破裂脳動脈瘤に対する血管内治療の基本セットアップとテクニック

Basic Setup and Coil Embolization Technique for Ruptured Cerebral Aneurysms

Point

・合併症低減のために治療環境を整備し，術前の検討からさまざまな状況に対処できるシステムを組むことが重要である．

・ガイディングカテーテル誘導からコイル挿入まで，コイル塞栓術に必要な基本テクニックを習得する．

・術中破裂や血栓性合併症といったトラブルの対処法を理解し，術前からシミュレーションしておくことが重要である．

　For treating ruptured cerebral aneurysms, it is important to understand the setup and basic technique of coil embolization. Safe and effective embolization relies on preoperative considerations that determine the treatment strategy, guide the optimization of the therapeutic environment, and help in the selection of appropriate device systems. Moreover, during aneurysmal embolization, basic techniques for microcatheter shaping and navigation, safe coil introduction, and precise use of occlusion balloons are indispensable. Microcatheter shaping should be based on three-dimensional digital subtraction angiography findings as well as the axes of the parent artery and aneurysm. The operator must understand the advantages and disadvantages of the two methods for navigating the microcatheter into the aneurysm. Furthermore, it is essential to preoperatively simulate and understand the approaches for managing aneurysmal embolization-related complications, such as intraoperative aneurysmal rupture and thromboembolism. Mastery of these steps is mandatory before undertaking embolization of ruptured cerebral aneurysms.