急性期破裂脳動脈瘤に対する瘤内塞栓療法 : クリッピング術第一選択である当院の治療成績(<特集>急性期破裂脳動脈瘤: ISAT後の適応と治療成績)  [in Japanese] Intraaneurysmal Embolization for Ruptured Aneurysm in the Acute Stage : Our Indication and Results(Topics : Ruptured Aneurysm, Post ISAT Era)  [in Japanese]

We evaluated our treatment protocol and results on the intraaneurysmal GDC embolization for ruptured aneurysm in the acute stage. Between 1998 and 2002, 55 aneurysms were treated by intraaneurysmal embolization and 252 aneurysms were treated by surgical neck clipping. Patients with ruptured aneurysm were always considered possible candidates for surgical clipping. If the patients had any difficulties and/or problems on surgical clipping, the patients were treated by intraaneurysmal embolization. In the intraaneurysmal embolization group, 2 patients were classified as Hunt & Kosnik Grade 1, 23 as Grade 2, 19 as Grade 3, 10 as Grade 4 and 1 as Grade 5. Nineteen aneurysms were located on the ICA, 10 on the AcomA, one on the ACA, 3 on the MCA, 3 on the VA and 19 on the BA. In the neck clipping group, 13 patients were classified as Grade 1, 123 as Grade 2, 80 as Grade 3, 32 as Grade 4 and 4 as Grade 5. Sixty-nine aneurysms were located on the ICA, 69 on the AcomA, 13 on the ACA, 67 on the MCA, 9 on the VA, 5 on the BA and 3 at other locations. Symptomatic vasospasm occurred in 2 cases (3.6%) in the intraaneurysmal embolization group and in 13 cases (5.2%) in the neck clipping group. Rebleeding within 3 months after treatment occurred in 1 case (1.8%) in the intraaneurysmal embolization group and in 4 (1.6%) cases in the neck clipping group. The modified Glasgow Outcome Scale (GOS) grade at discharge showed that 44 patients (80.0%) had good outcome (GR or MD) in the intraaneurysmal embolization group, and that 213 patients (84.5%) had good outcome in the surgical neck clipping group. Intraaneurysmal embolization for cases with surgical difficulties and/or problems was useful and may raise overall outcome.