Faculty Profiles - SUGIU Kenji

Role of Inflammation in Cerebral Vasospasm after Subarachnoid Hemorrhage: Expression of iNOS, NF-kappaB, IKK in the Major Cerebral Arteries and CSF Samples in Humans

ONO Shigeki, NISHIO Shinsaku, TOKUNAGA Koji, SUGIU Kenji, DATE Isao

Nosotchu no Geka Kenkyukai koenshu 32 ( 5 ) 315 - 319 2004

Language：Japanese Publisher：The Japanese Society on Surgery for Cerebral Stroke

We had an autopsy case who had suffered from severe subarachnoid hemorrhage (SAH). The case was a 74 year-old man who was in Fisher Group 3 and Hunt & Kosnik Grade 3 on admission. He was treated by intraarterial coil embolization to the anterior communicating artery aneurysm on Day 0, but the aneurysm reruptured on Day 8. Angiograms on Day 8 showed mild to moderate vasospasm in the right anterior and middle cerebral arteries. Although recoiling to the resting neck was performed immediately, the patient died on Day 11.<br> We were able to harvest the major cerebral arteries just 2 hours after death. RNA was extracted from each artery and then reverse transcription-polymerase chain reaction (RT-PCR) was carried out using human inducible nitric oxide synthase (iNOS) primers. Histological and immunocytochemical examination was done for iNOS, NF-kappaB, and I-kappaB kinase (IKK). Enzyme-Linked Immunosorbent Assay (ELISA) was performed using the cerebrospinal fluid of SAH patients who suffered from vasospasm for detecting iNOS protein. iNOS messenger RNA was up-regulated in the vasospastic arteries compared to the non-spastic one. Hematoxylin-eosin staining revealed that there were many white blood cells in both sides of the vascular wall. iNOS has been detected in some patients who suffered from SAH and was remarkably higher than that in patients showing no vasospasm but has not been detected in normal cerebrospinal fluid. On Day 5, iNOS protein in the CSF was highest during the course after SAH.<br> These results suggest that inflammation, especially, vascular injury by iNOS, may be important to understand the pathogenesis of cerebral vasospasm.<br>

DOI： 10.2335/scs.32.315

CiNii Article

脳血管攣縮に対する塩酸ファスジル動注療法中に痙攣を起こした1例.

佐々原渉, 小野成紀, 徳永浩司, 杉生憲志, 中嶋裕之, 伊達勲, 大本堯史

脳神経外科 2004

解離性椎骨動脈瘤に対する血管内動脈瘤コイル塞栓術.

佐藤元美, 槌田昌平, 徳永浩司, 杉生憲志

西宮市医師会医学雑誌 2004

破裂急性期椎骨動脈解離性動脈瘤に対する血管内治療.

杉生憲志, 徳永浩司, 伊達勲

脳神経外科 32,1229-1238 2004

Spiral versus J-shaped coils for neurovascular embolisation - an in-vitro study

K Sugiu, K Tokunaga, S Mandai, JB Martin, B Jean, DA Rufenacht

NEURORADIOLOGY 45 ( 7 ) 417 - 422 2003.7

Language：English Publisher：SPRINGER-VERLAG

Our purpose was to compare the characteristics of J-shaped detachable platinum coils with those of spiral coils in in-vitro vascular models. J-shaped coils consist of distal semicircular and proximal straight segments, the latter extending for most of the length of the coil. Spiral coils have a helical shape memory and are thus limited in expansion. In in-vitro silicone vascular models simulating intracranial aneurysms and dural arteriovenous fistulae, we compared J-shaped and spiral coils with regard to ease of delivery, anchoring and folding patterns, and stability in various types of vascular lumen. Delivery and retrieval were comparable. In large and irregular aneurysms and venous sinuses, J-shaped coils could form a more complex basket which conformed to the shape of the vascular cavity. The J-shaped coil was always in contact with the vessel wall. In wide-necked aneurysms, coil protrusion was more frequent with J-shaped coils, while spiral coils tended to stay compact and circular. Arteries were occluded in a shorter segment with spiral coils. J-shaped coils were safe and superior for large and irregular aneurysms or sinuses. Spiral coils were preferable for spherical aneurysms and segmental occlusion of arteries.

DOI： 10.1007/s00234-003-1012-2

Angioplasty and coiling of ruptured aneurysm with symptomatic vasospasm: Technical case report International journal

K Sugiu, A Katsumata, Y Ono, T Tamiya, T Ohmoto

SURGICAL NEUROLOGY 59 ( 5 ) 413 - 417 2003.5

Language：English Publisher：ELSEVIER SCIENCE INC

BACKGROUND Treating a ruptured cerebral aneurysm during symptomatic vasospasm is very difficult. We describe the successful endovascular treatment of such a case and discuss its efficacy.
CASE PRESENTATION A 34-year-old man had a sudden onset of severe headache. One week later, he was referred to our institute with gradually progressing right hemiparesis and global aphasia. Cerebral angiography demonstrated severe vasospasm of the left internal carotid artery system and an anterior communicating artery aneurysm. With the patient under general anesthesia, 90% occlusion of the aneurysm was achieved with detachable coils after successful dilatation of the spastic vessels. The patient had an uneventful postoperative course and his neurologic symptoms were improved. Seven months after the endovascular treatment, the enlarged neck remnant of the aneurysm was successfully clipped without difficulty.
CONCLUSION The simultaneous treatment of a ruptured aneurysm and vasospasm with percutaneous transluminal angioplasty and coils can produce a better outcome for the patient. (C) 2003 Elsevier Inc. All rights reserved.

DOI： 10.1016/S0090-3019(03)00071-5

De novo aneurysms [2] (multiple letters)

Biodun Ogungbo, Takao Yasuhara, Takashi Tamiya, Kenji Sugiu, Satoshi Inoue, Takashi Ohmoto

Journal of Neurosurgery 98 ( 4 ) 933 - 934 2003.4

Artificial cerebral aneurysm model for medical testing, training, and research

K Sugiu, JB Martin, B Jean, P Gailloud, S Mandai, DA Rufenacht

NEUROLOGIA MEDICO-CHIRURGICA 43 ( 2 ) 69 - 72 2003.2

Language：English Publisher：JAPAN NEUROSURGICAL SOC

Artificial models of cerebral aneurysms for medical training and testing of medical devices were constructed from corrosion casts of the main cerebral arteries of a human specimen. Three aneurysms with a variety of shapes were simulated at typical locations. Rigid and soft models were made of silicone using the "lost wax" technique. The transparent silicone models were anatomically accurate and reproducible copies of human vascular casts. These models could be connected in a closed circuit that used an electric pump to simulate pulsatile flow. Endovascular procedures and surgical clip application were performed under fluoroscopic or direct visual control. Surgical clipping, endoluminal coil manipulation, and consecutive hemodynamic changes were visualized by digital subtraction angiography and direct observation. The model provides trainee surgeons with an understanding of clinical conditions. New medical devices, such as platinum coils, would be experimentally implanted in the model under stable conditions. These anatomically accurate and reproducible models of cerebral vasculature and aneurysms are valuable for medical testing, training, and research.

DOI： 10.2176/nmc.43.69

自然血栓化した後大脳動脈末梢部紡錘状動脈瘤の1例

近藤聡彦, 安原隆雄, 杉生憲志, 大本堯史

脳神経外科 2003

新しい塞栓物質と今後の塞栓術の展開.

杉生憲志, 渡邊恭一, 佐々原渉

脳神経外科速報 13,1067-1073 2003

骨粗鬆症性椎体圧迫骨折に対する経皮的椎体形成術(percutaneous vertebroplasty)の手術手技.

徳永浩司, 杉生憲志, 三好康之, 小野恭裕, 伊達勲

脳神経外科速報 13,985-991 2003

経皮的椎体形成術─適応と手技─.

徳永浩司, 杉生憲志, 中嶋裕之, 伊達勲, 大本堯史, Martin JB, Ruefenacht DA

脳神経外科 31,7-14 2003

虚血性脳卒中に対する血管内治療―急性期〜慢性期―

杉生憲志

最新医学 58,886-892 2003

くも膜下出血後脳血管攣縮に対する当科の治療戦略─ウロキナーゼ脳室内bolus injectionおよび血管内治療（PTAと塩酸ファスジル動注）の効果─.

小野成紀, 伊達勲, 徳永浩司, 杉生憲志, 大本堯史

脳卒中の外科 2003

カタクロット（オザグレルナトリウム）と経皮的血管形成術(PTA)による治療が奏功した脳底動脈狭窄症の1例

小坂章, 渡邊恭一, 為佐信雄, 杉生憲志, 大本堯史

新薬と臨床 2003

De Novo Aneurysm

Yasuhara T, Tamiya T, Sugiu K, Inoue S, Ohmoto T

J. Neurosurg 2003

De novo formation and rupture of an aneurysm - Case report International journal

T Yasuhara, T Tamiya, K Sugiu, S Inoue, T Ohmoto

JOURNAL OF NEUROSURGERY 97 ( 3 ) 697 - 700 2002.9

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

The authors describe a case of de novo fori-nation and rupture of an aneurysm located at the junction of the left internal carotid artery and the superior hypophyseal artery in a middle-aged woman 2 months after another aneurysm, located on the anterior communicating artery, had been clipped. This case is rare because of the short interval between the last angiographic study performed at the first operation and the diagnosis of the de novo aneurysm; in this case the interval was only 47 days, compared with other cases in the literature in which the intervals were 3 to 34 years. Aneurysms can enlarge considerably in 2 to 4 weeks and can rupture at or soon after their formation. This case provides insight into aneurysm formation and rupture.

Performance of long J-shaped coils in large and giant intracranial aneurysms: an in vitro study

K Tokunaga, N Tanaka, K Sugiu, O Levrier, JB Martin, DA Rufenacht

NEURORADIOLOGY 44 ( 3 ) 261 - 267 2002.3

Language：English Publisher：SPRINGER-VERLAG

We evaluated the performance of long straight coils (Detach-18(R) J-shaped coils) in large and giant in-vitro aneurysms. The coils consisted of a distal semicircular part 7 or 15 mm in diameter and a proximal 70 em straight part having three types of stiffness: soft, standard, and stiff. We first investigated the ease of passage through a microcatheter in a realistic cerebral vessel model. Second, vie made silicone models simulating lateral-type aneurysms of various spherical dome diameters (12, 15, 20 and 30 mm) and neck sizes (3-10 mm; dome-to-neck ratio approximately 3:1) and connected them to a pulsating circulatory pump. We evaluated the anchoring and folding patterns of the coils, stability of the microcatheter and coils in the aneurysm, and smoothness of delivery and retrieval of coils. Third, we compared the conformability of a coil in a large, irregular aneurysm with that of a spiral coil. The long J-shaped coils were easily advanced and retrieved through a microcatheter in a tortuous vessel model. In 12, mm spherical aneurysms, each coil made a complex framework, and knot formation or damage to the coil during withdrawal was often observed. In 15 mm aneurysms, the coils were all easily delivered and retrieved; standard-stiffness coils adapted best to this size. In 20 mm aneurysms, frameworks were less complex but still good with a standard or stiff coil, but those with soft coil were unstable and changed significantly within 3 min of detachment due to gravity and pulsatile flow. In 30 mm aneurysms, soft coils filled only the lower part during introduction, whereas a stiff coil still made a favourable framework. Conformability of a long J-shaped coil was superior to that of a spiral coil in a large, irregular aneurysm. Long J-shaped coils conform well to various configurations of large and giant aneurysms and can shorten procedures since a. larger implant volume can be delivered with a single coil. Their principle of action may promote more favourable occlusion of irregular and large aneurysms by improved conformability and stability.

DOI： 10.1007/s00234-001-0712-8

Rescue balloon procedure for an emergency situation during coil embolization for cerebral aneurysms International journal

K Sugiu, JB Martin, B Jean, DA Rufenacht

JOURNAL OF NEUROSURGERY 96 ( 2 ) 373 - 376 2002.2

Language：English Publisher：AMER ASSOC NEUROLOGICAL SURGEONS

In this article the authors describe a rescue balloon procedure for coil implantation in three cases. In each patient, the coil seemed likely to unravel. The coils stretched when attempts were made to remove the partially implanted but trapped device. The inflation of a nondetachable microballoon in front of the aneurysm orifice allowed the surgeons to complete implantation of the coil and to avoid a more forceful and potentially harmful retrieval. This rescue balloon method may be useful for emergency situations, such as coil stretching, with or without migration.