大型未破裂脳動脈瘤に対する血管内治療術後の脳内出血の1例の検討

DOI Web Site 参考文献11件
  • Adam Tucker
    北見赤十字病院 脳神経外科 大阪医科大学 脳神経外科・脳血管内治療科
  • 宮地 茂
    愛知医科大学 脳神経外科・脳血管内治療センター
  • 大西 宏之
    大西脳神経外科病院
  • 平松 亮
    大阪医科大学 脳神経外科・脳血管内治療科
  • 黒岩 敏彦
    大阪医科大学 脳神経外科・脳血管内治療科

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タイトル別名
  • Intracerebral Hemorrhage after Endovascular Treatment of Unruptured Intracerebral Aneurysm: A Case Report and Review of the Literature

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<p>Purpose: Intracerebral hemorrhage (ICH) that develops after treatment of unruptured intracerebral aneurysms is a rare complication. We present one case of ICH after endovascular treatment and discuss the possible pathophysiologic mechanisms and preventative strategies.</p><p>Patient Case: A 51-year-old woman with left homonymous hemianopsia and a large paraclinoid (internal carotid-ophthalmic) aneurysm underwent flow diversion (FD) using the PipelineTM Embolization Device and coiling. Several hours postoperatively, she had motor aphasia with mild right hemiparesis, and head computed tomography revealed an ipsilateral frontotemporal hematoma. Magnetic resonance angiography and digital subtraction angiography suggested a form of hyperperfusion syndrome, and conservative management resulted in almost complete resolution of symptoms.</p><p>Conclusions: The etiology of ICH acutely following FD may be multifactorial due to dual antiplatelet therapy (DAPT) hyper-response and flow modification related to hyperperfusion and the Windkessel effect. Conservative management resulted in a good outcome. However, for severe hemorrhagic cases, platelet transfusion, discontinuation of DAPT to single antiplatelet therapy, and surgical intervention should be considered. Perioperative monitoring indicating antiplatelet hyper-response or radiographic hyperperfusion should direct strict blood pressure control and risk reduction precautions.</p>

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  • 脳卒中の外科

    脳卒中の外科 48 (2), 129-133, 2020

    一般社団法人 日本脳卒中の外科学会

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