最新医用画像による脳血管内手術の革新

抄録

Stroke, which includes cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage, is the fourth leading cause of death among Japanese people. Conquering a stroke is a significant challenge as it often affects patients, their families, and social resources. When medical treatment is ineffective in preventing recurrence, surgical intervention becomes the preferred option. Surgical treatment for stroke lesions can be done in two ways: direct surgery, which involves making a skin incision and a craniotomy to reach the lesion, and endovascular surgery, which 0515 involves using a catheter delivered via the radial or femoral artery to the lesion. During endovascular surgery, coils, embolic materials, and/or stents may be used to treat the lesion. Minimally invasive endovascular neurosurgery is generally preferred by patients, and its usage has increased over the years. However, some lesions may be more effectively treated with direct surgery rather than endovascular treatment. Imaging plays a critical role in the treatment strategy. Preoperative imaging is used to determine whether the lesion can be treated by endovascular surgery. Intraoperative imaging helps in selecting an appropriate device during treatment, and postoperative imaging is used to determine if recurrence or re-treatment is necessary. In recent years, various diagnostic imaging devices such as DSA (digital subtraction angiography), MRI (magnetic resonance imaging) and CT (computed tomography) have been developed, offering improved image quality and providing less invasive procedures for patients. This paper will present the latest perioperative imaging methods for endovascular surgery, including carotid artery stenosis, acute ischemic stroke, and unruptured aneurysms, using state-of-the-art imaging modalities.