急性期破裂脳動脈瘤の治療選択の現状(第二報) : 2005年前向き集計と1994年前向き集計との比較(<特集>急性期破裂脳動脈瘤の治療選択)  [in Japanese] Prospective SAH Study in Japan. Comparison Between 2005 Study and 1994 Study(<Topics>Prospective SAH Study)  [in Japanese]

To elucidate the contribution of endovascular treatment to the overall management outcome of ruptured cerebral aneurysms, prospective multicenter observational studies conducted over calendar years 1994 and 2005 are compared. The study in 2005 (Study 05) enrolled a total of 927 patients from 30 centers selected from among institutes of committee member of Japanese stroke surgery organization or symposium of vasospasm. Treatment modalities were left to each institute and finally 770 patients were treated. Clipping and coil embolization were performed on 79% and 21% of the patients, respectively. The study in 1994 (Study 94) enrolled 785 patients obtained from 11 institutes, and all the 525 patients were treated by clipping. Patient outcomes were evaluated 3 months (Study 94) and 1 year (Study 05) after onset and treatment, and overall management outcomes were evaluated. Patients' background such as age, aneurysm location and World Federation of Neurological Surgery (WFNS) grade were not significantly different in the 2 studies. As a result, favorable treatment outcomes were obtained in 74.5% of the cases in Study 94 and 75.6% in Study 05. However, overall favorable management outcomes including non-treated cases were obtained in 58.5% of the cases in Study 94 and 64.4% in Study 05, a significant improvement (p<0.01). A subgroup analysis demonstrated improvement of treatment outcomes in poor-grade (WFNS IV and V) patients and increased ratio of treated patients in poor grade, aged (>70 years old) and vertebrobasilar aneurysm patients. Compared with Study 05 to Study 94, treatment of ruptured cerebral aneurysm by either clipping or coil embolization improved, not treatment outcome, but overall management outcome than those treated clipping only.