ステントレトリーバーと吸引カテーテル

Stent Retrievers and Aspiration Catheters

Point

・急性虚血性脳卒中の機械的血栓回収療法において，ステントレトリーバー（SR），吸引カテーテル（AC）各種デバイスの特性に精通していることが治療成功のカギである．

・SRについては，血栓最適捕捉部位であるsweet spotの理解が重要である．

・ACを使用するADAPT（a direct aspiration first pass technique）およびcombined techniqueにおいては，各ACの先端外径，先端内径，有効長の理解と，対象血管径および誘導血管アクセスルートの最少径部を計測する習慣が，治療成功のために重要である．

　ASTER and ASTER 2 trials revealed no significant difference in clinical outcomes between stent retrievers (SR) and aspiration catheters (AC) and SR and combined technique for mechanical thrombectomy. Clinically, selecting an appropriate device should be individualized based on patient characteristics, underlying pathology, and operator expertise. A comprehensive understanding of device-specific technical features is essential to achieve a personalized and effective endovascular strategy. For SRs, this includes recognizing the “sweet spots” unique to each device. For ACs, operators must consider the inner and outer diameters and select the device based on precise measurement of the narrowest segment along the access route to ensure optimal navigation and firm engagement with the thrombus. Here, we provide a comprehensive summary of the SRs and ACs available in Japan and describe our institutional approach to device selecting using representative cases treated with the combined technique.