血管内治療の現状と新展開(<特集>脳動脈瘤に対する新たな考え方)  [in Japanese] Current Status and Future Prospects of Endovascular Treatment(<SPECIAL ISSUE>New Concept in Treatment for Cerebral Aneurysm)  [in Japanese]

脳動脈瘤に対する血管内治療は,螺旋状の単純なbare platinum coilの留置からはじまり,ワイドネック型動脈瘤への適応や長期成績の向上のために,balloon neck remodeling techniqueの導入,複雑な形状のコイルやsurface modification coilの開発,ステント支援塞栓術が行われるようになった,破裂急性期動脈瘤に関しては,ISATにより血管内治療の優位性が証明され,大きく治療法が血管内治療へシフトしたが,未破裂脳動脈瘤に関しては良好な成績が報告されているが,いまだその有効性は証明されていない.新しい治療法として海外ではflow diverterが臨床使用され,従来の血管内治療では困難であった,巨大動脈瘤,部分血栓化動脈瘤,紡錘状動脈瘤が治療されている.従来の瘤内塞栓術に加え,flow diverterによりさらに脳動脈瘤に対する適応が拡大しつつある.

Endovascular treatment for cerebral aneurysms originally started with simple helical bare platinum coils. Since then, balloon neck remodeling technique, complex shape coils, surface modification coils and stent assisted embolization have been developed to treat difficult aneurysms with stable long-term results. ISAT revealed the superiority of endovascular treatment for acutely ruptured aneurysms. However, the efficacy of endovascular treatment for unruptured aneurysms has not been established yet, even though there are many retrospective reports with good outcomes. As a new treatment modality, a flow diverter has started to be used to treat giant, partially thrombosed or fusiform aneurysms, which were difficult to cure by conventional methods, with promising initial results. Endovascular treatment employing this new method enables us to treat more aneurysms than ever.