Imamura Hirotoshi, Sakai Nobuyuki
Department of Neurosurgery, Kobe City Medical Center General Hospital.
No Shinkei Geka. 2021 Jan;49(1):146-155. doi: 10.11477/mf.1436204370.
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.
位于基底动脉顶端、前交通动脉和大脑中动脉的分叉型动脉瘤难以通过血管内弹簧圈栓塞治疗。原因之一是，由于该位置有两条大血管分支，用单个支架无法完全覆盖动脉瘤颈部。此外，载瘤动脉的血流直接流入动脉瘤瘤腔，会导致置入的弹簧圈再通。2020年，用于分叉型动脉瘤的新装置，如PulseRider和W-EB，在日本获得批准。PulseRider自9月起投入使用，W-EB预计在年底上市。PulseRider有独特的小叶，能轻松覆盖分叉型动脉瘤的宽颈，防止弹簧圈突入载瘤动脉。W-EB是一种镍钛诺自膨胀网状球囊植入物，通过在动脉瘤腔内展开可防止血流进入动脉瘤及随后引发的血栓形成。尽管我们尚未完全了解这两种装置的特点和优势，但期望这两种新装置能改善迄今为止难以治疗的分叉型动脉瘤的血管内治疗。
