研究者詳細 - 西堀　正洋

Intraoperative evaluation of local cerebral hemodynamic change by indocyanine green videoangiography: prediction of incidence and duration of postoperative transient neurological events in patients with moyamoya disease 国際誌 Open Access

Uda, K; Araki, Y; Muraoka, S; Ota, S; Wada, K; Yokoyama, K; Nishihori, M; Izumi, T; Okamoto, S; Wakabayashi, T

JOURNAL OF NEUROSURGERY 130 巻 ( 4 ) 頁： 1367 - 1375 2019年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Neurosurgery

OBJECTIVE Transient neurological events (TNEs) occur frequently in the acute phase after direct bypass surgery for moyamoya disease (MMD), but there is currently no way to predict them. FlowInsight is a specialized software for analyzing indocyanine green (ICG) videoangiography taken with a surgical microscope. The purpose of this study was to investigate whether intraoperative evaluation of local hemodynamic changes around anastomotic sites using FlowInsight could predict the incidence and duration of TNEs. METHODS From patients who were diagnosed with MMD in our hospital between August 2014 and March 2017 and who underwent superficial temporal artery–middle cerebral artery bypass surgery, we investigated 25 hemispheres (in 22 patients) in which intraoperative ICG analysis was performed using FlowInsight. To evaluate the local cerebral hemodynamics before and after anastomosis, regions of interest were set at 3 locations on the brain surface around the anastomotic site, and the mean cerebral blood flow (CBF), mean gradation (Grad), mean transit time (MTT), and mean time to peak (TTP) were calculated from the 3 regions of interest. Furthermore, the change rate in CBF (DCBF [%]) was calculated using the formula (postanastomosis mean CBF - preanastomosis mean CBF)/preanastomosis mean CBF. DGrad (%), DMTT (%), and DTTP (%) were similarly calculated. RESULTS Postoperative stroke without TNE occurred in 2 of the 25 hemispheres. These 2 hemispheres (in 2 patients) were excluded from the study, and data from the remaining 23 hemispheres (in 20 patients) were analyzed. For each parameter (DCBF, DGrad, DMTT, and DTTP) calculated by FlowInsight, the difference between the groups with and without TNEs was significant. The median values for DCBF and DGrad were significantly higher in the TNE group than in the no-TNE group (DCBF 30.13 vs 3.54, p = 0.0106; DGrad 62.05 vs 10.78, p = 0.00435), whereas the median values for DMTT and DTTP were significantly lower in the TNE group (DMTT -16.90 vs -7.393, p = 0.023; DTTP -29.07 vs -7.02, p = 0.00342). Comparison of the area under the curve (AUC) for each parameter showed that DTTP had the highest AUC and was the parameter with the highest diagnostic accuracy (AUC 0.857). The Youden index revealed that the optimal cutoff value of DTTP was -11.61 (sensitivity 77.8%, specificity 71.4%) as a predictor of TNEs. In addition, Spearman’s rank correlation coefficients were calculated, and DCBF, DGrad, DMTT, and DTTP each showed a strong correlation with the duration of TNEs. The larger the change in each parameter, the longer the TNEs persisted. CONCLUSIONS Intraoperative ICG videoangiography findings were correlated with the occurrence and duration of TNEs after direct bypass surgery for MMD. Screening for cases at high risk of TNEs can be achieved by ICG analysis using FlowInsight.

DOI： 10.3171/2017.10.JNS171523

Experimental study of the characteristics of various types of filling coils for intracranial aneurysm embolisation Open Access

Ito, M; Matsubara, N; Izumi, T; Miyachi, S; Ota, K; Imai, T; Nishihori, M; Wakabayashi, T

INTERVENTIONAL NEURORADIOLOGY 24 巻 ( 5 ) 頁： 513 - 519 2018年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Interventional Neuroradiology

Background: In endovascular embolisation for an intracranial aneurysm, after framing coil deployment, soft coils (often called filling coils) are usually selected to fill inside the cage of previous coils. Various kinds of filling coils are available, although each coil has its own characteristics. Understanding their differences to ensure proper coil selection is important to achieve successful embolisation. The purpose of this study was to investigate the characteristics of various filling coils. Materials and methods: The authors developed a radiolucent coil to evaluate the performance of coils under conditions simulating the course of embolisation. Experimental embolisation was performed by using a silicone aneurysm filled with radiolucent coils. Indices including area, circularity, centroid position and coefficient of variation were investigated by analysing the figures of the filling coils after being inserted into the radiolucent coil under fluoroscopy. Results: The characteristics of each coil depended on the coil design. The helical coil had the highest circularity and centroid position scores and lowest area score. Therefore, it tended to develop a compacted mass. The low shape-memory coil had the lowest circularity, second-highest centroid position and highest coefficient of variation scores. Therefore, it tended to develop irregularly shaped distribution with low reproducibility. Complex coils generally had higher area and circularity scores. Therefore, they tended to provide a balanced distribution with relatively expanded mass and less small compartmentation. Conclusions: The evaluated characteristics of various filling coils should be useful for appropriate selection of filling coils.

DOI： 10.1177/1591019918779196

Association between CYP2C19 genotype and the additional effect of cilostazol to clopidogrel resistance in neuroendovascular therapy.

Association between CYP2C19 genotype and the additional effect of cilostazol to clopidogrel resistance in neuroendovascular therapy

Tajima Hayato, Izumi Takashi, Miyachi Shigeru, Matsubara Noriaki, Ito Masashi, Imai Tasuku, Nishihori Masahiro, Shintai Kazunori, Okamoto Sho, Araki Yoshio, Kumakura Yasuo, Furukawa-Hibi Yoko, Yamada Kiyofumi, Wakabayashi Toshihiko

NAGOYA JOURNAL OF MEDICAL SCIENCE 80 巻 ( 2 ) 頁： 207-215 2018年5月

Tajima H, Izumi T, Miyachi S, Matsubara N, Ito M, Imai T, Nishihori M, Shintai K, Okamoto S, Araki Y, Kumakura Y, Furukawa-Hibi Y, Yamada K, Wakabayashi T

Nagoya journal of medical science 80 巻 ( 2 ) 頁： 207 - 215 2018年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

We investigated the association between CYP2C19 genotype and additional effect of cilostazol on clopidogrel resistance (CR) in neuroendovascular therapy. Between January 2012 and January 2016, 447 consecutive patients were administered with 75-mg cilostazol/day. The VerifyNow System was used for evaluating P2Y12 reaction units (PRU) > 230 and/or percentage inhibition of platelet function (% Inhibition) ≤ 20 as CR. Among 158 patients with CR, 31 were administered with additional 100- or 200-mg cilostazol/day and their platelet function was evaluated. According to CYP2C19 genotypes revealed using the Spartan RX and DNeasy Blood & Tissue Kit, patients were classified into three phenotypic groups: extensive metabolizer (EM, three patients), intermediate metabolizer (IM, 12 patients), and poor metabolizer (PM, 16 patients). Administration of additional cilostazol decreased PRU (EM group: 160.7 ± 85.2 after vs 278.3 ± 40.1 before, P = 0.15; IM group: 205.6 ± 74.0 vs 254.3 ± 35.0, P = 0.02; and PM group: 227.8 ± 52.2 vs 282.1 ± 30.4, P = 0.003), and increased % Inhibition (EM group: 40.0 ± 27.9 vs 9.3 ± 3.8, P = 0.25; IM group: 31.4 ± 18.0 vs 11.8 ± 8.2, P = 0.001; and PM group: 24.6 ± 15.0 vs 10.4 ± 9.3, P = 0.001). However, the rate of normalized-clopidogrel response, thromboembolic lesions, and bleeding complications were not significantly different among the three groups. Thus, the addition of cilostazol was effective on CR in terms of PRU, % Inhibition, rate of change of normalized-clopidogrel response, thromboembolic events, and bleeding complications irrespective of phenotype.

DOI： 10.18999/nagjms.80.2.207

Evaluation for shunted pouches of cavernous sinus dural arteriovenous fistula and the treatment outcome of transvenous embolization Open Access

Sato, M; Izumi, T; Matsubara, N; Nishihori, M; Miyachi, S; Wakabayashi, T

INTERVENTIONAL NEURORADIOLOGY 24 巻 ( 2 ) 頁： 189 - 196 2018年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Interventional Neuroradiology

Background: This study aimed to evaluate the detailed location and the number (single or multiple) of cavernous sinus dural arteriovenous fistula (CSDAVF) shunted pouches as well as the relationship between the characteristics of shunted pouch(es) and the treatment outcome of transvenous embolization for CSDAVF. Methods: A total of 23 consecutive patients with CSDAVFs who underwent angiogram and transvenous embolization were retrospectively analyzed. Shunted pouches were assessed using three-dimensional angiogram and multiplanar reformatted image obtained from the rotational angiogram data. Results: Of the 23 patients with CSDAVFs, 40 shunted pouches were identified. Twelve CSDAVFs had a single shunted pouch, and 11 had multiple shunted pouches. The mean CSDAVF with multiple shunted pouches was 2.5. The shunted pouches were more often found in the posterior compartment of the CS, which was connected with the intercavernous sinus (23/40; 57.5%). In 12 CSDAVFs with a single shunted pouch, 10 were treated with selective embolization and complete occlusion was achieved during the follow-up. Two CSDAVFs with single shunted pouch were just observed without intervention, and DAVFs disappeared spontaneously during the follow-up period. In 11 CSDAVFs with multiple shunted pouches, eight were treated with selective embolization and three with sinus embolization. In six of eight (75%), complete occlusion was achieved following selective embolization, but two of eight (25%) recurred and required retreatment. Conclusions: Rotational angiography data suggested that the shunted pouches of CSDAVFs were mostly located in the posterior compartment of the CS connected with the intercavernous sinus. Selective embolization for CSDAVFs with a single shunted pouch is the first-line treatment alternative to sinus packing, and selective embolization with multiple shunted pouches will be a considerable treatment option.

DOI： 10.1177/1591019917743064

もやもや病に対する間接血行再建術後における皮質および脳溝内のFLAIR高信号と術後一過性神経脱落症状との関連

荒木芳生, 岡本奨, 横山欣也, 太田慎次, 宇田憲司, 村岡真輔, 金森史哲, 西堀正洋, 泉孝嗣, 若林俊彦

脳卒中の外科 46 巻 ( 6 ) 頁： 439 - 444 2018年

Clinical Application of Insertion Force Sensor System for Coil Embolization of Intracranial Aneurysms

Matsubara, N; Miyachi, S; Izumi, T; Yamada, H; Marui, N; Ota, K; Tajima, H; Shintai, K; Ito, M; Imai, T; Nishihori, M; Wakabayashi, T

WORLD NEUROSURGERY 105 巻頁： 857 - 863 2017年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：World Neurosurgery

Introduction In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that force. In this article, coil insertion force was measured in cases of intracranial aneurysm using this sensor, and its actual clinical application was investigated. Methods The sensor consists of a hemostatic valve (Y-connector). A little flexure was intentionally added in the device, and it creates a bend in the delivery wire. The sensor measures the change in the position of the bent wire depending on the insertion force and translates it into a force value. Using this, embolization was performed for 10 unruptured intracranial aneurysms. Results The sensor adequately recorded the force, and it reflected the operators' usual clinical experience. The presence of the sensor did not affect the procedures. The sensor enabled the operators to objectively note and evaluate the insertion force and better cooperative handling was possible. Additionally, other members of the intervention team shared the information. Force records demonstrated the characteristic patterns according to every stage of coiling (framing, filling, and finishing). Conclusions The force sensor system adequately measured coil insertion force in intracranial aneurysm coil embolization procedures. The safety of this sensor was demonstrated in clinical application for the limited number of patients. This system is useful adjunct for assisting during coil embolization for an intracranial aneurysm.

DOI： 10.1016/j.wneu.2017.06.092

Coiling of a Ruptured Large Internal Carotid Artery Aneurysm via Extracranial-Intracranial Saphenous Vein Bypass Graft Just After Proximal Ligation of the Internal Carotid Artery

Tajima, H; Araki, Y; Izumi, T; Nishihori, M; Okamoto, S; Wakabayashi, T

WORLD NEUROSURGERY 98 巻頁： 879.e1 - 879.e4 2017年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：World Neurosurgery

Background Combined direct and endovascular surgery has been performed to treat large to giant internal carotid artery (ICA) aneurysms. This report describes successful treatment of a large ICA aneurysm by coiling of the aneurysm via an extracranial-intracranial saphenous vein (SV) graft just after bypass and ICA proximal ligation. Case Description A 66-year-old woman presented with a left ICA supraclinoid aneurysm with progressive visual field defect and impaired visual acuity in the left eye. While waiting for scheduled surgery, she experienced a subarachnoid hemorrhage. An extracranial-intracranial high-flow bypass using an SV graft and proximal ligation of the ICA were performed. Coiling of the aneurysm was immediately performed successfully via the SV bypass graft. The patient experienced no new neurologic deficit after this treatment. Follow-up radiologic evaluations using magnetic resonance imaging and magnetic resonance angiography revealed complete aneurysm occlusion. Conclusions Aneurysm coiling via an extracranial-intracranial SV bypass graft could offer an alternative when an antegrade access route to the ICA is not used because of prior parent artery ligation.

DOI： 10.1016/j.wneu.2016.11.066

A Case of Lateral Medullary Artery Arisen from the Posterior Meningeal Artery

Ito Masashi, Izumi Takashi, Nishihori Masahiro, Imai Tasuku, Tamari Yousuke, Tsukada Tetsuya, Ishida Mamoru, Kropp Asuka, Wakabayashi Toshihiko

脳神経血管内治療 11 巻 ( 12 ) 頁： 615 - 618 2017年

記述言語：英語出版者・発行元：特定非営利活動法人日本脳神経血管内治療学会

Objective: We encountered a patient with lateral medullary infarction during transarterial embolization of the posterior meningeal artery (PMA). We reviewed the anatomic characteristics/imaging findings of this disorder.Case Presentation: A 69-year-old male. Cerebral infarction involving the lateral medulla occurred during transarterial embolization of a dural arteriovenous fistula. It was considered to be a complication related to occlusion of a lateral medulla-penetrating vessel on microcatheter/guidewire operations in the PMA. When examining images in detail, the blood vessel could be confirmed using DSA and 3D angiography.Conclusion: When performing embolization, the presence of a brainstem-penetrating vessel originating from the PMA must be considered.

DOI： 10.5797/jnet.cr.2017-0038

The Treatment Outcome of Transarterial Embolization for Isolated Sinus Type Dural Arteriovenous Fistula between NBCA and Onyx

Imai Tasuku, Izumi Takashi, Matsubara Noriaki, Nishihori Masahiro, Ito Masashi, Sato Masaki, Tamari Yosuke, Ishida Mamoru, Tsukada Tetsuya, Miyachi Shigeru, Wakabayashi Toshihiko

Journal of Neuroendovascular Therapy 11 巻 ( 6 ) 頁： 279 - 287 2017年

記述言語：英語出版者・発行元：The Japanese Society for Neuroendovascular Therapy

Objective: The purpose of this study was to compare the clinical outcome of transarterial embolization for isolated sinus type dural arteriovenous fistula (iDAVF) using n-butyl-cyanoacrylate (NBCA) and Onyx.Methods: Seventeen lesions of iDAVF in 17 patients who underwent transarterial embolization between March 2008 and February 2015 were retrospectively analyzed. They were treated by embolization using NBCA in 10 patients, Onyx in 5 patients, and combination of NBCA and Onyx in 2 patients. We compared the results between embolization with NBCA and Onyx as follows: complete occlusion rate, number of embolized vessels, procedure-related complications, treatment time, dose of radiation exposure, amount of contrast agent, and total cost of the devices.Results: The complete occlusion rate of iDAVF was significantly higher in the Onyx group: 4 of 10 (40%) in NBCA and 5 of 5 (100%) in Onyx (P = 0.04). The number of treated vessels (5.1 ± 1.2 in NBCA, 1 in Onyx [P <0.001]), the maximum skin entrance dose (NBCA: 5030 ± 1646 [mGy], Onyx: 1670 ± 564 [mGy] in Onyx [P <0.01]), and total cost of the devices (601,265 ± 15,749 [yen] in NBCA, 374,210 ± 122,142 [yen] in Onyx [P <0.01]) were significantly higher in the NBCA. No significant difference was observed in the treatment time and contrast agent dose.Conclusion: In transarterial embolization of iDAVF, a higher complete occlusion rate was obtained with Onyx, which was also advantageous for reducing the exposure dose and cost of the devices.

DOI： 10.5797/jnet.oa.2016-0090

詳細な画像診断が治療戦略を決定するうえで有用であった破裂血豆状内頸動脈瘤の1 例

西堀正洋, 泉孝嗣, 松原功明, 宇田憲司, 新帯一憲, 田島隼人, 伊藤真史, 今井資, 若林俊彦

脳卒中 39 巻 ( 1 ) 頁： 24 - 28 2017年

記述言語：日本語出版者・発行元：一般社団法人日本脳卒中学会

38 歳女性．頭痛発症のくも膜下出血で受診した．急性期に動脈瘤を認めず，第14 病日の血管撮影で右内頸動脈にわずかな隆起性変化を認め，血豆状内頸動脈瘤が疑われた．MRI CISS 画像とCTA のMPR 画像を比較したところ，拡張部の前後に偽腔が広がり，近位側は眼動脈分岐部の内頸動脈後壁に及んでいると推測された．バルーン閉塞試験にて内頸動脈の遮断耐性は認められたが，眼窩内の血管が全く描出されなかったため，眼動脈を含む内頸動脈病変に対するtrapping は視力障害のリスクが非常に高いと考えられた．治療戦略をステント支援下コイル塞栓術とし，眼動脈を温存した．術後，視力障害を含めた神経症状はなく，動脈瘤の再発もなく経過良好である．本症例では，MRI や血管撮影の詳細な読影を行うことで，治療方針の決定のみならず，合併症リスクも回避することができた．

DOI： 10.3995/jstroke.10412

Treatment protocol based on assessment of clot quality during endovascular thrombectomy for acute ischemic stroke using the Trevo stent retriever 査読有り

Kojiro Ishikawa, Tomotaka Ohshima, Masahiro Nishihori, Tasuku Imai, Shunsaku Goto, Taiki Yamamoto, Toshihisa Nishizawa, Shinji Shimato, Kyozo Kato

NAGOYA JOURNAL OF MEDICAL SCIENCE 78 巻 ( 3 ) 頁： 255 - 265 2016年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：NAGOYA UNIV, SCH MED

The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment. Immediately after the Trevo was deployed, the stent delivery wire was pushed to open the stent by force (ACAPT technique). Clot quality was assessed on the basis of the perfusion status after deployment of the Trevo; continued occlusion or immediate reopening either reoccluded or maintained after the stent retriever had been in place for 5 min. If there was no obvious clot removal after the first pass with the Trevo, according to the quality of the clot, either a second pass was performed or another endovascular device was selected. Twelve consecutive patients with acute major cerebral artery occlusion were analyzed. Thrombolysis in cerebral infarction score 2b and 3 was achieved in 11 patients (91.7%) and 9 (75%) had a good clinical outcome after 90 days based on a modified Rankin scale score <= 2. Symptomatic intracranial hemorrhage occurred in 1 patient (8.3%). The overall mortality rate was 8.3%. Endovascular thrombectomy using the Trevo stent retriever for first-line treatment is feasible and effective.

Overlap stenting for in-stent restenosis after carotid artery stenting

Overlap stenting for in-stent restenosis after carotid artery stenting 査読有り

Nishihori Masahiro, Ohshima Tomotaka, Yamamoto Taiki, Goto Shunsaku, Nishizawa Toshihisa, Shimato Shinji, Izumi Takashi, Kato Kyozo

NAGOYA JOURNAL OF MEDICAL SCIENCE 78 巻 ( 2 ) 頁： 143 - 149 2016年5月

Overlap stenting for in-stent restenosis after carotid artery stenting.

Nishihori M, Ohshima T, Yamamoto T, Goto S, Nishizawa T, Shimato S, Izumi T, Kato K

Nagoya journal of medical science 78 巻 ( 2 ) 頁： 143 - 9 2016年5月

Nishihori Masahiro, Ohshima Tomotaka, Yamamoto Taiki, Goto Shunsaku, Nishizawa Toshihisa, Shimato Shinji, Izumi Takashi, Kato Kyozo

Nagoya Journal of Medical Science 78 巻 ( 2 ) 頁： 143 - 149 2016年5月

Comparison of Clinical Outcomes Using 10 Coil Versus 14 Coil in Endovascular Coil Embolization for Small and Medium-sized Intracranial Aneurysms: Efficacy of 14 Coil

Imai Tasuku, Ohshima Tomotaka, Goto Shunsaku, Yamamoto Taiki, Shimato Shinji, Nishizawa Toshihisa, Kato Kyozo, Nishihori Masahiro, Izumi Takashi, Wakabayashi Toshihiko

脳神経血管内治療 10 巻 ( 4 ) 頁： 196 - 200 2016年

記述言語：英語出版者・発行元：特定非営利活動法人日本脳神経血管内治療学会

Objective: The purpose of this retrospective study was to compare the therapeutic results of middle-sized or small cerebral aneurysms coiling using 10 coil (thickness, 0.0095 inch–0.012 inch) and 14 coil (thickness, 0.0135 inch) as a complex framing coil.Methods: Fifty aneurysms (maximum size, 4 mm–10 mm) in 50 patients treated in our hospital between May 2012 and May 2015 were assigned in this study. We compared the volume embolization rate, recurrence rate, initial occlusion grade between 14 coil (25 aneurysms) and 10 coil (25 aneurysms).Results: The mean volume embolization ratio was significantly higher (14 coil 37.5 ± 8.8%, 10 coil 32.6 ± 8.4%; P <0.05) in aneurysms coiled with 14 inch coil than those coiled with 10 inch coil. Fourteen inch coil has a higher initial occlusion grade, and lower recurrence rate than 10 coil, but these differences were not significant.Conclusion: The use of 14 inch framing coil to embolize middle-sized or small cerebral aneurysms is more effective in terms of a higher packing ratio.

DOI： 10.5797/jnet.oa.2016-0045

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その他リンク： http://search.jamas.or.jp/link/ui/2017210157

Comparison of Clinical Outcomes Using 10 Coil Versus 14 Coil in Endovascular Coil Embolization for Small and Medium-sized Intracranial Aneurysms: Efficacy of 14 Coil

Imai Tasuku, Ohshima Tomotaka, Goto Shunsaku, Yamamoto Taiki, Shimato Shinji, Nishizawa Toshihisa, Kato Kyozo, Nishihori Masahiro, Izumi Takashi, Wakabayashi Toshihiko

Journal of Neuroendovascular Therapy 10 巻 ( 4 ) 頁： 196 - 200 2016年

記述言語：英語出版者・発行元：The Japanese Society for Neuroendovascular Therapy

DOI： 10.5797/jnet.oa.2016-0045

Multimodal Assessment for Balloon Test Occlusion of the Internal Carotid Artery

Matsubara Noriaki, Izumi Takashi, Okamoto Sho, Araki Yoshio, Shintai Kazunori, Tajima Hayato, Imai Tasuku, Ito Masashi, Nishihori Masahiro, Miyachi Shigeru, Wakabayashi Toshihiko

Journal of Neuroendovascular Therapy 10 巻 ( 3 ) 頁： 108 - 115 2016年

記述言語：英語出版者・発行元：The Japanese Society for Neuroendovascular Therapy

Objective: Permanent therapeutic occlusion of the carotid artery is one of the treatment options for patients with a large/giant internal carotid artery aneurysm or tumor involving the neck or skull base. Balloon test occlusion (BTO) is performed to predict the tolerance of parent artery occlusion (PAO). The authors combined various modalities to improve the sensitivity of BTO. The purpose of this study is to present the efficacy of the multimodal BTO.Methods: Between January 2008 and September 2014, a total of 50 patients (internal carotid aneurysms: 39, neck or skull base tumor: 8, others: 3; mean 58.4 years, range 7–81 years; 10 men and 40 women) underwent multimodal BTO. Tolerance of PAO was evaluated by the algorithm with various assessment modalities including neurological symptoms with/without induced hypotension, findings of angiogram (collateral flow, venous phase laterality), perfusion CT, and stump pressure. Clinical data of patients with BTO were analyzed retrospectively. Procedures were performed in the angio/CT combination suite. BTO was performed in the usual fashion and when the patient passed the immediate test occlusion, perfusion CT was performed. Subsequently, the angiogram under balloon inflation followed. If the patient did not show neurological symptoms for 20 min, hypotension was induced by intravenous injection of the vasodilator. Neurological symptoms were then checked for more than 30 min.Results: By multimodal assessment of BTO, 33 patients were considered tolerable, six were partially tolerable, and 11 were intolerable. Thirteen of 33 patients with predictive tolerance underwent PAO without bypass, and all but one showed no hemodynamic ischemia postoperatively. Three of six patients with predictive partial tolerance were treated by PAO with extracranial-intracranial bypass, and they experienced no hemodynamic ischemia. In contrast, one with predictive partial tolerance treated by PAO without bypass developed ischemic events as feared.Conclusions: The multimodal BTO is helpful to evaluate the tolerance of PAO and is a reliable predictor of postoperative ischemic events. It reduces risks and increases treatment safety for permanent therapeutic occlusion of the carotid artery.

DOI： 10.5797/jnet.oa.2015-0012

自己拡張型ステント留置後血管は直達術時に安全に遮断可能か？

西堀正洋, 大島共貴, 山本太樹, 後藤峻作, 島戸真司, 西澤俊久, 加藤恭三

脳血管内治療 1 巻 ( 1 ) 頁： 1 - 7 2016年

記述言語：日本語出版者・発行元：特定非営利活動法人日本脳神経血管内治療学会

【目的】ステント留置後の頭蓋内血管に対して，直達手術による追加治療が必要となる状況は今後想定されうる．ステント留置血管を，チタンクリップで一時遮断することは安全に可能かin vitro で評価を行った．【方法】シリコンチューブに33％グリセリン溶液を灌流し加圧した．Enterprise VRD，Neuroform，Wingspan を展開後，チタンクリップで遮断し，圧を負荷して遮断部位の溶液漏出を観察した．また遮断解除後のステントをCone-beam CT で観察した．【結果】Enterprise VRD，Neuroform，Wingspan の順に遮断しやすかった．2 本のパーマネントクリップを用いることで180 mmHg までは，全てのステントが遮断可能であった．遮断解除後，ストラットの損傷はいずれも認めなかった．【結論】現在本邦で使用されている自己拡張ステントが留置されている血管に対して，直達手術時に一時的な血流遮断は可能と考えられた．ステント留置血管を遮断する場合は，パーマネントクリップを2 本用いるのが確実である．

DOI： 10.20626/nkc.oa.2015-0047