Neurological Surgery 脳神経外科41巻1号

2013年01月発行

連載 脳神経血管内治療医に必要な知識

（5）脳動脈瘤塞栓術の応用（補助テクニック）

著者： 今村博敏¹ 柴田帝式¹ 坂井信幸¹

所属機関： ¹神戸市立医療センター中央市民病院脳神経外科

ページ範囲：P.71 - P.82

Ⅰ．はじめに

　脳動脈瘤塞栓術の基本は，1本のマイクロカテーテルを脳動脈瘤に誘導し，離脱型コイルをできるだけ多く充塡するsimple techniqueである．しかし，実際にはsimple techniqueで満足する結果の塞栓術を行える脳動脈瘤は，われわれの経験では約25%である．大きな動脈瘤や，頚部の広い動脈瘤では単純にコイルを挿入すると，母血管にコイルが逸脱することが少なくない．このような場合はballoon assisted technique¹⁴⁾，stent assisted technique⁶⁾，double catheter technique⁸⁾などのadjunctive techniqueが必要となる．これまでわれわれは，約50%の症例でballoon assisted technique，約20%の症例でstent assisted techniqueを使用している．過去の報告ではadjunctive techniqueは血栓塞栓症の危険因子にはならないと報告されているが^1,3,15)，手技が煩雑になることに注意しなければならない．

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