Hunt-Hess 등급 V 뇌지주막하 출혈 환자의 혈관내 수술

Abstract

Objective : The outcome of patients with poor grade subarachnoid hemorrhage(SAH) is known to correlate to admission grade, and this poor grade patients have higher rebleeding rate after SAH. Patients with poor grade subarachnoid hemorrhage have been considered good candidates for endovascular treatment. The aim of the present study was to inveatigate and compare the outcomes of comservative treatment, surgical clipping, and endovascular treatnent for H-H grade V SAH patients. Methods : A retrospectively assessed, non-selective series of 89 consecutive poor grade patients with aneurysmal subarachnoid hemorrhage were analyzed between January 1995 and March 2003. 51 patients had conservative treatment and 13 patients had surgical clipping and 25 patients had coil embolization. Results : Among the 51 patients treated conservatively, 46 patients(90%) were died within 30th days, and among 13 patients treated surgically 5 patients (38.5%)were died. But, among 25 patients was done endovascular treatment only 7patients(28%)were died. The survival rate at endovanalar treatment (72%) was higher than those of conservative treatment(10%) and surgical clipping(61.5%). Endovascular treatment had the most favorable outcomes compared to other methods. Conclusions : Endovascular treatment for H-H grade V patients improved survival rate and favorable outcomes. A significant factor is influncing on the patients' survival rate in the endovascular treatment was a preprocedural patients' Glasgow coma Scale score. The survival rate in patients with GCS score(6~4) was good but not in those with GCS score of 3. Key Words : Subarachnoid hemorrhage, Hunt-Hess grade V, Coil embolization.