著者

Saya Ozaki Shigetaka Okamoto Naoki Shinohara

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.2021-0102, (Released:2022-06-18)

参考文献数

20

被引用文献数

2

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Objective: Determining the course of occluded vessels in advance will increase the success rate and safety of mechanical thrombectomy (MT). Herein, we evaluate the usefulness of MR fusion images created via 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (T2-SPACE) and 3D time-of-flight (TOF)-MRA for visualization of occluded vessels in patients with acute ischemic stroke (AIS) before MT.Methods: We enrolled 26 patients with AIS caused by intracranial large vessel occlusion who presented at our hospital and underwent MRI with fusion images unaffected by motion artifacts in our study. All patients underwent T2-SPACE and TOF-MRA followed by MT. We created fusion images of the T2-SPACE and TOF-MRA by combining a translucent image of the occluded artery produced by the flow void effect in T2-SPACE with the same vessel in a TOF-MRA image. Fusion images were compared with post-recanalization angiography and post-recanalization MRA, respectively, and the degree of agreement in depiction of M1 runs and M2 branching beyond the occlusion on three levels was assessed. Imaging evaluations were performed independently by two endovascular specialists.Results: The interobserver agreement of the MRI findings about the concordance of the occluded vessel’s run was excellent (kappa was 0.87 [confidence interval: 0.61–1.12]). In all, 21 patients (80.8%) had excellent imaging, four (15.4%) had fair imaging, and one (3.8%) had a divided opinion of the rating between excellent and fair imaging. No cases were judged to be poorly drawn. Even if there was a localized signal loss, its distal portion could be delineated, so it did not affect the estimation of the entire vessel run, and we found that the anatomical structures of the occluded vessels were distinctly visible in the fusion images.Conclusion: We demonstrated that MR fusion images derived using T2-SPACE and MRA methodologies could determine the courses of occluded vessels prior to MT performed for AIS. Fusion MR imaging may have potential as a preoperative test for ensuring effective and safe MT procedures.

著者

Dai Kamamoto Shoko Takahashi Satoshi Inoue Masateru Katayama Sadao Suga

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.2022-0005, (Released:2022-06-18)

参考文献数

11

被引用文献数

1

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Objective: The Mo.Ma Ultra is an embolic protection device used in carotid artery stenting (CAS). In cases of left internal carotid artery stenosis (ICS) in which the common carotid artery (CCA) branches off the aortic arch at a steep angle, insertion of the Mo.Ma Ultra into the CCA is sometimes difficult. We introduce a “buddy catheter technique” that helps guide the Mo.Ma Ultra into the CCA, with an additional 4 Fr catheter into the external carotid artery.Case Presentation: An 84-year-old man with left ICS whose CCA also branched off the aortic arch at a steep angle also underwent CAS. The “buddy catheter technique” was used, and the Mo.Ma Ultra was inserted smoothly. The buddy catheter technique displaces the left CCA upward. Displacement straightens the vessels anatomically, and the ledge effect can be prevented by aligning the course of the vessels with the wire. Nevertheless, this technique requires bilateral femoral puncture, and so, complications can occur.Conclusion: The buddy catheter technique may be considered in cases in which the left CCA branches off the aortic arch at a steep angle.

著者

Junko Sato Sachio Suzuki Makoto Sasaki Toshiharu Otaka Mizuho Aoi Yuji Uchida

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.2020-0118, (Released:2021-01-06)

参考文献数

19

被引用文献数

3

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Objective: The aim of the present study was to evaluate the usefulness of the T2-weighted three-dimensional sequence method, known as “basi-parallel anatomical scanning (BPAS)-magnetic resonance imaging (MRI),” in demonstrating the running course of the obstructed middle cerebral artery (MCA) before acute mechanical thrombectomy.Methods: Patients whose M1 part and internal carotid artery (ICA) were occluded on preprocedural MRA, but well demonstrated on MCA anatomical scanning (MAS)-MRI were enrolled in this study. The MAS-MR images for patients in whom thrombectomy was performed were compared with the post-thrombectomy angiography. We compared the running course of the C1-M2 bifurcation on MAS-MRI and angiography after thrombectomy, and the results were classified into 3 groups (Excellent, Good, and Poor).Results: A total of 13 patients (range: 54–89) were enrolled, among whom 12 underwent thrombectomy. We compared MAS-MRI and post-thrombectomy angiography in 10. On comparison between MAS-MRI and post-procedural angiography, visualization was excellent in six (60%) patients. The mean age was 75.7 years, ranging from 54 to 89, and 6 were males. 3 patients had ICA occlusion and seven had MCA occlusion.Conclusion: MAS-MRI was considered useful to clarify the running course of the MCA before acute mechanical thrombectomy.

著者

Ryosuke Tomio Tsuyoshi Uesugi Kazunori Akaji

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.14, no.3, pp.85-89, 2020 (Released:2020-03-20)

参考文献数

4

被引用文献数

1

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Objective: The optimal heating temperature and time for the Echelon10 and Excelsior SL-10 microcatheters using a heat gun was investigated. The durability of the microcatheters after heat gun shaping for the second and third times was also examined.Methods: HAKKO FV-310 was used as the heat gun in this study. This heat gun can be set to 115°C, 125°C, and others. We measured the temperature at 2.5 cm from the nozzle of the heat gun. The Echelon10 and SL-10 microcatheters were shaped under two temperature conditions (115°C and 125°C) and three heating times (30 sec, 60 sec, and 90 sec). The microcatheter shape before heating had twice the curvature of the targeted shape.Results: The temperatures at 2.5 cm from the nozzle were 120.6°C and 127.8°C with the heat gun set at 115°C and 125°C, respectively. There was no macroscopic difference in the results of heat gun shaping of the Echelon10 among temperature settings (115°C and 125°C) or heating times (30 sec, 60 sec, and 90 sec). As degeneration of the heated tip of the SL-10 at 125°C occurred in four of five trials, heat gun shaping was performed using the 115°C setting. There was no macroscopic difference in the results of heat gun shaping of the SL-10 among heating times. Shaping for the second and third times was successful at 115°C and 30-sec heating time.Conclusions: The Echelon10 and SL-10 can be successfully shaped from twice the curvature of the targeted shape using a heat gun at 120°C for 30 sec. Shaping for the second and third times was successful using the same settings. Degeneration of the SL-10 was noted at temperatures above 130°C.

著者

Akihiko Adachi Eiichi Kobayashi Ken Kado Naokatsu Saeki

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.10, no.5, pp.236-242, 2016 (Released:2016-11-30)

参考文献数

8

被引用文献数

7 6

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Objectives: Manual shaping of a straight microcatheter is required when guiding or retention of a microcatheter with a pre-shaped tip is difficult. According to the manufacturer’s instructions, it is recommended that the microcatheter be shaped by steaming “for 30s” and “25 mm away from the steam source”. However, insufficient shaping and blunting can occasionally occur during the procedure. In this technical note, we present the optimal conditions of shaping for a microcatheter system.Methods: In this study, we used a hot air gun (BOSCH, Gerlingen, Germany) as the shaping source and a Headway microcatheter (Microvention, CA, USA; Terumo, Tokyo, Japan). After measuring the difference between the preset and the actual temperature value, shaping was performed at different temperatures (preset temperature of 110°C–140°C) and time intervals (30s–120s).Results: The actual temperature was constant at 20°C below the preset temperature, at a distance of 2.5 cm from the hot air outlet. We performed shaping at a preset temperature of 110°C–140°C (i.e., 90°C–120°C actual temperature) for 30s–120s. Because the Headway microcatheter could not tolerate preset temperature higher than 130°C (i.e., actual temperature of 110°C), the distal tip fluffed, bubbled, and perforated. We examined the durability under each condition, comparing the shape just after mandrel removal, after micro-guidewire manipulation, and after stretching in a vascular model. The highest moldability and durability were achieved at a time interval of 90s–120s, and a preset temperature of 120°C (i.e., 100°C actual temperature).Conclusion: The Headway microcatheter showed the best performance at a heating time of 90s and a preset temperature of 120°C (i.e., 100°C actual temperature) in hot air gun shaping, although the optimal temperature and time interval may vary with the used microcatheter, depending on each instrument structure and materials.

著者

川崎 敏生 早瀬 睦 宮腰 明典 多喜 純也 中村 威彦 波多野 武人

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.cr.2015-0002, (Released:2015-04-27)

参考文献数

20

被引用文献数

3 4

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【目的】未破裂脳動脈瘤コイル塞栓術後に造影剤脳症と考えられる2 症例を経験したので報告する.【症例】症例1 は75 歳男性.右前大脳動脈に未破裂動脈瘤を認め,コイル塞栓術を施行直後から左上下肢不全麻痺を認めた.症例2は65 歳女性.未破裂左内頚動脈後交通動脈に対するコイル塞栓術直後から右上下肢不全麻痺と失語を認めた.2 症例共にCT にて患側大脳半球に高吸収域を認めたが,速やかに消失した.MRI では症状を呈するような虚血性病変は認められなかった.全身性痙攣も併発したが,完全に症状は消失し退院となった.【結論】造影剤脳症による合併症は稀ではあるが,血管内治療後の神経症状の原因として注意すべき病態である.

著者

梅田 靖之 石田 藤麿 辻 正範 古川 和博 佐野 貴則 当麻 直樹 阪井田 博司 霜坂 辰一 鈴木 秀謙

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.9, no.2, pp.69-77, 2015 (Released:2015-05-31)

参考文献数

21

被引用文献数

7 10

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【目的】瘤内コイル塞栓術を仮想した多孔質媒体モデルを用いた数値流体力学(computational fluid dynamics: CFD)解析をおこない,術後閉塞状態の予測に有用な血行力学的パラメータを開発する.【方法】コイル塞栓術を施行した未破裂脳動脈瘤20 例を対象とした.瘤内残存血流体積(residual flow volume,RFV)という血行力学的パラメータを考案し,術後閉塞状態の予測に有用か後方視的に検討した.【結果】術後6~12 カ月の脳血管撮影で完全閉塞は11 例,不完全閉塞は9 例であった.仮想コイル塞栓術後CFD 解析では,RFV は不完全閉塞群で有意に大きかった.RFV はreceiver operating characteristic(ROC)解析において,コイル充填率よりもROC 曲線下面積が大きく,RFV の閾値血流速度を1.0 cm/sec 以上とする設定が最も診断精度が高かった.【結語】多孔質媒体モデルを用いたCFD 解析により,術前算出可能なRFV が術後塞栓状態を予測する有用な血行力学的パラメータであることが明らかとなり,治療戦略への応用が期待できる.

著者

Koji Hirata Yoshiro Ito Go Ikeda Kazuya Uemura Masayuki Sato Aiki Marushima Mikito Hayakawa Yuji Tomono Yuji Matsumaru Akira Matsumura

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.15, no.12, pp.787-792, 2021 (Released:2021-12-20)

参考文献数

17

被引用文献数

2

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Objective: Asymptomatic intracranial dural arteriovenous fistula (DAVF) is a rare disease that is often undiagnosed before symptom onset. The present study aimed to examine the detection rate and radiological features of asymptomatic intracranial DAVF using brain MRI data obtained from the Japanese brain check-up system.Methods: We retrospectively identified 11745 individuals who underwent brain MRI between January 2010 and December 2014. After a routine brain MRI screening, a definite diagnosis was made based on DSA. Data regarding sex, age, disease location, classification type, and treatment method were extracted from the system database and patients’ medical records.Results: Six individuals (0.05%; mean age, 61.0 ± 9.7 years) were diagnosed with definite intracranial DAVF. The intracranial DAVFs were located in the transverse sinus, confluence, and tentorial sinus in 2, 1, and 3 case(s), respectively. Cortical venous reflux was confirmed in four cases (66.7%), and none of the cases had intracranial hemorrhage or venous congestion. All cases had infratentorial lesions and two-thirds were Borden type II/III.Conclusion: The detection rate of asymptomatic intracranial DAVF was 0.05% based on the analysis of MRI data from the brain check-up system. Low-flow shunt and tiny cortical venous reflux were likely missed on MRI.

著者

Akihiro Hirayama Satomi Asai Kittipong Srivatanakul Kazuma Yokota Hideaki Shigematsu Takatoshi Sorimachi Mitsunori Matsumae

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.15, no.8, pp.484-488, 2021 (Released:2021-08-20)

参考文献数

17

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Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2), which appeared at the end of 2019 and has spread rapidly worldwide. In Japan, the increasing number of people infected with SAR-CoV-2 is also a cause of concern for physicians managing stroke patients. From the perspective of viral transmission in the hospital, stroke physicians must determine whether patients who have been transported by emergency have confirmed or suspected COVID-19. For this reason, stroke physicians must also understand about the characteristics and accuracy of the test for COVID-19 diagnosis. This article describes the sensitivity of the clinical symptoms, imaging investigations such as chest radiography and chest CT, and accuracy of nucleic-acid amplification tests and antigen tests used in the diagnosis of COVID-19. However, it should be noted that the accuracy of specimen tests may change depending on the collection site, timing, and method, because positive results in these tested specimens depend on the viral loads. In performing medical treatment for stroke, high accuracy and rapid inspection for COVID-19 is desired, but this is not currently available. For acute stroke treatment, such as thrombectomy, we recommend that these emergency patients, who are suspected of COVID-19 by clinical symptoms and image investigations, should be treated with implementation of strict infection control against droplets, contact, and airborne transmission until the most sensitive polymerase chain reaction test result is confirmed as negative.

著者

小宮山 雅樹

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.9, no.1, pp.5-15, 2015 (Released:2015-03-31)

参考文献数

31

被引用文献数

2 1

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中枢神経系の血管病変の安全・確実な外科的治療や血管内治療に詳細な血管解剖の理解は必須である.そのような解剖の画像データは低侵襲なCT やMR で得られるようになり,今日では診断の第一選択になっている.カテーテル血管撮影には,検査自体の持つ避けることのできない種々の合併症の可能性があるが,今でも多くの症例において重要な診断手段である.著者は中枢神経系の血管系の画像診断,特にCT やMR の3 次元再構成画像に加えカテーテル血管撮影による画像診断における立体視(立体血管撮影)の役割の概説を行った.

著者

Junko Sato Sachio Suzuki Makoto Sasaki Toshiharu Otaka Mizuho Aoi Yuji Uchida

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.15, no.7, pp.421-428, 2021 (Released:2021-07-20)

参考文献数

19

被引用文献数

3

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Objective: The aim of the present study was to evaluate the usefulness of the T2-weighted three-dimensional sequence method, known as “basi-parallel anatomical scanning (BPAS)-magnetic resonance imaging (MRI),” in demonstrating the running course of the obstructed middle cerebral artery (MCA) before acute mechanical thrombectomy.Methods: Patients whose M1 part and internal carotid artery (ICA) were occluded on preprocedural MRA, but well demonstrated on MCA anatomical scanning (MAS)-MRI were enrolled in this study. The MAS-MR images for patients in whom thrombectomy was performed were compared with the post-thrombectomy angiography. We compared the running course of the C1-M2 bifurcation on MAS-MRI and angiography after thrombectomy, and the results were classified into 3 groups (Excellent, Good, and Poor).Results: A total of 13 patients (range: 54–89) were enrolled, among whom 12 underwent thrombectomy. We compared MAS-MRI and post-thrombectomy angiography in 10. On comparison between MAS-MRI and post-procedural angiography, visualization was excellent in six (60%) patients. The mean age was 75.7 years, ranging from 54 to 89, and 6 were males. 3 patients had ICA occlusion and seven had MCA occlusion.Conclusion: MAS-MRI was considered useful to clarify the running course of the MCA before acute mechanical thrombectomy.

著者

Haruki Otsubo Tomohide Yoshie Takashi Araga Kentaro Tatsuno Satoshi Takaishi Noriko Usuki Yasuyuki Yoshida Hajime Ono 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

pp.cr.2021-0061, (Released:2021-10-09)

参考文献数

8

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Objective: We report a case of contrast-induced encephalopathy (CIE) after repeated percutaneous transluminal angioplasty (PTA) for acute middle cerebral artery (MCA) occlusion.Case Presentation: An 88-year-old woman with left hemiparesis was transferred to our hospital by ambulance. MRI revealed acute MCA M1 occlusion. We performed intravenous tissue plasminogen activator therapy and PTA for right MCA occlusion, leading to complete recanalization and improvement in hemiparalysis. After approximately one week, restenosis of right MCA developed and PTA was performed again on day 11. However, her left hemiparesis exacerbated shortly thereafter. CT demonstrated leakage of contrast medium, and an extensive high-intensity area (HIA) on the white matter in the right cerebral hemisphere was noted on MRI FLAIR. The HIA on MRI and neurological deficits gradually improved after conservative treatment, but diffuse atrophy of the right cerebral hemisphere occurred and higher brain dysfunction remained.Conclusion: Repeated ischemia and reperfusion, and the frequent use of contrast media were considered the causes of CIE.

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

pp.oa.2021-0053, (Released:2021-10-08)

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

Kentaro Hayashi Yuka Ogawa Takashi Fujimoto Mitsuto Iwanaga Takeo Anda Takayuki Matsuo

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.2020-0130, (Released:2020-09-30)

参考文献数

20

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Objective: The effects of treatment methods for ruptured aneurysms on the incidence of vasospasm and normal pressure hydrocephalus (NPH) following subarachnoid hemorrhage (SAH) are controversial. We retrospectively examined the Nagasaki SAH registry data, and the complication rates of symptomatic vasospasm and NPH were analyzed based on the treatment methods.Materials and Methods: Between January 2015 and December 2017, 800 SAH patients were registered from 18 hospitals, and their age, sex, World Federation of Neurological Societies (WFNS) grade, Fisher group, size and location of cerebral aneurysms, treatment methods, incidence of symptomatic vasospasm and shunt-dependent hydrocephalus, and prognosis (discharge or 3 months later) were retrospectively analyzed. The effects of treatment methods for the ruptured aneurysm on the incidence of symptomatic vasospasm and shunt-dependent hydrocephalus were then statistically analyzed.Results: The mean age was 66.2 years old. There were 245 (30.6%) male patients and 555 (69.3%) female patients. Cerebral aneurysms were identified in 708 patients (87.5%) and surgical treatments were performed for 620. Neck clipping was employed in 416 patients (67.1%) and coil embolization was employed in 180 (29.0%). Symptomatic vasospasm developed in 118 (28.4%) in the clipping group and 30 (16.7%) in the coiling group (P = 0.0024). NPH developed in 148 (35.6%) in the clipping group and 42 (23.3%) in the coiling group (P = 0.0032). Vasospasm was listed as a major factor for an unfavorable outcome in 23 patients (8.9%) and as a minor factor in 33 (13.3%). NPH was listed as a major factor for an unfavorable outcome in 19 patients (3.5%) and as a minor factor in 46 (18.5%).Conclusions: The multicenter registry study demonstrated lower incidences of both symptomatic vasospasms and NPH in the coiling group than in the clipping group. This superiority may result in better outcomes in the coiling group.

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

vol.14, no.9, pp.381-389, 2020 (Released:2020-09-20)

参考文献数

20

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Objective: In cases of cerebral arteriovenous malformation (AVM) in which perforators are involved as feeder, hemostasis is difficult during surgical removal and postoperative hemorrhage may develop. If possible, presurgical embolization should be performed. However, when the anterior choroidal artery (AChA) is the feeder, the risk of embolization is particularly high, and there are few reports describing this situation. Authors report the treatment results of five cases of AVM in which a single operator performed presurgical embolization through the AChA and describe the technique with a review of the literature.Case Presentations: Of the five total cases (three men and two women; average age was 43.4 years [28–68 years]), one case presented with hemorrhage, two with epilepsy, the other ones with headache and trigeminal neuralgia, respectively. The lesions were located in the frontal lobe in one case and in the temporal lobe in four cases. On the Spetzler-Martin (SM) grading scale, four cases were grade III and one was grade IV. The eloquent area was involved within the nidus in four cases. Multimodal treatment was planned because all cases were high-grade AVM. Authors thought that performing presurgical embolization through the AChA would reduce the overall risk of treatment and performed the presurgical embolization. The embolization was possible in all cases, and the AVM was not angiographycally visible through the AChA in three cases. The blood flow through the AChA was reduced in two cases. All cases were awake immediately after embolization and no case had neurological symptom after embolization. CT or MRI after embolization revealed asymptomatic infarction in two cases. The AVM was removed safely without difficulty including hemostasis.Conclusion: In this series, there were no morbidity and embolization was performed relatively safely. Embolization through the AChA was suggested to be an effective treatment, but careful consideration is required in each individual case.

著者

榎本 由貴子 吉村 紳一 高木 俊範 辻本 真範 石澤 錠二 岩間 亨

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.5, pp.251-258, 2014 (Released:2015-02-03)

参考文献数

24

被引用文献数

2 3

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要旨: 【目的】緊急脳血管内治療時における抗血小板薬のローディングドーズ投与後の血小板反応性の経時的変化をVerifyNow system を用いて測定し,予定治療症例と比較検討する.【方法】2011 年6 月から2013 年12 月の間にクロピドグレル300 mg とアスピリン200 mg のローディングドーズ投与を行った急性期脳主幹動脈閉塞症;acute 群13例と,クロピドグレル300 mg のローディングドーズ投与のみを行った予定治療群;elective 群10 例.投与前,投与6・24・48〜72 時間後にVerifyNow を用いてaspirin reaction unit(ARU),P2Y12 reaction unit(PRU),% inhibition を測定し,その経時的変化を検討するとともに,24 時間後の低反応性(PRU>230,% inhibition<26%,ARU>550)に関連する因子について検討した.【結果】クロピドグレルの効果はelective 群では24 時間後に十分得られていたが,acute群では48 時間後以降も不十分であった.一方,アスピリンの効果は内服6 時間後には十分発現されていた.クロピドグレル低反応性(15/23 例:65.2%)はacute 群(p=0.0018)とbody mass index(p=0.005)に関連が認められた.アスピリン低反応性はacute 群の13 例中3 例(23.1%)に認め,年齢(79±1.73 vs 68.5±14.5,p=0.049)のみ関連が認められた.【結論】ローディングドーズ投与法は早期に効果が発現される投与法であるが,急性期脳梗塞においてはクロピドグレルの効果が発現されにくい可能性が示唆された.

著者

Taichiro Mizokami Takeshi Uwatoko Takashi Furukawa Eiji Higashi Yusuke Sakaki Natsuki Suetsugi Yuichiro Takamatsu Kenichi Matsumoto Hiroshi Takashima Hiroshi Sugimori Shuji Sakata

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.12, no.6, pp.314-319, 2018 (Released:2018-06-20)

参考文献数

20

被引用文献数

2 4

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Objective: We report the mechanical thrombectomy (MT) of posterior circulation large vessel occlusion (pc-LVO) in which the transradial approach (TRA) was selected as an initial approach route to reduce the duration of treatment.Case Presentation: We performed MT using the TRA for four patients with pc-LVO between November 2015 and March 2017. The TRA was used as an initial approach route in patients in whom preoperative MRI showed that the right vertebral artery (VA) was predominant. In all patients, the procedure could be accomplished without changing the approach route. Thrombolysis in Cerebral Infarction (TICI) 2b or better recanalization was achieved in all patients (100%), and TICI 3 recanalization in three patients (75%). Mean time from radial artery puncture to initial intracranial angiography and to the effective recanalization was 7.3 ± 1.5 and 28.8 ± 6.2 minutes, respectively. There was no complication at the site of puncture.Conclusion: Recanalization was promptly and effectively achieved by the MT of pc-LVO using the TRA. The results suggest that TRA can be utilized as an initial access route in patients in whom an approach to the right VA is possible.

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.6, pp.378-436, 2014

著者

黒田 淳子 藤中 俊之 中村 元 西田 武生 梶川 隆一郎 芝野 克彦 吉峰 俊樹

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.5, no.2, pp.106-111, 2011 (Released:2012-01-05)

参考文献数

16

被引用文献数

1

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【目的】bare platinum coilを用いた脳動脈瘤塞栓術(BC群)とbioacitive coilを用いた脳動脈瘤塞栓術(BAC群)の治療成績を比較し,bioactive coilの安全性および再開通予防効果について検討した.【方法】当院にて2007年1月~2009年12月までに動脈瘤瘤内塞栓術を行い,術後1年以内にfollow upの血管造影検査を行った破裂/未破裂脳動脈瘤を対象とし,治療直後およびfollow upでの塞栓状況,動脈瘤頚部での内皮新生を示唆するwhite collar signの有無,術後MRI DWIでの微小脳梗塞の有無について比較検討を行った.【結果】follow upの血管造影検査施行時に,治療直後と比べ塞栓状況が改善されたものはBC群で9.38%,BAC群で15.8%であり,有意差は認められないものの(p=0.58),BAC群で多い傾向にあった.また,動脈瘤ネック部分の内膜新生を示唆すると考えられているwhite collar signの有無に関しては,BC群の6.3%,BAC群の26.3%にみられ,有意差は認められないもののBAC群で多い傾向にあった(p=0.13).しかし,術後の微小梗塞はBA群よりも多い傾向にあり,血栓性合併症に対しては十分な注意が必要である.〈第26回日本脳神経血管内治療学会学術総会優秀演題推薦論文〉

著者

長畑 守雄 近藤 礼 毛利 渉 佐藤 慎治 山木 哲 長畑 仁子 齋藤 伸二郎 嘉山 孝正

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.7, no.3, pp.156-161, 2013

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【目的】機械的血栓回収療法(mechanical thrombectomy;MT)導入前後で,当院における急性期脳梗塞に対する治療動向と治療成績の変化を検討する.【方法】MT導入前(pre-MT期)10ヵ月とMT導入後(post-MT期)19ヵ月で,発症から6時間以内の急性期脳梗塞患者数,期間中の全脳梗塞患者に占める割合,施行された再灌流療法毎の重症度(National Institute of Health Stroke Scale;NIHSS)と転帰(modified Rankin Scale;mRS)を検討した.【結果】急性期脳梗塞症例数はpre-MT期が97(全脳梗塞症例の44.3%),post-MT期が250(同52.2%).これらに対するt-PA静注療法(intra-venous tissue-plasminogen activator;IV-tPA)の施行率はpre-MT期が12.4%,post-MT期が25.2%であった.Pre-MT期における局所線溶療法の施行率は5.2%,post-MT期におけるMTの施行率は11.6%であった.IV-tPAによる30日後mRS 0-2はpre-MT期で50.0%,post-MT期では48.0%であった.MTによる90日後mRS 0-2は37.9%であった【結論】Post-MT期にIV-tPAの施行率が上昇したのは,早期受診の重要性を訴えてきた当院の社会的啓発活動の効果で,より早期の来院例が増えた影響が大きいと思われた.当院においてMTは急性期脳梗塞患者の11.6%に対して施行され,4.4%で90日後mRS 0-2の転帰が得られた.