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Kurogi R, Nishimura K, Nakai M, Kada A, Kamitani S, Nakagawara J, Toyoda K, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, Nagata I, Matsuda S, Yoshimura S, Okuchi K, Suzuki A, Nakamura F, Onozuka D, Ido K, Kurogi A, Mukae N, Nishimura A, Arimura K, Kitazono T, Hagihara A, Iihara K. Comparing intracerebral hemorrhages associated with direct oral anticoagulants or warfarin. Neurology 2018; 90:e1143-e1149. [PMID: 29490916 PMCID: PMC5880631 DOI: 10.1212/wnl.0000000000005207] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 12/27/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. METHODS We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. RESULTS DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). CONCLUSIONS This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.
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Affiliation(s)
- Ryota Kurogi
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Kunihiro Nishimura
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Michikazu Nakai
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Akiko Kada
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Satoru Kamitani
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Jyoji Nakagawara
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Kazunori Toyoda
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Kuniaki Ogasawara
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Junichi Ono
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Yoshiaki Shiokawa
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Toru Aruga
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Shigeru Miyachi
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Izumi Nagata
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Shinya Matsuda
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Shinichi Yoshimura
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Kazuo Okuchi
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Akifumi Suzuki
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Fumiaki Nakamura
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Daisuke Onozuka
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Keisuke Ido
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Ai Kurogi
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Nobutaka Mukae
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Ataru Nishimura
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Koichi Arimura
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Takanari Kitazono
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Akihito Hagihara
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan
| | - Koji Iihara
- From the Departments of Neurosurgery (R.K., K. Ido, A. Kurogi, N.M., A.N., K.A., K. Iihara), Health Communication (D.O., A.H.), and Medicine and Clinical Science (T.K.), Graduate School of Medical Sciences, Kyushu University; Department of Neuroendovascular Surgery (R.K.), National Hospital Organization, Clinical Research Institute, Kyushu Medical Center, Fukuoka; Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (K.N., M.N.), Integrative Stroke Imaging Centre (J.N.), and Department of Cerebrovascular Medicine (K.T.), National Cerebral and Cardiovascular Center, Suita; Department of Clinical Trials and Research (A. Kada), National Hospital Organization, Nagoya Medical Center; Division of Health Services Research (S.K.), Center for Cancer Control and Information Services, National Cancer Center, Tokyo; Department of Neurosurgery (K. Ogasawara), Iwate Medical University, Morioka; Department of Neurosurgery (J.O.), Sanmu Medical Center; Department of Neurosurgery (Y.S.), Kyorin University, Mitaka; Department of Emergency and Critical Care Medicine (T.A.), Showa University Hospital, Shinagawa; Department of Neurosurgery (S. Miyachi), Osaka Medical College, Takatsuki; Department of Neurosurgery (I.N.), Kokura Memorial Hospital; Department of Preventive Medicine and Community Health (S. Matsuda), School of Medicine, University of Occupational and Environmental Health, Kitakyushu; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya; Department of Emergency and Critical Care Medicine (K. Okuchi), Nara Medical University, Kashihara; Department of Surgical Neurology (A.S.), Research Institute for Brain and Blood Vessels, Akita; and Division of Data Management Center for Cardiovascular Disease Information (F.N.), National Cerebral Cardiovascular Disease Information, Suita, Japan.
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