未破裂脳動脈瘤〈手技とデバイス編〉—未破裂脳動脈瘤に対する新しいデバイス

Unruptured Intracranial Aneurysms:Endovascular Techniques and Devices:New Devices for Unruptured Intracranial Aneurysms

Point

・脳動脈瘤の発生原因は親動脈壁損傷や先天的脆弱性であり，囊状・紡錘状拡張部分の物理的閉塞では根治は得られにくい．

・今後の血管内治療は低侵襲性だけでなく根治性も求められ，親動脈壁に修復機転をもたらすデバイスの開発が求められる．

・フローダイバーターや瘤内フローディスラプターは新生内膜形成を惹起し，親動脈壁に修復機転をもたらすことが期待される．

　Factors causing the formation and growth of intracranial aneurysms include injury and congenital vulnerability of the arterial wall. Therefore, coil embolization of the saccular and fusiform components of intracranial aneurysms is not always curative, and the risk of recurrence in the long-term follow-up is high. Recently, flow diverters（e.g., pipeline, FRED, and Surpass Streamline）and an intrasaccular flow disruptor（W-EB）have been introduced as alternative embolic devices for intracranial aneurysms. These devices can repair arterial walls through neointimal formation surrounding the aneurysm neck and achieve complete cure. The PulseRider is a type of neck bride stent for bifurcation aneurysms that can effectively prevent coil herniation into the parent artery.