破裂脳動脈瘤に対するGuglielmi Detachable Coi1による塞栓術

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Management in patients with ruptured cerebral aneurysms remain controversial. However, endovascular treatment of ruptured cerebral aneurysms with Guglielmi Detachable Coils (GDC) is gaining favor as an attractive alternative to surgical clipping. We analyze the experience with endovascular embolization to determine the safety and efficacy of endovascular treatment of ruptured cerebral aneurysms. We retrospectively analyzed 32 consecutive patients harboring 33 cerebral aneurysms. Patients with ruptured aneurysms are managed according to the following protocol: the primary treatment recommendation is endovascular embolization with GDC. Surgical clipping is recommended after failed attempts at embolization or in the presence of angiographical features that contraindicate endovascular treatment, such as a broad neck. Of 33 cerebral aneurysms, 9 (27.3%) were completely embolized, 8 (24.2%) were almost embolized but had a small neck remnant, and 16 (48.5%) showed a body filling. Symptomatic complications after endovascular treatment were found in 3 (9.4%) patients such as parent artery occlusion. Permanent morbidity and mortality related to the procedure were 6.3% and 3.1% respectively. Reembolization was performed in 7 (21.9%) patients and surgical clipping in 4 (12.1%) patients. After the treatment, 25 (78.1%) patients showed a favorable outcome such as good recovery and moderate disability, and 7 (21.9%) patients showed an unfavorable outcome such as severe disability, persistent vegetative state, and death. The results of this study suggest that short-term results of the embolization of ruptured aneurysms are favorable. However, the long-term investigation is important to clarify the significance of this treatment.
日本脳卒中の外科学会の論文
2000-05-31

破裂脳動脈瘤に対するGuglielmi Detachable Coi1による塞栓術

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