Faculty Profiles - SUGIU Kenji

Comparison between Spinal Dural Arteriovenous Fistula and Spinal Epidural Arteriovenous Fistula Reviewed

Masafumi Hiramatsu, Kenji Sugiu, Takao Yasuhara, Tomohito Hishikawa, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai, Isao Date

Journal of Neuroendovascular Therapy 13 ( 3 ) 114 - 119 2019

Recurrent Risk of Posterior Communicating Artery-preserving Coil Embolization for Internal Carotid Artery-Posterior Communicating Artery Aneurysm Reviewed

Masafumi Hiramtasu, Kenji Sugiu, Tomohito Hishikawa, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Satoshi Murai

Surgery for Cerebral Stroke 47 ( 3 ) 167 - 173 2019

Changing paradigms of periprocedural antithrombotic therapy in neuroendovascular therapy: Analysis of JR-NET 3

Yukiko Enomoto, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators, Daisuke Mizutani, Shinichi Yoshimura, Nobuyuki Sakai, Nobuyuki Sakai, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura

Neurologia Medico-Chirurgica 59 ( 7 ) 247 - 256 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

To evaluate the changing paradigms of periprocedural antithrombotic management in neuroendovascular therapy in Japan, we analyzed the details of the current periprocedural antithrombotic therapy and compared it with those of the previous generations. We retrospectively analyzed the data from the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey in Japan for neuroendovascular therapy between January 2010 and December 2014. A total of 26,233 patients underwent endovascular treatments to usually perform periprocedural antithrombotic therapy were retrospectively analyzed. We compared the results of JR-NET 3 with those of JR-NET 1 (January 2005 and December 2007) and JR-NET 2 (January 2008-December 2009). Post-procedural anticoagulant therapy was less utilized in JR-NET 3 than in JR-NET 2 (53.9% vs. 60.6%, P &lt
0.001). Pre-procedural antiplatelet therapy became more frequent and more intensive with each generation. The frequency of aggressive therapy (dual, and triple or more therapy) was 65.2% in JR-NET 3, which was significantly higher than that of JR-NET 1 and JR-NET 2 (41.5% and 61.2%, respectively, P &lt
0.001). However, periprocedural ischemic complications (2.0% vs. 5.8%, P &lt
0.001) significantly increased, despite aggressive antiplatelet therapy. Neuroendovascular periprocedural antithrombotic therapy is focused more on antiplatelet therapy than on anticoagulant therapy. Currently, antiplatelet therapy is more frequently used with a larger number of multiple agents, however, periprocedural ischemic complications significantly increased.

DOI： 10.2176/nmc.st.2018-0265

Real-world experience of carotid artery stenting in Japan: Analysis of 8458 cases from the JR-NET3 nationwide retrospective multi-center registries

Ryo Tokuda, The Japanese Registry of NeuroEndovascular Therapy (JR-NET) investigators, Shinichi Yoshimura, Kazutaka Uchida, Kiyofumi Yamada, Tetsu Satow, Koji Iihara, Nobuyuki Sakai, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada

Neurologia Medico-Chirurgica 59 ( 4 ) 117 - 125 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

We aimed to clarify the outcomes of carotid artery stenting (CAS) in the Japanese population. For this purpose, we reviewed data from the Japanese Registry of NeuroEndovascular Therapy 3 (JR-NET3), a retrospective, nation-wide, multi-center, observational study of neuroendovascular treatments in Japan. Of the 9207 patients who underwent CAS between January 2010 and December 2014, 8458 satisfied the inclusion criteria for our analysis. The outcome statistics of this JR-NET3 cohort were compared to those of JR-NET1 and 2 cohorts fitting the same inclusion criteria. Of the 8458 JR-NET3 patients analyzed, 8042 (95.1%) were treated by surgeons with board certification from the Japanese Society for NeuroEndovascular Therapy. Technical success was achieved in 8417 patients (99.5%), whereas 198 patients (2.3%) had clinically significant complications (CSCs). These findings mirrored those obtained for the JR-NET1 and 2 cohorts. On multivariate analysis, risk factors for CAS-associated CSC included symptomatic lesion [odds ratio (OR), 1.91
95% confidence interval (CI), 1.23-3.00
P = 0.003] and hypoechoic lesion on carotid artery ultrasound (OR, 1.85
95% CI, 1.21-2.84
P = 0.005), whereas use of closed-cell stents was a predictor of better outcome (OR, 0.53
95% CI, 0.35-0.79
P = 0.002). The findings of JR-NET3 reflect good outcomes of CAS, but non-modifiable risk factors reflecting lesion characteristics remain of concern. Using closed-cell stents is advisable. Technological advances such as the introduction of new materials may help further improve CAS outcomes in Japanese patients.

DOI： 10.2176/nmc.st.2018-0264

Japanese surveillance of neuroendovascular therapy in JR-NET - part ii. Japanese registry of neuroendovascular treatment 3. main report

Nobuyuki Sakai, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators, Kazutaka Uchida, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Shinichi Yoshimura, Hirotoshi Imamura, Chiaki Sakai, Yuji Matsumaru, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Akira Ishii, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yasushi Matsumoto, Ichiro Nakahara, Kenji Sugiu, Tomoaki Terada

Neurologia Medico-Chirurgica 59 ( 3 ) 106 - 115 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

This study, following Japanese Registry of NeuroEndovascular Treatment 1 and 2 (JR-NET 1 &amp
2), shows an annual trend of cases including adverse events and clinical outcomes at 30 days after NET. JR-NET3 was registered by 749 cumulative total number of physicians, certified by the Japanese Society of Neuroendovascular Therapy in 166 centers, between 2010 and 2014. Medical information about the patients was anonymized and retrospectively registered through a website. A total of 40,177 patients were recruited, 632 patients were excluded because data of preprocedural status were not available. So we analyzed 39,545 patients retrospectively. The proportion of octogenarians is increasing year-by-year and 14.7% in 2014 compared with 10.4% in 2010. Most frequent target disease is intracranial aneurysm. For the proportion of the treatment of intracranial aneurysm, 50.0% in 2010, but that has decreased to 44.8% in 2014. However, number of procedures were increased from 3150 in 2010 to 3419 in 2014. Although before the positive clinical evidence of mechanical thrombectomy for acute ischemic stroke (AIS) was established, the proportion of endovascular treatment for AIS increased 13.8% in 2014 compared with 6.3% in 2010. The number of patients requiring neuroendovascular treatment in Japan is increasing since 2010-2013, but that declined a little in 2014 caused by study operation suspended at the end of 2013. The outcomes of such therapy are clinically acceptable. Details of each type of treatment will be investigated in sub-analyses of the database.

DOI： 10.2176/nmc.oa.2018-0267

Endovascular therapy for ruptured vertebral artery dissecting aneurysms: Results from nationwide, retrospective, multi-center registries in Japan (JR-NET3)

Hajime Nakamura, Toshiyuki Fujinaka, Takeo Nishida, Haruhiko Kishima, Nobuyuki Sakai, Koji Iihara, Tetsu Satow, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshio Higashi, Masaru Hirohata, Akira Ishii, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura, JR-NET3 study group

Neurologia Medico-Chirurgica 59 ( 1 ) 10 - 18 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade
however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.

DOI： 10.2176/nmc.st.2018-0191

Parent artery occlusion for unruptured cerebral aneurysms: Results of the Japanese registry of neuroendovascular therapy 3

Hidehisa Nishi, Akira Ishii, Tetsu Satow, Koji Iihara, Nobuyuki Sakai, Masayuki Ezura, Akio Hyodo, Shigeru Miyachi, Susumu Miyamoto, Yoji Nagai, Kunihiro Nishimura, Kazunori Toyoda, Toshiyuki Fujinaka, Toshio Higashi, Masaru Hirohata, Hirotoshi Imamura, Yasushi Ito, Naoya Kuwayama, Hidenori Oishi, Yuji Matsumaru, Yasushi Matsumoto, Ichiro Nakahara, Chiaki Sakai, Kenji Sugiu, Tomoaki Terada, Shinichi Yoshimura, Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators

Neurologia Medico-Chirurgica 59 ( 1 ) 1 - 9 2019

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Neurosurgical Society

Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR)
2.34, 95% confidence interval (CI)
1.02–5.25
P = 0.04] and a small aneurysm size (&lt
5 mm) was associated with hemorrhagic complications (OR
9.85, 95% CI
1.07–221.0
P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.

DOI： 10.2176/nmc.st.2018-0190

JR-NET3解析における硬膜動静脈瘻に対する塞栓術の合併症と危険因子の解析

平松匡文, 杉生憲志, 菱川朋人, 西廣真吾, 木谷尚哉, 高橋悠, 村井智, 伊達勲, 桑山直也, 佐藤徹, 飯原弘二, 坂井信幸

脳血管内治療 3 ( Suppl. ) S48 - S48 2018.11

バルーン派術者によるバルーンリモデリングテクニック下コイル塞栓術の長期治療成績

村井智, 杉生憲志, 菱川朋人, 平松匡文, 西廣真吾, 木谷尚哉, 高橋悠, 伊達勲

脳血管内治療 3 ( Suppl. ) S157 - S157 2018.11

前頭蓋底硬膜動静脈瘻に対する血管内治療 4症例の報告

木谷尚哉, 杉生憲志, 菱川朋人, 平松匡文, 西廣真吾, 高橋悠, 村井智, 伊達勲

脳血管内治療 3 ( Suppl. ) S213 - S213 2018.11

本邦における頭蓋内腫瘍に対する塞栓術の治療成績 JR-NET2とJR-NET3の比較検討

菱川朋人, 杉生憲志, 村井智, 高橋悠, 木谷尚哉, 西廣真吾, 平松匡文, 佐藤徹, 飯原弘二, 伊達勲, 坂井信幸

脳血管内治療 3 ( Suppl. ) S91 - S91 2018.11

ラット中大脳動脈閉塞モデルにおけるcrossed cerebellar diaschisis

木谷尚哉, 杉生憲志, 菱川朋人, 安原隆雄, 平松匡文, 西廣真吾, 高橋悠, 村井智, 伊達勲

脳循環代謝 30 ( 1 ) 135 - 135 2018.10

幼児もやもや病の手術成績と長期予後

菱川朋人, 平松匡文, 杉生憲志, 伊達勲

脳循環代謝 30 ( 1 ) 105 - 105 2018.10

Ex vivo release of pipeline embolization device polytetrafluoroethylene sleeves: a technical note Reviewed International journal

Takahashi Y, Sugiu K, Haruma J, Murai S, Kidani N, Nishihiro S, Hiramatsu M, Hishikawa T, Date I

Journal of Neuroendovascular Therapy 12 ( 9 ) 463 - 468 2018.9

【Hybrid Neurosurgeonのための疾患別臨床脳血管解剖テキスト】(第1章)開頭手術と血管内治療の選択 dAVF 脊髄dAVF 脊髄dAVFの血管内治療

平松匡文, 杉生憲志

脳神経外科速報 ( 2018増刊 ) 161,163,165,167,169,171 - 161,163,165,167,169,171 2018.9

Language：Japanese Publisher：(株)メディカ出版

＜血管内治療のポイント(まとめ)＞(1)脊髄梗塞を予防するため、術前の詳細な画像診断、術中provocation testが重要(2)Drainer側までNBCAを注入するための術前画像診断を行い、治療戦略を立てる(3)術後の遅発性静脈血栓化を予防するため、術後のヘパリン投与を行う(著者抄録)

Efficacy and Safety of REVIVE SE Thrombectomy Device for Acute Ischemic Stroke: River JAPAN (Reperfuse Ischemic Vessels with Endovascular Recanalization Device in Japan). Reviewed

Sakai N, Ota S, Matsumoto Y, Kondo R, Satow T, Kubo M, Tsumoto T, Enomoto Y, Kataoka T, Imamura H, Todo K, Hayakawa M, Yamagami H, Toyoda K, Ito Y, Sugiu K, Matsumaru Y, Yoshimura S, RIVER JAPAN Investigators

Neurologia medico-chirurgica 58 ( 4 ) 164 - 172 2018.4

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

REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a. Secondary endpoints were clot migration/embolization; recanalization without symptomatic intracranial hemorrhage (ICH) at 24 h; symptomatic ICH; good neurological outcome (modified Rankin Scale score ≤2 National Institute of Health Stroke Scale (NIHSS) score decrease ≥10) at day 90; device- or procedure-related serious adverse events (SAEs) and mortality at day 90. To confirm non-inferiority of REVIVE, results were compared with historical data of the Merci Retriever. About 49 patients were enrolled (median age 73 years; males 46.9%; middle cerebral artery (MCA) occlusion 83.7%; median NIHSS score 17). A post-procedure TICI score ≥2a was observed in 73.5% (36/49, 95% confidence interval [CI] 58.9-85.1) of patients. No post-procedural clot migration/embolization events occurred. Successful recanalization without symptomatic ICH was observed in 62.5% (30/48, 95% CI 47.4-76.0). The good neurological outcome was achieved in 66.7% (32/48) patients. Symptomatic ICH and device- or procedure-related SAEs were reported in 6.3% and 12.2% of patients, respectively. Two deaths were reported. REVIVE demonstrated equivalent efficacy and safety as the Merci Retriever. Results suggest that REVIVE is effective and safe in recanalizing occluded intracranial arteries in AIS.

DOI： 10.2176/nmc.oa.2017-0145