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Backgrounds and Purpose: Neurological worsening often occurs in patients with acute perforating artery infarction including branch atheromatous disease (BAD) against antithrombotic therapies, leading to poor functional outcomes. However, the effective antithrombotic therapy has not been established. The purpose of our study was to clarify acute treatment strategies for perforating artery infarction at primary stroke centers (PSCs) in Japan. Methods: We conducted a web survey at 500 PSCs. We provided clinical information and DWI images of different perforating artery infarction cases such as lacunar stroke and BAD and asked acute treatment strategies in each case. Results: The response rate from PSCs was 38%. In cases with NIHSS 3 and 6 hours after stroke onset, dual antiplatelet therapy (aspirin+clopidogrel) was selected only in about 10% as initial treatments in BAD cases, whereas a combination therapy of 2 or more antiplatelets plus anticoagulants (mainly argatroban) was selected in about 70% of BAD cases and in 25% of lacunar stroke cases. A further antithrombotic agent was added on neurological worsening in approximately half of PSCs, which selected 2 or more antiplatelets plus anticoagulants for BAD cases. In a BAD case with NIHSS 6 and 2 hours of stroke onset, intravenous tPA was selected in 87%. At early neurological worsening after thrombolysis, 35% of PSCs answered that they initiated antithrombotic agents within 24 hours after thrombolysis. Conclusion: At most of PSCs in Japan, more aggressive antithrombotic therapies beyond current stroke treatment guideline may be conducted, especially for BAD.

There is ample epidemiological and animal-model evidence suggesting that intestinal inflammation is associated with the development of Parkinson’s disease (PD). Leucine-rich α2 glycoprotein (LRG) is a serum inflammatory biomarker used to monitor the activity of autoimmune diseases, including inflammatory bowel diseases. In this study, we aimed to investigate whether serum LRG could be used a biomarker of systemic inflammation in PD and to help distinguish disease states. Serum LRG and C-reactive protein (CRP) levels were measured in 66 patients with PD and 31 age-matched controls. We found that serum LRG levels were statistically significantly higher in the PD group than in the control group (PD: 13.9 ± 4.2 ng/mL, control: 12.1 ± 2.7 ng/mL, p = 0.036). LRG levels were also correlated with Charlson comorbidity index (CCI) and CRP levels. LRG levels in the PD group were correlated with Hoehn and Yahr stages (Spearman’s r = 0.40, p = 0.008). LRG levels were statistically significantly elevated in PD patients with dementia as compared to those without dementia (p = 0.0078). Multivariate analysis revealed a statistically significant correlation between PD and serum LRG levels after adjusting for serum CRP levels, and CCI (p = 0.019). We conclude that serum LRG levels could be considered a potential biomarker for systemic inflammation in PD.

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Background: It is generally believed that patientswith acute stroke with ASPECT score (ASPECTS) ≥6 benefit from endovascular thrombectomy.OBJECTIVE:The purpose of the study was to examine the benefit of endovascular thrombectomy for stroke patients with low ASPECTS. Materials and Methods: Among 425 consecutive stroke patients treated with endovascular recanalization for occlusion of the anterior circulation at our hospital from March 2007 to June 2018, those with ASPECTS≤6 were included in the study. These patients were classified into three groups based on ASPECTS of 6 (APS6), 5 (APS5), and ≤4 (APS4). Preprocedural factors, procedures, and angiographic and clinical outcomes were compared among the three groups. Results: A total of 125 patients were included in the analysis, with 48, 39, and 38 in the APS6, APS5, and APS4 groups, respectively. Median age (75, 77, and 80 years), median DWI-ASPECTS (5, 3, and 3), sparing of pyramidal tract (33, 20, and 8), median baseline NIHSS (21, 23, and 23), occluded site (ICA-MCA: 16-32, 16-23, and 19-19), median onset to door time (128, 204, and 220 min), median door to puncture time (98, 74, and 74 min), intravenous rt-PA (8, 6, and 5), median door to recanalization time (94, 76, and 90 min), median onset to recanalization time (326, 350, and 399 min), complete recanalization (TICI 2b/3: 38, 30, and 24), and median onset to recanalization time (326, 350, and 399 min) did not differ significantly among the three groups. However, the APS4 group had a lower favorable outcome rate (mRS 0-2 at 3 months: 25%, 21%, and 7.8%) and a higher cerebral herniation rate (6.3%, 5.1%, and 18%). Conclusions: Caution is required regarding the indication for endovascular thrombectomy in stroke patients with ASPECTS≤4 because these patients may have a lower favorable outcome rate and a higher rate of cerebral herniation.