Ion beam照射ePTFEを用いた脳動脈瘤のwrap-clipping

Intracranial aneurysms are usually treated with either microsurgical clipping or endovascular coiling. However, since neither so-called broad-neck aneurysms nor dog-ear remnants at neck clipping are suitable for such treatment options, a wrapping technique is applied for such cases. The material for aneurysmal wrapping demands both stable adherence and no reactive inflammatory response. We have developed a newly improved ePTFE by ion beam irradiation technique that is biologically inert and able to firmly adhere to surrounding tissue. Based on the lastest studies, Ar+ ion at energy of 150 keV with a fluence of 5×1014 ions/cm2 was chosen to irradiate into ePTFE. Using this ion beam irradiated ePTFE, wrap-clipping was performed in 2 cases and coating was made to dog-ear remnant after clipping in 12 cases. Wrapping technique was easy and ion beam irradiated ePTFE instantly adhered to the aneurysm dome with fibrin glue. After surgery, no aneurysm developed rebleeding. Only 1 case developed subarachnoid hemorrhage due to ruptured dissecting aneurysm at the dominant VA. The patient was treated with wrap-clipping, but died because of serious preoperative SAH grade. These results indicate that application of this technology may offer one of the best materials for aneurysm wrapping.