Objective: Endovascular embolization of very small aneurysms (under 3 mm in maximum diameter) is considered to be high risk for aneurysm perforation. Methods: We compared initial angiographic results of ruptured aneurysms between under 3 mm in diameter (21 cases, small group) and over 3 mm in diameter (85 cases, non-small group), the results of short-term follow-up angiography in the small group were also demonstrated. In the small group, extremely soft coils were mainly used for aneurysmal filing. Results: The technical success rates in the small and in the non-small groups were 95.2% and 100%, respectively. Initial angiographic results showed that complete occlusion was obtained in 65.0% of the small group and 52.9% of the non-small group. The mean packing densities in the small and non-small groups were 47.1±11.4% and 26.4±9.5%, respectively, showing the packing density in the small group was significantly higher than those in the non-small group (p<0.001). Intra-operative aneurysmal perforation occurred in 14% and 2.4% in the small and non-small groups, respectively (p=0.08), but none resulted in neurological worsening. In the small group, post-operative rerupture occurred in 5%. Follow-up angiography was performed in 12 cases (60%) at 3–12 months after the procedure, and complete occlusion was obtained in 92%. Conclusion: Endovascular embolization of very small aneurysms is more likely to result in intra-operative aneurysmal perforation compared to larger aneurysms. The use of extremely soft coils could obtain a high packing density, and suitable for repairing these perforations.
【目的】前大脳動脈瘤に対するステント支援下塞栓中に，一時的に母血管が閉塞した症例を報告する．【症例】症例は75 歳男性．右前大脳動脈A2 部に最大径10 mm の動脈瘤をみとめ，母血管径は2.5 mm であった．Jailing techniqueにて，塞栓術を施行した．カテーテルを引いて11 本目のコイルを挿入したところ，母血管が近位より閉塞した．カテーテルを抜去したところ，母血管は再開通した．【結論】先端がコイル塊およびステントと血管壁の間に捕捉された状態でカテーテルを引き戻したため，直線化し母血管が捻れ閉塞したと考えられた．母血管径が小さい場合，ステントと血管壁の間にカテーテルが捕捉されることがある．
【目的】大脳鎌テント移行部硬膜動静脈瘻（falcotentorial DAVF）に流入するartery of Davidoff and Schechter 上の破裂動脈瘤に対してコイル塞栓術を行った1 例を報告する．【症例】51 歳，男性，WFNS Grade Ⅰのくも膜下出血で後大脳動脈硬膜枝（artery of Davidoff and Schechter）を主な流入動脈とするfalcotentorial DAVF を認めた．流入動脈上の瘤からの出血と判断し急性期に母血管塞栓を含めた瘤内塞栓術を行った．慢性期に他の流入動脈に対する塞栓術を追加しシャントはほぼ消失した．【結論】本例はartery of Davidoff and Schechter 上の動脈瘤にコイル塞栓術を行った初めての報告である．同動脈は後大脳動脈より分岐する硬膜枝でありfalcotentorial DAVF の流入動脈となり得る．この硬膜枝への多発動脈瘤形成は極めて稀であり，破裂後のコイル塞栓術は有用な治療法であった．
Objective: The Amplatzer vascular plug (AVP) is a new embolic device with advantages in embolization of high-flow vessels. We report a case involving implantation of an AVP into the retromandibular vein and coil-embolization of an arteriovenous fistula (AVF). Case presentation: We present the case of a 31-year-old woman with an external carotid artery (ECA)-retromandibular vein AVF. She complained of pulsatile tinnitus after a sagittal split-ramus osteotomy. The high-flow left ECAretromandibular vein AVF was depicted in the arterial phase using selective external carotid angiography (ECAG). Endovascular embolization treatment of the fistula using an AVP and coils was planned. We initially intended to introduce the AVP into the fistula via a transvenous route through the left external jugular vein, but could not pass the 5-Fr guiding catheter round the hairpin curve between the fistula and ECA. We therefore changed treatment strategy, placing an 8 mm AVP into the retromandibular vein. Fistula closure was almost obtained after implantation, but shunt flow from a narrow channel remained. We then embolized the fistula using coils, from the AVP to the fistula inlet. The fistula was occluded using five coils. Conclusion: We treated the patient with implantation of an AVP in the retromandibular vein and coil-embolization of the AVF. Advantages of the AVP are its stability for high-flow vessel occlusion and its cost-effectiveness when compared with coils. However, this device has disadvantages in the ease of its delivery to distal vessels. Therefore, using this device in craniofacial lesions needs technical refinement.