陶山 謙一郎

Background Administration of andexanet alfa has shown to achieve hemostatic efficacy in factor Xa inhibitor (FXai)-associated intracranial hemorrhage (ICrH). Code stroke (CS), implemented through the visual task management application Task Calc. Stroke (TCS) facilitates timely reperfusion therapy for acute ischemic stroke. However, the association between TCS-based CS and in-hospital treatment time of andexanet for FXai-associated ICrH remains unknown. Methods In this single-center retrospective study, patients with FXai-associated ICrH who received andexanet were enrolled from May 2022 to May 2025. TCS was activated via prehospital notification when patients presented with at least one of the clinical symptoms including face dropping, arm weakness, or speech difficulty with a time from onset or last known well of <24 h. Multivariable linear regression was performed to investigate the association between TCS-based CS and door-to-andexanet administration time. Results Forty-two patients (22 men, median age 80 years) were included. The primary location of hemorrhage was intracerebral ( n  = 26), epidural/subdural ( n  = 8), or subarachnoid ( n  = 8). Among them, 17 (41.5%) were treated with TCS-based CS. The door-to-andexanet administration time was shorter in patients treated with TCS-based CS compared to those without (90 min vs. 132 min, p  < 0.01). Multivariable analysis showed that TCS-based CS was associated with door-to-andexanet administration time (Exp [ β ] 0.58, 95% confidence interval 0.43–0.77) after adjustment with arrival during regular hours and baseline hematoma volume. Conclusion TCS-based CS was associated with a shorter door-to-andexanet administration time for FXai-associated ICrH. The outcome benefit from improved treatment times warrants further investigation.

BACKGROUND: This study evaluated the safety and efficacy of a treatment strategy for Posterior communicating artery (PCOM) aneurysms using first-line Woven EndoBridge (WEB), supplemented by Flow diverter (FD) in selected cases. METHODS: This retrospective study included patients who underwent endovascular treatment for PCOM aneurysms between January 2021 and March 2025. Aneurysms were categorized as fetal or non-fetal. A first-line WEB strategy was adopted when morphology was suitable. Radiological and clinical outcomes were assessed. RESULTS: Forty-six PCOM aneurysms met the criteria: 14 fetal-type and 32 non-fetal-type. All previously untreated fetal-type aneurysms were treated with WEB (n = 9). In the non-fetal group, the initial treatments included WEB (n = 14), FD (n = 10), and coiling (n = 4). All recurrent fetal-type aneurysms were retreated with FD (n = 5), whereas non-fetal recurrences were managed with FD (n = 3) or coiling (n = 1), depending on prior treatment. At a median follow-up of 21 months, complete occlusion was achieved in 66.7% of fetal-type and 59.4% of non-fetal-type aneurysms (P = 0.739), and adequate occlusion was achieved in 75.0% and 90.6%, respectively (P = 0.321). Retreatment was required in two cases (4.3%): one in the fetal group (7.1%) and one in the non-fetal group (3.1%) (p = 0.512). No modified Rankin Scale worsening or major complications occurred. No significant differences in treatment efficacy were observed among modalities selected under the WEB first-line strategy. CONCLUSION: A first-line WEB strategy is safe and effective for PCOM aneurysms, including fetal-type variants, with outcomes for fetal-type aneurysms comparable to non-fetal-type aneurysms.

Purpose Digital subtraction angiography (DSA) is the gold standard for follow-up evaluation of intracranial aneurysms treated with the Woven EndoBridge (WEB) device. This study aimed to assess the efficacy of high-resolution CT angiography (HR-CTA) as a less invasive alternative by comparing its diagnostic performance with that of DSA. Methods This single-center retrospective study analyzed the angiographic and clinical data of patients treated with the WEB device for cerebral aneurysms between January 2021 and December 2024. Patients who underwent HR-CTA within 2 weeks before or after follow-up DSA were included. Occlusion status was assessed using the Bicêtre Occlusion Scale Score (BOSS) and binary classification. The concordance rate between HR-CTA and DSA was evaluated. Results A total of 54 eligible examinations were identified. Using the BOSS, 46 examinations were concordant, resulting in an agreement rate of 85.2%. The Cohen’s κ coefficient was 0.81 (95% CI 0.69 to 0.93), indicating a very high level of agreement. All discordant cases resulted from HR-CTA overestimating occlusion status; however, HR-CTA accurately identified aneurysm remnants. Univariate analyses identified BOSS 0’ as the only significant factor contributing to discrepancies. In the binary evaluation, all 54 examinations were fully concordant (κ=1.00, 95% CI 1.00 to 1.00). Conclusions HR-CTA demonstrated a high concordance rate with DSA for evaluating occlusion status after WEB placement. Its reliable assessment of aneurysm remnants suggests HR-CTA could serve as a practical and less invasive alternative to DSA in follow-up evaluations.