記述言語：日本語   出版者・発行元：(一社)日本神経学会  

症例は44歳男性.左上肢の脱力発作で始まる2回の全身痙攣があり,MRIで右中心前回皮質直下白質に局所性T2延長領域を呈し,周囲の脳表に一部ガドリニウム増強効果を認めた.レベチラセタムで発作は消失し,他に神経学的異常はなかった.炎症性疾患を疑ったが,HLA-B54/Cw1を認めるものの発熱や皮膚病変はなく髄液の細胞数やIL-6値は正常であった.MRIで病変対側の脳表にわずかなflow voidsを,CT angiographyで皮質静脈の早期描出を認め,脳血管造影で右高位円蓋部を含む計4ヶ所に動静脈シャントを同定した.血管塞栓術を施行し病変は縮小し,以後痙攣の再発はない.(著者抄録)

記述言語：英語   出版者・発行元：(一社)日本神経学会  

記述言語：英語  

Blood blister-like aneurysms (BBAs) are rare and challenging intracranial aneurysms. They pose significant diagnostic and surgical risks due to their delicate walls. Accounting for a small percentage of intracranial aneurysms, BBAs are pathologically pseudoaneurysms, often resulting from arterial dissection, with a high tendency to rupture. This report underscores the critical nature of BBAs by reviewing a case in which subarachnoid hemorrhage caused by a BBA rupture was difficult to diagnose with conventional imaging. We highlight the efficacy of three-dimensional (3D) high-resolution vessel wall imaging (VWI) in discerning the subtle vascular abnormality of BBAs. The integration of the black-blood imaging technique within VWI provides superior contrast between the aneurysm and surrounding tissues, facilitating clearer visualization of the aneurysmal wall. The use of 3D T1-weighted imaging provides intricate details of the vessel wall including its contrast enhancement, which is crucial for a comprehensive assessment of a ruptured aneurysm. This case is consistent with the existing literature, supporting the role of VWI in the identification of ruptured BBAs, an area with limited but growing information on its diagnostic value. VWI is precise and accurate in the preoperative diagnosis of BBAs, emphasizing its potential to improve patient management and outcomes, especially in conditions with high risks of morbidity and mortality.

DOI： 10.7759/cureus.58376

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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: Pediatrics  

OBJECTIVE: Intellectual function declines in about 30% of children with moyamoya disease (MMD). Memory function underpins higher order brain function, but the relationship between intellectual function and memory in pediatric MMD patients has not been well studied. This study aimed to investigate correlations between scores on the Wechsler Intelligence Scale for Children (WISC) and the Benton Visual Retention Test (BVRT), a visual memory test that can be administered to children, in children with MMD. Relationships between intellectual function or memory and regional cerebral blood flow (rCBF) have also not been well clarified in pediatric MMD patients. The authors also investigated associations between WISC or BVRT scores and rCBF in various brain regions. METHODS: WISC and BVRT scores and rCBF were assessed in 17 children with ischemic-onset MMD before revascularization. Single-photon emission CT with 123I-iodoamphetamine was used to measure rCBF. Relationships between WISC and BVRT scores were evaluated using Spearman's correlation coefficient and multivariate linear regression analysis. Cutoff values were identified for BVRT scores. Sensitivity and specificity were calculated to predict full-scale intelligence quotient (FSIQ) > 85 or ≤ 85. Associations between rCBF and WISC or BVRT scores were evaluated using linear regression analysis. RESULTS: BVRT scores were significantly correlated with FSIQ and scores on the Working Memory Index (WMI), Processing Speed Index, and Verbal Comprehension Index (VCI)/Verbal Intelligence Quotient (VIQ) of WISC. Multivariate linear regression revealed that number correct score and number of errors score of BVRT were associated with FSIQ. As cutoff values, a number correct score of 5 and a number of errors score of 8 offered the most reliable predictors of FSIQ > 85 and ≤ 85, respectively. FSIQ correlated positively with rCBF in the right and left hemispheres, right and left ganglia, right and left thalamus, right and left cerebellum, right middle cerebral artery (MCA) territory, pons, and vermis. WMI score was positively associated with rCBF in the right hemisphere, right anterior cerebral artery territory, right MCA territory, right basal ganglia, right and left thalamus, right and left cerebellum, pons, and vermis. CONCLUSIONS: BVRT score correlated well with WISC index scores, suggesting that BVRT may be helpful in screening for intellectual impairments in children with MMD. In the MCA territory, basal ganglia, thalamus, cerebellum, pons, and vermis, rCBF associated well with WISC index scores, suggesting that reduced rCBF in relevant brain regions may influence intellectual function.

DOI： 10.3171/2023.11.PEDS23317

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

Moyamoya disease (MMD) is characterized by progressive arterial occlusion, causing chronic hemodynamic impairment, which can reduce brain volume. A novel quantitative technique, synthetic magnetic resonance imaging (SyMRI), can evaluate brain volume. This study aimed to investigate whether brain volume measured with SyMRI correlated with cerebral blood flow (CBF) and brain function in adult MMD. In this retrospective study, 18 adult patients with MMD were included. CBF was measured using iodine-123-N-isopropyl-p-iodoamphetamine single photon emission computed tomography. Cerebrovascular reactivity (CVR) to acetazolamide challenge was also evaluated. Brain function was measured using the Wechsler Adult Intelligence Scales (WAIS)-III/IV and the WAIS-R tests. Gray matter (GM), white matter, and myelin-correlated volumes were evaluated in six areas. Resting CBF was positively correlated with GM fractions in the right anterior cerebral arterial and right middle cerebral arterial (MCA) territories. CVR was positively correlated with GM fraction in the right posterior cerebral arterial (PCA) territory. Full-Scale Intelligence Quotient and Verbal Comprehension Index scores were marginally positively correlated with GM fractions in the left PCA territory. Processing Speed Index score was marginally positively correlated with GM fraction in the right MCA territory. The SyMRI-measured territorial GM fraction correlated with CBF and brain function in patients with MMD.

DOI： 10.1038/s41598-024-56210-2

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：その他   掲載種別：研究論文（学術雑誌）   出版者・発行元：Neurology and Clinical Neuroscience  

Abstract

Magnetic resonance imaging of spinal dural arteriovenous fistula (SDAVF) shows longitudinally extensive spinal cord lesions mimicking neoplastic or inflammatory myelopathy. On positron emission tomography/computed tomography (PET/CT), we report two patients who showed focal ¹⁸F‐fluorodeoxyglucose (FDG) uptake in longitudinally extensive spinal cord lesions. These lesions were indistinguishable from tumors or myelitis but were finally diagnosed as SDAVF. Although PET/CT availability may be limited, in cases of myelopathy with diagnostic challenges, it is important to recognize that focal FDG uptake can be observed in SDAVF.

DOI： 10.1111/ncn3.12794

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

BACKGROUND: The systemic manifestations of coronavirus disease 2019 (COVID-19) include hyperinflammatory reactions in various organs. Recent studies showed evidence for the frequent involvement of central nervous system in affected patients; however, little is known about clinical features of cerebrovascular diseases in childhood-onset COVID-19. CASE PRESENTATION: A 10-year-old boy recovered from SARS-CoV-2 infection without complication. On 14 days after infection, he presented with loss of consciousness. A head computed tomography detected a ruptured cerebral aneurysm at the left posterior cerebral artery accompanying subarachnoid hemorrhage (SAH). Immediate surgical intervention did not rescue the patient, resulting in the demise 7 days after admission. Serological and genetic tests excluded the diagnosis of vasculitis and connective tissue disorders. Retrospective analysis showed markedly higher levels of interleukin (IL)-1β, IL-6 and IL-8 in the cerebrospinal fluid than the serum sample concurrently obtained. A review of literature indicated that adult patients with COVID-19 have a risk for the later development of SAH during the convalescent phase of COVID-19. CONCLUSIONS: SAH is a severe complication of COVID-19 in children and adults who have asymptomatic cerebrovascular aneurysms. The markedly high levels of cytokines detected in the cerebrospinal fluid suggested that intracranial hyperinflammatory condition might be one of the possible mechanisms involved in the rupture of a preexisting cerebrovascular aneurysms.

DOI： 10.1186/s12883-023-03493-z

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記述言語：日本語   出版者・発行元：特定非営利活動法人 日本脳神経外科救急学会　Neurosurgical Emergency  

<p>　Carotid webは頚部内頚動脈起始部後壁に発生し得る柵状構造物であり，線維筋性異形成の亜型と考えられる．Carotid web部分で血流のうっ滞が発生し，それによって生じる塞栓物質によって脳梗塞の原因となりうる．特に脳卒中危険因子の持たない若年患者において脳梗塞を引き起こすとされている．治療方法としては内科的治療のみでは再発する可能性が高く，頚動脈血行再建術が考慮される．頚動脈血行再建術の方法については，以前から頚動脈内膜剝離術の報告がされているが，最近は頚動脈ステント留置術（carotid arterial stenting; CAS）の報告が増加している．今回，我々は中大脳動脈閉塞症で発症した症候性carotid webに対して機械的血栓回収術に引き続きCASを施行し良好な経過を得た３例を経験したため，文献的考察を加え報告する．</p>

DOI： 10.24723/jsne.29.1_63

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記述言語：日本語   出版者・発行元：日本神経学会  

<p>症例は44歳男性．左上肢の脱力発作で始まる2回の全身痙攣があり，MRIで右中心前回皮質直下白質に局所性T₂延長領域を呈し，周囲の脳表に一部ガドリニウム増強効果を認めた．レベチラセタムで発作は消失し，他に神経学的異常はなかった．炎症性疾患を疑ったが，HLA-B54/Cw1を認めるものの発熱や皮膚病変はなく髄液の細胞数やIL-6値は正常であった．MRIで病変対側の脳表にわずかなflow voidsを，CT angiographyで皮質静脈の早期描出を認め，脳血管造影で右高位円蓋部を含む計4ヶ所に動静脈シャントを同定した．血管塞栓術を施行し病変は縮小し，以後痙攣の再発はない．</p>

DOI： 10.5692/clinicalneurol.cn-001947

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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  

OBJECTIVE: Cognitive function can decline in adults with moyamoya disease (MMD). Memory, which is an essential but complex and multifaceted function, underpins executive and intellectual functions. However, the relationship between memory and executive or intellectual functions in adults with MMD has not been well studied. The relationship between memory and cerebral blood flow has also not been elucidated. This study investigated correlations between memory, executive function, and intellectual function, and associations between cerebral blood flow and memory in adults with MMD. METHODS: Memory, executive function, and intellectual function were assessed using the Wechsler Memory Scale-Revised (WMS-R), Frontal Assessment Battery (FAB), and Wechsler Adult Intelligence Scale (WAIS) third or fourth edition, respectively, in 31 adults with MMD. Cerebral blood flow was measured with iodine 123I-iodoamphetamine single-photon emission computed tomography. RESULTS: WMS-R scores correlated significantly with total FAB and WAIS scores before and after revascularization. Cerebral blood flow in the left posterior cerebral artery territory correlated positively with WMS-R and WAIS scores pre- and postoperatively. Postoperative cerebrovascular reserves of the right cerebellum, pons, and vermis were positively associated with visual memory, and postoperative cerebrovascular reserve of the pons was also associated with general memory. CONCLUSIONS: Memory function correlates with executive and intellectual functions in adults with MMD. The FAB, which requires about 10 min to administer, might be useful to screen for memory dysfunction. Memory might be vulnerable to hypoperfusion in the posterior cerebral artery territory among adults with MMD. Postoperative cerebrovascular reserve might help predict memory dysfunction in adults with MMD.

DOI： 10.1016/j.wneu.2023.09.092

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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 Magnetic Resonance Imaging  

Arterial spin labeling (ASL) is a noninvasive imaging technique that labels the proton spins in arterial blood and uses them as endogenous tracers. Brain perfusion imaging with ASL is becoming increasingly common in clinical practice, and clinical applications of ASL for intracranial magnetic resonance angiography (MRA) have also been demonstrated. Unlike computed tomography (CT) angiography and cerebral angiography, ASL-based MRA does not require contrast agents. ASL-based MRA overcomes most of the disadvantages of time-of-flight (TOF) MRA. Several schemes have been developed for ASL-based MRA; the most common method has been pulsed ASL, but more recently pseudo-continuous ASL, which provides a higher signal-to-noise ratio (SNR), has been used more frequently. New methods that have been developed include direct intracranial labeling methods such as velocity-selective ASL and acceleration-selective ASL. MRA using an extremely short echo time (eg, silent MRA) or ultrashort echo-time (TE) MRA can suppress metal susceptibility artifacts and is ideal for patients with a metallic device implanted in a cerebral vessel. Vessel-selective 4D ASL MRA can provide digital subtraction angiography (DSA)-like images. This review highlights the principles, clinical applications, and characteristics of various ASL-based MRA techniques. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

DOI： 10.1002/jmri.29119

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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: Case Lessons  

BACKGROUND: The authors report a case of symptomatic cavernous sinus (CS) dural arteriovenous fistula (dAVF) that was successfully treated using direct puncture of the superior ophthalmic vein (SOV) with craniotomy. CS dAVF is commonly treated using transvenous embolization (TVE), with the most common access route via the inferior petrosal sinus (IPS). However, this route is sometimes unavailable because of an occluded, hypoplastic, aplastic, or tortuous IPS. The SOV is an alternative, albeit tortuous and long, route to the CS; therefore, direct SOV puncture is occasionally performed. Direct SOV puncture is mostly percutaneous; however, in this case, it was difficult because of subcutaneous SOV narrowing. OBSERVATIONS: As the patient experienced increased intraocular pressure, decreased vision, and eye movement disorders, CS embolization was performed via direct puncture with a craniotomy because of other access difficulties. LESSONS: Several reports have described CS dAVF in patients receiving endovascular treatment via direct SOV puncture using a transorbital approach. However, to the best of the authors' knowledge, this is the first reported case of a CS dAVF treated using TVE with craniotomy. This approach is useful when the SOV cannot be reached intravenously and its distance from the epidermis is long.

DOI： 10.3171/CASE23464

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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: Case Lessons  

BACKGROUND: We report a case of symptomatic, progressive stenosis of a persistent primitive hypoglossal artery (PPHA), which was successfully treated with percutaneous transluminal angioplasty (PTA) of the origin of the PPHA. The PPHA is a type of carotid-basilar anastomosis with an incidence of 0.02% to 0.10%. It originates from the internal carotid artery (ICA), passes through the hypoglossal canal, and merges with the basilar artery. In many cases, the ipsilateral vertebral artery is hypoplastic; therefore, PPHA stenosis causes cerebral infarction in the posterior circulation territory, as in this case. OBSERVATIONS: The patient's right PPHA had severe and progressive stenosis; therefore, he experienced cerebral infarction despite medical treatment. Therefore, PTA for the stenosis was performed, which ceased the recurrence of cerebral infarction and dizziness by improving blood flow in the posterior circulation. LESSONS: Several reports have described ICA stenosis accompanied by PPHA or PPHA stenosis in patients receiving endovascular treatments. Almost all cases were nonprogressive, and the treatment procedure was stenting. However, in our case, the PPHA stenosis was progressive, and we performed PTA because the patient experienced resistance to antiplatelet drugs and had poor collateral flow.

DOI： 10.3171/CASE23427

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

Angiogenic factors associated with Moyamoya disease (MMD) are overexpressed in M2 polarized microglia in ischemic stroke, suggesting that microglia may be involved in the pathophysiology of MMD; however, existing approaches are not applicable to explore this hypothesis. Herein we applied blood induced microglial-like (iMG) cells. We recruited 25 adult patients with MMD and 24 healthy volunteers. Patients with MMD were subdivided into progressive (N = 7) or stable (N = 18) group whether novel symptoms or radiographic advancement of Suzuki stage within 1 year was observed or not. We produced 3 types of iMG cells; resting, M1-, and M2-induced cells from monocytes, then RNA sequencing followed by GO and KEGG pathway enrichment analysis and qPCR assay were performed. RNA sequencing of M2-induced iMG cells revealed that 600 genes were significantly upregulated (338) or downregulated (262) in patients with MMD. Inflammation and immune-related factors and angiogenesis-related factors were specifically associated with MMD in GO analysis. qPCR for MMP9, VEGFA, and TGFB1 expression validated these findings. This study is the first to demonstrate that M2 microglia may be involved in the angiogenic process of MMD. The iMG technique provides a promising approach to explore the bioactivity of microglia in cerebrovascular diseases.

DOI： 10.1038/s41598-023-41456-z

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記述言語：日本語   出版者・発行元：The Mt. Fuji Workshop on CVD事務局  

2013年1月～2020年12月に包括的脳卒中センター6施設における血栓回収術(MT)885例のうち、癌関連血栓症(CAT)に伴う脳主幹動脈閉塞症23例(女性74%:年齢中央値77歳)に対するMTの成績について後方視的検討を行った。非CAT群862例(女性49%:年齢中央値79歳)との比較では、女性の割合が有意に多く、発症前の抗凝固薬内服が高く、t-PA静注療法の施行例が少なく、院内発症率が有意に高かった。CAT群は90日後の機能予後および死亡率が不良であったが死因の多くが癌の増悪であり、再開通率や合併症率は非CAT群と有意差は認めなかった。

記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本小児神経学会  

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

OBJECTIVES: To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan. DESIGN: Retrospective study. SETTING: Six hundred and thirty-one primary care institutions in Japan. PARTICIPANTS: Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3-6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1-25 points). RESULTS: In the overall cohort, in-hospital mortality decreased (year for trend, OR (95&#37; CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6&#37; to 38.5&#37;, while that of those who received coiling and those left untreated gradually increased from 16.9&#37; to 22.6&#37; and 35.4&#37; to 38&#37;, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality. CONCLUSIONS: The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era.

DOI： 10.1136/bmjopen-2022-068642

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記述言語：日本語  

記述言語：日本語   出版者・発行元：(一社)日本小児神経学会  

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掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：Proceedings of SPIE - The International Society for Optical Engineering  

Intracerebral hematoma (ICH) is a blood clot that forms when a blood vessel in the brain ruptures for some reason and the spilled blood coagulates. ICH has a high morbidity and mortality rate, accounting for approximately 10% of all strokes. Manual segmentation of ICH in head CT images is very complicated, time consuming, and troublesome. When ICH perforates the ventricular wall and blood flows into the ventricle, there is little difference in CT value between ICH and intraventricular hemorrhage (IVH), and the boundary between them is unclear. Convolutional neural network (CNN) has proven to be a reliable method in the field of image recognition. In addition, quantification of ICH may aid in decision making in ICH treatment. In this study, we introduce CNN in a stepwise manner to differentiate ICH and IVH in the process and extract ICH regions. The results in 18 stroke patients show that our method is promising in the extraction of ICH regions with an accuracy of 75.2%.

DOI： 10.1117/12.2667011

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記述言語：日本語   出版者・発行元：福岡医学会  

Purpose : We investigated the relationship between the arterial transit artifact (ATA) of the petrous portion of the internal carotid artery (pICA) on 1.5-T pulsed arterial spin labeling (ASL) perfusion images and hemodynamic changes on digital subtraction angiography (DSA) before and after carotid artery stenting (CAS) in patients with ICA stenosis. Method : ASL images were taken with postlabeling delay (PLD) of 1.5 s and 2.0 s before and after CAS, and these findings were compared with those of DSA in nine patients. Results : On pre-CAS ASL, ATA of the pICA was visualized both on PLD 1.5 s and 2.0 s in six cases, in which DSA demonstrated stagnation of contrast medium in the pICA and delayed visualization of the distal MCA. Immediately after CAS, DSA showed improvement in these findings : pICA was either visualized or not visualized on ASL images at 1.5 s, and disappeared at 2.0s. Conclusion : The presence of ATA of the pICA both on PLD 1.5 and 2.0 s suggests stagnation of blood flow within pICA with delayed visualization of the MCA and its disappearance after the CAS demonstrates improvement of these findings.

DOI： 10.15017/6788682

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

BACKGROUND: Intracranial aneurysms (ICA) rarely occur in children under 3 years of age. Little is known for neuroimaging parameters that predict survival and clinical outcomes of patients with ICA in early childhood. CASE PRESENTATION: A 2-year-old girl showed intracranial hemorrhage due to a rupture of aneurysm at the middle cerebral artery. Quantitative measurements of ischemic damages on the head computed tomography (CT) marked an extremely low score of 2 points with modified Alberta Stroke Program Early CT Score (mASPECTS). She died 15 days after admission. In publications from 2021 to 2022, we found 21 children who were under 3 years of age at onset of ICA. None of them died, but two of three patients who had mASPECTS scores 0-8 showed developmental delay and/or epilepsy as neurological complications. CONCLUSION: Early CT findings are applicable for predicting survival and neurological outcomes of young children with intracranial hemorrhage.

DOI： 10.1186/s12883-022-03022-4

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記述言語：日本語   出版者・発行元：福岡医学会  

内頸動脈の椎体骨部(pICA)におけるarterial transit artifact(ATA)描出の臨床的意義について、頸動脈ステント留置(CAS)前後の一定時間後(PLD)1.5秒、2.0秒のarterial spin labeling(ASL)所見と造影剤注入後1.5秒、2.0秒のDSA所見を比較検討した。2021年4月～2022年3月の期間に同一術者により行われたCAS症例のうち、術前後にtime-of-flight法によるMRAおよびASLを含むMRIとECD-SPECTを行った9例(全例男性、平均71.3歳)を対象とした。CAS前のASLでは非手術側のpICAのATAはPLD 1.5、2.0秒ともに描出されないか、1.5秒で描出されても2.0秒では消失した。しかし、手術側のpICAは6例において1.5秒で強く描出され、2.0秒でも消失せずに残存した。ICA狭窄におけるpICAのATAがPLD 1.5、2.0秒ともに描出されることは頭蓋内arterial transit timeの遅延を伴うpICA内の血流停滞を意味し、CAS後の消失はこれらの改善を示唆しているものと考えられた。

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

PURPOSE: Accurate assessment of cerebral perfusion in moyamoya disease is necessary to determine the indication for treatment. We aimed to investigate the usefulness of dynamic PCASL using a variable TR scheme with optimized background suppression in the evaluation of cerebral perfusion in moyamoya disease. METHODS: We retrospectively analyzed the images of 24 patients (6 men and 18 women, mean age 31.4 ± 18.2 years) with moyamoya disease; each of whom was imaged with both dynamic PCASL using the variable-TR scheme and 123IMP SPECT with acetazolamide challenge. ASL dynamic data at 10 phases are acquired by changing the LD and PLD. The background suppression timing was optimized for each phase. CBF and ATT were measured with ASL, and CBF and CVR to an acetazolamide challenge were measured with SPECT. RESULTS: A significant moderate correlation was found between the CBF measured by dynamic PCASL and that by SPECT (r = 0.53, P < 0.001). The CBF measured by dynamic PCASL (52.5 ± 13.3 ml/100 mg/min) was significantly higher than that measured by SPECT (43.0 ± 12.6 ml/100 mg/min, P < 0.001). The ATT measured by dynamic PCASL showed a significant correlation with the CVR measured by SPECT (r = 0.44, P < 0.001). ATT was significantly longer in areas where the CVR was impaired (CVR < 18.4&#37;, ATT = 1812 ± 353 ms) than in areas where it was preserved (CVR > 18.4&#37;, ATT = 1301 ± 437 ms, P < 0.001). The ROC analysis showed a moderate accuracy (AUC = 0.807, sensitivity = 87.7&#37;, specificity = 70.4&#37;) when the cutoff value of ATT was set at 1518 ms. CONCLUSION: Dynamic PCASL using this scheme was found to be useful for assessing cerebral perfusion in moyamoya disease.

DOI： 10.1007/s00234-022-03095-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.25259/SNI_422_2022.eCollection 2022.

記述言語：日本語   出版者・発行元：The Mt. Fuji Workshop on CVD事務局  

もやもや病に対するSTA-MCAバイパス術後の過灌流症候群(CHS)の発症を術前に予測することは現在困難である。以前、ハイパースペクトルカメラ(HSC)によって脳表血流を評価できることを報告した。HSCは、可視域にわたる脳皮質表面の連続スペクトルデータ(ハイパースペクトル画像データ)を撮影し、このデータを光学的固有信号に変換することで、脳表の酸素飽和度を算出することができる。今回、HSCを用いてSTA-MCAバイパス術前後の脳表皮質の酸素飽和度を算出し、脳血流を評価することでCHSを予測できるのではないかと考え、自験例で検証を行った。対象は2018～2020年にSTA-MCAバイパス術を行った患者29例とした。神経学的症状やSPECT所見からCHSと診断されたのは5例で、この5例(CHS群)と他の24例(非CHS群)とで脳表皮質の酸素飽和度を比較するとCHS群が有意に高かった(33±28% vs 8±14%)。酸素飽和度増加率のROC分析を行った結果、酸素飽和度の15%以上の増加があれば術後CHSを予測しうることが示された(感度85.0%、特異度81.3%)。

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: Case Lessons  

BACKGROUND: Cerebrovascular events and infection are among the most common complications of left ventricular assist device (LVAD) therapy. The authors reported on a patient with an infectious intracranial aneurysm (IIA) associated with LVAD infection that was successfully occluded by endovascular therapy. OBSERVATIONS: A 37-year-old man with severe heart failure received an implantable LVAD. He was diagnosed with candidemia due to driveline infection 44 months after LVAD implantation, and empirical antibiotic therapy was started. After 4 days of antibiotic treatment, the patient experienced sudden dizziness. Computed tomography (CT) revealed subarachnoid hemorrhage in the right frontal lobe, and CT angiography revealed multiple aneurysms in the peripheral lesion of the anterior cerebral artery (ACA) and middle cerebral artery. Two weeks and 4 days after the first bleeding, aneurysms on the ACA reruptured. Each aneurysm was treated with endovascular embolization using n-butyl cyanoacrylate. Subsequently, the patient had no rebleeding of IIAs. The LVAD was replaced, and bloodstream infection was controlled. He received a heart transplant and was independent 2 years after the heart transplant. LESSONS: LVAD-associated IIAs have high mortality and an increased risk of surgical complications. However, endovascular obliteration may be safe and thus improve prognosis.

DOI： 10.3171/CASE21559

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記述言語：英語   出版者・発行元：American Journal of Neuroradiology  

BACKGROUND AND PURPOSE: An accurate assessment of the hemodynamics of an intracranial dural AVF is necessary for treatment planning. We aimed to investigate the utility of 4D-MRA based on superselective pseudocontinuous arterial spin-labeling with CENTRA-keyhole and view-sharing (4D-S-PACK) for the vessel-selective visualization of intracranial dural AVFs. MATERIALS AND METHODS: We retrospectively analyzed the images of 21 patients (12 men and 9 women; mean age, 62.2 [SD,19.2] years) with intracranial dural AVFs, each of whom was imaged with DSA, 4D-S-PACK, and nonselective 4D-MRA based on pseudocontinuous arterial spin-labeling combined with CENTRA-keyhole and view-sharing (4D-PACK). The shunt location, venous drainage patterns, feeding artery identification, and Borden classification were evaluated by 2 observers using both MRA methods on separate occasions. Vessel selectivity was evaluated on 4D-S-PACK. RESULTS: Shunt locations were correctly evaluated in all 21 patients by both observers on both MRA methods. With 4D-S-PACK, observers 1 and 2 detected 76 (80.0%, P, .001) and 73 (76.8%, P, .001) feeding arteries of the 95 feeding arteries identified on DSA but only 39 (41.1%) and 46 (48.4%) feeding arteries with nonselective 4D-PACK, respectively. Both observers correctly identified 10 of the 11 patients with cortical venous reflux confirmed by DSA with both 4D-S-PACK and 4D-PACK (sensitivity = 90.9%, specificity = 90.9% for each method), and they made accurate Borden classifications in 20 of the 21 patients (95.2%) on both MRA methods. Of the 84 vessel territories examined, vessel selectivity was graded 3 or 4 in 73 (91.2%) and 66 (88.0%) territories by observers 1 and 2, respectively. CONCLUSIONS: 4D-S-PACK is useful for the identification of feeding arteries and accurate classifications of intracranial dural AVFs and can be a useful noninvasive clinical tool.

DOI： 10.3174/ajnr.A7426

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記述言語：日本語   出版者・発行元：(公財)大和証券ヘルス財団  

脳梗塞血栓回収療法を施行した763例の治療データベースを解析し、高齢者脳梗塞患者に対する血栓回収療法有効性予測スコアを作成した。内頸動脈・中大脳動脈閉塞かつ発症前の生活自立(mRS 0-2)患者は523例で、そのうち75歳以上の高齢者は316例(52%)、中大脳動脈M2以遠の末梢病変は61例(21%)であった。90日後mRS 0-2を予後良好とし、多変量解析を行ったところ、高齢者群は非高齢者群と比較し予後良好の割合が低かった。高齢者群のみで解析を行った場合は性別、NIH Stroke Scale(NIHSS)、mTICI2b以上の再開通が有意に予後良好と相関していた。年齢、女性、抗凝固薬内服、tPA非使用、末梢病変、NIHSS、ASPECTS、発症前mRS2、脂質異常症の有無計22点による予後予測スコアを作成した。本スコアにおいて、カットオフ値7点以下により比較的高い精度で予後良好を予測できると考えられた。

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1136/neurintsurg-2021-017837.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.25259/SNI_1077_2021.

DOI： 10.1161/str.53.suppl_1.TMP66

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

症例は42歳の男性.23年前に左総頸動脈と左鎖骨下動脈の閉塞を伴う高安動脈炎と診断されたが,内服加療により血管炎の活動性は落ち着いていた.経過中,腎性高血圧の指摘があり,降圧剤が処方された.今回,突然の頭痛を主訴に前交通動脈瘤破裂によるくも膜下出血を発症した.各種治療を施すも,再破裂や脳血管攣縮,脳梗塞を合併し死亡した.剖検にて前交通動脈に複数の嚢状動脈瘤を認めたが,組織学的に血管炎や粥状硬化および壁の解離を認めなかった.高安動脈炎により左総頸動脈は外頸動脈分岐部直前まで閉塞していたが,内頸動脈は開存していた.高安動脈炎では,脳梗塞,一過性脳虚血発作の合併頻度が高いが,動脈瘤形成やくも膜下出血に関する報告は少ない.抗血小板剤の使用も推奨される本疾患において,血行力学的機序によると考えられる脳動脈瘤破裂のリスクや寛解期における閉塞血管の血行再建術についても考慮する必要があると思われる.(著者抄録)

記述言語：日本語   出版者・発行元：バイオメディカル・ファジィ・システム学会  

Intracerebral hematoma (ICH) is a disease with high mortality and poor prognosis rate, accounting for approximately 10% of all cerebrovascular disease. Manual extraction of ICH regions lacks accuracy and speed, and a quantitative evaluation method is needed. In this study, we propose a method that divides the extraction of ICH regions into multiple stages and extracts the target using two-class classification based on convolutional neural network. The performance of the model is evaluated using 18 subjects with intraventricular hemorrhage, and it is shown that the proposed method is promising for the extraction of ICH regions in a region with high absorption rates.

DOI： 10.24466/pacbfsa.35.0_a-2

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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  

<p>症例は42歳の男性．23年前に左総頸動脈と左鎖骨下動脈の閉塞を伴う高安動脈炎と診断されたが，内服加療により血管炎の活動性は落ち着いていた．経過中，腎性高血圧の指摘があり，降圧剤が処方された．今回，突然の頭痛を主訴に前交通動脈瘤破裂によるくも膜下出血を発症した．各種治療を施すも，再破裂や脳血管攣縮，脳梗塞を合併し死亡した．剖検にて前交通動脈に複数の囊状動脈瘤を認めたが，組織学的に血管炎や粥状硬化および壁の解離を認めなかった．高安動脈炎により左総頸動脈は外頸動脈分岐部直前まで閉塞していたが，内頸動脈は開存していた．高安動脈炎では，脳梗塞，一過性脳虚血発作の合併頻度が高いが，動脈瘤形成やくも膜下出血に関する報告は少ない．抗血小板剤の使用も推奨される本疾患において，血行力学的機序によると考えられる脳動脈瘤破裂のリスクや寛解期における閉塞血管の血行再建術についても考慮する必要があると思われる．</p>

DOI： 10.3995/jstroke.10922

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記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Long-term outcomes after surgical treatment of arachnoid cysts (ACs) have not been reported adequately. Impaired visual acuity is not a common symptom of shunt dependency syndrome due to cyst-peritoneal (CP) shunt malfunction for ACs. We report a case of CP shunt malfunction, who presented only impaired visual acuity as a symptom, long after the initial surgical treatment. Case Description: A 16-year-old boy was surgically treated for the left frontal AC with CP shunting at 2 years of age. Extension of the peritoneal shunt catheter was performed at 15 years of age. A year later, he started experiencing impairment of visual acuity without headaches, which worsened to bilateral light perception. The presence of bilateral optic atrophy was confirmed. The AC in the left frontal lobe had enlarged very slightly, with shortening of the intracystic catheter, and the cerebrospinal fluid pressure was elevated to 30 cmH2O. He was treated with lumboperitoneal shunting. The visual acuity showed limited improvement. Conclusion: The possibility of CP shunt malfunction and shunt dependency syndrome should be considered, even if the patient presented only impaired visual acuity and no significant changes in the size of the ACs are observed.

DOI： 10.25259/SNI_1077_2021

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記述言語：英語   出版者・発行元：Surgical Neurology International  

Background: Angiolipomas are benign mesenchymal tumors comprising mature adipocytes and abnormal blood vessels, commonly found in the subcutaneous tissue of the trunk and rarely in the skull. Furthermore, sporadic cases of angiolipoma with arteriovenous fistula (AVF) have been reported. Case Description: We reported the case of a 72-year-old woman who presented with head swelling, seizures, and cognitive dysfunction. Computed tomography and magnetic resonance imaging revealed a right frontal bone tumor exceeding a sagittal suture of up to 10.7 cm. Angiography revealed AVF and varices formation. Endovascular embolization was performed to treat the AVF and reduce blood loss during surgical resection. Two days after the embolization, a craniotomy was performed; however, uncontrollable bleeding was observed at the time of tumor resection. Postoperatively, the patient was symptom-free and has been stable for 2 years without recurrence. Conclusion: Despite careful preoperative evaluation and treatment planning, the patient in this case report was difficult to treat. Such cases require adequate preparation.

DOI： 10.25259/SNI_422_2022

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記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1523/ENEURO.0098-21.2021.

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 NeuroInterventional Surgery  

BACKGROUND: The efficacy of combined stent retriever (SR) and aspiration catheter (AC; combined technique: CBT) use for acute ischemic stroke (AIS) is unclear. We investigated the safety and efficacy of single-unit CBT (SCBT)-retrieving the thrombus as a single unit with SR and AC into the guide catheter-compared with single use of either SR or contact aspiration (CA). METHODS: We analysed 763 consecutive patients who underwent mechanical thrombectomy for AIS between January 2013 and January 2020, at six comprehensive stroke centers. Patients were divided into SCBT and single device (SR/CA) groups. The successful recanalization with first pass (SRFP) and other procedural outcomes were compared between groups. RESULTS: Overall, 240 SCBT and 301 SR/CA (SR 128, CA 173) patients were analyzed. SRFP (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2c, 43.3&#37; vs 27.9&#37;, p<0.001; mTICI 3, 35.8&#37; vs 25.5&#37;, p=0.009) and final mTICI ≥2b recanalization (89.1&#37; vs 82.0&#37;, p=0.020) rates were significantly higher, puncture-to-reperfusion time was shorter (median (IQR) 43 (31.5-69) vs 55 (38-82.2) min, p<0.001), and the number of passes were fewer (mean±SD 1.72±0.92 vs 1.99±1.01, p<0.001) in the SCBT group. Procedural complications were similar between the groups. In subgroup analysis, SCBT was more effective in women, cardioembolic stroke patients, and internal carotid artery and M2 occlusions. CONCLUSIONS: SCBT increases the SRFP rate and shortens the puncture-to-reperfusion time without increasing procedural complications.

DOI： 10.1136/neurintsurg-2021-017837

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1159/000513289.

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1253/circj.CJ-20-0639.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In Japan there is no consensus on how to efficiently measure quality indicators (QIs), defined as a standard of care, for acute ischemic stroke (AIS). Using information from a health insurance claims database and electronic medical records, we evaluated the feasibility and validity of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) or endovascular therapy (EVT).Methods and Results:AIS patients receiving rt-PA or EVT between 2013 and 2015 were identified. We selected 17 AIS QI measures for primary stroke centers (PSCs) and 8 for comprehensive stroke centers (CSCs). Defined QIs were calculated for each hospital and then averaged. In total, the data of 8,206 patients (rt-PA 83.7&#37;, EVT 34.9&#37;) from 172 hospitals were obtained. Median National Institute of Health Stroke Scale score at admission was 14, and 37.7&#37; of the patients were functionally independent at discharge. All target QIs were successfully measured with fewer missing values, and the accuracy of preset data was about 90&#37;. Adherence rates were low (<50&#37;) in 5 QI measures among PSCs, including door-to-needle time ≤1 h, and in 1 QI measure among CSCs (door-to-brain and vascular imaging time ≤30 min). CONCLUSIONS: Measuring QIs for AIS by this novel approach was feasible and reliable in the provision of a national benchmark.

DOI： 10.1253/circj.CJ-20-0639

記述言語：英語  

BACKGROUND: The authors document the first case of pure arterial malformations (PAMs) of the posterior communicating artery (PCoA), which were successfully treated with microsurgical clipping of the main body of the PAMs. PAMs are defined as dilated, overlapping, and tortuous arteries with a coil-like appearance and/or a mass of arterial loops without any associated venous component. Although PAMs usually have a benign history and are often incidental findings, this case presented with acute progression of visual field impairment. OBSERVATIONS: Because the patient's right optic tract was affected by the loop of PAMs of the PCoA, the authors performed microsurgical clipping of the main body of the PAMs using endoscopy, which ceased the progression of symptoms without any complications. LESSONS: There have been several reports of PAMs receiving surgical treatment for accompanying lesions. However, in this case, the lesion to the main body of PAMs was the cause of visual field impairment and was successfully treated with microsurgical clipping.

DOI： 10.3171/CASE2037

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： doi: 10.1007/s00330-020-07057-4. Epub 2020 Jul 21.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics. DESIGN: A hospital-based cross-sectional study. SETTING: We sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018. PARTICIPANTS: 749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan. MAIN OUTCOME MEASURES: CSC capabilities were assessed using the validated scoring system (CSC score: 1-25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis. RESULTS: Among the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13-19), 18 (14-20) and 19 (15-21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20&#37; increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20&#37; decrease in community education. A lower baseline CSC score (OR: 0.82, 95&#37; CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95&#37; CI 1.2 to 13.0) and the number of stroke physicians (7-9) (OR: 2.6, 95&#37; CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location. CONCLUSIONS: There was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area.

DOI： 10.1136/bmjopen-2019-033055

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To evaluate the usefulness of 4D-MR angiography based on super-selective pseudo-continuous ASL combined with keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization and to examine the ability of this technique to visualize brain arteriovenous malformations (AVMs). METHODS: In this retrospective study, 15 patients (ten men and five women, mean age 44.0 ± 16.9 years) with brain AVMs were enrolled. All patients were imaged with 4D-PACK (non-selective), 4D-S-PACK, and digital subtraction angiography (DSA). Observers evaluated vessel selectivity, identification of feeding arteries and venous drainage patterns, visualization scores, and contrast-to-noise ratio (CNR) for each AVM component. Measurements were compared between the MR methods. RESULTS: Vessel selectivity was graded 4 in 43/45 (95.6&#37;, observer 1) and 42/45 (93.3&#37;, observer 2) territories and graded 3 in two (observer 1) and three (observer 2) territories. The sensitivity and specificity for identification of feeding arteries for both observers was 88.9&#37; and 100&#37; on 4D-PACK, and 100&#37; and 100&#37; on 4D-S-PACK, respectively. For venous drainage, the sensitivity and specificity was 100&#37; on both methods for observer 1. The sensitivity and specificity for observer 2 was 94.4&#37; and 83.3&#37; on 4D-PACK, and 94.4&#37; and 91.7&#37; on 4D-S-PACK, respectively. The CNRs at the timepoint of 1600 ms were slightly lower in 4D-S-PACK than in 4D-PACK for all AVM components (Feeding artery, p = .02; nidus, p = .001; and draining artery, p = .02). The visualization scores for both observers were not significantly different between 4D-PACK and 4D-S-PACK for all components. CONCLUSIONS: 4D-S-PACK could be a useful non-invasive clinical tool for assessing hemodynamics in brain AVMs. KEY POINTS: • The 4D-MR angiography based on super-selective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) enabled excellent vessel selectivity. • The 4D-S-PACK enabled the perfect identification of feeding arteries of brain arteriovenous malformation (AVM). • 4D-S-PACK could be a non-invasive clinical tool for assessing hemodynamics in brain AVMs.

DOI： 10.1007/s00330-020-07057-4

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0230953. eCollection 2020.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Improved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH. METHODS: The authors conducted a nationwide retrospective cohort study in 27,490 SAH patients who underwent clipping or coiling in 621 institutions between 2010 and 2015 and whose data were collected from the Japanese nationwide J-ASPECT Diagnosis Procedure Combination database. The CSC capabilities of each hospital were assessed by use of a validated scoring system based on answers to a previously reported 25-item questionnaire (CSC score 1-25 points). Hospitals were classified into quartiles based on CSC scores and case volumes of clipping or coiling for SAH. RESULTS: Overall, the absolute risk reductions associated with high versus low case volumes and high versus low CSC scores were relatively small. Nevertheless, in patients who underwent clipping, a high case volume (> 14 cases/yr) was significantly associated with reduced in-hospital mortality (Q1 as control, Q4 OR 0.71, 95&#37; CI 0.55-0.90) but not with short-term poor outcome. In patients who underwent coiling, a high case volume (> 9 cases/yr) was associated with reduced in-hospital mortality (Q4 OR 0.69, 95&#37; CI 0.53-0.90) and short-term poor outcomes (Q3 [> 5 cases/yr] OR 0.75, 95&#37; CI 0.59-0.96 vs Q4 OR 0.65, 95&#37; CI 0.51-0.82). A high CSC score (> 19 points) was significantly associated with reduced in-hospital mortality for clipping (OR 0.68, 95&#37; CI 0.54-0.86) but not coiling treatment. There was no association between CSC capabilities and short-term poor outcomes. CONCLUSIONS: The effects of case volume and CSC capabilities on in-hospital mortality and short-term functional outcomes in SAH patients differed between patients undergoing clipping and those undergoing coiling. In the modern endovascular era, better outcomes of clipping may be achieved in facilities with high CSC capabilities.

DOI： 10.3171/2019.12.JNS192584

記述言語：英語   掲載種別：研究論文（その他学術会議資料等）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with hereditary hemorrhagic telangiectasia(HHT)are known to have high rates of cerebral arteriovenous malformations(AVMs). Compared to patients with sporadic AVMs, patients with HHT are less likely to present with ruptured AVMs. CASE REPORT: A 14-year-old male patient presented with headache that had lasted for 2 days. CT revealed an intracerebral hemorrhage in the right parietal lobe, and enhanced CT revealed an AVM in the upper part of the hematoma. The size of the nidus was 20 mm, and its feeders were the right superior internal parietal artery and a branch of the anterior cerebral artery. In addition, the AVM had no deep drainer. We also found another AVM in the right temporal lobe and identified telangiectasia of the nose using digital subtraction angiography. We suspected HHT and performed whole body CT, which revealed an arteriovenous fistula in the right lung and a hematoma-like lesion in the spleen. Thus, we diagnosed the patient with HHT. His ruptured AVM was removed electively. CONCLUSION: We report a case of HHT that presented as an intracerebral hemorrhage in a patient. Based on our case study findings, it is necessary to perform long-term follow-up not only for brain AVMs but also for visceral vascular malformations in such patients, as well as perform HHT screening for families. Although such cases are rare, some features of HHT must be considered to accurately diagnose suspected HHT.

DOI： 10.11477/mf.1436204116

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database. METHODS AND RESULTS: We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013-2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6&#37; and 58.7&#37;; discharge anticoagulation for atrial fibrillation, 64.4&#37;; discharge antihypertensive agents, 51.7&#37;; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9&#37;; death complications of diagnostic neuroangiography, 0.4&#37;). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics. CONCLUSIONS: We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.

DOI： 10.1253/circj.CJ-19-0089

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The epidemiology of patients with traumatic brain injury (TBI) has changed dramatically over recent decades as a result of rapid advances in aging societies. We assessed the influence of age on outcomes of patients with TBI and sought to identify prognostic factors for in-hospital mortality of TBI among elderly patients. METHODS: Using a nationwide database, we analyzed data from 5651 patients with TBI. Univariate analysis was conducted to compare patient demographics, neurologic status on admission, radiologic findings, systemic complication rates, length of hospital stay, in-hospital mortality, and home discharge rates between elderly and nonelderly groups. Multivariable analysis was conducted to determine prognostic factors for in-hospital mortality among elderly patients. RESULTS: Overall in-hospital mortality was significantly higher in elderly patients (12.8&#37; vs. 19.3&#37;; P < 0.001). In-hospital mortality of elderly patients with mild TBI increased significantly at >7 days after admission, whereas that of elderly patients with moderate or severe TBI was significantly higher immediately after admission. Age (odds ratio [OR], 1.62; P = 0.024), male sex (OR, 1.30; P = 0.004), Japan Coma Scale score on admission (OR, 5.95, P < 0.001), and incidence of acute subdural hematoma (OR, 1.89; P < 0.001) were associated with in-hospital mortality in elderly patients with TBI. CONCLUSIONS: Elderly patients with TBI showed significantly higher in-hospital mortality. Delayed increases in in-hospital mortality were observed among elderly patients with mild TBI. Level of consciousness on admission was the strongest predictor of in-hospital mortality among elderly patients.

DOI： 10.1016/j.wneu.2019.05.140

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. AIMS: To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. METHODS: This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1-25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3-6) at discharge were examined using hierarchical logistic regression models. RESULTS: Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6&#37; to 5.0&#37;, and from 48.7&#37; to 43.1&#37;, respectively). The preceding comprehensive stroke center score increase (in 2010-2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95&#37; confidence interval): 0.97 (0.95-0.99), 0.97 (0.95-0.998), 1.07 (1.04-1.10), and 1.21 (1.14-1.28), respectively). CONCLUSIONS: This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.

DOI： 10.1177/1747493019884526

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate the performance of acceleration-selective arterial spin labeling (AccASL) MR angiography in the visualization of brain arteriovenous malformations (AVMs) in comparison with digital subtraction angiography (DSA) and time-of-flight (TOF) MR angiography. METHODS: Twenty-one patients with brain AVM (mean age 31.1 ± 18.6 years; 11 males, 10 females) underwent TOF and AccASL MR angiography and DSA. Two neuroradiologists conducted an observer study for detection, nidus size, eloquence, venous drainage pattern, and Spetzler-Martin (SM) grade. The evaluations included the visualization of each AVM component with reference to DSA and assessments of contrast-to-noise ratio (CNR). The kappa statistic, repeated measures analysis of variance, Wilcoxon matched pairs test, and paired t test were used. RESULTS: Both observers detected more AVMs with AccASL (95.2&#37;, 90.5&#37; for Observers 1 and 2) than with TOF (76.2&#37; and 71.4&#37;, respectively). The inter-modality agreement between AccASL and DSA was almost perfect for the eloquence, venous drainage pattern, and SM grade for Observer 1 and moderate for the venous drainage pattern and substantial for the eloquence and SM grade for Observer 2. The visualization scores were higher with AccASL than with TOF for the feeding artery (AccASL, 4.5 ± 1.0 vs. TOF, 3.9 ± 1.5, p = 0.0214), nidus (4.6 ± 1.1 vs. 3.2 ± 1.5, p = 0.0006), and draining vein (4.6 ± 1.0 vs. 2.2 ± 1.1, p < 0.0001), respectively. The CNRs in the nidus were higher in AccASL than in TOF (29.9 ± 16.7 vs. 20.8 ± 16.5, p = 0.0002), as in the draining vein (23.2 ± 13.0 vs. 12.6 ± 12.0, p = 0.0010), respectively. CONCLUSIONS: AccASL better visualized brain AVMs compared with TOF and was useful for grading without the use of contrast agents.

DOI： 10.1007/s00234-019-02217-w

記述言語：日本語  

Objective : With advent of an endovascular suite in the operating room (hybrid OR), it has been reported recently that combination therapy with surgical and endovascular procedures in hybrid OR for complex cerebrovascular diseases is feasible. / Materials and methods : We analyzed the 15 consecutive cases who underwent combination therapy with hybrid OR in our hospital from October 2014 to September 2017 (8 Aneurysms, 3 carotid artery stenosis, and 4 dural arteriovenous fistulas (DAVF)). / Results : All procedures were performed successfully. We performed bypass surgery and endovascular trapping with endovascular procedure for all aneurysm cases. In 3 cases of carotid artery stenosis, we performed carotid artery stenting (CAS) with direct puncture of common carotid artery for 2 cases and rescue stenting with carotid endarterectomy for 1 case. Perioperative antiplatelet therapy was performed in all cases of unruptured aneurysms and carotid artery stenosis. In the cases of DAVF, we performed transarterial or transvenous embolization combined with craniotomy, or shunt ligation with selective indocyanine green videoangiography using microcatheter. Systemic full heparinization was performed during all endovascular procedures. There was no symptomatic hemorrhagic and ischemic complication. There was no neurological deterioration of modified Rankin scale at discharge except for the case of symptomatic hyperperfusion after CAS. / Conclusion : Combination therapy with hybrid OR for complex cerebrovascular disease is safe and feasible.

DOI： 10.15017/2545089

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2176/nmc.oa.2018-0325.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Japan has a rapidly aging population and the application of neuroendovascular therapy (NET) for cerebrovascular diseases among elderly patients has increased, but feasibility and safety of NET for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of NET by analyzing the Japanese nationwide database, the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET 3). In total, 35,972 patients in the JR-NET 3 were analyzed retrospectively. "Elderly patients" were defined as those aged ≥75 years. Approximately one-quarter of patients who received NET were elderly patients. The proportion of patients with modified Rankin Scale (mRS) 0-2 before treatment and 30 days after NET was significantly low across all diseases in the elderly patients. Technical success rates were generally high across all procedures, but complication rate was significantly higher among elderly patients; ischemic complications were significantly higher with NET for unruptured aneurysms (UA) and carotid artery stenosis (CAS). Multivariate analysis revealed that mRS 0-2 before treatment [odds ratio (OR): 0.56, 95&#37; confidence interval (CI): 0.34-0.94, P = 0.03], middle cerebral artery aneurysm (OR: 0.33, 95&#37; CI: 0.12-0.92, P = 0.04), and complete obliteration (OR: 0.66, 95&#37; CI: 0.44-0.97, P = 0.03) were associated with ischemic complications with NET for UA. Moreover, mRS 0-2 before treatment (OR: 0.55, 95&#37; CI: 0.36-0.86, P < 0.01), high intensity with time-of-flight magnetic resonance angiography (OR: 1.55, 95&#37; CI: 1.03-2.32, P = 0.04), open-cell stent (OR: 2.20, 95&#37; CI: 1.50-3.22, P <0.01) were associated with ischemic complications with NET for CAS. Taken together, our findings indicate that cautious and precise selection of patients suitable for NET is necessary.

DOI： 10.2176/nmc.oa.2018-0325

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although endovascular coiling of unruptured aneurysms is widely accepted, the endovascular treatment of wide-neck bifurcation aneurysms remains one of the most challenging morphologies. Our purpose was to describe our experience with 24-month follow-up for the treatment of unruptured intracranial bifurcation aneurysms using the PulseRider (Cerenovus, New Brunswick, NJ). METHODS: This study is a single-center, single-arm registry performed under institutional review board control to evaluate efficacy and safety of the PulseRider. Patients with bifurcation aneurysms were identified and enrolled prospectively. Angiography immediately after treatment and at 6 months, and magnetic resonance imaging and magnetic resonance angiography at 12- and 24-month follow-up were retrospectively analyzed. A modified Rankin score was obtained prior to procedure, at discharge, and at 6-, 12- and 24-month follow-up visits. RESULTS: Eight patients with a mean age of 66 years were treated with the PulseRider. All patients had bifurcation aneurysms (2 anterior communicating, 2 carotid terminus, and 4 basilar apex). The aneurysm diameters ranged from 4.6 to 13.6 mm (mean 7.4 mm) with dome/neck ratio ranging from 1.4 to 2.2 (mean 1.6). In all cases, the PulseRider was successfully deployed. Complete occlusion was demonstrated at 6-month follow-up on 6 of 8 (75&#37;), near complete occlusion in 1 of 8 (12.5&#37;), and residual aneurysm in 1 of 8 (12.5&#37;) patients. There was no change or recurrence on magnetic resonance angiography, nor clinical complication after the procedure through 24-month follow-up. CONCLUSIONS: Our experience with 24-month follow-up demonstrated favorable efficacy in the treatment of intracranial wide-neck bifurcation aneurysms using the PulseRider.

DOI： 10.1016/j.wneu.2019.04.177

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: To evaluate the performance of acceleration-selective arterial spin labeling (AccASL) MR angiography in the visualization of brain arteriovenous malformations (AVMs) in comparison with digital subtraction angiography (DSA) and time-of-flight (TOF) MR angiography. Methods: Twenty-one patients with brain AVM (mean age 31.1 ± 18.6 years; 11 males, 10 females) underwent TOF and AccASL MR angiography and DSA. Two neuroradiologists conducted an observer study for detection, nidus size, eloquence, venous drainage pattern, and Spetzler-Martin (SM) grade. The evaluations included the visualization of each AVM component with reference to DSA and assessments of contrast-to-noise ratio (CNR). The kappa statistic, repeated measures analysis of variance, Wilcoxon matched pairs test, and paired t test were used. Results: Both observers detected more AVMs with AccASL (95.2%, 90.5% for Observers 1 and 2) than with TOF (76.2% and 71.4%, respectively). The inter-modality agreement between AccASL and DSA was almost perfect for the eloquence, venous drainage pattern, and SM grade for Observer 1 and moderate for the venous drainage pattern and substantial for the eloquence and SM grade for Observer 2. The visualization scores were higher with AccASL than with TOF for the feeding artery (AccASL, 4.5 ± 1.0 vs. TOF, 3.9 ± 1.5, p = 0.0214), nidus (4.6 ± 1.1 vs. 3.2 ± 1.5, p = 0.0006), and draining vein (4.6 ± 1.0 vs. 2.2 ± 1.1, p < 0.0001), respectively. The CNRs in the nidus were higher in AccASL than in TOF (29.9 ± 16.7 vs. 20.8 ± 16.5, p = 0.0002), as in the draining vein (23.2 ± 13.0 vs. 12.6 ± 12.0, p = 0.0010), respectively. Conclusions: AccASL better visualized brain AVMs compared with TOF and was useful for grading without the use of contrast agents.

DOI： 10.1007/s00234-019-02217-w

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Purpose: Recent studies have demonstrated that endovascular reperfusion therapy improves clinical outcomes at 90 days after ischemic stroke. However, the effects on long-term outcomes are not well known. We hypothesized that successful reperfusion might be associated with long-term improvement beyond 90 days after endovascular therapy. To assess the long-term effects beyond 90 days, we analyzed the association of successful reperfusion with a temporal change in modified Rankin Scale (mRS) score from 90 days to 1 year after endovascular therapy. >bold<>italic<Methods:>/italic<>/bold< We retrospectively analyzed a database of consecutive patients with acute ischemic stroke who received endovascular therapy between April 2006 and March 2016 at 4 centers. We compared the incidences of improvement and deterioration in patients with successful reperfusion (i.e., modified thrombolysis in cerebral infarction score of 2b or 3) with those in patients with unsuccessful reperfusion. We defined improvement and deterioration as decrease and increase on the mRS score by 1 point or more from 90 days to 1 year after endovascular therapy respectively. >bold<>italic<Results:>/italic<>/bold< A total of 268 patients were included in the current study. The rate of patients with improvement tended to be higher in patients with successful reperfusion than in patients with unsuccessful reperfusion (20% [34/167 patients] vs. 12% [12/101], >italic
/italic< = 0.07). The rate of patients with deterioration was lower in patients with successful reperfusion than in patients with unsuccessful reperfusion (25% [42/167] vs. 42% [42/101], >italic
/italic< < 0.01). After adjustment for confounders, successful reperfusion was associated with improvement (adjusted OR 2.65; 95% CI 1.23-5.73; >italic
/italic< < 0.05) and deterioration (adjusted OR 0.33; 95% CI 0.18-0.62; >italic
/italic< < 0.01), independent of the 90-day mRS score. >bold<>italic<Conclusions:>/italic<>/bold< Successful reperfusion has further beneficial legacy effects on long-term outcomes beyond 90 days after stroke.

DOI： 10.1159/000499190

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Although endovascular coiling of unruptured aneurysms is widely accepted, the endovascular treatment of wide-neck bifurcation aneurysms remains one of the most challenging morphologies. Our purpose was to describe our experience with 24-month follow-up for the treatment of unruptured intracranial bifurcation aneurysms using the PulseRider (Cerenovus, New Brunswick, NJ). Methods: This study is a single-center, single-arm registry performed under institutional review board control to evaluate efficacy and safety of the PulseRider. Patients with bifurcation aneurysms were identified and enrolled prospectively. Angiography immediately after treatment and at 6 months, and magnetic resonance imaging and magnetic resonance angiography at 12- and 24-month follow-up were retrospectively analyzed. A modified Rankin score was obtained prior to procedure, at discharge, and at 6-, 12- and 24-month follow-up visits. Results: Eight patients with a mean age of 66 years were treated with the PulseRider. All patients had bifurcation aneurysms (2 anterior communicating, 2 carotid terminus, and 4 basilar apex). The aneurysm diameters ranged from 4.6 to 13.6 mm (mean 7.4 mm) with dome/neck ratio ranging from 1.4 to 2.2 (mean 1.6). In all cases, the PulseRider was successfully deployed. Complete occlusion was demonstrated at 6-month follow-up on 6 of 8 (75%), near complete occlusion in 1 of 8 (12.5%), and residual aneurysm in 1 of 8 (12.5%) patients. There was no change or recurrence on magnetic resonance angiography, nor clinical complication after the procedure through 24-month follow-up. Conclusions: Our experience with 24-month follow-up demonstrated favorable efficacy in the treatment of intracranial wide-neck bifurcation aneurysms using the PulseRider.

DOI： 10.1016/j.wneu.2019.04.177

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To evaluate the performance of four-dimensional pseudo-continuous arterial spin labeling (4D-pCASL)-based angiography using CENTRA-keyhole and view sharing (4D-PACK) in the visualization of flow dynamics in distal cerebral arteries and leptomeningeal anastomosis (LMA) collaterals in moyamoya disease in comparison with contrast inherent inflow-enhanced multiphase angiography (CINEMA), with reference to digital subtraction angiography (DSA). METHODS: Thirty-two cerebral hemispheres from 19 patients with moyamoya disease (mean age, 29.7 ± 19.6 years; five males, 14 females) underwent both 4D-MR angiography and DSA. Qualitative evaluations included the visualization of anterograde middle cerebral artery (MCA) flow and retrograde flow via LMA collaterals with reference to DSA. Quantitative evaluations included assessments of the contrast-to-noise ratio (CNR) on these vessels. The linear mixed-effect model was used to compare the 4D-PACK and CINEMA methods. RESULTS: The vessel visualization scores were significantly higher with 4D-PACK than with CINEMA in the visualization of anterograde flow for both Observer 1 (CINEMA, 3.53 ± 1.39; 4D-PACK, 4.53 ± 0.80; p < 0.0001) and Observer 2 (CINEMA, 3.50±1.39; 4D-PACK, 4.31 ± 0.86; p = 0.0009). The scores were higher with 4D-PACK than with CINEMA in the visualization of retrograde flow for both Observer 1 (CINEMA, 3.44 ± 1.05; 4D-PACK, 4.47 ± 0.88; p < 0.0001) and Observer 2 (CINEMA, 3.19 ± 1.20; 4D-PACK, 4.38 ± 0.91; p < 0.0001). The maximum CNR in the anterograde flow was higher in 4D-PACK (40.1 ± 16.1, p = 0.0001) than in CINEMA (27.0 ± 16.6). The maximum CNR in the retrograde flow was higher in 4D-PACK (36.1 ± 10.0, p < 0.0001) than in CINEMA (15.4 ± 8.0). CONCLUSIONS: The 4D-PACK provided better visualization and higher CNRs in distal cerebral arteries and LMA collaterals compared with CINEMA in patients with this disease. KEY POINTS: • The 4D-PACK enables good visualization of distal cerebral arteries in moyamoya disease. • The 4D-PACK enables direct visualization of leptomeningeal collateral vessels in moyamoya disease. • Vessel visualization by 4D-PACK can be useful in assessing cerebral hemodynamics.

DOI： 10.1007/s00330-018-5462-7

記述言語：日本語  

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and purpose: Although in-stent protrusion is a potential risk factor for thromboembolism following carotid artery stenting, the correlation between in-stent protrusion and postoperative ipsilateral stroke has not been well examined. Materials and methods: We retrospectively reviewed 342 consecutive carotid artery lesions in 319 patients who underwent carotid artery stenting between April 2008 and April 2015. After excluding cases with carotid artery dissection and acute occlusion, 301 lesions in total of 277 patients were included in the analysis. We examined the association between in-stent protrusion, which was detected by intravascular ultrasound, and postoperative ipsilateral stroke within 30 days. Results: In-stent protrusion was observed in 47 (15.6%) lesions, of which postoperative ipsilateral stroke within 30 days occurred with 4 (8.5%) lesions. All these events occurred within 10 days after treatment. On the other hand, only 1 (0.39%) of the 256 lesions without in-stent protrusion showed this symptom, and the event occurred at 30 days after treatment. Thus, lesions with in-stent protrusion had a higher cumulative risk of ipsilateral stroke than those without in-stent protrusion (8.5% vs 0.4% at 30 days, log-rank P < 0.001). In-stent protrusion, which was more often seen in symptomatic lesions, was associated with a vulnerable plaque assessed by MRI. After adjustment for postoperative stroke risks such as symptomatic lesions, plaque vulnerability, age or sex, in-stent protrusion was still significantly associated with postoperative ipsilateral stroke within 30 days (OR = 27.03, P = 0.001). Conclusions: Postoperative ipsilateral stroke was observed more frequently in patients with demonstrated in-stent protrusion (ISP) following CAS.

DOI： 10.1016/j.neurad.2018.02.009

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND PURPOSE: Although in-stent protrusion is a potential risk factor for thromboembolism following carotid artery stenting, the correlation between in-stent protrusion and postoperative ipsilateral stroke has not been well examined. MATERIALS AND METHODS: We retrospectively reviewed 342 consecutive carotid artery lesions in 319 patients who underwent carotid artery stenting between April 2008 and April 2015. After excluding cases with carotid artery dissection and acute occlusion, 301 lesions in total of 277 patients were included in the analysis. We examined the association between in-stent protrusion, which was detected by intravascular ultrasound, and postoperative ipsilateral stroke within 30 days. RESULTS: In-stent protrusion was observed in 47 (15.6&#37;) lesions, of which postoperative ipsilateral stroke within 30 days occurred with 4 (8.5&#37;) lesions. All these events occurred within 10 days after treatment. On the other hand, only 1 (0.39&#37;) of the 256 lesions without in-stent protrusion showed this symptom, and the event occurred at 30days after treatment. Thus, lesions with in-stent protrusion had a higher cumulative risk of ipsilateral stroke than those without in-stent protrusion (8.5&#37; vs 0.4&#37; at 30 days, log-rank P < 0.001). In-stent protrusion, which was more often seen in symptomatic lesions, was associated with a vulnerable plaque assessed by MRI. After adjustment for postoperative stroke risks such as symptomatic lesions, plaque vulnerability, age or sex, in-stent protrusion was still significantly associated with postoperative ipsilateral stroke within 30 days (OR = 27.03, P = 0.001). CONCLUSIONS: Postoperative ipsilateral stroke was observed more frequently in patients with demonstrated in-stent protrusion (ISP) following CAS.

DOI： 10.1016/j.neurad.2018.02.009

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The 2016 edition of the World Health Organization Classification of Tumors of the Central Nervous System introduced “diffuse midline glioma H3 K27M mutant” as a new diagnostic entity. These tumors predominately affect pediatric patients and arise from midline structures such as the brainstem, thalamus and spinal cord. Here, we report a rare patient with spinal ganglioglioma carrying an H3 K27M mutation. A 10-year-old boy presented with an intramedullary tumor in the cervical spinal cord. The lesion was partially removed and histologically diagnosed as ganglioglioma. After the remnant tumor grew within 3 months after surgery, the patient underwent radiotherapy. Genetic analyses revealed an H3F3A K27M mutation but no other genetic alterations such as IDH and BRAF mutations. This case may point to pathological heterogeneity in gliomas with H3 K27M mutations.

DOI： 10.1111/neup.12471

記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.9472-17

記述言語：英語  

The 2016 edition of the World Health Organization Classification of Tumors of the Central Nervous System introduced "diffuse midline glioma H3 K27M mutant" as a new diagnostic entity. These tumors predominately affect pediatric patients and arise from midline structures such as the brainstem, thalamus and spinal cord. Here, we report a rare patient with spinal ganglioglioma carrying an H3 K27M mutation. A 10-year-old boy presented with an intramedullary tumor in the cervical spinal cord. The lesion was partially removed and histologically diagnosed as ganglioglioma. After the remnant tumor grew within 3 months after surgery, the patient underwent radiotherapy. Genetic analyses revealed an H3F3A K27M mutation but no other genetic alterations such as IDH and BRAF mutations. This case may point to pathological heterogeneity in gliomas with H3 K27M mutations.

DOI： 10.1111/neup.12471

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. Methods We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC-and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. Results DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). Conclusions This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

DOI： 10.1212/WNL.0000000000005207

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)-associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. METHODS: We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. RESULTS: DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3&#37;; warfarin-associated ICHs: 39.4&#37;; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3&#37;; warfarin-associated ICHs: 9.9&#37;; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). CONCLUSIONS: This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.

DOI： 10.1212/WNL.0000000000005207

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: To evaluate and compare the performance of accelerationselective arterial spin labeling (AccASL) magnetic resonance (MR) angiography in the visualization of cerebral arteries and collateral vessels in patients with Moyamoya disease with that of time-of-flight (TOF) MR angiography, with digital subtraction angiography (DSA) as the reference standard. Materials and Methods: Thirty-six cerebral hemispheres from 22 patients with Moyamoya disease underwent TOF and AccASL MR angiography and DSA. Qualitative evaluations included imaging of the terminal internal carotid artery (ICA), distal middle cerebral arteries (MCAs), Moyamoya vessels, and leptomeningeal anastomosis (LMA) collaterals with reference to DSA. Quantitative evaluations included assessment of contrast-tonoise ratio (CNR) and number of vessels in MCA branches. The linear mixed-effect model was used to compare the two methods. Results: Mean scores for qualitative evaluation were significantly higher with AccASL angiography than with TOF angiography for imaging distal MCAs (3.9 6 0.3 [standard deviation] vs 2.9 6 1.1; P , .001), Moyamoya vessels (3.6 6 0.6 vs 2.7 6 0.9, P , .001), and LMA collaterals (3.8 6 0.6 vs 1.8 6 0.7, P , .001). Scores for steno-occlusive degree around the terminal ICAs were better with TOF angiography than with AccASL angiography (2.6 6 0.5 vs 2.4 6 0.6, P = .023). CNRs in the M4 segment were significantly higher with AccASL angiography (11.9 6 12.9, P , .001) than with TOF angiography (4.1 6 7.9). The number of vessels was significantly higher with AccASL angiography (18.3 6 5.0, P , .001) than with TOF angiography (8.9 6 4.9). The increase in the number of vessels from TOF angiography to AccASL angiography was greater in patients with severe ICA stenoocclusion (late ICA stage group, 11.4 6 4.5; early ICA stage group, 6.8 6 4.0; P = .007) and well-developed leptomeningeal anastomosis (mildly developed LMA group, 7.1 6 4.3; well-developed LMA group, 11.3 6 4.5; P = .011). Conclusion: AccASL MR angiography enables better visualization of distal cerebral arteries and collateral vessels in patients with Moyamoya disease than does TOF MR angiography, while TOF MR angiography enables better visualization of stenosis of proximal arteries. Both methods work in a mutually beneficial manner in the assessment of cerebral arteries.

DOI： 10.1148/radiol.2017162279

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose To evaluate and compare the performance of acceleration-selective arterial spin labeling (AccASL) magnetic resonance (MR) angiography in the visualization of cerebral arteries and collateral vessels in patients with Moyamoya disease with that of time-of-flight (TOF) MR angiography, with digital subtraction angiography (DSA) as the reference standard. Materials and Methods Thirty-six cerebral hemispheres from 22 patients with Moyamoya disease underwent TOF and AccASL MR angiography and DSA. Qualitative evaluations included imaging of the terminal internal carotid artery (ICA), distal middle cerebral arteries (MCAs), Moyamoya vessels, and leptomeningeal anastomosis (LMA) collaterals with reference to DSA. Quantitative evaluations included assessment of contrast-to-noise ratio (CNR) and number of vessels in MCA branches. The linear mixed-effect model was used to compare the two methods. Results Mean scores for qualitative evaluation were significantly higher with AccASL angiography than with TOF angiography for imaging distal MCAs (3.9 ± 0.3 [standard deviation] vs 2.9 ± 1.1; P < .001), Moyamoya vessels (3.6 ± 0.6 vs 2.7 ± 0.9, P < .001), and LMA collaterals (3.8 ± 0.6 vs 1.8 ± 0.7, P < .001). Scores for steno-occlusive degree around the terminal ICAs were better with TOF angiography than with AccASL angiography (2.6 ± 0.5 vs 2.4 ± 0.6, P = .023). CNRs in the M4 segment were significantly higher with AccASL angiography (11.9 ± 12.9, P < .001) than with TOF angiography (4.1 ± 7.9). The number of vessels was significantly higher with AccASL angiography (18.3 ± 5.0, P < .001) than with TOF angiography (8.9 ± 4.9). The increase in the number of vessels from TOF angiography to AccASL angiography was greater in patients with severe ICA steno-occlusion (late ICA stage group, 11.4 ± 4.5; early ICA stage group, 6.8 ± 4.0; P = .007) and well-developed leptomeningeal anastomosis (mildly developed LMA group, 7.1 ± 4.3; well-developed LMA group, 11.3 ± 4.5; P = .011). Conclusion AccASL MR angiography enables better visualization of distal cerebral arteries and collateral vessels in patients with Moyamoya disease than does TOF MR angiography, while TOF MR angiography enables better visualization of stenosis of proximal arteries. Both methods work in a mutually beneficial manner in the assessment of cerebral arteries. © RSNA, 2017 Online supplemental material is available for this article.

DOI： 10.1148/radiol.2017162279

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.9472-17

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Although extracranial-intracranial (EC-IC) bypass is an effective treatment strategy for symptomatic moyamoya disease, surgeons need to be cautious regarding the possibility of postoperative hemorrhagic complications in patients with a concurrent coagulation disorder. Here, we describe a case of EC-IC bypass for moyamoya disease concurrent with von Willebrand disease type 1. Case Description Following perioperative replacement of the von Willebrand factor, the patient showed an uneventful and uncomplicated clinical course. Conclusion This is the first reported case of EC-IC bypass being performed for moyamoya disease in a patient with concurrent von Willebrand disease. We emphasize the importance of appropriate management with replacement of the von Willebrand factor during the perioperative period to avoid hemorrhagic complications.

DOI： 10.1016/j.wneu.2017.08.141

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although extracranial-intracranial (EC-IC) bypass is an effective treatment strategy for symptomatic moyamoya disease, surgeons need to be cautious regarding the possibility of postoperative hemorrhagic complications in patients with a concurrent coagulation disorder. Here, we describe a case of EC-IC bypass for moyamoya disease concurrent with von Willebrand disease type 1. CASE DESCRIPTION: Following perioperative replacement of the von Willebrand factor, the patient showed an uneventful and uncomplicated clinical course. CONCLUSION: This is the first reported case of EC-IC bypass being performed for moyamoya disease in a patient with concurrent von Willebrand disease. We emphasize the importance of appropriate management with replacement of the von Willebrand factor during the perioperative period to avoid hemorrhagic complications.

DOI： 10.1016/j.wneu.2017.08.141

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語  

Safety and Efficacy of Prasugrel with Endovascular Treatment for Unruptured Cerebral Aneurysm

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11477/mf.1436203635

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The development of stent-like devices has increased treatment options for complex internal carotid artery (ICA) aneurysms, but the optimal treatment remains unclear. The purpose of this study was to evaluate the safety and efficacy of endovascular parent-artery occlusion (PAO) for ICA aneurysms. We retrospectively reviewed 28 patients with unruptured ICA aneurysms ⩾10mm treated with PAO between April 2002 and March 2015 at our institution. Patients who developed neurologic symptoms or with venous-phase delay >2s during balloon test occlusion were not treated by PAO. Patients with venous-phase delays of 1-2s underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass prior to PAO. The median patient age was 65 (range, 26-84)years. Nineteen aneurysms (68&#37;) were located in the cavernous segment. The median aneurysm size was 25 (range 11-40)mm. Venous-phase delay of 1-2s was observed in five patients. Perioperative ischemic complications (N=9, 32&#37;), which occurred within 30days after treatment, were significantly associated with venous-phase delays of 1-2s (p<0.01) and history of hypertension (p<0.01). Six-month morbidity was observed in one (3.6&#37;) patient. Complete occlusion at final follow-up and delayed (i.e. ⩾31days after treatment) ischemic events were observed in 100&#37; and 0&#37; of patients, respectively, over a median period of 63 (range, 6-147) months. Despite the high frequency of perioperative ischemic episodes, endovascular PAO with selective use of STA-MCA bypass showed excellent long-term outcomes in patients with unruptured ICA aneurysms ⩾10mm.

DOI： 10.1016/j.jocn.2016.11.009

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The development of stent-like devices has increased treatment options for complex internal carotid artery (ICA) aneurysms, but the optimal treatment remains unclear. The purpose of this study was to evaluate the safety and efficacy of endovascular parent-artery occlusion (PAO) for ICA aneurysms. We retrospectively reviewed 28 patients with unruptured ICA aneurysms ⩾10 mm treated with PAO between April 2002 and March 2015 at our institution. Patients who developed neurologic symptoms or with venous-phase delay >2 s during balloon test occlusion were not treated by PAO. Patients with venous-phase delays of 1–2 s underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass prior to PAO. The median patient age was 65 (range, 26–84) years. Nineteen aneurysms (68%) were located in the cavernous segment. The median aneurysm size was 25 (range 11–40) mm. Venous-phase delay of 1–2 s was observed in five patients. Perioperative ischemic complications (N = 9, 32%), which occurred within 30 days after treatment, were significantly associated with venous-phase delays of 1–2 s (p < 0.01) and history of hypertension (p < 0.01). Six-month morbidity was observed in one (3.6%) patient. Complete occlusion at final follow-up and delayed (i.e. ⩾31 days after treatment) ischemic events were observed in 100% and 0% of patients, respectively, over a median period of 63 (range, 6–147) months. Despite the high frequency of perioperative ischemic episodes, endovascular PAO with selective use of STA-MCA bypass showed excellent long-term outcomes in patients with unruptured ICA aneurysms ⩾10 mm.

DOI： 10.1016/j.jocn.2016.11.009

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Concurrent spinal tumors such as schwannomas and meningiomas are usually associated with neurofibromatosis type 2(NF2). Here we report an extremely rare case of concurrent schwannoma and meningioma at the same cervical spinal level. This patient did not meet the diagnostic criteria for NF2. Because the surgical strategy for spinal schwannomas may differ if meningiomas are concurrently present, it is important to pay attention to preoperative imaging findings. Unlike in previous patients, however, it was difficult to diagnose the presence of two different tumors based on preoperative images of the present patient. Preoperative images and intraoperative findings must therefore be carefully assessed to determine whether spinal tumors extending into the intradural and extradural spaces consist of concurrent schwannomas and meningiomas.

DOI： 10.7887/jcns.26.750

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracranial artery dissection (IAD) is a relatively rare cause of stroke, but it has been recognized increasingly with recent advances of the neuroimaging technique. Since rebleeding occurs frequently in the acute stage in the ruptured IAD, urgent surgical treatment should be performed to prevent rebleeding. On the other hand, surgical treatment for unruptured IAD is controversial because it has little risk for bleeding. However, surgical treatment for unruptured IAD may be considered if the formation or enlargement of the aneurysmal dilatation has been confirmed. Since there are several proposed surgical strategies for IAD, it is important to select an appropriate strategy on a case-by-case basis. If the risk of infarction due to vessel occlusion is high, combined bypass surgery should be considered.

DOI： 10.2176/nmc.ra.2015-0312

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pericytes are mural cells abundantly present in cerebral microvessels and play important roles, including the formation and maintenance of the blood-brain barrier. Nox4 is a major source of reactive oxygen species in cardiovascular cells and modulate cellular functions, particularly under pathological conditions. In the present study, we found that the expression of Nox4 was markedly induced in microvascular cells, including pericytes, in peri-infarct areas after middle cerebral artery occlusion stroke models in mice. The upregulation of Nox4 was greater in a permanent middle cerebral artery occlusion model compared with an ischemia/reperfusion transient middle cerebral artery occlusion model. We performed permanent middle cerebral artery occlusion on mice with Nox4 overexpression in pericytes (Tg-Nox4). Infarct volume was significantly greater with enhanced reactive oxygen species production and blood-brain barrier breakdown in peri-infarct areas in Tg-Nox4, compared with littermate controls. In cultured brain pericytes, Nox4 was significantly upregulated by hypoxia and was promptly downregulated by reoxygenation. Phosphorylation of NFκB and production of matrix metalloproteinase 9 were significantly increased in both cultured pericytes overexpressing Nox4 and in peri-infarct areas in Tg-Nox4. Collectively, Nox4 is upregulated in pericytes in peri-infarct areas after acute brain ischemia and may enhance blood-brain barrier breakdown through activation of NFκB and matrix metalloproteinase 9, thereby causing enlargement of infarct volume.

DOI： 10.1177/0271678X15606456

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recently, several new randomized controlled trials have been reported which showed the efficacy of neuroendovascular therapy for acute ischemic stroke. Confirming the major vessel occlusion in the proximal anterior circulation, limited ischemic core and preserved ischemic penumbra, using stent retrievers to achieve successful reperfusion, and shortening the onset-to-reperfusion time were the essential factors to achieve good clinical outcome. With these new evidences, it has been proved that neuroendovascular therapy became one of the standard treatments for acute ischemic stroke.

記述言語：日本語  

New evidences of neuroendovascular therapy for acute ischemic stroke
Recently, several new randomized controlled trials have been reported which showed the efficacy of neuroendovascular therapy for acute ischemic stroke. Confirming the major vessel occlusion in the proximal anterior circulation, limited ischemic core and preserved ischemic penumbra, using stent retrievers to achieve successful reperfusion, and shortening the onset-to-reperfusion time were the essential factors to achieve good clinical outcome. With these new evidences, it has been proved that neuroendovascular therapy became one of the standard treatments for acute ischemic stroke.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Central nervous system (CNS) pericytes have been recognized as an indispensable component of the neurovascular unit. The expression of platelet-derived growth factor receptor β (PDGFRβ) is markedly increased in CNS pericytes after brain ischemia. It has been elucidated that PDGFRβ, expressed in pericytes and pericyte-derived fibroblast-like cells, plays important roles in the maintenance of the blood-brain barrier (BBB) and in the repair process in infarct areas. The aim of this study was to uncover how the PDGFRβ expression is regulated in pericytes after brain ischemia. We found that basic fibroblast growth factor (bFGF), but neither hypoxia at 1% O₂ nor acidification at pH 6.5, significantly upregulated the PDGFRβ expression in human cultured CNS pericytes. SU5402, an inhibitor of FGF receptor (FGFR), and inhibitors of its downstream effectors Akt and Erk abolished the bFGF-induced upregulation of PDGFRβ. On the other hand, acidification significantly upregulated the expression of bFGF, while hypoxia upregulated the expression of FGFR1 in the pericytes. The expression of bFGF and FGFR1 was markedly induced in the ischemic hemisphere after ischemic insult in a middle cerebral artery occlusion stroke model. Immunofluorescent double labeling demonstrated that the expression of bFGF and FGFR1 was co-localized with PDGFRβ-positive cells in peri-infarct areas. Moreover, treatment with bFGF enhanced cell growth and the PDGF-BB-induced migratory activity of cultured pericytes, which were significantly suppressed by SU5402 or Sunitinib, an inhibitor of PDGFR. These data suggested that increased bFGF upregulates the expression of PDGFRβ and may enhance PDGFRβ-mediated pericyte functions after brain ischemia.

DOI： 10.1016/j.brainres.2015.11.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Central nervous system (CNS) pericytes have been recognized as an indispensable component of the neurovascular unit. The expression of platelet-derived growth factor receptor β (PDGFRβ) is markedly increased in CNS pericytes after brain ischemia. It has been elucidated that PDGFRβ, expressed in pericytes and pericyte-derived fibroblast-like cells, plays important roles in the maintenance of the blood-brain barrier (BBB) and in the repair process in infarct areas. The aim of this study was to uncover how the PDGFRβ expression is regulated in pericytes after brain ischemia. We found that basic fibroblast growth factor (bFGF), but neither hypoxia at 1&#37; O2 nor acidification at pH 6.5, significantly upregulated the PDGFRβ expression in human cultured CNS pericytes. SU5402, an inhibitor of FGF receptor (FGFR), and inhibitors of its downstream effectors Akt and Erk abolished the bFGF-induced upregulation of PDGFRβ. On the other hand, acidification significantly upregulated the expression of bFGF, while hypoxia upregulated the expression of FGFR1 in the pericytes. The expression of bFGF and FGFR1 was markedly induced in the ischemic hemisphere after ischemic insult in a middle cerebral artery occlusion stroke model. Immunofluorescent double labeling demonstrated that the expression of bFGF and FGFR1 was co-localized with PDGFRβ-positive cells in peri-infarct areas. Moreover, treatment with bFGF enhanced cell growth and the PDGF-BB-induced migratory activity of cultured pericytes, which were significantly suppressed by SU5402 or Sunitinib, an inhibitor of PDGFR. These data suggested that increased bFGF upregulates the expression of PDGFRβ and may enhance PDGFRβ-mediated pericyte functions after brain ischemia.

DOI： 10.1016/j.brainres.2015.11.003

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intracranial artery dissection (IAD) is a relatively rare cause of stroke, but it has been recognized increasingly with recent advances of the neuroimaging technique. Since rebleeding occurs frequently in the acute stage in the ruptured IAD, urgent surgical treatment should be performed to prevent rebleeding. On the other hand, surgical treatment for unruptured IAD is controversial because it has little risk for bleeding. However, surgical treatment for unruptured IAD may be considered if the formation or enlargement of the aneurysmal dilatation has been confirmed. Since there are several proposed surgical strategies for IAD, it is important to select an appropriate strategy on a case-by-case basis. If the risk of infarction due to vessel occlusion is high, combined bypass surgery should be considered.

DOI： 10.2176/nmc.ra.2015-0312

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The basic technique for endovascular treatment of intracranial aneurysm is a simple method requiring a single microcatheter and a long enough detachable coil for the coil embolization. Key factors for technical success are stability of the microcatheter based on the direction of the parent artery in relation to the aneurysm. Additionaly, the appropriate selection of framing, filling and finishing coils is another important factor. If adjunctive techniques are required, balloon and or stent assisted methods are available. But in most instances, the simple method will suffice and is therefore the most important and basic strategy for endovascular treatment of intracranial aneurysms.

DOI： 10.7887/jcns.24.833

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Fibrosis is concomitant with repair processes following injuries in the central nervous system (CNS). Pericytes are considered as an origin of fibrosis-forming cells in the CNS. Here, we examined whether platelet-derived growth factor receptor β (PDGFRβ), a well-known indispensable molecule for migration, proliferation, and survival of pericytes, was involved in the production of extracellular matrix proteins, fibronectin and collagen type I, which is crucial for fibrosis after ischemic stroke. Immunohistochemistry demonstrated induction of PDGFRβ expression in vascular cells of peri-infarct areas at 3-7days in a mouse stroke model. The PDGFRβ-expressing cells extended from peri-infarct areas toward the ischemic core after day 7 while expressing fibronectin and collagen type I in the infarct areas. In contrast, desmin and α-smooth muscle actin, markers of pericytes, were only expressed in vascular cells. In PDGFRβ heterozygous knockout mice, the expression of fibronectin and collagen type I was attenuated at both mRNA and protein levels with an enlargement of the infarct volume after ischemic stroke compared with that in wild-type littermates. In cultured brain pericytes, the expression of PDGF-B, PDGFRβ, fibronectin, and collagen type I, but not desmin, was significantly increased by serum depletion (SD). The SD-induced upregulation of fibronectin and collagen type I was suppressed by SU11652, an inhibitor of PDGFRβ, while PDGF-B further increased the SD-induced upregulation. In conclusion, the expression level of PDGFRβ may be a crucial determinant of fibrosis after ischemic stroke. Moreover, PDGFRβ signaling participates in the production of fibronectin and collagen type I after ischemic stroke.

DOI： 10.1016/j.expneurol.2014.12.007

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Fibrosis is concomitant with repair processes following injuries in the central nervous system (CNS). Pericytes are considered as an origin of fibrosis-forming cells in the CNS. Here, we examined whether platelet-derived growth factor receptor β (PDGFRβ), a well-known indispensable molecule for migration, proliferation, and survival of pericytes, was involved in the production of extracellular matrix proteins, fibronectin and collagen type I, which is crucial for fibrosis after ischemic stroke. Immunohistochemistry demonstrated induction of PDGFRβ expression in vascular cells of peri-infarct areas at 3-7. days in a mouse stroke model. The PDGFRβ-expressing cells extended from peri-infarct areas toward the ischemic core after day 7 while expressing fibronectin and collagen type I in the infarct areas. In contrast, desmin and α-smooth muscle actin, markers of pericytes, were only expressed in vascular cells. In PDGFRβ heterozygous knockout mice, the expression of fibronectin and collagen type I was attenuated at both mRNA and protein levels with an enlargement of the infarct volume after ischemic stroke compared with that in wild-type littermates. In cultured brain pericytes, the expression of PDGF-B, PDGFRβ, fibronectin, and collagen type I, but not desmin, was significantly increased by serum depletion (SD). The SD-induced upregulation of fibronectin and collagen type I was suppressed by SU11652, an inhibitor of PDGFRβ, while PDGF-B further increased the SD-induced upregulation. In conclusion, the expression level of PDGFRβ may be a crucial determinant of fibrosis after ischemic stroke. Moreover, PDGFRβ signaling participates in the production of fibronectin and collagen type I after ischemic stroke.

DOI： 10.1016/j.expneurol.2014.12.007

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: We have previously shown that Na(+)/H(+) exchanger isoform 1 (NHE1) plays an important role in Ca(2+) signaling and cell proliferation in human central nervous system (CNS) pericytes. The aims of the present study were to elucidate how NHE1-induced Ca(2+) signaling during acidosis is transformed into cellular responses in CNS pericytes. METHODS AND RESULTS: Human CNS pericytes were cultured, and the activation of cAMP responsive element-binding protein (CREB) was evaluated by Western blotting analysis, immunofluorescence, and luciferase assays. In human CNS pericytes, low extracellular Na(+) or low pH generated Ca(2+) oscillation and subsequently phosphorylated Ca(2+)/calmodulin-dependent kinase II (CaMKII) and CREB in a time-dependent manner. Focal cerebral ischemia was applied using photothrombotic distal middle cerebral artery occlusion in mice, and the phosphorylation of CREB and the production of interleukin-6 were observed in pericytes migrating into the peri-infarct penumbra during the early phase after ischemic insult. CONCLUSIONS: Our results indicate that extracellular acidosis induces Ca(2+) oscillation via NHE1, leading to Ca(2+)/CaMKII-dependent CREB activation in human CNS pericytes. Acidosis may upregulate a variety of proteins, such as interleukin-6, through the NHE1-Ca2+/CaMKII-CREB pathway in brain pericytes and may thus modulate brain ischemic insult.

DOI： 10.1161/ATVBAHA.112.254946

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neurotrophins are crucial regulators of neuronal survival and death. Evidence suggests that cells comprising the neurovascular unit (NVU) cooperatively mediate neuronal development, survival and regeneration. The aim of this study was to test whether cerebrovascular cells, endothelial cells and pericytes, produce neurotrophins and play neuroprotective roles during hypoxic insults. We examined the expression of neurotrophins and their receptors in cultured human cerebral microvascular endothelial cells and pericytes, astrocytes and the rat neuronal cell line PC12. Differentiated PC12 cells expressed TrkA, the NGF receptor, which was significantly upregulated by hypoxia at 1&#37; O(2) and regulated neuronal survival. Both pericytes and astrocytes expressed three neurotrophins, i.e. NGF, BDNF and NT-3, while TrkB and TrkC, specific receptors for BDNF and NT-3, were expressed in astrocytes, but not pericytes. In response to hypoxia, among the neurotrophins expressed in pericytes and astrocytes only NT-3 expression was significantly upregulated in pericytes. Treatment of astrocytes with NT-3 significantly activated Erk1/2 and increased the expression of NGF both at mRNA and protein levels. The MEK1 inhibitor U0126 or siRNA-mediated knockdown of TrkC abolished the NT-3-induced upregulation of NGF in astrocytes. Taken together, cerebral microvascular pericytes and astrocytes are potent producers of neurotrophins in the NVU. In response to hypoxia, pericytes increase NT-3 production, which induces astrocytes to increase NGF production through the TrkC-Erk1/2 pathway. The interplay between pericytes and astrocytes through neurotrophins in the NVU may play an important role in neuronal survival under hypoxic conditions.

DOI： 10.1016/j.mvr.2012.02.009

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Platelet derived growth factor (PDGF)-B plays a neuroprotective role in brain damages, including ischemic stroke. It has been suggested recently that PDGF receptor β (PDGFRβ) expressed in brain pericytes as well as in neurons and astrocytes may mediate the neuroprotective role of PDGF-B. The aims of this study were to elucidate the roles of PDGFRβ signaling in brain pericytes after ischemic stroke. In a rat middle cerebral artery occlusion (MCAO) model, PDGFRβ expression was induced specifically in the pericytes in peri-infarct areas and its level was gradually increased. PDGF-B induced marked phosphorylation of Akt in cultured brain pericytes. Consistently, PDGF-B was upregulated in endothelial cells in per-infarct areas and Akt was strongly phosphorylated in the PDGFRβ-expressing pericytes in periinfarct areas after MCAO. In the cultured pericytes, PDGF-B induced cell growth and anti-apoptotic responses through Akt. Furthermore, PDGF-B significantly increased the expression of nerve growth factor (NGF) and neurotrophin-3 (NT-3) through Akt in the pericytes. Thus, the PDGFRβ-Akt signaling in brain pericytes may play various important roles leading to neuroprotection after ischemic stroke.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Infants with acute hydrocephalus often present with nonspecific neurological signs, and cystic choroid plexus papilloma (CPP) is a very rare cause of acute obstructive hydrocephalus. The authors present the case of a 1-year-old girl who became irritable, started vomiting, and became comatose within a day. Magnetic resonance (MR) imaging revealed a cystic lesion in the third ventricle as well as hydrocephalus. Although the aqueduct appeared to be patent, phase-contrast MR imaging showed no pulsatile flow of cerebrospinal fluid in the ventricles. An emergent endoscopic third ventriculostomy was performed. Endoscopic examination revealed a highly mobile cyst attached by a pedicle to the choroid plexus adjacent to the Monro foramen in the lateral ventricle. The cyst was totally excised during the endoscopic procedure and was subsequently diagnosed as a CPP on the basis of histopathological findings. Purely cystic CPP is a very rare pathological entity; however, when it does occur, it can cause obstructive hydrocephalus which, without rapid diagnosis and surgical intervention, could lead to sudden death.

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Infants with acute hydrocephalus often present with nonspecific neurological signs, and cystic choroid plexus papilloma (CPP) is a very rare cause of acute obstructive hydrocephalus. The authors present the case of a 1-year-old girl who became irritable, started vomiting, and became comatose within a day. Magnetic resonance (MR) imaging revealed a cystic lesion in the third ventricle as well as hydrocephalus. Although the aqueduct appeared to be patent, phase-contrast MR imaging showed no pulsatile flow of cerebrospinal fluid in the ventricles. An emergent endoscopic third ventriculostomy was performed. Endoscopic examination revealed a highly mobile cyst attached by a pedicle to the choroid plexus adjacent to the Monro foramen in the lateral ventricle. The cyst was totally excised during the endoscopic procedure and was subsequently diagnosed as a CPP on the basis of histopathological findings. Purely cystic CPP is a very rare pathological entity; however, when it does occur, it can cause obstructive hydrocephalus which, without rapid diagnosis and surgical intervention, could lead to sudden death.

記述言語：日本語  

症例は45歳男性. 42歳時に噴門側部分胃切除を施行.術後,眼球運動障害と四肢脱力,体幹失調を2回繰り返した.頭部MRIで両側視床および中脳水道周囲に異常信号域を認め,血中ビタミンB1が著明に低下していた.入院当日よりビタミンB1を投与開始したところ2日目には眼球運動障害は消失, 2週間後には歩行可能となった.大酒家でなくても胃切除の既往を有する例では少量のアルコール摂取でも繰り返しWernicke脳症を起こす可能性が考えられた.

DOI： 10.2169/naika.94.1606

記述言語：日本語  

症例は45歳男性. 42歳時に噴門側部分胃切除を施行.術後,眼球運動障害と四肢脱力,体幹失調を2回繰り返した.頭部MRIで両側視床および中脳水道周囲に異常信号域を認め,血中ビタミンB1が著明に低下していた.入院当日よりビタミンB1を投与開始したところ2日目には眼球運動障害は消失, 2週間後には歩行可能となった.大酒家でなくても胃切除の既往を有する例では少量のアルコール摂取でも繰り返しWernicke脳症を起こす可能性が考えられた.

DOI： 10.2169/naika.94.1606

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/naika.94.1606

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   著書種別：学術書

Ⅲ-12.カテーテル脳血管撮影

記述言語：日本語  

開催年月日： 2024年11月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：京都   国名：日本国  

開催年月日： 2024年11月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：京都   国名：日本国  

開催年月日： 2024年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：京都   国名：日本国  

開催年月日： 2024年11月

記述言語：日本語  

開催地：京都   国名：日本国  

開催年月日： 2024年10月

記述言語：日本語  

開催地：横浜   国名：日本国  

開催年月日： 2024年10月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：横浜   国名：日本国  

開催年月日： 2024年10月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：横浜   国名：日本国  

開催年月日： 2024年5月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：大阪   国名：日本国  

開催年月日： 2024年3月

記述言語：日本語   会議種別：口頭発表（招待・特別）  

開催地：横浜   国名：日本国  

開催年月日： 2024年3月

記述言語：英語   会議種別：口頭発表（招待・特別）  

開催地：WEB   国名：日本国  

開催年月日： 2023年6月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：大阪   国名：日本国  

開催年月日： 2023年6月

記述言語：英語   会議種別：口頭発表（一般）  

開催地：WEB   国名：日本国  

開催年月日： 2023年6月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2023年6月

記述言語：英語  

開催地：New Orleans   国名：アメリカ合衆国  

開催年月日： 2023年6月

記述言語：日本語  

開催地：WEB   国名：日本国  

開催年月日： 2023年6月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2023年6月

記述言語：日本語  

国名：日本国  

開催年月日： 2023年6月

記述言語：英語  

開催地：Kyoto   国名：日本国  

開催年月日： 2023年6月

記述言語：英語  

国名：日本国  

開催年月日： 2023年6月

記述言語：日本語  

開催地：東京   国名：日本国  

開催年月日： 2023年6月

記述言語：日本語  

開催地：大阪   国名：日本国  

開催年月日： 2023年3月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：WEB   国名：日本国  

開催年月日： 2021年11月

記述言語：英語  

開催地：福岡   国名：日本国  

開催年月日： 2021年10月

記述言語：日本語  

開催地：横浜   国名：日本国  

開催年月日： 2021年9月

記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：web   国名：日本国  

開催年月日： 2021年5月

記述言語：日本語   会議種別：公開講演，セミナー，チュートリアル，講習，講義等  

開催地：web   国名：日本国  

開催年月日： 2021年3月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2020年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2020年11月 - 2021年5月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2020年8月 - 2021年5月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2019年11月

記述言語：日本語   会議種別：口頭発表（一般）  

開催地：福岡   国名：日本国  

開催年月日： 2019年6月

記述言語：英語  

国名：日本国  

開催年月日： 2018年1月

記述言語：英語  

開催地：Los Angeles   国名：日本国  

開催年月日： 2017年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

開催地：東京   国名：日本国  

開催年月日： 2017年10月 - 2018年10月

記述言語：日本語  

開催地：名古屋   国名：日本国  

開催年月日： 2017年10月

記述言語：日本語  

開催地：Budapest   国名：日本国  

開催年月日： 2017年3月

記述言語：日本語  

開催地：大阪   国名：日本国  

開催年月日： 2017年2月

記述言語：英語  

開催地：Houston   国名：アメリカ合衆国  

【Background and purpose】In the rapidly aging society of Japan, improvement of the emergency medical care system for stroke is an urgent concern. In prehospital care for stroke, appropriate triage, selection of the delivery facility, and decreased transport time contribute directly to prognosis. The standard treatment for acute ischemic stroke (AIS) has changed dramatically. With the introduction of new thrombectomy devices, proper placement of comprehensive stroke centers (CSCs) should be reconsidered. Accordingly, a nationwide survey is needed to develop an efficient prehospital care system. The aim of this study was to elucidate problems in prehospital care for stroke in Japan, using a nationwide fire department (FD) questionnaire survey. 【Materials and methods】We conducted a questionnaire survey of 733 FDs in Japan with the cooperation of the Japanese Society of Emergency Medicine and the Emergency Planning Office of the Fire and Disaster Management Agency. The questionnaires evaluated utilization status of the Prehospital Stroke Life Support (PSLS) protocol and prehospital stroke scale (PSS), awareness of standard treatment with new devices, information on delivery facilities and transportation, use of information and communication technology (ICT), and the retraining system for paramedics. 【Results】Data obtained from 664 FDs (91%) were analyzed. The PSLS protocol and PSS were used by 47.2% and 59.6%, respectively. Surprisingly, only 35.6% of FDs had knowledge about the latest treatment for AIS, and half of the FDs did not have an opportunity to learn about treatment. The proportion of FDs with a CSC in their jurisdictions was decreased in rural areas compared with urban areas (19.2% vs. 49.8%). However, helicopter transportation and ICT were not adequately utilized even in rural areas. Only half of the FDs urged paramedics to attend a PSLS course. 【Conclusion】We demonstrated problems with prehospital care for stroke in Japan using a nationwide FD questionnaire survey. Placement of CSCs, adequacy of the transportation system, and communication between physicians and paramedics should be reevaluated.

開催年月日： 2016年11月

記述言語：日本語  

国名：日本国  

開催年月日： 2016年11月

記述言語：英語  

開催地：Fukuoka   国名：日本国  

開催年月日： 2016年11月

記述言語：日本語   会議種別：シンポジウム・ワークショップ パネル（公募）  

国名：日本国  

開催年月日： 2016年10月

記述言語：日本語  

開催地：福岡   国名：日本国  

開催年月日： 2016年4月

記述言語：日本語  

開催地：札幌   国名：日本国  

開催年月日： 2015年11月

記述言語：日本語  

開催地：岡山   国名：日本国  

開催年月日： 2015年11月

記述言語：日本語  

開催地：岡山   国名：日本国  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語   出版者・発行元：(株)日本臨床社  

記述言語：日本語   出版者・発行元：(株)メディカ出版  

記述言語：英語   掲載種別：記事・総説・解説・論説等（学術雑誌）  

記述言語：日本語