脳血管内治療部｜診療部門・中央診療部門｜診療科・部門一覧

2024年04月01日現在

部長から皆さまへ

脳血管内手術は血管の中に極微細のカテーテルを頭蓋内血管まで挿入し、レントゲン透視下に血管の内部から脳血管障害（脳卒中）やある種の脳腫瘍等を治療する新しい分野です。従来の開頭方法による手術では治療困難であった様々な疾患が、この方法によって治療可能となってきました。慈恵医大脳血管内治療部では脳血管障害を中心に最先端の診療および研究を行っています。現在、脳血管内治療部では以下のような病気に対する治療を行っています。

診療部長／教授　村山　雄一

診療内容

脳神経領域に関わる、脳動脈瘤、脳血管奇形、硬膜動静脈瘻、脳梗塞、頚動脈狭窄・脳血管疾患全般の外科的診療
カテーテルによる脳血管内手術、開頭手術に対応するHybrid 手術室を駆使した外科的治療と脳血管内治療の融合
脳卒中診療では、Hybrid手術を利用した、診断、検査、治療、治療後の脳血流評価まで一括して可能にする「One stop service Stroke Care」の確立
医工連携を基盤とした産学共同連携を利用した基礎および臨床研究。
新しい治療機器の開発

くわしくは脳血管内治療センターホームページをご覧ください。

当診療科の得意分野・特色

脳動脈瘤に対しては従来からのコイル塞栓術のみならずフローダイバーターと呼ばれる新しい網目の細かなステント留置術など最新の低侵襲治療を手がけております。脳梗塞に対する急性期血栓回収術や、脳梗塞の原因となる頚部頚動脈狭窄症に対する頚動脈ステント留置術(CAS)も積極的に行っています。また脳動静脈奇形や硬膜動静脈瘻は診療部長である村山が開発に携わった脳動静脈奇形に対する液体塞栓物質であるOnyxを用いた治療により、根治生の高い治療を目指しています。現在国内最大規模総勢9名の脳血管内治療専門医（内　脳血管内治療指導医3名）が診療に従事し、安全性と技術力の高い治療を提供しています。

未破裂脳動脈瘤について

脳ドックなどで偶然発見される未破裂脳動脈瘤が増えています。当院では全国から年間600−700例の新規患者さんが紹介受診されますが、最も重要なことは、破裂の危険は個々の動脈瘤によって異なり、動脈瘤の場所や大きさによっては保存的治療でも破裂することなく一生そのままの方が多数いらっしゃることです。当院では2003年以降で6,000例以上の未破裂脳動脈瘤を診断しておりますが、さまざまな破裂リスクの評価を行い治療の適応を慎重に検討しています。

実際に治療を行ったのは約30％です。治療の際は患者さんの画像データから実物大動脈瘤モデルを3Dプリンターで作成し、より安全な治療を心がけております。また塞栓コイルやステントなどの医療機器開発も積極的に行っています。破裂のリスクが低いと判断した患者さんは定期検診で経過をみております。当科における破裂のリスク解析研究は海外からも高い評価を得、さまざまな国際研究に参加しております。未破裂脳動脈瘤が発見されて不安を抱えているかたは一度ご相談ください。

参考文献

Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies.
Greving JP, Wermer MJ, Brown RD Jr, Morita A, Juvela S, Yonekura M, Ishibashi T, Torner JC, Nakayama T, Rinkel GJ, Algra A.
Lancet Neurol. 2014 Jan;13(1):59-66.
Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group.
Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown RD Jr, Connolly ES Jr, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H, Kirkpatrick PJ, Knuckey N, Koivisto T, Lanzino G, Lawton MT, Leroux P, McDougall CG, Mee E, Mocco J, Molyneux A, Morgan MK, Mori K, Morita A, Murayama Y, Nagahiro S, Pasqualin A, Raabe A, Raymond J, Rinkel GJ, Rüfenacht D, Seifert V, Spears J, Steiger HJ, Steinmetz H, Torner JC, Vajkoczy P, Wanke I, Wong GK, Wong JH, Macdonald RL.
Stroke. 2014 May;45(5):1523-30.
Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes.
Hetts SW, Turk A, English JD, Dowd CF, Mocco J, Prestigiacomo C, Nesbit G, Ge SG, Jin JN, Carroll K, Murayama Y, Gholkar A, Barnwell S, Lopes D, Johnston SC, McDougall C; Matrix and Platinum Science Trial Investigators.
AJNR Am J Neuroradiol. 2014 Apr;35(4):698-705.
Risk Analysis of Unruptured Intracranial Aneurysms: Prospective 10-Year Cohort Study. Murayama Y, Takao H, Ishibashi T, Saguchi T, Ebara M, Yuki I, Arakawa H, Irie K, Urashima M, Molyneux AJ.
Stroke. 2016 Feb;47(2):365-71.
ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms.
Backes D, Rinkel GJE, Greving JP, Velthuis BK, Murayama Y, Takao H, Ishibashi T, Igase M, terBrugge KG, Agid R, Jääskeläinen JE, Lindgren AE, Koivisto T, von Und Zu Fraunberg M, Matsubara S, Moroi J, Wong GKC, Abrigo JM, Igase K, Matsumoto K, Wermer MJH, van Walderveen MAA, Algra A, Vergouwen MDI.
Neurology. 2017 Apr 25;88(17):1600-1606.

3Dプリンターで作成した動脈瘤モデルとカスタムメイドカテーテル

診療スタッフ

診療部長	村山　雄一
診療副部長	石橋　敏寛
診療医員	加藤　直樹、菅　一成、畑岡　峻介、長山　剛太、佐野　透、府賀　道康、榎本　弘幸、石川　耕平、中山　陽介

治療実績

脳血管内手術・脳動脈瘤　治療件数　年次推移

手術件数

脳血管内手術　分類	2019年	2020年	2021年	2022年	2023年
破裂脳動脈瘤塞栓術	11	8	7	11	18
未破裂脳動脈瘤塞栓術	160	132	141	137	146
脳動静脈奇形	14	4	5	7	2
脊髄血管奇形塞栓術(脊髄硬膜動静脈瘻含む)	0	0	1	1	1
硬膜動静脈瘻塞栓術（脊髄は含まず）	14	13	16	14	14
直接型頚動脈海綿静脈洞瘻塞栓術	2	1	0	2	0
頭蓋内腫瘍塞栓術	13	18	1	0	5
頭頚部病変塞栓術	0	2	15	9	14
その他塞栓術	2	2	2	6	0
頚動脈ステント留置術	27	12	1	3	14
頭蓋外血管形成術/ステント留置術（CAS以外）	1	0	21	14	1
頭蓋内血管形成術/ステント留置術	0	1	1	1	0
脳動脈再開通療法	20	17	1	0	16
脳血管攣縮治療	1	1	18	21	0
その他血管内治療	0	0	7	3	2
脳血管内手術　総計	265	211	237	229	221

発表論文 (2020-2023)

- Kan I, Oishi H, Hyodo A, Nemoto S, Fujimura S, Ishibashi T, Sumita K, Takigawa T, Teranishi K, Kodama T, Kato N, Takao H, Murayama Y. A Novel Braided Stent With Customized Simulation Software for Treatment of Intracranial Aneurysms: Multicenter Prospective Trial Before Unrestricted Clinical Application. Oper Neurosurg (Hagerstown). 2024 Feb 1;26(2):180-187. doi: 10.1227/ons.0000000000000928. Epub 2023 Oct 11. PMID: 37819087.

- Abe Y, Ishibashi T, Otani K, Kan I, Murayama Y. Virtual coil images can optimize the visualization of the neckline of intracranial aneurysms during coil embolization: A technical note. Surg Neurol Int. 2023 Sep 29;14:349. doi: 10.25259/SNI6752023. PMID: 37810302; PMCID: PMC10559515.

- Fujimura S, Yamanaka Y, Takao H, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Yamamoto M, Murayama Y. Hemodynamic and morphological differences in cerebral aneurysms between before and after rupture. J Neurosurg. 2023 Sep 1;140(3):774-782. doi: 10.3171/2023.6.JNS23289. PMID: 37657114.

- Fuga M, Tanaka T, Tachi R, Tomoto K, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms. Surg Neurol Int. 2023 Jul 7;14:233. doi: 10.25259/SNI3552023. PMID: 37560592; PMCID: PMC10408647.

- Fuga M, Tanaka T, Tachi R, Yamana S, Irie K, Kajiwara I, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Contrast Injection from an Intermediate Catheter Placed in an Intradural Artery is Associated with Contrast-Induced Encephalopathy following Neurointervention. AJNR Am J Neuroradiol. 2023 Sep;44(9):1057-1063. doi: 10.3174/ajnr.A7944. Epub 2023 Aug 3. PMID: 37536732; PMCID: PMC10494956.

- Fuga M, Tanaka T, Tachi R, Tomoto K, Kazami K, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Risk factors for radial artery occlusion after neurointervention for unruptured intracranial aneurysm via transradial access. Interv Neuroradiol. 2023 Jul 27:15910199231189927. doi: 10.1177/15910199231189927. Epub ahead of print. PMID: 37499188.

- Fuga M, Tanaka T, Tachi R, Irie K, Kajiwara I, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Efficacy and safety of fetal posterior cerebral artery stented coil embolization for fetal posterior cerebral aneurysms. Interv Neuroradiol. 2023 Jul 17:15910199231188556. doi: 10.1177/15910199231188556. Epub ahead of print. PMID: 37461290.

- Fuga M, Tanaka T, Tachi R, Tomoto K, Okawa S, Ishibashi T, Hasegawa Y, Murayama Y. Compartment syndrome associated with vascular avulsion caused by transradial access in neurointervention for unruptured intracranial aneurysm: illustrative case. J Neurosurg Case Lessons. 2023 Mar 6;5(10):CASE22559. doi: 10.3171/CASE22559. PMID: 36880514; PMCID: PMC10550665.

- Kato N, Kakizaki S, Hirokawa Y, Michishita S, Ishii T, Terao T, Murayama Y. Encephalo-Arterio-Synangiosis with Cranioplasty after Treatment of Acute Subdural Hematoma Associated with Subcortical Hemorrhage Due to Unilateral Moyamoya Disease. Case Rep Neurol Med. 2023 Jan 17;2023:1787738. doi: 10.1155/2023/1787738. PMID: 36704418; PMCID: PMC9873458.

- Fuga M, Tanaka T, Tachi R, Tomoto K, Okawa S, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms. Neuroradiol J. 2023 Aug;36(4):442-452. doi: 10.1177/19714009221147230. Epub 2022 Dec 23. PMID: 36564905; PMCID: PMC10588597.

- Fuga M, Tanaka T, Tachi R, Tomoto K, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis. 2023 Feb;32(2):106924. doi: 10.1016/j.jstrokecerebrovasdis.2022.106924. Epub 2022 Dec 9. PMID: 36508756.

- Kato N, Otani K, Abe Y, Sano T, Nagayama G, Sasaki Y, Ikemura A, Kan I, Kodama T, Ishibashi T, Murayama Y. Diagnostic performance of intraoperative cone beam computed tomography compared with postoperative magnetic resonance imaging for detecting hemorrhagic transformation after endovascular treatment following large vessel occlusion. J Stroke Cerebrovasc Dis. 2022 Nov;31(11):106790. doi: 10.1016/j.jstrokecerebrovasdis.2022.106790. Epub 2022 Sep 22. PMID: 36156445.

- Fuga M, Tanaka T, Tachi R, Nogami R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Horizontal stenting via retrograde route for recurrent ruptured posterior communicating artery aneurysm after clipping: A case report and literature review. Clin Case Rep. 2022 May 27;10(5):e05920. doi: 10.1002/ccr3.5920. PMID: 35664521; PMCID: PMC9136509.

- Ishibashi T, Kaku S, Sonoda S, Murayama Y. Remote neuro-endovascular consultation using a secure telemedicine system: A feasibility study. Surg Neurol Int. 2022 Feb 11;13:47. doi: 10.25259/SNI11652021. PMID: 35242413; PMCID: PMC8888291.

- Uchiyama Y, Fujimura S, Takao H, Ono H, Katayama K, Suzuki T, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Murayama Y, Yamamoto M. Extraction of patient-specific boundary conditions from 4D-DSA and their influence on CFD simulations of cerebral aneurysms. Comput Methods Biomech Biomed Engin. 2022 Aug;25(11):1222-1234. doi: 10.1080/10255842.2021.2005035. Epub 2022 Feb 23. PMID: 35195493.

- Fuga M, Tanaka T, Irie K, Kajiwara I, Tachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center's experience. J Clin Neurosci. 2022 Apr;98:175-181. doi: 10.1016/j.jocn.2022.02.009. Epub 2022 Feb 17. PMID: 35183894.

- Fujimura S, Tanaka K, Takao H, Okudaira T, Koseki H, Hasebe A, Suzuki T, Uchiyama Y, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Hayakawa M, Yamamoto M, Murayama Y. Computational fluid dynamic analysis of the initiation of cerebral aneurysms. J Neurosurg. 2021 Dec 21:1-9. doi: 10.3171/2021.8.JNS211452. Epub ahead of print. PMID: 34933277.

- Kato N, Ishibashi T, Maruyama F, Otani K, Kakizaki S, Nagayama G, Ikemura A, Hataoka S, Kan I, Kodama T, Murayama Y. Clinical outcomes of procedures combining endovascular embolization with a direct surgical approach in a hybrid operating room for the treatment of refractory dural arteriovenous fistulas. Surg Neurol Int. 2021 Aug 30;12:439. doi: 10.25259/SNI4862021. PMID: 34513202; PMCID: PMC8422465.

- Koseki H, Murayama Y. [History and Recent Development of Basic Research Using an Experimental Intracranial Aneurysm Model]. No Shinkei Geka. 2021 Jul;49(4):888-897. Japanese. doi: 10.11477/mf.1436204467. PMID: 34376621.

- Ishibashi T, Maruyama F, Kan I, Sano T, Murayama Y. Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone. Surg Neurol Int. 2021 Mar 2;12:85. doi: 10.25259/SNI8582020. PMID: 33767889; PMCID: PMC7982113.

- Takao H, Sakai K, Mitsumura H, Komatsu T, Yuki I, Takeshita K, Sakuta K, Ishibashi T, Sakano T, Yeh Y, Karagiozov K, Fisher M, Iguchi Y, Murayama Y. A Smartphone Application as a Telemedicine Tool for Stroke Care Management. Neurol Med Chir (Tokyo). 2021 Apr 15;61(4):260-267. doi: 10.2176/nmc.oa.2020-0302. Epub 2021 Mar 12. PMID: 33716234; PMCID: PMC8048116.

- Takao H, Sakai K, Mitsumura H, Komatsu T, Yuki I, Takeshita K, Sakuta K, Ishibashi T, Sakano T, Yeh Y, Karagiozov K, Fisher M, Iguchi Y, Murayama Y. A Smartphone Application as a Telemedicine Tool for Stroke Care Management. Neurol Med Chir (Tokyo). 2021 Mar 12. doi: 10.2176/nmc.oa.2020-0302. Epub ahead of print. PMID: 33716234.

- Ishibashi T, Maruyama F, Kan I, Sano T, Murayama Y. Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone. Surg Neurol Int. 2021 Mar 2;12:85. doi:10.25259/SNI8582020. PMID: 33767889; PMCID: PMC7982113.

- Sakai K, Sato T, Komatsu T, Mitsumura H, Iguchi Y, Ishibashi T, Murayama Y, Takeshita K, Takao H. Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy. Neurol Sci. 2021 Feb 26:1?6. doi: 10.1007/s10072-021-05132-2. Epub ahead of print. PMID: 33638012; PMCID: PMC7908941.

- Michishita S, Ishibashi T, Yuki I, Urashima M, Karagiozov K, Kodama T, Kan I, Nishimura K, Kato N, Ikemura A, Murayama Y. Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment. Interv Neuroradiol. 2021 Feb 21:1591019921996886. doi: 10.1177/1591019921996886. Epub ahead of print. PMID: 33615875.

- Kato N, Yuki I, Otani K, Ishibashi T, Kakizaki S, Nagayama G, Maruyama F, Ikemura A, Kan I, Kodama T, Abe Y, Murayama Y. Flow Diverter Apposition in Patients with Large or Giant Intracranial Aneurysms Evaluated on Three-Dimensional Fusion Images Acquired by High-Resolution Cone-Beam Computed Tomography and Digital Subtraction Angiography. World Neurosurg. 2021 Mar;147: e388-e395. doi: 10.1016/j.wneu.2020.12.068. Epub 2021 Jan 7. PMID:33359518.

- Kato N, Nishimura K, Sonoda S, Kakizaki S, Nagayama G, Aoki K, Maruyama F, Ikemura A, Kan I, Kodama T, Kaku S, Yuki I, Ishibashi T, Otani K, Murayama Y. Comparison of Clinical Outcomes After Stent-Assisted Coiling with 3 Types of Self-Expanding Laser-Cut Stents in Patients with Wide-Necked Intracranial Aneurysms. World Neurosurg. 2021 Feb;146:e701-e707. doi: 10.1016/j.wneu.2020.10.166. Epub 2020 Nov 9. PMID: 33181375.

- Kato N, Yuki I, Hataoka S, Dahmani C, Otani K, Abe Y, Kakizaki S, Nagayama G, Maruyama F, Ikemura A, Kan I, Kodama T, Ishibashi T, Murayama Y. 4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations. J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105327. doi:10.1016/j.jstrokecerebrovasdis.2020.105327. Epub 2020 Sep 28. PMID: 32992207.

- Kan I, Karagiozov K, Ito S, Sato S, Murayama Y. Microcatheter Originating Debris during Neuroendovascular Procedures: Mechanism of Dislodgement and Its Prevention. AJNR Am J Neuroradiol. 2020 Oct;41(10):1879-1881. doi:10.3174/ajnr.A6723. Epub 2020 Aug 27. PMID: 32855184; PMCID: PMC7661062.

- Kakizaki S, Ishibashi T, Kato N, Kan I, Nishimura K, Murayama Y. Complete Obliteration of a Foramen Magnum Dural Arteriovenous Fistula by Microsurgery After Failed Endovascular Treatment Using Onyx: Case Report and Literature Review. World Neurosurg. 2020 Dec;144:43-49. doi: 10.1016/j.wneu.2020.08.077. Epub 2020 Aug 15. PMID: 32805464.

- Maruyama F, Ishibashi T, Kato N, Karagiozov K, Kan I, Kodama T, Murayama Y.“Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients.” Interv Neuroradiol. 2021 Jan 7:1591019920987345. doi: 10.1177/1591019920987345. Online ahead of print.

- Ikemura A, Ishibashi T, Otani K, Yuki I, Kodama T, Kan I, Kato N, Murayama Y. Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms. AJNR Am J Neuroradiol. 2020 Feb;41(2):286-292. doi: 10.3174/ajnr.A6386. Epub 2020 Jan 30.

- Kan I, Ishibashi T, Sakuta K, Fujimura S, Yuki I, Kaku S, Kodama T, Kato N, Nishimura K, Aoki K, Sasaki Y, Karagiozov K, Murayama Y. Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization. World Neurosurg. 2020 Feb;134:e731-e738. doi: 10.1016/j.wneu.2019.10.179.

脳血管内治療部