脳底動脈先端部動脈瘤に対するコイル塞栓術

Endovascular Treatment for Basilar Tip Aneurysms

Ⅰ．はじめに

　脳底動脈先端部動脈瘤は，一般に開頭clipping術が解剖学的に困難で，血管内治療が有利とされている^2-4,8,16,21)．海外からは脳底動脈先端部動脈瘤に対する血管内治療の有用性を示唆する論文はいくつか報告されているが，本邦からの多数例の報告はない^2,4,16,21)．今回，2000年以降にコイル塞栓術を行った同動脈瘤79例を対象とし，その成績を検討した．

　The aim of this study was to analyze the effect of endovascular treatment of basilar (BA) tip aneurysms.

　The authors performed a retrospective analysis of 79 aneurysms of the BA tip that had been treated using endovascular coil embolization for the last 11 years. Fifty-six patients were women, and 23 were men. The average age of the patients was 63.7 years (range, 35-83 year). The average maximum diameter of the aneurysms was 8.0 mm (range, 2-30 mm). Forty-seven patients (60%) presented with acute subarachnoid hemorrhage (SAH), 1 patient (1%) had an unruptured aneurysm with mass effect, and 31 patients (39%) had incidental aneurysms. Immediate anatomic outcomes demonstrated complete occlusion (CO) in 53 aneurysms (67%), residual neck (RN) in 22 aneurysms (28%), and residual aneurysm (RA) in 4 aneurysms (5%). One patient died from rebleeding 6 hours after the embolization. Another patient suffered from rebleeding 6 years after the initial embolization, and was successfully treated with re-embolization. Four patients suffered from asymptomatic P1 occlusion. No symptomatic complication was observed in the unruptured group. Retreatment was performed in 5 patients, including 4 broad-neck large ruptured aneurysms and 1 giant thrombosed aneurysm.

　Angiographic and clinical results have been improving in recent cases in this study. Technical advances such as highly compliant balloon remodeling microcatheter and 3D-reconstructed digital angiography contributed to this improvement. Our results indicate that endovascular treatment of BA tip aneurysm is safe and effective. The long-term stability after coil embolization is still a matter of concern. Further improvement is expected.