急性期破裂脳動脈瘤に対するEnterprise VRDを用いた瘤内塞栓術におけるオザグレルの有用性

Abstract

We evaluate the safety and efficacy of ozagrel sodium (ozagrel) in stent-assisted coil embolization (SACE) of acutely (＜72 hours) ruptured wide-necked intracranial aneurysms, including primary success rates and short-term follow-up results. Approval by an institutional review board was obtained for this retrospective study. Results in 20 consecutive patients (6 men, 14 women; mean age, 68.2 years; range, 45–89 years) who were treated with SACE for acutely ruptured wide-necked intracranial aneurysms were evaluated. All patients were treated with Enterprise VRD stents (Johnson & Johnson Codman, Miami, FL, USA). Patients were treated with systemic heparinization and treated intraoperatively with an intravenous bolus infusion of 40 mg of ozagrel followed by intravenous drip infusion of 40 mg of ozagrel for 30 minutes. Single or dual oral antiplatelet agents were administrated immediately after the procedures. The modified Rankin Scale (mRS) was recorded at discharge. The indications for use of stent-assist were failure of the balloon remodeling technique (n＝10), coil tail protrusion (n＝1), coil instability (n＝5), and intentional (n＝4). All aneurysms were treated successfully with SACE. Complete occlusion was achieved in 13 cases (65%), nearly complete occlusion in six (30%), and partial occlusion in one (5%). One patient (5%) with a large middle cerebral artery aneurysm that resulted in partial occlusion developed embolic complications three days after the procedure, but she recovered and was discharged with an mRS score of 1. Perioperatively, ventricular drainage was performed in four patients (20%), spinal drainage in 11 (55%), and ventriculo-peritoneal shunt in two (10%). None presented with hemorrhagic complications. At the time of discharge, 15 patients (75%) had recovered in good condition (mRS 0–2), four were moderately or severely disabled (mRS 3–5), and one (5%) died (mRS 6) from primary brain damage. The remaining 19 patients developed no ischemic or hemorrhagic complications during the mean follow-up duration of 6.7 months. Our results indicate that ozagrel is a safe and effective antiplatelet agent in Enterprise VRD-assisted coiling in acutely ruptured intracranial aneurysms.