Publications by authors named "Masataka Yoshimura"

Background: Intra-and extracranial artery dissections are uncommon but significant causes of ischemic stroke and subarachnoid hemorrhage (SAH). While individual dissections are well-documented, simultaneous dissections of multiple vessels leading to both hemorrhagic and ischemic strokes are extremely rare.

Case Description: A 41-year-old man presented with acute onset of headache, vomiting, and loss of consciousness.

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Cyanobacteria can produce alkanes equivalent to diesel fuels through a two-step enzymatic process involving acyl-(acyl carrier protein) reductase (AAR) and aldehyde deformylating oxygenase (ADO), providing a potential renewable biofuel source. AAR binds to ADO for efficient delivery of an aldehyde substrate and they have been proposed to dissociate when the alkane product is released from the same site as the substrate entrance of ADO. However, the dynamics of the substrate and product in ADO during substrate entry and product release are poorly understood.

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Background: Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography.

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Article Synopsis
  • Distal transradial access (dTRA) through the anatomical snuffbox offers benefits for endovascular treatments but faces challenges due to the small diameter of the radial artery affecting the use of balloon-guide catheters (BGCs).
  • A study involving 170 patients treated with sheathless dTRA using an 8Fr Optimo BGC found a radial artery occlusion (RAO) rate of 28%, with a significant correlation between smaller artery diameter and higher RAO risk.
  • The research suggests a threshold of 2.4 mm for radial artery diameter to predict RAO risk, indicating that careful evaluation of artery size is essential for choosing large-bore BGCs; further studies are needed for validation and
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  • Thromboembolism is a critical concern in patients undergoing endovascular treatment for ruptured cerebral aneurysms, and administering antiplatelet agents like aspirin before the procedure may lower this risk.
  • The study, called ASTOP, is a multicenter, randomized, double-blind trial involving 484 patients, comparing the effects of 200 mg of aspirin versus a placebo prior to treatment.
  • Primary outcomes will focus on measuring thromboembolic complications and ischemic lesions during the procedure, while secondary outcomes will assess cerebral ischemic events, bleeding incidents, and patient functional status after 90 days.
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Background: Various degrees of thrombosis have been reported in patients with giant aneurysms. However, small, unruptured aneurysms rarely resolve spontaneously. Herein, we report a case of a small unruptured aneurysm in the clinoid segment (C3) of the left internal carotid artery (ICA) that showed almost complete occlusion at the 1-year follow-up.

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Article Synopsis
  • The study examines clinical outcomes of two treatment options for distal anterior cerebral artery (DACA) aneurysms: microsurgery and endovascular treatment (EVT).
  • It analyzes data from 166 patients across 16 stroke centers, comparing the efficacy, complications, and recurrence rates of both treatments over a median follow-up of 15.3 months.
  • Findings suggest that while EVT may be a viable alternative to microsurgery, especially for unruptured aneurysms, it shows higher recurrence and retreatment rates, particularly in cases of ruptured aneurysms, highlighting the need for careful monitoring.
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Background And Objectives: Although intraprocedural rupture (IPR) is rare, it is a devastating complication of endovascular treatment (EVT) for intracranial aneurysms. Very few studies have been conducted on IPR, and the safety and efficacy of management techniques of IPR have not been investigated.

Methods: Patients who experienced IPR during EVT between 2013 and 2022 were enrolled from a multicenter observational registry.

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Article Synopsis
  • - The study aimed to establish a method for predicting vascular access difficulty during mechanical thrombectomy by using a specific measurement called the distance from the sternum to the ascending aorta (S-AAD) from chest CT scans.
  • - Researchers analyzed data from 115 patients who underwent mechanical thrombectomy and found that a shorter S-AAD was significantly correlated with longer guiding times, indicating access difficulty.
  • - The findings suggest that a S-AAD of less than 5 mm is a strong predictor of challenging access, which can help clinicians choose better devices and approaches before the intervention.
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Subarachnoid hemorrhage due to the A1 segment of an anterior cerebral artery dissecting aneurysm is rare. Therefore, a standard treatment has not been established. Though several case reports of direct surgery exist, there are few reports on endovascular treatment.

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  • This study investigates the effectiveness of first-line contact aspiration compared to other treatment strategies for basilar artery occlusion in endovascular thrombectomy.
  • A total of 84 patients from 16 Japanese stroke centers were analyzed, with findings showing no significant differences in recanalization rates but indicating contact aspiration led to faster results.
  • The results suggest that while contact aspiration gives better functional outcomes, the main advantage is a significantly shorter time from puncture to successful recanalization.
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  • The study presents a rare case of symptomatic acute carotid artery occlusion after carotid endarterectomy in a 57-year-old female with a preexisting subclavian artery steal phenomenon.
  • This patient experienced symptoms of cerebral perfusion deficiency due to occlusion of the treated carotid artery the day after surgery.
  • The occlusion was successfully resolved using subclavian artery stenting, leading to improved cerebral blood flow and symptom relief.
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Cyanobacteriochromes (CBCRs) are cyanobacterial photoreceptors distantly related to the phytochromes sensing red and far-red light reversibly. Only the cGMP phosphodiesterase/Adenylate cyclase/FhlA (GAF) domain is needed for chromophore incorporation and proper photoconversion. The CBCR GAF domains covalently ligate linear tetrapyrrole chromophores and show reversible photoconversion between two light-absorbing states.

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Aim: Assessing the indication for elective neuro-endovascular treatment (EVT) in older patients requires consideration of the impact of systemic comorbidities on their overall reduced life expectancy. The objective of this study was to determine the long-term outcomes of elective neuro-EVT in patients aged ≥80 years, and to investigate the impact of pre-existing cancer on their long-term outcomes.

Methods: Of the patients enrolled in multicenter observational registry, those aged ≥80 years undergoing elective neuro-EVT between 2011 and 2020 were enrolled.

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Objective: Basilar artery occlusion (BAO) secondary to traumatic vertebral artery (VA) dissection caused by vertebral fracture is a rare cause of acute ischemic stroke, and optimal management, such as antithrombotic agents, surgical fixation, and parent artery occlusion (PAO), has been controversial. We report a case in which mechanical thrombectomy and PAO were performed for a BAO due to right VA dissection caused by a transverse foramen fracture of the axis vertebra.

Case Presentation: A patient in her 80s suffered from a backward fall, and a neck CT revealed a fracture and dislocation of the right lateral mass of the axis and a compressed transverse foramen.

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Cyanobacteriochrome (CBCR) photoreceptors are distantly related to the canonical red/far-red reversible phytochrome photoreceptors. In the case of the CBCRs, only the GAF domain is required for chromophore incorporation and photoconversion. The GAF domains of CBCR are highly diversified into many lineages to sense various colors of light.

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Article Synopsis
  • The study aimed to explore how baseline infarct area and collateral status affect clinical outcomes in stroke patients with acute basilar artery occlusion after undergoing endovascular treatment.
  • It analyzed 86 patients treated within 24 hours, finding that those with a higher baseline infarct score (pc-ASPECTS ≥ 7) had better chances of recovery, with 43% achieving good outcomes.
  • It concluded that while pc-ASPECTS is a reliable predictor of positive clinical outcomes after treatment, the collateral status scores did not show a significant impact.
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  • The study aimed to determine how the location of brain infarcts, measured by the posterior circulation Alberta Stroke Program Early Computed Tomographic Score (pc-ASPECTS), affects patient outcomes after endovascular therapy for basilar artery occlusion.
  • Among 100 participants, 51% achieved favorable outcomes, with younger age, lower pre-treatment stroke severity, and higher pc-ASPECTS scores linked to better recovery.
  • The research concluded that higher pc-ASPECTS scores are predictive of better outcomes, while bilateral cerebellar infarction is associated with poorer recovery chances.
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Background And Purpose: To investigate the associations of perioperative P2Y12 reaction units (PRU) measured using VerifyNow with ischemic and bleeding events, and to determine the PRU threshold in the setting of elective neuro-endovascular treatment (EVT) for intracranial/extracranial vascular disease in patients taking aspirin and clopidogrel.

Methods: Of the patients undergoing elective neuro-EVT while taking aspirin and clopidogrel, those taking both antiplatelet agents for 7 days or more and whose PRU and aspirin reaction units (ARU) were measured were included. The primary and safety outcomes were defined as symptomatic ischemic and major bleeding events within 30 days after EVT.

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Background: Postoperative cerebral embolic stroke is a serious complication of pulmonary lobectomy, occurring in 1.1% of patients undergoing lobectomy through video-assisted thoracoscopic surgery (VATS). The mechanism of this complication is thought to be embolic stroke caused by thrombus formed due to stagnation in the pulmonary vein stump after VATS lobectomy.

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Objective: There are few detailed reports on abducens nerve palsy due to a ruptured vertebral artery dissecting aneurysm (VADA). We investigated the clinical characteristics and long-term course of abducens nerve palsy in ruptured VADA patients treated by endovascular surgery.

Methods: Of the 51 cases of ruptured VADA treated by endovascular intervention from 2011 to 2019, 31 with a good/fair outcome, in which ocular motility disorder was able to be followed, were included and investigated.

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Objective: The assessment of platelet functions is necessary to prevent both thromboembolic and hemorrhagic complications under dual antiplatelet therapy (DAPT). Using the VerifyNow (Accumetrics, Inc., San Diego, CA, USA) assay, this study aimed to reveal time-dependent changes in platelet functions after carotid artery stenting (CAS).

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