Neurological Surgery 脳神経外科46巻4号

2018年04月発行

研究

直径3mm以下の微小脳動脈瘤に対するコイル塞栓術—手技の工夫，注意点と文献レビュー

著者： 前田一史¹ 元家亮太¹ 辛島聡志¹ 尾辻亮介¹ 連乃駿¹ 長岡慎太郎¹ 伊飼美明¹ 宇野淳二¹ 魏秀復¹

所属機関： ¹馬場記念病院脳神経外科

ページ範囲：P.303 - P.312

Ⅰ．はじめに
　脳動脈瘤に対するコイル塞栓術はその有効性が多数報告され，今後，破裂，未破裂例を問わず，ますます治療件数は増加していくと思われる．3mm以下の動脈瘤を「微小動脈瘤」，「very small aneurysm」あるいは「tiny aneurysm」と表現する文献が多く^1,2)，術中破裂の危険性が一般の脳動脈瘤に比べて高く，手技的にも難易度が高いとされる^3,16,26)．今回われわれは，当院で施行した3mm以下の微小脳動脈瘤コイル塞栓術に関して検証を行い，治療の現状や手技の工夫について，文献的考察を交えて報告する．

参考文献

1) Anokwute MC, Braca JA, Bohnstedt B, DeNardo A, Scott J, Cohen-Gadol A, Sahlein DH：Endovascular treatment of ruptured tiny（≤ 3mm）intracranial aneurysms in the setting of subarachnoid hemorrhage：a case series of 20 patients and literature review. J Clin Neurosci 40：52-56, 2017

2) Asif KS, Sattar A, Lazzaro MA, Fitzsimmons BF, Lynch JR, Zaidat OO：Consecutive endovascular treatment of 20 ruptured very small（＜3mm）anterior communicating artery aneurysms. Interv Neurol 5：57-64, 2016

3) Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF：Endovascular treatment of very small（3mm or smaller）intracranial aneurysms：report of a consecutive series and a meta-analysis. Stroke 41 116-121, 2010

4) Chae KS, Jeon P, Kim KH, Kim ST, Kim HJ, Byun HS：Endovascular coil embolization of very small intracranial aneurysms. Korean J Radiol 11：536-541, 2010

5) Chen Z, Feng H, Tang W, Liu Z, Miao H, Zhu G：Endovascular treatment of very small intracranial aneurysms. Surg Neurol 70：30-35, 2008

6) Cronqvist ME, Moret J：Detachable coil embolization of intracranial aneursysms. In Connors JJ Ⅲ, Wojak JC（eds）：Interventional Neuroradiology. Saunders, Philadelphia, 1999, pp.294-316

7) Fang C, Li MH, Zhu YQ, Tan HQ, Zhang PL, Xu HW, Wang W, Zhou B：The effectiveness and feasibility of endovascular coil embolization for very small cerebral aneurysms：mid- and long-term follow-up. Ann Vasc Surg 24：400-407, 2010

8) Gil A, Vega P, Murias E, Cuellar H：Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms. J Neurosurg 112：585-588, 2010

9) Gimonet H, Desal HA, Mosimann PJ, Stracke P, Daumas-Duport B, Lintia-Gaultier A, Bourcier R, Chapot R：A new endovascular technique for small anterior choroidal artery aneurysms. A consecutive series using the 3-catheter-protective technique. J Neuroradiol 43 3：223-226, 2016

10) Hong B, Yang PF, Zhao R, Huang QH, Xu Y, Yang ZG, Liu J：Endovascular treatment of ruptured tiny intracranial aneurysms. J Clin Neurosci 18：655-660, 2011

11) Kuroiwa T, Shimizu F, Yamashita T, Hiramatsu R, Yagi R, Kimura S, Yamada Y, Yamada M：Coil embolization of cerebral tiny aneurysm. JNET 10：243-248, 2016

12) Li CH, Su XH, Zhang B, Han YF, Zhang EW, Yang L, Zhang DL, Yang ST, Yan ZQ, Gao BL：The stent-assisted coil-jailing technique facilitates efficient embolization of tiny cerebral aneurysms. Korean J Radiol 15：850-857, 2014

13) Lim YC, Kim BM, Shin YS, Kim SY, Chung J：Structual limitations of currently available microcatheters and coils for endovascular coiling of very small aneurysms. Neuroradiology 50：423-427, 2008

14) Mansour O, Megahed M, Schumacher M, Weber J, Khalil M：Coiling of ruptured tiny cerebral aneurysms, feasibility, safety, and durability at midterm follow-up, and individual experience. Clin Neuroradiol 23：103-111, 2013

15) 松本博之，武本英樹，廣鰭洋子，鐵尾佳章，西山弘一，増尾　修，中尾直之：直径3mm以下の微小脳動脈瘤に対するコイル塞栓術の治療成績—手技における注意点と工夫—．脳卒中の外科43：275-282, 2015

16) Nguyen TN, Raymond J, Guilbert F, Roy D, Bérubé MD, Mahmoud M, Weill A：Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg 108：1088-1092, 2008

17) 岡田秀雄，寺田友昭：短径1.0mmの破裂極小前交通動脈瘤に対して1本のTarget nano coilで塞栓術を施行した1例：テクニカルノート．JNET 8：298-304, 2014

18) 大島幸亮，寺田友昭，檜山孝美，大久保信治，池田律子，小林博雄，工藤　忠：微小脳動脈瘤の塞栓術における出血性合併症の検討．脳卒中の外科41：110-115, 2013

19) Suzuki S, Kurata A, Ohmomo T, Sagiuchi T, Niki J, Yamada M, Oka H, Fujii K, Kan S：Endovascular surgery for very small ruptured intracranial aneurysms. Technical note. J Neurosurg 105：777-780, 2006

20) Tone O, Tomita H, Tamaki M, Akimoto H, Shigeta K, Sampetrean O, Fujii M：Coil embolization for ruptured cerebral aneurysms of 2×3mm diameter. Interv Neuroradiol 12（Suppl 1）：97-100, 2006

21) 堤　正則，相川　博，鬼塚正成，伊香　稔，児玉智信，新居浩平，濱口周子，江藤輔聖，坂本王哉，井上律郎，中右博也，風川　清：微小破裂前交通動脈瘤に対するコイル塞栓術．脳卒中の外科37：162-166, 2009

22) UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T：The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366：2474-2482, 2012

23) van Rooij WJ, Keeren GJ, Peluso JP, Sluzewski M：Clinical and angiographic results of coiling of 196 very small（＜or＝3mm）intracranial aneurysms. AJNR Am J Neuroradiol 30：835-839, 2009

24) Wei M, Ren H, Yin L：The combinational use of dual microcatheter technique and new hypersoft helical coil for endovascular treatment of tiny intracranial aneurysm with difficult geometry. Interv Neuroradiol 22：18-25, 2016

25) Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O'Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC；International Study of Unruptured Intracranial Aneurysms Investigators：Unruptured intracranial aneurysms：natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362（9378）：103-110, 2003

26) 山浦生也，浦元智司，木寺摩美，松本　強，福島康久，新光阿以子，内田和孝：最大径3mm以下小型動脈瘤のコイル塞栓術．JNET 4：99-105, 2010

27) Yang MS, Wong HF, Yang TH, Chen YL, Chan SW, Lee HJ, Tung YW, Tu CW, Chen TY：Alternative option in the treatment of very small ruptured intracranial aneurysms. Surg Neurol 72 Suppl 2：S41-46, 2009

28) Yang MS, Yang TH, Ou CH, Chan SW, Chen TI, Yang CJ, Chiang CM, Huang WC：Complex coil assisted single coil embolization for small intracranial aneurysm. Neurointervention 8：105-109, 2013

29) Zhang Y, Yang M, Zhang H, Zhang X, Li Y, Jiang C, Liu J, Yang X：Stent-assisted coiling may prevent the recurrence of very small ruptured intracranial aneurysms：a multicenter study. World Neurosurg 100：22-29, 2017