Publications (19)83.98 Total impact
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Article: The clinical results of transcervical carotid artery stenting and frequency chosen as the approach route of carotid artery stenting in 1,067 consecutive cases.
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ABSTRACT: BACKGROUND: Carotid artery stenting (CAS) is generally performed via a transfemoral approach. A transbrachial approach is usually chosen as an alternative when CAS via a transfemoral approach is difficult. At our institutions, a transcervical approach is chosen when the previous two approach routes are not available. We reviewed CAS cases treated via the transcervical route in our 1,067 CAS series to investigate the safety, feasibility, and frequency of this procedure as an approach route of CAS. METHODS: We performed 1,067 CAS procedures in 1,067 consecutive cases between December 2002 and June 2011. Initially, a transfemoral route was chosen, and secondarily a transbrachial route, the last choice was a transcervical route. A transbrachial approach was chosen in 96 (9.0 %) cases and a transcervical approach in ten (0.9 %). We reviewed the characteristics and outcomes of CAS performed via a transcervical approach. RESULTS: CAS was successfully performed on all ten transcervical-approach patients. Eight procedures were performed under local anesthesia and two under general anesthesia. Perioperative morbidity and mortality were both 0 %. The modified Rankin scale (mRS) showed no deterioration at 3 months except for one case whose mRS became five because of an embolic stroke after aortic valve replacement. CONCLUSIONS: CAS via a transcervical approach was safe and feasible, and its frequency chosen as an approach route was 0.9 %. This procedure can be an alternative to transfemoral or transbrachial approaches when CAS via either of these approaches is too difficult.Acta Neurochirurgica 05/2013; · 1.52 Impact Factor -
Article: Cilostazol activates function of bone marrow-derived endothelial progenitor cell for re-endothelialization in a carotid balloon injury model.
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ABSTRACT: Cilostazol(CLZ) has been used as a vasodilating anti-platelet drug clinically and demonstrated to inhibit proliferation of smooth muscle cells and effect on endothelial cells. However, the effect of CLZ on re-endothelialization including bone marrow (BM)-derived endothelial progenitor cell (EPC) contribution is unclear. We have investigated the hypothesis that CLZ might accelerate re-endothelialization with EPCs. Balloon carotid denudation was performed in male Sprague-Dawley rats. CLZ group was given CLZ mixed feed from 2 weeks before carotid injury. Control group was fed normal diet. CLZ accelerated re-endothelialization at 2 weeks after surgery and resulted in a significant reduction of neointima formation 4 weeks after surgery compared with that in control group. CLZ also increased the number of circulating EPCs throughout the time course. We examined the contribution of BM-derived EPCs to re-endothelialization by BM transplantation from Tie2/lacZ mice to nude rats. The number of Tie2-regulated X-gal positive cells on injured arterial luminal surface was increased at 2 weeks after surgery in CLZ group compared with that in control group. In vitro, CLZ enhanced proliferation, adhesion and migration activity, and differentiation with mRNA upregulation of adhesion molecule integrin αvβ3, chemokine receptor CXCR4 and growth factor VEGF assessed by real-time RT-PCR in rat BM-derived cultured EPCs. In addition, CLZ markedly increased the expression of SDF-1α that is a ligand of CXCR4 receptor in EPCs, in the media following vascular injury. CLZ promotes EPC mobilization from BM and EPC recruitment to sites of arterial injury, and thereby inhibited neointima formation with acceleration of re-endothelialization with EPCs as well as pre-existing endothelial cells in a rat carotid balloon injury model. CLZ could be not only an anti-platelet agent but also a promising tool for endothelial regeneration, which is a key event for preventing atherosclerosis or restenosis after vascular intervention.PLoS ONE 01/2011; 6(9):e24646. · 4.09 Impact Factor -
Article: Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage.
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ABSTRACT: The efficacy and pitfalls of endovascular recanalization were evaluated in cases of internal carotid artery (ICA) occlusion in the subacute to chronic stage. Fourteen cases (15 lesions) of symptomatic ICA occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. The Parodi embolic protection system was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal ICA to the common carotid artery. Recanalization of the occluded ICA was possible in 14 of 15 lesions. The occlusion points were 10 cervical ICAs and 4 petrous/cavernous ICAs in successfully recanalized cases. Ischemic symptoms disappeared completely after the treatment, and new ischemic symptoms did not appear related to the treated lesion. Single photon emission computed tomography findings demonstrated the improvement of hemodynamic compromise in all cases. One case showed right middle cerebral artery branch occlusion during the procedure, but this patient's neurological symptoms were stable due to preexisting hemiparesis. Endovascular recanalization was possible and effective in improving hemodynamic compromise. However, there are still several problems with this technique, such as hyperperfusion syndrome after recanalization, cerebral embolism during treatment, durability after treatment, and identification of the occlusion point before treatment. Endovascular recanalization using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise or refractoriness to antiplatelet therapy, even in the subacute to chronic stage of the illness.Journal of Neurosurgery 08/2009; 112(3):563-71. · 2.96 Impact Factor -
Article: Successful recanalization by in-stent percutaneous transluminal angioplasty with distal protection for acute carotid stent thrombosis.
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ABSTRACT: A 71-year-old male presented with severe left cervical internal carotid artery stenosis manifesting as repeated transient ischemic attacks consisting of right hemiparesis and motor aphasia. Carotid artery stenting (CAS) under distal protection was performed to prevent further ischemic events. This procedure was uneventful. However, the patient exhibited progressive right hemiparesis and motor aphasia 3 days after CAS. Emergent angiography revealed carotid artery occlusion due to in-stent thrombosis. In-stent percutaneous transluminal angioplasty (PTA) was performed under distal protection. The carotid artery was recanalized with small residual thrombus. The neurological deficits almost completely disappeared after PTA. Follow-up angiography 9 months after stenting showed restenosis but no in-stent thrombosis. Carotid thrombosis after CAS can be resolved by in-stent PTA under distal protection and subsequent treatment with antithrombotic agents.Neurologia medico-chirurgica 11/2006; 46(10):495-9. · 0.61 Impact Factor -
Article: Endovascular treatment for pseudo-occlusion of the internal carotid artery.
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ABSTRACT: The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. Twenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion. All pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%. The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.Neurosurgery 09/2006; 59(2):301-9; discussion 301-9. · 2.79 Impact Factor -
Article: Hemorrhagic complications after endovascular therapy for atherosclerotic intracranial arterial stenoses.
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ABSTRACT: Hemorrhagic complications were analyzed in 106 procedures of 99 patients treated with percutaneous transluminal angioplasty (PTA) or stenting for intracranial arterial stenoses. Ninety-nine patients with intracranial arterial stenosis were treated with PTA or stenting 106 times from January 1995 to December 2003. Fifty-seven patients had intracranial internal carotid artery stenosis, 23 had middle cerebral artery stenosis, and 19 had vertebrobasilar stenosis. Evaluation of hemodynamic compromise via single-photon emission computed tomography was performed 50 times for 50 patients before the treatment. Four hemorrhagic complications occurred in 106 procedures. Two of these cases involved intracerebral hemorrhage after PTA or stenting in the treated vascular territory 30 minutes and 16 hours after the treatment, respectively. One case showed subarachnoid hemorrhage, which appeared 6 hours after treatment. Hemodynamic compromise was found on single-photon emission computed tomography in these three cases. The last case with a hemorrhagic complication was a hemorrhagic infarction after recanalization of stent thrombosis, which appeared 3 days after stenting. Hyperperfusion syndrome was strongly suggested as the cause of hemorrhage in the two cases associated with intracerebral hemorrhage. The rate of hemorrhagic complication directly related to the procedure of PTA or stenting was 3%, and hyperperfusion syndrome was suggested as the cause of hemorrhage in two cases (2%), from the perspective of clinical characteristics and single-photon emission computed tomographic findings.Neurosurgery 09/2006; 59(2):310-8; discussion 310-8. · 2.79 Impact Factor -
Article: Carotid artery stenting for stenosis with intraluminal thrombus.
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ABSTRACT: Since intraluminal thrombus in the context of carotid artery stenosis is rarely encountered, treatment for this condition remains controversial. The present paper describes six cases of carotid artery stenosis with thrombus and discusses the efficacy and complications of carotid artery stenting (CAS). From April 2002 to May 2004, six patients with carotid artery stenosis and intraluminal thrombus receiving medical therapy underwent CAS at our institution. CAS was performed with distal protection alone (method 1) in three patients, and three other patients underwent CAS with reversed-flow system and distal protection (method 2). Two of six patients experienced worsening neurologic symptoms despite medical therapy. All six patients were successfully treated with CAS and showed satisfactory patency of the artery. Embolic lesions were detected on diffusion-weighted MRI after the procedure in all patients treated with method 1 but not in patients treated with method 2. Complications included stent thrombosis (n=1) and in-stent thrombus (n=1). All six patients achieved a modified Rankin Scale 1 or 2 classification at 30 days after stenting. In conclusion, CAS was feasible for stenosis even with intraluminal thrombus. Use of method 2 for this condition may reduce the incidence of thromboembolic events although our series was small in number.Neuroradiology 02/2006; 48(1):54-9. · 2.82 Impact Factor -
Article: Progressive attenuation of myocardial vascular endothelial growth factor expression is a seminal event in diabetic cardiomyopathy: restoration of microvascular homeostasis and recovery of cardiac function in diabetic cardiomyopathy after replenishment of local vascular endothelial growth factor.
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ABSTRACT: Diabetic cardiomyopathy (DCM) is characterized by microvascular pathology and interstitial fibrosis, which leads to progressive heart failure; however, the pathogenesis of DCM remains uncertain. Using the streptozotocin-induced diabetic rat model, we evaluated the natural course of DCM over a period of 1 year by serial echocardiography, Western blot analysis for vascular endothelial growth factor (VEGF), endothelial progenitor cell assays, myocardial blood flow measurements, and histopathologic analysis that included terminal dUTP nick end-labeling (TUNEL), capillary and cardiomyocyte density, and fibrosis area. Downregulation of myocardial VEGF expression preceded all other features of DCM and was followed by increased apoptosis of endothelial cells, decreased numbers of circulating endothelial progenitor cells, decreased capillary density, and impaired myocardial perfusion. Apoptosis and necrosis of cardiomyocytes ensued, along with fibrosis and progressive diastolic and then systolic dysfunction. To provide further evidence of the central role of VEGF in the pathophysiology of DCM, we replenished myocardial VEGF expression using naked DNA gene therapy via direct intramyocardial injection of plasmid DNA encoding VEGF (phVEGF165). VEGF-replenished rats showed increased capillary density, decreased endothelial cell and cardiomyocyte apoptosis, and in situ differentiation of bone marrow-derived endothelial progenitor cells into endothelial cells. These anatomic findings were accompanied by significant improvements in cardiac function. These findings suggest that downregulation of VEGF may compromise microvascular homeostasis in the myocardium and thereby play a central role in the pathogenesis of DCM.Circulation 05/2005; 111(16):2073-85. · 14.74 Impact Factor -
Article: Use of an embolic protection system during endovascular recanalization of a totally occluded cervical internal carotid artery at the chronic stage. Case report.
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ABSTRACT: A symptomatic internal carotid artery (ICA) occlusion with hemodynamic compromise was treated at its chronic stage by using an endovascular technique. An embolic protection system was used during the recanalization procedure to prevent stroke by reversing the flow from the distal ICA to the common carotid artery. The totally occluded ICA was completely recanalized through percutaneous transluminal angioplasty and stent placement. The patient's symptom (transient ischemic attack) disappeared completely after treatment with no new neurological deficit. Single-photon emission computerized tomography findings confirmed improvement of the hemodynamic compromise, and no new high-intensity spots appeared on diffusion-weighted magnetic resonance imaging after treatment. This case shows that endovascular recanalization by using an embolic protection device can be considered as an alternative treatment for symptomatic ICA occlusion with hemodynamic compromise and refractoriness to antiplatelet therapy, even in the chronic stage of the illness.Journal of Neurosurgery 04/2005; 102(3):558-64. · 2.96 Impact Factor -
Article: Patency of perforating arteries after stent placement? A study using an in vivo experimental atherosclerosis-induced model.
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ABSTRACT: The recent advent of flexible stents has enabled their application in intracranial atherosclerotic disease. However, it is unclear whether perforating artery occlusion occurs after stent placement in atherosclerotic stenotic vessels. We investigated this issue by using experimental atherosclerosis-induced rabbits. A stainless steel balloon-expandable stent was deployed into the atherosclerosis-induced abdominal aorta across the lumbar artery in six New Zealand white rabbits. This model system is suitable because the diameter of the abdominal aorta is similar to that of human intracranial arteries. We evaluated the patency of the lumbar artery by using angiography and scanning electron microscopy (SEM) 3 months after stent placement. Histopathologic evaluation also was performed in one rabbit. The lumbar artery was patent in five of six rabbits per angiography. The lumbar artery was occluded with an intraluminal thrombus in one rabbit. However, SEM findings demonstrated that the stent struts were covered completely with a thick neointima and the ostium of the lumbar artery became narrowed in all cases. In the one lumbar artery that was occluded at angiography, histopathologic findings confirmed that intraluminal thrombus surrounded the stent struts crossing the ostium. We observed luminal narrowing after stent placement in an atherosclerotic stenotic vessel, although patency of the perforating arteries was generally maintained.American Journal of Neuroradiology 04/2005; 26(3):543-8. · 2.93 Impact Factor -
Article: Diffusion-weighted imaging abnormalities after percutaneous transluminal angioplasty and stenting for intracranial atherosclerotic disease.
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ABSTRACT: The literature contains relatively few reports of distal embolism associated with intervention for intracranial atherosclerotic disease. Our purpose was to evaluate the frequency of thromboembolic events after percutaneous transluminal angioplasty (PTA) or stent placement in this setting by using diffusion-weighted (DW) imaging. Between October 1999 and January 2004, 16 consecutive patients with symptomatic intracranial arterial stenosis greater than 60% were treated with PTA or stent placement without a protection system. Whole-brain DW imaging was performed before and after intervention. DW imaging findings were retrospectively analyzed and divided into three groups according to new hyperintensities: type A was none; type B, a single lesion; and type C, multiple lesions. Nine type A, five type B, and three type C lesions were detected after the interventions. All hyperintense lesions were less than 5 mm in diameter. All type C lesions occurred in the context of internal carotid artery stenosis treated with stent placement. DW imaging abnormalities occurred most frequently when PTA followed by stent placement was performed for long internal carotid artery stenoses. No new neurologic deficits occurred in any patient. In this series, PTA or stent placement or both for intracranial atherosclerotic lesions was safe. New DW imaging abnormalities were less frequent in patients who underwent PTA alone or primary stent placement than in those receiving PTA followed by stent placement.American Journal of Neuroradiology 03/2005; 26(2):385-9. · 2.93 Impact Factor -
Article: Endovascular therapy for acute thrombotic occlusion of the intracranial artery.
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ABSTRACT: The goal of this study was to evaluate the efficacy of endovascular therapy for acute thrombotic occlusion. Six patients with acute thrombotic occlusion in the middle cerebral or basilar arteries underwent treatment with intra-arterial thrombolysis, followed by assessment of residual stenosis. If residual stenosis was greater than 70%, percutaneous transluminal angioplasty (PTA) was performed in the same session; otherwise, patients were anticoagulated, and PTA was performed several days later. Successful recanalization was achieved in five of six patients. One patient died of massive infarction, because of the failure of recanalization of the M1 segment. At discharge, modified Rankin scale distribution of the patients was: grade 0, one patient; grade 1, one patient; grade 2, two patients; grade 3, one patient; grade 6, one patient. Retreatment was required via PTA or stenting in two patients in which type C stenosis was present. In conclusion, endovascular therapy for acute thrombotic occlusion of an intracranial artery appears to be effective compared to conservative therapy. However, further refinement of the technique is required to prevent various complications, including vessel perforation, dissection, perforating artery occlusion and restenosis.Neuroradiology 07/2004; 46(6):453-8. · 2.82 Impact Factor -
Article: Results of endovascular treatment of internal carotid artery stenoses with a newly developed balloon protection catheter.
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ABSTRACT: A new balloon protection catheter to prevent distal emboli during internal carotid artery percutaneous transluminal angioplasty and stenting was developed, and its efficacy was evaluated in both an experimental model and clinical cases. The balloon protection catheter was navigated over a steerable 0.014-inch guidewire to negotiate tight stenoses and sharp bends, which would cause difficulties for the passage of a flow-directed balloon catheter. Percutaneous transluminal angioplasty and stenting were performed for 85 consecutive patients with 87 stenotic lesions of the cervical internal carotid artery, with two different methods using this protection system. Distal protection was provided only after dilation for the initial 38 lesions (Group I), but the latter 49 lesions were treated in both the pre- and postdilation periods (Group II). The effects of using the balloon protection catheter with the embolic debris clearance technique were evaluated with pre- and postoperative magnetic resonance imaging for each group. The balloon protection catheter was introduced beyond the stenosis in all cases. In Group I, one symptomatic embolic stroke was caused by distal embolization resulting from atheromatous plaque, and high-intensity areas appeared on diffusion-weighted magnetic resonance imaging scans in 47% of cases. In contrast, in Group II, there were no strokes related to the procedure, although one patient with multiple risk factors died suddenly on the second day after stenting. Diffusion-weighted imaging scans demonstrated small, high-intensity areas in 19% of cases in Group II. The overall morbidity/mortality rate in our series was 2.3%. Our new balloon protection catheter was reliably navigated across internal carotid artery stenoses and reduced distal embolism in clinical cases.Neurosurgery 10/2003; 53(3):617-23; discussion 623-5. · 2.79 Impact Factor -
Article: Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement.
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ABSTRACT: The effects of percutaneous transluminal angioplasty (PTA) and stent placement for stenosis of the petrous or cavernous portion of the internal carotid artery (ICA) were compared. Twenty-four patients with symptomatic, greater than 60% stenosis of the petrous or cavernous portion of the ICA were treated using PTA or stent placement; 15 were treated with PTA and nine with stent insertion. Initial and follow-up results (> 3 months posttreatment) were compared in each group. Stenotic portions of the ICA were successfully opened in 13 of 15 patients in the PTA group, and in all nine patients in the stent-treated group. In one case in the PTA group stent delivery was attempted; however, the device could not pass through the vessel's tortuous curve, and PTA alone was performed in this case. Postoperatively, the mean stenotic ratio decreased from 72.1 to 29.6% in the PTA group, and from 75.6 to 2.2% in the stent-treated group. In four patients in the PTA group, stenoses greater than 50% were demonstrated on follow-up angiography performed at 3 to 6 months after PTA. In the stent-treated group, no restenosis was encountered, although in one case acute occlusion of the stent occurred; the device was recanalized with PTA and infusion of tissue plasminogen activator. This case was the only one of the 24 in which any neurological deficits related to the endovascular procedure occurred. Stent placement brought a greater gain in diameter than did PTA at the initial and late follow-up period; this gain was statistically significant. Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.Journal of Neurosurgery 03/2003; 98(3):491-7. · 2.96 Impact Factor -
Article: Stromal cell-derived factor-1 effects on ex vivo expanded endothelial progenitor cell recruitment for ischemic neovascularization.
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ABSTRACT: Stromal cell-derived factor-1 (SDF-1) is a chemokine considered to play an important role in the trafficking of hematopoietic stem cells. Given the close relationship between hematopoietic stem cells and endothelial progenitor cells (EPCs), we investigated the effect of SDF-1 on EPC-mediated vasculogenesis. Flow cytometric analysis demonstrated expression of CXCR4, the receptor of SDF-1, by 66+/-3% of EPCs after 7 days in culture. In vitro modified Boyden chamber assay showed a dose-dependent EPC migration toward SDF-1 (control versus 10 ng/mL SDF-1 versus 100 ng/mL SDF-1, 24+/-2 versus 71+/-3 versus 140+/-6 cells/mm2; P<0.0001). SDF-1 attenuated EPC apoptosis (control versus SDF-1, 27+/-1 versus 7+/-1%; P<0.0001). To investigate the effect of SDF-1 in vivo, we locally injected SDF-1 into athymic ischemic hindlimb muscle of nude mice combined with human EPC transplantation to determine whether SDF-1 augmented EPC-induced vasculogenesis. Fluorescence microscopic examination disclosed increased local accumulation of fluorescence-labeled EPCs in ischemic muscle in the SDF-1 treatment group (control versus SDF-1=241+/-25 versus 445+/-24 cells/mm2, P<0.0001). At day 28 after treatment, ischemic tissue perfusion was improved in the SDF-1 group and capillary density was also increased. (control versus SDF-1, 355+/-26 versus 551+/-30 cells/mm2; P<0.0001). These findings indicate that locally delivered SDF-1 augments vasculogenesis and subsequently contributes to ischemic neovascularization in vivo by augmenting EPC recruitment in ischemic tissues.Circulation 03/2003; 107(9):1322-8. · 14.74 Impact Factor -
Article: Intramyocardial transplantation of autologous endothelial progenitor cells for therapeutic neovascularization of myocardial ischemia.
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ABSTRACT: We investigated whether catheter-based, intramyocardial transplantation of autologous endothelial progenitor cells can enhance neovascularization in myocardial ischemia. Myocardial ischemia was induced by placement of an ameroid constrictor around swine left circumflex artery. Four weeks after constrictor placement, CD31+ mononuclear cells (MNCs) were freshly isolated from the peripheral blood of each animal. After overnight incubation of CD31+ MNCs in noncoated plates, nonadhesive cells (NA/CD31+ MNCs) were harvested as the endothelial progenitor cell-enriched fraction. Nonadhesive CD31- cells (NA/CD31- MNCs) were also prepared. Autologous transplantation of 10(7) NA/CD31+ MNCs, 10(7) NA/CD31- MNCs, or PBS was performed with a NOGA mapping injection catheter to target ischemic myocardium. In a parallel study, 10(5) human CD34+ MNCs, 10(5) human CD34- MNCs, or PBS was transplanted into ischemic myocardium of nude rats 10 minutes after ligation of the left anterior descending coronary artery. In the swine study, ischemic area by NOGA mapping, Rentrop grade angiographic collateral development, and echocardiographic left ventricular ejection fraction improved significantly 4 weeks after transplantation of NA/CD31+ MNCs but not after injection of NA/CD31- MNCs or PBS. Capillary density in ischemic myocardium 4 weeks after transplantation was significantly greater in the NA/CD31+ MNC group than the control groups. In the rat study, echocardiographic left ventricular systolic function and capillary density were significantly better preserved in the CD34+ MNC group than in the control groups 4 weeks after myocardial ischemia. These favorable outcomes encourage future clinical trials of catheter-based, intramyocardial transplantation of autologous CD34+ MNCs in the setting of chronic myocardial ischemia.Circulation 02/2003; 107(3):461-8. · 14.74 Impact Factor -
Article: Study of the patency of small arterial branches after stent placement with an experimental in vivo model.
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ABSTRACT: The patency of intracranial perforating arteries after stent placement is unknown despite the general clinical use of intracranial arterial stenting. We deployed stainless steel stents in the abdominal aorta across the lumbar artery in eight normal rabbits in which the diameters of the abdominal arterial vessels were similar to those of human intracranial arteries. We evaluated the patency via angiographic and scanning electron microscopic methods 3 months after stent placement. Histopathologic evaluation was also performed for one rabbit. The lumbar arteries were patent, even when stent struts crossed the ostium, except in one rabbit in which intimal dissection occurred intraoperatively. The scanning electron microscopy showed that the regenerative endothelium had grown onto the strut at the ostium of the lumbar artery. We confirmed the patency of the lumbar arteries in this study by using normal rabbits. Thus, intracranial stenting may not pose a risk of occluding perforating arteries of the same diameter of the lumbar artery, even if stent struts cover the ostium.American Journal of Neuroradiology 05/2002; 23(4):706-10. · 2.93 Impact Factor -
Article: Presigmoid approach for cavernous angioma in the pons--technical note.
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ABSTRACT: Surgical treatment of brainstem lesions has been encouraged after the development of magnetic resonance imaging. However, direct approaches to intra-axial lesions in the brainstem still carry a high risk of morbidity because the neuronal structures can be injured along the entry routes. We present two patients whose pontine cavernous angiomas were removed via incision of the lateral aspect of the pons with presigmoid approach. The first case, a 41-year-old woman, presented with paresis of the cranial nerves VI, VII, and VIII, and left hemiparesis progressing over 2 weeks caused by a cavernous angioma ventrally located in the lower pons. The second case, a 50-year-old woman, developed dizziness over 2 months due to a large cavernous angioma in the center of the pons. These lesions were totally removed through the presigmoid approach and no additional neurological deficits were observed. An image-guided navigation system was used for the craniotomy and removal of the lesion in the second patient. The presigmoid approach provides a safe route to intra-axial lesions in the pons. A technique for presigmoid craniotomy with one-piece bone flap under the image-guided navigation is also described.Neurologia medico-chirurgica 03/2002; 42(2):91-6; discussion 97-8. · 0.61 Impact Factor -
Article: Multiple cerebral aneurysms with persistent primitive trigeminal artery
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ABSTRACT: We report a patient with a persistent primitive trigeminal artery (PPTA) detected incidentally during cerebral angiography for the ruptured aneurysm. Cerebral angiography revealed a PPTA and eight anterior circulation cerebral aneurysms. Although cerebrovascular fragility, hemodynamic stress and hypertension are well known as etiologic factors for development of cerebral aneurysms, there is a known association of aneurysms with a PPTA, fetal carotid-basilar anastomosis. Furthermore, this case is rare from the viewpoint of aneurysm multiplicity.Journal of Clinical Neuroscience 01/1999; · 1.25 Impact Factor
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2002–2006
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Wakayama University
Wakayama-shi, Wakayama-ken, Japan
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