血管内手術の最先端 脳動脈瘤コイル塞栓術におけるＭｏｄｉｆｉｅｄ Ｒｅｍｏｄｅｌｉｎｇ Ｔｅｃｈｎｉｑｕｅの検討

Abstract

The purpose of this study was to determine the efficacy of various modifications for the remodeling technique, i.e., microcatheter tip re-shaping in the parent vessel, balloon setting with exchange microguidewire, balloon catheter navigation with another balloon in the targeted aneurysm, and retrograde approach of the balloon catheter. Remodeling technique is balloon assisted coil embolization for wide neck cerebral aneurysms, first documented by Jacques Moret. Under the neck protection with temporally inflated balloon in the parent vessel, platinum coils are delivered via another microcatheter. Not all wide neck aneurysms are suitable for remodeling technique because of the complex structure of the parent vessels surrounding the aneurysm orifice. Some microcatheter tips could be re-shaped inside the normal artery at body temperature. Intensive bending of the microcatheter tip for a short while is of some help to difficult navigation. Occasionally, we find it difficult to navigate the stiff balloon catheter across the aneurysm neck. An exchange microguidewire of 300 cm length is useful if a supple microcatheter can be navigated in the same route as the balloon catheter is placed. A stiff balloon catheter can replace the microcatheter with the exchange guidewire. For a large aneurysm with wide neck, the balloon catheter can be navigated beyond the aneurysm with assistance of another balloon inflation inside the targeted aneurysm. Furthermore, retrograde navigation of the balloon catheter against the blood flow passing through the communicating vessels could be helpful under specific situations. During 2003-2006, 11 of these modifications were applied to 31 remodeling procedures. One hemorrhagic complication and 2 recurrences of treated aneurysms were observed. With illustrative cases, we report the details concerning these procedures.