Neurological Surgery 脳神経外科38巻11号

2010年11月発行

総説

脳動脈瘤に対する血管内治療の長期成績

著者： 大石英則¹ 山本宗孝¹ 吉田賢作¹ 新井一¹

所属機関： ¹順天堂大学医学部附属順天堂医院脳神経外科

ページ範囲：P.973 - P.982

Ⅰ．は じ め に

　1991年のGDC（Guglielmi detachable coil）導入以降^21,22)，脳動脈瘤に対する血管内治療，特に離脱型プラチナコイル（Fig. 1）を用いて脳動脈瘤を選択的に塞栓する“コイリング術”はクリッピング術とならんで重要な治療オプションとなっている．わが国でも1998年以降からコイリング術の施行が可能となった．現在までに，その効果や安全性などについて数多くの報告がなされているが^{8-10,15,42,54)}，それらの中で欧米，主に英国を中心に行われた多施設共同無作為試験であるISAT（International Subarachnoid Aneurysm Trial）^42,44)の結果は，急性期破裂脳動脈瘤に対する治療法選択に大きな影響を与えた．これらを背景にわが国でも脳動脈瘤治療における破裂予防法としてコイリング術を第一選択治療とする施設が増加しつつある．しかし一方で，コイリング術後の出血，再開通，動脈瘤増大に関する報告は多く^{5,24,42-44,46)}，クリッピング術に比べて長期的な出血予防効果が劣ること，解剖学的根治率が低いことなどが問題視されている．そこで本稿では脳動脈瘤に対するコイリング術の長期成績について文献報告を中心に概説する．

参考文献

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