Detachable Balloon Treatment of Dissecting Vertebral Aneurysm in Its Acute Stage of Subarachnoid Hemorrhage

概要

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Percutaneous embolization of the parent artery using detachable balloon in three cases of vertebral dissecting aneurysm is reported. These patients were treated within 4 days after subarachnoid hemorrhage following diagnostic angiography. Under local anesthesia, an introducing catheter was positioned into the affected vertebral artery either trans-femorally or trans-axillary. The detachable balloon was situated proximal to the aneurysm and detached after the confirmation of no neurological deficits and good collateral circulation by tolerance test for 15-20 minutes. Cares were taken not to induce rebleeding from the aneurysm. At first, systemic heparinization was not indicated. All procedures were performed in induced hypotension. Intravascular maneuver was limited as seldom as possible. Thrombosis of aneurysm was confirmed either by follow-up angiography or autopsy. Two cases who were grade V (Hunt & Kosnik) at admission died of severe vasospasm. PICA which was proximal to aneurysm was preserved through ipsilateral collateral from ascending cervical to C<SUB>1-2</SUB> vertebral segmental branch. Detachable balloon occlusion of the vertebral artery for dissecting aneurysm is thought to be less invasive, more indicative and a safer procedure compared to conventional surgical proximal occlusion therapy.
The Japanese Society on Surgery for Cerebral Strokeの論文