新たな分岐部脳動脈瘤用デバイス（PulseRider，W-EB）の適応と使用法は？

Indications and Usage of New Devices such as PulseRider and W-EB for Bifurcation-type Aneurysms

Point

・分岐部wide neck型脳動脈瘤に対する新たなデバイス（PulseRider，W-EB）が2020年から使用可能になった．

・PulseRiderは2本の分岐血管をカバーするように展開され，動脈瘤へ挿入するコイルの親動脈への逸脱を防ぐデバイスである．

・W-EBは動脈瘤内に留置することで，瘤内への血流を遮断し，血栓化を促進し動脈瘤を閉塞させるデバイスである．

　Bifurcation-type aneurysms located at the basilar tip, anterior communicating artery, and middle cerebral artery are difficult to treat by endovascular coil embolization. One reason for this is that it is impossible to completely cover the aneurysm neck with a single stent because of the branching of two large vessels at the location. Moreover, the parent artery blood flows directly into the aneurysm dome and induces recanalization of the placed coils. In 2020, new devices for bifurcation aneurysms, such as PulseRider and W-EB, were approved in Japan. PulseRider has been in use since September, and W-EB is expected to be available by the end of the year. PulseRider has unique leaflets, which easily cover the broad neck of bifurcation aneurysms and prevent the coil from protruding into the parent artery. W-EB is a nitinol self-expandable mesh ball implant that can prevent blood flow into the aneurysm and subsequent induced thrombosis by deployment in the aneurysm sac. Although we do not yet completely know the features and advantages of either, we expect these two new devices to improve endovascular treatment of bifurcation-type aneurysms that thus far have been difficult to treat.