Research ArticleORIGINAL RESEARCH
Optimal endovascular therapy technique for isolated intracranial atherothrombotic stroke-related large vessel occlusion in the acute to subacute stage
Mikiya Beppu, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Seigo Shindo, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura and for the RESCUE AT-LVO Investigators
American Journal of Neuroradiology July 2024, ajnr.A8399; DOI: https://doi.org/10.3174/ajnr.A8399
Mikiya Beppu
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Kazutaka Uchida
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Nobuyuki Sakai
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hiroshi Yamagami
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Kazunori Toyoda
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Yuji Matsumaru
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Yasushi Matsumoto
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Kenichi Todo
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Mikito Hayakawa
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Seigo Shindo
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Shinzo Ota
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Masafumi Morimoto
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Masataka Takeuchi
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hirotoshi Imamura
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hiroyuki Ikeda
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Kanta Tanaka
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hideyuki Ishihara
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hiroto Kakita
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Takanori Sano
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Hayato Araki
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Tatsufumi Nomura
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Fumihiro Sakakibara
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Manabu Shirakawa
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
Shinichi Yoshimura
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
From the Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (M.B., K.U., M.S., S.Y., F.S.); Neurovascular Research & Neuroendovascular Therapy, Kobe City Medical Center General Hospital, Kobe, Japan (N.S.), Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan (H.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T., K.T.); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan (Y.M.); Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan (Y.M.); Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan (K.T.); Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (M. H.); Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (S.S.); Department of Neurology, Kumamoto University, Kumamoto, Japan (S.S.); Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan (S.O.); Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Kanagawa, Japan (M.M.); Department of Neurosurgery, Seisho Hospital, Odawara, Japan (M.T.); Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.I.); Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan (H.I.); Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan (H.I.); Department of Neurosurgery, Shimizu Hospital, Kyoto, Japan (H.K.); Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.S.); Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan (H.A.); Neuroendovascular Therapy Center, Ohkawara Neurosurgical Hospital, Muroran, Hokkaido, Japan (T.N.)
ABSTRACT
BACKGROUND AND PURPOSE: Reocclusion after treatment is a concern in endovascular therapy (EVT) for isolated intracranial atherothrombotic stroke-related large vessel occlusion (AT-LVO). However, the optimal EVT technique for AT-LVO has not yet been investigated. This study evaluated the optimal EVT technique for AT-LVO in a real-world setting.
MATERIALS AND METHODS: We conducted a historical multicenter registry study at 51 centers that enrolled patients with AT-LVO. We divided the patients into three groups based on the EVT technique: mechanical thrombectomy alone (MT-only), percutaneous transluminal angioplasty (PTA), and stent deployment (Stent). MT alone was classified into the MT-only group, PTA and MT-PTA into the PTA group, and MT-Stent, MT-PTA-Stent, PTA-Stent, and Stent-only into the Stent group. The primary outcome was the incidence of reocclusion of the treated vessels within 90 days of EVT completion.
RESULTS: We enrolled 770 patients and analyzed 509 patients. The rates in the MT-only, PTA, and Stent groups were 40.7, 44.4, and 14.9%, respectively. The incidence rate of residual stenosis >70% of final angiography was significantly higher in the MT-only group than in the PTA and Stent groups (MT-only vs. PTA vs. Stent: 34.5% vs. 26.3% vs. 13.2%, p=0.002). The reocclusion rate was significantly lower in the PTA group than in the MT-only group (adjusted hazard ratio [95% confidence interval], 0.48 [0.29–0.80]). Of the patients, 83.5% experienced reocclusion within 10 days after EVT. Alarmingly, a substantial subset (approximately 62.0%) of patients underwent reocclusion within 2 days of EVT. The incidence of modified Rankin scale scores of 0–2 90 days after EVT was not significantly different among the three groups. The incidences of symptomatic intracranial hemorrhage (ICH), any other ICH, and death were not significantly different.
CONCLUSIONS: The incidence rate of reocclusion was significantly lower in the PTA group than in the MT-only group. We found no significant difference in reocclusion rates between the Stent and MT-only groups. In Japan, GP IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with MT-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-EVT.
ABBREVIATIONS: EVT = endovascular treatment; LVO = large vessel occlusion; MT = mechanical thrombectomy; PTA = percutaneous transluminal angioplasty; ICH = intracranial hemorrhage; SD = standard deviation; IQR = interquartile range; HRs = hazard ratios; BMI = body mass index; LDL = low-density lipoprotein; HDL = high-density lipoprotein; DAPT = dual antiplatelet therapy; TAPT = triple antiplatelet therapy
Footnotes
Dr. Hayakawa, Dr. Ota, Dr. Morimoto, Dr. Tanaka, and Dr. Kakita declare no conflicts of interest.
- © 2024 by American Journal of Neuroradiology
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Accepted Manuscript
Mikiya Beppu, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Seigo Shindo, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura, for the RESCUE AT-LVO Investigators
Optimal endovascular therapy technique for isolated intracranial atherothrombotic stroke-related large vessel occlusion in the acute to subacute stage
American Journal of Neuroradiology Jul 2024, ajnr.A8399; DOI: 10.3174/ajnr.A8399
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Accepted Manuscript
Optimal endovascular therapy technique for isolated intracranial atherothrombotic stroke-related large vessel occlusion in the acute to subacute stage
Mikiya Beppu, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Seigo Shindo, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura, for the RESCUE AT-LVO Investigators
American Journal of Neuroradiology Jul 2024, ajnr.A8399; DOI: 10.3174/ajnr.A8399
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