Preoperative prediction of aneurysm recurrence after endovascular surgery using individualized computational fluid dynamics

• Project/Area Number: 16K10783
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Neurosurgery
• Research Institution: Kanazawa University
• Principal Investigator: Misaki Kouichi 金沢大学, 附属病院, 講師 (20507082)
• Research Collaborator: Nambu Iku
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2018: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2017: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2016: ¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
• Keywords: 数値流体解析 / 脳動脈瘤 / 血管内手術 / 再発 / 圧力 / 無次元化 / 数値流体力学的解析 / コイル塞栓術 / 脳・神経

Outline of Final Research Achievements

In this study, we evaluated the risk factors of aneurysm recurrence after endovascular surgery using computational fluid dynamics. Our study showed that high pressure at the virtual coil surface is risk factor of aneurysm recurrence. The problem concerning individualization of the analysis was resolved by normalization of the results. The pressure elevation calculated with normalization showed high values of sensitivity (100%) and specificity (93%) for aneurysm recurrence. We can predict the aneurysm recurrence by preoperative analysis of pressure elevation with high accuracy.

Academic Significance and Societal Importance of the Research Achievements

くも膜下出血の原因である脳動脈瘤の治療は、従来から行われる開頭クリッピング手術は治療後の再発が約1%と少ないが、開頭手術であるため侵襲が大きい欠点がある。一方、瘤内コイル塞栓術は大腿動脈の穿刺によって行えるため侵襲が少ないが、欠点はコイルの継続的な圧縮による動脈瘤の再発で、約10-15%に再治療が必要となる点にある。本研究によって血管内治療後の再発因子を治療前に予測できるようになったため、再発を回避する治療方針をたてることが可能となったことは臨床的に有用で意義深い。

Research Products

• [Journal Article] High Pressure in Virtual Postcoiling Model is a Predictor of Internal Carotid Artery Aneurysm Recurrence After Coiling (2018)
  • Author(s): Nambu Iku、Misaki Kouichi、Uchiyama Naoyuki、Mohri Masanao、Suzuki Takashi、Takao Hiroyuki、Murayama Yuichi、Futami Kazuya、Kawamura Tomoki、Inoguchi Yasushi、Matsuzawa Teruo、Nakada Mitsutoshi
  • Journal Title: Neurosurgery Volume: 83 Issue: 3 Pages: 1-7
  • DOI: 10.1093/neuros/nyy073
  • Peer Reviewed / Open Access
• [Journal Article] Objective evaluation of cerebrovascular reactivity for acetazolamide predicts cerebral hyperperfusion after carotid artery stenting: Comparison with region of interest methods (2018)
  • Author(s): Misaki Kouichi、Uchiyama Naoyuki、Inaki Anri、Kinuya Seigo、Nambu Iku、Kamide Tomoya、Mohri Masanao、Hayashi Yasuhiko、Nakada Mitsutoshi
  • Journal Title: J Neuroradiol. Volume: 17 Issue: 6 Pages: 30361-30369
  • DOI: 10.1016/j.neurad.2018.02.008
  • NAID: 120006532179
  • Peer Reviewed / Open Access
• [Journal Article] Hyperperfusion syndrome after trapping with high-flow bypass for a giant paraclinoid internal carotid artery aneurysm (2018)
  • Author(s): Mohri Masanao、Ichinose Toshiya、Uchiyama Naoyuki、Misaki Kouichi、Nambu Iku、Takabatake Yasushi、Nakada Mitsutoshi
  • Journal Title: World Neurosurgery Volume: 115 Pages: 143-146
  • DOI: 10.1016/j.wneu.2018.04.081
  • Peer Reviewed / Open Access
• [Journal Article] Physical Risk Factors of Hemorrhagic Complications Associated with Angio-Seal Closure Device Use in Neurointerventional Procedures (2018)
  • Author(s): Aida Yasuhiro、Misaki Kouichi、Kamide Tomoya、Mohri Masanao、Uchiyama Naoyuki、Nakada Mitsutoshi
  • Journal Title: World Neurosurg. Volume: 111 Pages: e850-e855
  • DOI: 10.1016/j.wneu.2017.12.179
  • Peer Reviewed / Open Access
• [Journal Article] Carotid artery plaque diagnosis using CT (2018)
  • Author(s): Misaki K, Uchiyama N, Mohri M, Nakada M
  • Journal Title: Journal of Neuroendovascular Therapy Volume: 12 Pages: 592-596
  • NAID: 130007536249
  • Peer Reviewed
• [Journal Article] Estimated pretreatment hemodynamic prognostic factors of aneurysm recurrence after endovascular embolization (2017)
  • Author(s): Misaki Kouichi、Takao Hiroyuki、Suzuki Takashi、Nishimura Kengo、Kan Issei、Yuki Ichiro、Ishibashi Toshihiro、Yamamoto Makoto、Murayama Yuichi
  • Journal Title: Technology and Health Care Volume: 25 Issue: 5 Pages: 843-850
  • DOI: 10.3233/thc-160495
  • Peer Reviewed / Open Access
• [Journal Article] Unique Venous Drainage of a Sphenoid Wing Dural Arteriovenous Fistula with Ocular Symptoms (2017)
  • Author(s): Misaki Kouichi、Uchiyama Naoyuki、Mohri Masanao、Aida Yasuhiro、Uno Takehiro、Nakada Mitsutoshi
  • Journal Title: World Neurosurgery Volume: 97 Pages: 753.e1-753.e5
  • DOI: 10.1016/j.wneu.2016.10.055
  • NAID: 120005973608
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Concurrent cervical dural and multiple perimedullary arteriovenous fistulas presenting with subarachnoid hemorrhage: The source of bleeding was invisible at initial angiography (2017)
  • Author(s): Nambu Iku、Uchiyama Naoyuki、Misaki Kouichi、Mohri Masanao、Nakada Mitsutoshi
  • Journal Title: Surgical Neurology International Volume: 8 Issue: 1 Pages: 2-2
  • DOI: 10.4103/2152-7806.198729
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Delayed asymptomatic coil migrations toward different arteries after aneurysmal embolization: case report (2017)
  • Author(s): Tomoya Kamide, Kouichi Misaki, Iku Nambu, Masanao Mohri, Naoyuki Uchiyama, Mitsutoshi Nakada
  • Journal Title: Acta Neurochirurgica Volume: 159 Issue: 3 Pages: 593-598
  • DOI: 10.1007/s00701-017-3083-6
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Inflow hemodynamics evaluated by using four-dimensional flow magnetic resonance imaging and the size ratio of unruptured cerebral aneurysms (2017)
  • Author(s): Futami Kazuya、Nambu Iku、Kitabayashi Tomohiro、Sano Hiroki、Misaki Kouichi、Uchiyama Naoyuki、Nakada Mitsutoshi
  • Journal Title: Neuroradiology Volume: 59 Issue: 4 Pages: 411-418
  • DOI: 10.1007/s00234-017-1801-7
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Intraoperative Rupture of Unruptured Cerebral Aneurysm during Craniotomy: A Case Report (2017)
  • Author(s): Yoshiki Kenji、Misaki Kouichi、Nambu Iku、Fukui Issei、Mohri Masanao、Uchiyama Naoyuki、Nakada Mitsutoshi
  • Journal Title: Case Reports in Neurology Volume: 9 Issue: 3 Pages: 261-266
  • DOI: 10.1159/000480425
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Long-term predictive factors of the morphology based outcome in bare platinum coiled intracranial aneurysms: Evaluation by pre- and post-contrast 3D time-of-flight MR angiography (2017)
  • Author(s): Ueda Fumiaki、Uchiyama Naoyuki、Mohri Masanao、Misaki Kouichi、Matsui Osamu、Kida Shinya、Sanada Junichiro、Yoshikawa Jun、Aburano Hiroyuki、Yoshie Yuichi、Gabata Toshifumi
  • Journal Title: Neurologia i Neurochirurgia Polska Volume: 51 Issue: 2 Pages: 116-126
  • DOI: 10.1016/j.pjnns.2017.01.002
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Prediction of carotid artery in-stent restenosis by quantitative assessment of vulnerable plaque using computed tomography. (2016)
  • Author(s): Misaki K, Uchiyama N, Mohri M, Hayashi Y, Ueda F, Nakada M.
  • Journal Title: J Neuroradiol. Volume: 43 Issue: 1 Pages: 18-24
  • DOI: 10.1016/j.neurad.2015.09.002
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Optimizing the Volume of the Initial Framing Coil to Facilitate Tight Packing of Intracranial Aneurysms. (2016)
  • Author(s): Misaki K, Uchiyama N, Nambu I, Aida Y, Kamide T, Mohri M, Ueda F, Nakada M.
  • Journal Title: World Neurosurg. Volume: 90 Pages: 397-402
  • DOI: 10.1016/j.wneu.2016.03.027
  • NAID: 120005771097
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Pseudoaneurysm formation caused by the withdrawal of a Trevo ProVue stent at a tortuous cerebral vessel: a case report. (2016)
  • Author(s): Misaki K, Uchiyama N, Mohri M, Kamide T, Tsutsui T, Kanamori N, Kurokawa K, Nakada M.
  • Journal Title: Acta Neurochir (Wien). Volume: 158 Issue: 11 Pages: 2085-2088
  • DOI: 10.1007/s00701-016-2952-8
  • NAID: 120005851369
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Intracranial aneurysm formation after radiotherapy for medulloblastoma (2016)
  • Author(s): Kamide T, Mohri M, Misaki K, Uchiyama N, Nakada M
  • Journal Title: Surgical Neurology International Volume: 21 Issue: 38 Pages: 880-880
  • DOI: 10.4103/2152-7806.194501
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Inflow Jet Patterns of Unruptured Cerebral Aneurysms Based on the Flow Velocity in the Parent Artery: Evaluation Using 4D Flow MRI. (2016)
  • Author(s): Futami K, Kitabayashi T, Sano H, Misaki K, Uchiyama N, Ueda F, Nakada M.
  • Journal Title: AJNR Am J Neuroradiol. Volume: 37 Issue: 7 Pages: 1318-1323
  • DOI: 10.3174/ajnr.a4704
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Treatment result in the initial stage of Kanazawa mobile embolectomy team for acute ischemic stroke (2016)
  • Author(s): Uchiyama N, Misaki K, Mohri M, Kamide T, Hirota Y, Higashi R, Minamide H, Kohda Y, Asahi T, Shoin K, Iwato M, Kita D, Hamada Y, Yoshida Y, Nakada M
  • Journal Title: Neurologia Medico-Chirurgica Volume: 56 Pages: 737-744
  • NAID: 130005250444
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Presentation] Clinical significance of computational fluid dynamics for aneurysm recurrence after coiling (2019)
  • Author(s): Misaki K, Nambu I, Tkehiro U, Uchiyama N, Nakada M
  • Organizer: Pavlov First St. Petersburg State Medical University International Day of DNA-2019 VI International conference
  • Int'l Joint Research / Invited
• [Presentation] 術前の再発予測に基づいた脳動脈瘤塞栓術の治療戦術（シンポジウム） (2019)
  • Author(s): 見崎孝一、宇野豪洋、南部育、吉川陽文、内山尚之、中田光俊
  • Organizer: 第28回脳神経外科手術と機器学会
• [Presentation] Clinical significance of computational fluid dynamics for aneurysm recurrence after coiling. (2018)
  • Author(s): Misaki K, Nambu I, Uno T, Uchiyama N, Nakada M
  • Organizer: The 6th Japan Russia Neurosurgical Symposium
  • Int'l Joint Research
• [Presentation] 未破裂脳動脈瘤に流入する血流の流体力学的検証 CFDと 4D flow MRIの比較 (2018)
  • Author(s): 見崎孝一、二見一也、宇野豪洋、南部育、内山尚之、中田光俊
  • Organizer: 第48回日本脳卒中の外科学会学術集会
• [Presentation] 血管内治療におけるコメディカルスタッフとの関わり（シンポジウム） (2018)
  • Author(s): 見崎孝一、内山尚之、中田光俊
  • Organizer: 第21回日本臨床脳神経外科学会
  • Invited
• [Presentation] 脳動脈瘤における数値流体力学解析のICG蛍光血管撮影による妥当性の検証 (2017)
  • Author(s): 見崎孝一、宇野豪洋、南部育、毛利正直、内山尚之、中田光俊
  • Organizer: 第13回日本脳神経外科光線力学学会
• [Presentation] 無症候性頚動脈狭窄症の脳梗塞発症の危険因子 (2017)
  • Author(s): 見崎孝一、宇野豪洋、毛利正直、内山尚之、中田光俊
  • Organizer: 第76回脳神経外科学会学術総会
• [Presentation] ステント併用下コイル塞栓術においてステントに絡んだコイルの回収に難渋した１例 (2017)
  • Author(s): 見崎孝一、福島大輔、池田清延、吉田優也、毛利正直、内山尚之、中田光俊
  • Organizer: 第48回日本脳神経血管内治療学会中部地方会
• [Presentation] 一般外科の術前に発見された無症候性頚動脈狭窄症の脳梗塞発症と死亡の危険因子 (2017)
  • Author(s): 見崎孝一、宇野豪洋、毛利正直、内山尚之、中田光俊
  • Organizer: 第43回日本脳卒中学会学術集会
• [Presentation] 123I-IMP-SPECTによる頚動脈ステント留置術後の過灌流現象の予測：SEE解析とROI法の比較 (2017)
  • Author(s): 見崎孝一、稲木杏吏、内山尚之、毛利正直、中田光俊
  • Organizer: 第20回千里浜脳循環代謝カンファレンス
• [Presentation] 123I-IMP SPECTによる頚動脈ステント留置術後の過灌流現象の術前予測 (2016)
  • Author(s): 見崎孝一、内山尚之、毛利正直、中田光俊
  • Organizer: 第32回NPO法人日本脳神経血管内治療学会学術総会
  • Place of Presentation: 神戸
  • Year and Date: 2016-11-24
• [Presentation] 頚動脈ステント留置術後の過灌流現象の予測因子 (2016)
  • Author(s): 見崎孝一、福井一生、毛利正直、内山尚之、中田光俊
  • Organizer: 第75回脳神経外科学会学術総会
  • Place of Presentation: 福岡
  • Year and Date: 2016-09-30
• [Presentation] 頚動脈ステント留置術後の過灌流現象の予測因子 (2016)
  • Author(s): 見崎孝一、上出智也、毛利正直、内山尚之、中田光俊
  • Organizer: 第45回日本脳卒中の外科学会学術集会
  • Place of Presentation: 札幌
  • Year and Date: 2016-04-16
• [Presentation] 内頚動脈血豆状破裂動脈瘤に対して急性期にステント併用下のコイル塞栓術を行った１例 (2016)
  • Author(s): 見崎孝一、内山尚之、毛利正直、上出智也、福井一生、中田光俊
  • Organizer: 第45回日本脳神経血管内治療学会中部地方会
  • Place of Presentation: 名古屋
  • Year and Date: 2016-04-02
• [Book] 基礎からよくわかる 実践的CFD（数値流体力学）入門 脳血管編 (2017)
  • Author(s): 見崎孝一、髙尾洋之、鈴木貴士、山本 誠、村山雄一
  • Total Pages: 288
  • Publisher: メディカ出版
  • ISBN: 9784840461474