Faculty Profiles - SUGIU Kenji

Papers - SUGIU Kenji

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新世代のCAS 治療適応とデバイス選択頸動脈狭窄症に対する治療法およびデバイスの選択と治療成績

徳永浩司, 杉生憲志, 大熊佑, 伊丹尚多, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 151 - 151 2010.11

バルーン保護下の頸動脈ステント留置術におけるdebrisの組織学的評価

伊丹尚多, 菱川朋人, 大熊佑, 小野成紀, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 4 ( 4 ) 282 - 282 2010.11

Percutaneous Balloon Angioplasty for Acute Occlusion of Intracranial Arteries Reviewed International journal

Koji Tokunaga, Kenji Sugiu, Kimihiro Yoshino, Yoshinori Terai, Takashi Imaoka, Akira Handa, Nobuyuki Hirotsune, Noboru Kusaka, Isao Date

NEUROSURGERY 67 ( 3 ) 189 - 196 2010.9

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited.
OBJECTIVE: To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries.
METHODS: Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed.
RESULTS: The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 x 103 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case.
CONCLUSIONS: Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications.

DOI： 10.1227/01.NEU.0000380954.29925.CE

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脳血管攣縮と脳保護くも膜下出血後脳血管攣縮の基礎

小野成紀, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

Neurosonology 23 ( 増刊 ) 44 - 44 2010.6

脳血管攣縮検出のための簡易型脳内酸素飽和度監視装置INVOSの長所・短所

小野成紀, 有光帥二, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳血管攣縮 25 43 - 46 2010.3

Language：Japanese Publisher：スパズム・シンポジウム事務局

脳血管攣縮(CV)検出のための簡易型脳内酸素飽和度監視装置(INVOS)をくも膜下出血(SAH)術後に頭皮上に装着することにより、CV期における脳血流変化の検知の可能性について検討した。その結果、他の目的におけるINVOSの有用性と同様にCV検知でもINVOSモニターの有用性が示された。また、経時的にASH発症初期・CV期・CV回復期でのそれぞれの脳血流状態がリアルタイムに示されたことは特記すべきことであった。一方、SAH発症期では脳にうっ血性の変化を生じ、回復するに従って局所血流も低下、CV期には更に局所血流が低下して、回復期にはCVの程度、神経学所見と一致したINVOS値の上昇が認められた。一部症例ではSPECTとの比較を行うことができ、INVOS値と実際の脳血流の整合性も確認可能であったが、INVOSセンサー自体が貼付できない、うまくdetectできないなど技術的な問題と、ごく局所のCVや末梢性CVではdetect困難な場合があるなどCVの性質による問題点も挙げられた。以上、これらのことより、INVOSは簡便で非侵襲的な検査法であり、リアルタイムに脳内酸素飽和度の測定が可能で、脳血流モニターとして有用であると考えられた。

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Bioactive coilの中期成績 Cerecyte coilあるいはMatrix2 coilを用いた脳動脈瘤塞栓術の手術手技と治療成績

徳永浩司, 杉生憲志, 西田あゆみ, 大熊佑, 伊丹尚多, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 3 ( 4 ) 145 - 145 2009.11

頸動脈ステント留置術において回収されたdebrisの組織学的検討

伊丹尚多, 大熊佑, 菱川朋人, 西田あゆみ, 小野成紀, 徳永浩司, 杉生憲志, 伊達勲

JNET: Journal of Neuroendovascular Therapy 3 ( 4 ) 292 - 292 2009.11

簡易型脳内酸素飽和度監視装置INVOSによるくも膜下出血後脳血管攣縮の検出

小野成紀, 有光帥二, 小川智之, 菱川朋人, 徳永浩司, 杉生憲志, 伊達勲

脳血管攣縮 24 67 - 69 2009.3

頸部内頸動脈狭窄症におけるCEAとCAS術後の医用画像を用いた患者特異的モデルと仮想モデルの流体力学シミュレーション

早瀬仁志, 中山敏男, 徳永浩司, 杉生憲志, 西田あゆみ, 有光帥二, 菱川朋人, 小野成紀, 太田信, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 297 - 297 2008.11

内頸動脈窩部動脈瘤に対する血管内治療

西田あゆみ, 杉生憲志, 徳永浩司, 早瀬仁志, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 154 - 154 2008.11

無症候性病変の安全な血管内治療はどうあるべきか? 無症候性病変に対する脳神経血管内治療

杉生憲志, 徳永浩司, 西田あゆみ, 早瀬仁志, 平松匡文, 小野成紀, 菱川朋人, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 133 - 133 2008.11

経皮的後頭部皮下静脈穿刺による硬膜動静脈動瘻の塞栓術を施行した一例

平松匡文, 杉生憲志, 徳永浩司, 早瀬仁志, 西田あゆみ, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 277 - 277 2008.11

頸動脈狭窄症に対するAngioguard XPを用いた頸動脈ステント留置術(CAS)の周術期神経学的合併症 GuardWire使用CASの前期および後期の成績と比較して

徳永浩司, 杉生憲志, 西田あゆみ, 平松匡文, 早瀬仁志, 有光帥二, 菱川朋人, 小野成紀, 伊達勲

JNET: Journal of Neuroendovascular Therapy 2 ( 4 ) 160 - 160 2008.11

頸部頸動脈狭窄症 CEA vs CAS 頸動脈狭窄症に対するステント留置術と内膜剥離術治療成績、術後の頸動脈形状、血流速度およびcomputational flow dynamicsの比較検討

徳永浩司, 杉生憲志, 早瀬仁志, 有光帥二, 菱川朋人, 西田あゆみ, 小野成紀, 中山敏男, 太田信, 伊達勲

日本脳神経外科学会総会CD-ROM抄録集 67回 2E - 08 2008.10

Multimodality therapy for cerebral vasospasm after SAH: Importance of intensive care and intraarterial injection of fasudil hydrochloride

Shigeki Ono, S. Arimitsu, T. Ogawa, K. Onoda, K. Tokunaga, K. Sugiu, I. Date

Acta Neurochirurgica, Supplementum ( 104 ) 279 - 281 2008

Language：English Publishing type：Research paper (international conference proceedings) Publisher：Springer-Verlag Wien

Until now, no absolute therapy for cerebral vasospasm (VS) after subarachnoid haemorrhage (SAH) has been established. Here we examine the efficacy of intensive multimodality therapy, contrasting with the treatment in the non-multimodality period in our institute. For 10 years, a total of 108 patients who suffered subarachnoid haemorrhage (SAH) were divided into two groups. Group A patients are from a period of time when there was no particular standardized protocol for treating SAH, i.e. 1996-2000. Group B patients include the intensive care group for treating SAH, and we employed multimodality therapy on Group B by using intraventricular urokinase (UK) injection, lumbar (LD) or cisternal drainages (CD) and timely intraarterial fasudil hydrochloride (FH) injection in the second half of the period with a standardized protocol. Urokinase was given as a bolus administration from a ventricular drain 12 h after surgery, and prophylactic mild hypertension and normovolemia were strictly performed. If symptomatic spasm were detected, immediate intraarterial FH injection or percutaneous transluminal angioplasty was performed. Angiographic and symptomatic vasospasm and the Glasgow outcome scale score 3 months post SAH were evaluated. Angiographic vasospasm occurred in 64.2% and 59% in groups A and B, respectively. Symptomatic vasospasm was observed in 56.5% of Group A and 37.1% of Group B. There was a statistical significance between the percentages of symptomatic vasospasm in Groups A and B (p = 0.0422), but no significant differences were seen in angiographic vasospasm between these 2 groups. As for the outcome, 25.7% of Group A and 10.8% of Group B were poor outcome, and statistical significance (p = 0.001) was seen between these two groups. It is worth noting that there were no deaths due to vasospasm in Group B, in contrast to the 14.8% death rate in Group A. Introduction of multimodality therapy was effective to prevent symptomatic vasospasm and improved the patients' outcome. © 2008 Springer-Verlag.

DOI： 10.1007/978-3-211-75718-5_57

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Continuous evaluation of regional oxygen saturation using invosr for monitoring of cerebral vasospasm after subarachnoid hemorrhage

Shigeki Ono, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of Cerebral Blood Flow and Metabolism 27 ( 1 ) BP55 - 08 2007.11

Language：English Publishing type：Research paper (international conference proceedings)

Objective: There are several tools for detection of cerebral vasospasm (VS) after subarachnoid hemorrhage (SAH), however, transcranial Doppler (TCD) is not always accurate for detecting VS, and microdialysis is, somehow, an invasive method. Although angiography is a gold-standard method to make a diagnosis of VS, it is not continuous and is not a bed-side examination for detecting VS. INVOSR monitoring which measures the regional oxygen saturation (rSO2) by using near inflated spectroscopy has been used for detecting cerebral ischemia during operations as reported elsewhere. We here use this noninvasive monitoring system for detecting cortical ischemia due to VS by measuring the continuous rSO2 after SAH, and determine whether it is useful for detecting VS and beneficial for treatment of VS. Methods: Six patients who suffered from SAH were nominated in this study. The probes of INVOSR (INVOS 5100R, Somanetics Corporation, MI, USA) were attached to the scalp in the areas anticipated to show VS considering the thickness of clots, from day 3 to the end of VS. After clipping or coiling, angiography was routinely performed around day 7 after SAH, or, at the timing if rSO2 continuously decreased by 10% compared to that of the contralateral side, or when the patients showed additional neurological deficits. If VS was detected, interventional treatment was performed using superselective intraarterial injection of Fasudil hydrochloride by microcatheters or percutaneous transluminal angioplasty if possible. This performance was once in a day at a maximum, and if the patients deteriorated the next day, the interventional therapy was repeatedly performed until the neurological deficits recovered. Results: The locations of ruptured aneurysms were 2 distal anterior cerebral artery, and 2 internal carotidposterior communicating artery, one middle cerebral artery, and one basilar artery-superior cerebral artery. Angiographic VS was seen in 4 of 6 patients. Symptomatic VS was seen in 2 of the patients having angiographic VS. Generally, INVOS value was around 70-65 in the both side in the early phase of the hemorrhagic attack, and then, gradually stabilized around the value of 60 from around the day 4 to 6. When INVOS value became less than 55, angiographic or symptomatic VS tended to occur. Recovery from ischemia seen on angiography or single photon emission CT also correlated with reincrease of rSO2 by INVOSR. Discussion: INVOSR is handy and noninvasive monitor for detecting VS after SAH. And it also evaluates chronological real-time rSO2 in the region of VS. This monitoring system may be superior to the conventional monitoring systems such as TCD or single photon emission CT.

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When cerebral vasospasm after subarachnoid hemorrhage begins and ends?: Definition of vasospasm using angiography

Shigeki Ono, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Isao Date

Journal of Cerebral Blood Flow and Metabolism 27 ( 1 ) BP54 - 09 2007.11

Language：English Publishing type：Research paper (international conference proceedings)

Cerebral vasospasm (VS) after subarachnoid hemorrhage (SAH) is one of the fatal strokes causing severe brain ischemia. So far, many types of treatments for VS have been applied, such as triple H therapy, clot fibrinolysis, spinal drainage, endovascular treatment, or administration of vasodilatory agents, but its pathophysiology has been still unknown, and absolute therapeutic strategies have not been established yet. One of the reasons why the strategies of VS treatment has not been confirmed is that clear definition of VS has not given until now. For instance, there are many cases which have no symptoms while these patients have obvious angiographic VS, or it is difficult to distinguish between real VS symptoms and neurological deterioration due to fever, abnormal blood levels of electrolytes, primary brain damages from SAH. Therefore, incidence of VS and the timing of its treatment are sometimes different among each facility. From 2000, we define VS as angiographic VS in our institute. When symptomatic VS is suspected clinically, emergency angiography is immediately performed and confirm VS. And then if necessary, endovascular therapy is given. Even if there are no VS symptoms during spasm periods, we routinely perform angiography on around day 7 as shown in the following protocol (see table). Under this protocol, angiographic VS was seen in 59.7% of the 57 patients, while, symptomatic VS was seen in 37.1%. In this study, we discuss the advantages of this definition of VS by angiography. Table: A. Treatment after surgery 1) Drains(always inserted) Ventricular drainage (VD) + cisternal (CD) or lumber drainage (LD) 2) Fibrinolysis UK 30,000IU/day, injected through VD Repeated if necessary by Day 4 3) General management(under strict control) Normo-hypertension, normovolemia (≧120mmHg, CVP≒8-10) Hct(≦9.0mg/dl), ICP(≧20mmH2O),and electrolytes(≧130meq/L) Ozagrel Na (i.v.) Fasudil (i.v.) 4) Intravascular treatment (if severe angiographic VS was detected.) Fasudil (i.a.) Percutaneous transluminal angioplasty (PTA) B. Detection of VS 1) TCD monitor 2) Neurological changes 3) Angiography When TCD or neurological changes are detected On day 7 (routine exam.) 4) INVOS5100R(Somanetics, USA): 2005∼ Near infrared spectroscopy, measuring rSO2.

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A case of a ruptured vertebral artery dissecting aneurysm recanalized after internal trapping Reviewed

Yoichiro Kikuchi, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Takushi Nishimura, Isao Date

NEUROLOGICAL SURGERY 35 ( 8 ) 813 - 819 2007.8

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

A 35-year-old male experienced a sudden onset of severe headache. A CT scan revealed subarachnoid hemorrhage. By cerebral angiography, he was diagnosed as having a ruptured right vertebral artery dissecting aneurysm (VADA). It was successfully treated by endovascular occlusion of the affected site, including the aneurysm and parent artery, by using detachable coils. A follow-up angiography obtained seven months after the first treatment revealed the recanalization of the right vertebral artery and dissected aneurysm in an antegrade fashion. A skull X-ray image was useful for detecting the change in appearance of the coils. The second embolization was successfully performed in the same manner Based on this rare case, the authors emphasize that a careful angiographic analysis and complete internal trapping of the dissecting site are important in the treatment of the ruptured VADA.

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Endovascular treatment of adult pial arteriovenous fistula Reviewed

Naohisa Itami, Kenji Sugiu, Koji Tokunaga, Shigeki Ono, Keisuke Onoda, Isao Date

NEUROLOGICAL SURGERY 35 ( 6 ) 599 - 605 2007.6

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：IGAKU-SHOIN LTD

The authors report a case of adult pial arteriovenous fistula successfully treated by endovascular glue embolization. A 65-year-old man presented with left hemiparesis and was admitted to the local hospital. Computed tomography scan showed a cerebral hematoma. Cerebral angiography revealed pial single-channel arteriovenous fistula at the right angular artery. An emergent craniotomy was performed and hematoma was successfully evacuated on the next day. Since the post-operative angiography revealed a persisting arteriovenous fistula, the patient was referred to our institute for additional treatment. With the patient under local anesthesia, endovascular treatment was performed through the trans-femoral artery approach. A flow-guided microcatheter was successfully navigated just proximal to the fistula site. Histoacryl was then injected, and complete obliteration of the fistula was obtained. The subsequent course was uneventful and the patient returned to his daily life with only very mild left hemiparesis. Endovascular glue embolization plays an important role in the treatment of pial arteriovenous fistula.

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[Preoperative assessment of microvascular decompression for hemifacial spasm with fusion imaging of 3D MR cisternogram/angiogram]. Reviewed

Onoda K, Satoh T, Miyosnhi Y, Tokunaga K, Sugiu K, Date I

No shinkei geka. Neurological surgery 34 ( 8 ) 785 - 791 2006.8

Language：Japanese Publishing type：Research paper (scientific journal)

The preoperative assessment of microvascular decompression (MVD) for hemifacial spasm has been performed with MRI, but assessment of the compressive status by 2D imaging has a number of limitations. We used a fusion image of the 3D MR cisternogram and co-registered 3D MR angiogram, reconstructed from MR cisternogram, obtained by 3D fast spin-echo sequence, and MR angiography, 3D time-of-flight and spoiled-gradient recalled sequences, for the preoperative assessment of the offending artery in 10 patients with hemifacial spasm. The anatomical relationship of the nerve-vessel complex was assessed on the simulated images, and compared with the intraoperative findings. The fusion image of the 3D MR cisternogram/angiogram depicted contours of the brain, nerves, and vessels clearly, and that allowed precise assessment of the pathogenic compression of the facial nerve by the offending vessels, comparative to the operative findings. The fusion imaging of the 3D MR cisternogram/angiogram may provide useful information in the surgical planning of MVD for hemifacial spasm.

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