Embolizationn of acutely ruptured cerebral aneurysms.
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概要
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Rerupture must be prevented in treating acutely ruptured cerebral aneurysms. Such prevention had been achieved by microsurgically clipping aneurysms. With the advent of endovascular techniques such as the use of Guglielmi detachable coils (GDC), the efficacy of endovascular treatment is being described in growing numbers of reports. GDC enables us to approach a cerebral aneurysm without craniotomy, retraction, or dissection of the brain, and is now recognized as less invasive treatment for aneurysms. Our department introduced this technique in March 1997 as the choice treatment of choice for acutely ruptured aneurysms. We assessed the efficacy of GDC embolization. We retrospectively analyzed 73 consecutive cases of acutely ruptured aneurysm treated with GDCs in our department from March 1997 to June 2000. Average patient age was 56.8 years, with 17 over the age of 70. In this series, 8 were classified as Hunt and Hess neurological Grade I, 22 as Grade II, 24 as Grade III, 13 as Grade IV, and 6 as Grade V. Intraaneurysmal occlusion under general anesthesia was use to treat 10 aneurysms and 3 were treated by proximal occlusion of the parent artery under local anesthesia. To prevent vasospasm, most patients underwent spinal drainage to remove subarachnoid clots. Symptomatic complications related to embolization occurred in 9 cases, including 4 intraoperative ruptures, 4 ischemic accidents, and 1 vessel perforation with a guidewire. Permanent morbidity related to complications occurred in 4 (6%) and mortality in and 2 (3%). Among those whom embolization was insufficient due to a wide neck or irregular shape, 4 aneurysmal reruptures occurred during the acute period. Symptomatic vasospasm occurred in 19%, with permanent morbidity related to vasospasm in 4% of these but no mortality. Reembolization in the chronic period was conducted in 12 case, and clipping with craniotomy in 7. Outcomes were good in 55 cases (75%). Among Grades I, II, and III, 85% showed good outcomes. Our results suggest that treating acutely ruptured aneurysms with GDCs is effective, with an acceptable risk of complications. More long-term follow-up evaluation is necessary, and results are expected to improve.
- 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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