Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan

Yoneda, Yukihiro; Uehara, Toshiyuki; Yamasaki, Hiroshi; Kita, Yasushi; Tabuchi, Mototsugu; Mori, Etsuro

doi:10.1161/01.str.0000056171.55342.ff

Cited by 97 publications

(128 citation statements)

References 54 publications

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“…Edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one, MCI-186, Radicut; Mitsubishi Tanabe Pharma Corporation, Osaka, Japan) was the first neuroprotective drug to be introduced worldwide and, since 2001, has been used in Japan to treat patients with cerebral infarction (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

Beyond neurological disease: New targets for edaravone (Review)

Kikuchi¹,

Uchikado²,

Miyagi³

et al. 2011

Int J Mol Med

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Section: Introductionmentioning

confidence: 99%

Beyond neurological disease: New targets for edaravone (Review)

Kikuchi¹,

Uchikado²,

Miyagi³

et al. 2011

Int J Mol Med

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“…Although lens and maximum local skin doses were far less than the thresholds for deterministic effects, since radiation risks would be increased in repeated CT examinations, efforts should be devoted to dose reduction in stroke CT examinations. Most patients with suspected stroke undergo either CT or MRI as the initial diagnostic examination [1,2]. MRI has some advantages over CT in depicting stroke lesions; however, the provision of MR scanners in general hospitals is still low, an examination takes more time and patients with pacemakers cannot undergo MRI examinations.…”

mentioning

confidence: 99%

“…Most patients with suspected stroke undergo either CT or MRI as the initial diagnostic examination [1,2]. MRI has some advantages over CT in depicting stroke lesions; however, the provision of MR scanners in general hospitals is still low, an examination takes more time and patients with pacemakers cannot undergo MRI examinations.…”

mentioning

confidence: 99%

Radiation dose evaluation in multidetector-row CT imaging for acute stroke with an anthropomorphic phantom

Yamauchi-Kawara

Fujii²,

Aoyama³

et al. 2010

BJR

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ABSTRACT. This study evaluated radiation dose and dose reduction in CT imaging for acute stroke. Radiation doses in three types of CT imaging (i.e. non-contrast-enhanced CT, CT perfusion (CTP) and CT angiography (CTA)) were measured with an in-phantom dosimetry system for 4-, 16-and 64-detector CT scanners in 5 hospitals. To examine the relationship between image quality and radiation dose in CTA, image contrast-to-noise ratio was evaluated. Doses to the brain, lens, salivary glands and local skin obtained with scan protocols in routine use were: 42-71 mGy, 30-88 mGy, 3.9-7.3 mGy and 40-97 mGy in non-contrast-enhanced CT; 41-75 mGy, 9.9-10 mGy, 1.5-2.1 mGy and 107-143 mGy in CTP; and 8.2-55 mGy, 26-69 mGy, 2.0-73 mGy and 32-72 mGy in CTA. For the combination of these CT examinations, on average a patient would receive 236 mGy for the maximum local skin dose and 4.2 mSv for the effective dose evaluated by the International Commission on Radiological Protection (ICRP) 103. Effective doses in CTP in this study were less than those obtained with representative protocols of Western countries. Average effective doses in each CT examination were not more than 1.5 mSv. The use of reduced kV and a narrow scan range would be effective in dose reduction of CTA and CTP, and intermittent scanning would be essential in CTP. Although lens and maximum local skin doses were far less than the thresholds for deterministic effects, since radiation risks would be increased in repeated CT examinations, efforts should be devoted to dose reduction in stroke CT examinations. Most patients with suspected stroke undergo either CT or MRI as the initial diagnostic examination [1,2]. MRI has some advantages over CT in depicting stroke lesions; however, the provision of MR scanners in general hospitals is still low, an examination takes more time and patients with pacemakers cannot undergo MRI examinations. While CT techniques carry the risk of radiation exposure, CT scanners are nearly always available [3] and scans can be done quickly. Schramm et al [4] have reported that CT images obtained by the combination of various CT examinations allow diagnostic assessment of acute stroke with a quality comparable with that of stroke MRI. So CT examination has some advantages for the diagnosis of acute stroke patients who have no time to lose.The diagnostic CT examination for acute stroke generally requires three imaging techniques: non-contrast-enhanced CT of the head; CT perfusion (CTP); and CT angiography (CTA) of intracranial vessels. In these CT examinations the local skin dose in CTP might be considerably high. In a previous study we reported that the maximum skin dose was as high as 712 mGy, 13 times higher than that in non-contrast-enhanced CT of the head [5]. Although the latest multidetector-row CT (MDCT) scanners have a dose reduction function of intermittent scanning or shuttle scanning, detailed patient doses using the function have not been reported.The CTA technique has been developing with great potential owing to high scan speed and ...

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“…6) However, the precise mechanism of neuroprotection afforded by MCI-186 remains obscure. Therefore, in the present study, we attempted to clarify whether MCI-186 might directly provide neuroprotection against I/R injury by inhibiting lipid peroxidation in cultured neural cells.…”

mentioning

confidence: 99%

MCI-186 (3-Methyl-1-phenyl-2-pyrazolin-5-one) Attenuated Simulated Ischemia/Reperfusion Injury in Cultured Rat Hippocampal Cells

Xin-sheng

Wang

et al. 2006

Biological & Pharmaceutical Bulletin

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The reactive oxygen species and Ca 2؉ overload play a critical role in ischemia/reperfusion (I/R) injury. MCI-186 has potent effects in the brain as a free radical scavenger in ischemia-reperfusion. Acute glucose-oxygen deprivation and subsequent reoxygenation were used to model ischemia/reperfusion injury in cultured hippocampal cells. MCI-186 reduced malondialdehyde level and raised the SOD activity when applied upon reoxygenation in a dose-dependent manner compared with the untreated group. The peak neuroprotective effects occurred at 100 and 300 m mM. Intracellular free calcium concentration ([Ca 2؉ ] i ) was significantly reduced in the 100 m mM MCI-186-treated group compared to the untreated group (32.5؎4.0 versus 50.2؎3.6, pϽ0.01). Treatment with 100 m mM MCI-186 significantly inhibited the decrease of mitochondria membrane potential after simulated ischemia/ reperfusion (204؎11.6% compared with the untreated group, pϽ0.01). Cell apoptotic rate was significantly decreased following MCI-186 treatment from 33.7؎2.3% (untreated group) to 16.6؎1.4% (100 m mM MCI-186 treated group). There was no significantly protective difference between 100 and 300 m mM MCI-186. MCI-186 effectively protects neuron injury after simulated ischemia/reperfusion by inhibiting lipid peroxidation, reducing Ca 2؉ overload, elevating mitochondria membrane potential, and decreasing apoptosis.

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Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan

Cited by 97 publications

References 54 publications

Beyond neurological disease: New targets for edaravone (Review)

Beyond neurological disease: New targets for edaravone (Review)

Radiation dose evaluation in multidetector-row CT imaging for acute stroke with an anthropomorphic phantom

MCI-186 (3-Methyl-1-phenyl-2-pyrazolin-5-one) Attenuated Simulated Ischemia/Reperfusion Injury in Cultured Rat Hippocampal Cells

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