研究者詳細 - 杉生　憲志

Determinants of Poor Outcome After Aneurysmal Subarachnoid Hemorrhage when both Clipping and Coiling Are Available: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan

Waro Taki, Nobuyuki Sakai, Hidenori Suzuki, Akio Hyodo, Shigeru Nemoto, Toshio Hyogo, Tomoaki Terada, Kouichi Satoh, Naoya Kuwayama, Shigeru Miyachi, Masaki Komiyama, Masayuki Ezura, Yuichi Murayama, Hiroshi Sakaida, Masayuki Maeda, Hiroshi Nagai, Taketo Kataoka, Shoichiro Ishihara, Yorio Koguchi, Shigeki Kobayashi, Yukiko Enomoto, Kiyofumi Yamada, Shinichi Yoshimura, Yasushi Matsumoto, Masaru Hirohata, Nobuyuki Sakai, Hidemitsu Adachi, Yasushi Ueno, Takeharu Kunieda, Chiaki Sakai, Hiroshi Yamagami, Hirotoshi Imamura, Masaomi Koyanagi, Kenichi Todo, Shiro Yamamoto, Yoji Kuramoto, Makoto Sonobe, Noriyuki Kato, Teruyasu Hirayama, Tsuneo Kano, Isao Naito, Shunji Matsubara, Junichiro Satomi, Koichi Satoh, Hidekazu Hamada, Naoki Toma, Fumio Asakura, Hidenori Suzuki, Hiroshi Sakaida, Satoshi Matsushima, Tadashi Shibuya, Hidenori Oishi, Hiroshi Abe, Yoshifumi Konishi, Eishi Sato, Mitsugu Nakamura, Akira Kurata, Katsumi Houya, Takanori Uchida, Akio Hyodo, Ichiro Nakahara, Toshio Higashi, Nozomi Murai, Yasushi Iwamuro, Yoshihiko Watanabe, Hideaki Nakagaki, Masahiro Takezawa, Daiki Murata, Yoichi Murayama, Toshihiro Ishibashi, Takayuki Saguchi, Masaki Ebara, Hideki Arakawa, Koreaki Irie, Naoya Kuwayama, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Katsunori Nanba, Shigeru Nemoto, Masanori Tsutsumi, Kiyoshi Kazekawa, Mikito Hayakawa, Yuji Matsumaru, Yoshihiro Matsubayashi, Tomomi Sakabayashi, Keiko Miyakoda, Wataru Oohashi, Masaki Sano, Emiko Uno, Makiko Toyooka, Kaori Kuronaka, Kazuro Sakamoto, Hiroshi Nagai, Masanori Fukushima, Toshio Hyogo

WORLD NEUROSURGERY 76 ( 5 ) 437 - 445 2011年11月

記述言語：英語掲載種別：書評論文，書評，文献紹介等出版者・発行元：ELSEVIER SCIENCE INC

OBJECTIVE: To examine current determinants of poor outcome after aneurysmal subarachnoid hemorrhage (SAH) when ruptured aneurysms are treated with either microsurgery (clipping) or endovascular treatment (coiling) depending on each patient's characteristics.
METHODS: Between March 2006 and February 2007, 534 patients with SAH were enrolled in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) project. Patients were treated according to the preference of investigators who were experienced in performing both clipping and coiling. Factors influencing poor outcome (12-month modified Rankin Scale [mRS], 3-6) were determined using multivariate logistic regression analyses.
RESULTS: In this cohort, 32.4% of patients were World Federation of Neurosurgical Societies (WFNS) grade IV-V, and 28.1% had a poor outcome. Clipping was preferably performed for small aneurysms with a wide neck and for middle cerebral artery (MCA) aneurysms, whereas coiling was preferred for larger, internal carotid artery (ICA) and posterior circulation aneurysms. In addition to increasing age, admission WFNS grade IV-V, preadmission aneurysmal rerupture, vasospasm-induced cerebral infarct, pneumonia, sepsis, shunt-dependent hydrocephalus and seizure, postclipping hemorrhagic complications (odds ratio 4.8, 95% confidence interval 1.5-15.3, P < 0.01), and postcoiling ischemic complications (odds ratio 4.4, 95% confidence interval 1.3-15.2, P < 0.05) significantly caused poor outcomes, although the complications did not affect mortality. Type of treatment modality and size and location of aneurysms did not influence outcome.
CONCLUSIONS: Introducing an endovascular treatment option has made aneurysm characteristics less important to outcome, but procedural complications are problematic and should be reduced to improve outcome.

DOI： 10.1016/j.wneu.2011.04.026

Endovascular Coil Embolization of a Ruptured Distal Anterior Choroidal Artery Aneurysm Associated With Ipsilateral Middle Cerebral Artery Occlusion-Case Report

Ayumi Nishida, Koji Tokunaga, Tomohito Hishikawa, Kenji Sugiu, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 51 ( 10 ) 716 - 719 2011年10月

記述言語：英語出版者・発行元：JAPAN NEUROSURGICAL SOC

An 84-year-old woman with a history of hypertension and a brain infarction presented with a rare distal anterior choroidal artery (AChoA) aneurysm not associated with moyamoya disease manifesting as sudden onset of headache caused by intraventricular hemorrhage. Digital subtraction angiography revealed a peripheral aneurysm in the left AChoA located distal to the plexal point and steno-occlusive changes of the proximal left middle cerebral artery (MCA) and the left posterior cerebral artery (PCA). Collateral arterial channels to the left MCA and left PCA territories were observed along the left AChoA. No neuroimaging findings were compatible with moyamoya disease. Since the aneurysm did not shrink at 2 months after the onset, endovascular treatment was indicated. Under local anesthesia, a microcatheter was placed into the AChoA proximal to the aneurysm with the aid of a 0.008-inch microguidewire. After a provocation test, three detachable platinum coils were delivered into the aneurysm and the parent artery. Complete obliteration of the aneurysm was achieved without additional neurological sequelae. Successful treatment of a ruptured distal AChoA aneurysm associated with atherosclerotic changes of the intracranial arteries was achieved using a meticulous endovascular technique.

DOI： 10.2176/nmc.51.716

Effectiveness of intraoperative near-infrared indocyanine green videoangiography in a case with recurrent spinal perimedullary arteriovenous fistula 国際誌

Yasuyuki Miyoshi, Takao Yasuhara, Ayumi Nishida, Koji Tokunaga, Kenji Sugiu, Isao Date

CLINICAL NEUROLOGY AND NEUROSURGERY 113 ( 3 ) 239 - 242 2011年4月

Posterior reversible encephalopathy syndrome 国際誌

Takao Yasuhara, Koji Tokunaga, Tomohito Hishikawa, Shigeki Ono, Yasuyuki Miyoshi, Kenji Sugiu, Isao Date

JOURNAL OF CLINICAL NEUROSCIENCE 18 ( 3 ) 406 - 409 2011年3月

記述言語：英語出版者・発行元：ELSEVIER SCI LTD

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parieto-occipital lobes on T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. We described three patients with PRES of varied etiologies. Patient 1 was a young man with severe hypertension who presented with headache and visual disturbance. Patient 2 had leukemia and was receiving umbilical cord blood cell transplantation with immunosuppressant, and developed PRES with convulsions. Patient 3 was a pregnant woman with renal failure, who repeatedly developed PRES with convulsions. FLAIR and apparent diffusion coefficient mapping were useful in detecting PRES lesions in our patients, although diffusion-weighted imaging and CT scans had limited use in the diagnosis. Adequate and prompt treatment with antihypertensive medication immediately ameliorated the symptoms, with improvement of abnormal MRI findings. In previous reports, delayed diagnosis might have affected the prognosis. Further work on the clinical manifestations of PRES and its therapy is required. (C) 2010 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2010.06.011

脳血管内治療の最前線.

杉生憲志

医工学治療 23 ( 3 ) 181 - 186 2011年

MicroPlexコイル─特にHydroCoilについて─.

杉生憲志

Rad Fan 9 ( 10 ) 68 - 70 2011年

ケアミックス型病院におけるくも膜下出血の診療経験 —地域医療におけるケアミックス型病院を再考する—.

中川実, 藤原賢次郎, 坂本千穂子, 城戸由紀子, 徳永浩司, 杉生憲志

脳卒中 33 313 - 318 2011年

経静脈的液体塞栓術にて治療した海綿静脈洞部硬膜動静脈瘻の2例

平松匡文, 杉生憲志, 徳永浩司, 西田あゆみ, 栗山充夫, 前城朝英, 寺坂薫, 伊達勲

脳神経外科 39 ( 12 ) 1189 - 1196 2011年

Supraclinoid瘤（IC-Achor, IC-PC）のコイル塞栓術.

杉生憲志

脳神経外科速報 21 ( 9 ) 970 - 981 2011年

脊髄くも膜下出血後Adamkiewicz動脈に生じた血管攣縮.

三好康之, 近藤聡彦, 安原隆雄, 西田あゆみ, 徳永浩司, 杉生憲志, 伊達勲

BRAIN and NERVE 63 ( 2 ) 182 - 183 2011年

Retrospective Survey of Endovascular Treatment for Ruptured Intracranial Aneurysm in Japan: Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) Study

Nobuyuki Sakai, Waro Taki, Shinichi Yoshimura, Toshio Hyogo, Masayuki Ezura, Yasushi Matsumoto, Yasushi Ito, Hiroshi Abe, Makoto Sonobe, Shigeki Kobayashi, Shigeru Nemoto, Yuichi Murayama, Yuji Matsumaru, Hidenori Oishi, Naoya Kuwayama, Shigeru Miyachi, Tomoaki Terada, Masaki Komiyama, Toshiyuki Fujinaka, Kenji Sugiu, Koichi Sato, Ichiro Nakahara, Kiyoshi Kazekawa, Masaru Hirohata, Akio Hyodo, Chiaki Sakai

NEUROLOGIA MEDICO-CHIRURGICA 50 ( 11 ) 961 - 965 2010年11月

記述言語：英語出版者・発行元：JAPAN NEUROSURGICAL SOC

Annual retrospective surveys of 20 to 31 medical centers performing endovascular treatment of cerebral aneurysms in Japan from 1997 to 2008 were performed to analyze technical and clinical outcomes of en dovascular treatment for ruptured cerebral aneurysm Patients treated with dome embolization using bare platinum coils within 14 days after onset were retrospectively selected, and clinical features, and technical and clinical outcomes at discharge were studied Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) 1 covers patients treated from 1997, when the Guglielmi detachable coil was introduced, to 2002, lust after International Subarachnoid Aneurysm Trial was reported RESAT 2 to RESAT 7 were conducted annually between 2003 and 2008 Among 5,624 patients with ruptured aneurysms treated within 14 days after onset, 4,782 patients were treated by dome embolization using platinum detachable coils The patients in this large retrospective survey included 35 8% aged over 70 years, 36 6% with posterior circulation aneurysms, and 29 3% with poor grades (Hunt and Kosnik grades IV and V) The proportion of patients aged over 70 years tended to increase each year from 33 4% in RESAT 1 to 39 8% in RESAT 7, and the proportion of those with posterior circulation aneurysms decreased from 44 2% in RESAT 1 to 23 8% in RESAT 7 (p <0 001) Overall technical success was obtained in 4,666 patients (97 6%), and favorable clinical outcome (good recovery and moderate disability) at discharge was obtained in 88 0% of grade I-III cases and 73 6% of grade I-V cases Procedure-related morbidity was 2 9% and mortality was 0 8% Despite this survey involving high proportions of aged, posterior circulation, and poor-grade patients, the technical success rate and immediate clinical results were relatively favorable The patient prognosis and aneurysm changes must be investigated over a longer period, together with the effects of the introduction of new endovascular devices for cerebral aneurysms

DOI： 10.2176/nmc.50.961

Optimal Dose of Plasmid Vascular Endothelial Growth Factor for Enhancement of Angiogenesis in the Rat Brain Ischemia Model

Atsushi Katsumata, Kenji Sugiu, Koji Tokunaga, Noboru Kusaka, Kyoichi Watanabe, Ayumi Nishida, Katsunari Namba, Hirofumi Hamada, Hiroyuki Nakashima, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 50 ( 6 ) 449 - 455 2010年6月

記述言語：英語出版者・発行元：JAPAN NEUROSURGICAL SOC

Vascular endothelial growth factor (VEGF) administration has recently been assessed as a therapeutic strategy for ischemic diseases including brain ischemia because of its angiogenic effect. However, VEGF also causes detrimental adverse effects by increasing vascular permeability. This study examined whether plasmid human VEGF (phVEGF) administration induced angiogenic effects in the rat brain ischemia model caused by permanent ligation of both common carotid arteries, and investigated the occurrence of adverse effects. Administration of various doses (0-200 mu g) of phVEGF in the temporal muscle was followed by encephalo-myo-synangiosis. Thirty days after treatment, the numbers and areas of capillaries per field in the extracted brains were analyzed with the National Institutes of Health Image software program. The maximal angiogenic effect occurred with a 100 mu g dose of phVEGF in the numbers and areas of capillaries in the VEGF-treated brains. Histological examination showed no apparent adverse effects in the brain parenchyma even at the highest administration dose (200 mu g) of phVEGF. The maximal angiogenic effect at the optimal dose of phVEGF can be considered under the threshold to cause serious adverse effects in the rat brain.

DOI： 10.2176/nmc.50.449

Percutaneous balloon angioplasty for acute occlusion of intracranial arteries.

Tokunaga K, Sugiu K, Yoshino K, Terai Y, Imaoka T, Handa A, Hirotsune N, Kusaka N, Date I

Neurosurgery 67 ( ONS Suppl 1 ) ons189-ons197 2010年

細胞移植療法.

菊池陽一郎, 安原隆雄, 伊達勲, 杉生憲志

総合臨床 59 ( 12 ) 2396 - 2399 2010年

Rebleeding From a Vertebral Artery Dissecting Aneurysm After Endovascular Internal Trapping: Adverse Effect of Intrathecal Urokinase Injection or Incomplete Occlusion?-Case Report

Kenji Sugiu, Koji Tokunaga, Shigeki Ono, Ayumi Nishida, Isao Date

NEUROLOGIA MEDICO-CHIRURGICA 49 ( 12 ) 597 - 600 2009年12月

記述言語：英語出版者・発行元：JAPAN NEUROSURGICAL SOC

A 67-year-old woman suffered rebleeding from a ruptured vertebral artery dissecting aneurysm after endovascular internal trapping. The dissecting aneurysm was initially successfully occluded with the affected vertebral artery using detachable coils. However, rebleeding from the aneurysm occurred on the next day. The rebleeding may have resulted from the thrombolytic effect of urokinase, which was injected intrathecally 3 hours before rebleeding occurred, or the relatively loose coil packing of the aneurysm. This case indicates the potential risk of intrathecal use of thrombolytic agents and the importance of complete tight coil packing of the whole dissected site in the treatment of ruptured vertebral artery dissecting aneurysms.

DOI： 10.2176/nmc.49.597

SIGNIFICANT DIFFERENCES IN THE POSTOPERATIVE MORPHOLOGICAL AND HEMODYNAMIC CONDITIONS OF CAROTID ARTERIES OF PATIENTS UNDERGOING STENTING OR ENDARTERECTOMY WITH PATCH ANGIOPLASTY 国際誌

Koji Tokunaga, Kenji Sugiu, Hitoshi Hayase, Ayumi Nishida, Isao Date

NEUROSURGERY 65 ( 5 ) 884 - 888 2009年11月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

OBJECTIVE: Carotid endarterectomy with a patch graft (Patch CEA) has been our Standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of carotid arteries after CAS or Patch CEA.
METHODS: Thirty-one patients undergoing CAS or Patch CEA were included. The pre- and postoperative shapes of the carotid arteries were evaluated by angiography and ultrasonography. Doppler waveforms were recorded in the middle portion of the common carotid artery and in the internal carotid artery bulb to measure flow velocities, including peak systolic, mean, and end-diastolic velocities.
RESULTS: Eighteen patients were treated by CAS, and Patch CEA was performed for 13 patients. Preoperatively, there were no differences in the degrees of stenosis or the flow velocities between the 2 groups. The averages of the diameters of the postoperative internal carotid artery bulbs were 4.5 mm in the CAS group and 7.0 mm in the Ratch CEA group (P < 0.01). The averages of peak systolic, mean, and end-diastolic velocities measured in the internal carotid artery were 80, 42, and 25 cm/s, respectively, in the CAS group, and were significantly greater than those (53, 28, and 16 cm/s, respectively) in the Patch CEA group (P < 0.01).
CONCLUSION: Significant differences in postoperative morphological and hemodynamic conditions between CAS and Patch CEA were observed. The impact of these differences will be determined by further studies.

DOI： 10.1227/01.NEU.0000358952.12917.DF

SIGNIFICANT DIFFERENCES IN THE POSTOPERATIVE MORPHOLOGICAL AND HEMODYNAMIC CONDITIONS OF CAROTID ARTERIES OF PATIENTS UNDERGOING STENTING OR ENDARTERECTOMY WITH PATCH ANGIOPLASTY

Koji Tokunaga, Kenji Sugiu, Hitoshi Hayase, Ayumi Nishida, Isao Date

NEUROSURGERY 65 ( 5 ) 884 - 888 2009年11月

記述言語：英語出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS

DOI： 10.1227/01.NEU.0000358952.12917.DF