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Neurological Surgery No Shinkei Geka Volume 40, Issue 1 （January 2012）

Neurological Surgery 脳神経外科 40巻1号（2012年1月発行）

Japanese English

研究

未破裂脳動脈瘤コイル塞栓術時にコイルが母血管に突出した症例における予後の検討 Research of Postoperative Complications after Coil Protrusions in Embolization of Unruptured Cerebral Aneurysms 山尾幸広 ¹ , 佐藤徹 ² , 村尾健一 ³ , 宮本享 ¹ , 飯原弘二 ² Yukihiro YAMAO ¹ , Tetsu SATOW ² , Kenichi MURAO ³ , Susumu MIYAMOTO ¹ , Koji IIHARA ² ¹京都大学脳神経外科 ²国立循環器病研究センター脳神経外科 ³城山病院脳血管内治療科 ¹Department of Neurosurgery,Kyoto University ²Department of Neurosurgery,National Cerebral and Cardiovascular Center ³Department of Neuroendovascular Therapy,Shiroyama Hospital キーワード： coil embolization , protrusion , postoperative complication , antiplatelet therapy , unruptured cerebral aneurysm Keyword: coil embolization , protrusion , postoperative complication , antiplatelet therapy , unruptured cerebral aneurysm pp.23-29

発行日 2012年1月10日 Published Date 2012/1/10

DOI https://doi.org/10.11477/mf.1436101622

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Ⅰ．はじめに

　脳動脈瘤のコイル塞栓術はGDC（Guglielmi detachable coil）の普及に伴い，飛躍的に増加してきた^3,4)．ISAT（International Subarachnoid Aneurysm Trial）⁹⁾にも認められるように，従来のクリッピング術に対してコイル塞栓術の治療成績が劣らないことも報告されている．また，コイルの改良，バルーンなどの併用により，従来困難とされていた脳動脈瘤に対してもコイル塞栓術による治療が可能となり，コイル塞栓術を選択する症例が増加してきている．ただ，コイル塞栓術周術期の合併症として血栓塞栓症，血管損傷，コイルの母血管への突出などが挙げられる．コイルが母血管へ突出した症例において，経験的には塞栓性合併症の増加や，新たな神経学的症状の出現を認めていないが，現在のところevidenceは存在していない．今回われわれは，未破裂脳動脈瘤コイル塞栓術時にコイルが母血管に突出した症例の予後の検討を行ったので報告する．

　Objectives: Postoperative courses in “coil-protruded” cases in embolization of unruptured cerebral aneurysms remain unknown. The purpose of this study is to investigate postoperative complications after coil protrusions.

　Methods: From May 2003 to December 2007, 90 consecutive cases with unruptured cerebral aneurysm treated by coil embolization were examined at National Cerebral and Cardiovascular Center. All patients received antiplatelet therapy prior to the procedure. The patterns of protrusions were classified into three; tail (T), loop (L), unraveled (U).

　Results: Coil protrusions were observed in 17 cases (18.9%). Symptomatic ischemic complications occurred in 7 cases (7.8%). One case occurred in coil protrusions (group P) and 6 cases occurred in no coil protrusions (group N). Infarctions on MR diffusion-weighted image within 7 days after embolization were found in 10 cases (58.8%) in group P and in 28 cases (38.4%) in group N. Infarction on MR fluid attenuated inversion recovery 7 days or later were found in 0 in group P, and in 4 (5.5%) in group N. There were no significant differences.

　The number of each protrusion pattern was as follows: T was 12 cases, L was 3 cases and U was 2 cases. Symptomatic ischemia was observed in one case (8.3%) in T. Infarctions on MR diffusion-weighted image within 7 days after embolization were found in 7 (58.3%), 1 (33.3%) and 2 (100%), respectively. There were no significant differences between the three morphological patterns.

　Conclusion: In this retrospective study,coil protrusion after embolization of unruptured cerebral aneurysms on antiplatelet therapy,did not increase the incidence of ischemic complications.