A simulation study of the cost of cerebral vasospasm treatments with clazosentan: A mathematical model using time-driven activity-based costing.Jieyu Zhao; Kota Kurisu; Kazuki Ohashi; Toshiya Osanai; Katsuhiko Ogasawara; Miki Fujimura
PloS one, 21, 1, e0340076, 2026年,
［責任著者］,
［国際誌］英語, 研究論文（学術雑誌）, In this work, we aimed to assess the impact of clazosentan on clinical labour time costs within Japan's value-based healthcare system using time-driven activity-based costing. Time-driven activity-based costing was employed to analyse the labour time costs associated with preventing cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Time-driven activity-based costing simplifies cost analysis by utilising time as the primary cost driver. We compared two treatment approaches: conventional therapy with fasudil hydrochloride and postoperative therapy with clazosentan. Scenario and sensitivity analyses were performed to assess the impact of physicians' costs on the results. The use of clazosentan for the prevention of cerebral vasospasm significantly reduced human resource costs, particularly in cases where symptomatic vasospasm did not occur, yielding savings of approximately 51,343 yen. The greatest cost reductions were observed among nursing staff, with a 30% decrease in the absence of symptomatic vasospasm and a 15% reduction when symptomatic vasospasm was present. The cost reductions for physicians were comparatively smaller, particularly in cases where symptomatic vasospasm occurred. Sensitivity analyses indicated that clazosentan reduced overall costs by approximately 35,000-50,000 yen; however, costs increased in the presence of symptomatic vasospasm. Clazosentan for subarachnoid haemorrhage treatment significantly reduces human resource costs, especially in nursing staff. These findings support the potential of clazosentan for broader clinical use, given its cost-savings and clinical benefits in reducing cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
Coil embolization via donor superficial temporal artery for de novo aneurysm associated with revascularization surgery in a patient with moyamoya disease: illustrative case.Toma Shirai; Kota Kurisu; Masaki Ito; Toshiya Osanai; Haruto Uchino; Miki Fujimura
Journal of neurosurgery. Case lessons, 10, 18, 2025年11月03日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: De novo aneurysm formation at the anastomotic site of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD) is an exceptionally rare but clinically significant complication. Previously reported cases were treated with direct microsurgery, where preservation of established pial synangiosis was a major concern. The authors herein report the first case successfully treated with endovascular coil embolization, achieving complete preservation of pial synangiosis and a favorable clinical outcome. OBSERVATIONS: A 53-year-old man had undergone combined revascularization surgery for MMD 14 years earlier. Although the patient remained asymptomatic, follow-up MR angiography revealed a gradually enlarging de novo aneurysm with daughter sac formation at the anastomotic site. Cerebral angiography demonstrated a narrow-neck saccular aneurysm and a well-developed donor STA, allowing access for endovascular treatment. A microcatheter was advanced into the aneurysm via a distal access catheter placed in the STA, and coil embolization with five coils achieved complete obliteration. The patient recovered uneventfully, and follow-up imaging confirmed the durable occlusion. LESSONS: Endovascular therapy represents a valuable treatment option for de novo aneurysm after STA-MCA anastomosis in MMD, as it completely preserves established collaterals. Careful patient selection and meticulous procedural planning are essential to ensure safety and efficacy. https://thejns.org/doi/10.3171/CASE25666.
放射線誘発性頸部内頸動脈狭窄症に対するDual Layer Stentを用いたステント留置術 周術期合併症と再狭窄に関する検討
奥山 友浩; 栗栖 宏多; 長内 俊也; 杉山 拓; 内野 晴登; 和田 始; 瀧澤 克己; 藤村 幹
日本脳神経血管内治療学会学術集会抄録集, 41回, 405, 405, (一社)日本脳神経血管内治療学会, 2025年11月
日本語
皮質静脈逆流を伴うDAVFに対するTAE治療の現状 TVEとの比較
栗栖 宏多; 長内 俊也; 杉山 拓; 内野 晴登; 藤村 幹
日本脳神経血管内治療学会学術集会抄録集, 41回, 891, 891, (一社)日本脳神経血管内治療学会, 2025年11月
日本語
Feasibility and Reliability of a Novel Tele-stroke Care Unit System in a Japanese Hospital.Haruto Uchino; Toshiya Osanai; Yusuke Shimoda; Hisayasu Saito; Miki Fujimura
Neurologia medico-chirurgica, 2025年09月18日,
［国内誌］英語, 研究論文（学術雑誌）, Stroke care units, which provide intensive management for acute stroke, are widely used in Japan. However, recent legal restrictions on physicians' overtime may challenge continuous specialist coverage, particularly in resource-limited settings. To address this issue, we developed a tele-stroke care units system that provides remote support from stroke specialists. We aimed to evaluate the feasibility and reliability of this system for remote neurological assessment. The system integrates live-streaming and medical image viewing between a local stroke care unit and a remote university hospital through the International Organization for Standardization 27001-compliant Join LiveView application (Allm, Inc., Japan). Remote physicians accessed real-time videos through ceiling-mounted pan-tilt-zoom cameras and communicated bidirectionally using a wireless speaker. We assessed the audiovisual quality, conducted remote National Institutes of Health Stroke Scale examinations in 20 patients with stroke, and compared the results with those of bedside assessments. Remote physicians successfully evaluated all National Institutes of Health Stroke Scale categories using camera-zoom functions, with or without local staff assistance. Video and audio quality were sufficient for clinical assessment and communication. Median total National Institutes of Health Stroke Scale scores were 7.5 (bedside) and 6.5 (remote). Excellent or perfect inter-rater reliability was observed in all 13 categories, with a total score correlation coefficient of 0.998 (p < 0.0001). The tele-stroke care unit system showed sufficient audiovisual quality for effective remote neurological assessment and may serve as a practical solution for acute stroke management in facilities facing workforce shortages, thereby contributing to sustainable stroke care.
Feasibility and non-inferiority of mobile telementoring for digital subtraction angiography: a single-center observational study.Toshiya Osanai; Haruto Uchino; Kikutaro Tokairin; Kota Kurisu; Miki Fujimura
Journal of neurointerventional surgery, 2025年07月10日,
［筆頭著者, 責任著者］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Telementoring is an emerging approach in surgical education that offers remote supervision and guidance through digital platforms. This study aimed to evaluate the feasibility and non-inferiority of a mobile-based telementoring system for digital subtraction angiography (DSA) and compare it with traditional face-to-face mentoring. METHODS: This prospective, single-center observational study included 71 patients who underwent DSA between April 2021 and May 2024. Patients were categorized into control (n=48, face-to-face mentoring) and telementoring (n=23) groups. A mobile telementoring system (JOIN, Allm Inc., Tokyo, Japan), which enabled real-time image sharing and voice communication between the examiner and the remote supervisor, was employed. The primary endpoints were contrast volume, procedural time, and radiation dose, with a non-inferiority margin of 20% applied. RESULTS: No significant differences were observed between the two groups in contrast volume (88.3±39.6 mL vs 97.1±36.4 mL, p=0.499), procedural time (44.1±17.7 min vs 50.7±19.0 min, p=0.308), or radiation dose (427.9±262.2 mGy vs 506.6±307.1 mGy, p=0.346). Non-inferiority was confirmed across all primary endpoints. No procedural complications occurred. Qualitative feedback indicated high user satisfaction, with the system facilitating effective remote supervision and decision-making. CONCLUSIONS: This study demonstrates the feasibility and non-inferiority of a mobile telementoring system for DSA, effectively supporting real-time remote guidance and reducing the need for on-site supervision. Its implementation may enhance access to expert mentoring, particularly in regions with limited specialist availability, contributing to equitable and efficient cerebrovascular care.
北海道における異なる急性期脳梗塞医療体制による治療プロセスの比較
大橋 和貴; 東海林 菊太郎; 長内 俊也; 森井 康博; 栗栖 宏多; 藤村 幹; 小笠原 克彦
日本医療情報学会春季学術大会プログラム・抄録集, 29回, 92, 93, (一社)日本医療情報学会, 2025年07月
日本語
Efficacy and safety of stem cell therapy for acute and subacute ischemic stroke: a systematic review and meta-analysis.Toshiya Osanai; Soichiro Takamiya; Yasuhiro Morii; Katsuhiko Ogasawara; Kiyohiro Houkin; Miki Fujimura
Scientific reports, 15, 1, 21214, 21214, 2025年07月01日,
［筆頭著者, 責任著者］,
［国際誌］英語, 研究論文（学術雑誌）, The efficacy of stem cell therapy for ischemic stroke in terms of functional outcomes remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (PROSPERO: CRD42024503763) to assess the efficacy and safety of stem cell therapy for acute/subacute ischemic stroke, focusing on long-term outcomes. Studies of patients undergoing stem cell transplantation within 1 month of stroke onset were included. We searched five databases for publications up to January 17, 2024. Summary data were extracted from published reports. The primary outcome was the modified Rankin Scale (mRS) score. Measures of effect were risk ratios (RRs) with 95% confidence intervals (CIs). A random-effects model was used when I2 was > 25%; otherwise, a fixed-effects model was used. Common serious adverse events were epilepsy, gastrointestinal disorders, and cardiac disorders. The risk of bias was assessed using the Cochrane Risk of Bias tool version 2. In total, 13 trials involving 872 (519 men) patients were included. The 1-year incidence of mRS scores 0-1 was higher in the cell-therapy group (45/195) than that in the control group (23/179; RR = 1.74 [95% CI = 1.09-2.77]; p = 0.020; I2 = 0%). The 90-day incidence of mRS scores 0-2 was also higher (RR = 1.31 [95% CI = 1.01-1.70]; p = 0.044; I2 = 0%). No significant differences were observed in serious adverse events or mortality. Stem cell therapy for acute/subacute ischemic stroke within 1 month of onset is safe and significantly improves long-term functional outcomes, although the mechanisms of action need to be elucidated and treatment protocols standardized to establish stem cell therapy as a standard care option for ischemic stroke.
硬膜動静脈瘻を伴う脳静脈洞血栓症による頭蓋内圧亢進により両側視力低下をきたした1例
穴田 麻眞子; 野村 太一; 武石 侑杜; 岩見 昂亮; 芳野 正修; 工藤 彰彦; 上床 尚; 白井 慎一; 岩田 育子; 松島 理明; 矢口 裕章; 長内 俊也; 藤村 幹; 矢部 一郎
臨床神経学, 65, 6, 474, 474, (一社)日本神経学会, 2025年06月
日本語
Role and Efficacy of Direct Surgery in the Management of Intracranial Dural Arteriovenous Fistulas.Taku Sugiyama; Toshiya Osanai; Masaki Ito; Haruto Uchino; Miki Fujimura
Acta neurochirurgica. Supplement, 136, 61, 67, 2025年,
［国際誌］英語, 研究論文（学術雑誌）, PURPOSE: Although endovascular treatment (EVT) is often the treatment of choice for intracranial dural arteriovenous fistula (dAVF), direct surgery is an efficient option for many types of dAVFs. Herein, we present a relatively large case series of direct surgical patients to discuss the role and efficacy of direct surgery in managing intracranial dAVFs. METHODS: 43 consecutive patients with dAVFs (ethmoid, n = 11; middle fossa, n = 1; convexity, n = 2; tentorium, n = 11; superior sagittal sinus, n = 2; transverse-sigmoid sinus, n = 11; and cranio-vertebral junction [CVJ], n = 5) treated with direct surgery were retrospectively assessed. Here, 21 (48.8%) and six (14.0%) patients presented with intracranial hemorrhage (ICH) and nonhemorrhagic neurological deficits, respectively. Factors for the selection of direct surgery, prior EVT, surgical procedure, and surgical outcomes were investigated. RESULTS: The ethmoidal location and massive ICH presentation were associated with the predominant selection of direct surgery. Incomplete obliteration via prior EVT was frequently observed in CVJ dAVF, as well as in tentorial dAVFs with pial arterial supply. Permanent surgery-related complications and incomplete obliteration were observed in 7.0% and 2.4% of the patients, respectively. Regarding long-term outcomes, recurrence was not observed postoperatively during the 1336 patient-month follow-up period, and favorable outcomes (modified Rankin scale of 0-2) at the last evaluation were achieved in 82.5% of patients. CONCLUSION: Direct surgery is an effective therapeutic option for dAVFs located in the ethmoid, CVJ, or tentorium; those presenting with massive ICH; and those with pial arterial supply.
破裂脳動脈瘤に対するコイル塞栓とクリッピング後の周術期管理の医療経済学的検討 新規脳血管攣縮予防薬導入による影響
栗栖 宏多; 長内 俊也; 大橋 和貴; 趙 捷宇; 小笠原 克彦; 杉山 拓; 藤村 幹
日本脳神経血管内治療学会学術集会抄録集, 40回, 459, 459, (一社)日本脳神経血管内治療学会, 2024年11月
日本語
Letter to the Editor Response.Kota Kurisu; Tomohiro Okuyama; Toshiya Osanai; Masaki Ito; Taku Sugiyama; Haruto Uchino; Miki Fujimura
Journal of neurosurgery. Case lessons, 8, 18, 2024年10月28日,
［国際誌］英語, 研究論文（学術雑誌）
[Endovascular Treatment of Delayed Cerebral Vasospasms].Kota Kurisu; Yusuke Shimoda; Toshiya Osanai; Miki Fujimura
No shinkei geka. Neurological surgery, 52, 5, 1023, 1030, 2024年09月,
［国内誌］日本語, 研究論文（学術雑誌）, Delayed cerebral vasospasm is a major complication following subarachnoid hemorrhage and a primary cause of delayed cerebral ischemia. While various preventive treatments exist, some patients still develop severe vasospasm, highlighting the need for better rescue therapies. This article explores endovascular treatment as a rescue option for vasospasm, focusing on the clinical characteristics and roles of intra-arterial vasodilator injection therapy and percutaneous transluminal angioplasty(PTA). Despite a lack of strong evidence from large clinical trials, advancements in endovascular technology have positioned both intra-arterial vasodilator injection therapy and PTA as promising and safe rescue options for severe vasospasm. Careful selection of the appropriate approach is crucial for achieving optimal clinical outcomes, considering the unique characteristics, advantages, and limitations of each method. Further clinical trials are necessary to definitively confirm this hypothesis.
Optimal catheter selection for acute stroke patients with type III aortic arch based on magnetic resonance angiography road mapping of the para-aortic trans-femoral access route before mechanical thrombectomy.Satoshi Kobayashi; Toshiya Osanai; Noriyuki Fujima; Akiyoshi Hamaguchi; Taku Sugiyama; Toshitaka Nakamura; Kazutoshi Hida; Hiroyuki Itosaka; Yoshimasa Niiya; Miki Fujimura
World neurosurgery, 190, e153-e157, 2024年07月16日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Although mechanical thrombectomy for acute ischemic stroke has a high recanalization rate, procedurally challenging lesions remain in approximately 10% of the cases. Type III aortic arches, due to their anatomical configuration, are a fundamental problem impacting this procedure. This study aimed to determine whether optimal catheter selection for type III aortic arches, using magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route, reduces the time required for mechanical thrombectomy. METHODS: We retrospectively evaluated 203 consecutive patients who underwent mechanical thrombectomy at multiple centers between April 2018 and July 2022. Twenty-three patients were diagnosed with a type III aortic arch using MRA-based road mapping performed to visualize the para-aortic access route before neuro-interventional procedures. Among the 23 patients with type III aortic arches, 10 received a Simmons-type catheter (initial Simmons group) and 13 received a JB-2-type catheter® (initial JB-2 group) as their first inner catheter. The time required for mechanical thrombectomy was compared between the groups. RESULTS: Compared with the initial JB-2 group, the initial Simmons group exhibited a significantly shorter "puncture-to-recanalization time" (105 vs. 53 min, p = 0.009) and "door-to-recanalization time" (164 vs. 129 min, p = 0.032). CONCLUSIONS: Optimal catheter selection by identifying the aortic arch before mechanical thrombectomy using MRA-based road mapping effectively reduced the mechanical thrombectomy time. This suggests that even in type III aorta cases, appropriate catheter selection may shorten the mechanical thrombectomy time and improve acute ischemic stroke prognosis.
Effective Smartphone Application Use for Postoperative Management of Moyamoya Disease.Haruto Uchino; Toshiya Osanai; Masaki Ito; Kota Kurisu; Taku Sugiyama; Miki Fujimura
Neurologia medico-chirurgica, 64, 7, 272, 277, 2024年06月05日,
［国内誌］英語, 研究論文（学術雑誌）, Continuous and careful management is necessary after revascularization surgery for moyamoya disease (MMD). The postoperative information has been shared in person or by telephone and emails among doctors; however, this is not always efficient. We aimed to describe the feasibility of remote diagnosis and text chats using a smartphone application on postoperative MMD management. Twenty consecutive patients who underwent combined direct and indirect revascularization for MMD were prospectively investigated in this study. In ten patients, the operator viewed postoperative images uploaded on a smartphone screen using the Join application (Allm Inc., Tokyo, Japan). The doctors shared the radiological findings and treatment plans using the group text chat function and performed postoperative management. We evaluated the intermodality agreements of radiological findings between the smartphone screen and conventional viewer. Postoperative courses were compared between the two patient groups that used or did not use the application. All postoperative images were uploaded to the cloud server and the operator viewed them remotely on the smartphone screen without restriction of location. Detected abnormal findings were cerebral hyperperfusion (CHP), CHP-related watershed shift phenomenon, fluid-attenuated inversion recovery cortical hyperintensity, high signal intensity on diffusion-weighted imaging, CHP-related crossed cerebellar diaschisis, and hypoperfusion. Radiological agreement between the modalities was good in all cases, and additional findings were not obtained on the conventional viewer. The postoperative courses of the Join group were as good as those of the control group. Remote radiological diagnosis and text chat using a smartphone application were feasible and useful for efficient and safe postoperative MMD management.
Visual dysfunction and neurodegeneration caused by severe inflammatory optic neuropathy after coil embolization of a paraclinoid aneurysm: illustrative case.Tomohiro Okuyama; Kota Kurisu; Toshiya Osanai; Masaki Ito; Taku Sugiyama; Haruto Uchino; Miki Fujimura
Journal of neurosurgery. Case lessons, 7, 20, 2024年05月13日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Visual impairment due to delayed optic neuropathy is a rare complication of the endovascular treatment of paraclinoid aneurysms. An inflammatory response induced in the treated aneurysm wall is a known mechanism underlying this pathophysiology. The authors describe a case with severe and progressive optic neuropathy leading to neuronal degeneration and severe visual dysfunction. OBSERVATIONS: A 42-year-old female with a history of surgical clipping for a paraclinoid aneurysm presented with a recurrence. Although the patient was unaware of any visual dysfunction, a preoperative ophthalmological examination revealed mild inferior quadrantanopia in the left eye. The coil embolization procedure was uneventful; however, the following day, the patient experienced progressive visual impairment, which worsened despite the initiation of steroid therapy. Ophthalmological examination revealed a severe decrease in visual acuity and further deterioration of the visual field. Magnetic resonance imaging showed remarkable swelling and edema of the left optic nerve adjacent to the treated aneurysm. Despite continued steroid therapy, the patient's visual function did not recover well due to subsequent optic nerve degeneration. LESSONS: Optic neuropathy after endovascular procedures can lead to severe visual dysfunction. Careful management is essential, particularly when treating a symptomatic paraclinoid aneurysm, even if symptoms are only apparent on detailed examination.
Systemic immune-inflammation index in dural arteriovenous fistula: a feasible biomarker reflecting its clinical characteristicsKota Kurisu; Toshiya Osanai; Yutaka Morishima; Masaki Ito; Haruto Uchino; Taku Sugiyama; Miki Fujimura
Acta Neurochirurgica, 166, 1, 180, 180, Springer Science and Business Media LLC, 2024年04月16日,
［国際誌］英語, 研究論文（学術雑誌）, PURPOSE: The systemic immune-inflammation index (SII), a marker of systemic inflammation, can be calculated using peripheral blood tests. Although the SII has been reported as a feasible biomarker in various cerebrovascular diseases, no studies have explored in dural arteriovenous fistula (DAVF). A retrospective cohort study was performed to test whether the SII reflects the clinical characteristics of DAVF and whether this index could serve as a feasible biomarker. METHODS: This study included 28 patients who underwent endovascular treatment (39 sessions) for DAVF between 2014 and 2023. The SII was calculated using the following formula: platelet count multiplied by neutrophil count divided by lymphocyte count. We investigated the correlation between the SII and various clinical characteristics of DAVF, including symptom manifestation, and digital subtraction angiography findings. Additionally, we compared pre- and post-endovascular treatment changes in the SII. RESULTS: A significantly higher SII was observed in patients with multiple lesions, clinical symptoms (particularly aggressive symptoms), pseudophelebitic pattern (PPP), and sinus occlusion. Multivariate regression analysis revealed that the presence of symptoms (coefficient 270.9, P = 0.021) and PPP (coefficient 272.4, P = 0.017) were independent factors contributing to SII elevation. Notably, following endovascular treatment, there was a significant decrease in the elevated SII in patients whose symptoms resolved (P = 0.039) and where the DAVF was angiographically cured (P = 0.012). CONCLUSION: Elevation of the SII in patients with advanced DAVF and its decrease following endovascular treatment suggests that the SII reflects the disease condition and indicates its potential as a promising biomarker.
Optimal Transport System for Acute Ischemic Stroke Patients: A Cost-Effectiveness Analysis.Yasuhiro Morii; Toshiya Osanai; Kensuke Fujiwara; Yuji Tani; Soichiro Takamiya; Takumi Tanikawa; Katsuhiko Ogasawara
Studies in health technology and informatics, 310, 1558, 1559, 2024年01月25日,
［国際誌］英語, 研究論文（学術雑誌）, This study conducted cost utility analysis comparing 4 systems of transporting acute ischemic stroke patients in Hokkaido, Japan. Hypothetical patients were generated on a geographic information system, and their outcomes were estimated according to their transport time to hospitals administering tissue plasminogen activator and/or endovascular thrombectomy. The transport systems where a neurointerventionist traveled for earlier endovascular thrombectomy were most cost-effective in some rural areas, while direct transportation to comprehensive stroke centers was more cost-effective in other areas.
Allogeneic Stem Cell Therapy for Acute Ischemic StrokeKiyohiro Houkin; Toshiya Osanai; Shinichiro Uchiyama; Kazuo Minematsu; Akihiko Taguchi; Katsuhiko Maruichi; Yoshimasa Niiya; Katsuyuki Asaoka; Yoshihiro Kuga; Katsumi Takizawa; Koichi Haraguchi; Shinichi Yoshimura; Kazumi Kimura; Koji Tokunaga; Atsuo Aoyama; Fusao Ikawa; Chikanori Inenaga; Tatsuya Abe; Atsushi Tominaga; Shinichi Takahashi; Kohsuke Kudo; Miki Fujimura; Taku Sugiyama; Masaki Ito; Masahito Kawabori; David C. Hess; Sean I. Savitz; Teruyuki Hirano; Kiyohiro Houkin; Toshiya Osanai; Katsuhiko Maruichi; Yoshimasa Niiya; Katsuyuki Asaoka; Katsumi Takizawa; Kouichi Haraguchi; Rokuya Tanikawa; Akira Tempaku; Yusuke Shimoda; Masanori Isobe; Kenji Kamiyama; Masafumi Ohtaki; Norihito Shimamura; Junta Moroi; Aiki Marushima; Shinichi Takahashi; Takao Urabe; Teruyuki Hirano; Kazumi Kimura; Kazuo Kitagawa; Hidetoshi Kasuya; Yoshikane Izawa; Yasuyuki Iguchi; Koichi Oki; Koichi Kato; Yoshihisa Yamano; Satoshi Kuroda; Atsushi Sato; Chikanori Inenaga; Keizo Yasui; Kazunori Toyoda; Shinichi Yoshimura; Nobuyuki Sakai; Yoshihiro Kuga; Atsuo Aoyama; Fusao Ikawa; Koji Tokunaga; Atsushi Tominaga; Yasushi Takagi; Masahiro Yasaka; Tatsuya Abe; Takayuki Matsuo; Toshiro Yonehara; Tadashi Terasaki; Hideki Matsuoka
JAMA Neurology, 81, 2, 154, 162, American Medical Association (AMA), 2024年01月16日,
［筆頭著者, 責任著者］,
［国際誌］英語, 研究論文（学術雑誌）, Importance
Cell therapy is a promising treatment approach for stroke and other diseases. However, it is unknown whether MultiStem (HLCM051), a bone marrow–derived, allogeneic, multipotent adult progenitor cell product, has the potential to treat ischemic stroke.
Objective
To assess the efficacy and safety of MultiStem when administered within 18 to 36 hours of ischemic stroke onset.
Design, Setting, and Participants
The Treatment Evaluation of Acute Stroke Using Regenerative Cells (TREASURE) multicenter, double-blind, parallel-group, placebo-controlled phase 2/3 randomized clinical trial was conducted at 44 academic and clinical centers in Japan between November 15, 2017, and March 29, 2022. Inclusion criteria were age 20 years or older, presence of acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 8-20 at baseline), confirmed acute infarction involving the cerebral cortex and measuring more than 2 cm on the major axis (determined with diffusion-weighted magnetic resonance imaging), and a modified Rankin Scale (mRS) score of 0 or 1 before stroke onset. Data analysis was performed between May 9 and August 15, 2022.
Exposure
Patients were randomly assigned to either intravenous MultiStem in 1 single unit of 1.2 billion cells or intravenous placebo within 18 to 36 hours of ischemic stroke onset.
Main Outcomes and Measures
The primary end points were safety and excellent outcome at day 90, measured as a composite of a modified Rankin Scale (mRS) score of 1 or less, a NIHSS score of 1 or less, and a Barthel index score of 95 or greater. The secondary end points were excellent outcome at day 365, mRS score distribution at days 90 and 365, and mRS score of 0 to 1 and 0 to 2 at day 90. Statistical analysis of efficacy was performed using the Cochran-Mantel-Haenszel test.
Results
This study included 206 patients (104 received MultiStem and 102 received placebo). Their mean age was 76.5 (range, 35-95) years, and more than half of patients were men (112 [54.4%]). There were no between-group differences in primary and secondary end points. The proportion of excellent outcomes at day 90 did not differ significantly between the MultiStem and placebo groups (12 [11.5%] vs 10 [9.8%], P = .90; adjusted risk difference, 0.5% [95% CI, −7.3% to 8.3%]). The frequency of adverse events was similar between treatment groups.
Conclusions and Relevance
In this randomized clinical trial, intravenous administration of allogeneic cell therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes. Further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria, as indicated by the exploratory analyses in this study.
Trial Registration
ClinicalTrials.gov Identifier: NCT02961504
効率的な人的資源の活用を目指したtele-SCUシステム実証実験内野 晴登; 長内 俊也; 下田 祐介; 齋藤 久泰; 飛驒 一利; 藤村 幹
脳神経外科ジャーナル, 33, 8, 563, 566, 一般社団法人日本脳神経外科コングレス, 2024年
日本語, 本邦では, stroke care unit (SCU) が広く普及しており, 急性期脳卒中治療の基盤となっている. 一方, 2024年から医師の時間外労働時間に上限が設定され, 人的要員に関するSCU施設基準を満たせない施設が出る可能性がある. われわれは遠隔医師が, 人員の限られた施設を補助するtele-SCUシステムを考案し, その実現可能性について実証研究を行っている. 本システムでは, 医療画像の共有, 遠隔操作可能な天井ネットワークカメラによる患者映像のストリーミング, 遠隔医師と現地SCUスタッフもしくは患者のビデオ通話などを可能とした. 映像解像度, 音声の質, 映像・音声遅延, ネットワークカメラの操作性は遠隔で神経診察を行ううえで支障がないことを確認できた. Tele-SCUは, 急性期脳卒中治療において医療の質を担保しつつ, 医師の効率的な働き方に寄与する可能性がある.
遠隔診断支援による脳梗塞血栓溶解療法の国内および北海道における現状と課題内野 晴登; 長内 俊也; 藤村 幹
脳神経外科ジャーナル, 33, 2, 128, 133, 一般社団法人日本脳神経外科コングレス, 2024年
日本語, 急性期脳梗塞に対するrt-PA静注療法は, 機械的血栓回収療法が普及しつつある現在においても, 標準治療の1つとして重要である. 一方, 日本では2005年の認可後20年弱が経過するが, その実施率は欧米諸国よりも低く, 地域格差もいまだ存在するのが現状である. 脳卒中専門医の不足する地域では遠隔診断支援を用いたdrip and shipといった診療体制が, 実施率向上において一定の効果を上げることが国内外で報告されてきた. その体制構築には地域格差があり, われわれが実施した北海道の脳卒中基幹施設に対するアンケート調査では, drip and shipの実施率が低いこと, 広大な面積をもつ同地域での遠隔診断支援の必要性が明らかとなった. 近年, 汎用性の高い遠隔診断用アプリケーションが脳神経外科領域でも普及してきている. それらを活用した遠隔診断支援によるrt-PA静注療法の実施率の向上, 脳卒中医療の均てん化に対する期待が高まっている.
北海道の脳卒中医療および脳神経外科医療におけるICT普及を目指す試み長内 俊也; 内野 晴登; 藤村 幹
脳神経外科ジャーナル, 33, 6, 432, 436, 一般社団法人日本脳神経外科コングレス, 2024年
日本語, 近年, 虚血性脳卒中に対する治療成績が大きく改善したが, 一方で血管内治療の普及により脳卒中治療医師の負担が増加しており, 特に医療過疎地では脳卒中医療の質を維持しつつ, 医師の負担を軽減することが難しくなってきている. これらの課題に対処する手段として, 情報通信技術 (information and communication technology : ICT) の活用が期待されている. 本稿では, 脳卒中医療および脳神経外科診療におけるICTの活用について, 当教室における具体的な取り組みを述べ, 今後の展望について考察する.
The Capacitated Maximal Covering Location Problem Improves Access to Stroke Treatment: A Cross-Sectional Simulation Study.Kyohei Bando; Kazuki Ohashi; Kensuke Fujiwara; Toshiya Osanai; Yasuhiro Morii; Takumi Tanikawa; Miki Fujimura; Katsuhiko Ogasawara
Health services insights, 17, 11786329241263699, 11786329241263699, 2024年,
［国際誌］英語, 研究論文（学術雑誌）, Disparities in accessing advanced stroke treatment have been recognized as a policy challenge in multiple countries, including Japan, necessitating priority solutions. Nevertheless, more practical healthcare policies must be implemented due to the limited availability of healthcare staff and financial resources in most nations. This study aimed to evaluate the supply and demand balance of mechanical thrombectomy (MT) and identify areas with high priority for enhancing stroke centers. The target area of this study was Hokkaido, Japan. We adopted the capacitated maximal covering location problem (CMCLP) to propose an optimal allocation without increasing the number of medical facilities. Four realistic scenarios with varying levels of total MT supply capacity for Primary stroke centers and assuming a range of 90 minutes by car from the center were created and simulated. From scenarios 1 to 4, the coverage increased by approximately 53% to 85%, scenarios 2 and 3 had 5% oversupply, and scenario 4 had an oversupply of approximately 20%. When the supply capacity cap was eliminated and 8 PSCs received 31 or more patients, they became priority enhancement targets. The CMCLP estimates demand coverage considering the supply and demand balance and indicates areas and facilities where MT supply capacity enhancement is a priority.
Optimal allocation of physicians improves accessibility and workload disparities in stroke care.Kazuki Ohashi; Toshiya Osanai; Kyohei Bando; Kensuke Fujiwara; Takumi Tanikawa; Yuji Tani; Soichiro Takamiya; Hirotaka Sato; Yasuhiro Morii; Tomoki Ishikawa; Katsuhiko Ogasawara
International journal for equity in health, 22, 1, 233, 233, 2023年11月07日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload. METHODS: This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists. RESULTS: The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities. CONCLUSIONS: The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.
CAS中の徐脈・低血圧に対するカテコラミン投与にてたこつぼ型心筋症と血栓性のステント閉塞を来たした1例
舘澤 諒大; 栗栖 宏太; 長内 俊也; 大前 敬介; 伊東 雅基; 杉山 拓; 石井 伸明; 藤村 幹
脳血管内治療, 8, Suppl., S776, S776, (NPO)日本脳神経血管内治療学会, 2023年11月
日本語
硬膜動静脈瘻におけるSystemic immune-inflammation indexの動態に関する検討
栗栖 宏多; 長内 俊也; 森島 穣; 伊東 雅基; 内野 晴登; 杉山 拓; 藤村 幹
脳循環代謝, 35, 1, 102, 102, (一社)日本脳循環代謝学会, 2023年11月
日本語
Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological studyKazuki Ohashi; Toshiya Osanai; Kensuke Fujiwara; Takumi Tanikawa; Yuji Tani; Soichiro Takamiya; Hirotaka Sato; Yasuhiro Morii; Katsuhiko Ogasawara
Frontiers in Neurology, 14, 1209446, 1209446, Frontiers Media SA, 2023年09月05日,
［国際誌］英語, 研究論文（学術雑誌）, Background
Advances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions.
Methods
We used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk.
Results
The median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor’s degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido.
Conclusion
Access to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor’s degrees or above are at risk of death from stroke.
Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients.Yasuhiro Morii; Kagari Abiko; Toshiya Osanai; Jiro Takami; Takumi Tanikawa; Kensuke Fujiwara; Kiyohiro Houkin; Katsuhiko Ogasawara
Cost effectiveness and resource allocation : C/E, 21, 1, 12, 12, 2023年02月01日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer's perspective, and public healthcare and long-term care payer's perspective in Japan. METHODS: Cost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis. RESULTS: The ICER was $6339/QALY from public health payer's perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payer's perspective. The result of sensitivity analysis confirmed the results. CONCLUSION: The results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.
Comparison of Access Route for Endovascular Treatment by Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRA and Contrast-Enhanced MRASatoshi Kobayashi; Toshiya Osanai; Taku Sugiyama; Noriyuki Fujima; Ryo Takagi; Isao Yokota; Akiyoshi Hamaguchi; Toshitaka Nakamura; Kazutoshi Hida; Miki Fujimura
Journal of Neuroendovascular Therapy, 17, 6, 120, 124, The Japanese Society for Neuroendovascular Therapy, 2023年,
［国内誌］英語, 研究論文（学術雑誌）, OBJECTIVE: In endovascular treatment, it is important to evaluate the access route for placing a catheter into the common carotid artery (CCA) promptly and safely prior to the procedure. We examined whether non-contrast MRA using time-spatial labeling inversion pulse (Time-SLIP) can be used in patients prior to endovascular thrombectomy for acute ischemic stroke. We compared Time-SLIP MRA to contrast-enhanced (CE) MRA and evaluated the efficacy in the evaluation of access routes. METHODS: We retrospectively reviewed 31 patients admitted between October 2018 and December 2018 for cerebral infarction at our hospital. Blood vessels were imaged from the aortic arch to the CCA. A radiologist blindly evaluated quality score, stenosis, shape of the aorta, and degree of tortuosity. RESULTS: There were no "non-diagnostic" images. The sensitivity, specificity, positive predictive value, and negative predictive value for stenosis were 83%, 96%, 83%, and 96%, respectively. The sensitivity for the aorta type classification was 100%. The sensitivity for mild tortuosity was 93%, for moderate was 100%, and for severe was 100%. CONCLUSION: Time-SLIP MRA can be an alternative to CE MRA in access route assessment for patients with cerebral infarction who are not eligible for acute thrombectomy therapy.
北海道における一次脳卒中センターの均てん化シミュレーション
坂東 恭平; 大橋 和貴; 藤原 健祐; 谷川 琢海; 長内 俊也; 小笠原 克彦
医療情報学連合大会論文集, 42回, 777, 778, (一社)日本医療情報学会, 2022年11月
日本語
急性期脳梗塞患者の搬送方法が治療へのアクセシビリティに及ぼす影響 地理情報システムを用いたシミュレーション
森井 康博; 長内 俊也; 藤原 健祐; 高宮 宗一朗; 坂東 恭平; 谷川 琢海; 谷 祐児; 佐藤 広崇; 大橋 和貴; 石川 智基; 小笠原 克彦
医療情報学連合大会論文集, 42回, 779, 780, (一社)日本医療情報学会, 2022年11月
日本語
脳血管内治療術者指導においてのTelementoringの有用性についての検討
長内 俊也; 大川原 舞; 前田 拓真; 山口 裕之; 藤村 幹
脳血管内治療, 7, Suppl., S162, S162, (NPO)日本脳神経血管内治療学会, 2022年11月
日本語
北海道における一次脳卒中センターの均てん化シミュレーション
坂東 恭平; 大橋 和貴; 藤原 健祐; 谷川 琢海; 長内 俊也; 小笠原 克彦
医療情報学連合大会論文集, 42回, 777, 778, (一社)日本医療情報学会, 2022年11月
日本語
急性期脳梗塞患者の搬送方法が治療へのアクセシビリティに及ぼす影響 地理情報システムを用いたシミュレーション
森井 康博; 長内 俊也; 藤原 健祐; 高宮 宗一朗; 坂東 恭平; 谷川 琢海; 谷 祐児; 佐藤 広崇; 大橋 和貴; 石川 智基; 小笠原 克彦
医療情報学連合大会論文集, 42回, 779, 780, (一社)日本医療情報学会, 2022年11月
日本語
血栓回収療法の適応拡大にともなう医師負担を考慮した、血管内治療提供体制の構築
長内 俊也; 大橋 和貴; 坂東 恭平; 森井 康博; 藤原 健祐; 谷川 琢海; 小笠原 克彦; 藤村 幹
脳血管内治療, 7, Suppl., S52, S52, (NPO)日本脳神経血管内治療学会, 2022年11月
日本語
Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan: an ecological study using a conditional autoregressive model.Kazuki Ohashi; Toshiya Osanai; Kensuke Fujiwara; Takumi Tanikawa; Yuji Tani; Soichiro Takamiya; Hirotaka Sato; Yasuhiro Morii; Kyohei Bando; Katsuhiko Ogasawara
International journal of health geographics, 21, 1, 16, 16, 2022年10月31日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Accessibility to stroke treatments is a challenge that depends on the place of residence. However, recent advances in medical technology have improved health outcomes. Nevertheless, the geographic heterogeneity of medical resources may increase regional disparities. Therefore, evaluating spatial and temporal influences of the medical system on regional outcomes and advanced treatment of cerebral infarction are important from a health policy perspective. This spatial and temporal study aims to identify factors associated with mortality and to clarify regional disparities in cerebral infarction mortality at municipality level. METHODS: This ecological study used public data between 2010 and 2020 from municipalities in Hokkaido, Japan. We applied spatial and temporal condition autoregression analysis in a Bayesian setting, with inference based on the Markov chain Monte Carlo simulation. The response variable was the number of deaths due to cerebral infarction (ICD-10 code: I63). The explanatory variables were healthcare accessibility and socioeconomic status. RESULTS: The large number of emergency hospitals per 10,000 people (relative risk (RR) = 0.906, credible interval (Cr) = 0.861 to 0.954) was associated with low mortality. On the other hand, the large number of general hospitals per 10,000 people (RR = 1.123, Cr = 1.068 to 1.178) and longer distance to primary stroke centers (RR = 1.064, Cr = 1.014 to 1.110) were associated with high mortality. The standardized mortality ratio decreased from 2010 to 2020 in Hokkaido by approximately 44%. Regional disparity in mortality remained at the same level from 2010 to 2015, after which it narrowed by approximately 5% to 2020. After mapping, we identified municipalities with high mortality rates that emerged in Hokkaido's central and northeastern parts. CONCLUSION: Cerebral infarction mortality rates and the disparity in Hokkaido improved during the study period (2010-2020). This study emphasized that healthcare accessibility through places such as emergency hospitals and primary stroke centers was important in determining cerebral infarction mortality at the municipality level. In addition, this study identified municipalities with high mortality rates that require healthcare policy changes. The impact of socioeconomic factors on stroke is a global challenge, and improving access to healthcare may reduce disparities in outcomes.
Gluing blood into gel by electrostatic interaction using a water-soluble polymer as an embolic agent.Zhiping Jin; Hailong Fan; Toshiya Osanai; Takayuki Nonoyama; Takayuki Kurokawa; Hideki Hyodoh; Kotaro Matoba; Akiko Takeuchi; Jian Ping Gong; Miki Fujimura
Proceedings of the National Academy of Sciences of the United States of America, 119, 42, e2206685119, 2022年10月18日,
［国際誌］英語, 研究論文（学術雑誌）, Liquid embolic agents are widely used for the endovascular embolization of vascular conditions. However, embolization based on phase transition is limited by the adhesion of the microcatheter to the embolic agent, use of an organic solvent, unintentional catheter retention, and other complications. By mimicking thrombus formation, a water-soluble polymer that rapidly glues blood into a gel without triggering coagulation was developed. The polymer, which consists of cationic and aromatic residues with adjacent sequences, shows electrostatic adhesion with negatively charged blood substances in a physiological environment, while common polycations cannot. Aqueous polymer solutions are injectable through clinical microcatheters and needles. The formed blood gel neither adhered to the catheter nor blocked the port. Postoperative computed tomography imaging showed that the polymer can block the rat femoral artery in vivo and remain at the injection site without nontarget embolization. This study provides an alternative for the development of waterborne embolic agents.
血行再建術後も再出血を繰り返す側副血行路末梢性動脈瘤を伴う成人出血型もやもや病の治療
伊東 雅基; 内野 晴登; 杉山 拓; 長内 俊也; 川堀 真人; 藤村 幹
脳循環代謝, 34, 1, 124, 124, (一社)日本脳循環代謝学会, 2022年10月
日本語
亜急性期〜慢性期脳虚血病態の治療 脳血管動脈硬化性疾患に対する亜急性/慢性期EC-ICバイパスの現代的適応
杉山 拓; 伊東 雅基; 内野 晴登; 長内 俊也; 川堀 真人; 藤村 幹
脳循環代謝, 34, 1, 74, 74, (一社)日本脳循環代謝学会, 2022年10月
日本語
血行再建術後も再出血を繰り返す側副血行路末梢性動脈瘤を伴う成人出血型もやもや病の治療
伊東 雅基; 内野 晴登; 杉山 拓; 長内 俊也; 川堀 真人; 藤村 幹
脳循環代謝, 34, 1, 124, 124, (一社)日本脳循環代謝学会, 2022年10月
日本語
経皮的脳血栓回収療法を実施する医師を新規配置した場合における費用対効果 北海道を対象とした検討
森井 康博; 長内 俊也; 谷 祐児; 藤原 健祐; 坂東 恭平; 石川 智基; 高宮 宗一朗; 谷川 琢海; 大橋 和貴; 佐藤 広崇; 小笠原 克彦
日本医療・病院管理学会誌, 59, Suppl., 186, 186, (一社)日本医療・病院管理学会, 2022年09月
日本語
【グローカル脳神経外科-1】もやもや病 治療の現状と研究課題について
藤村 幹; 伊東 雅基; 杉山 拓; 川堀 真人; 長内 俊也
脳神経外科ジャーナル, 31, 9, 579, 585, (一社)日本脳神経外科コングレス, 2022年09月
日本語
Potential crowdedness of mechanical thrombectomy and cerebral infarction mortality in Japan: Application of inverted two-step floating catchment area method.Kazuki Ohashi; Kensuke Fujiwara; Toshiya Osanai; Takumi Tanikawa; Kyohei Bando; Shojiro Yamasaki; Tomohiro Aoki; Songzi Gu; Katsuhiko Ogasawara
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 31, 9, 106625, 106625, 2022年07月04日,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVES: This study aimed to evaluate a stroke medical delivery system based on population coverage and the potential crowdedness index (PCI) of mechanical thrombectomy and investigate the relationship between PCI and cerebral infarction mortality in Japan. MATERIALS AND METHODS: This cross-sectional study defined 662 facilities and 1605 neurointerventionalists as supply, population aged 55 years or older as demand, and set the reachable area for demand as 120 min in driving time. Multiple regression analysis adjusted for spatial autocorrelation was used to examine the relationship between PCI and cerebral infarction mortality. RESULTS: In the 2020 data, 99% of the population aged 55 years or older had access to mechanical thrombectomy (≤120 min), and the PCI ranged from 5876 to 129838, with a median of 30426. From 2020 to 2035, the PCI is estimated to increase (30426 to 32510), decreasing after 2035 (32510 to 29469). The PCI distribution exhibited geographical heterogeneity. High PCI values emerged in eastern Japan. According to regression analysis, the increase in PCI by 1% led to an increase of 0.13% in standardized mortality ratio of cerebral infarction in men. However, PCI did not significantly correlate with cerebral infarction mortality in women. CONCLUSIONS: PCI for hospitals based on supply and demand was geographically heterogeneous in Japan. Optimization of PCI contributes equalization of mechanical thrombectomy provision system and may improve cerebral infarction mortality.
Spontaneous Obliteration of a Dissecting Aneurysm of Recurrent Artery of Heubner Monitored by Serial Magnetic Resonance Vessel Wall Imaging.Asuka Nakazaki; Masaki Ito; Masanori Isobe; Takeshi Takahashi; Taichi Nomura; Fumiaki Fujihara; Toyohiko Isu; Taku Sugiyama; Toshiya Osanai; Miki Fujimura
Asian journal of neurosurgery, 17, 2, 331, 336, 2022年06月,
［国際誌］英語, 研究論文（学術雑誌）, Aneurysms of the recurrent artery of Heubner (RAH) are known to be one of the uncommon cerebral aneurysms, predominantly presenting with bleeding symptoms. Previously, nine cases of the RAH aneurysms have been reported, all of which were treated surgically or endovascularly and most cases developed postoperative cerebral infarct in the ipsilateral caudate nucleus. Herein, we report a man presenting with transient ischemic attack due to diffuse cerebral vasospasm from a minor non-disabling subarachnoid hemorrhage (SAH) from an RAH aneurysm. He visited our hospital 7 days after the first experience of a thunderclap headache complaining with transient unilateral motor weakness and thin SAH in the right sylvian fissure. Diagnostic catheter angiography revealed a dissecting fusiform aneurysm (8 mm in size) originating from the left RAH contralateral to the thin SAH. Contrast-enhanced magnetic resonance vessel wall imaging (MR-VWI) helped to identify the ruptured nature of the RAH aneurysm. Owing to his delayed ischemic condition after minor SAH, he was conservatively treated with serial MR-VWI monitoring. The aneurysm was spontaneously obliterated with an asymptomatic lacunar infarct in the ipsilateral caudate nucleus in a month. Together, this case was considered as the dissecting aneurysm of RAH with a favorable outcome after the conservative management. Although long-term follow-up is mandatory because the disappearance of the vessel wall enhancement does not necessarily secure the permanent cure of the lesion, serial MR-VWI is helpful to diagnose the ruptured nature and monitor its chronological change in combination with conventional radiological imaging techniques.
The health economic effects of an imaging technology–based telemedicine system for rural neuro-emergency patient careHirotaka Sato; Manabu Kinoshita; Yuji Tani; Teruo Kimura; Toshiya Osanai; Hiroaki Osanai; Katsuhiko Ogasawara
Neurosurgical Focus, 52, 6, E2, E2, Journal of Neurosurgery Publishing Group (JNSPG), 2022年06月,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVE
“Join,” an imaging technology–based telemedicine system, allows simultaneous radiological information sharing between physically remote institutions, virtually connecting advanced medical institutions and rural hospitals. This study aimed to elucidate the health economics effect of Join for neurological telemedicine in rural areas in Hokkaido, Japan.
METHODS
Information concerning 189 requests for patient transfer from Furano Kyokai Hospital, a regional rural hospital, to Asahikawa Medical University Hospital (AMUH), an advanced academic medical institution, was retrospectively collected. The Join system was established between Furano Kyokai Hospital and AMUH in February 2019. Data collected from patients between April 2017 and December 2018 were included in the non-Join group, and those collected between February 2019 and October 2020 were included in the Join group. Clinical variables, reasons for patient transfer requests, duration of hospital stay, and medical costs per patient were analyzed between these two groups. Furthermore, clinical characteristics were compared between patients who were transferred and not transferred based on Join.
RESULTS
More patients were discharged < 7 days after transfer to AMUH in the non-Join group compared with the Join group (p = 0.02). When focusing on the Join group, more patients who were not transferred were discharged < 1 week (p < 0.01). On the other hand, more patients required surgery (p = 0.01) when transferred. The ratio of patients whose medical cost was < USD5000 substantially decreased, from 33% for the non-Join group to 13% for the Join group.
CONCLUSIONS
An imaging technology–based telemedicine system, Join, contributed to reducing unnecessary neuro-emergency patient transfer in a remote rural area, and telemedicine with an integrated smartphone system allowed medical personnel to effectively triage at a distance neuro-emergency patients requiring advanced tertiary care.
Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST).Fatih Seker; Johanna T Fifi; Jacob R Morey; Toshiya Osanai; Sogo Oki; Caspar Brekenfeld; Jens Fiehler; Martin Bendszus; Markus A Möhlenbruch
Journal of neurointerventional surgery, 2022年05月02日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Interhospital transfer of stroke patients (drip and ship concept) is associated with longer treatment times compared with primary admission to a comprehensive stroke center (mothership concept). In recent years, studies on a novel concept of performing endovascular thrombectomy (EVT) at external hospitals (EXT) by transferring neurointerventionalists, instead of patients, have been published. This collaborative study aimed at answering the question of whether EXT saves time in the workflow of acute stroke treatment across various geographical regions. METHODS: This was a patient level pooled analysis of one prospective observational study and four retrospective cohort studies, the EVEREST collaboration (EndoVascular thrombEctomy at Referring and External STroke centers). Time from initial stroke imaging to EVT (vascular puncture) was compared in mothership, drip and ship, and EXT concepts. RESULTS: In total, 1001 stroke patients from various geographical regions who underwent EVT due to large vessel occlusion were included. These were divided into mothership (n=162, 16.2%), drip and ship (n=458, 45.8%), and EXT (n=381, 38.1%) cohorts. The median time periods from onset to EVT (195 min vs 320 min, p<0.001) and from imaging to EVT (97 min vs 184 min, p<0.001) in EXT were significantly shorter than for drip and ship thrombectomy concept. CONCLUSIONS: This pooled analysis of the EVEREST collaboration adds evidence that performing EVT at external hospitals can save time compared with drip and ship across various geographical regions. We encourage conducting randomized controlled trials comparing both triage concepts.
内頸動脈瘤術後に急激な意識障害をきたした神経線維腫症1型の一剖検例
京野 里虹; 種井 善一; 岡崎 ななせ; 長内 俊也; 小田 義崇; 谷川 聖; 杉野 弘和; 津田 真寿美; 藤村 幹; 田中 伸哉
日本病理学会会誌, 111, 1, 356, 356, (一社)日本病理学会, 2022年03月
日本語
Efficacy of the MRA-Based Road Mapping of the Para-Aortic Access Route before Mechanical Thrombectomy in Patients with Acute Ischemic Stroke.Satoshi Kobayashi; Toshiya Osanai; Noriyuki Fujima; Akiyoshi Hamaguchi; Taku Sugiyama; Toshitaka Nakamura; Kazutoshi Hida; Miki Fujimura
Cerebrovascular diseases extra, 12, 1, 47, 52, 2022年,
［国際誌］英語, 研究論文（学術雑誌）, INTRODUCTION: The aim of this study was to clarify whether magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route can reduce the procedural time of mechanical thrombectomy in patients with acute ischemic stroke. We further investigated the role of pre-procedural MRA-based road mapping in optimal initial catheter selection for rapid mechanical thrombectomy. MATERIALS AND METHODS: We retrospectively reviewed 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at our hospital between April 2018 and May 2021. Twenty-nine patients underwent MRA-based road mapping to visualize the para-aortic access route, whereas 28 patients only underwent routine head magnetic resonance imaging/angiography without MRA-based road mapping before neuro-interventional procedures. We then compared the basic procedural times required for mechanical thrombectomy, such as the time from femoral artery puncture to recanalization ("puncture to recanalization time") and the time from the admission to recanalization ("door to recanalization time"), between the groups. RESULTS: MRA-based road mapping significantly reduced the "puncture to recanalization time" (52.0 min vs. 70.0 min; p = 0.019) and the "door to recanalization time" (146 min vs. 183 min; p = 0.013). CONCLUSION: MRA-based road mapping of the para-aortic access route is useful to reduce the procedural time of mechanical thrombectomy in acute stroke patients, possibly by enabling optimal initial catheter selection during the procedure.
Intradural lumbar radicular arteriovenous malformation mimicking perimedullary arteriovenous malformation of the conus medullaris: illustrative case.Izumi Koyanagi; Yasuhiro Chiba; Hiroyuki Imamura; Toshiya Osanai
Journal of neurosurgery. Case lessons, 2, 21, CASE21551, 2021年11月22日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Intradural radicular arteriovenous malformation (AVM) of the cauda equina is a rare entity of spinal AVMs. Because of the specific arterial supply of the conus medullaris and cauda equina, AVMs in this area sometimes present with confusing radiological features. OBSERVATIONS: The authors reported a rare case of intradural radicular AVM arising from the lumbar posterior root. The patient presented with urinary symptoms with multiple flow void around the conus medullaris, as shown on magnetic resonance imaging. Digital subtraction angiography demonstrated arteriovenous shunt at the left side of the conus medullaris fed by the anterior spinal artery via anastomotic channel to the posterior spinal artery and rich perimedullary drainers. There was another arteriovenous shunt at the L3 level from the left L4 radicular artery. Preoperative diagnosis was perimedullary AVM with radicular arteriovenous fistula. Direct surgery with indocyanine green angiography revealed that the actual arteriovenous shunt was located at the left L4 posterior root. The AVM was successfully treated by coagulation of feeding branches. LESSONS: Unilateral arteriovenous shunt fed by either posterior or anterior spinal artery at the conus medullaris may include AVM of the cauda equina despite abundant perimedullary venous drainage. Careful pre- and intraoperative diagnostic imaging is necessary for appropriate treatment.
新規塞栓物質としてのカチオンパイゲルの基礎的実験
金 芝萍; 長内 俊也; 山崎 和義; 藤村 幹; 野々山 貴之; 黒川 孝幸
脳血管内治療, 6, Suppl., S133, S133, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
脳梗塞:急性期治療 進行性虚血性脳卒中に対するEC-ICバイパス術
杉山 拓; 伊東 雅基; 長内 俊也; 藤村 幹
脳循環代謝, 33, 1, 73, 73, (一社)日本脳循環代謝学会, 2021年11月
日本語
破裂脳動脈瘤コイル塞栓術後に遅発性のコイル突出を認めた1例
舘澤 諒大; 長内 俊也; 東海林 菊太郎; 伊東 雅基; 進藤 崇史; 中崎 明日香; 杉山 拓; 藤村 幹
脳血管内治療, 6, Suppl., S248, S248, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
びまん性脳血管攣縮による一過性脳虚血発作で発症したHeubner動脈瘤破裂の自然消失 症例報告
中崎 明日香; 伊東 雅基; 磯部 正則; 藤原 史明; 井須 豊彦; 野村 太一; 数又 研; 長内 俊也; 杉山 拓; 藤村 幹
脳血管内治療, 6, Suppl., S249, S249, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
一時的血流遮断下のDistal Filter protectionの元、CASPERを用いたCarotid artery stentingの術後DWI陽性率についての検討
長内 俊也; 東海林 菊太郎; 杉山 拓; 伊東 雅基; 小林 聡
脳血管内治療, 6, Suppl., S287, S287, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
北海道における急性期脳梗塞治療の地理的アクセシビリティについて 2-step floating catchment area(2sFCA)法の有用性の検討
坂東 恭平; 藤原 健祐; 谷川 琢海; 長内 俊也; 小笠原 克彦
医療情報学連合大会論文集, 41回, 559, 560, (一社)日本医療情報学会, 2021年11月
日本語
北海道における急性期脳梗塞治療の地理的アクセシビリティについて 2-step floating catchment area(2sFCA)法の有用性の検討
坂東 恭平; 藤原 健祐; 谷川 琢海; 長内 俊也; 小笠原 克彦
医療情報学連合大会論文集, 41回, 559, 560, (一社)日本医療情報学会, 2021年11月
日本語
破裂脳動脈瘤コイル塞栓術後に遅発性のコイル突出を認めた1例
舘澤 諒大; 長内 俊也; 東海林 菊太郎; 伊東 雅基; 進藤 崇史; 中崎 明日香; 杉山 拓; 藤村 幹
脳血管内治療, 6, Suppl., S248, S248, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
びまん性脳血管攣縮による一過性脳虚血発作で発症したHeubner動脈瘤破裂の自然消失 症例報告
中崎 明日香; 伊東 雅基; 磯部 正則; 藤原 史明; 井須 豊彦; 野村 太一; 数又 研; 長内 俊也; 杉山 拓; 藤村 幹
脳血管内治療, 6, Suppl., S249, S249, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
一時的血流遮断下のDistal Filter protectionの元、CASPERを用いたCarotid artery stentingの術後DWI陽性率についての検討
長内 俊也; 東海林 菊太郎; 杉山 拓; 伊東 雅基; 小林 聡
脳血管内治療, 6, Suppl., S287, S287, (NPO)日本脳神経血管内治療学会, 2021年11月
日本語
脳梗塞:急性期治療 進行性虚血性脳卒中に対するEC-ICバイパス術
杉山 拓; 伊東 雅基; 長内 俊也; 藤村 幹
脳循環代謝, 33, 1, 73, 73, (一社)日本脳循環代謝学会, 2021年11月
日本語
Efficacy of Carotid Artery Stenting Performed under General Anesthesia with Somatosensory Evoked Potential Monitoring.Masayuki Gekka; Toshiya Osanai; Takeshi Aoki; Naoki Nakayama; Ken Kazumata; Kiyohiro Houkin; Miki Fujimura
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 30, 10, 106007, 106007, 2021年08月15日,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVES: During carotid artery stenting (CAS), hemodynamics may be affected by the carotid sinus reflex in some cases. Although general anesthesia has been reported to stabilize intraoperative hemodynamics, the patient's neurological condition must be assessed indirectly. Therefore, we investigated the changes in intraoperative hemodynamics and perioperative complications of CAS under general anesthesia and evaluated the efficacy of somatosensory evoked potential (SEP) monitoring in detecting a reduction in perfusion during CAS. MATERIALS AND METHODS: From April 2011 to August 2016,57 consecutive patients who underwent CAS under general anesthesia were evaluated. The follow-up period ranged from 3 to 8 years. During CAS, anesthesiologists monitored and managed the hemodynamics. SEP monitoring was performed during the CAS procedure in all patients. RESULTS: Intraoperative hypotension (systolic blood pressure ≤ 100 mmHg) was evident in 16 patients (28.1%), and 13 patients (22.8%) experienced intraoperative bradycardia; however, all of these cases were promptly managed under general anesthesia. None of the patients showed systolic blood pressure < 50 mmHg from baseline. Regarding perioperative complications, none of the patients exhibited myocardial infarction or postoperative hyperperfusion symptoms, and there was no mortality. Among 21 patients (36.8%) with a decrease in the intraoperative SEP, 3 (5.3%) exhibited transient ischemic symptoms and 1 (1.8%) had postoperative infarction. CONCLUSIONS: CAS under general anesthesia is a safe and effective management option in terms of intraoperative hemodynamic stability. In addition, our findings indicate that SEP monitoring could be helpful in evaluating transient postoperative cerebral ischemia or cerebral infarction after CAS.
Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke.Yasuhiro Morii; Toshiya Osanai; Kensuke Fujiwara; Takumi Tanikawa; Kiyohiro Houkin; Songzi Gu; Katsuhiko Ogasawara
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 30, 8, 105843, 105843, 2021年08月,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVES: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. MATERIALS AND METHODS: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. RESULTS: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. CONCLUSIONS: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.
Intraoperative Identification of the Shunt Point of Spinal Arteriovenous Malformations by a Selective Arterial Injection of Saline to Subtract Signals of Indocyanine Green: Technical Note.Soichiro Takamiya; Kazuyoshi Yamazaki; Kikutaro Tokairin; Toshiya Osanai; Takashi Shindo; Toshitaka Seki; Miki Fujimura
World neurosurgery, 151, 132, 137, 2021年07月,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: It is crucial to identify a shunt point for spinal arteriovenous malformation (AVM) treatment. For this purpose, some intraoperative supports have been reported-intravenous injection of indocyanine green (ICG), selective arterial injection of ICG, and selective arterial injection of saline with a high frame rate digital camera. However, there are difficulties in accurately identifying the shunt point, especially if the lesion has multiple feeders. The aim of this technical note was to report a novel method, selective arterial injection of saline to subtract signals of ICG, to precisely identify perimedullary arteriovenous fistula shunt points having multiple feeding arteries. METHODS: After exposing the lesion, a 4-F catheter was cannulated into the origins of the segmental artery. ICG was injected intravenously as a first step, and then heparinized saline solution was flushed from the catheter. RESULTS: Compared with other methods, this method could identify the exact shunt point and was effective for certain shunt point obliterations. CONCLUSIONS: Despite having similar invasiveness, selective arterial injection of saline to subtract signals of ICG is superior to previously described techniques, such as selective arterial injection of ICG. Therefore, it will be useful in spinal arteriovenous malformation surgical treatment.
Type 3大動脈弓模型の3分枝へのカテーテライゼーション(Catheterization into branches of simplified type 3 arch models)
曽山 武士; 今井 哲秋; 吉野 裕紀; 高橋 文也; 森田 亮; 阿保 大介; 吉田 大介; 東海林 菊太郎; 長内 俊也; 工藤 與亮
日本インターベンショナルラジオロジー学会雑誌, 36, Suppl., 159, 159, (一社)日本インターベンショナルラジオロジー学会, 2021年04月
英語
Use of magnetic resonance venography for inferior petrosal sinus sampling.Kikutaro Tokairin; Toshiya Osanai; Noriyuki Fujima; Kinya Ishizaka; Hiroaki Motegi; Yukitomo Ishi; Hiraku Kameda; Taku Sugiyama; Ken Kazumata; Naoki Nakayama
The journal of vascular access, 23, 3, 1129729821997263, 1129729821997263, 2021年02月24日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing's disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. METHODS: Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group (N = 8) and no-MRV group (N = 11) before IPSS. RESULTS: There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group (p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. CONCLUSIONS: Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.
[Familial Mediterranean Fever-Associated Lenticulostriate Artery Aneurysm Presenting with Intracranial Hemorrhage and Disappearing Spontaneously: A Case Report].Asuka Nakazaki; Taku Sugiyama; Ryota Tatezawa; Hiroyuki Kono; Yutaka Morishima; Toshiya Osanai; Naoki Nakayama; Ken Kazumata
Brain and nerve = Shinkei kenkyu no shinpo, 73, 1, 89, 93, 2021年01月,
［国内誌］日本語, 研究論文（学術雑誌）, Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.
Vascular Smooth Muscle Cell Derived from IPS Cell of Moyamoya Disease - Comparative Characterization with Endothelial Cell Transcriptome.Kikutaro Tokairin; Shuji Hamauchi; Masaki Ito; Ken Kazumata; Taku Sugiyama; Naoki Nakayama; Masahito Kawabori; Toshiya Osanai; Kiyohiro Houkin
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 29, 12, 105305, 105305, 2020年12月,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Moyamoya disease (MMD) is an occlusive cerebrovascular disease, causing stroke in children and young adults with unknown etiology. The fundamental pathology is fibrocellular intimal thickening of cerebral arteries, in which vascular smooth muscle cells (VSMCs) are observed as one of the major cell types. Although the characteristics of circulating smooth muscle progenitor cells have been previously reported, the VSMCs are poorly characterized in MMD. We aimed to characterize VSMCs in MMD using induced pluripotent stem cell (iPSC)-technology. METHODS: We differentiated VSMCs from neural crest stem cells (NCSCs) using peripheral blood mononuclear cell-derived iPSCs and compared biological and transcriptome features under naïve culture conditions between three independent healthy control (HC) subjects and three MMD patients. VSMC transcriptome profiles were also compared to those of endothelial cells (ECs) differentiated from the same iPSCs. RESULTS: Homogeneous spindle-shaped cells differentiated from iPSCs exhibited smooth muscle cell marker expressions, including α-smooth muscle actin (αSMA, 82.3 ± 6.7% and 81.0 ± 6.7%); calponin (91.3 ± 2.1% and 90.9 ± 1.3%); myosin heavy chain-11 (MYH11, 96.9 ± 0.7% and 97.1 ± 0.3%) without significance of differences between the two groups. Real-time PCR showed few PECAM1 and CD34 gene expressions in both groups, indicating features of differentiated VSMCs. There were no significant differences in cellular proliferation (p = 0.45), migration (p = 0.60), and contractile abilities (p = 0.96) between the two groups. Transcriptome analysis demonstrated similar gene expression profiles of VSMCs in HC subjects and MMD patients with six differentially expressed genes (DEGs); while ECs showed a distinct transcriptome profile in MMD patients with 120 DEGs. The Wnt-signaling pathway was a significant pathway in VSMCs. CONCLUSIONS: This is the first study that established VSMCs from NCSCs using MMD patient-derived iPSCs and demonstrated similar biological function and transcriptome profile of iPSC-derived VMSCs in MMD patients and HC subjects under naïve single culture condition. Comparative transcriptome features between iPSC-derived VSMCs and ECs, displaying distinct transcriptome in the ECs, suggested that pathological traits can be driven by naïve ECs predominantly and VSMCs may require specific environmental factors in MMD, which provides novel insight into the pathophysiology of MMD. Our iPSC derived VSMC model can contribute to further investigations of diagnostic and therapeutic target of MMD in addition to the current iPSC derived EC model.
Microsurgical Findings of Pial Arterial Feeders in Intracranial Dural Arteriovenous Fistulae: A Case Series.Michinari Okamoto; Taku Sugiyama; Naoki Nakayama; Satoshi Ushikoshi; Ken Kazumata; Toshiya Osanai; Kikutaro Tokairin; Yusuke Shimoda; Kiyohiro Houkin
Operative neurosurgery (Hagerstown, Md.), 19, 6, 691, 700, 2020年11月16日,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Pial arterial feeders in an intracranial dural arteriovenous fistula (dAVF) are risk factors for both ischemic and hemorrhagic complications during endovascular embolization. Microsurgery in dAVF with pial arterial feeders has rarely been reported. OBJECTIVE: To assess our original experience with microsurgery for dAVF with pial arterial feeders by investigating surgical findings and outcomes. METHODS: In 40 patients with intracranial dAVF who underwent microsurgery, we found 8 patients who had pial arterial feeders. A retrospective review was conducted. RESULTS: The locations of the dAVFs were as follows: tentorium, 2 patients; Galenic system, 1; straight sinus, 1; torcula, 1; transverse sinus, 1; ethmoid, 1; and convexity, 1. Preoperative angiography revealed that the pial arterial feeders originated from the middle cerebral artery in 2 patients, the anterior cerebral artery in 1, the posterior cerebral artery in 2, and the posterior medial choroidal artery in 1. Of note, in 2 patients (6.7%), feeders from the superior cerebellar artery were determined to be angiographically occult during preoperative examination and were detected through careful intraoperative observation and arachnoid dissection. In 5 cases, the additional obliteration of the pial arterial feeders and/or more distal cortical venous drainers after the simple disconnection of proximal cortical drainers was necessary to cure the dAVF. Finally, all shunts were cured with only 1 minor complication. CONCLUSION: Although microsurgical results were acceptable, the surgeon should be aware of the presence of pial arterial feeders even after the simple disconnection of cortical venous drainage. Angiographically occult feeders may also exist.
Letter: An International Investigation Into the COVID-19 Pandemic and Workforce Depletion in Highly Specialized Neurointerventional Units - Insights From Stroke Thrombectomy and Aneurysm Registry and Endovascular Neurosurgery Research Group.Ali Alawieh; Sami Al Kasab; Eyad Almallouhi; Michael R Levitt; Pascal M Jabbour; Ahmad Sweid; Robert M Starke; Vasu Saini; Kyle M Fargen; Stacey Q Wolfe; Adam S Arthur; Nitin Goyal; Isabel Fragata; Ilko Maier; Charles Matouk; Brian M Howard; Jonathan A Grossberg; Michael Cawley; Peter Kan; Muhammad Hafeez; Justin Singer; R Webster Crowley; Krishna C Joshi; Waleed Brinjikji; Luis E Savastano; Christopher S Ogilvy; Santiago Gomez-Paz; Elad Levy; Muhammad Waqas; Maxim Mokin; Erol Veznedaroglu; Mandy Binning; Justin Mascitelli; Albert J Yoo; Jazba Soomro; Richard W Williamson; Reda M Chalhoub; Andrew Grande; Roberto Crosa; Sharon Webb; Marios Psychogios; Andrew F Ducruet; Felipe C Albuquerque; Neil Majmundar; Raymond Turner; Walter Casagrande; Fawaz Al-Mufti; Reade De Leacy; J Mocco; Richard D Fessler; Toshiya Osanai; Shakeel A Chowdhry; Min Park; Clemens M Schirmer; Andrew Ringer; Alejandro M Spiotta
Neurosurgery, 87, 6, E697-E699, 2020年09月07日,
［国際誌］英語, 研究論文（学術雑誌）
Neuroprotective effects of combination therapy of regional cold perfusion and hemoglobin-based oxygen carrier administration on rat transient cerebral ischemia.Yasuhiro Ito; Takeo Abumiya; Teruyuki Komatsu; Ryosuke Funaki; Masayuki Gekka; Kota Kurisu; Taku Sugiyama; Masahito Kawabori; Toshiya Osanai; Naoki Nakayama; Ken Kazumata; Kiyohiro Houkin
Brain research, 1746, 147012, 147012, 2020年07月09日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Regional cold perfusion and hemoglobin-based oxygen carrier administration both exert neuroprotective effects against cerebral ischemia reperfusion injury. We herein investigated whether the combination of these two therapies leads to stronger neuroprotective effects. Combination therapy was performed with the regional perfusion of cold HemoAct, a core-shell structured hemoglobin-albumin cluster, in a rat transient middle cerebral artery occlusion model. The effects of combination therapy, the intra-arterial administration of 10 °C HemoAct (10H) initiated at the onset of reperfusion, were compared with those of monotherapies, the intra-arterial administration of 10 °C saline (10S) and 37 °C HemoAct (37H), and an untreated control under the condition of 2-hour ischemia/24-hour reperfusion. The durability of therapeutic effects and the therapeutic time window of combination therapy were assessed based on comparisons with the 10H and control groups. Significantly better neurological findings and smaller infarct volumes were observed in the three treated (10S, 37H, and 10H) groups than in the control group. Among the 3 treated groups, only the 10H group showed significant improvements over the control group in the other items examined, including cerebral blood flow reduction, brain edema, and protein extravasation. The significant therapeutic effects of combination therapy on neurological disabilities and infarct volumes were confirmed at least until 7 days after reperfusion. Furthermore, combination therapy ameliorated neurological disabilities and hemorrhagic transformation in rats subjected to 4- and 5-hour ischemia/24-hour reperfusion. Since therapeutic effects may be expected until at least 5 h of complete ischemia and reperfusion, this combination therapy is a promising neuroprotective strategy against severe ischemic stroke.
[Successful Total Resection with Preceding Arterial Coil Embolization of Intradural Extramedullary Tumor at Craniovertebral Junction Encasing Dominant-side Vertebral Artery].Ryota Tatezawa; Motoyuki Iwasaki; Kazutoshi Hida; Toshiya Osanai; Masahito Kawabori; Rena Morita; Tomohiro Yamauchi; Yoshimasa Niiya; Koji Furukawa; Takeo Abumiya; Shoji Mabuchi
No shinkei geka. Neurological surgery, 48, 6, 509, 514, 2020年06月,
［国内誌］日本語, 研究論文（学術雑誌）, OBJECTIVE: The surgical resection of craniovertebral junction(CVJ)meningioma is challenging because of the neighboring brainstem, lower cranial nerves, and vertebral artery(VA). Moreover, encasement of the VA by the tumor can raise the risk of complications and require cautious manipulation during surgery. CASE: A 46-year-old woman presented with a one-year history of neck pain. She had temporal hemiplegia and numbness on her left side. Magnetic resonance imaging(MRI)showed a CVJ meningioma pushing the brainstem from the right vertebral side and encasing the right VA. Digital subtraction angiography(DSA)showed two feeding arteries arising from the right VA and a sunburst sign. The right VA was the dominant side but did not have the right posterior inferior cerebellar artery(PICA). The anterior spinal artery(ASA)was dominant in the left VA. We performed a balloon test occlusion(BTO)for 20 min and it did not cause any complications;therefore, we occluded the VA using endovascular coils. After 4 days, we removed the meningioma in the prone position, using a far-lateral approach and C1-laminectomy. The laterally located meningioma pushed the brainstem. After detaching the tumor from the dura, we cut the encased VA and the tumor was resected safely(Simpson grade II). Postoperatively, she developed temporal thermal hypoalgesia on the left side of her body. Magnetic resonance imaging showed a microinfarction in the medulla. CONCLUSION: If the VA test occlusion provides a clear result, pre-operative endovascular sacrifice of the VA encased by CVJ meningioma is a feasible treatment strategy.
Rare Case of Spinal Dural Arteriovenous Fistula with Radiculopathy, without Myelopathy or Spinal Edema on Magnetic Resonance Imaging.Sogo Oki; Toshiya Osanai; Kikutaro Tokairin; Soichiro Takamiya; Kazuyoshi Yamazaki; Tetsuaki Imai; Toshitaka Seki
World neurosurgery, 138, 404, 407, 2020年04月03日,
［査読有り］,
［国際誌］英語, BACKGROUND: Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations; they frequently cause progressive myelopathy including gait disturbances and sensory disorders. CASE DESCRIPTION: We report a rare case of a middle-aged man who experienced right-sided chest pain and Th4 radiculopathy, without any other neurologic presentations. Magnetic resonance imaging showed a flow void sign on the dorsal aspect of the spinal cord; spinal angiography revealed an arteriovenous shunt between a radicular artery and an intradural vein. Suspecting SDAVF as the cause of the chest pain, we performed surgical resection. Intraoperatively, we observed compression of the rootlet by the draining vein. Right chest pain disappeared completely after obliteration of the SDAVF. The present patient had vascular compression of the spinal nerve rootlet without any venous congestion. CONCLUSIONS: Our experience shows that SDAVF can present not only as a myelopathy but also as a radiculopathy, indicating that radiculopathy may become a main symptom of SDAVF.
Combined structural and diffusion tensor imaging detection of ischemic injury in moyamoya disease: relation to disease advancement and cerebral hypoperfusion.Ken Kazumata; Kikutaro Tokairin; Masaki Ito; Haruto Uchino; Taku Sugiyama; Masahito Kawabori; Toshiya Osanai; Khin Khin Tha; Kiyohiro Houkin
Journal of neurosurgery, 134, 3, 1, 10, 2020年04月03日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVE: The microstructural integrity of gray and white matter is decreased in adult moyamoya disease, suggesting covert ischemic injury as a mechanism of cognitive dysfunction. Establishing a microstructural brain imaging marker is critical for monitoring cognitive outcomes following surgical interventions. The authors of the present study determined the pathophysiological basis of altered microstructural brain injury in relation to advanced arterial occlusion, cerebral hypoperfusion, and cognitive function. METHODS: The authors examined 58 patients without apparent brain lesions and 30 healthy controls by using structural MRI, as well as diffusion tensor imaging (DTI). Arterial occlusion in each hemisphere was classified as early or advanced stage based on MRA and posterior cerebral artery (PCA) involvement. Regional cerebral blood flow (rCBF) was measured with N-isopropyl-p-[123I]-iodoamphetamine SPECT. Furthermore, cognitive performance was examined using the Wechsler Adult Intelligence Scale, Third Edition and the Trail Making Test (TMT). Both voxel- and region of interest-based analyses were performed for groupwise comparisons, as well as correlation analysis, using parameters such as cognitive test scores; gray matter volume; fractional anisotropy (FA) of association fiber tracts, including the inferior frontooccipital fasciculus (IFOF) and superior longitudinal fasciculus (SLF); PCA involvement; and rCBF. RESULTS: Compared to the early stages, advanced stages of arterial occlusion in the left hemisphere were associated with a lower Performance IQ (p = 0.031), decreased anterior cingulate volumes (p = 0.0001, uncorrected), and lower FA in the IFOF, cingulum, and forceps major (all p < 0.01, all uncorrected). There was no significant difference in rCBF between the early and the advanced stage. In patients with an advanced stage, PCA involvement was correlated with a significantly lower Full Scale IQ (p = 0.036), cingulate volume (p < 0.01, uncorrected), and FA of the left SLF (p = 0.0002, uncorrected) compared to those with an intact PCA. The rCBF was positively correlated with FA of the SLF, IFOF, and forceps major (r > 0.34, p < 0.05). Global gray matter volumes were moderately correlated with TMT part A (r = 0.40, p = 0.003). FA values in the left SLF were moderately associated with processing speed (r = 0.40, p = 0.002). CONCLUSIONS: Although hemodynamic compensation may mask cerebral ischemia in advanced stages of adult moyamoya disease, the disease progression is detrimental to gray and white matter microstructure as well as cognition. In particular, additional PCA involvement in advanced disease stages may impair key neural substrates such as the cingulum and SLF. Thus, combined structural MRI and DTI are potentially useful for tracking the neural integrity of key neural substrates associated with cognitive function and detecting subtle anatomical changes associated with persistent ischemia, as well as disease progression.
Le FortI型骨切り術に合併したmaxillary動静脈瘻に対し血管内塞栓術を行った1例後藤 秀輔; 長内 俊也; 牛越 聡; 栗栖 宏多; 下田 祐介; 寳金 清博
Neurological Surgery, 48, 4, 335, 340, (株)医学書院, 2020年04月
日本語, 40代男性。幼少期の転倒を原因とする顎変形症および咬合不全に対するLe Fort I型骨切り術、下顎枝矢状分割術が行われ、翌々日に拍動性の耳鳴りを自覚した。MRI/MRA、血管造影所見より、顎動脈の動静脈瘻(maxillary AVF)と診断し、血管内治療を行った。手術は、シャント周囲の血管が蛇行し血管径が細いため、シャント部位の直近までマイクロカテーテルを誘導してNBCA注入を行って塞栓した。術直後より耳鳴りは消失し、新たな神経症状や周術期合併症は認めなかった。本症例は顎動脈の1st segment、pterygoid plexusのAVFで、手術操作による引き抜き損傷などが発生機序と考えられた。
[Embolization of Arteriovenous Fistulae of the Maxillary Artery after Le Fort I Osteotomy:A Case Report].Shuho Gotoh; Toshiya Osanai; Satoshi Ushikoshi; Kota Kurisu; Yusuke Shimoda; Kiyohiro Houkin
No shinkei geka. Neurological surgery, 48, 4, 335, 340, 2020年04月,
［査読有り］,
［国内誌］日本語, 研究論文（学術雑誌）, BACKGROUND: Le Fort I osteotomy, one of the most common techniques applied to correct jaw deformities, is generally considered operatively safe. However, a few articles reported that this procedure can lead to formation of arteriovenous fistulae(AVF)involving the maxillary artery infrequently. CASE REPORT: A man in his 40s with a jaw deformity underwent Le Fort I osteotomy. Two days later, he noticed pulsating tinnitus in his right ear. Angiography revealed AVF between the proximal part of the maxillary artery(first segment)and the pterygoid plexus. On further evaluation, AVF were embolized with n-butyl-2-cyanoacrylate(NBCA). Obliteration of AVF was confirmed on the final angiography. The tinnitus resolved shortly after the embolization. CONCLUSION: Embolization with NBCA is a promising treatment for maxillary AVF after Le Fort I osteotomy.
Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review.Taku Sugiyama; Naoki Nakayama; Satoshi Ushikoshi; Ken Kazumata; Michinari Okamoto; Masaki Ito; Toshiya Osanai; Yusuke Shimoda; Kazuki Uchida; Daisuke Shimbo; Yasuhiro Ito; Katsuyuki Asaoka; Toshitaka Nakamura; Satoshi Kuroda; Kiyohiro Houkin
Neurosurgical review, 44, 1, 435, 450, 2020年01月02日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Although microsurgery is an established treatment modality for intracranial dural arteriovenous fistula (dAVF), data regarding the perioperative complication rate, cure rate, and long-term outcomes remain scarce. The aims of this study were to describe our original experience with microsurgery, including the surgical complications and pitfalls, and conduct a systematic review of the relevant literature. A multicenter cohort of patients with dAVF treated by microsurgery was retrospectively assessed. In addition, the PubMed database was searched for published studies involving microsurgery for dAVF, and the complication rate, cure rate, and long-term outcomes were estimated. The total number of patients in our multicenter series and published articles was 553 (593 surgeries). The overall rates of transient complications, permanent complications, death, and incomplete treatment were 11.4, 4.0, 1.2, and 6.5%, respectively. A favorable outcome was achieved for 90.1% patients, even though almost half of the patients presented with intracranial hemorrhage. Of note, the incidence of recurrence was only one per 8241 patient-months of postoperative follow-up. Surgeries for anterior cranial fossa dAVF were associated with a lower complication rate, whereas those for tentorial dAVF were associated with higher complication and incomplete treatment rates. The complication and incomplete treatment rates were lower with simple disconnection of cortical venous drainage than with radical occlusion/resection of dural shunts. Our findings suggest that the cure rate, complication rates, and outcomes of microsurgery for dAVF are acceptable; thus, it could be a feasible second-line treatment option for dAVF. However, surgeons should be aware of the specific adverse events of microsurgery.
Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy.Sogo Oki; Masahito Kawabori; Sumire Echizenya; Yusuke Shimoda; Daisuke Shimbo; Toshiya Osanai; Kazuki Uchida; Kiyohiro Houkin
Frontiers in neurology, 11, 572589, 572589, 2020年,
［国際誌］英語, 研究論文（学術雑誌）, Endovascular thrombectomy (EVT) is the preferred treatment strategy for patients with acute ischemic stroke (AIS). However, clinical outcome and prognosis in patients who undergo EVT in response to AIS with concomitant malignancy have not been fully elucidated. Data of patients with malignancy who underwent EVT at participating institutions between January 2015 and April 2019 were retrospectively analyzed. Patient characteristics, treatment methods, posttreatment strategy, and long-term prognosis were evaluated in 12 patients with prediagnoses of malignancy. Good revascularization (TICI 2b or higher) was achieved in 10 of 12 patients. Among the eight patients who survived more than 2 weeks from onset, four patients showed good clinical outcome [modified Rankin Scale (mRS) <2] at 60 days posttreatment and were able to continue treatment for malignancy. However, seven of eight patients died within a year of EVT (median survival, 83 days) due to progression of malignancy. One-year survival was achieved in only one patient whose etiology of stroke was determined as infectious endocarditis and not Trousseau syndrome. Even after successful revascularization and good short-term clinical outcome, the long-term prognosis after thrombectomy in patients with malignancy was poor. Thrombectomy for concomitant malignancy requires judicious decision, and further studies are necessary to fully elucidate its efficacy.
Tentorial dural AVFの治療戦略
下田 祐介; 森島 穣; 牛越 聡; 長内 俊也; 杉山 拓; 中山 若樹
脳血管内治療, 4, Suppl., S98, S98, (NPO)日本脳神経血管内治療学会, 2019年11月
日本語
Onyxを用いた硬膜動静脈瘻に対する塞栓術
牛越 聡; 下田 裕介; 長内 俊也; 中山 若樹; 杉山 拓
脳血管内治療, 4, Suppl., S163, S163, (NPO)日本脳神経血管内治療学会, 2019年11月
日本語
GISを用いた脳卒中診療拠点病院の適正配置モデルの検討
藤原 健祐; 長内 俊也; 森井 康博; 谷 松子; 谷川 琢海; 小笠原 克彦
医療情報学連合大会論文集, 39回, 447, 447, (一社)日本医療情報学会, 2019年11月
日本語
血管内治療における非造影MRAと造影MRAによるアクセスルートの比較
小林 聡; 長内 俊也; 中山 若樹; 数又 研; 藤間 憲幸; 中村 俊孝; 飛騨 一利
脳血管内治療, 4, Suppl., S384, S384, (NPO)日本脳神経血管内治療学会, 2019年11月
日本語
北海道での理想的な血栓回収療法提供体制の確立に向けた取り組み
長内 俊也; 東海林 菊太郎; 今井 哲秋; 寳金 清博; 小笠原 克彦
脳血管内治療, 4, Suppl., S160, S160, (NPO)日本脳神経血管内治療学会, 2019年11月, ［査読有り］
日本語
下錐体静脈洞サンプリングにおけるアクセスルートMR venography
東海林 菊太郎; 長内 俊也; 藤間 憲幸; 牛越 聡; 茂木 洋晃; 伊師 雪友; 寳金 清博
脳血管内治療, 4, Suppl., S217, S217, (NPO)日本脳神経血管内治療学会, 2019年11月, ［査読有り］
日本語
Association of cognitive function with cerebral blood flow in children with moyamoya disease.Ken Kazumata; Kikutaro Tokairin; Taku Sugiyama; Masaki Ito; Haruto Uchino; Toshiya Osanai; Masahito Kawabori; Naoki Nakayama; Kiyohiro Houkin
Journal of neurosurgery. Pediatrics, 1, 7, 2019年10月11日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, OBJECTIVE: The cognitive effects of main cerebral artery occlusive lesions are unclear in children with moyamoya disease (MMD). The authors aimed to investigate cognitive function in the presurgical phase of pediatric patients with MMD with no apparent brain lesions. METHODS: In this prospective, observational, single-center study, 21 children (mean age 10 ± 3.0 years, range 5-14 years) diagnosed with MMD at Hokkaido University Hospital between 2012 and 2018 were enrolled. A cross-sectional evaluation of intellectual ability was performed using the Wechsler Intelligence Scale for Children-Fourth Edition at the initial diagnosis. rCBF was measured using [123I] N-isopropyl p-iodoamphetamine/SPECT. The associations among clinical factors, disease severity, regional cerebral blood flow (rCBF), and intelligence test scores were also examined. RESULTS: The mean full-scale intelligence quotient (FIQ) was 101.8 ± 12.5 (range 76-125) in children with no apparent brain lesions. A significant difference in the intelligence scale index score was observed, most frequently (42.9%) between working memory index (WMI) and verbal comprehension index (VCI; VCI - WMI > 11 points). Regional CBF was significantly reduced both in the left and right medial frontal cortices (left: 61.3 ± 5.3 ml/100 g/min, right 65.3 ± 5.3 ml/100 g/min; p < 0.001) compared to the cerebellum (77.8 ± 6.8 ml/100 g/min). There was a significant association of rCBF in the left dorsolateral prefrontal cortex (DLPFC) with FIQ (r = 0.46, p = 0.034), perceptual reasoning index (PRI; r = 0.44, p = 0.045), and processing speed index (PSI; r = 0.44, p = 0.045). There was an association between rCBF of the left medial frontal cortex and PSI (r = 0.49, p = 0.026). Age of onset, family history, ischemic symptoms, and angiographic severity were not associated with poor cognitive performance. CONCLUSIONS: Although average intellectual ability was not reduced in children with MMD, the association of reduced rCBF in the left DLPFC and medial frontal cortex with FIQ, PRI, and PSI suggests mild cognitive dysfunction due to cerebral hypoperfusion.
Cauda equina occupation ratio as a new imaging parameter for the evaluation of spinal dural arteriovenous fistulae.Yamahata H; Yamaguchi S; Osanai T; Takeda M; Mitsuhara T; Mori M; Tanaka S; Yonenaga M; Taguchi A; Watanabe Y; Abiko M; Seki T; Sasamori T; Arita K; Yoshimoto K
World neurosurgery, 130, e1020-e1027, 2019年10月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Because spinal dural arteriovenous fistulae (SDAVF) are rare and their clinical presentation is nonspecific, they are often overlooked during diagnostic evaluations. Typical magnetic resonance imaging (MRI) findings are intramedullary T2-weighted signal hyperintensity and perimedullary flow voids. There are few reports on the characteristic signs of the cauda equina. We assessed the significance of a new imaging parameter, the cauda equina occupation ratio (CEOR), for the evaluation of SDAVF. METHODS: We retrospectively analyzed the clinical charts and radiological findings of 20 SDAVF patients treated at our institutions. We evaluated sagittal T2-weighted MRI scans and assessed the CEOR, the occupation ratio of the cauda equina compared to the sagittal diameter of the corresponding lumbar spinal canal. The controls were 21 age- and sex-matched subjects. RESULTS: Of the 20 SDAVF, 10 were at the thoracic and 10 at the lumbar spine. There was no significant difference between the preoperative CEOR and the spinal level of the fistulae or the neurological signs. On preoperative MRI scans, the mean CEOR was 56.0 ± 7.8; postoperatively, it was 37.1 ± 7.4 (P = 0.000). The preoperative CEOR was significantly larger in SDAVF patients than in the controls (P = 0.000); postoperatively, it was smaller than in the controls (P = 0.14). CONCLUSIONS: The preoperative CEOR was larger in patients with SDAVF than in the controls. It normalized after successful occlusion of the fistula. Our findings indicate that the CEOR is a useful parameter for the pre- and postoperative evaluation of SDAVF.
A Cost-Effectiveness Simulation of Specialist Dispatching System in Japan for Treatments of Patients with Acute Ischemic Stroke Using a Geographic Information System.Morii Y; Osanai T; Ishikawa T; Fujiwara K; Tanikawa T; Kobayashi E; Ogasawara K
Studies in health technology and informatics, 264, 1861, 1862, 2019年08月21日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Regional disparities in the implementation rates of recombinant tissue-type plasminogen activator and endovascular thrombectomy treatments have been reported in Japan. We simulated the cost-effectiveness of specialist dispatching system in Hokkaido, Japan using Geographic Information System. In the system a qualified specialist is dispatched to another hospital for endovascular thrombectomy. Since the system improved patient accessibility, and the cost- effectiveness was excellent, the system could help enhance the equality and cost-effectiveness of ischemic stroke treatments in Hokkaido.
Cost Effectiveness of Drive and Retrieve System in Hokkaido for Acute Ischemic Stroke Patient Treatment Using Geographic Information System.Morii Y; Osanai T; Ishikawa T; Fujiwara K; Tanikawa T; Houkin K; Kobayashi E; Ogasawara K
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 28, 8, 2292, 2301, 2019年08月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND AND PURPOSE: Although endovascular thrombectomy combined with recombinant tissue-type plasminogen activator is effective for treatment of acute ischemic stroke, regional disparities in implementation rates of those treatments have been reported. Drive and retrieve system, where a qualified neurointerventionist travels to another primary stroke center for endovascular thrombectomy, has been practiced in parts of Hokkaido, Japan. This study aims to simulate the cost effectiveness of the drive and retrieve system, which can be a method to enhance equality and cost effectiveness of treatments for acute ischemic stroke. MATERIALS AND METHODS: The number of patients who had acute ischemic stroke in 2015 is estimated. Those patients are generated according to the population distribution, and thereafter patient transport time is analyzed in the 3 scenarios (1) 60-minute drive scenario, (2) 90-minute drive scenario, in which the drive and retrieve system operates within 60-minute or 90-minute driving distance (3) without the system, using geographic information system. Incremental cost-effectiveness rate, quality-adjusted life years, and medical and nursing care costs are estimated from the analyzed transport time. FINDINGS: The incremental cost-effectiveness rate by implementing the system was dominant. Cost reductions of $213,190 in 60-minute drive scenario, and $247,274 in the 90-minute scenario were expected, respectively. Such benefits are the most significant in Soya, Emmon, Rumoi, and Kamikawahokubu medical areas. CONCLUSIONS: The drive and retrieve system could enhance regional equality and cost effectiveness of ischemic stroke treatments in Hokkaido, which can be achieved using existing resources. Further studies are required to clarify its cost effectiveness from hospital perspective.
Efficacy of 'drive and retrieve' as a cooperative method for prompt endovascular treatment for acute ischemic stroke.Toshiya Osanai; Yasuhiro Ito; Satoshi Ushikoshi; Takeshi Aoki; Masahito Kawabori; Kensuke Fujiwara; Katsuhiko Ogasawara; Kikutaro Tokairin; Katsuhiko Maruichi; Naoki Nakayama; Ken Kazumata; Kota Ono; Kiyohiro Houkin
Journal of neurointerventional surgery, 11, 8, 757, 761, 2019年08月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Outcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized 'mothership' method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, 'drive and retrieve' describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke. OBJECTIVE: To describe the drive and retrieve system and verify the effects of this new collaboration on outcomes in patients with acute ischemic stroke among facilities. METHODS: This non-randomized, single-arm study retrospectively analyzed patients who met the inclusion criteria for endovascular treatment provided through a drive and retrieve system. Among the 122 patients treated by this system, we analyzed the time of onset to recanalization as the primary outcome. We also analyzed the efficacy of the drive and retrieve system using geographic information system analysis. RESULTS: The median time from onset to recanalization was 229 min (IQR 170-307 min, 95% CI 201 to 252 min). The upper limit of the 95% CI for the time from onset to recanalization was shorter than the median times reported in two previous trials. Geographic information system analysis revealed an upward trend in the population coverage rate in each secondary medical area after the drive and retrieve method was introduced. CONCLUSION: The drive and retrieve method may be an effective form of cooperation between facilities located within 1 hour of a comprehensive stroke center.
Contrecoup Injury-Induced Middle Meningeal Arteriovenous Fistula Detected by Time-of-Flight Magnetic Resonance Angiography and Magnetic Resonance Arterial Spin Labeling: Case Report and Review of the Literature.Kikutaro Tokairin; Toshiya Osanai; Ken Kazumata; Ryosuke Sawaya; Kiyohiro Houkin
World neurosurgery, 127, 79, 84, 2019年07月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Middle meningeal arteriovenous fistula (MM-AVF) is rare; however, it will sometimes be followed by intracranial hemorrhage or progressive symptoms caused by abnormal shunt flow. Radiological examination and endovascular treatment of this condition have recently advanced; thus, we have described the pathogenesis, clinical features, and appropriate diagnostic and therapeutic management of MM-AVF. We also reviewed the reported data of the past 35 years, including 30 cases of MM-AVF. CASE DESCRIPTION: We report the case of 24-year-old man who had presented with right tinnitus who had experienced previous head trauma on the opposite side to the tinnitus ear. Time-of-flight magnetic resonance angiography and magnetic resonance arterial spin labeling findings were suggestive of MM-AVF, and catheter angiography confirmed MM-AVF with shunt flow draining into the cavernous sinus. Endovascular transarterial embolization was performed, and the MM-AVF was embolized successfully using detachable coils and n-butyl-2-cyanoacrylate. The tinnitus disappeared completely immediately after the treatment. CONCLUSIONS: MM-AVF is caused, not only by coup injury, but also by contrecoup injury. Time-of-flight magnetic resonance angiography and magnetic resonance arterial spin labeling are useful for detecting MM-AVF. Endovascular transarterial embolization is an effective and safe treatment.
Estimation of the number of feeding arteries of spinal arteriovenous malformations by using three-dimensional digital subtraction angiography.Takamiya S; Osanai T; Seki T; Fujima N; Hida K; Asano T; Yamazaki K; Hamauchi S; Sasamori T; Ono K; Terasaka S; Houkin K
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 28, 4, 842, 848, 2019年04月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, PURPOSE: Spinal angiography is the gold standard for evaluation or diagnosis of spinal arteriovenous malformations (AVMs). However, some feeding arteries might be overlooked when multiple feeders exist. This study aimed to retrospectively review cases of spinal intra-dural AVMs, which were identified by three-dimensional digital subtraction angiography (3D-DSA), and attempted to estimate the number of feeding arteries. METHODS: We retrospectively reviewed patients with spinal intra-dural AVMs who underwent 3D-DSA at Hokkaido University Hospital from January 2005 to December 2016. We selected 9 patients in whom we could obtain data of multi-planar reconstruction of 3D-DSA. We measured the computed tomography (CT) values of feeding arteries and draining veins. The CT values represented the averages of maximum CT values of 5 continuous axial slices. The ratio of the CT value of feeders to that of drainers (F/D ratio) was calculated. The correlation between the F/D ratio and the number of feeders was examined with Pearson's correlation coefficient. RESULTS: The average number of feeders was 2.3 (1-4), and the number of feeders was significantly positively correlated with the F/D ratio (r = 0.855, P = .003). CONCLUSIONS: We conclude that the number of feeding arteries of spinal intra-dural AVMs can be estimated by using the F/D ratio obtained from 3D-DSA. These slides can be retrieved under Electronic Supplementary Material.
Electrocardiogram-triggered angiography non-contrast enhanced (TRANCE) imaging to assess access route prior to diagnostic cerebral angiography.Osanai T; Kazumata K; Kobayashi S; Fujima N; Kurisu K; Shimoda Y; Houkin K
World neurosurgery, 119, 237, 241, 2018年11月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Electrocardiogram (ECG)-triggered angiography non-contrast-enhanced (TRANCE) imaging is useful for investigating peripheral vessel diseases; however, its efficacy for access route assessment in cerebral angiography has yet to be reported. Therefore we aimed to evaluate the efficacy of TRANCE imaging in the assessment of the access route before diagnostic subtraction angiography for cerebral vascular disorders. METHODS: TRANCE imaging was performed in all patients undergoing catheter angiography for disease diagnosis at our institute between April 2014 and March 2015. This study included 31 patients (14 men, 17 women) and investigated potential changes in the planned puncture site before and during the procedure (including the reason for the change) as our main outcome. RESULTS: TRANCE was successfully conducted in all of the patients recruited. TRANCE images led to an alteration in the approach vessel for 5 cases. The mean procedure time for angiography was <60 minutes. The median total number of catheters and guidewires used during catheter angiography was 1 (range: 1-3) and 1 (range: 1-2), respectively. There were no catheter angiography-related complications. CONCLUSIONS: TRANCE imaging before diagnostic angiography is useful because it allows detailed assessment of the access route. This practice may reduce procedure time, thus resulting in fewer complications.
Tentrial dural AVFの治療戦略
下田 祐介; 岡本 迪成; 牛越 聡; 長内 俊也; 中山 若樹; 杉山 拓; 宝金 清博
脳血管内治療, 3, Suppl., S192, S192, (NPO)日本脳神経血管内治療学会, 2018年11月
日本語
北海道における血栓回収療法の現状 Geometric information system(GIS)を用いた検討
長内 俊也; 東海林 菊太郎; 宝金 清博; 藤原 健祐; 小笠原 克彦
脳血管内治療, 3, Suppl., S224, S224, (NPO)日本脳神経血管内治療学会, 2018年11月
日本語
血管内治療におけるMRAとCTAによるアクセスルートの比較
小林 聡; 長内 俊也; 中山 若樹; 鐙谷 武雄; 数又 研; 藤間 憲幸; 清水 幸衣; 大野 浩太; 宝金 清博
脳血管内治療, 3, Suppl., S268, S268, (NPO)日本脳神経血管内治療学会, 2018年11月
日本語
Novel Hemoglobin-Based Oxygen Carrier Bound With Albumin Shows Neuroprotection With Possible Antioxidant Effects.Gekka M; Abumiya T; Komatsu T; Funaki R; Kurisu K; Shimbo D; Kawabori M; Osanai T; Nakayama N; Kazumata K; Houkin K
Stroke, 49, 8, 1960, 1968, 2018年08月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Background and Purpose- A hemoglobin-albumin cluster, 1 core of hemoglobin covalently bound with 3 shell albumins, designated as HemoAct was developed as a hemoglobin-based oxygen carrier. We aim to investigate neuroprotection by HemoAct in transient cerebral ischemia and elucidate its underlying mechanisms. Methods- Male rats were subjected to 2-hour transient middle cerebral artery occlusion and were then administered HemoAct transarterially at the onset of reperfusion. Neurological and pathological findings were examined after 24 hours of reperfusion to identify neuroprotection by HemoAct. Intermittent measurements of cortical blood flow and oxygen content were performed, and a histopathologic analysis was conducted on rats during the early phase of reperfusion to assess the therapeutic mechanism of HemoAct. In addition, the antioxidant effects of HemoAct were examined in hypoxia/reoxygenation-treated rat brain microvascular endothelial cells. Results- Neurological deterioration, infarct and edema development, and the activation of MMP-9 (matrix metalloprotease-9) and lipid peroxidation after 24 hours of reperfusion were significantly ameliorated by the HemoAct treatment. Reductions in blood flow and tissue partial oxygen pressure in the cortical penumbra after 6 hours of reperfusion were significantly ameliorated by the HemoAct treatment. The histopathologic analysis of the cortical penumbra revealed that HemoAct in HemoAct-treated rats showed superior microvascular perfusion with the mitigation of microvascular narrowing changes than autologous erythrocytes in nontreated rats. Although HemoAct extravasated into the ischemic core with serum protein, it did not induce an increase in serum extravasation or reactive oxygen species production in the ischemic core. In vitro experiments with rat brain microvascular endothelial cells revealed that HemoAct significantly suppressed cellular reactive oxygen species production in hypoxia/reoxygenation-treated cells, similar to albumin. Conclusions- HemoAct exerted robust neuroprotection in transient cerebral ischemia. Superior microvascular perfusion with an oxygen delivery capability and possible antioxidant effects appear to be the underlying neuroprotective mechanisms.
Treatment evaluation of acute stroke for using in regenerative cell elements (TREASURE) trial: Rationale and design.Osanai T; Houkin K; Uchiyama S; Minematsu K; Taguchi A; Terasaka S
International journal of stroke : official journal of the International Stroke Society, 13, 4, 444, 448, 2018年06月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Rationale MultiStem® (HLM051) is one of the promising allogenic cell products for acute ischemic stroke with strong evidence. A previous phase 2 randomized, double-blind, placebo-controlled, multicenter dose-escalation trial showed the safety of MultiStem® for acute ischemic stroke, with a time window beyond that of rt-PA and endovascular thrombectomy. We aim to obtain stronger evidence and to show the efficacy of the MultiStem® for treatment of ischemic stroke. Sample size Estimated sample size is 220 (110 patients per group), which has 90% power at 5% significance level. Methods and design TREASURE is a randomized, double-blind, placebo-controlled, multicenter phase 2/3 trial. The trial will be done at 31 medical centers in Japan. Patients with acute ischemic stroke including motor or speech deficit defined by a National Institution of Health Stroke Scale (NIHSS) score of 8-20 at baseline will be randomized 1:1 to receive a single intravenous infusion of MultiStem® or placebo within 18-36 h of stroke onset. Study outcomes Primary outcome in this study is the proportion of patients with an excellent outcome at day 90 defined by the functional assessment. Trial registration ClinicalTrials.gov (NCT02961504). Conclusion The TREASURE trial will provide a novel treatment option and expand the therapeutic window for patients with stroke if the results are positive.
Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Moyamoya Disease: Region-Symptom Mapping and Estimating a Critical Threshold.Ken Kazumata; Haruto Uchino; Kikutaro Tokairin; Masaki Ito; Tohru Shiga; Toshiya Osanai; Masahito Kawabori
World neurosurgery, 114, e388-e395, e395, 2018年06月,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, BACKGROUND: Cerebral hyperperfusion complicates the postoperative course of patients with moyamoya disease after direct revascularization surgery. There is no clear distinction between cerebral hyperperfusion syndrome and benign postoperative increase in regional cerebral blood flow (rCBF). OBJECTIVE: The present study aimed to determine clinically relevant changes in rCBF, anatomical correlations, and factors associated with transient neurologic symptoms after revascularization surgery in moyamoya disease. METHODS: Whole-brain voxel-based perfusion mapping was used to identify regions involved in cerebral hyperperfusion and quantify the changes in 105 hemispheric surgeries with the use of single-photon computed tomography acquired on postoperative day 7. The changes in rCBF were quantitatively analyzed, and associations with cerebral hyperperfusion syndrome were determined. RESULTS: Transient neurologic symptoms appeared with rCBF increase in 37.9% of adults. Speech impairments were associated with an increase in rCBF in the operculo-insula region. Cheiro-oral syndrome was associated with the posterior insula as well as the prefrontal region. A receiver operating curve analysis yielded transient neurologic symptoms with maximum accuracy at >15.5% increase from baseline. Age and preoperative rCBF were independently associated with transient neurologic symptoms (P < 0.001). CONCLUSIONS: Areas showing rCBF increase during the experience of transient neurologic symptoms were spatially compatible with the known functional anatomy of the brain. An increase of approximately 15% from baseline was found to be critical, which is a far lower threshold than what has been reported previously. Increasing age was significantly associated with the occurrence of symptomatic hyperperfusion. Furthermore, patients with preserved rCBF also showed symptomatic hyperperfusion.
Human Recombinant Peptide Sponge Enables Novel, Less Invasive Cell Therapy for Ischemic Stroke.Miyamoto M; Nakamura K; Shichinohe H; Yamauchi T; Ito M; Saito H; Kawabori M; Osanai T; Sasaki T; Houkin K; Kuroda S
Stem cells international, 2018, 4829534, 4829534, 2018年,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, Bone marrow stromal cell (BMSC) transplantation has the therapeutic potential for ischemic stroke. However, it is unclear which delivery routes would yield both safety and maximal therapeutic benefits. We assessed whether a novel recombinant peptide (RCP) sponge, that resembles human collagen, could act as a less invasive and beneficial scaffold in cell therapy for ischemic stroke. BMSCs from green fluorescent protein-transgenic rats were cultured and Sprague-Dawley rats were subjected to permanent middle cerebral artery occlusion (MCAo). A BMSC-RCP sponge construct was transplanted onto the ipsilateral intact neocortex 7 days after MCAo. A BMSC suspension or vehicle was transplanted into the ipsilateral striatum. Rat motor function was serially evaluated and histological analysis was performed 5 weeks after transplantation. The results showed that BMSCs could proliferate well in the RCP sponge and the BMSC-RCP sponge significantly promoted functional recovery, compared with the vehicle group. Histological analysis revealed that the RCP sponge provoked few inflammatory reactions in the host brain. Moreover, some BMSCs migrated to the peri-infarct area and differentiated into neurons in the BMSC-RCP sponge group. These findings suggest that the RCP sponge may be a promising candidate for animal protein-free scaffolds in cell therapy for ischemic stroke in humans.
Regional transarterial hypothermic infusion in combination with endovascular thrombectomy in acute ischaemic stroke with cerebral main arterial occlusion: protocol to investigate safety of the clinical trial.Kikutaro Tokairin; Toshiya Osanai; Takeo Abumiya; Ken Kazumata; Kota Ono; Kiyohiro Houkin
BMJ open, 7, 8, e016502, 2017年08月29日,
［査読有り］,
［国際誌］英語, 研究論文（学術雑誌）, INTRODUCTION: Acute cerebral ischaemia with main cerebral artery occlusion requires treatment with intravenous tissue plasminogen activator administration and/or endovascular thrombectomy. However, some patients fail to recover even after recanalisation because of ischaemia/reperfusion (I/R) injury. We hypothesised that regional transarterial hypothermic infusion would be effective for patients with I/R injury. The aim of this study is to validate the safety of this procedure. METHODS AND ANALYSIS: This is a clinical exploratory study to evaluate safety of regional transarterial hypothermic infusion in combination with endovascular thrombectomy. Patients with acute ischaemic stroke and a National Institutes of Health Stroke Scale (NIHSS) score of 5-29 who require endovascular thrombectomy are eligible for the study. When no improvement in NIHSS score after the recanalisation is achieved by thrombectomy, cold saline (15°C) will be administered through a microcatheter located in the ipsilateral internal carotid artery. The primary endpoints of this study are mortality and morbidity. The secondary endpoint is deleterious effects on clinical data such as symptoms, radiographic findings and physiological data. The primary and secondary endpoints will be accumulated as case series because this study will be conducted on a small sample of seven patients. ETHICS AND DISSEMINATION: All protocols and the informed consent form comply with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethics review committees at the Hokkaido University Hospital approved the study protocols. The results of the study will be disseminated at several research conferences and also contributed to peer-reviewed journals. The study will be implemented and reported in line with the SPIRIT statement. TRIAL REGISTRATION NUMBER: UMIN Clinical Trails Registry (UMIN000018255); pre-results.
内頸動脈(C2)瘤の手術治療成績の検討 直達手術と血管内治療との比較
下田 祐介; 牛越 聡; 安田 宏; 安喰 稔; 長内 俊也; 中山 若樹; 宝金 清博
脳血管内治療, 1, Suppl., S124, S124, (NPO)日本脳神経血管内治療学会, 2016年11月
日本語
EZO trialの初期成績
長内 俊也; 牛越 聡; 青樹 毅; 宝金 清博
脳血管内治療, 1, Suppl., S269, S269, (NPO)日本脳神経血管内治療学会, 2016年11月
日本語
Successful Acute Endovascular Therapy of Cerebral Embolism for a Patient with Ventricle-assist Device: Case ReportKobayashi Satoshi; Osanai Toshiya; Miyamoto Michiyuki; Shimoda Yusuke; Ushikochi Satoshi; Ooka Tomonori; Matsui Yoshiro; Hatanaka Kanako; Houkin Kiyohiro
Journal of Neuroendovascular Therapy, 特定非営利活動法人 日本脳神経血管内治療学会, 2016年
英語, Objective: Ventricular assist devices (VAD) are used as a bridge to heart transplantation. Cerebral embolism can develop in patients with VADs despite a strict anticoagulation therapy. We report two cases of successful acute endovascular therapy with Penumbra system for cerebral embolism.Case Presentations: Case 1: A 20-year-old woman with a VAD presented with right facial palsy and right monoparesis. 3D-computed tomography angiography (3D-CTA) demonstrated left middle cerebral artery (MCA) occlusion. We successfully performed endovascular recanalization of the left MCA with Thrombolysis in Cerebral Infarction (TICI) Grade3 perfusion, and the patient's symptoms significantly improved. The patient's condition improved to nearly the pre-treatment state. However, due to repeated strokes, the patient developed disturbances of consciousness, aphasia, and complete paralysis of the left lower limb. Furthermore, the infection worsened, and the patient eventually developed a circulatory disorder of the VAD and died. Case 2: A 34-year-old man with VAD presented with sudden disturbances of consciousness and right hemiparesis. Computed tomography (CT) scan revealed no early abnormalities. We performed endovascular recanalization of the left internal carotid artery (IC) top with TICI 3 perfusion. After endovascular treatment, CT scan did not reveal a cerebral infarction. The patient eventually achieved an National Institutes of Health Stroke Scale (NIHSS) score of 0 point and received a heart transplant. In case 2, we pathologically analyzed the retrieved thrombus and confirmed the thrombus to be mainly composed of fibrin. There were no complications of hemorrhage in either case.Conclusion: A suction-type thrombectomy device is believed to be the first choice for patients with VAD.
脊髄硬膜動静脈瘻に対する血管内治療の現状と塞栓術成功因子の検討栗栖 宏多; 長内 俊也; 飛彈 一利; 浅野 剛; 牛越 聡; 関 俊隆; 笹森 徹; 寶金 清博
JNET: Journal of Neuroendovascular Therapy, 9, 6, S316, S316, (NPO)日本脳神経血管内治療学会, 2015年11月
日本語
補助人工心臓装着患者の脳塞栓症に対して急性期血管内治療が奏功した二例小林 聡; 宮本 倫行; 長内 俊也; 下田 祐介; 牛越 聡; 大岡 智学; 松居 善郎; 宝金 清博
JNET: Journal of Neuroendovascular Therapy, 8, 6, 374, 374, (NPO)日本脳神経血管内治療学会, 2014年12月
日本語
頭蓋内多血性腫瘍に対するNBCA塞栓術長内 俊也
日本インターベンショナルラジオロジー学会雑誌, 29, 3, 272, 277, The Japanese Society of Interventional Radiology, 2014年
日本語, Particles such as PVA, Microbead and Gelform powder have been used for embolization of intracranial hypervascular tumors. However, particulate materials have been sometimes described as having high risk of bleeding after embolization and less benefit.
NBCA, the liquid material used for the embolization of AVM, has been reported as a promising embolization material for hypervascular brain tumors recently. In this article we note the efficacy of NBCA as an embolization materials, the way to use NBCA in a practical manner, complications occurring during the embolization procedure, and previously reported histopathological findings.
骨髄間質細胞の動脈内送達の治療効果(Therapeutic effects of intra-arterial delivery of bone marrow stromal cells)
長内 俊也; 黒田 敏; 七戸 秀夫; 久下 裕司; 玉木 長良; 宝金 清博
脳循環代謝, 24, 1, 147, 147, (一社)日本脳循環代謝学会, 2012年11月
日本語
クリッピング後長期間経過した後に再発した前交通動脈瘤とその臨床的意義穂刈正昭; 中山若樹; 黒田敏; 長内俊也; 濱内祝嗣; 遠藤将吾; 宝金清博
脳神経外科速報, 22, 8, 938-942, 942, (株)メディカ出版, 2012年08月10日
日本語, 46歳女。前交通動脈瘤破裂に対してクリッピング術を行い、術後の脳血管撮影でcomplete clippingを確認していたが、19年後に動脈瘤の再発を認めた。初回治療時には右A1-2 bifurcation typeの動脈瘤に対してpterional approachで前交通動脈(AcomA)に平行に過不足ないクリッピングが行われていたが、AcomA側に及んでいた壁の薄い部分(クリップブレード上側脇)から動脈瘤が再発し、前および上向きに伸展したと考えられた。両側前開頭interhemisphaericアプローチでクリッピング術を行い、以前のクリップを外すことなく母動脈に対して直交するかたちで余すことなくクリッピングできた。
【脊椎・脊髄のトラブルシューティング-合併症の予防と対策】脊髄血管内治療における合併症とその対策
長内 俊也; 飛騨 一利; 牛越 聡; 浅野 剛; 青山 剛; 宝金 清博
脊椎脊髄ジャーナル, 25, 8, 793, 799, (株)三輪書店, 2012年08月
日本語
脊髄硬膜動静脈瘻における治療の問題点について飛騨 一利; 青山 剛; 矢野 俊介; 長内 俊也; 宝金 清博
北海道整形災害外科学会雑誌, 54, 1, 145, 145, 北海道整形災害外科学会, 2012年08月
日本語
脊髄硬膜動静脈瘻の臨床像青山 剛; 飛騨 一利; 矢野 俊介; 浅野 剛; 長内 俊也; 宝金 清博
Journal of Spine Research, 3, 3, 566, 566, (一社)日本脊椎脊髄病学会, 2012年03月
日本語
脊椎高流量動静脈シャントに対する治療方針淺野 剛; 飛騨 一利; 長内 俊也; 青山 剛; 宝金 清博
JNET: Journal of Neuroendovascular Therapy, 5, 4, 168, 168, (NPO)日本脳神経血管内治療学会, 2011年11月
日本語
Hypervascular tumorに対する術前NBCA塞栓術長内 俊也; 浅野 剛; 寺坂 俊介; 飛騨 一利; 宝金 清博; 鐙 邦芳; 伊東 学; 磯部 正則; 野村 三起夫
JNET: Journal of Neuroendovascular Therapy, 5, 4, 389, 389, (NPO)日本脳神経血管内治療学会, 2011年11月
日本語
くも膜下出血急性期に high flow bypass を行った破裂内頚動脈瘤の手術 : 特に内頚背側型動脈瘤の治療について数又 研; 浅岡 克行; 横山 由佳; 板本 孝治; 牛越 聡; 長内 俊也
脳卒中の外科 = Surgery for cerebral stroke, 38, 4, 207, 215, The Japanese Society on Surgery for Cerebral Stroke, 2010年07月31日
日本語, We report our preliminary experience using radial artery graft bypass in patients with ruptured internal carotid artery aneurysm. The following types of 12 ruptured internal carotid artery aneurysms were treated: dorsomedial aneurysms with ill-defined necks (in 8 patients); tiny paraclinoid aneurysms projected in the superior (n=1) and ventral (n=1) direction; fusiform aneurysm (n=1) located between the C1 segment and M1 segment; and an IC-PC aneurysm (n=1) previously clipped 15 years before. Bypass procedures employed were EC-radial artery-M2 bypass in 6, and temporary using RA-M2 bypass (i.e., forearm vascular pedicle) in 6. Complete obliteration of aneurysms with no ischemic complication was achieved in all dorsomedial internal carotid aneurysms. Graft failure occurred in 1 case. Our experience emphasizes the importance of achieving vascular anastomosis in various clinical settings. We also describe a proposed strategy to obliterate blister aneurysm.
不完全コイル塞栓術後の脳動脈瘤に対する外科治療黒田 敏; 牛越 聡; 新谷 好正; 長内 俊也; 石川 達哉; 瀧川 修吾; 宝金 清博; 岩崎 喜信
Neurological Surgery, 32, 6, 645, 650, (株)医学書院, 2004年06月
日本語, 症例1は37歳女で,両側内頸動脈瘤が発見された.両側内頸動脈瘤-眼動脈分岐部動脈瘤と診断した.右内頸動脈瘤でcoil compactionによる残存頸部の拡大が認められた.橈骨動脈グラフトを採取して外頸動脈-中大脳動脈バイパス術を施行した.右後頭葉に脳梗塞が出現し,左同名半盲を後遺して自宅退院した.症例2は55歳女で,血小板減少症であった.突然の頭痛が出現し,くも膜下出血と診断された.コイル塞栓術を実施し,破裂部位は閉塞されていると判断して手技を終了した.その後,クリッピング術を施行し,術後2年間,動脈瘤の再発はない.症例3は54歳男で,突然の頭痛,意識障害が発症し,CT上ではびまん性くも膜下出血を認めた.コイル塞栓術を実施し,腰椎ドレナージを施行し,意識障害は徐々に改善した.その後開頭術を施行し,脳動脈瘤の根治が確認され退院した
脳卒中治療と医療経済長内俊也; 長内俊也; 栗栖宏多; 栗栖宏多; 大橋和貴; ZHAO Jieyu; 森井康博; 小笠原克彦; 藤村幹; 藤村幹, 脳卒中, 47, 2, 2025年
脳血管内治療における遠隔手術支援前田拓真; 大川原舞; 長内俊也; 越阪部学; 上田幹也; 山口裕之; 前田高宏, 脳血管内治療(Web), 7, Supplement, 2022年
Traumatic brain injuryとFerroptosisの関連性についての研究
金 芝萍; 長内 俊也, 日本脳神経外傷学会プログラム・抄録集, 44回, 117, 117, 2021年01月
(一社)日本脳神経外傷学会, 日本語
Onyxを用い根治を目指した硬膜動静脈瘻に対する塞栓術
牛越 聡; 長内 俊也; 下田 祐介; 新谷 好正; 山内 朋祐; 石井 伸明, 脳血管内治療, 5, Suppl., 51, 51, 2020年11月
(NPO)日本脳神経血管内治療学会, 日本語
DeFrictorによる経動脈的塞栓術についての検討
長内 俊也; 東海林 菊太郎; 今井 哲秋; 杉山 拓; 中山 若樹; 数又 研; 寳金 清博, 脳血管内治療, 5, Suppl., 68, 68, 2020年11月
(NPO)日本脳神経血管内治療学会, 日本語
急性期血行再建術における非造影MRAによるアクセスルートの有用性
小林 聡; 長内 俊也; 中山 若樹; 数又 研; 杉山 拓; 藤間 憲幸; 濱口 明巧; 中村 俊孝; 飛騨 一利, 脳血管内治療, 5, Suppl., 23, 23, 2020年11月
(NPO)日本脳神経血管内治療学会, 日本語
最重症くも膜下出血(WFNS Grade V)に対するコイル塞栓術の治療成績
東海林 菊太郎; 長内 俊也; 杉山 拓; 数又 研; 中山 若樹, 脳血管内治療, 5, Suppl., 53, 53, 2020年11月
(NPO)日本脳神経血管内治療学会, 日本語
全国における急性期脳梗塞に対する血栓回収療法研修施設の地理的分布の評価
谷 松子; 藤原 健祐; 谷川 琢海; 長内 俊也; 小笠原 克彦, 医療情報学連合大会論文集, 40回, 631, 632, 2020年11月
(一社)日本医療情報学会, 日本語
優位側椎骨動脈浸潤を伴った頭蓋頸椎移行部硬膜内髄外腫瘍に対し,椎骨動脈塞栓術を行い全摘出し得た1例舘澤 諒大; 岩崎 素之; 飛騨 一利; 長内 俊也; 川堀 真人; 守田 玲菜; 山内 朋裕; 新谷 好正; 古川 浩司; 鐙谷 武雄; 馬渕 正二, Neurological Surgery, 48, 6, 509, 514, 2020年06月
46歳女。主訴は後頸部痛、一過性左片麻痺で、頭頸部MRIではCVJ部の右側を基部とした硬膜内髄外に腫瘤性病変を認め、延髄尾側〜上位頸髄を圧排し椎骨動脈(VA)が内包されていた。脳血管造影検査では右VAの筋枝2本が腫瘍のfeederとなり、右posterior inferior cerebellar arteryは描出されず、右小脳はanterior inferior cerebellar arteryにより灌流されていた。前脊髄動脈は左VAからの描出が強かった。髄膜腫を疑い、右VA閉塞試験で20分以上神経陽性所見が出現しないことを確認後、VAのコイル塞栓を施行した。塞栓4日後の腹臥位にてfar lateral approach、C1 laminectomyによる腫瘍摘出術を施行した。露出したVAはコイル毎に離断して以後の作業を容易にし、腫瘍を安全に摘出した。術後、右延髄に点状梗塞を認め左半身の温痛覚障害が出現したが、短期で改善し社会復帰した。, (株)医学書院, 日本語
Tentorial dural AVFの治療戦略
下田 祐介; 森島 穣; 牛越 聡; 長内 俊也; 杉山 拓; 中山 若樹, 脳血管内治療, 4, Suppl., S98, S98, 2019年11月
(NPO)日本脳神経血管内治療学会, 日本語
Onyxを用いた硬膜動静脈瘻に対する塞栓術
牛越 聡; 下田 裕介; 長内 俊也; 中山 若樹; 杉山 拓, 脳血管内治療, 4, Suppl., S163, S163, 2019年11月
(NPO)日本脳神経血管内治療学会, 日本語
Tentrial dural AVFの治療戦略
下田 祐介; 岡本 迪成; 牛越 聡; 長内 俊也; 中山 若樹; 杉山 拓; 宝金 清博, 脳血管内治療, 3, Suppl., S192, S192, 2018年11月
(NPO)日本脳神経血管内治療学会, 日本語
血管内治療におけるMRAとCTAによるアクセスルートの比較
小林 聡; 長内 俊也; 中山 若樹; 鐙谷 武雄; 数又 研; 藤間 憲幸; 清水 幸衣; 大野 浩太; 宝金 清博, 脳血管内治療, 3, Suppl., S268, S268, 2018年11月
(NPO)日本脳神経血管内治療学会, 日本語
頭蓋内硬膜動静脈瘻に対する4D-MRAの検討
東海林 菊太郎; 長内 俊也; 藤間 憲幸; 牛越 聡; 寳金 清博, 脳血管内治療, 3, Suppl., S203, S203, 2018年11月
(NPO)日本脳神経血管内治療学会, 日本語
北海道の急性期脳梗塞診療に対する地理的アクセシビリティ分析藤原健祐; 長内俊也; 小林永一; 谷川琢海; 小笠原克彦, 医療情報学連合大会論文集, 37th (CD-ROM), ROMBUNNO.3‐L‐4‐PP12‐1, 1113, 2017年11月01日
(一社)日本医療情報学会, 日本語
頸動脈直接穿刺を行った血栓回収療法の3例
川堀 真人; 長内 俊也; 新谷 好正; 岩崎 素之; 馬渕 正二; 宝金 清博, 脳血管内治療, 2, Suppl., S305, S305, 2017年11月
(NPO)日本脳神経血管内治療学会, 日本語
急性期虚血病態を治す/急性期脳虚血病態を治療する 脳虚血再灌流時の微小循環障害にターゲットをおいた脳保護療法の開発
鐙谷 武雄; 月花 正幸; 栗栖 宏多; 新保 大輔; 長内 俊也; 中山 若樹; 数又 研; 宝金 清博, 脳循環代謝, 29, 1, 96, 96, 2017年11月
日本脳循環代謝学会, 日本語
急性期脳梗塞における脳血栓回収療法後のASL高信号部位は最終脳梗塞部位を予想しうる
後藤 秀輔; 川堀 真人; 岩崎 素之; 新谷 好正; 馬渕 正二; 長内 俊也; 宝金 清博, 脳血管内治療, 1, Suppl., S66, S66, 2016年11月
(NPO)日本脳神経血管内治療学会, 日本語
血栓回収療法におけるアプローチルート評価目的の心電図同期大動脈弓MRAの有効性の検討
川堀 真人; 長内 俊也; 後藤 秀輔; 新谷 好正; 岩崎 素之; 馬渕 正二; 宝金 清博, 脳血管内治療, 1, Suppl., S190, S190, 2016年11月
(NPO)日本脳神経血管内治療学会, 日本語
全身麻酔下頸動脈ステント留置術の有用性と術中モニタリング
月花 正幸; 青樹 毅; 長内 俊也; 中山 若樹; 数又 研; 鐙谷 武雄; 七戸 秀夫; 寳金 清博, 脳血管内治療, 1, Suppl., S224, S224, 2016年11月
(NPO)日本脳神経血管内治療学会, 日本語
研究 髄膜腫の術前塞栓の有用性 エンボスフィアの使用経験
下田 祐介; 長内 俊也; 寺坂 俊介; 小林 浩之; 山口 秀; 遠藤 将吾; 畑中 佳奈子; 寳金 清博, Neurological Surgery, 44, 7, 555, 560, 2016年07月
髄膜腫における術前塞栓の有用性について検討した。巨大な髄膜腫摘出術前にエンボスフィアで塞栓術を実施した4例(男性1名、女性3名、65〜79歳)を対象とした。塞栓術後、平均腫瘍最大径は58.8±9.2→57.3±10.8mm、平均腫瘍体積は70.6±41.5→66.7±36.8mLと減少したが、有意差はなかった。術中の出血量は、塞栓術後6日目に摘出をした症例で最も少なかった。エンボスフィアはHE染色で内部が無構造であった。摘出標本では4例中2例に壊死を認めた。標本中の局在は主として血管内であるため周囲に血管壁構造を伴うことが多く、von Kossa染色で染色されないことが特徴として挙げられた。合併症として網膜中心動脈閉塞症が1例でみられた。, (株)医学書院, 日本語
部分血栓化動脈瘤による三叉神経痛様の眼周囲痛に対しステント併用コイル塞栓術が著効した1例月花正幸; 長内俊也; 数又研; 牛越聡; 高宮宗一郎; 斉藤巧実; 中山若樹; 七戸秀夫; 鐙谷武雄; 宝金清博, 脳神経外科速報, 26, 5, 515‐521, 521, 2016年05月10日
症例は30歳代女性で、6ヵ月前、頭痛を主訴に受診し、類もやもや病と右後大脳動脈(PCA)血栓化動脈瘤と診断され経過観察となった。1ヵ月前より、突発的な右眼周囲痛の激しい痛みが出現し、動脈瘤の明らかな増大を認めた。三叉神経痛様の右眼周囲痛に対して、カルバマゼピンを処方し軽度症状の改善を認めた。急速な動脈瘤の増大と新たな脳神経障害を認めているため手術の方針となった。片側の類もやもや病と右PCAの下向き大型部分血栓化動脈瘤の診断にて、EC-IC bypass併用の血管内母血管閉塞術を試みた。術2週間後にステント併用コイル塞栓術を施行した。術翌日から右眼周囲の疼痛は消失し、カルバマゼピンは休薬した。術後9ヵ月後のMRIでは若干の血栓化瘤の縮小を認め、疼痛の再発は認めない。, (株)メディカ出版, 日本語
頸動脈分岐部に生じた可動性プラークに対するCASとCEAの治療戦略
川堀 真人; 長内 俊也; 新谷 好正; 岩崎 素之; 馬渕 正二; 寶金 清博, JNET: Journal of Neuroendovascular Therapy, 9, 6, S403, S403, 2015年11月
(NPO)日本脳神経血管内治療学会, 日本語
脊髄硬膜動静脈瘻の治療後における痛み,生活の質の調査笹森徹; 関俊隆; 飛彈一利; 長内俊也; 矢野俊介; 寳金清博, 脊髄外科, 28, 3, 306, 309, 2014年12月25日
治療後追跡した脊髄硬膜動静脈瘻患者49例に痛みやQOLに関するアンケートを依頼し、32例(男24例、女8例、平均69.1歳)より有効回答を得た。治療後平均86.3ヵ月において、Aminoff-Logue scaleスコアは治療前に比較し歩行で20例、排尿機能で8例が改善していた。3ヵ月以上持続する腰痛は15例、下肢痛は26例に認め、腰痛は術前から有り11例、術後出現4例、下肢痛はそれぞれ14例、12例であった。腰痛のnumerical rating scaleはslight 3例、moderate 7例、severe 5例、下肢痛ではそれぞれ5例、8例、13例であった。神経障害性疼痛の要素を含むと判定されるpainDETECTスコア13点以上は、腰痛5例、下肢痛21例に認めた。健康関連QOL尺度(SF-36v2)では、全ての下位尺度のスコアが国民標準値を有意に下回っていた。腰下肢痛の有無で比較すると、「体の痛み」で有意差を認めた以外に、他の全下位尺度も腰下肢痛有り群が低い傾向であった。, (一社)日本脊髄外科学会, 日本語
小脳AVMに対して術前塞栓術を行なった3症例長内俊也; 中山若樹; 牛越聡; 下田祐介; 栗栖宏多; 宝金清博, J Neuroendovascular Ther, 8, 6, 406, 406, 2014年12月01日
(NPO)日本脳神経血管内治療学会, 日本語
長期予後に基づく脊髄硬膜動静脈瘻に対する治療戦略の検証笹森徹; 笹森徹; 飛騨一利; 矢野俊介; 浅野剛; 長内俊也; 青山剛; 岩崎喜信; 斉藤久壽; 宝金清博, J Neuroendovascular Ther, 6, 5, 424, 424, 2012年11月01日
(NPO)日本脳神経血管内治療学会, 日本語
巨大延髄背側血管芽腫の治療経験伊師雪友; 山崎和義; 栗栖宏多; 濱内祝嗣; 下田祐介; 浅野剛; 長内俊也; 小林浩之; 寺坂俊介; 寳金清博, 日本脳腫瘍の外科学会プログラム・抄録集, 17th, 2012年
脳卒中に対する骨髄間質細胞移植研究の現状と課題黒田 敏; 七戸 秀夫; 杉山 拓; 伊東 雅基; 川堀 真人; 千葉 泰弘; 長内 俊也; 丸一 勝彦; 宝金 清博; 岩崎 喜信, 脳卒中, 32, 6, 532, 537, 2010年11月25日
第35回日本脳卒中学会 シンポジウム1 総説, 日本脳卒中学会, 日本語
Merciレトリーバー導入に向けた当院での血行再建療法長内 俊也; 牛越 聡; 数又 研; 杉山 拓; 横山 由佳; 浅岡 克行; 板本 孝治, JNET: Journal of Neuroendovascular Therapy, 4, 4, 295, 295, 2010年11月
(NPO)日本脳神経血管内治療学会, 日本語
ラット大脳凍結損傷モデルへの骨髄間質細胞の動注移植
長内 俊也; 黒田 敏; 千葉 泰弘; 丸一 勝彦; 杉山 拓; 安田 宏; 七戸 秀夫; 岩崎 喜信, 日本神経外傷学会プログラム・抄録集, 32回, 043, 043, 2009年04月
(一社)日本脳神経外傷学会, 日本語
骨髄間質細胞(BMSC)の移植はびまん性軸策損傷(DAI)による高次脳機能障害を改善する 11C-FMZ PET/CTを用いた検討
丸一 勝彦; 黒田 敏; 千葉 泰弘; 長内 俊也; 穂刈 正昭; 杉山 拓; 七戸 秀夫; 岩崎 喜信, 日本神経外傷学会プログラム・抄録集, 32回, 045, 045, 2009年04月
(一社)日本脳神経外傷学会, 日本語
破裂解離性椎骨動脈瘤に対する治療方針長内俊也; 牛越聡; 菊池統; 横山由佳; 数又研; 浅岡克行; 板本孝治; 安田宏; 斉藤久寿; 吉本哲之; 金子貞夫; 柏葉武; 浅野剛; 中山若樹; 黒田敏; 岩崎喜信, 日本脳神経外科学会総会抄録集(CD-ROM), 68th, ROMBUNNO.3D-O072-05, 2009年
日本語
脳梗塞を合併した成人 Still 病の1例穂刈 正昭; 黒田 敏; 長内 俊也; 鐙谷 武雄; 渥美 達也; 小池 隆夫; 岩崎 喜信, 脳卒中, 29, 3, 483, 487, 2007年05月25日
日本語
