Faculty Profiles - SUGIU Kenji

Usefulness of 3-Dimensional CT Angiograms Obtained by 64-Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula International journal

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kohei Tsuda, Matsuhiro Imaoka, Atsushi Kawahara, Kenjiro Fujiwara

JOURNAL OF NEUROIMAGING 19 ( 2 ) 179 - 182 2009.4

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

The authors reported a case of a dural arteriovenous fistula (DAVF) in the left transverse-sigmoid sinus, in which 3-dimensional computed tomography (CT) angiograms (3D-CTAs) by a 64-section multidetector row CT scanner were useful for its diagnosis and treatment. The DAVF in the left transverse-sigmoid sinus appeared on the digital subtraction angiogram. 3D-CTAs were obtained by a 64-section multidetector row CT scanner before an endovascular treatment. The feeders and draining veins of the DAVF were clearly demonstrated on the 3D-CTAs, which clarified the relationship between the normal dural sinuses and DAVF. The DAVF was successfully treated with endovascular surgery, a transvenous embolization through the mastoid emissary vein, which was easily detected by using the 3D-CTA, showing both the subcutaneous vein and calvalium. 3D-CTAs by a 64-section multidetector row CT scanner are useful for both diagnosis and treatment of DAVFs.
J Neuroimaging 2009;19:179-182.

DOI： 10.1111/j.1552-6569.2007.00228.x

Usefulness of 3-Dimensional CT Angiograms Obtained by 64-Section Multidetector Row CT Scanner for Dural Arteriovenous Fistula

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kohei Tsuda, Matsuhiro Imaoka, Atsushi Kawahara, Kenjiro Fujiwara

JOURNAL OF NEUROIMAGING 19 ( 2 ) 179 - 182 2009.4

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

DOI： 10.1111/j.1552-6569.2007.00228.x

Dural Arteriovenous Fistula CT Appearance Case Report and Review

Minoru Nakagawa, Kenji Sugiu, Koji Tokunaga, Kenjiro Fujiwara

NEUROSURGERY QUARTERLY 19 ( 1 ) 46 - 49 2009.3

Language：English Publishing type：Book review, literature introduction, etc. Publisher：LIPPINCOTT WILLIAMS & WILKINS

Images of dural arteriovenous fistula (DAVF) on computed tomography (CT) are usually normal when 110 hemorrhages have occurred from the DAVF. Therefore, it is difficult to diagnose DAVF by plain CT scans which are usually performed in an initial examination. We present a rare case with DAVF in the transverse-sigmoid sinus that Could be diagnosed by reversible speckled high-density spots on a plain CT scan. A 46-year-old man had suffered from depression and had taken some antidepressants for 4 years. He developed a Gerstmann's syndrome and came to our hospital. On a plain CT scan obtained on admission, multiple high-density spots were demonstrated scattered in the left temporal, parietal, and occipital lobes. Subsequently, a digital Subtraction angiography was performed. A DAVF in the left transverse-sigmoid sinus was apparent on the angiogram. The DAVF was successfully treated with endovascular Surgery. The speckled high density decreased on the postoperative plain CT scan. Multiple high-density abnormalities in the brain shown on a plain CT scan are a rare but important finding for diagnosis of DAVF. Further examinations such as magnetic resonance angiography or digital subtraction angiography should be performed in case with these changes to access the possibility of DAVF.

DOI： 10.1097/WNQ.0b013e31818242fe

Percutaneous Coil Embolization Using the Direct Puncture Technique for a Subclavian Artery Pseudoaneurysm After Inadvertent Puncture

Hidefumi Mimura, Hideo Gobara, Takao Hiraki, Hiroyasu Fujiwara, Jun Sakurai, Kenji Sugiu, Susumu Kanazawa

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 32 ( 2 ) 371 - 373 2009.3

Percutaneous Coil Embolization Using the Direct Puncture Technique for a Subclavian Artery Pseudoaneurysm After Inadvertent Puncture International journal

Hidefumi Mimura, Hideo Gobara, Takao Hiraki, Hiroyasu Fujiwara, Jun Sakurai, Kenji Sugiu, Susumu Kanazawa

CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 32 ( 2 ) 371 - 373 2009.3

スパズムへの新しいアプローチ基礎から臨床まで 11Rを用いた新しいタンパク質導入法脳血管障害治療への効果的な新しい薬物導入システムの確立

小野成紀, 小川智之, 市川智継, 有光帥二, 菱川朋人, 徳永浩司, 杉生憲志, 富澤一仁, 松井秀樹, 伊達勲

脳血管攣縮 24 11 - 14 2009.3

Protein Transduction Method for Cerebrovascular Disorders

Tomoyuki Ogawa, Shigeki Ono, Tomotsugu Ichikawa, Seiji Arimitsu, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Kazuhito Tomizawa, Hideki Matsui, Isao Date

ACTA MEDICA OKAYAMA 63 ( 1 ) 1 - 7 2009.2

Language：English Publishing type：Book review, literature introduction, etc. Publisher：OKAYAMA UNIV MED SCHOOL

Many studies have shown that a motif of 11 consecutive arginines (11R) is one of the most effective protein transduction domains (PTD) for introducing proteins into the cell membrane. By conjugating this "11R", all sorts of proteins can effectively and harmlessly be transferred into any kind of cell. We therefore examined the transduction efficiency of 11R in cerebral arteries and obtained results showing that 11R fused enhanced green fluorescent protein (11R-EGFP) immediately and effectively penetrated all layers of the rat basilar artery (BA), especially the tunica media. This method provides a revolutionary approach to cerebral arteries and ours is the first study to demonstrate the successful transduction of a PTD fused protein into the cerebral arteries. In this review, we present an outline of our studies and other key studies related to cerebral vasospasm and 11R, problems to be overcome, and predictions regarding future use of the 11R protein transduction method for cerebral vasospasm (CV).

Protein Transduction Method for Cerebrovascular Disorders

Tomoyuki Ogawa, Shigeki Ono, Tomotsugu Ichikawa, Seiji Arimitsu, Keisuke Onoda, Koji Tokunaga, Kenji Sugiu, Kazuhito Tomizawa, Hideki Matsui, Isao Date

ACTA MEDICA OKAYAMA 63 ( 1 ) 1 - 7 2009.2

Language：English Publisher：OKAYAMA UNIV MED SCHOOL

Treatment results of carotid artery stenting under distal protection with the use of Angioguard XP compared with those of PercuSurge GuardWire

Koji Tokunaga, Kenji Sugiu, Ayumi Nishida, Masafumi Hiramatsu, Tomohito Hishikawa, Shigeki Ono, Isao Date

Journal of Neuroendovascular Therapy 3 ( 2 ) 79 - 85 2009

Language：English

Objective: To compare clinical results of carotid artery stenting (CAS) under distal protection with the use of Angioguard XP and PercuSurge GuardWire. Methods: 138 patients treated by CAS under distal protection from September 2002 to November 2008 were included in this study. 85 patients treated with GuardWire were divided into 2 sequential groups, the early GW group (n=42) and the late GW group (n=43). Angioguard XP was used in 53 patients (the AG group) from November 2007. Treatment results from the 3 groups were investigated. Results: A stent was successfully deployed in all patients. 1 patient in the early GW group died of intracerebral hemorrhage which developed 5 days after CAS. In the late GW group, 1 patient died of multiple organ failure after intraoperative abdominal wall hemorrhage and another patient showed persistent hemiparesis due to intracerebral hemorrhage which occurred 1 week after CAS. Procedure-associated learning curve was not demonstrated between the 2 groups. In the AG group, postoperative MRI diffusion-weighted imaging disclosed new high-intensity lesions in the area of the treated carotid artery in 7 patients, in which 2 patients suffered from thromboembolic strokes. Conclusion: Hemorrhagic complications were causes of disability for patients treated with GuardWire. Thromboembolic events were more frequently encountered in patients undergoing CAS with Angioguard XP. © 2009, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.3.79

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

Language：English

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

Endovascular treatment for Bow hunter's syndrome: Case report

K. Sugiu, T. Agari, K. Tokunaga, A. Nishida, I. Date

Minimally Invasive Neurosurgery 52 ( 4 ) 193 - 195 2009

Language：English

Introduction: Bow hunter's syndrome is a unique clinical entity caused by mechanical occlusion of the vertebral artery on head rotation. Although it is usually treated by direct surgical intervention, we report successful treatment using endovascular stent placement for contralateral vertebral artery stenosis. Case Description: A 56-year-old man presented with repeated vertigo and loss of consciousness caused by turning his head to the left. Right vertebral angiogram showed no abnormalities with the head in the neutral position. However, with the head rotated 60 to the left, the right vertebral artery was completely occluded at the C1-2 level. A three-dimensional angiogram with bone window clearly demonstrated vertebral artery compression at the C1-2 level by the bony structure. The left subclavian angiogram revealed severe stenosis at the origin of the left vertebral artery. Left vertebral artery angioplasty followed by stent placement was successfully performed under local anesthesia. The patient showed an uneventful postoperative course and his preoperative symptoms disappeared. At 6 months postoperatively, a left subclavian angiogram showed good patency of the stented left vertebral artery and the patient showed no recurrent symptoms. Conclusion: Vertebral artery stenting is a useful and less invasive option in the treatment of bow hunter's syndrome in the setting of contralateral vertebral artery stenosis. © Georg Thieme Verlag KG Stuttgart.

DOI： 10.1055/s-0029-1239501

血管内治療が行われる疾患と治療㈪脳動静脈奇形、頚動脈狭窄症など

杉生憲志

BRAIN NURSING 25 ( 10 ) 34 - 40 2009

血管内治療が行われる疾患と適応㈰脳動脈瘤

杉生憲志

BRAIN NURSING 25 ( 10 ) 29 - 33 2009

右中大脳動脈狭窄症に対して、PTAとシロスタゾール（プレタール）の併用にて改善を認めた1例

渡邊恭一, 杉生憲志, 島津洋介, 井上智, 桐山英樹, 松本健五

Progress in Medicine 29 ( 11 ) 2835 - 2838 2009

Percutaneous transvenous embolization of transverse / sigmoid sinus dural arteriovenous fistula through the mastoid emissary vein: Case report

Masafumi Hiramatsu, Kenji Sugiu, Koji Tokunaga, Ayumi Nishida, Hitoshi Hayase, Yasuyuki Miyoshi, Kenjiro Fujiwara, Minoru Nakagawa, Isao Date

Journal of Neuroendovascular Therapy 3 ( 2 ) 112 - 117 2009

Language：English

Objective: Percutaneous transvenous embolization (TVE) of a transverse/sigmoid sinus dural arteriovenous fistula (TS/SS dAVF) through the mastoid emissary vein (MEV) is reported. Case presentation: A 46-year-old man was admitted to our hospital for cerebral venous infarction. Angiography revealed left TS/SS dAVF with isolated sinus and retrograde cortical venous reflux. Transarterial embolization resulted in successful reduction of the shunt flow and improvement of the clinical symptoms. Transvenous approach through the occluded dural sinus into the affected sinus failed. Direct puncture of the dilated occipital vein was then performed, and TVE using coils was performed successfully through the MEV. This procedure resulted in complete disappearance of the dAVF. Conclusion: This technique is a simple and good alternative treatment in patients for whom conventional approach to the isolated sinus is difficult to adopt, if there is the drainage of the dilated mastoid emissary vein. © 2009, The Japanese Society for Neuroendovascular Therapy. All rights reserved.

DOI： 10.5797/jnet.3.112

Japanese Society of Neuro-Endovascular Treatment Specialist Qualification System. Six Years' Experience and Introduction of an Animal Model Examination

T. Hyogo, W. Taki, M. Negoro, A. Takahashi, M. Edura, A. Hyodo, S. Kobayashi, M. Komiyama, N. Kuwayama, Y. Matsumaru, S. Miyachi, K. Murao, Y. Murayama, I. Nakahara, S. Nemoto, N. Sakai, K. Satoh, M. Sonobe, K. Sugiu, T. Terada, S. Yoshimura, T. Abe, Y. Itoh, H. Kiyosue, H. Nagashima, M. Nakamura, S. Matsushima

INTERVENTIONAL NEURORADIOLOGY 14 ( 3 ) 235 - 240 2008.9

11Rを用いた脳血管に対する新しい蛋白質導入法

小川智之, 小野成紀, 市川智継, 有光帥二, 小野田惠介, 徳永浩司, 杉生憲志, 富澤一仁, 松井秀樹, 伊達勲

岡山医学会雑誌 120 ( 2 ) 129 - 133 2008.8

Language：Japanese Publisher：岡山医学会

脳血管に対する外来蛋白質導入法としての「蛋白質セラピー法」の可能性を模索するため、11Rにマーカー蛋白質である緑色蛍光色素タンパク(EGFP)を融合させて(11R-EGFP)、脳血管に対する導入効率を検討した。ラット大槽内に11R-EGFP、EGFPまたは生理食塩水を注入し、注入2、6時間後に脳底動脈を取り出し凍結切片を作成し、蛍光顕微鏡で観察した。その結果、注入2、6時間後に11R-EGFPタンパク質は、脳底動脈壁へ著明に導入されていた。一方、11Rを付加していないEGFPは、くも膜下腔にその存在を認めたが、脳底動脈壁には導入を認めなかった。部位別に導入効果率を検討するため、Scionイメージで蛍光強度の測定を行ったところ、11R-EGFP群は、EGFPおよび生理食塩水注入群と比較して、特に中膜に高い蛍光強度を示した。蛋白質セラピーのこれらの特徴は、くも膜下出血後の脳血管攣縮や脳梗塞等の急性で一過性の脳血管障害の治療に適していると考えられた。