A Case of Multiple Intracranial Hemorrhages due to a Ruptured Neoplastic Cerebral Aneurysm Secondary to Metastasis of Poorly Differentiated Parotid Gland Carcinoma

Article

Author: Nakata, Hidekazu ; Yamamoto, Kazumi ; Takenaka, Tomofumi ; Fukuya, Syogo ; Wakayama, Akatsuki ; Tateishi, Akihiro ; Taniguchi, Masaaki ; Irizato, Naoki

Neoplastic cerebral aneurysms (NCAs) are rare. This study reported a case of an NCA secondary to a poorly differentiated carcinoma of the parotid gland. An 84-year-old Japanese woman undergoing treatment for parotid gland cancer was admitted to our hospital with headache and progressive loss of consciousness. Based on computed tomography (CT) and CT angiography (CTA), a diagnosis of subarachnoid hemorrhage due to rupture of a left posterior inferior cerebellar artery aneurysm was made, and emergency aneurysmectomy was performed. Pathological examination of the resected aneurysm showed an NCA secondary to parotid carcinoma. After the aneurysmectomy, her condition stabilized; however, 33 days later, the patient developed an intracerebral hemorrhage, and a new aneurysm was confirmed in the right middle cerebral artery. To the best of our knowledge, there have been no previous reports on cases of NCAs secondary to parotid carcinoma. The pathology and clinical course strongly suggest that NCAs derived from malignant tumors may have an aggressive course.

01 Dec 2024·Stroke

Randomized Controlled Trial of Cilostazol Addition for In-Stent Restenosis After Carotid Artery Stenting

Article

Author: Matsumaru, Yuji ; Sakai, Nobuyuki ; Ezura, Masayuki ; Ogasawara, Kuniaki ; Yamagami, Hiroshi ; Ozaki, Tomohiko ; Sasaki, Makoto ; Minematsu, Kazuo ; Sakai, Chiaki ; Nagai, Yoji ; Matsumoto, Yasushi ; Ishihara, Hideyuki ; Nagata, Izumi ; Yoshimura, Shinichi ; Nagatsuka, Kazuyuki

BACKGROUND:Restenosis after carotid artery stenting (CAS) is associated with the risk of developing ischemic stroke. We aimed to evaluate the inhibitory effect of cilostazol addition on in-stent restenosis (ISR) in patients treated with CAS.METHODS:In a randomized, open-label, blind-end point trial, patients with symptomatic and asymptomatic carotid artery stenosis and scheduled for CAS were randomly assigned to adding cilostazol (50 or 100 mg, twice per day) on other antiplatelets from 3 days before CAS or not adding cilostazol. Concomitant use of other antiplatelets was unrestricted. ISR was diagnosed by a peak systolic velocity of at least 1.75 m/s on duplex ultrasonography. The primary outcome was incidence of ISR within 2 years after CAS. Secondary outcomes included occurrences of cardiovascular events or any death and hemorrhagic events.RESULTS: Participants were recruited from December 2010 to September 2015. Although the sample size was initially set to be 900 (450 in each group), 631 patients (mean age 69.9 years, 558 men, 325 in the cilostazol, and 306 in the noncilostazol group) were included in the primary analysis. Within 2 years’ follow-up, ISR occurred in 31 of 325 patients (cumulative incidence 10.8%) in the cilostazol group and 46 of 306 patients (19.6%) in the noncilostazol group (hazard ratio, 0.64 [95% CI, 0.41–1.0]; P =0.056). In the exploratory analysis, incidence of ISR beyond 30 days after CAS was lower in the cilostazol group than in the noncilostazol group (10.3% versus 19.3%; P =0.040). Incidences of cardiovascular events or any death and hemorrhagic events were similar between the groups (6.2% versus 6.7% and 2.3% versus 1.4%, respectively). CONCLUSIONS:The addition of cilostazol to other antiplatelet agents could contribute to the reduction of ISR in the chronic stage of patients who underwent CAS, the authenticity of which depends on further studies with sufficient statistical power.REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01261234.

01 Nov 2024·eClinicalMedicine

Efficacy and safety of adrenomedullin for acute ischemic stroke (AMFIS): a phase 2, randomized, double-blinded, placebo-controlled, clinical trial

Article

Author: Yamaguchi, Eriko ; Tanaka, Tomotaka ; Fukuma, Kazuki ; Ihara, Masafumi ; Nagatsuka, Kazuyuki ; Tanaka, Kenta ; Kitamura, Kazuo ; Tsuji, Masahiro ; Washida, Kazuo ; Hattori, Yorito ; Yoshimoto, Takeshi ; Yamamoto, Haruko ; Abe, Soichiro ; Ishiyama, Hiroyuki ; Omae, Katsuhiro ; Yamagami, Hiroshi ; Minami, Manabu ; Kita, Toshihiro ; Saito, Satoshi

BackgroundAdrenomedullin has angiogenic and vasoprotective effects in acute ischemic stroke (AIS). This investigator-initiated trial aimed to evaluate the safety, efficacy, and optimal administration of adrenomedullin in treating AIS.MethodsIn this single-center, multi-cohort, double-blinded, randomized, placebo-controlled, Phase II trial, patients with AIS received pulsed adrenomedullin (9 ng/kg/min for 8 h daily over 7 days) or placebo in the first-half cohort, and continuous-pulsed adrenomedullin (9 ng/kg/min for 72 h during the first 3 days and 8 h daily between Day 4-7) or placebo in the second-half cohort. We included male and female patients aged 20-90 years with newly confirmed ischemic lesions on diffusion-weighted magnetic resonance imaging, and for whom protocol treatment could be initiated within 24 h of symptom onset. The primary safety endpoint was the occurrence of intervention-related severe adverse events. For the primary efficacy endpoint, the least square means and 95% confidence intervals of National Institutes of Health Stroke Scale (NIHSS) scores up to 7 days post-intervention initiation were calculated using generalized estimating equation models. This trial was registered at Japan Registry of Clinical Trials, jRCT2051190092.FindingsBetween January 16, 2020, and November 14, 2021, 60 patients were enrolled (median [interquartile range] age, 75 [66-81] years; NIHSS score, 3 [2-4]; 21 [35.0%] females). Neither intervention-related serious adverse events nor severe adverse events were observed in patients receiving adrenomedullin. No life-threatening adverse events or deaths were reported. The least square means (95% confidence intervals) of the changes in NIHSS scores from pre-treatment to Day 7 were -0.76 (-1.43 to -0.09) in the adrenomedullin group (-1.08 [-2.17 to 0.00] in the pulsed adrenomedullin group and -0.42 [-1.12 to 0.29] in the continuous-pulsed adrenomedullin group) and -1.08 (-2.11 to -0.05) in the placebo group.InterpretationAdrenomedullin was well tolerated in patients with non-severe, non-embolic AIS, although its beneficial effects were not demonstrated. It is necessary to show the efficacy of adrenomedullin in further clinical trials.FundingJapan Agency for Medical Research and Development.

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