JNET 9:192 196, 2015 症例報告 スーパー政宗 ( 第二報 ) - 初期臨床経験 - Super-Masamune: initial clinical experience Masayuki EZURA, Naoto KIMURA, Hiroshi UENOHARA Department of Neurosurgery, NHO Sendai Medical Center Abstract Objective: We recently developed Super-Masamune. It is a double lumen balloon microcatheter, which is recently approved as an assist balloon for aneurysmal coil embolization in Japan. We report our initial clinical experiences of Super-Masamune. Case 1: A 73-year-old female with unruptured right internal carotid artery aneurysm was admitted for embolization. Super-Masamune was introduced into the aneurysm. At first, it was used as a standard microcatheter for coil insertion. Then, balloon of the super-masamune was inflated, and the guide wire lumen of the super-masamune was still used for coil insertion. Finally, the super-masamune was moved to the internal carotid artery and was used as assist balloon. Case 2: A 68-year-old female with unruptured basilar tip aneurysm was admitted for embolization. Most part of the aneurysm was ridden on the right posterior cerebral artery (PCA). Branching angle of the right PCA was very acute. So, super-masamune was introduced into the left PCA. Even in this position, the balloon of super-masamune was bulged into the right PCA and the neck of aneurysm was completely protected. Conclusion: In clinical use, the balloon itself is very compliant. It easily herniates to free space and makes better neck protection possible. Because of double lumen, it can be used not only as neck plasty balloon, but also as the catheter for coil insertion. Key words Super-Masamune, neck plasty, remodeling technique, assist balloon, HyperForm 983-8520 2-8-8 E-mail: ezuram@snh.go.jp Received April 7, 2015 Accepted May 20, 2015 doi: 10.5797/jnet.cr.2015-0019 はじめに 1 症例 1 73 8 mm Excellsior SL10 Stryker, Kalamazoo, MI, USA Fig. 1A 6 F 6 F 192
Fig. 1B SL10 Fig. 1C Fig. 1D 症例 2 68 2006 MRI 7.0 mm 6.0 mm 6.0 mm 4.3 mm Fig. 2A, B PCA P1 P1 PCA P1 PCA PCA P1 P1 P1 P1 6 F 5 F 6 F 6 F 5 F 5 F 5 F PCA 6 F P1 Fig. 2C 9 Fig. 2D 考察 1997 2,3 GrapeVine Micro Interventional Systems, Sunnyvale, CA, USA Comodore Johnson & Johnson, Miami, FL, USA Copernic Balt Extrusion, Montmorency, France HyperForm HyperForm HyperForm 4 HyperForm 5 7 Scepter MicroVention TERUMO, Tustin, CA, USA 2.1 F 2.8 F 2.8 F 3.4 F 6 F 8 Scepter HyperForm proximal 193
A B C D Fig. 1. Lateral views of right internal carotid artery (ICA) angiograms during embolization of unruptured IC-PC aneurysm in a 73-year-old female. A: Immediately before embolization. Super-Masamune is introduced to the upper portion (arrow), and SL 10 to the lower portion (arrowhead). B: Inflation of super-masamune located in the aneurysm. Note that the distal portion of balloon is bulging into the ICA (arrow). C: Inflation of Super-Masamune located in the ICA. D: Immediately after embolization. Aneurysm is completely embolized. 194
A B C D Fig. 2. Anteroposterior views of right vertebral artery (VA) angiograms during embolization of unruptured basilar tip aneurysm in a 68-yearold female. A: Immediately before embolization. B: 3D digital subtraction angiogram. C: Inflation of Super-Masamune. Note that Super-Masamune is bulging into the right P1 portion. D: Immediately after embolization. Aneurysm is completely embolized with complete preservation of the right P1 as well as the right superior cerebellar artery. 195
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