Neurological Surgery 脳神経外科51巻6号

2023年11月発行

総説

血管内治療におけるflow diverterの現状

著者： 尾崎友彦¹

所属機関： ¹大阪大学大学院医学系研究科脳神経外科学

ページ範囲：P.1133 - P.1148

Ⅰ はじめに
　Flow diverter（FD）は，本邦では2015年4月にPipeline^TM Flex（Covidien，現Medtronic）が薬事承認され，その治療の歴史がスタートした．以降，『頭蓋内動脈ステント（脳動脈瘤治療用Flow Diverter）適正使用指針 第3版』^1）に基づき治療が行われている．2023年現在，3種類のFDが使用可能となっており，FD導入前には治療困難であった大型動脈瘤や後方循環動脈瘤に対しても，安全に治療が行えるようになってきた．さらに近年，エビデンスの蓄積^2-4）により，動脈瘤のサイズも10 mm以下の瘤にまで適応拡大されている．
　しかし，克服すべき課題も残されている．まず，母血管内に金属量の多いFDを留置することによる血栓性塞栓症，さらにそれを防止するための長期にわたる抗血小板薬内服の必要性が挙げられる．また，動脈瘤治癒までには数カ月を要するため，FD留置後の動脈瘤破裂，いわゆる遅発性破裂（delayed aneurysmal rupture）も課題である^5）．さらに，大きな分岐血管をもつ動脈瘤などの，FD留置後も瘤内血流停滞を得にくく瘤が治癒しないFD不応例にも考慮が必要である^6）．
　本稿では，FDの治療適応を含めた基本情報と，これまでのエビデンスに基づいた現状，さらには今後の展望に関して報告する．

参考文献

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