2023 Fiscal Year Final Research Report

Study on growth reduction of unruptured cerebral aneurysms from the point of view of hemodynamics

Research Project

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Project/Area Number	20K09339
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 56010:Neurosurgery-related
Research Institution	Department of Clinical Research, National Hospital Organization Kyoto Medical Center
Principal Investigator	Fukuda Shunichi 独立行政法人国立病院機構(京都医療センター臨床研究センター), 糖尿病研究部, 研究室長 (10600546)
Co-Investigator(Kenkyū-buntansha)	下權谷祐児日本大学, 工学部, 准教授 (30552575)
Project Period (FY)	2020-04-01 – 2024-03-31
Keywords	脳動脈瘤 / 壁ずり応力 / 増大 / 治療薬 / P2X4 / 血行力学
Outline of Final Research Achievements	The J-ASPECT Study searched for patients taking paroxetine who had unruptured cerebral aneurysms or underwent cerebral aneurysm coil embolization. 78 stroke centers participated, and 37 patients with unruptured aneurysms and 38 patients after coil embolization met the criteria. Comparing these with 396 controls with unruptured aneurysms and 308 controls with coil implantation by multivariate analysis and propensity score matching, paroxetine significantly reduced the incidence and rate of aneurysm growth and significantly reduced the rate of recanalization 1 year after coil embolization. A prospective observational study was performed on patients with unruptured cerebral aneurysms. CFD analysis was performed using 3D-CT imaging data and found that there were two distinct hemodynamic environments that were significantly involved in aneurysm growth.
Free Research Field	脳血管障害における血行力学的因子の役割研究と治療薬の開発
Academic Significance and Societal Importance of the Research Achievements	脳動脈瘤破裂予防薬は未だ存在せず、開頭クリッピング術やコイル塞栓術のような外科的治療法しか選択肢がない。また、クリッピング術よりも新脩度が低いコイル塞栓術は、術後再発率が高いという欠点があるが、後後再発予防薬は未だ存在しない。したがって、これらの予防薬の開発が待たれている。今回の研究によって，パロキセチンを含むP2X4阻害薬が動脈瘤破裂およびコイル塞栓術後再開通に対する予防薬として臨床的に応用できる可能性があることを示唆している。脳動脈瘤の発生・増大・破裂には血行力学的要素が大きく関与していることが想定されているが、今まで不明であった増大に関しての血行力学的環境が明らかになった。