Spontaneous T wave alternans in Brugada syndrome. A 43-year-old man with an episode of syncope showed ECG patterns of coved-type ST elevation in leads V1-V3 and right bundle branch block pattern. The patient had spontaneous T wave alternans at baseline, and T wave alternans diminished with distinct development of ST elevation after administration of Na+ channel blocker, and during oral glucose load and atrial pacing. Na+ channel mutation may contribute to the genesis of his ECG changes.

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In the final stage of coil embolization, microcatheter kickback often occurs and it may be difficult to fill the remaining space with a coil. To avoid microcatheter kickback and achieve successful embolization, soft type coils such as ED coil-10 Extra Soft type R (EDC-10ES) are frequently used as a finishing coil. We compared six different brands of finishing coils to evaluate the efficacy of EDC-10ES. Case Presentations: This paper presents a representative case of small cerebral aneurysm treated with only EDC-10 ES coils were presented. Furthermore, to compare the degree of coil softness and microcatheter kickback, we verified the in vitro coil performance of six different brands of finishing coils. The first experiment compared the degree of microcatheter kickback in the final stage of coil embolization and the second experiment tested the softness of the delivery wire. Conclusion: The results verified that EDC-10 ES has less microcatheter kickback in relation to both the coil and delivery wire, compared to the other finishing coils. Consequently, EDC-10 ES was evaluated as a coil with extremely high softness, allowing stable coil placement in the final stage of embolization.

profile visualized intraluminal support (LVIS) Jr. was useful, and review its usefulness and tips. Case Presentations: Case 1: A 75-year-old male with a left internal carotid-posterior communicating (IC-PC) aneurysm (maximum diameter: 11 mm, neck diameter: 7.0 mm). The posterior communicating (P-com; 2.3 mm) had branched from the aneurysmal dome. Stent-assisted coil embolization (SACE) was performed by inserting an LVIS Jr. 3.5 × 28 on the fetal-type posterior cerebral artery (PCA). P-com side and an LVIS Jr. 3.5 × 18 on the internal carotid artery (ICA) side (T-stent technique). Case 2: An 80-year-old female with a right IC-PC aneurysm (maximum diameter: 6.0 mm, neck diameter: 5.4 mm). The P-com (2.2 mm) had branched from the aneurysmal dome. SACE was performed by inserting an LVIS Jr. 2.5 × 13 on the fetal-type PCA. P-com side and a Neuroform Atlas 4.5 × 21 on the ICA side. Case 3: A 61-year-old female with a left vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysm (maximum diameter: 6.4 mm, neck diameter: 5.6 mm, PICA diameter: 2.2 mm). SACE was performed by inserting an LVIS Jr. 2.5 × 13 on the PICA side and an LVIS Blue 4.5 × 23 on the VA side. Conclusion: The T-stent technique with an LVIS Jr. was useful for achieving neck formation for a wide-necked aneurysm directly branching from an aneurysm or preserving branches measuring ≥2 mm in diameter. We reported its tips.

We investigated the safety and efficacy of consciousness sedation with dexmedetomidine (DEX) during the endovascular treatment of patients with acute cerebral infarction. Between April 2014 and November 2016, 38 stroke patients underwent endovascular thrombectomy (EVT) under local anesthesia and DEX consciousness sedation. The continuous intravenous administration of low-dose DEX (0.3–0.4 μg/kg/h) was started before entering the operating room. Patients not completely immobilized received an iv bolus of pentazocine (PTZ) and/or DEX (0.5–0.6 μg/kg/h). EVT was performed using a stent retriever and/or direct thrombo-aspiration. DEX sedation was stopped as soon as the operation was finished. A stent retriever was used in 8 (21.1%), direct thrombo-aspiration in 10 (26.3%), a stent retriever plus thrombo-aspiration in 14 (36.8%), and other devices in 6 patients (15.8%). Reperfusion exceeding 50% (thrombolysis in cerebral infarction >2b) was obtained in 30 patients (78.9%). DEX sedation alone immobilized 24 patients (63.2%), 14 (36.8%) required the additional injection of DEX or PTZ when EVT devices were navigated to the lesion. The administration of DEX and PTZ elicited no significant respiratory depression or cardiac dysfunction interfering with the procedures. Consciousness sedation by DEX was effective during the endovascular treatment of acute stroke patients. Under DEX sedation and the injection of PTZ, EVT was possible without significantly changing the patients’ vital signs.