経動脈的塞栓術（TAE）で使用するデバイス

Devices and Techniques for Transarterial Embolization of Dural Arteriovenous Fistulas: Current Trends in the Use of Liquid Embolic Agents and Microcatheters

Point

・経動脈的塞栓術（TAE）に用いる液体塞栓物質には，析出型のOnyx^TM（Medtronic）と，重合型のヒストアクリル^®（ビー・ブラウンエースクラップ），TRUFILL^TM n-BCA（Cerenovus/Johnson ＆ Johnson）があり，性能差による使い分けが可能である．

・極細径マイクロカテーテルであるDeFrictor^® Nano（メディコスヒラタ）は末梢への到達性に優れ，シャント近傍からの塞栓を可能にし，静脈側への塞栓物質の到達を容易にした．

・罹患静脈洞が正常な脳静脈還流経路として機能している例においては，バルーンによる静脈洞保護を併用した，Onyx^TM TAEが有用である．

　Transarterial embolization (TAE) of dural arteriovenous fistulas (DAVFs) has evolved significantly following insurance approval of liquid embolic agents such as Onyx^TM and Histoacryl^® (n-butyl-2-cyanoacrylate［NBCA］). Onyx allows prolonged injection and controlled penetration into the venous side, whereas NBCA offers rapid polymerization and thrombogenicity. The success of TAE depends on the selection of appropriate delivery devices. The ultra-fine microcatheter, DeFrictor^® nano, provides superior distal access to small feeders near the shunt point, thereby facilitating effective embolization. In cases where the affected sinus serves as a normal venous drainage route, sinus protection balloon-assisted TAE is useful for achieving both shunt occlusion and preservation of venous function. This technique allows retrograde embolization of multiple feeders through the venous side. Understanding the characteristics of various liquid embolic agents and specialized devices is essential for achieving complete cure and preventing recurrence. This review discusses the latest devices and effective strategies for TAE of DAVFs.