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Takahashi H, Matsushige T, Hashimoto Y, Hara T, Hosogai M, Kobayashi S, Horie N. Compatibility of the semijailing technique with extremely soft i-ED coils for ruptured blood blister-like and dissecting aneurysms: patient series. J Neurosurg Case Lessons 2024; 7:CASE23741. [PMID: 38467051 PMCID: PMC10936938 DOI: 10.3171/case23741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Optimal treatment options for ruptured blood blister-like aneurysms (BBAs) and dissecting aneurysms (DAs) have not yet been established. Endovascular treatment may achieve vessel reconstruction with the preservation of antegrade blood flow; however, securing curative hemostasis at the fragile rupture point remains a major concern. OBSERVATIONS Two ruptured BBAs and two ruptured DAs treated by stent-assisted coiling with the semijailing technique in the last 2 years are described herein. The devices used were braided stents and i-ED coils, which are new low-memory shape and extremely soft coils. Neither rebleeding nor ischemic complications were observed. All patients had a favorable outcome and showed no recurrence after treatment. LESSONS All aneurysms were treated without ischemic complications or rebleeding. The good compatibility of braided stents and the new concept coils in stent-assisted coiling by the semijailing technique provides insight into these intractable hemorrhagic vascular pathologies.
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Affiliation(s)
- Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
- Department of Neurosurgery, Onomichi General Hospital, Hiroshima, Japan; and
| | - Takeshi Hara
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shohei Kobayashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hashimoto Y, Matsushige T, Kawano R, Hara T, Kobayashi S, Kaneko M, Ono C, Horie N. High signal intensity of the intraaneurysmal sac on T1 CUBE imaging as a predictor of aneurysm stability after coil embolization. J Neurosurg 2024; 140:144-152. [PMID: 37439478 DOI: 10.3171/2023.5.jns23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/09/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Histopathological studies of aneurysms after coil embolization showed that thrombus formation during the first month after endovascular treatment (EVT) played an important role in the healing process. The authors hypothesized that dedicated T1-weighted imaging may be used to predict stable aneurysms by visualizing the thrombus status within coil-treated aneurysms. Therefore, this study investigated the relationship between the signal intensity (SI) of the intraaneurysmal sac after coil embolization and aneurysm stability. METHODS The study population included 82 patients with 86 aneurysms who underwent T1-weighted 3D black-blood fast spin-echo (T1 CUBE) imaging within 1 month after coil embolization between 2019 and 2022. The relative SI of a coil-treated aneurysm (RSIcoiled) was calculated as follows: the mean SI of the intraaneurysmal sac/the mean SI of the genu of the corpus callosum. Aneurysms with enlarged remnants on MR angiography (MRA) within 6 months after EVT were defined as recurrence, while a decrease of intraaneurysmal flow on MRA was defined as improved embolization status. Stable aneurysms were defined as improvement or no change in embolization status 6 months after coil embolization. The volume embolization ratio (VER) was calculated as the ratio of the packed coil volume to the aneurysm volume. Differences between stable and recurrent aneurysms were examined. All aneurysms were divided into high and low RSIcoiled groups based on the cutoff value of RSIcoiled, and differences between the two groups were also evaluated. RESULTS Recurrence was confirmed for 26 of 86 aneurysms. A univariable analysis showed that small aneurysms, high VER, and high RSIcoiled were associated with aneurysm stability. In the receiver operating characteristic curve analysis, the optimal cutoff value for RSIcoiled to differentiate stable from recurrent aneurysms was 0.54. The cutoff value for RSIcoiled was selected as 0.50 (sensitivity 0.77, specificity 0.70) because it was half the value of the SI of the corpus callosum and close to the optimal cutoff value. In a multivariable analysis, RSIcoiled > 0.50 (OR 8.1, 95% CI 2.5-27) remained a significant factor for aneurysm stability. The high RSIcoiled group showed a higher rate of an improved embolization status (26% vs 6.1%, p = 0.022) and stable aneurysms (85% vs 15%, p = 0.0002). CONCLUSIONS RSIcoiled was associated with postcoiling aneurysm stability. High RSIcoiled might imply intraaneurysmal thrombus formation associated with the healing process of coil-treated aneurysms.
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Affiliation(s)
| | | | - Reo Kawano
- 2Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Aichi
| | - Takeshi Hara
- Departments of1Neurosurgery and Interventional Neuroradiology
| | | | | | - Chiaki Ono
- 4Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima
| | - Nobutaka Horie
- 5Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hashimoto Y, Karasaki K, Hara T, Kobayashi S, Kaneko M, Ono C, Matsushige T, Yoshizumi M. Distribution of osteoprotegerin in unruptured intracranial aneurysms in humans: association with aneurysm wall protective remodeling. J Neurosurg 2023:1-8. [PMID: 38157535 DOI: 10.3171/2023.10.jns231410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Aneurysm wall inflammation is associated with lesion instability in unruptured intracranial aneurysms (UIAs). However, most UIAs remain unruptured during lifelong follow-ups because of simultaneous protective remodeling against the inflammatory response. The protective effects of osteoprotegerin (OPG) in intracranial and abdominal aortic aneurysms have been suggested using rodent models; however, the role of this protein in UIAs in humans remains unclear. Herein, the authors examined the relationship between OPG expression and aneurysm wall integrity in intraoperatively resected UIAs by using immunohistochemical and immunofluorescence staining. METHODS Sixteen UIA wall tissue specimens resected between 2017 and 2022 were analyzed. Aneurysm growth was defined as an enlargement > 1 mm or an obvious morphological change over the course of more than 6 months. Three high-power fields were randomly selected from areas expressing high and low levels of OPG within the same aneurysm. To clarify the role of OPG in the human aneurysm wall, the authors compared averaged values for the following pathological features between the 2 OPG expression groups: aneurysm wall thickness, collagen, macrophages, smooth muscle cells, and transforming growth factor beta 1 (TGF-β1). Immunohistochemical staining within the entire tissue area was also analyzed to determine the relationships between OPG expression and different aneurysm growth patterns. Pathological findings were compared between high and low OPG expression levels using the Wilcoxon signed-rank test. RESULTS The heterogeneous expression of OPG was detected in the walls of UIAs. Lesions expressing high OPG levels had thicker aneurysm walls (327 vs 180 μm, p = 0.002) and higher expression levels of TGF-β1 (8.5% vs 5.4%, p = 0.002) than those expressing low OPG levels. The expression of TGF-β1 was colocalized with that of OPG mainly in the tunica media. Furthermore, lesions expressing high OPG levels had larger α-SMA+ areas (25% vs 13%, p = 0.002). Aneurysm growth was observed in 6 of 9 UIAs with available data: whole sac expansion in 4 and secondary aneurysm formation in 2. Among the 6 UIAs with aneurysm growth, OPG expression was relatively higher in the UIAs with an internal elastic lamina than in those without (17% vs 6.9%). CONCLUSIONS Aneurysm wall integrity was associated with OPG expression in the aneurysm wall. Collectively, the study results indicated that OPG is associated with protective remodeling, which may contribute to the retention of aneurysm wall structures.
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Affiliation(s)
| | - Kohei Karasaki
- 2Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima; and
| | - Takeshi Hara
- Departments of1Neurosurgery and Interventional Neuroradiology
| | | | | | - Chiaki Ono
- 4Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima
| | | | - Masao Yoshizumi
- 5Department of Nursing Science, Yasuda Women's University, Hiroshima, Japan
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van der Kamp LT, Edjlali M, Naggara O, Matsushige T, Bulters DO, Digpal R, Zhu C, Saloner D, Hu P, Zhai X, Mossa-Basha M, Tian B, Sakamoto S, Fu Q, Ruigrok YM, Zhao H, Chen H, Rinkel GJE, van der Schaaf IC, Vergouwen MDI. Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study. Eur Radiol 2023:10.1007/s00330-023-10388-7. [PMID: 38108888 DOI: 10.1007/s00330-023-10388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES In patients with an unruptured intracranial aneurysm, gadolinium enhancement of the aneurysm wall is associated with growth and rupture. However, most previous studies did not have a longitudinal design and did not adjust for aneurysm size, which is the main predictor of aneurysm instability and the most important determinant of wall enhancement. We investigated whether aneurysm wall enhancement predicts aneurysm growth and rupture during follow-up and whether the predictive value was independent of aneurysm size. MATERIALS AND METHODS In this multicentre longitudinal cohort study, individual patient data were obtained from twelve international cohorts. Inclusion criteria were as follows: 18 years or older with ≥ 1 untreated unruptured intracranial aneurysm < 15 mm; gadolinium-enhanced aneurysm wall imaging and MRA at baseline; and MRA or rupture during follow-up. Patients were included between November 2012 and November 2019. We calculated crude hazard ratios with 95%CI of aneurysm wall enhancement for growth (≥ 1 mm increase) or rupture and adjusted for aneurysm size. RESULTS In 455 patients (mean age (SD), 60 (13) years; 323 (71%) women) with 559 aneurysms, growth or rupture occurred in 13/194 (6.7%) aneurysms with wall enhancement and in 9/365 (2.5%) aneurysms without enhancement (crude hazard ratio 3.1 [95%CI: 1.3-7.4], adjusted hazard ratio 1.4 [95%CI: 0.5-3.7]) with a median follow-up duration of 1.2 years. CONCLUSIONS Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not independent of aneurysm size. CLINICAL RELEVANCE STATEMENT Gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, since it appears to have no additional value to conventional predictors. KEY POINTS • Although aneurysm wall enhancement is associated with aneurysm instability in cross-sectional studies, it remains unknown whether it predicts risk of aneurysm growth or rupture in longitudinal studies. • Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not when adjusting for aneurysm size. • While gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, it may hold potential for aneurysms smaller than 7 mm.
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Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands.
| | - Myriam Edjlali
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré and Ambroise Paré, DMU Smart Imaging, Laboratoire d'imagerie Biomédicale Multimodale (BioMaps), GH Université Paris-Saclay, Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, GHU Paris, Centre Hospitalier Sainte-Anne, Paris, France
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Diederik O Bulters
- Department of Neurosurgery, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ronneil Digpal
- Department of Neurosurgery, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Peng Hu
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Capital Medical University, Bejing, China
| | - Xiaodong Zhai
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Capital Medical University, Bejing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Shigeyuki Sakamoto
- Department of Neurosurgery and Interventional Neuroradiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Qichang Fu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijun Chen
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Bejing, China
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
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Hashimoto Y, Matsushige T, Kawano R, Yoshiyama M, Hara T, Kobayashi S, Ono C, Sakamoto S, Horie N. Headache characteristics to screen for cervicocerebral artery dissection in patients with acute onset unusual headache. Headache 2023; 63:283-289. [PMID: 36748124 DOI: 10.1111/head.14454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this preplanned primary analysis was to investigate the clinical manifestations of headache to screen for CAD patients with acute onset headache only. BACKGROUND Spontaneous cervicocerebral artery dissection (CAD) with acute onset headache is not rare in clinical practice; however, it is underdiagnosed. On the other hand, subsequent infarction or subarachnoid hemorrhage mainly occurs within 1 week of headache onset. METHODS Between April 2017 and January 2022, we conducted a single-center, cross-sectional retrospective study on 197 consecutive referred patients from neurosurgical outpatient clinics with acute onset unusual headache (stronger or longer headache than usual). All patients underwent magnetic resonance imaging to screen for secondary headache and were diagnosed based on the diagnostic protocol. We examined patient background data and the following headache characteristics: distribution, condition at the onset of headache, accompanying vomiting or nausea, worsening headache, and analgesic effects against headache. These factors were analyzed to identify independent diagnostic predictors of CAD. In this study, the rate of missing data was 41% for improvement of headache by analgesia and multiple imputation by chained equations was performed. RESULTS A total of 93 patients (46 men and 47 women; mean age: 48 years, range: 25-73 years) were diagnosed with CAD. Univariate logistic regression analysis showed CAD was associated with current smoking, systolic blood pressure >140 mmHg, unilateral headache, worsening headache, and no headache improvement by analgesia. Unilateral, worsening headache and no headache improvement by analgesia remained independent diagnostic predictors in multivariable logistic regression after multiple imputation. No headache improvement by analgesia had the highest sensitivity (86%), while worsening headache had the highest specificity (84%). CONCLUSIONS CAD needs to be considered in patients with unilateral, worsening headache and no headache improvement by analgesia.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Reo Kawano
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Takeshi Hara
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shohei Kobayashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hara T, Matsushige T, Yoshiyama M, Hashimoto Y, Kobayashi S, Sakamoto S. Association of circumferential aneurysm wall enhancement with recurrence after coiling of unruptured intracranial aneurysms: a preliminary vessel wall imaging study. J Neurosurg 2023; 138:147-153. [PMID: 35594885 DOI: 10.3171/2022.4.jns22421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Recent histopathological studies of unruptured intracranial aneurysms (UIAs) have confirmed that aneurysm wall enhancement (AWE) on MR vessel wall imaging (VWI) is related to wall degeneration with in vivo inflammatory cell infiltration. Therefore, pretreatment aneurysm wall status on VWI may be associated with recurrence after endovascular treatment. METHODS VWI with gadolinium was performed on 67 consecutive saccular UIAs before endovascular treatment between April 2017 and June 2021. The mean (range) follow-up period after treatment was 24.4 (6-54) months. AWE patterns were classified as circumferential AWE (CAWE), focal AWE (FAWE), and negative AWE (NAWE). The authors retrospectively investigated the relationship between aneurysm recurrence and AWE patterns, as well as conventional risk factors. RESULTS Sixty-seven patients with 67 saccular UIAs were eligible for the present study. AWE patterns were as follows: 10 CAWE (14.9%), 20 FAWE (29.9%), and 37 NAWE (55.2%). Follow-up MRA detected aneurysm recurrence in 18 of 69 cases (26.1%). Univariate analysis identified maximum diameter (mean ± SD 5.8 ± 2.2 mm in patients with stable aneurysms vs 7.7 ± 3.8 mm in those with unstable aneurysms, p = 0.02), aspect ratio (1.4 ± 0.5 vs 1.1 ± 0.4, p < 0.01), aneurysm location in posterior circulation (4.1% vs 27.8%, p < 0.01), volume embolization ratio (29.6% ± 7.8% vs 25.2% ± 6.1%, p = 0.02), and AWE pattern (p = 0.04) as significant predictive factors of recurrence. Among the 3 AWE patterns, CAWE was significantly more frequent in the unstable group, but no significant differences in stability of the treated aneurysms were observed with the FAWE and NAWE patterns. In multivariate logistic regression analysis, CAWE pattern (OR 14.2, 95% CI 1.8-110.8, p = 0.01) and volume embolization ratio ≥ 25% (OR 8.6, 95% CI 2.1-34.3, p < 0.01) remained as significant factors associated with aneurysm stability after coiling. CONCLUSIONS VWI before coiling provides novel insights into the stability of treated aneurysms. Aneurysms with the CAWE pattern on VWI before coiling may be less stable after treatment.
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Affiliation(s)
- Takeshi Hara
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital; and
| | - Toshinori Matsushige
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital; and
| | - Michitsura Yoshiyama
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital; and
| | - Yukishige Hashimoto
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital; and
| | - Shohei Kobayashi
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital; and
| | - Shigeyuki Sakamoto
- 2Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Matsushige T, Hashimoto Y, Ogawa T, Makimoto G, Yoshiyama M, Hara T, Kobayashi S, Sakamoto S. The impact of high-resolution cone-beam CT findings on decision-making for the treatment of unruptured middle cerebral artery aneurysms. Neurosurg Rev 2022; 46:26. [PMID: 36575355 DOI: 10.1007/s10143-022-01933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
Even with the advent of endovascular treatment for intracranial aneurysms, microsurgical clipping continues to play a significant role in the treatment of middle cerebral artery (MCA) aneurysms. Securing perforators around unruptured intracranial aneurysms (UIAs) is essential for minimizing procedural risks in each treatment option. Therefore, we herein investigated whether the findings of high-resolution cone-beam computed tomography (HR-CBCT) have an impact on decision-making for the treatment of MCA UIAs. Patients with MCA UIAs between October 2017 and September 2021 were consecutively recruited for this study. All patients underwent HR-CBCT and 3D-DSA before treatment. The imaging quality of both modalities to visualize the microvasculature around aneurysms was evaluated. Specific findings on the microvasculature surrounding aneurysms on HR-CBCT were investigated to facilitate microsurgical clipping. Fifty-two MCA UIAs were treated, including 43 by microsurgical clipping and 9 by endovascular approaches. The overall imaging quality of HR-CBCT was superior to that of 3D-DSA. Regarding microsurgical insights, sensitivity and specificity for the visualization of small vessels around aneurysms were 79 and 100%, respectively, using HR-CBCT, and 57 and 93%, respectively, using 3D-DSA. The presence of a low-density band between adhesive vessels and aneurysm sacs was indicative of successful and safe microsurgical dissection between these structures. HR-CBCT enabled visualization of the intracranial microvasculature around MCA UIAs at the submillimeter level in vivo. In cases in which the tight adhesion of the microvasculature to the aneurysm sac is indicated by HR-CBCT, an endovascular approach may be considered in order to avoid the risks associated with securing perforators.
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Affiliation(s)
- Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan.
| | - Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan
| | - Taichi Ogawa
- Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Gosuke Makimoto
- Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan
| | - Takeshi Hara
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan
| | - Shohei Kobayashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, 1-2-1 Kameyama-minami, Asakitaku, Hiroshima, 731 0293, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hashimoto Y, Matsushige T, Kawano R, Yoshiyama M, Hara T, Kobayashi S, Ono C, Sakamoto S, Horie N. Diagnostic accuracy of MR vessel wall imaging at 2 weeks to predict morphological healing of vertebral artery dissection. J Stroke Cerebrovasc Dis 2022; 31:106728. [PMID: 36030577 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES The spontaneous healing of non-hemorrhagic intracranial vertebral artery dissection (VAD) may be associated with the stabilization of intramural hematoma (IMH). We previously suggested that the signal intensity of IMH increases until approximately 2 weeks in VAD with spontaneous healing. We herein investigated the diagnostic accuracy of the signal intensity of IMH at 2 weeks to predict the spontaneous healing of VAD. METHODS From April 2017 to April 2021, we prospectively investigated patients with non-hemorrhagic VAD who underwent vessel wall imaging (VWI). Morphological healing of VAD was evaluated by MR angiography three months after its onset. The relative signal intensity (RSI) of IMH against the posterior cervical muscle on VWI was calculated. Univariate and multivariate analyses were performed on factors associated with the spontaneous healing of VAD among patient baseline data, vascular morphology at the diagnosis, and RSI parameters. RESULTS Forty-eight patients (23 men and 25 women; mean age: 51 years, range: 34-73 years) with 50 non-hemorrhagic VAD were included in the present study. Spontaneous healing was observed in 28 VAD (56%). RSI two weeks after the onset of VAD (RSI2w) and morphological feature such as the string sign were associated with spontaneous healing, respectively. The multivariate logistic regression analysis identified RSI2w as an independent predictive factor of spontaneous healing (OR: 7.3; 95% CI, 1.9-28, p = 0.004). The cut-off value for RSI2w to predict spontaneous healing was 1.22 (AUC = 0.90, sensitivity: 91%, specificity: 82%). CONCLUSION RSI2w predicted the spontaneous healing of non-hemorrhagic VAD 3 months after its onset.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan.
| | - Reo Kawano
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Takeshi Hara
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shohei Kobayashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan
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Shimonaga K, Matsushige T, Takahashi H, Hashimoto Y, Yoshiyama M, Kaneko M, Sakamoto S. Association of Neutrophil Extracellular Traps with plaque instability in patient with carotid artery stenosis. Ann Vasc Surg 2022; 85:284-291. [PMID: 35276352 DOI: 10.1016/j.avsg.2022.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/27/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Vulnerable carotid plaques are related to cerebral thromboembolic and ischemic events. Neutrophil extracellular traps (NETs) can induce endothelial dysfunction, and induce inflammation and coagulation. The aim of the present study was to investigate NETs in patients with carotid artery plaques. METHODS Carotid plaques were collected by carotid endarterectomy (CEA) from 26 symptomatic and 8 asymptomatic patients between August 2017 and January 2021. The specimens were stained with hematoxylin-eosin and Elastica-van Gieson. Immunohistochemistry was performed staining by CD31 for identifying endothelial cells. NETs were detected by digoxigenin-labeled anti-histone H3 (HH3)(citrulline R2+R8+R17). The relationships between the presence of NETs and patient profile and histopathological findings were assessed. RESULTS HH3-positive cells were detected in 17 (asymptomatic=2 symptomatic=15) of 34 carotid plaques (median=9.7/mm). The number of NETs was correlated with the number of diffusion-weighted imaging high-intensity lesions [p=0.01], plaque rupture [p=0.001], intraplaque hemorrhage [p=0.02], intra luminal thrombus [p=0.001], and thin fibrous cap [p=0.001]. CONCLUSIONS The presence of NETs was associated with the instability of carotid plaques, intraluminal thrombus, which may lead to subsequent cerebral infarction. Clarifying the roles of NETs in carotid plaques may improve the treatment of carotid artery disease.
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Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Histopathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Sato T, Matsushige T, Chen B, Gembruch O, Dammann P, Jabbarli R, Forsting M, Junker A, Maderwald S, Quick HH, Ladd ME, Sure U, Wrede KH. Correlation Between Thrombus Signal Intensity and Aneurysm Wall Thickness in Partially Thrombosed Intracranial Aneurysms Using 7T Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging. Front Neurol 2022; 13:758126. [PMID: 35250805 PMCID: PMC8894319 DOI: 10.3389/fneur.2022.758126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study is to investigate the relationship between the thrombus signal intensity and aneurysm wall thickness in partially thrombosed intracranial aneurysms in vivo with magnetization-prepared rapid acquisition gradient echo (MPRAGE) taken using 7T magnetic resonance imaging (MRI) and correlate the findings to wall instability. Methods Sixteen partially thrombosed intracranial aneurysms were evaluated using a 7T whole-body MR system with nonenhanced MPRAGE. To normalize the thrombus signal intensity, its highest signal intensity was compared to that of the anterior corpus callosum of the same subject, and the signal intensity ratio was calculated. The correlation between the thrombus signal intensity ratio and the thickness of the aneurysm wall was analyzed. Furthermore, aneurysmal histopathological specimens from six tissue samples were compared with radiological findings to detect any correlation. Results The mean thrombus signal intensity ratio was 0.57 (standard error of the mean [SEM] 0.06, range 0.25–1.01). The mean thickness of the aneurysm wall was 1.25 (SEM 0.08, range 0.84–1.55) mm. The thrombus signal intensity ratio significantly correlated with the aneurysm wall thickness (p < 0.01). The aneurysm walls with the high thrombus signal intensity ratio were significantly thicker. In histopathological examinations, three patients with a hypointense thrombus had fewer macrophages infiltrating the thrombus and a thin degenerated aneurysmal wall. In contrast, three patients with a hyperintense thrombus had abundant macrophages infiltrating the thrombus. Conclusion The thrombus signal intensity ratio in partially thrombosed intracranial aneurysms correlated with aneurysm wall thickness and histologic features, indicating wall instability.
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Affiliation(s)
- Taku Sato
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
- *Correspondence: Taku Sato
| | - Toshinori Matsushige
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Bixia Chen
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Junker
- Institute of Neuropathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
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Shimonaga K, Hama S, Furui A, Yanagawa A, Kandori A, Atsumori H, Yamawaki S, Matsushige T, Tsuji T. Increased cerebrovascular reactivity in selected brain regions after extracranial-intracranial bypass improves the speed and accuracy of visual cancellation in patients with severe steno-occlusive disease: a preliminary study. Neurosurg Rev 2022; 45:2257-2268. [PMID: 35094203 PMCID: PMC9160123 DOI: 10.1007/s10143-021-01720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/24/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
The effect of the change in cerebrovascular reactivity (CVR) in each brain area on cognitive function after extracranial-intracranial bypass (EC-IC bypass) was examined. Eighteen patients who underwent EC-IC bypass for severe unilateral steno-occlusive disease were included. Single-photon emission CT (SPECT) for evaluating CVR and the visual cancellation (VC) task were performed before and after surgery. The accuracy of VC was expressed by the arithmetic mean of the age-matched correct answer rate and the accurate answer rate, and the averages of the time (time score) and accuracy (accuracy score) of the four VC subtests were used. The speed of VC tended to be slower, whereas accuracy was maintained before surgery. The EC-IC bypass improved CVR mainly in the cerebral hemisphere on the surgical side. On bivariate analysis, when CVR increased post-operatively, accuracy improved on both surgical sides, but the time score was faster on the left and slower on the right surgical side. Stepwise multiple regression analysis showed that the number of the brain regions associated with the time score was 5 and that associated with the accuracy score was 4. In the hemodynamically ischemic brain, processing speed might be adjusted so that accuracy would be maintained based on the speed-accuracy trade-off mechanism that may become engaged separately in the left and right cerebral hemispheres when performing VC. When considering the treatment for hemodynamic ischemia, the relationship between CVR change and the speed-accuracy trade-off in each brain region should be considered.
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Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, 731-0293, Japan
| | - Seiji Hama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734 8551, Japan.
- Department of Rehabilitation, Hibino Hospital, Hiroshima, 731-3164, Japan.
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, 734‑8551, Japan.
| | - Akira Furui
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, 739-8527, Japan
| | - Akiko Yanagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734 8551, Japan
- Department of Rehabilitation, Hibino Hospital, Hiroshima, 731-3164, Japan
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, 734‑8551, Japan
| | - Akihiko Kandori
- Center for Exploratory Research, Research and Development Group, Hitachi. Ltd, Tokyo, 185-8601, Japan
| | - Hirokazu Atsumori
- Center for Exploratory Research, Research and Development Group, Hitachi. Ltd, Tokyo, 185-8601, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, 734‑8551, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, 731-0293, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, 739-8527, Japan
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Araki H, Uchida K, Yoshimura S, Kurisu K, Shime N, Sakamoto S, Aoki S, Ichinose N, Kajihara Y, Tominaga A, Naka H, Mizoue T, Sumida M, Hirotsune N, Nomura E, Matsushige T, Kanazawa J, Kato Y, Kawamoto Y, Kuroki K, Morimoto T. Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke. J Neurointerv Surg 2021; 14:677-682. [PMID: 34413244 PMCID: PMC9209665 DOI: 10.1136/neurintsurg-2021-017863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals. OBJECTIVE To explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI). METHODS We implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO. RESULTS The cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO. CONCLUSIONS Use of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke.
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Affiliation(s)
- Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.,Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Yosuke Kajihara
- Department of Neurosurgery, Itsukaichi Memorial Hospital, Hiroshima, Japan
| | - Atsushi Tominaga
- Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiromitsu Naka
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masayuki Sumida
- Department of Neurosurgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Nobuyuki Hirotsune
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Yukio Kato
- Department of Neurosurgery, Saiseikai Hiroshima Hospital, Aki-gun, Japan
| | | | - Kazuhiko Kuroki
- Department of Neurosurgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
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13
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Hashimoto Y, Matsushige T, Kawano R, Shimonaga K, Yoshiyama M, Takahashi H, Kaneko M, Ono C, Sakamoto S. Segmentation of aneurysm wall enhancement in evolving unruptured intracranial aneurysms. J Neurosurg 2021; 136:449-455. [PMID: 34388724 DOI: 10.3171/2021.2.jns2114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Morphological changes in unruptured intracranial aneurysms (UIAs) are an imaging marker of aneurysm instability. Recent studies have indicated the ability of MR vessel wall imaging (VWI) to stratify unstable UIAs based on a correlation with histopathological aneurysm wall inflammation. In the present study the authors investigated the relationships between aneurysm growth patterns and the segmentation of aneurysm wall enhancement (AWE) in VWI. METHODS A total of 120 aneurysms with serial angiography from a follow-up period of at least 2 years (mean 65 months, range 24-215 months) were assessed by VWI. Two readers independently evaluated the patterns of morphological changes (stable, whole sac expansion, and secondary aneurysm formation) and the segmentation of AWE (no, focal, and circumferential AWE). The contrast enhancement ratio of the aneurysm wall versus the pituitary stalk (CRstalk) was calculated for the quantitative assessment of AWE. Statistical analyses were performed to investigate the relationships between AWE patterns and patient baseline profiles, aneurysm characteristics, and morphological modifications. RESULTS Forty-one of 120 UIAs (34%) exhibited aneurysm growth (whole sac expansion in 19 and secondary aneurysm formation in 22). AWE was detected in 35 of 120 UIAs (focal AWE in 25 and circumferential AWE in 10). The maximum diameter of, irregularities in, and morphological modifications in aneurysms were associated with the segmentation of AWE. Focal AWE correlated with secondary aneurysm formation, and circumferential AWE correlated with whole sac expansion. In focal AWE, CRstalk was significantly higher in secondary aneurysm formation than in stable UIAs. UIAs without AWE (categorized as no AWE) correlated with aneurysm stability. CONCLUSIONS The segmentation of AWE was associated with aneurysm growth scenarios and may provide a novel insight into the evaluation of unstable UIAs.
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Affiliation(s)
- Yukishige Hashimoto
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital
| | - Toshinori Matsushige
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital
| | - Reo Kawano
- 2Clinical Research Center in Hiroshima, Hiroshima University Hospital
| | - Koji Shimonaga
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital
| | - Michitsura Yoshiyama
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital
| | - Hiroki Takahashi
- 1Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital
| | - Mayumi Kaneko
- 3Department of Pathology, Hiroshima City Asa Citizens Hospital
| | - Chiaki Ono
- 4Department of Radiology, Hiroshima City Asa Citizens Hospital; and
| | - Shigeyuki Sakamoto
- 5Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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14
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Hashimoto Y, Matsushige T, Shimonaga K, Yoshiyama M, Takahashi H, Ono C, Sakamoto S. Monitoring Intramural Hematoma on Vessel Wall Imaging to Evaluate the Healing of Intracranial Vertebral Artery Dissection. J Stroke Cerebrovasc Dis 2021; 30:105992. [PMID: 34293642 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Unruptured intracranial vertebral artery dissection (VAD) generally heals spontaneously. A chronological evaluation of intramural hematoma (IMH) using T1-weighted vessel wall imaging (VWI) may provide a more detailed understanding of the pathophysiology of VAD. We herein investigated the relationship between chronological signal changes in IMH on VWI and the spontaneous healing of VAD. MATERIALS AND METHODS We retrospectively investigated 26 patients with 27 unruptured VADs who underwent magnetic resonance (MR) imaging more than three times during the follow-up period. Morphological changes were evaluated using MR angiography (MRA). The relative signal intensity (RSI) of IMH against the posterior cervical muscle on T1-weighted VWI was calculated. The ratio of chronological RSI changes was defined as follows: maximum RSI/minimum RSI (RSI max/min). Based on the median value of RSI max/min, 27 VADs were divided into VADs with and without chronological RSI changes. Statistical analyses were performed to compare clinical and radiological findings between the two groups. RESULTS Spontaneous healing occurred in 17 out of 27 VADs (63%). The median value of RSI max/min was 1.48. The RSI of VADs with chronological RSI changes (RSI max/min ≥ 1.48) increased until three weeks after their onset and decreased over time, while that of VADs without chronological RSI changes (RSI max/min < 1.48) showed no change. The frequency of healing was significantly higher in VADs with than without chronological RSI changes (100% vs 23%, p < 0.0001). CONCLUSIONS Chronological signal changes in IMH on T1-weighted VWI have potential as a diagnostic imaging marker of the spontaneous healing of VAD.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Hiroshima, Asakitaku 731 0293, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Hiroshima, Asakitaku 731 0293, Japan; Department of Neurosurgery Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan.
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Hiroshima, Asakitaku 731 0293, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Hiroshima, Asakitaku 731 0293, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Hiroshima, Asakitaku 731 0293, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan
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Shimonaga K, Matsushige T, Takahashi H, Hashimoto Y, Yoshiyama M, Ono C, Sakamoto S. Peptidylarginine Deiminase 4 as a Possible Biomarker of Plaque Instability in Carotid Artery Stenosis. J Stroke Cerebrovasc Dis 2021; 30:105816. [PMID: 33906071 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105816] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Neutrophil extracellular traps (NETs) exhibit pro-inflammatory and pro-thrombotic properties. However, they have only been reported as important regulators in atherosclerosis, especially in atherothrombosis. We investigated the presence of NETs and plaque instability in patients with carotid artery stenosis. MATERIAL AND METHODS A total of 39 consecutive patients with carotid artery stenosis were evaluated. All patients underwent carotid artery stenting (CAS) with dual protection (simultaneous flow reversal + distal filter) and blood aspiration as a method of distal embolism prevention. Local arterial blood was aspirated at the stent site and peptidylarginine deiminase 4 (PAD4), which is essential for the formation of NETs, was measured. The relationships between PAD4 and the patient profile, blood examination and plaque data were investigated. RESULTS The mean value of PAD4 in local arterial blood in CAS was 0.5 ng/ml. Bivariate analysis demonstrated that PAD4 was associated with the neutrophil to lymphocyte ratio (p = 0.007), high-density lipoprotein (p = 0.02), triglycerides to high-density lipoprotein ratio (p = 0.007), ulceration (p = 0.02) and plaque contrast enhancement on T1 black blood imaging (p = 0.03). In multiple linear regression analyses, PAD4 was correlated with the neutrophil to lymphocyte ratio (p = 0.01) and ulceration (p = 0.01, cut-off value: 0.49 odds ratio: 19.3). CONCLUSIONS PAD4, representative of the presence of NETs, was high in carotid plaques with unstable features. The neutrophil to lymphocyte ratio in peripheral blood was suggested to be a biomarker of vulnerable plaques. Elucidating the role of NETs may aid in clarifying factors that promote the instability of carotid plaques.
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Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan.
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan.
| | - Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan.
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan.
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Hashimoto Y, Matsushige T, Ogawa T, Sakuragouchi H, Shimonaga K, Takahashi H, Yoshiyama M, Ono C, Sakamoto S. Impact of Cone-Beam Computed Tomography Angiography on Visualization of Sylvian Veins. World Neurosurg 2020; 143:e206-e214. [PMID: 32712404 DOI: 10.1016/j.wneu.2020.07.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A detailed understanding of the anatomy of Sylvian veins preoperatively is needed for venous-preserving Sylvian dissection. Better visualization of the venous architecture will facilitate surgical strategies for Sylvian dissection. This study evaluated and compared the image quality of the Sylvian veins and their tributaries using high-resolution cone-beam computed tomography angiography (CBCT-A) and three-dimensional computed tomography angiography (3D-CTA). METHODS Twenty-four patients who underwent 3D-CTA and CBCT-A as a preoperative simulation for clipping of unruptured intracranial aneurysms were retrospectively reviewed. In comparisons with intraoperative inspections, 3 raters evaluated the image quality of the Sylvian veins by 3D-CTA and CBCT-A with a 5-point scale. Visualization of the Sylvian veins and their tributaries by the 2 imaging modalities was compared using Wilcoxon signed rank test. RESULTS CBCT-A showed superior image quality to 3D-CTA in evaluations of the discrimination of adjacent superficial Sylvian veins (2.8 ± 0.80 vs. 4.6 ± 0.37, P < 0.0001), adjacent Sylvian veins at the sphenoid wing (3.1 ± 0.71 vs. 4.1 ± 0.56, P = 0.0001), and visualization of the tributaries of the Sylvian veins (2.5 ± 0.70 vs. 4.4 ± 0.37, P < 0.0001). CONCLUSIONS CBCT-A was superior to 3D-CTA for visualizing the Sylvian veins and their tributaries. CBCT-A will provide important information on the anatomy of the Sylvian veins preoperatively.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Taichi Ogawa
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Michitsura Yoshiyama
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hashimoto Y, Matsushige T, Shimonaga K, Takahashi H, Mizoue T, Kaneko M, Ono C, Yamashita H, Yoshioka H, Sakamoto S, Kurisu K. Magnetic resonance vessel wall imaging predicts morphological deterioration in unruptured intracranial artery dissection. J Stroke Cerebrovasc Dis 2020; 29:105006. [PMID: 32807422 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The mechanism involved in progression of unruptured intracranial artery dissection (IAD) is poorly understood. We investigated the relationship between contrast enhancement of dissecting lesions on magnetic resonance vessel wall imaging (MR-VWI) and unruptured IAD progression on the hypothesis that this finding might predict its instability. METHODS A total of 49 unruptured IADs were investigated retrospectively. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and the dissecting lesion/pituitary stalk contrast enhancement ratio (CRstalk) was calculated. Unruptured IAD progression was defined as morphological deterioration; progressive dilatation or stenosis. The relations between unruptured IAD progression and potential risk factors were statistically investigated. RESULTS Morphological deterioration was demonstrated in eleven of 49 unruptured IADs (22 %). The CRstalk value and male predominance was significantly higher in progressed IADs than stable ones (1.0 vs. 0.65; p = 0.0035, 82% vs 37%; p= 0.015, respectively). On stepwise multivariable logistic regression analysis, the CRstalk value was independently associated with unruptured IAD progression with odds ratio of 102.5 (95% CI, 2.59-4059, P=0.0013). The optimal cutoff value of CRstalk to estimate IADs with progression was 0.87 (sensitivity, 0.82; specificity, 0.74). Multimodalic images showed contrast enhancement on VWI corresponded to residual stagnant flow in dissecting lesions. CONCLUSIONS Quantitative analysis of contrast enhancement on VWI could predict instability of unruptured IADs. Contrast enhancement in dissecting lesions would be a clue to understand the mechanism of unruptured IAD progression.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Takahashi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Yamashita
- Department of Neurology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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18
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Shimonaga K, Hama S, Tsuji T, Yoshimura K, Nishino S, Yanagawa A, Soh Z, Matsushige T, Mizoue T, Onoda K, Yamashita H, Yamawaki S, Kurisu K. The right hemisphere is important for driving-related cognitive function after stroke. Neurosurg Rev 2020; 44:977-985. [PMID: 32162124 DOI: 10.1007/s10143-020-01272-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/01/2020] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
Considering quality of life (QOL) after stroke, car driving is one of the most important abilities for returning to the community. In this study, directed attention and sustained attention, which are thought to be crucial for driving, were examined. Identification of specific brain structure abnormalities associated with post-stroke cognitive dysfunction related to driving ability would help in determining fitness for car driving after stroke. Magnetic resonance imaging was performed in 57 post-stroke patients (51 men; mean age, 63 ± 11 years) who were assessed for attention deficit using a standardized test (the Clinical Assessment for Attention, CAT), which includes a Continuous Performance Test (CPT)-simple version (CPT-SRT), the Behavioral Inattention Test (BIT), and a driving simulator (handle task for dividing attention, and simple and selective reaction times for sustained attention). A statistical non-parametric map (SnPM) that displayed the association between lesion location and cognitive function for car driving was created. From the SnPM analysis, the overlay plots were localized to the right hemisphere during handling the hit task for bilateral sides (left hemisphere damage related to right-side neglect and right hemisphere damage related to left-side neglect) and during simple and selective reaction times (false recognition was related to damage of both hemispheres). A stepwise multiple linear regression analysis confirmed the importance of both hemispheres, especially the right hemisphere, for cognitive function and car driving ability. The present study demonstrated that the right hemisphere has a crucial role for maintaining directed attention and sustained attention, which maintain car driving ability, improving QOL for stroke survivors.
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Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Seiji Hama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. .,Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan.
| | - Toshio Tsuji
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | | | - Shinya Nishino
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Akiko Yanagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan
| | - Zu Soh
- Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Keiichi Onoda
- Department of Neurology, Shimane University, Matsue, Shimane, Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neuroscience, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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19
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Hashimoto Y, Matsushige T, Shimonaga K, Takahashi H, Ono C, Yamashita H, Mizoue T. Abstract TP86: Clinical Significance of Gadolinium Enhancement in Non-Hemorrhagic Intracranial Artery Dissection. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The mechanisms involved in progression of non-hemorrhagic intracranial artery dissection (IAD) are poorly understood. Contrast enhancement of intracranial saccular aneurysms on magnetic resonance vessel wall imaging (VWI) is thought to predict instability. We investigated the relationship between contrast enhancement of dissecting lesions and progression of IADs based on the hypothesis that this finding might predict instability.
Methods:
A total of 39 IADs in 36 patients (17 women and 19 men; mean age: 49 years) were investigated retrospectively. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and the vessel wall/pituitary stalk contrast enhancement ratio (CRstalk) was calculated. Progression of IADs was defined as morphological deterioration; progressive dilatation or stenosis. The relations between IAD progression and potential risk factors, including patient demographic data, IAD morphology, and VWI findings, were investigated by statistical analysis.
Results:
The mean follow-up period was 9.7 months (range: 1-24 months). Progression was detected in 6 of 39 IADs (15%). Five IADs demonstrated aneurysmal dilatation and the other showed stenosis/occlusion. There were no significant differences of demographic factors between the patients with or without IADs progression. IADs with aneurysmal dilation demonstrated significant morphological deterioration (p=0.01). All IADs without contrast enhancement (n=7) improved within one month. Contrast enhancement corresponded to the pseudo-lumen of dissecting lesions. The CRstalk value was significantly higher in IADs with progression than in stable lesions (1.10 ± 0.09 vs. 0.80 ± 0.05, p =0.01).
Conclusions:
The pseudo-lumen of dissecting lesions may be identified by contrast enhancement. Quantitative analysis of contrast enhancement could be useful for predicting instability of IADs during follow-up.
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Affiliation(s)
| | | | | | | | - Chiaki Ono
- Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
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20
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Hashimoto Y, Furukawa K, Shimonaga K, Takahashi H, Ono C, Kaneko M, Mizoue T, Ishida F, Suzuki H, Matsushige T. Abstract WMP34: Multimodal Evaluation of Unruptured Intracranial Aneurysm Wall. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Recent studies have suggested that MR-vessel wall imaging (VWI) or computational fluid dynamics (CFD) could evaluate aneurysm wall features in unruptured intracranial aneurysms (UIAs). The combination of these modalities might be comprehensive and help better understanding of the pathophysiology of aneurysm wall. This study was performed to disclose the relationship between VWI and hemodynamic characteristics evaluated by CFD.
Methods:
From April 2017 through May 2019, a total of 36 microsurgically-treated UIAs preoperatively underwent VWI and CFD were reviewed. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and aneurysm wall enhancement (AWE) was evaluated. CFD was carried out using patient specific geometry models from three-dimensional CT angiography. Morphological variables, intraoperative inspection and hemodynamic parameters were statistically analyzed between enhanced and nonenhanced wall of UIAs. Fourteen UIAs were available for histopathological examination.
Results:
In morphological variables, maximum diameter and irregularity were associated with AWE (p=0.02, respectively). AWE lesions corresponded to intraoperatively inspected atherosclerotic lesions of UIAs (sensitivity, 0.90; specificity, 0.79). Among hemodynamic parameters, oscillatory velocity index that suggests the directional changes of the flow velocity was significantly higher in UIAs with AWE (p=0.02). Histopathologic studies revealed that wall thickening accompanied by atherosclerosis, neovascularization, and macrophage infiltration corresponded to AWE lesions, while UIAs without AWE demonstrated various histopathological findings such as myointimal hyperplasia or thinning wall with loss of mural cells and wall degeneration.
Conclusions:
Pathophysiology of AWE could be explained as atherosclerotic changes with inflammation presumably associated with aberrant flow conditions in irregular UIAs. VWI and CFD are complementarily valuable imaging techniques to understand an aneurysm wall pathophysiology.
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Affiliation(s)
| | | | - Koji Shimonaga
- Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
| | | | - Chiaki Ono
- Radiology, Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
| | - Mayumi Kaneko
- Pathology, Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
| | - Tatsuya Mizoue
- Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
| | | | | | - Toshinori Matsushige
- Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hosp, Hiroshima, Japan
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21
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Shimonaga K, Matsushige T, Ishii D, Sakamoto S, Hosogai M, Kawasumi T, Kaneko M, Ono C, Kurisu K. Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms. Stroke 2019; 49:2516-2519. [PMID: 30355091 DOI: 10.1161/strokeaha.118.021819] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The clinical significance of vessel wall imaging (VWI) remains unclear in patients with unruptured intracranial aneurysms. This study was performed to investigate the correlations between aneurysm wall imaging findings and histopathologic aneurysm wall architectures. Methods- A total of 9 aneurysms was evaluated by VWI and subsequently characterized with histopathology. We used VWI to visualize the aneurysm wall and determine if there was aneurysm wall enhancement after gadolinium contrast administration. Results- Aneurysm wall structures were identified in 6 of 9 unruptured intracranial aneurysms by native VWI, and wall enhancement was identified in 5 of these 6 aneurysms. Histopathologic studies revealed that wall thickening accompanied by atherosclerosis, neovascularization, and macrophage infiltration corresponded to visualization of the aneurysm wall by native VWI and to aneurysm wall enhancement. Conclusions- VWI can visualize thickening of the aneurysm wall, and wall enhancement corresponded to histologically confirmed degenerative changes accompanied by neovascularization and prominent macrophage infiltration.
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Affiliation(s)
- Koji Shimonaga
- From the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.S., T.M., D.I., S.S., K.K.).,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan (K.S., T.M., M.H., T.K.)
| | - Toshinori Matsushige
- From the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.S., T.M., D.I., S.S., K.K.).,Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan (K.S., T.M., M.H., T.K.)
| | - Daizo Ishii
- From the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.S., T.M., D.I., S.S., K.K.)
| | - Shigeyuki Sakamoto
- From the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.S., T.M., D.I., S.S., K.K.)
| | - Masahiro Hosogai
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan (K.S., T.M., M.H., T.K.)
| | - Tomohiro Kawasumi
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan (K.S., T.M., M.H., T.K.)
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Japan (M.K.)
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Japan (C.O.)
| | - Kaoru Kurisu
- From the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.S., T.M., D.I., S.S., K.K.)
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22
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Hashimoto Y, Matsushige T, Shimonaga K, Hosogai M, Kaneko M, Ono C, Mizoue T. Vessel Wall Imaging Predicts the Presence of Atherosclerotic Lesions in Unruptured Intracranial Aneurysms. World Neurosurg 2019; 132:e775-e782. [PMID: 31415889 DOI: 10.1016/j.wneu.2019.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies have suggested that magnetic resonance vessel wall imaging (VWI) can visualize thickened intracranial aneurysm wall. We aimed to investigate correlations between VWI findings and intraoperative aneurysm wall features based on the hypothesis that VWI can visualize atherosclerotic changes in unruptured intracranial aneurysm (UIA) walls. METHODS A total of 36 microsurgically treated UIAs were retrospectively reviewed. All aneurysms underwent VWI before microsurgical clipping, and fusion images with time-of-flight magnetic resonance angiography were created to localize aneurysm wall enhancement (AWE) lesions. Intraoperatively, 2 neurosurgeons who were blinded to the VWI findings evaluated the aneurysm wall features, giving each aneurysm an atherosclerosis score on a 5-point scale (5: yellowish, 4: whitish, 3: normal, 2: slightly reddish, 1: reddish). We defined atherosclerotic lesions as those having average scores ≥4. We evaluated the rate of correspondence between AWE lesions and atherosclerotic lesions, and the factors associated with AWE. RESULTS Sixteen of the 36 UIAs (44%) were identified as AWE. The sensitivity, specificity, positive predictive value, and negative predictive value of correspondence between AWE lesions and atherosclerotic lesions were 79%, 94%, 94%, and 80%, respectively. The average atherosclerosis scores (4.2 ± 0.5 vs. 2.7 ± 0.9; P < 0.001) were significantly higher in aneurysms with AWE. Twelve of 16 UIAs with wall enhancement had wall thinning adjacent to the part with AWE. CONCLUSIONS AWE lesions corresponded with intraoperatively confirmed atherosclerotic lesions of UIAs. Detecting these lesions would be valuable in exploring UIAs with wall degeneration.
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Affiliation(s)
- Yukishige Hashimoto
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
| | - Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Mayumi Kaneko
- Department of Pathology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Chiaki Ono
- Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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23
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Sato T, Matsushige T, Chen B, Gembruch O, Dammann P, Jabbarli R, Forsting M, Junker A, Maderwald S, Quick HH, Ladd ME, Sure U, Wrede KH. Wall Contrast Enhancement of Thrombosed Intracranial Aneurysms at 7T MRI. AJNR Am J Neuroradiol 2019; 40:1106-1111. [PMID: 31147351 DOI: 10.3174/ajnr.a6084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of wall contrast enhancement in thrombosed intracranial aneurysms is incompletely understood. This in vivo study aimed to investigate wall microstructures with gadolinium-enhanced 7T MR imaging. MATERIALS AND METHODS Thirteen patients with 14 thrombosed intracranial aneurysms were evaluated using a 7T whole-body MR imaging system with nonenhanced and gadolinium-enhanced high-resolution MPRAGE. Tissue samples were available in 5 cases, and histopathologic findings were correlated with 7T MR imaging to identify the gadolinium-enhancing microstructures. RESULTS Partial or complete inner wall enhancement correlated with neovascularization of the inner wall layer and the adjacent thrombus. Additional partial or complete outer wall enhancement can be explained by formation of vasa vasorum in the outer aneurysm wall layer. The double-rim enhancement correlated with perifocal edema and wall histologic findings suggestive of instability. CONCLUSIONS Two distinct aneurysm wall microstructures responsible for gadolinium enhancement not depictable at lower spatial resolutions can be visualized in vivo using high-resolution gadolinium-enhanced 7T MR imaging.
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Affiliation(s)
- T Sato
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery (T.S.), Fukushima Medical University, Fukushima, Japan
| | - T Matsushige
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery and Interventional Neuroradiology (T.M.), Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - B Chen
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - O Gembruch
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - P Dammann
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - R Jabbarli
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
| | - M Forsting
- University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F.)
| | - A Junker
- Institute of Neuropathology (A.J.)
| | - S Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - H H Quick
- High Field and Hybrid MR Imaging (H.H.Q.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - M E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
- Medical Physics in Radiology (M.E.L.), German Cancer Research Center, Heidelberg, Germany
- Faculty of Physics and Astronomy and Faculty of Medicine (M.E.L.), University of Heidelberg, Heidelberg, Germany
| | - U Sure
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
| | - K H Wrede
- From the Department of Neurosurgery (T.S., T.M., B.C., O.G., P.D., R.J., U.S., K.H.W.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.S., T.M., B.C., O.G., P.D., S.M., H.H.Q., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
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Matsushige T, Shimonaga K, Ishii D, Sakamoto S, Hosogai M, Hashimoto Y, Kaneko M, Ono C, Mizoue T, Kurisu K. Vessel Wall Imaging of Evolving Unruptured Intracranial Aneurysms. Stroke 2019; 50:1891-1894. [PMID: 31167619 DOI: 10.1161/strokeaha.119.025245] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Unruptured intracranial aneurysms (UIAs) have various scenarios of growth and rupture. Magnetic resonance vessel wall imaging can detect aneurysmal wall thickening with inflammation and neovascularization. This study was performed to explore the vessel wall imaging findings of UIAs with consecutive follow-up. Methods- A total of 60 aneurysms with serial angiography over 2 years (mean period, 49 months, range, 24-192 months) were evaluated by vessel wall imaging. UIAs were morphologically categorized into 3 patterns: stable, whole sac expansion, or daughter sac formation. Aneurysm wall enhancement (AWE) was evaluated after administration of gadolinium. Results- Thirty-three of the 60 UIAs (55%) demonstrated no morphological changes, whereas 16 UIAS (27%) showed whole sac expansion and 11 UIAs (18%) demonstrated daughter sac formation. AWE was significantly less frequent in stable UIAs compared with UIAs showing morphological changes ( P<0.01). Aneurysms with daughter sac formation showed a significantly higher frequency of AWE than those demonstrating whole sac expansion. In the majority of UIAs with daughter sac formation, AWE was detected in the main aneurysm and not in the developing component. Conclusions- UIAs demonstrate various modes of growth. The pattern of AWE might be useful for identifying unfavorable morphological changes of UIAs.
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Affiliation(s)
- Toshinori Matsushige
- From the Department of Neurosurgery and Interventional Neuroradiology (T.M., K.S., M.H., Y.H., T.M.), Hiroshima City Asa Citizens Hospital, Japan.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (T.M., K.S., D.I., S.S., K.K.)
| | - Koji Shimonaga
- From the Department of Neurosurgery and Interventional Neuroradiology (T.M., K.S., M.H., Y.H., T.M.), Hiroshima City Asa Citizens Hospital, Japan.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (T.M., K.S., D.I., S.S., K.K.)
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (T.M., K.S., D.I., S.S., K.K.)
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (T.M., K.S., D.I., S.S., K.K.)
| | - Masahiro Hosogai
- From the Department of Neurosurgery and Interventional Neuroradiology (T.M., K.S., M.H., Y.H., T.M.), Hiroshima City Asa Citizens Hospital, Japan
| | - Yukishige Hashimoto
- From the Department of Neurosurgery and Interventional Neuroradiology (T.M., K.S., M.H., Y.H., T.M.), Hiroshima City Asa Citizens Hospital, Japan
| | - Mayumi Kaneko
- Department of Pathology (M.K.), Hiroshima City Asa Citizens Hospital, Japan
| | - Chiaki Ono
- Department of Radiology (C.O.), Hiroshima City Asa Citizens Hospital, Japan
| | - Tatsuya Mizoue
- From the Department of Neurosurgery and Interventional Neuroradiology (T.M., K.S., M.H., Y.H., T.M.), Hiroshima City Asa Citizens Hospital, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (T.M., K.S., D.I., S.S., K.K.)
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25
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Ikawa F, Michihata N, Matsushige T, Abiko M, Ishii D, Oshita J, Okazaki T, Sakamoto S, Kurogi R, Iihara K, Nishimura K, Morita A, Fushimi K, Yasunaga H, Kurisu K. In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:655-667. [PMID: 30941595 DOI: 10.1007/s10143-019-01096-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
There has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based on the nationwide databases published from 2007 to 2018. According to this propensity score-matched analysis, no significant association for poor outcome of mRS > 2 was shown between surgical clipping and endovascular coiling (47.7% vs 48.3%, p = 0.48). However, significantly lower in-hospital mortality was revealed after surgical clipping than endovascular coiling (7.1% vs 12.2%, p < 0.001). Meta-analysis of propensity score-matched analysis in the nationwide database showed no significant association for poor outcome at discharge between them (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.93 to 1.26; p = 0.31). Meta-analysis of propensity score-matched analysis for in-hospital mortality was lower after surgical clipping than after endovascular coiling, however, without significant difference (OR, 0.74; 95% CI, 0.52 to 1.04; p = 0.08). Further prospective randomized controlled study with all grade aSAH should be necessary to validate the in-hospital mortality and poor outcome.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaru Abiko
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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26
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Shimonaga K, Ishii D, Matsushige T. Response by Shimonaga et al to Letter Regarding Article, "Clinicopathological Insights From Vessel Wall Imaging of Unruptured Intracranial Aneurysms". Stroke 2019; 50:e19. [PMID: 30580747 DOI: 10.1161/strokeaha.118.023850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koji Shimonaga
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Japan
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27
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Okazaki T, Sakamoto S, Ishii D, Oshita J, Matsushige T, Shinagawa K, Ichinose N, Matsuda S, Kurisu K. A Pial Arteriovenous Fistula in Infancy as the Presenting Manifestation of Hereditary Hemorrhagic Telangiectasia. World Neurosurg 2018; 122:322-325. [PMID: 30391600 DOI: 10.1016/j.wneu.2018.10.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pial arteriovenous fistulas (PAVFs) are rare, accounting for 1.6%-4.7% of all intracranial vascular malformations. Often diagnosed in childhood, about 30% are associated with hereditary hemorrhagic telangiectasia. A case of PAVF diagnosed soon after birth and given cerebrovascular therapy 4 months after birth is reported. CASE DESCRIPTION The patient presented with heart failure immediately after birth. Ultrasonography of the head showed abnormal blood flow in the brain. On digital subtraction angiography performed 4 months after birth, a PAVF with a dural feeder shunt and a giant varix at the posterior temporal part was confirmed. After transarterial embolization (TAE), shunt blood flow disappeared. New shunt flow from the right posterior cerebral artery into the varix was confirmed by magnetic resonance imaging 3 months after the operation. A second TAE procedure using a liquid embolic material was performed and confirmed the complete disappearance of the shunt. CONCLUSIONS This report describes a case of infant PAVF with heart failure, a giant varix, hydrocephalus, and intraventricular hemorrhage treated by TAE using platinum coils and liquid embolic material.
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Affiliation(s)
- Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsuhiro Shinagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiko Ichinose
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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28
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Isobe N, Ikawa F, Tominaga A, Kuroki K, Sadatomo T, Mizoue T, Hamasaki O, Matsushige T, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Factors Related to Frailty Associated with Clinical Deterioration After Meningioma Surgery in the Elderly. World Neurosurg 2018; 119:e167-e173. [DOI: 10.1016/j.wneu.2018.07.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
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29
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Ishii D, Okazaki T, Matsushige T, Shinagawa K, Sakamoto S, Oshita J, Kurisu K. Chronic Dilatation of Superficial Temporal Artery and Middle Meningeal Artery Associated with Development of Collateral Circulation After Bypass Surgery for Moyamoya Angiopathy. World Neurosurg 2018; 119:e864-e873. [DOI: 10.1016/j.wneu.2018.07.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
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30
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Hosogai M, Matsushige T, Shimonaga K, Kawasumi T, Kurisu K, Sakamoto S. Stent-Assisted Coil Embolization for Ruptured Intracranial Dissecting Aneurysms Involving Essential Vessels. World Neurosurg 2018; 119:e728-e733. [DOI: 10.1016/j.wneu.2018.07.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/28/2022]
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31
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Ishii D, Matsushige T, Okazaki T, Shinagawa K, Sakamoto S, Oshita J, Kurisu K. Marked Changes in Blood-Brain Barrier Biomarkers After Direct Bypass Surgery for Moyamoya Angiopathy: Preliminary Study. World Neurosurg 2018; 120:e611-e616. [PMID: 30165210 DOI: 10.1016/j.wneu.2018.08.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The blood-brain barrier (BBB) of patients with moyamoya angiopathy (MMA) is unstable, which may contribute to transient neurologic symptoms (TNS) after direct bypass surgery. However, BBB-related proteins have never been investigated. The purpose of this study was to evaluate the perioperative serum levels of biomarkers representing BBB function in MMA patients based on the hypothesis that postoperative hemodynamic change may disrupt the BBB. METHODS A total of 12 hemispheres in 11 patients with MMA were prospectively examined. Direct revascularization surgery was performed for all cases. The serum levels of tight junction (occludin and claudin 5), adherens junction (vascular endothelial-cadherin) proteins, and matrix metalloproteinase (MMP)-2 and MMP-9 were measured quantitatively 1 day before surgery and on postoperative days 1, 4, and 7. RESULTS Successful patency of the direct bypass was achieved in all. The serum level of occludin was significantly increased on postoperative day 1, and the levels in 2 cases with TNS were markedly elevated over 10-fold higher than baseline. Furthermore, the postoperative MMP-9 levels were significantly elevated on each day. On the other hand, there was no significant fluctuation in claudin 5, vascular endothelial-cadherin, and MMP-2 level. CONCLUSIONS Marked changes in biomarkers representing the tight junction of the BBB were observed. These preliminary results suggest that marked hemodynamic change and TNS in some patients are associated with disruption of the BBB after direct bypass surgery for MMA.
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Affiliation(s)
- Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsuhiro Shinagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kraemer M, Karakaya R, Matsushige T, Graf J, Albrecht P, Hartung HP, Berlit P, Laumer R, Diesner F. Efficacy of STA-MCA bypass surgery in moyamoya angiopathy: long-term follow-up of the Caucasian Krupp Hospital cohort with 81 procedures. J Neurol 2018; 265:2425-2433. [PMID: 30155735 DOI: 10.1007/s00415-018-9031-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite the consensus on the efficacy of revascularizing surgery in moyamoya angiopathy (MA) in Asia, the indication in Caucasian moyamoya patients is controversially discussed. OBJECTIVE The efficacy of revascularizing surgery in adult European patients with MA should be clarified. METHODS This study retrospectively analyzed the rate of further strokes and hemorrhages as well as MRI and Duplex ultrasound features during long-term follow up after STA-MCA bypass. RESULTS Eighty-one STA-MCA bypass procedures in 54 patients with MA operated in one single German institution were analyzed. All 54 patients (100%) were Caucasians. After two diffusion restricted spots in MRI perioperatively (2.5%) and short-lasting symptoms directly after surgery, no patient experienced further new symptoms related to stroke or hemorrhages nor no new gliotic scars or microbleeds on MRI for 38.2 months. Duplex ultrasound 3 months after surgery documented bypass patency in 100% and sonographic sign for good relevance of the bypass in 96.2%. In addition, the diameter of the donor vessel had increased in 89.9% as an indicator for the relevance of the bypass. Semi-quantitative analysis of perfusion changes in the operated hemispheres demonstrated an increase in perfusion in the MCA territory in 56 of 74 (75.7%) hemispheres 36.7 months after surgery. In MRA images, a reduction of typical moyamoya collaterals was found in 65 of 79 hemispheres (82.3%) after a mean of 37.2 months. CONCLUSION Direct STA-MCA bypass is an effective therapy in Caucasian patients with hemodynamically compromised MA.
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Affiliation(s)
- Markus Kraemer
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany. .,Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Rusen Karakaya
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Peter Berlit
- Department of Neurology, Alfried Krupp von Bohlen und Halbach Hospital, Alfried-Krupp-Strasse 21, 45117, Essen, Germany
| | - Rudolf Laumer
- Department of Neurosurgery, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany
| | - Frank Diesner
- Department of Neurosurgery, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130, Essen, Germany
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Sakamoto S, Matsushige T, Abiko M, Shimonaga K, Hosogai M, Okazaki T, Ishii D, Oshita J, Kurisu K. Navigation of a 6-French guiding sheath into the common carotid artery using a tri-axial catheter system in transbrachial carotid artery stenting. Interv Neuroradiol 2018; 25:38-43. [PMID: 30114964 DOI: 10.1177/1591019918795034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Placement of a large-bore guiding sheath or catheter into the common carotid artery (CCA) is crucial in transbrachial carotid artery stenting (CAS). Herein, we describe technical tips for the navigation of a 6-French guiding sheath into the CCA using a tri-axial catheter system in transbrachial CAS. MATERIALS AND METHODS A total of 27 patients underwent transbrachial CAS. For the right side, a 6-French straight guiding sheath was navigated directly into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French straight guiding catheter. For the left side, a 6-French Simmons guiding sheath was navigated into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French Simmons guiding catheter. After the placement of a 6-French guiding sheath into the CCA, CAS was performed under distal filter or balloon protection. RESULTS Fifteen patients had a right carotid stenosis and 12 patients had a left carotid stenosis. The 6-French guiding sheath was safely placed with ease and provided adequate stabilization for CAS. All procedures were successfully performed without any complications. CONCLUSION The use of a tri-axial catheter system for the navigation of a 6-French guiding sheath into the CCA appears safe and efficient, allowing transbrachial CAS, with 6-French guiding sheath stabilization, to be performed without any complication.
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Affiliation(s)
- Shigeyuki Sakamoto
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshinori Matsushige
- 2 Department of Neurosurgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaru Abiko
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Koji Shimonaga
- 2 Department of Neurosurgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hosogai
- 2 Department of Neurosurgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Takahito Okazaki
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Daizo Ishii
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Jumpei Oshita
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kaoru Kurisu
- 1 Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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34
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Okazaki T, Sakamoto S, Shinagawa K, Ichinose N, Ishii D, Matsushige T, Kiura Y, Kurisu K. Detection of in-stent protrusion (ISP) by intravascular ultrasound during carotid stenting: Usefulness of stent-in-stent placement for ISP. Eur Radiol 2018; 29:77-84. [DOI: 10.1007/s00330-018-5636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022]
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35
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Matsushige T, Kraemer M, Sato T, Berlit P, Forsting M, Ladd ME, Jabbarli R, Sure U, Khan N, Schlamann M, Wrede KH. Visualization and Classification of Deeply Seated Collateral Networks in Moyamoya Angiopathy with 7T MRI. AJNR Am J Neuroradiol 2018; 39:1248-1254. [PMID: 29880473 DOI: 10.3174/ajnr.a5700] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Collateral networks in Moyamoya angiopathy have a complex angioarchitecture difficult to comprehend on conventional examinations. This study aimed to evaluate morphologic patterns and the delineation of deeply seated collateral networks using ultra-high-field MRA in comparison with conventional DSA. MATERIALS AND METHODS Fifteen white patients with Moyamoya angiopathy were investigated in this prospective trial. Sequences acquired at 7T were TOF-MRA with 0.22 × 0.22 × 0.41 mm3 resolution and MPRAGE with 0.7 × 0.7 × 0.7 mm3 resolution. Four raters evaluated the presence of deeply seated collateral networks and image quality in a consensus reading of DSA, TOF-MRA, and MPRAGE using a 5-point scale in axial source images and maximum intensity projections. Delineation of deeply seated collateral networks by different imaging modalities was compared by means of the McNemar test, whereas image quality was compared using the Wilcoxon signed-rank test. RESULTS The relevant deeply seated collateral networks were classified into 2 categories and 6 pathways. A total of 100 collateral networks were detected on DSA; 106, on TOF-MRA; and 73, on MPRAGE. Delineation of deeply seated collateral networks was comparable between TOF-MRA and DSA (P = .25); however, both were better than MPRAGE (P < .001). CONCLUSIONS This study demonstrates excellent delineation of 6 distinct deeply seated collateral network pathways in Moyamoya angiopathy in white adults using 7T TOF-MRA, comparable to DSA.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - M Kraemer
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany.,Department of Neurology (M.K.), University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Sato
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Department of Neurosurgery (T.S.), Fukushima Medical University, Fukushima, Japan
| | - P Berlit
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany
| | - M E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany.,Medical Physics in Radiology (M.E.L.), German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine (M.E.L.), University of Heidelberg, Heidelberg, Germany
| | - R Jabbarli
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - U Sure
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - N Khan
- Moyamoya Center, Division of Pediatric Neurosurgery (N.K.), Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.F., M.S.), University Hospital Essen, Essen, Germany.,Department of Neuroradiology (M.S.), University Hospital Cologne, Cologne, Germany
| | - K H Wrede
- From the Department of Neurosurgery (T.M., T.S., R.J., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany .,Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., T.S., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
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Matsushige T, Sakamoto S, Ishii D, Shinagawa K, Shimonaga K, Hosogai M, Kawasumi T, Oshita J, Okazaki T, Kurisu K. Safety and efficacy of a new outreach distal access catheter, TACTICS, for coil embolization of unruptured intracranial aneurysms. Interv Neuroradiol 2018; 24:482-488. [PMID: 29783870 DOI: 10.1177/1591019918774888] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and purpose Current large-bore catheters can be easily and safely placed in the intracranial vessels for the stabilization of microcatheters in several neurointervention scenarios. We considered that a novel 3.4 French catheter (TACTICS, Technorat Corporation, Aichi, Japan) might be useful for intermediate/distal access in a triaxial system. Here, we present our initial experience using the TACTICS catheter for treatment of intracranial aneurysms. Materials and methods A total of 35 endovascular coils were placed to embolize unruptured intracranial aneurysms of the anterior circulation using the TACTICS catheter between December 2016 and November 2017. These procedures were retrospectively reviewed to assess aneurysmal obliteration (Raymond's classification), the volume embolization ratio (VER) and procedural complications in comparison with 96 conventional coil treatments during the 3-year period up to 2016. Data were matched for aneurysmal morphology (location, maximum diameter and aspect ratio) by the propensity method. Results In all procedures, the TACTICS catheter was atraumatically landed beyond the carotid siphon. There were no hemorrhagic or symptomatic ischemic complications. After propensity matching, 68 procedures were assessed (34 in each group). Achievement of Raymond's scale 1 (complete occlusion) showed the same frequency in both groups (50% vs. 50%, p = 0.23). The VER was significantly higher with the TACTICS catheter than with the conventional method (34.0% vs. 28.7%, p = 0.003). Conclusion We reviewed our initial experience of the TACTICS catheter. It can be used as an intermediate catheter for safe and effective endovascular coil embolization of anterior circulation aneurysms.
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Affiliation(s)
- Toshinori Matsushige
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,2 Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daizo Ishii
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsuhiro Shinagawa
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koji Shimonaga
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,2 Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hosogai
- 2 Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Tomohiro Kawasumi
- 2 Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Junpei Oshita
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahito Okazaki
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- 1 Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ishii D, Sakamoto S, Okazaki T, Matsushige T, Shinagawa K, Ichinose N, Kurisu K. Overlapped Stenting Is Associated with Postoperative Hypotension after Carotid Artery Stenting. J Stroke Cerebrovasc Dis 2018; 27:653-659. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022] Open
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Ishii D, Matsushige T, Okazaki T, Shinagawa K, Sakamoto S, Oshita J, Kurisu K. Abstract TP405: Drastic Changes of Blood-brain Barrier Biomarkers After Direct Bypass Surgery for Moyamoya Angiopathy - A Preliminary Study -. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Drastic hemodynamic change can be expected after direct bypass surgery for moyamoya angiopathy (MMA). However hemodynamic hyperperfusion could be observed presumably because of the increased permeability of blood-brain barrier (BBB). The assessment of BBB related molecular proteins has never been investigated. The purpose of this study was to evaluate the perioperative serum levels of biomarkers representing BBB function in MMA patients based on the hypothesis that postoperative hemodynamic change may cause the instability of BBB.
Methods:
A total of 13 hemispheres in 12 patients with MMA were prospectively investigated. A superficial temporal artery - middle cerebral artery direct bypass was performed in all cases. All patients had blood examinations before and postoperative day (POD) 1, 4 and 7, respectively. The serum levels of tight juction proteins (occludin [OCLN] and claudin 5 [CLDN5]) and an adherence junction protein (vascular endothelial [VE]-cadherin) were measured quantitatively using enzyme linked immunosorbent assay. The percent change of these proteins compared to preoperative was calculated.
Results:
Successful patency of the direct bypass was obtained in all cases. No apparent hemorrhagic or ischemic changes were observed on CT and MR image in this study. The mean percent changes of OCLN, CLDN5 and VE-Cadherin on POD 1 were 523.3 ± 598.0%, 108.7 ± 297.0% and -23.9 ± 25.5%, respectively. The following changes of OCLN and CLDN were decreased; -7.7 ± 63.8% and 80.0 ± 320.9% on POD 4 and -9.1 ± 54.2% and 36.3 ± 209.1% on POD 7, respectively. On the other hand, there was no remarkable fluctuation on those of VE-Cadherin in this series. The serum levels of OCLN and CLDN5 on POD 1 were markedly elevated over 10 folds higher than baseline in two patients, who had transient neurological symptoms within 13 days after the surgery.
Conclusion:
In patients with MMA undergone direct bypass surgery, drastic changes of biomarkers representing tight junction of BBB were observed. These preliminary results suggested that marked hemodynamic change and temporary neurological symptom in some patients might be associated with the instability of BBB after direct bypass surgery for MMA.
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Ikawa F, Abiko M, Ishii D, Ohshita J, Matsushige T, Okazaki T, Sakamoto S, Hida E, Kobayashi S, Kurisu K. Analysis of outcome at discharge after aneurysmal subarachnoid hemorrhage in Japan according to the Japanese stroke databank. Neurosurg Rev 2017; 41:567-574. [PMID: 28821992 DOI: 10.1007/s10143-017-0894-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
Abstract
The outcomes at discharge for ruptured cerebral aneurysms after subarachnoid hemorrhage (SAH) were investigated using data from the Japanese stroke databank. Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients had SAH caused by ruptured saccular aneurysm. Of these, 3593 patients (1140 men and 2453 women; mean age 61.3 ± 13.7 years) were treated by surgical clipping (SC) and/or endovascular coiling (EC). The outcomes of modified Rankin scale (mRS) at discharge were compared between the SC and EC groups. There were 2666 cases in the SC group, 881 cases in the EC group, and 46 cases in the SC and EC group. The rates of poor outcome of mRS > 2 were 33.0 and 45.5% in the SC and EC groups (p < 0.05), respectively. Cases were selected using two types of criteria compatible with both treatments. Under the first compatible criteria, the rates of poor outcome of mRS > 2 were 18.9 and 24.8% in the SC and EC groups (p < 0.05), respectively. Under the second compatible criteria, the rates of poor outcome of mRS > 2 were 16.0 and 14.8% in the SC and EC groups (p = 0.22), respectively. No significant differences were found in clinical characteristics or outcomes between the two groups. Multivariate analysis of aneurysmal SAH revealed no significant risk for poor outcome associated with the treatment method. The present study was not a randomized controlled study, but no significant differences in mRS at discharge were found between SC and EC in the Japanese stroke databank.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Masaru Abiko
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Jyunpei Ohshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Eisuke Hida
- Center for Integrated Medical Research, Educational Research Division, Central Clinical Facilities, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Ishii D, Okazaki T, Matsushige T, Shinagawa K, Ichinose N, Sakamoto S, Kurisu K. Postoperative Dilatation of Superficial Temporal Artery Associated with Transient Neurologic Symptoms After Direct Bypass Surgery for Moyamoya Angiopathy. World Neurosurg 2017; 106:435-441. [PMID: 28720528 DOI: 10.1016/j.wneu.2017.07.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In moyamoya angiopathy, transient neurologic symptoms (TNS) are occasionally observed after superficial temporal artery (STA)-middle cerebral artery direct bypass surgery. The purpose of this study was to investigate the correlation between TNS and postoperative magnetic resonance imaging as well as perform a perfusion study. METHODS We reviewed 52 hemispheres in 33 consecutive patients with moyamoya angiopathy. TNS were defined as reversible neurologic dysfunction without any apparent intracranial infarction or hemorrhage. All patients underwent magnetic resonance imaging and single-photon emission computed tomography before and within 5 days after surgery. Maximum diameter of STA on time-of-flight magnetic resonance angiography and the dilatation ratio of STA were calculated. The presence of signal changes on fluid-attenuated inversion recovery images and regional cerebral blood flow were also evaluated. RESULTS TNS were observed in 13 of 52 (25%) cases 1-16 days after surgery. The mean preoperative STA dilatation, postoperative STA dilatation, and dilatation ratio of STA were 1.33 mm ± 0.27, 1.67 mm ± 0.30, and 29.31% ± 28.13%. Postoperative intraparenchymal cortical hyperintensity lesions and high-intensity signals in the cortex sulci (ivy sign) were detected in 24 (46.2%) cases and 29 (55.8%) cases, respectively. Univariate analyses demonstrated no association between TNS and postoperative signal change on fluid-attenuated inversion recovery images as well as cerebral blood flow. Only >1.5-fold dilatation of STA was significantly correlated with TNS (P < 0.0001). CONCLUSIONS STA dilatation was correlated with TNS after direct bypass surgery for moyamoya angiopathy.
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Affiliation(s)
- Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katsuhiro Shinagawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiko Ichinose
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Isozaki M, Satow T, Matsushige T, Mori H, Iihara K. Superselective Provocative Test with Propofol Using Motor-Evoked Potential Monitoring for Managing Cerebral Arteriovenous Malformations Fed by the Anterior Choroidal Artery. J Stroke Cerebrovasc Dis 2016; 25:e153-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/27/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022] Open
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Dammann P, Wrede K, Zhu Y, Matsushige T, Maderwald S, Umutlu L, Quick HH, Hehr U, Rath M, Ladd ME, Felbor U, Sure U. Correlation of the venous angioarchitecture of multiple cerebral cavernous malformations with familial or sporadic disease: a susceptibility-weighted imaging study with 7-Tesla MRI. J Neurosurg 2016; 126:570-577. [PMID: 27153162 DOI: 10.3171/2016.2.jns152322] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple cerebral cavernous malformations (CCMs) are rare lesions that occur in sporadic or familial form. Depending on the disease form, the natural history and treatment of the lesions strongly vary. Molecular analysis of an underlying germline mutation (CCM1-3) is the most sensitive screening method to distinguish between sporadic and familial cases. However, based on the different pathomechanisms that are believed to be involved in either form, significant distinctions in the CCM-associated cerebral venous angioarchitecture should be detectable. This has not been systematically studied. METHODS A consecutive series of 28 patients with multiple CCMs (681 total) diagnosed on 1.5-T MRI underwent genetic screening for CCM1-3 mutations and high-resolution susceptibility-weighted imaging (SWI) of the cerebral venous angioarchitecture with 7-T MRI. Imaging data were analyzed to examine the CCM-associated venous angioarchitecture. Results were correlated with findings of molecular analysis for CCM1-3 mutations. RESULTS Two different SWI patterns (sporadic and familial) were found. The presence of associated developmental venous anomalies correlated with negative screening for germline mutations (11 sporadic) in all cases. All patients with confirmed familial disease showed normal underlying venous angioarchitecture. Additionally, a very unusual case of a probable somatic mutation is presented. CONCLUSIONS The SWI results of the venous angioarchitecture of multiple CCMs correlate with sporadic or familial disease. These results are consistent with the theory that venous anomalies are causative for the sporadic form of multiple CCMs.
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Affiliation(s)
| | | | | | - Toshinori Matsushige
- Department of Neurosurgery.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Lale Umutlu
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, and.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Harald H Quick
- High Field and Hybrid MR Imaging, University Hospital Essen.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen
| | - Ute Hehr
- Center for and Department of Human Genetics, University of Regensburg
| | - Matthias Rath
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald
| | - Mark E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Ute Felbor
- Department of Human Genetics, University Medicine Greifswald and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald
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Matsushige T, Kraemer M, Schlamann M, Berlit P, Forsting M, Ladd ME, Sure U, Wrede KH. Ventricular Microaneurysms in Moyamoya Angiopathy Visualized with 7T MR Angiography. AJNR Am J Neuroradiol 2016; 37:1669-72. [PMID: 27151748 DOI: 10.3174/ajnr.a4786] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/05/2016] [Indexed: 11/07/2022]
Abstract
The pathophysiologic role of hemodynamic alteration to peripheral vessels in Moyamoya angiopathy and the formation of microaneurysms remains unclear. The purpose of this study was to investigate microaneurysms in collateral Moyamoya vessels by using 7T ultra-high-field MR imaging. Ten patients with Moyamoya disease were evaluated with TOF-MRA at 7T acquired with 0.22 × 0.22 × 0.41 mm(3) resolution. In 10 patients, 4 microaneuryms located in the ventricles were delineated. The mean diameters of collateral vessels and microaneurysms arising from those vessels were 0.87 mm (range, 0.79-1.07 mm) and 0.80 mm (range, 0.56-0.96 mm), respectively. In 1 case with follow-up scans 6 months after a direct extracranial-intracranial bypass operation, the microaneurysm disappeared. Ventricular microaneurysms in Moyamoya angiopathy collateral vessels, inaccessible by conventional imaging techniques, can be detected by 7T TOF-MRA.
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Affiliation(s)
- T Matsushige
- From the Departments of Neurosurgery (T.M., U.S., K.H.W.) Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - M Kraemer
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany
| | - M Schlamann
- Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Department of Neuroradiology (M.S.), University Hospital Giessen, Giessen, Germany
| | - P Berlit
- Department of Neurology (M.K., P.B.), Alfried Krupp Hospital, Essen, Germany
| | - M Forsting
- Diagnostic and Interventional Radiology and Neuroradiology (M.S., M.F.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M E Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany Division of Medical Physics in Radiology (M.E.L.), German Cancer Research Center, Heidelberg, Germany
| | - U Sure
- From the Departments of Neurosurgery (T.M., U.S., K.H.W.)
| | - K H Wrede
- From the Departments of Neurosurgery (T.M., U.S., K.H.W.) Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., M.E.L., K.H.W.), University Duisburg-Essen, Essen, Germany
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Matsushige T, Chen B, Ringelstein A, Umutlu L, Forsting M, Quick HH, Sure U, Wrede KH. Giant Intracranial Aneurysms at 7T MRI. AJNR Am J Neuroradiol 2016; 37:636-41. [PMID: 26564437 DOI: 10.3174/ajnr.a4569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022]
Abstract
Giant intracranial aneurysms are rare vascular pathologies associated with high morbidity and mortality. The purpose of this in vivo study was to assess giant intracranial aneurysms and their wall microstructure by 7T MR imaging, previously only visualized in histopathologic examinations. Seven giant intracranial aneurysms were evaluated, and 2 aneurysms were available for histopathologic examination. Six of 7 (85.7%) showed intraluminal thrombus of various sizes. Aneurysm walls were depicted as hypointense in TOF-MRA and SWI sequences with excellent contrast ratios to adjacent brain parenchyma (range, 0.01-0.60 and 0.58-0.96, respectively). The triple-layered microstructure of the aneurysm walls was visualized in all aneurysms in TOF-MRA and SWI. This could be related to iron deposition in the wall, similar to the findings in 2 available histopathologic specimens. In vivo 7T TOF-MRA and SWI can delineate the aneurysm wall and the triple-layered wall microstructure in giant intracranial aneurysms.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Department of Neurosurgery (T.M.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - B Chen
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
| | - A Ringelstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - L Umutlu
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R., L.U., M.F.)
| | - H H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany High Field and Hybrid MR Imaging (H.H.Q.), University Hospital Essen, Essen, Germany
| | - U Sure
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - K H Wrede
- From the Department of Neurosurgery (T.M., B.C., U.S., K.H.W.), University Hospital Essen, University Duisburg-Essen, Essen, Germany Erwin L. Hahn Institute for Magnetic Resonance Imaging (T.M., B.C., L.U., H.H.Q., K.H.W.), University Duisburg-Essen, Essen, Germany
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Wrede KH, Matsushige T, Goericke SL, Chen B, Umutlu L, Quick HH, Ladd ME, Johst S, Forsting M, Sure U, Schlamann M. Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography. Eur Radiol 2016; 27:354-364. [DOI: 10.1007/s00330-016-4323-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 11/25/2022]
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Matsushige T, Akiyama Y, Okazaki T, Shinagawa K, Ichinose N, Awai K, Kurisu K. Vascular Wall Imaging of Unruptured Cerebral Aneurysms with a Hybrid of Opposite-Contrast MR Angiography. AJNR Am J Neuroradiol 2015; 36:1507-11. [PMID: 25929881 DOI: 10.3174/ajnr.a4318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Inflammation and degeneration of the intracranial saccular aneurysm wall play a major role in aneurysm formation, development and subsequent rupture. The aim of this study was to characterize the walls of unruptured intracranial aneurysms by using a hybrid of opposite-contrast MRA at 3T. MATERIALS AND METHODS Fourteen consecutive patients with 17 unruptured intracranial aneurysms who initially underwent clipping surgery were prospectively evaluated. All aneurysms were scanned preoperatively by using a hybrid of opposite-contrast MRA in 3T high-resolution MR imaging. We classified intraoperative findings of atherosclerotic plaques in the aneurysms into 3 grades: grade A (major plaques), grade B (minor plaques), and grade C (no plaques). The contrast ratio of the high-intensity area was also measured relative to the background low-intensity area inside the carotid artery. RESULTS Findings from preoperative plaque imaging of the aneurysm corresponded to the intraoperative findings in 15 of 16 aneurysms (excluding 1 that was impossible to visualize in its entirety due to anatomic reasons). Overall sensitivity and specificity of the hybrid of opposite-contrast MRA were 88.9% and 100%, respectively. During the operation, 4 aneurysms were classified as grade A; 5, as grade B; and 7, as grade C. The means of the contrast ratio for grades A, B, and C were 0.72 ± 0.03, 0.34 ± 0.30, and -0.02 ± 0.09, respectively. CONCLUSIONS The hybrid of opposite-contrast MRA can detect visible atherosclerotic plaques in the unruptured aneurysm wall, and the contrast ratio in intracranial aneurysms correlated with their presence and extent. A study including a larger series is needed to validate the diagnostic potential of this imaging technique.
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Affiliation(s)
- T Matsushige
- From the Department of Neurosurgery (T.M., T.O., K.S., N.I., K.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Department of Neurosurgery (T.M.), University Hospital Essen, Essen, Germany
| | - Y Akiyama
- Department of Diagnostic Radiology (Y.A., K.A.), Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - T Okazaki
- From the Department of Neurosurgery (T.M., T.O., K.S., N.I., K.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - K Shinagawa
- From the Department of Neurosurgery (T.M., T.O., K.S., N.I., K.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - N Ichinose
- From the Department of Neurosurgery (T.M., T.O., K.S., N.I., K.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - K Awai
- Department of Diagnostic Radiology (Y.A., K.A.), Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - K Kurisu
- From the Department of Neurosurgery (T.M., T.O., K.S., N.I., K.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Koltzenburg G, Matsushige T, Schulte-Frohlinde D. The Mechanism of Decay of the Radical HO—CH—CH2—OCOCH3 in Aqueous Solutions. A Conductometric Pulse Radiolysis Study. ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1976-0713] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From conductivity changes following a 1 µs electron pulse applied to Ν2Ο saturated H2O or D2Ο solutions of acetic acid 2-hydroxyethyl esterthe rate constants of the monomolecular decay of the radical HO-ĊH-CH2-OCOCH3 (1) in H2O and of DO-ĊH-CH2-OCOCH3 in D2O were derived, reaction (1).
A value of k1 of 5.5 · 105 s-1 ± 25%, at 22 to 24°C, independent of the above solvents and of pH (or pD) was obtained. It is concluded that the rate determining step of reaction (1) is the heterolytic fragmentation of the carbon acetate bond in 1 followed by formation of H+.
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Affiliation(s)
- G. Koltzenburg
- Institut für Strahlenchemie im Max-Planck-Institut für Kohlenforschung, Mülheim a. d. Ruhr
| | - T. Matsushige
- Institut für Strahlenchemie im Max-Planck-Institut für Kohlenforschung, Mülheim a. d. Ruhr
| | - D. Schulte-Frohlinde
- Institut für Strahlenchemie im Max-Planck-Institut für Kohlenforschung, Mülheim a. d. Ruhr
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Satow T, Murao K, Matsushige T, Fukuda K, Miyamoto S, Iihara K. Superselective shunt occlusion for the treatment of cavernous sinus dural arteriovenous fistulae. Neurosurgery 2014; 73:ons100-5. [PMID: 23538401 DOI: 10.1227/neu.0b013e31828ba578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In treating cavernous sinus dural arteriovenous fistulae (CSdAVFs), transvenous embolization of the whole affected sinus is usually performed, which may result in the disturbance of normal venous drainage or permanent cranial nerve palsy. OBJECTIVE To describe superselective shunt occlusion of CSdAVFs. METHODS Between July 2005 and August 2011, we had 20 consecutive cases of CSdAVFs. In 14 cases (70%), we could detect the restricted locus of arteriovenous shunts by 3-dimensional rotational angiography and/or superselective arteriography. After navigating the microcatheter to the shunt segment, consecutive superselective arteriovenography was performed to confirm the location of the microcatheter at the proper position. RESULTS In 12 of 14 cases (85.7%) in which the shunt was restricted, coiling only in the small venous pouch or compartment, which was just downstream of the shunt point, led to complete disappearance of the shunt without obliterating the entire sinus. No recurrence or permanent cranial nerve palsy was observed during the follow-up period with a mean of 46 months (range, 3-69 months) in 12 cases treated by superselective shunt occlusion. CONCLUSION This technique, which enables complete extirpation of shunts by small amounts of coils, is a feasible way to treat CSdAVFs with excellent mid- to long-term results. Understanding of the angioarchitecture by 3-dimensional rotational angiography and consecutive superselective arteriovenography was useful. This method should be considered before sinus packing or mere obliteration of dangerous venous outlets.
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Affiliation(s)
- Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
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Tanaka K, Ohara T, Ishigami A, Ikeda Y, Matsushige T, Satow T, Ishibashi-Ueda H, Iihara K, Toyoda K. Fatal Multiple Systemic Emboli after Intravenous Thrombolysis for Cardioembolic Stroke. J Stroke Cerebrovasc Dis 2014; 23:395-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/24/2022] Open
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Iihara K, Satow T, Matsushige T, Kataoka H, Nakajima N, Fukuda K, Isozaki M, Maruyama D, Nakae T, Hashimoto N. Hybrid Operating Room for the Treatment of Complex Neurovascular and Brachiocephalic Lesions. J Stroke Cerebrovasc Dis 2013; 22:e277-85. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/19/2012] [Accepted: 07/15/2012] [Indexed: 02/07/2023] Open
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