뇌동맥류의 혈관내 수술의 임상적 분석

Abstract

Background. The author evaluate the usefulness, results, and technical problem of endovascular treatment of cerebral aneurysms with Guglielmi detachable coil(GDC). Method From November 2000 to October 2004 , forty patients with 33 ruptured and 7 unruptured aneurysms were treated with GDC embolization. Thirty-one aneurysms were located in the anterior circulation and 9 in the posterior circulation. Aneurysms sue was categorized small(n=32) and large(n=7) giant(n=1) and neck size was categorized narrow(n=31) or wide(n=9). We statistically analyzged occlusion rate according to the location, rupture, size, and neck sue of aneurysms, and investigated the procedure-related complications and clinical outcomes. Result GDC treatment of aneursyms was successful in 40 aneurysms of 38 patients(95%). Total occlusion was achieved in 24(65.8%) cases, subtotal occlusion in 9(23.7%), and incomplete occlusion in 4(10.5%). Each total occlusion rate was 75% in small-sized, 14.3% in large-sized, 70.9% in narrow-necked, and 33.3% in wide-necked aneurysms. Location and rupture of aneurysms did not influence occlusion rate. The technical complications included 4 thromboembolism, 3 parent artery occlusion, and 1 perforation of aneurysm. Procedure-related morbidity and mortality were 10.3% and 2.6%. 1 incompletely embolized aneurysm in anterior circulation rebled during the follow-up period. Conclusion Embolization of intracranial aneurysms with GDC is safe, effective and reliable, and short-term clinical results of endovascular treatment of cerebral aneurysm indicate that this procedure is a useful alternative approach in cerebral aneurysms. However, the rebleeding by aneurysmal recanalization or regrowth and intraoperative thromboembolism are major limitation of GDC treatment. Follow-up angiography and further technical improvement are mandatory to overcome rebleeding and thromboembolism.