Nishimura Shinjitsu, Fujita Tomoaki, Sakata Hiroyuki, Hori Emiko, Mino Masaki, Nishijima Michiharu, Midorikawa Hiroshi
Department of Neurosurgery, Aomori Prefectual Central Hospital, 2-1-1 Higashi-Tsukurimichi, Aomori 030-8553, Japan.
No Shinkei Geka. 2009 Aug;37(8):757-63.
The inpact of the International Subarachnoid Aneurysm Trial (ISAT) trial publication in 2002 and major technical advances in neuroimaging, endovascular devices and techniques have resulted in increasing numbers of patients with ruptured aneurysms undergoing endovascular coiling, as first-line treatment for aneurysm occlusion. We treated six cases of ruptured aneurysms with this strategy, with choice of clipping as as additional treatment following intentional partial coiling. In this series, patients ranged in age from 36 to 74 years and included one man and five women. Three aneurysms were located in AcomA, 1 in ACA, and 2 in MCA. The reasons for the choice of this strategy were clinical and angiographical spasm in 2, high general surgical risk in 2, and other reasons in 2 cases, respectively. The mean interval between the first partial coiling and final clipping was 33 days. All cases were successfully clipped without difficulties and coil removal were performed in 3 cases for follow up examination. It is proposed that the choice of this strategy contributes to progresses in overall outcomes in cases of aneurysmal subarachnoid hemorrhage.
2002年国际蛛网膜下腔动脉瘤试验（ISAT）的试验结果公布，以及神经影像学、血管内装置和技术的重大进展，使得越来越多的破裂动脉瘤患者接受血管内栓塞治疗，作为动脉瘤闭塞的一线治疗方法。我们采用这种策略治疗了6例破裂动脉瘤患者，并在有意部分栓塞后选择夹闭作为额外治疗。在这个系列中，患者年龄在36至74岁之间，包括1名男性和5名女性。3个动脉瘤位于前交通动脉（AcomA），1个位于大脑前动脉（ACA），2个位于大脑中动脉（MCA）。选择这种策略的原因分别是2例存在临床和血管造影痉挛，2例存在较高的普通外科手术风险，以及另外两例存在其他原因。首次部分栓塞与最终夹闭之间的平均间隔为33天。所有病例均成功夹闭，无困难，3例进行了线圈取出以进行随访检查。有人提出，这种策略的选择有助于改善动脉瘤性蛛网膜下腔出血病例的总体预后。
