Endovascular Treatment of 105 Cases of Acute Intracranial Aneurysm: Practical Aspects, Complications, Outcome, and Prospects.
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Objective: Since endovascular embolization with Guglielmi Detachable Coils (GDC) was introduced in April 1997, we have used this as the treatment of first choice in treating acute ruptured cerebral aneurysm based on our definition of candidates for this treatment modality. We retrospectively analyzed our patient series and discuss problems with this therapy. Methods: Candidates defined for GDC embolization had (1) an aneurysm at least 2.0mm or more in size, (2) the aneurysm neck easily distinguished from surrounding vessels on digital subtraction angiography (DSA), and (3) no massive hemorrhage in computed tomography (CT). Subjects numbered 105 treated in the 3-year period ending in May 2000. Results: The outcome of Hunt & Kosnic grade V aneurysm without hydrocephalus was poor, suggesting that such patients be treated after their consciousness level had improved. The outcome of elderly patients with a better grade were favorable even when they underwent embolization in the acute stage. Intraoperative bleeding occurred in 3 when the aneurysm was pierced with a catheter or guidewire and by coils in 3. Intraoperative vascular occlusion occurred in 2 with middle cerebral aneurysm and catheter-related thrombosis in 2. Rebleeding occurred in 5 due to loose packing in 2, coil compaction in 2, and an IC-dorsal aneurysm in 1. Symptomatic vasospasm occurred in 5.7% (6 of 105). Coil compaction was noted in 7 in which the long diameter of the aneurysm tended to be 7mm or more, 2 of which rebled. Conclusion: Intraoperative complications such as bleeding, vascular occlusion, and rebleeding due to loose coil packing may be avoided by selecting optimal candidates and employing skilled technique. Among issues remaining is increasing the embolization accuracy by developing better thromoblization and aneurysm organization to prevent coil compaction and aneurysm regrowth.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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