Hyperform occlusion balloonを用いて破裂急性期にコイル塞栓術を施行した脳底動脈先端広頸動脈瘤の1例

Coil Embolization with a Hyperform Occlusion Balloon for an Acutely Ruptured Wide-necked Basilar Tip Aneurysm： Case Report

Ⅰ．はじめに

　広頸動脈瘤は標準的なコイル塞栓術だけでは十分な塞栓効果が得られず，いまだ多くの問題が残る治療困難な動脈瘤の1つである．これまでにバルーンやステントを併用したneck remodeling techniqueや3Dコイルの開発など，手技およびデバイスに様々な工夫がされてきた^1,3-6,10)．今回，われわれは新たなバルーンであるHyperform occlusion balloon（Micro Therapeutics, Irvine, CA）を用いてコイル塞栓術を行う機会を得たので，このバルーンの特性とneck remodelingにおける有用性を報告し，neck remodelingを行う際の問題点についても考察する．

A 54-year-old woman was admitted to our hospital because of severe headache. CT scan demonstrated subarachnoid hemorrhage (SAH),and cerebral angiography revealed a wide-necked basilar tip aneurysm with a bleb and a small basilar artery-left superior cerebellar artery aneurysm. She was treated with coil embolization using a neck remodeling technique one day after SAH. Guiding catheters were introduced into the bilateral vertebral artery via the transfemoral route. A Hyperform occlusion balloon catheter was introduced into the left posterior cerebral artery (PCA) through the left vertebral artery,and was placed at the neck of the basilar tip aneurysm for neck remodeling. Then,the microcatheter for coil deployment was placed in the dome of the aneurysm through the right vertebral artery. The coil was deployed in the aneurysm while the balloon was inflated across the neck. The inflated Hyperform occlusion balloon was partially herniated into the dome of the aneurysm. The distal part of the balloon was positioned in the left PCA segment,and its proximal part was positioned in the basilar artery. The balloon conformed easily to the aneurysmal neck and its surrounding vessel structure. When the balloon was deflated,the coil did not protrude into the parent artery,and was stable in the aneurysm. Angiography immediately after the procedure showed complete occlusion of the aneurysm with patency of both PCAs. The Hyperform occlusion balloon is very compliant and supple,so it easily changes from its cylindrical shape when inflated to expand into the origin of the arterial branches emerging from the aneurysm neck. We think this balloon is a useful device for treating wide-necked aneurysms located at arterial bifurcation.