planar imaging technique, motion-probing gradient in 15 orientations, b value 1000...
Two phase 2 studies of alteplase in acute ischemic stroke 3 to 6 hours after onset, Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET; a randomized, controlled, double-blinded trial), and Diffusion Perfusion for Understanding Stroke Evolution Study (DEFUSE; open-label, treatment only) using MR imaging-based outcomes have been conducted. We pooled individual patient data from these assess the response alteplase. The primary hypothesis was that would significantly attenuate infarct...
Yamada et al. reported MR tractography depicting damage to the left hemisphere arcuate fasciculus in association with presumed conduction aphasia a patient who had sustained stroke.1 We concur authors’ findings that is engulfed by lesion, but disagree implications this supports specific diagnosis of aphasia, and necessarily associated patient. These distinctions are important from both heuristic clinical perspectives. Distinguishing other forms process, not an imaging one, classic lesion...
Platelet-derived microparticles (PDMPs) have attracted attention as blood coagulation-promoting, endothelial cell-activating factors. The objective of this study was to determine the parameters associated with elevated PDMP levels and examine their relationship atherosclerotic lesions main intracranial extracranial arteries.Participants included a control group (C) 61 patients no apparent cerebral vascular 110 acute-phase infarction, consisting small-vessel occlusion (S) 34 patients,...
Background and Purpose— The discrimination between paroxysmal sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed assess differences clinical outcomes mostly anticoagulated patients with AF who had previous ischemic transient attack. Methods— Using data from 1192 nonvalvular acute attack were registered SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment Improvement-Nonvalvular AF;...
Background The aim of the present study was to investigate efficacy and safety antiplatelet (aspirin plus cilostazol) dual therapy for patients with noncardioembolic stroke within 48 hours symptom onset. Methods Results ADS (Acute Aspirin Plus Cilostazol Dual Therapy Non‐Cardiogenic Stroke Patients Within Hours Symptom Onset ) is an investigator‐initiated, prospective, multicenter (34 hospitals in Japan), randomized, open‐label, aspirin‐controlled trial. Acute onset were studied. subjects...
Background:We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry Japan.
Background: Enlarged perivascular spaces (PVS), a marker of cerebral small vessel disease (SVD), are considered to increase the risk stroke. However, there is limited data on benfits and harms antithrombotic agents in patients with PVS. We assessed association PVS hemorrhagic or ischemic events receiving agents. Methods: This an investigator-initiated, prospective, multicenter observational study that enrolled cerebrovascular cardiovascular diseases who were taking oral from 52 hospitals...
We investigated the 992 consecutive patients with acute embolic stroke and identified potential sources (PES) for 88.3% applying transesophageal echocardiography (TEE). classified into 3 groups, Group A (n = 560): PES were after general examinations, B 366): TEE or long-term EEG monitoring C 66): could not be performed. In A, continuous atrial fibrillation (cAf) was most prevalent 464, 82.8%), succeeded by myocardial infarction 39, 6.9%) Trousseau syndrome 27, 4.8%), etc. B,...
Background and Purpose There is limited data on the characteristics of stroke in young adults East Asia including Japan. We aimed to clarify clinical ischemic Japanese adults. Methods prospectively enrolled patients aged 18 50 years old who were admitted 5 high-volume centers within 14 days after onset between February 2018 January 2023. collected imaging based study protocol analyzed them for conventional specific risk factors, etiology, outcome. Results 275 subjects (median age, 46 years;...
Most previously reported mutations in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) result an odd number of cysteine residues within the epidermal growth factor (EGF)-like repeats Notch3. We report here R75P mutation two Japanese CADASIL families not directly involving located first EGF-like repeats. Probands both had repeated episodes stroke, depression, dementia as well T2 high-intensity lesions basal ganglia periventricular white...
<i>Aims:</i> To find neurological or neuroimaging signs to predict deterioration in acute lacunar infarctions. <i>Methods:</i> Sixty-one consecutive patients with a supratentorial infarct, who were admitted within 48 h, studied retrospectively. Progressive-type stroke (PS) was defined as progressive motor deficits that arose 7 days after onset, by using the ratings of National Institutes Health Stroke Scale. <i>Results:</i> Sixteen (26%) classified into PS...
Reduced cerebrovascular reactivity (CVR) is an important step in the pathogenesis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The present study utilized quantitative single photon emission computed tomography (SPECT) autoradiographic (ARG) method reactive hyperemia peripheral arterial tonometry (RH-PAT) to assess vasoreactivity intracranial arteries patients CADASIL.Quantitative SPECT studies were conducted eight CADASIL, while...
The ischemic penumbra may be classical, with complete annular configuration around the infarct core, or nonclassical a more fragmented pattern. We tested hypotheses that these penumbral patterns may: associated specific predictive factors, influence growth and clinical outcome, effect of tissue plasminogen activator (t-PA).Using EPITHET/DEFUSE data set, in which patients received alteplase placebo 3 to 6 hours poststroke, perfusion-weighted imaging diffusion-weighted images were analyzed....
Background and Purpose— The mismatch lesion volumes defined by perfusion-weighted imaging exceeding diffusion-weighted have been used as a marker of ischemic penumbral tissue. Defining the perfusion thresholding has shown promise practical tool; several positron emission tomography studies indicated more probabilistic relationship between infarction. Here, we randomized controlled trial dataset tissue-type plasminogen activator 3 to 6 hours after stroke to: (1) quantify severity...