Neurological Surgery 脳神経外科49巻1号

2021年01月発行

特集 脳動脈瘤—Q ＆ Aで学ぶ開頭術，血管内治療のコツと使い分け Ⅲ脳動脈瘤に対する血管内治療

脳動脈瘤用バルーンとステントの選択と使用のコツは？

著者： 白川学¹

所属機関： ¹兵庫医科大学脳神経外科

ページ範囲：P.111 - P.118

Point
・バルーンおよびステントを用いてneck remodelingを行う際は，各デバイスの特徴を理解して症例ごとに選択すべきである．
・ステントアシストテクニックは，バルーンアシストテクニックと比較して合併症率は高くないが，抗血小板薬の長期内服が必要となる．
・Semi-jailingテクニックにopen-cell stentを用いるとマイクロカテーテルの可動性を高め，塞栓率も上昇する．

参考文献

1）Wang C, et al：Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics：a comparison with Enterprise stents and the Pipeline device. J Transl Med 14：199, 2016

2）Sluzewski M, et al：Balloon-assisted coil embolization of intracranial aneurysms：incidence, complications, and angiography results. J Neurosurg 105：396-399, 2006

3）Santillan A, et al：Balloon-assisted coil embolization of intracranial aneurysms is not associated with increased periprocedural complications. J Neurointerv Surg 5（Suppl 3）：iii56-iii61, 2013

4）Santillan A, et al：Intraprocedural aneurysmal rupture during coil embolization of brain aneurysms：role of balloon-assisted coiling. AJNR Am J Neuroradiol 33：2017-2021, 2012

5）McLaughlin N, et al：Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms：a systematic review. Surg Neurol Int 4：43, 2013

6）Bechan RS, et al：Stent-assisted coil embolization of intracranial aneurysms：complications in acutely ruptured versus unruptured aneurysms. AJNR Am J Neuroradiol 37：502-507, 2016

7）Roh H, et al：Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms. J Neurosurg 133：814-820, 2020

8）Consoli A, et al：Assisted coiling of saccular wide-necked unruptured intracranial aneurysms：stent versus balloon. J Neurointerv Surg 8：52-57, 2016

9）Wang F, et al：Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms：a systematic review ＆ meta-analysis. J Neurol Sci 364：160-166, 2016

10）Hong B, et al：Semi-jailing technique for coil embolization of complex, wide-necked intracranial aneurysms. Neurosurgery 65：1131-1138；discussion 1138-1139, 2009

11）Shirakawa M, et al：Coil embolization for cerebral aneurysms using a semi-jailing technique and open-cell stent. World Neurosurg 125：e16-e21, 2019