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Yasumasa Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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Aggressive antiplatelet treatment for acute branch atheromatous disease type infarcts: a 12‐year prospective study
International journal of stroke : official journal of the International Stroke Society, 2014Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Yoshinari Nagakane, Masahiro Makino, Takashi Koizumi, Naoki Makita, Ichiro AkiguchiAbstract:Penetrating artery infarcts that are predominantly caused by occlusion at the vessel orifices of larger caliber penetrating Arteries by atheromatous plaque can represent a distinctive stroke entity as intracranial branch atheromatous disease (BAD) 1. BAD often shows progressive motor deficits leading to severe disability 2. Thrombolytic therapy by tissue plasminogen activator has not been demonstrated to be effective for BAD 3. We designed a combined use of antiplatelet agents for BAD. During 12 years, 313 consecutive patients with BAD located within the territories of lenticulostriate Arteries (LSAs) and anterior Pontine Arteries (APAs) were prospectively collected. Treatment protocols are as follows: phase 1 (2001–2005, n = 105), the medical treatment that was considered best; phase 2 (2005–2009, n = 104), a combined treatment of argatroban, cilostazol, and edaravone; and phase 3 (2009–20012, n = 104), additional clopidogrel on top of the phase 2 protocol. Functional outcome was assessed by the modified Rankin scale (mRS) at one-month after stroke onset. As a result, in the total population, the phase 2 and the phase 3 showed better outcome than the phase 1 (P = 0·0004 and P
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Abstract TP147: How Different Vascular Pathologies Of Penetrating Artery Disease And Large Parent Arterial Disease Are Associated With Progressive Motor Deficits.
Stroke, 2013Co-Authors: Yasumasa Yamamoto, Yoshinari NagakaneAbstract:Background and Purpose: Penetrating artery infarcts (PAI) are caused by two different vascular pathologies those include atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). PAI are sometimes accompanied by underlying large parent arterial disease (LPAD). We investigated the relationship between 2 different atheromatous lesions, BAD and LPAD, and how 2 lesions may associate with progressive motor deficits (PMD). Subjects and methods: We studied consecutive 568 patients with acute PAI in the territories of the lenticulostriate artery (LSA) (n=373) or paramedian Pontine Arteries (PPA) (n=195). The LPAD was defined as middle cerebral artery atherosclerosis responsible for LSA infarct or basilar artery atherosclerosis for PPA infarct evaluated by MRA. BAD of the LSA was defined as infarcts visible for 3 or more axial slices at a slice thickness of 7 mm and that of the APA was unilateral infarcts extending to the basal surface of the pons. Other type than BAD were categorized as LD. Finally, patients were classified into 4 groups: G1. LD type infarct in the territory of LSA (n=208), G2. BAD type in the LSA (n=164), G3. LD type in the PPA (n=69), G4. BAD type in the PPA (n=122). PMD was defined as worsening by ≥1 point in the motor item of the NIHSS. Results: The prevalence of LPAD in 4 groups was as follows: G1; 12 (5.7%), G2; 48 (29.2), G3; 14 (20.2), G4; 68 (55.7). PMD in 4 groups was as follows: G1; 25 (12.0%), G2; 78 (47.5), G3; 8 (11.5), G4; 42 (34.4). Logistic regression analysis was performed estimating G1 as reference to calculate the odds ratio of each group for PMD. Univariate analysis: G2; 6.7 (P Conclusion: BAD and LPAD were strongly associated each other. Although BAD were significantly correlated with PMD in both territories of LSA and PPA, LPAD was not significantly associated with PMD. BAD, rather than LPAD, appears to be more crucial for PMD in acute PAI patients.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits
Journal of the Neurological Sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Abstract Background Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. Methods We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10 mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Results Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p = 0.0001) and in anterior Pontine Arteries group (OR: 5.32, p = 0.0018). Conclusions Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
Journal of the neurological sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p=0.0001) and in anterior Pontine Arteries group (OR: 5.32, p=0.0018). Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts. Copyright © 2011 Elsevier B.V. All rights reserved.
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Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
Journal of the neurological sciences, 2010Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro Akiguchi, Kotaro OzasaAbstract:Progressive motor deficits (PMD) are common in cerebral penetrating artery disease (PAD) during the acute stage and leads to severe disability. Reliable predictors and stroke mechanism for PMD in PAD have been yet to be elucidated. Moreover, difference of predictors between topographically classified PAD has not ever been systematically studied. Three hundred ninety two consecutive patients with acute PAD (<20 mm) who showed lacunar motor syndrome and admitted within 24 h after onset were selected for this study. Patients were divided into 2 groups whose infarcts were topographically located within the territories of lenticulostriate Arteries (LSA), and anterior Pontine Arteries (APA). Within each of the 2 groups, factors associated with PMD were analyzed. Progressive motor deficits were found in 55 patients (21.0%) in LSA group and 38 patients (29.0%) in APA group. In multivariate analysis, female sex and severity of motor deficit on admission (NIHSS 5 or more) were common independent predictors for PMD in both groups. The specific predictors were single infarcts without concomitant silent lacunar infarcts and preceding TIAs in LSA group and diabetes mellitus in APA group. Predictive factors for PMD were different in the 2 different territory groups. Diabetes mellitus was particularly associated with PMD in APA group.
Ichiro Akiguchi - One of the best experts on this subject based on the ideXlab platform.
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Aggressive antiplatelet treatment for acute branch atheromatous disease type infarcts: a 12‐year prospective study
International journal of stroke : official journal of the International Stroke Society, 2014Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Yoshinari Nagakane, Masahiro Makino, Takashi Koizumi, Naoki Makita, Ichiro AkiguchiAbstract:Penetrating artery infarcts that are predominantly caused by occlusion at the vessel orifices of larger caliber penetrating Arteries by atheromatous plaque can represent a distinctive stroke entity as intracranial branch atheromatous disease (BAD) 1. BAD often shows progressive motor deficits leading to severe disability 2. Thrombolytic therapy by tissue plasminogen activator has not been demonstrated to be effective for BAD 3. We designed a combined use of antiplatelet agents for BAD. During 12 years, 313 consecutive patients with BAD located within the territories of lenticulostriate Arteries (LSAs) and anterior Pontine Arteries (APAs) were prospectively collected. Treatment protocols are as follows: phase 1 (2001–2005, n = 105), the medical treatment that was considered best; phase 2 (2005–2009, n = 104), a combined treatment of argatroban, cilostazol, and edaravone; and phase 3 (2009–20012, n = 104), additional clopidogrel on top of the phase 2 protocol. Functional outcome was assessed by the modified Rankin scale (mRS) at one-month after stroke onset. As a result, in the total population, the phase 2 and the phase 3 showed better outcome than the phase 1 (P = 0·0004 and P
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits
Journal of the Neurological Sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Abstract Background Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. Methods We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10 mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Results Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p = 0.0001) and in anterior Pontine Arteries group (OR: 5.32, p = 0.0018). Conclusions Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
Journal of the neurological sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p=0.0001) and in anterior Pontine Arteries group (OR: 5.32, p=0.0018). Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts. Copyright © 2011 Elsevier B.V. All rights reserved.
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Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
Journal of the neurological sciences, 2010Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro Akiguchi, Kotaro OzasaAbstract:Progressive motor deficits (PMD) are common in cerebral penetrating artery disease (PAD) during the acute stage and leads to severe disability. Reliable predictors and stroke mechanism for PMD in PAD have been yet to be elucidated. Moreover, difference of predictors between topographically classified PAD has not ever been systematically studied. Three hundred ninety two consecutive patients with acute PAD (<20 mm) who showed lacunar motor syndrome and admitted within 24 h after onset were selected for this study. Patients were divided into 2 groups whose infarcts were topographically located within the territories of lenticulostriate Arteries (LSA), and anterior Pontine Arteries (APA). Within each of the 2 groups, factors associated with PMD were analyzed. Progressive motor deficits were found in 55 patients (21.0%) in LSA group and 38 patients (29.0%) in APA group. In multivariate analysis, female sex and severity of motor deficit on admission (NIHSS 5 or more) were common independent predictors for PMD in both groups. The specific predictors were single infarcts without concomitant silent lacunar infarcts and preceding TIAs in LSA group and diabetes mellitus in APA group. Predictive factors for PMD were different in the 2 different territory groups. Diabetes mellitus was particularly associated with PMD in APA group.
Tomoyuki Ohara - One of the best experts on this subject based on the ideXlab platform.
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Aggressive antiplatelet treatment for acute branch atheromatous disease type infarcts: a 12‐year prospective study
International journal of stroke : official journal of the International Stroke Society, 2014Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Yoshinari Nagakane, Masahiro Makino, Takashi Koizumi, Naoki Makita, Ichiro AkiguchiAbstract:Penetrating artery infarcts that are predominantly caused by occlusion at the vessel orifices of larger caliber penetrating Arteries by atheromatous plaque can represent a distinctive stroke entity as intracranial branch atheromatous disease (BAD) 1. BAD often shows progressive motor deficits leading to severe disability 2. Thrombolytic therapy by tissue plasminogen activator has not been demonstrated to be effective for BAD 3. We designed a combined use of antiplatelet agents for BAD. During 12 years, 313 consecutive patients with BAD located within the territories of lenticulostriate Arteries (LSAs) and anterior Pontine Arteries (APAs) were prospectively collected. Treatment protocols are as follows: phase 1 (2001–2005, n = 105), the medical treatment that was considered best; phase 2 (2005–2009, n = 104), a combined treatment of argatroban, cilostazol, and edaravone; and phase 3 (2009–20012, n = 104), additional clopidogrel on top of the phase 2 protocol. Functional outcome was assessed by the modified Rankin scale (mRS) at one-month after stroke onset. As a result, in the total population, the phase 2 and the phase 3 showed better outcome than the phase 1 (P = 0·0004 and P
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits
Journal of the Neurological Sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Abstract Background Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. Methods We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10 mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Results Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p = 0.0001) and in anterior Pontine Arteries group (OR: 5.32, p = 0.0018). Conclusions Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
Journal of the neurological sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p=0.0001) and in anterior Pontine Arteries group (OR: 5.32, p=0.0018). Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts. Copyright © 2011 Elsevier B.V. All rights reserved.
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Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
Journal of the neurological sciences, 2010Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro Akiguchi, Kotaro OzasaAbstract:Progressive motor deficits (PMD) are common in cerebral penetrating artery disease (PAD) during the acute stage and leads to severe disability. Reliable predictors and stroke mechanism for PMD in PAD have been yet to be elucidated. Moreover, difference of predictors between topographically classified PAD has not ever been systematically studied. Three hundred ninety two consecutive patients with acute PAD (<20 mm) who showed lacunar motor syndrome and admitted within 24 h after onset were selected for this study. Patients were divided into 2 groups whose infarcts were topographically located within the territories of lenticulostriate Arteries (LSA), and anterior Pontine Arteries (APA). Within each of the 2 groups, factors associated with PMD were analyzed. Progressive motor deficits were found in 55 patients (21.0%) in LSA group and 38 patients (29.0%) in APA group. In multivariate analysis, female sex and severity of motor deficit on admission (NIHSS 5 or more) were common independent predictors for PMD in both groups. The specific predictors were single infarcts without concomitant silent lacunar infarcts and preceding TIAs in LSA group and diabetes mellitus in APA group. Predictive factors for PMD were different in the 2 different territory groups. Diabetes mellitus was particularly associated with PMD in APA group.
Aiko Tamura - One of the best experts on this subject based on the ideXlab platform.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits
Journal of the Neurological Sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Abstract Background Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. Methods We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10 mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Results Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p = 0.0001) and in anterior Pontine Arteries group (OR: 5.32, p = 0.0018). Conclusions Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
Journal of the neurological sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p=0.0001) and in anterior Pontine Arteries group (OR: 5.32, p=0.0018). Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts. Copyright © 2011 Elsevier B.V. All rights reserved.
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Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
Journal of the neurological sciences, 2010Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro Akiguchi, Kotaro OzasaAbstract:Progressive motor deficits (PMD) are common in cerebral penetrating artery disease (PAD) during the acute stage and leads to severe disability. Reliable predictors and stroke mechanism for PMD in PAD have been yet to be elucidated. Moreover, difference of predictors between topographically classified PAD has not ever been systematically studied. Three hundred ninety two consecutive patients with acute PAD (<20 mm) who showed lacunar motor syndrome and admitted within 24 h after onset were selected for this study. Patients were divided into 2 groups whose infarcts were topographically located within the territories of lenticulostriate Arteries (LSA), and anterior Pontine Arteries (APA). Within each of the 2 groups, factors associated with PMD were analyzed. Progressive motor deficits were found in 55 patients (21.0%) in LSA group and 38 patients (29.0%) in APA group. In multivariate analysis, female sex and severity of motor deficit on admission (NIHSS 5 or more) were common independent predictors for PMD in both groups. The specific predictors were single infarcts without concomitant silent lacunar infarcts and preceding TIAs in LSA group and diabetes mellitus in APA group. Predictive factors for PMD were different in the 2 different territory groups. Diabetes mellitus was particularly associated with PMD in APA group.
Akiko Hosomi - One of the best experts on this subject based on the ideXlab platform.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits
Journal of the Neurological Sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Abstract Background Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. Methods We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10 mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Results Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p = 0.0001) and in anterior Pontine Arteries group (OR: 5.32, p = 0.0018). Conclusions Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts.
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Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits.
Journal of the neurological sciences, 2011Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro AkiguchiAbstract:Small deep brain infarcts are often caused by two different vascular pathologies: 1. atheromatous occlusion at the orifice of large caliber penetrating Arteries termed branch atheromatous disease (BAD) and 2. lipohyalinotic degenerative changes termed lipohyalinotic degeneration (LD). We herein analyze and describe the characteristics of these 2 different pathologies. We studied 394 patients with penetrating artery territory infarcts in the territories of the lenticulostriate Arteries and anterior Pontine Arteries. Radiologically defined BAD of the lenticulostriate Arteries was defined as infarcts with size more than 10mm in diameter on axial slice and visible for 3 or more axial slices, and that of the anterior Pontine Arteries was defined as unilateral infarcts extending to the basal surface of the pons. Within each of the 2 territory groups, differences between BAD and LD were compared. Ninety five patients in the lenticulostriate Arteries group (36.1%) and 78 patients in anterior Pontine Arteries group (59.5%) were classified as BAD. Initial NIHSS, incidence of progressive motor deficits and poor functional outcome were significantly higher and incidence of concomitant silent lacunar infarcts tended to be lower in BAD than LD. In logistic regression analysis, BAD compared with LD was independently associated with PMD, in lenticulostriate Arteries group (OR: 4.21, p=0.0001) and in anterior Pontine Arteries group (OR: 5.32, p=0.0018). Radiologically defined BAD and LD had different characteristics. BAD was significantly associated with progressive motor deficits and considered as a major vascular mechanism of progressive motor deficits in penetrating artery infarcts. Copyright © 2011 Elsevier B.V. All rights reserved.
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Predictive factors for progressive motor deficits in penetrating artery infarctions in two different arterial territories.
Journal of the neurological sciences, 2010Co-Authors: Yasumasa Yamamoto, Tomoyuki Ohara, Masashi Hamanaka, Akiko Hosomi, Aiko Tamura, Ichiro Akiguchi, Kotaro OzasaAbstract:Progressive motor deficits (PMD) are common in cerebral penetrating artery disease (PAD) during the acute stage and leads to severe disability. Reliable predictors and stroke mechanism for PMD in PAD have been yet to be elucidated. Moreover, difference of predictors between topographically classified PAD has not ever been systematically studied. Three hundred ninety two consecutive patients with acute PAD (<20 mm) who showed lacunar motor syndrome and admitted within 24 h after onset were selected for this study. Patients were divided into 2 groups whose infarcts were topographically located within the territories of lenticulostriate Arteries (LSA), and anterior Pontine Arteries (APA). Within each of the 2 groups, factors associated with PMD were analyzed. Progressive motor deficits were found in 55 patients (21.0%) in LSA group and 38 patients (29.0%) in APA group. In multivariate analysis, female sex and severity of motor deficit on admission (NIHSS 5 or more) were common independent predictors for PMD in both groups. The specific predictors were single infarcts without concomitant silent lacunar infarcts and preceding TIAs in LSA group and diabetes mellitus in APA group. Predictive factors for PMD were different in the 2 different territory groups. Diabetes mellitus was particularly associated with PMD in APA group.