Ozaki Tomohiko
Department of Neurosurgery, Graduate School of Medicine, Osaka University.
No Shinkei Geka. 2023 Nov;51(6):1133-1148. doi: 10.11477/mf.1436204861.
Since Pipeline Flex(Covidien/Medtronic)was approved in April 2015, flow diverter(FD)treatment has started in Japan. Three kinds of FDs(Pipeline, FRED and Surpass)are available now, and we have been able to treat a variety of aneurysms, including those that are giant-sized and located posterior circulation, which had been difficult to treat safely before the appearance of the FD. In addition, indications for FDs have been expanding with increasing evidence. However, there are some challenges that need to be overcome. First, thromboembolic complications due to high metallic amounts in FD must be considered. The long duration of antiplatelet therapy must be continued to reduce thromboembolic complications, but the precise required-duration of this therapy has not yet been determined. Second, FD treatment requires a few months before an aneurysmal cure is achieved. Therefore, there is a possibility of an aneurysmal rupture after FD deployment. In addition, there are some kinds of aneurysms for which FD treatment is less effective, such as aneurysms with a large branch vessel. In this review, I describe the details of each FD and the current state of FD, based on the evidence.
自2015年4月Pipeline Flex（柯惠医疗/美敦力公司）获批以来，血流导向（FD）治疗已在日本开展。目前有三种FD产品（Pipeline、FRED和Surpass）可供使用，我们已经能够治疗各种动脉瘤，包括巨大型和位于后循环的动脉瘤，在FD出现之前，这些动脉瘤很难安全地进行治疗。此外，随着证据的增加，FD的适应证也在不断扩大。然而，仍有一些挑战需要克服。首先，必须考虑FD中金属含量高导致的血栓栓塞并发症。为减少血栓栓塞并发症，必须持续较长时间的抗血小板治疗，但这种治疗的确切所需时长尚未确定。其次，FD治疗需要几个月才能实现动脉瘤治愈。因此，在植入FD后存在动脉瘤破裂的可能性。此外，对于某些类型的动脉瘤，如伴有大分支血管的动脉瘤，FD治疗效果较差。在这篇综述中，我将根据现有证据描述每种FD的详细情况以及FD的当前状况。
