著者

Shunsuke Tanoue Kenichiro Ono Toru Yoshiura Masataka Miyama Hidenori Okawa Toshiki Shirotani

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.tn.2020-0060, (Released:2021-01-06)

参考文献数

19

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Objective: We report a case of mechanical thrombectomy (MT) via the distal transradial approach (dTRA) and technical tips.Case Presentation: An 89-year-old woman was transferred to our hospital due to back pain after a fall and sudden-onset left hemiparesis. We performed MT because three-dimensional computed tomography angiography (3D-CTA) revealed right middle cerebral artery (MCA) occlusion. The access route was Type 3 aortic arch. The abdominal aorta and common iliac artery were tortuous and partially dissected, and she had a lumbar vertebra fracture. We selected dTRA in consideration of safety, ease of access, and less postoperative postural restriction. The first pass resulted in complete recanalization using an aspiration catheter and stent retriever. Her symptoms rapidly improved and she was discharged with a modified Rankin Scale score of 1.Conclusion: dTRA in MT may be a treatment option.

著者

岡本 宗司 久保 道也 林 智秀 堀 聡 堀 恵美子 柴田 孝 堀江 幸男 桑山 直也 黒田 敏

出版者

特定非営利活動法人 日本脳神経血管内治療学会

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.8, no.3, pp.159-165, 2014

被引用文献数

3

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【目的】神経線維腫症に合併した頭蓋外巨大内頚動脈瘤破裂例に対してtriple coaxial system を用いて内頚動脈トラッピング術を施行したので報告する.【症例】症例は41 歳の神経線維腫の女性.左頸部の急激な腫脹,嗄声,嚥下障害が生じ,当院に入院した.頚部CT では長径約40 mm の頭蓋外内頚動脈瘤を認め,咽喉頭部が対側に偏位していた.MRI では,動脈瘤からの出血を示唆する所見があり,再出血防止目的で緊急血管内治療を行った.血管脆弱性と術後のmass effect 増大防止の観点から動脈瘤の前後で内頚動脈をトラッピングする方針とした.バルーン付きガイディングカテーテルをproximal flow control 用に内頚動脈起始部に留置し,動脈瘤の遠位にマイクロカテーテルを誘導したが,支持性が弱く,コイル挿入時に動脈瘤内にキックバックした.そこでインナーカテーテルとして4FrセルリアンGTM を組み合わせ,triple coaxial system とした.その結果,瘤の遠位・近位ともに内頚動脈にコイルをコンパクトに留置でき,トラッピングすることができた.術後,症状は改善し,MRI では,動脈瘤の血栓化を認めた.【結論】頚部内頸動脈瘤に対して母血管のトラッピングを行う場合,バルーン付きガイディングカテーテルに4Fr インナーカテーテルを組み合わせたtriple coaxial system は有用と思われた.

著者

Takehiro Katano Kentaro Suzuki Ryutaro Kimura Toru Nakagami Shinichiro Numao Yuho Takeshi Yuji Nishi Takuya Kanamaru Jyunya Aoki Yasuhiro Nishiyama Kazumi Kimura

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.14, no.10, pp.454-460, 2020 (Released:2020-10-20)

参考文献数

18

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Objective: We report two cases of thrombectomy for upper extremity artery occlusion with major cerebral artery occlusion using mechanical thrombectomy devices for acute ischemic stroke.Case Presentations: Case 1 was a 79-year-old woman admitted for left internal carotid artery occlusion and left upper extremity artery occlusion. Case 2 was an 87-year-old woman admitted for left middle cerebral artery occlusion and bilateral upper extremity artery occlusion. After performing mechanical thrombectomy for the cerebral artery, we achieved good recanalization of the brachial artery using the same devices in Case 1 and Case 2.Conclusions: Thrombectomy using acute ischemic stroke mechanical thrombectomy devices for upper extremity artery occlusion is useful for recanalization.

著者

Mikito Hayakawa

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.ra.2023-0056, (Released:2023-10-06)

参考文献数

50

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Since stroke is often associated with cancer, acute stroke patients with cancer undergoing endovascular therapy (EVT) are not uncommon. Reportedly, the proportion of such cases is approximately 6%–7% of all stroke EVT cases. Ischemic stroke in patients with active cancer (cancer-associated stroke) includes not only strokes caused by cancer-related hypercoagulability but also coincident strokes due to common etiologies, strokes associated with tumor emboli, direct tumor invasion of blood vessels, and strokes associated with cancer therapy. Stroke caused by cancer-related hypercoagulability itself encompasses various entities, including paradoxical embolism, stroke due to nonbacterial thrombotic endocarditis, and in situ arterial occlusion due to disseminated intravascular coagulation or thrombotic microangiopathy. Thus, diverse mechanisms contribute to cancer-associated stroke, emphasizing the need to consider individualized treatment strategies for acute cases involving large vessel occlusion. Observational studies have shown that EVT for cancer-associated stroke results in poorer clinical outcomes, but with comparable rates of successful reperfusion and symptomatic intracranial hemorrhage when compared with stroke patients without cancer. This suggests that denying patients EVT solely on the basis of comorbid active cancer is inappropriate, and decision-making should be shared with the patients and their families, preferably through a multidisciplinary team approach. Thrombi retrieved from patients with stroke caused by cancer-related hypercoagulability have unique characteristics, being predominantly platelet rich and difficult to retrieve. Preprocedural imaging and serum biomarkers, including the hyperdense vessel sign on non-contrast CT, susceptibility vessel sign on T2* or susceptibility-weighted MRI, three-territory sign on MRI, and D-dimer levels, are valuable in evaluating the stroke subtype and thrombus features. Thrombectomy techniques, such as contact aspiration and stent retriever monotherapy, have shown varying degrees of effectiveness for stroke caused by cancer-related hypercoagulability, warranting further study. After reperfusion therapy, appropriate treatment for the prevention of stroke recurrence should be initiated, considering the specific stroke subtypes. In conclusion, cancer-associated stroke encompasses diverse subtypes, and thrombi associated with stroke caused by cancer-related hypercoagulability present various challenges for thrombectomy. Individualized treatment approaches based on underlying mechanisms are essential for improving outcomes in acute stroke patients with active cancer. Optimization of preprocedural diagnosis, EVT techniques, and secondary prevention of stroke caused by cancer-related hypercoagulability will lead to better management of these patients and enhance their quality of life.

著者

金丸 英樹 佐藤 徹 菅田 真生 石井 大造 丸山 大輔 林 正孝 濱野 栄佳 井手口 稔 片岡 大治 高橋 淳

出版者

特定非営利活動法人 日本脳神経血管内治療学会

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.jnet.oa.2015-0039, (Released:2015-10-02)

参考文献数

11

被引用文献数

4 1

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要旨: 【目的】近年脳血管内治療は普及の一途をとげているが,病変へのアクセス時に,ガイディングカテーテル(GC)を母血管に干渉せず留置できるかどうかは治療の成否に関与する重要な因子の一つである.そこで,GC を留置する際に機械的血管攣縮(mechanical vasospasm; mVS)を惹起する因子について検討した.【方法】対象は2012 年8 月1 日より2014 年7 月31 日までの2 年間に未破裂脳動脈瘤に対しコイル塞栓術を施行した連続64 例とし後方視的に検討した.mVS の定義として,GC を留置した母血管径が25%以上狭小化するものとした.【結果】mVS は24 例(38%)に認め,そのうちGC のサイズ変更を要したものは5 例,その他の症例では先端位置を変えることで攣縮所見は全例軽快した.mVS と関連する因子として,より年齢が若いこと(p<0.001),女性(p=0.03),高血圧でないもの(p=0.03)を認めた.Body Mass Index,Adjunctive technique の有無,治療後のDWI 高信号域の有無,治療時間,部位(ICA/VA),抗血小板療法(Single/Dual)は関連を認めなかった.【結論】より年齢の若い症例,女性,高血圧のない症例では機械的血管攣縮を引き起こしやすいと考えられる.

著者

Kentaro Mori Yu Iida Akira Tamase Motohiro Nomura Yoshihisa Kitamura Yuichi Kawabata Tatsu Nakano

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.ai.2017-0087, (Released:2018-01-18)

参考文献数

3

被引用文献数

1 1

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This study describes hyperintensity of dural venous sinuses due to jugular venous reflux (JVR) and their respiration- and position-induced changes, and discusses the significance of this phenomenon in endovascular treatment.

著者

Hayatsura Hanada Kouhei Nii Kimiya Sakamoto Ritsurou Inoue Yoko Hirata Kodai Matsuda Jun Tsugawa Sho Takeshita Sachiko Shirakawa Toshio Higashi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.17, no.3, pp.73-79, 2023 (Released:2023-03-20)

参考文献数

20

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Objective: Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy.Methods: Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents.Results: Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045).Conclusion: Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.

著者

Hidekazu Yamazaki Masafumi Morimoto Chiyoe Hikita Mitsuhiro Iwasaki Masahiro Maeda Yasufumi Inaka Shinya Fukuta Hiroaki Sato

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0035, (Released:2022-10-29)

参考文献数

14

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Objective: Mechanical thrombectomy (MT) for middle cerebral artery M2 occlusion (M2O) is challenging because the procedure is performed in a narrow and tortuous artery. In this study, we compared MT using an aspiration catheter (AC) versus a stent retriever (SR) used alone, and retrospectively evaluated the efficacy and safety of MT using an AC for M2O.Methods: Seventy-four consecutive patients who underwent MT for M2O at our institution between April 2016 and April 2020 were evaluated. The subjects were classified into those treated by AC (AC group) or SR alone (SR group). The AC group included patients treated by both contact aspiration and a combination technique of AC and SR. Background factors and outcomes, including modified treatment in cerebral infarction (mTICI) 2c-3 recanalization, were compared between the groups.Results: AC and SR groups consisted of 47 and 27 patients respectively. Among them, the rate of mTICI 2b-3 was 93.6% vs 92.6%, and that of mTICI 2c-3 was 72.3% vs 48.2% (P = 0.004). The perioperative symptomatic subarachnoid hemorrhage (SAH) rate was 0% vs 7.4%, and modified Rankin scale scores of 0–2 were 78.6% vs 50% (P = 0.03). In the AC group, the mTICI 2c-3 rate was higher in patients in whom the AC was adequately advanced to the thrombus compared to those with inadequate AC advancement (83.3% vs 36.3%, P = 0.002).Conclusion: The rate of mTICI 2c-3 was higher in the AC than SR group, with no cases of symptomatic SAH. MT using AC for M2O might achieve safe and effective thrombectomy.

著者

Kuniharu Imai Kento Takeda Keisuke Fujii Chiyo Kawaura Takuya Nishimoto Masaki Mori Yuki Yamamoto Takashi Izumi

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0041, (Released:2022-10-28)

参考文献数

13

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Objective: Neuroendovascular treatments are less invasive than surgical clipping. However, the number of fluoroscopy runs may be greater when a contrast medium is used than when routine angiography is performed. Several recent studies have suggested that an iodinated contrast medium causes an increase in the radiation dose. Therefore, it is clinically important to identify physical factors causing amplification of the radiation dose. The purpose of this study was to investigate how dilution of a contrast medium with water influences the amplification effect of the radiation dose using simulation analysis.Methods: Three different types of commercially available contrast media, namely, iopamidol, iohexol, and iodixanol, were diluted 1.7–3.3 times with water and placed in the left brain parenchyma of a numerical brain phantom. Using the Monte Carlo simulation method, the phantom was exposed to X-ray beams under constant exposure conditions, and the energy absorbed in the entire region of the left brain parenchyma was estimated. At the same time, the content and volume of a contrast medium in the cerebral vessels were predicted on the basis of pharmacokinetic and fractal analyses.Results: The increase in absorbed energy was attributed to secondary electrons emitted from the contrast medium and varied depending on its content and volume. Interestingly, the amount of energy absorbed increased with increasing dilution of the contrast medium. Furthermore, the amplification effect of the radiation dose varied according to the type of contrast medium used.Conclusion: These results suggest that the amplification effect of the radiation dose is closely related to an increase in the cross-sectional area in which the X-rays interact with the contrast medium, which is caused by increased distribution of contrast medium in the cerebral vessels. When the contrast medium is diluted with water, its spread in the cerebral vessels plays a more important role than its content in the amplification effect of the radiation dose.

著者

Bumpei Kikuchi Kazuhiro Ando Yoshihiro Mouri Toru Takino Jun Watanabe Tetsuro Tamura Shinya Yamashita

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0047, (Released:2022-10-15)

参考文献数

30

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Objective: Time to recanalization is directly linked to cerebral infarction prognosis. However, patients transferred from another hospital take longer to arrive than those transported directly. To minimize time to recanalization, the emergency room (ER) skip strategy for hospital transfers was executed and reviewed.Methods: From April 2019, patients transferred from another hospital for mechanical thrombectomy were carried into the angio-suite using emergency service stretchers. Results for these patients (ER skip group) were compared with those for patients transported directly to our hospital (Direct group).Results: Among 108 cases in 32 months, 99 patients (91.7%) had major cerebral artery occlusion and underwent endovascular treatment. No differences in age, baseline National Institutes of Health Stroke Scale score, effective recanalization rate, or proportion of posterior circulation cases were seen between groups. The ER skip group (26 patients) showed significantly longer median time from onset to arrival (240 vs. 120 min; p = 0.0001) and significantly shorter median time from arrival to groin puncture (11 vs. 69 min; p = 0.0000). No significant differences were evident in time from groin puncture to recanalization (39 vs. 45 min), time from onset to recanalization (298 vs. 244 min), or rate of modified Rankin Scale score 0–2 after 90 days (42.3% vs. 32.9%). Median time from alarm to recanalization (266 vs. 176 min; p = 0.0001) was significantly longer in the ER skip group. Door-to-puncture (DTP) time for the Direct group gradually fell as the number of cases increased, reaching 40 min by the end of study period. In contrast, DTP time for the ER skip group remained extremely short and did not change further. The proportion of patients who underwent both CT and MRI before endovascular treatment was significantly lower in the Direct group (30.1%) than in the ER skip group (57.7%). In the ER skip group, median length of stay in the primary hospital was 119 min, and the median duration of interhospital transfer was 16 min.Conclusion: The ER skip strategy for patients transferred with large vessel occlusion achieved favorable outcomes comparable to that for direct transport cases. Direct transport to a thrombectomy-capable stroke center remains ideal, however, because the time to intervention is improving for direct transport cases each year.

著者

Hiroyuki Mizuno Masanori Aihara Koji Sato Chikashi Negishi Nobuo Sasaguchi Hideyuki Kurihara Yuhei Yoshimoto

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0039, (Released:2022-10-14)

参考文献数

16

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Objective: Evaluation of intracranial stent placement by MRI suffers the problems of signal artifacts during time-of-flight MRA (TOF-MRA). Therefore, angiographic examination is required for detailed intravascular assessment of the stent placement site. Recently, 3D T1-turbo spin echo (3D-TSE) has been developed for evaluation of carotid artery stent placement. We investigated the use of the 3D-TSE imaging method for the evaluation of intracranial vascular stent placement.Methods: The subjects consisted of nine patients who underwent intracranial vascular stent placement between April 2015 and December 2019. Postoperatively, the lumens of the placed stents were measured by TOF-MRA, DSA, and 3D-TSE imaging. Analysis was performed by type of stent and placement site.Results: The stents used were Neuroform Atlas (3 patients), LVIS (3 patients), LVIS Jr (2 patients), and Integrity (1 patient). TOF-MRA of the stent placement site showed defects in the image or poor visualization in all nine patients, whereas 3D-TSE imaging visualized the lumen at the stent indwelling site in all patients. The blood vessel diameter measured by the DSA and 3D-TSE imaging exhibited positive correlations regardless of the stent type and placement site.Conclusions: 3D-TSE imaging allows visualization of the lumen of the site of an intracranial vascular stent, regardless of the type of stent or the vessel. Thus, this method may be useful for evaluating the vascular lumen of a lesion.

著者

Tomohide Yoshie Yuki Matsuda Yutaka Arakawa Haruki Otsubo Takashi Araga Kentaro Tatsuno Satoshi Takaishi Noriko Usuki Toshihiro Ueda

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.16, no.6, pp.294-300, 2022 (Released:2022-06-20)

参考文献数

14

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Objective: In various fields, differences in eye-gazing patterns during tasks between experts and novices have been evaluated. The aim of this study was to investigate gazing patterns during neuro-endovascular treatment using an eye-tracking device and assess whether gazing patterns depend on the physician’s experience or skill.Methods: Seven physicians performed coil embolization for a cerebral aneurysm in a silicone vessel model under biplane X-ray fluoroscopy, and their gazing patterns were recorded using an eye-tracking device. The subjects were divided into three groups according to experience, highly experienced (Expert) group, intermediately experienced (Trainee) group, and less experienced (Novice) group. The duration of fixation on the anterior–posterior (AP) view screen, lateral (LR) view, and out-of-screen were compared between each group.Results: During microcatheter navigation, the Expert and Trainee groups spent a long time on fixation to AP, while the Novice group split their attention between each location. In coil insertion, the Expert group gazed at both the AP and the LR views with more saccades between screens. In contrast, the Trainee group spent most of their time only on the AP view screen and the Novice group spent longer out-of-screen.Conclusion: An eye-tracking device can detect different gazing patterns among physicians with several experiences and skill levels of neuroendovascular treatment. Learning the gazing patterns of experts using eye tracking may be a good educational tool for novices and trainees.

著者

Yuichiro Tsurusaki Shota Sakai Takao Morita Kenji Miki Daisuke Inoue Sei Haga Shoji Arihiro

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2022-0049, (Released:2022-08-20)

参考文献数

9

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Objective: We report a case of huge scrotal hematoma during emergency mechanical thrombectomy.Case Presentation: An 85-year-old man presented with sudden aphasia and right-sided hemiplegia. He was diagnosed with cerebral infarction due to left M1 occlusion and underwent an emergency mechanical thrombectomy. The treatment was completed with full recanalization, but when replacing the long sheath in the right femoral artery with a short sheath, the patient flexed his leg. The sheath could not be replaced, resulting in a massive scrotal hematoma. Shortly after, the patient went into cardiopulmonary arrest but recovered spontaneous circulation after cardiopulmonary resuscitation. The puncture site was treated hemostatically with manual compression, and the scrotal hematoma was not enlarged. He was transferred to another hospital with a modified Rankin Scale score of 5.Conclusion: Scrotal hematoma is a rare but potentially fatal puncture site complication that should be considered during neuro-endovascular treatment.

著者

Tsubasa Okuyama Saori Kubota Hiromichi Oishi Satoshi Ishige Toshio Machida

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0030, (Released:2022-08-19)

参考文献数

14

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Objective: The development of large-bore aspiration catheters (ACs) has advanced the treatment of mechanical thrombectomy (MT) and their use requires larger guiding catheters (GCs). However, due to the small vessel diameter of the vertebral artery (VA), it can be difficult to cannulate large-bore GC to the VA. This study aims to determine the percentage of VAs that are amenable to GC placement based on the use of a large-bore AC and to clarify the diameters of VAs in the general population using neck MRA.Methods: Left and right VA diameters were measured in 1394 consecutive adult patients who underwent neck MRA at our hospital between April 2020 and June 2021. Sex and left/right differences in the VA diameters, as well as the conformity ratios of GCs (6, 7, and 8 French) to right and left VAs, were examined.Results: The patients ranged in age from 18 to 98 years (mean 70.8 ± 13.5 years), with 770 (55.2%) males. The left and right VA mean diameters were 2.82 ± 0.75 mm (range 0–5.1 mm) and 2.65 ± 0.75 mm (range 0–5.3 mm), respectively. The conformity ratios of 6, 7, and 8 French GC to left and right VAs were 85.3% and 79.9%, 74.9% and 68.4%, and 60.9% and 53.7%, respectively.Conclusion: When performing MT for the posterior circulation system, a large-bore AC of 0.060 inches or larger is usually required, and GC placement of 7-French or larger is necessary. The results of this study showed that 7-French GC placement is achievable in approximately 70% of these cases.

著者

Miyahito Kugai Takehiro Suyama Masahiko Kitano Yoshiko Tominaga Shinsuke Tominaga

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.cr.2022-0032, (Released:2022-08-10)

参考文献数

21

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Objective: Treatment of large posterior cerebral artery (PCA) aneurysm involving the P1–P2 segment is difficult by both neurosurgery and endovascular treatment. Balloon occlusion test (BOT) to identify precise peripheral collateral flow is difficult prior to parent artery occlusion (PAO). Besides, PAO at the aneurysm at this location can cause peripheral cortical infarction of the occipital and temporal lobes and/or perforator infarction involving the midbrain and thalamus perfused by the perforating artery arising from the P1–P2 segment. However, detection of the perforator during PAO is difficult.Case Presentation: The patient was a 49-year-old woman. At the age of 43 years, a right large PCA aneurysm was discovered in the right P1–P2 segment. A simple technique coiling was performed. As recurrence was identified 1 year later, embolization was performed using a same procedure. Since further recurrences were later found, a third round of treatment was planned. Somatosensory-evoked potential (SEP) was recorded as intraoperative electrophysiological monitoring. Tortuosity of the right PCA was observed at the aneurysm neck and the distal right PCA could not be secured. We could neither perform stent-assisted coil embolization nor BOT in the right PCA. Hence, we inflated the balloon in the basilar artery and checked the collateral circulation routes retrograde into the right PCA from the right middle cerebral artery via a leptomeningeal anastomosis. PAO was performed on the right P1–P2 segment at the aneurysm neck. The signal of the SEP was not decreased, and the aneurysm was not visualized. Another coil was added to strengthen the PAO to the right P1 segment, which decreased the SEP amplitude in the extremities by 3 minutes after. As the last coil was thought to be occluding the perforator branching from the right P1 segment, it was removed without detaching. The SEP amplitude began to improve and recovered by 9 minutes after. There was no postoperative deficit. No recurrence of aneurysm was observed on MRA 9 months postoperatively.Conclusion: During PAO at the P1 segment of large PCA aneurysm involving the P1–P2 segment, SEP may be helpful to prevent perforator infarction, even if perforating artery originating from the proximal portion of the aneurysm was not detected by angiography.

著者

Kimihiko Orito Sosyo Kajiwara Yasuharu Takeuchi Kiyohiko Sakata Toshi Abe Shuichi Tanoue Yusuke Uchiyama Masaru Hirohata Motohiro Morioka

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2021-0106, (Released:2022-08-10)

参考文献数

11

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Objective: The mechanism of transient cortical blindness after endovascular treatment—a rare phenomenon—has not been elucidated; however, it is assumed to be related to contrast medium leakage (CML). We investigated the relationship between postoperative CML and cortical blindness in patients who underwent endovascular treatment for vascular lesions of posterior circulation.Methods: This retrospective cohort study included 28 patients who underwent endovascular treatment for posterior circulation aneurysms at our hospital between January 2014 and December 2018. Cerebral CT was performed immediately after endovascular treatment and 24 h later. CT images were retrospectively evaluated with special interest in the presence and distribution of leakage of the contrast medium (CM). Patients were classified into the following three groups based on CT findings: Group A, no CML (11 patients); Group B, unilateral CML (5 patients); and Group C, bilateral CML (9 patients).Results: The posterior circulation aneurysms were located in the basilar artery in 13 (52.0%) cases, in the posterior cerebral artery in 1 (4.0%) case, and in the vertebral artery in 11 (44.0%) cases. There was no difference regarding the adjunctive technique used for endovascular treatment between the groups. Patients in Group C used a significantly larger amount of CM than those in the other two groups. A longer operation time was associated with a larger amount of CM used during treatment. VerifyNow assay revealed that the P2Y12 reaction unit was significantly lower in Groups B and C. Cortical blindness was transiently observed in 2 of 9 patients (22.2%) in Group C, both of which showed CML surrounding the bilateral parieto-occipital sulcus.Conclusion: Both patients with cortical blindness showed bilateral CML, both of which showed CML surrounding the bilateral parieto-occipital sulcus. The CM-induced blood–brain barrier disruption may be the cause of cortical blindness.

著者

Hiroo Yamaga Yusuke Tsuboko Tomoaki Terada Kiyotaka Iwasaki

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2021-0099, (Released:2022-07-21)

参考文献数

22

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Objective: To facilitate understanding for the safe use of the Wingspan stent, a comprehensive literature analysis was conducted, and incidence rates of 30-day stroke or death before and after the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial were compared. We also investigated the associations between 30-day stroke or death rate and four lesion vessels, the internal carotid artery (ICA), middle cerebral artery (MCA), basilar artery (BA), and vertebral artery (VA).Methods: We searched MEDLINE, Embase, Web of Science, and Cochrane Library databases. The incidence rates of 30-day stroke or death in pre- and post-SAMMPRIS were compared using forest plots and funnel plots.Results: Thirty studies (15 before and 15 after the SAMMPRIS) were identified, comprising 2071 patients. Post-SAMMPRIS studies showed lower incidence rates of 30-day stroke or death compared to the pre-SAMMPRIS studies (8.5% vs. 5.6%, p = 0.014). The odds ratio of 30-day stroke or death of the post-SAMMPRIS group compared to that of the pre-SAMMPRIS group was 0.64 (95% confidence interval: 0.45–0.92, p = 0.014).The average 30-day stroke or death rates of overall, pre-, and post-SAMMPIS studies were 1.1%, 1.1%, and 1.1% for ICA; 6.2%, 8.8%, and 5.3% for MCA; 0.9%, 6.0%, and 2.7% for VA; and 13.5%, 15.1%, and 12.5% for BA, respectively. The post-SAMMPRIS study group showed significantly lower event rates for the treatment of MCA and VA than the pre-SAMMPRIS group did (p = 0.003 and p = 0.006, respectively). The incidence rates of ischemic and hemorrhagic stroke were 3.5% and 2.0%, respectively.Conclusion: This systematic surveillance study indicated that the modification of the indications for use based on the results of the SAMMPRIS trial for the Wingspan stent was effective in reducing 30-day stroke or death.

著者

Tsuyoshi Ohta Tetsu Satow Manabu Inoue Kanta Tanaka Junpei Koge Takeshi Yoshimoto Eika Hamano Taichi Ikedo Masatake Sumi Koji Shimonaga Yuji Kushi Hisae Mori Koji Iihara Masafumi Ihara Masatoshi Koga Kazunori Toyoda Hiroharu Kataoka

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0018, (Released:2022-07-20)

参考文献数

17

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Objective: To evaluate whether changes in the practice of mechanical thrombectomy could affect the clinical outcomes during the coronavirus disease (COVID-19) pandemic.Methods: Patients who underwent mechanical thrombectomy from April 2019 to March 2021 for anterior circulation proximal large artery occlusion in our institute were divided into two groups of pre- and post-COVID-19, with April 2020 assumed to be the start of the COVID-19 era with the first declaration of a state of emergency. We compared patient characteristics, proportions of patient selection depending on rapid processing of perfusion and diffusion (RAPID) CT perfusion, outcomes including treatment variables such as time and reperfusion status, and patient independence at 3 months.Results: Data for 112 patients (median age, 79 years; 44 females) were included in the analysis. A total of 50 patients were assigned to the pre-COVID-19 group (45%). More patients were selected with RAPID CT perfusion in the post-COVID-19 compared with the pre-COVID-19 (69% vs. 16%; P <0.001). Treatment details and clinical outcomes did not differ between the groups, including the door-to-puncture time (median [interquartile range], 66 [54–90] min vs. 74 [61–89] min; P = 0.15), proportions of significant reperfusion (82% vs. 87%; P = 0.60), and modified Rankin scale score of ≤2 at 3 months (46% vs. 45%; P >0.99). Multivariate logistic regression analysis for the clinical outcome of modified Rankin scale score of ≤2 at 3 months was performed and included the following factors: age, sex, the onset-to-door time, significant reperfusion, and pre- and post-COVID-19. The treatment period did not influence the outcomes (post-COVID-19 group, odds ratio, 0.79; 95% confidence interval, 0.34–1.85, P = 0.59).Conclusion: In the setting of a limited access to emergency MRI during the COVID-19 pandemic, RAPID CT perfusion was performed significantly more often. Changes in the practice of mechanical thrombectomy with the protected code stroke did not bring the different level of treatment and clinical outcomes as before.

著者

Hiroyuki Kikuchi Yuta Sato Kenichi Ogata Syohei Kimura

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.tn.2021-0094, (Released:2022-07-15)

参考文献数

5

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Objective: It is often difficult and has a potential risk of vessel injury to navigate a catheter or a microcatheter through the difficult types of aortic arches and through an occluded segment of the intracranial arteries under fluoroscopic guidance alone. Herein, we demonstrate a supportive technique of virtual fluoroscopic imaging from a data of non-contrast CT for a case of thrombectomy for acute occlusion of the right middle cerebral artery (MCA).Case Presentation: An 85-year-old woman was transferred to our hospital with complaints of left-sided paralysis, dysarthria, and aphasia. CT revealed a hyperdense MCA sign, suggesting acute right MCA occlusion. CT showed bovine type of aortic arch too. Subsequently, mechanical thrombectomy was performed with the right brachial approach. A guiding catheter and a microcatheter system were successfully navigated into the target lesion under virtual fluoroscopic imaging guidance, and then thrombolysis in cerebral infarction (TICI) 3 recanalization was obtained in puncture-to-recanalization time of 37 minutes.Conclusion: Virtual fluoroscopic images helped us to perform thrombectomy in a case of acute MCA occlusion, which provided anatomical information on the artery distal to the occlusion site, and were useful in determining the direction of the wire guidance.

著者

Satoru Kawauchi Koichi Chida Takashi Moritake Yusuke Hamada Shogo Yoda Hideyuki Sakuma Wataro Tsuruta Yuji Matsumaru

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2022-0024, (Released:2022-07-14)

参考文献数

30

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Objective: In interventional neuroradiology (INR), the evaluation of the peak skin dose (PSD) and lens dose is important because the patient radiation dose increases in cases in which the procedure is more difficult and complex. This study evaluated the radiation doses during INR procedures using a direct measurement system.Methods: Radiation dose measurements during INR were performed in 332 patients with unruptured aneurysm (URAN), dural arteriovenous fistula (DAVF), and arteriovenous malformation (AVM). The PSD and bilateral lens doses were analyzed for each disease. The Pearson correlation test was used to determine whether the PSD and lens doses were linearly related to the reference air kerma (Ka,r).Results: In all cases, the PSD and right and left lens doses were 2.36 ± 1.28 Gy, 114.2 ± 54.6 mGy, and 189.8 ± 160.3 mGy, respectively. The PSD and lens doses of the DAVF and AVM cases were significantly higher than those of the URAN case. The Pearson correlation test revealed statistically significant positive correlations between Ka,r and PSD, Ka,r and right lens dose, and Ka,r and left lens dose.Conclusion: The characteristics of radiation dose in INR were clarified. Owing to the concern of increased radiation doses exceeding the threshold values in DAVF and AVM cases, protection from radiation is required. Simple regression analysis revealed the possibility of precisely predicting PSD using Ka,r.