2017 年 11 巻 3 号 p. 165-172
Clinical evidence regarding a new endovascular treatment device, flow diverter (FD), for large/giant cerebral aneurysms is introduced. Currently, three kinds of FD, Pipeline, Surpass, and FRED, are being used in our country.Pipeline: Pipeline was successfully placed in 107/108 patients (99.1%) in PUFS trial. An international study, IntrePED, collected clinical data of 793 patients with 906 aneurysms, and showed favorable clinical results with relatively low neurologic morbidity-mortality (7.4%). However, adverse events were more frequent in large, ruptured, and posterior circulation aneurysms. Ischemic stroke was the majority of complications (4.7%). On the other hand, delayed rupture of the treated aneurysm was rare (0.6%).Surpass: In a prospective, single-armed, multicenter clinical study of Surpass flow diverter, successful placement was observed in 161 of 186 aneurysms (98%), and neurologic death or any stroke within 6 months was seen in 18 patients (12%).FRED: In FRED, clinical reports regarding 29 patients with 34 aneurysms showed 100% successful placement and no complications in 26 cases (89%).A recent meta-analysis reported that FDs were used for unruptured aneurysms, particularly, of the internal carotid or vertebrobasilar artery, and fusiform, dissecting, or wide-necked saccular aneurysms, and progressive occlusion of the aneurysm during follow-up after the procedure and neurologic morbidity in 3.5% and death in 3.4% in 1483 patients with 1704 aneurysms.In conclusion, FDs are shown as relatively safe and useful devices for aneurysms with complex anatomical structures which are not treatable by coiling or clipping. A better clinical result is expected by selecting appropriate patients and careful treatment with FDs in the future.