急性期破裂脳動脈瘤における不完全初回治療に対する追加治療法の選択 : clippingかcoilingか(<特集>脳動脈瘤の複合手術)  [in Japanese] Choice of Clipping or Coiling as Additional Treatment Following Incomplete Initial Treatment for Ruptured Intracranial Aneurysms in the Acute Stage(<Topics> Multimodality Therapy for Cerebral Aneurysms)  [in Japanese]

The initial treatment for ruptured intracranial aneurysm in the acute stage may be unsuccessful or incomplete. The strategy and outcome of additional treatment have become unclear since the introduction of Guglielmi detachable coils. Between January 1996 and July 2005, 730 patients underwent clipping (636 cases) or coiling (94 cases) for ruptured intracranial aneurysms in the acute stage at our institution, and 26 patients (3.6%) required subsequent surgery or other intervention. These 26 patients were classified into 4 groups: initial clipping followed by additional coiling (Group A), clipping followed by clipping or wrapping (Group B), coiling followed by clipping or wrapping (Group C), and coiling followed by coiling (Group D). The outcomes at discharge were evaluated with the GOS. In Group A (8 patients), 4 patients had good outcomes and 4 had poor outcomes, whereas in Group B (3 patients), all had good outcomes. After initial clipping, 11 of 636 patients (1.73%) required additional treatment, 5 of these 11 (45.5%) suffered re-rupture, and 4 (36.4%) had poor outcomes. In Group C (9 patients) and Group D (6 patients), all patients had good recovery. After initial coiling, 15 of 94 patients (16.0%) required additional treatment. None of these 15 (0%) suffered re-rupture, and all (100%) had good outcomes. Present experience with intravascular treatment cannot determine the superiority of any method of additional treatment, so the choice should be decided case-by-case. We emphasize the need for better results at the initial treatment and close neuroimaging follow-up.