Koiso Takao, Komatsu Yoji, Watanabe Daisuke, Hosoo Hisayuki, Sato Masayuki, Ito Yoshiro, Takigawa Tomoji, Hayakawa Mikito, Marushima Aiki, Tsuruta Wataro, Kato Noriyuki, Uemura Kazuya, Suzuki Kensuke, Hyodo Akio, Ishikawa Eichi, Matsumaru Yuji
Department of Neurosurgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
Department of Neurosurgery & Stroke, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Neuroendovasc Ther. 2024;18(12):313-320. doi: 10.5797/jnet.oa.2024-0054. Epub 2024 Oct 19.
Middle cerebral artery (MCA) aneurysms are difficult to treat with coil embolization (CE) due to their location and shape, but the number of CE-treated MCA has gradually increased as treatment techniques have improved. However, the outcomes of CE for ruptured MCA aneurysms are poorly understood. This study aimed to evaluate the outcomes of CE for ruptured MCA aneurysms.
We retrospectively analyzed the medical records of patients with aneurysmal subarachnoid hemorrhages (aSAH) that were treated with CE between 2013 and 2020, and compared the differences in outcomes depending on aneurysm location.
A total of 468 patients with aSAH were included: 39 patients had ruptured MCA aneurysms (group M), and 429 had ruptured aneurysms at other sites (group O). There were no significant differences between the background characteristics of the 2 groups. Also, there were no significant intergroup differences in occlusion status, the frequency of complications such as ischemia, hemorrhaging, rebleeding, retreatment, or the modified Rankin Scale score at discharge. However, intracerebral hemorrhage (ICH) removal was required significantly more frequently in group M than in group O (10.3% vs. 0.5%, p = 0.0006). By case-matching analysis, there were no significant differences in these outcomes. All MCA cases that needed removal had more than 36 ml of hematoma volume. Logistic regression analysis showed that the existence of ICH at onset was a poor prognostic factor for ruptured MCA aneurysms.
CE for ruptured MCA aneurysms produced acceptable outcomes in selected cases. However, the indications for CE in patients with ICH should be carefully considered.
大脑中动脉（MCA）动脉瘤因其位置和形状，采用弹簧圈栓塞术（CE）治疗难度较大，但随着治疗技术的改进，接受CE治疗的MCA动脉瘤数量逐渐增加。然而，对于破裂MCA动脉瘤的CE治疗效果，人们了解甚少。本研究旨在评估破裂MCA动脉瘤的CE治疗效果。
我们回顾性分析了2013年至2020年间接受CE治疗的动脉瘤性蛛网膜下腔出血（aSAH）患者的病历，并比较了根据动脉瘤位置不同的治疗效果差异。
共纳入468例aSAH患者：39例患有破裂的MCA动脉瘤（M组），429例在其他部位患有破裂动脉瘤（O组）。两组的背景特征无显著差异。此外，在闭塞状态、缺血、出血、再出血、再次治疗等并发症发生频率或出院时改良Rankin量表评分方面，组间也无显著差异。然而，M组比O组更频繁地需要进行脑内出血（ICH）清除（10.3%对0.5%，p = 0.0006）。通过病例匹配分析，这些结果无显著差异。所有需要清除的MCA病例血肿体积均超过36 ml。逻辑回归分析表明，发病时存在ICH是破裂MCA动脉瘤预后不良的因素。
对于破裂的MCA动脉瘤，CE在部分病例中取得了可接受 的治疗效果。然而，对于ICH患者，应谨慎考虑CE的适应证。
