破裂脳動脈瘤に対する瘤内塞栓術 : 合併症例の検討  [in Japanese] Endovascular Embolization for Ruptured Cerebral Aneurysms  [in Japanese]

We treated ruptured intracranial aneurysms with endosaccular embolization using Guglielmi Detachable Coils (GDC) in 192 patients treated in Nagoya University and affiliated hospitals over the past 7 years. Hunt & Kosnik grading was I in 18 patients, II in 78, III in 51, IV in 38, and V in 7, respectively. One hundred and seven aneurysms were located in the anterior circulation and 85 in the posterior circulation. Complete obliteration was obtained in 105 (55%), subtotal in 76 (40%), and partial in 11 (5%) aneurysms. We experienced 27 intraprocedural complications, including 11 intraoperative ruptures and 16 thromboembolisms. Permanent morbidity and mortality related to the procedure were 4.7% and 2.1%, respectively. An analysis of complication cases based on the aneurysmal configuration and location showed that tiny aneurysms and vertebral aneurysms (VA-PICA) should be carefully treated to avoid possible perioperative hemorrhagic complications. Due attention should also be paid to thromboembolic complications on the treatment of aneurysms located in middle cerebral, basilar-tip and posterior inferior cerebellar artery because of its branching in close relationship to the aneurismal neck.