高齢者破裂脳動脈りゅうに対するりゅう内塞栓術の治療成績

Abstract

We retrospectively assessed endovascular treatment by selective embolization with detachable platinum coils of ruptured intracranial aneurysms in 42 patients over 70 years of age (ranging from 70 to 91 years old). Preoperative Hunt and Hess grading revealed that 7 patients were in Grade I, 13 in Grade II, 9 in Grade III, 8 in Grade IV and 5 in Grade V. The aneurysms were located in the internal carotid artery in 18 patients, in the anterior communicating artery in 8, in the distal anterior cerebral artery in 5, in the middle cerebral artery in 4 and in the posterior circulation in 5. The approach was transfemoral in 39 patients, transbrachial in 1 and transcarotid in 2. The immediate angiographical outcomes were complete occlusion in 21 patients (50%), neck remnant in 8 (19%) and body filling in 13 (31%). No procedure-related morbidity or mortality was observed. The follow-up period by either conventional angiography or magnetic resonance angiography ranged from 3 to 17 months in 17 patients. Rebleeding was not observed during the follow-up period. Clinical outcomes were evaluated using the Glasgow Outcome Scale (GOS). In the 29 patients with Grade I-III, 25 patients (86%) showed good recovery or moderate disability and 4 showed severe disability or vegetative state. In the 13 patients with Grade IV-V, 4 patients (31%) showed good recovery or moderate disability and 9 (69%) showed severely disability or vegetative state or died. Symptomatic cerebral vasospasm occurred in 6 patients (21%) of Grade I-III patients. The main cause of poor outcome in Grade I-III patients was cerebral vasospasm in 2 and pneumonia in 2. Endovascular surgery is a useful therapeutic option for treatment of ruptured intracranial aneurysm in patients over 70 years of age, especially those in Hunt and Hess Grade I-III. However, treatment indication should be carefully determined in poor-grade patients.