術中破裂を避ける工夫と破裂時の対応は？

How to Avoid Intraoperative Rupture and What to Do When It Ruptures

Point

・破裂時にしてはいけないこと：穿孔したカテーテルやコイルを慌てて抜去してしまう．

・破裂時にすべきこと：血圧を下げる，ヘパリンをリバースする，バルーンで動脈瘤への血流を遮断する．

　Intracranial aneurysm rupture is the main fatal complication of coil embolization for an intracranial aneurysm performed in conjunction with systemic heparinization. We answered five clinical questions about anesthesia, systemic heparinization, intraoperative aneurysmal rupture, the balloon-assisted technique, and the next step of initial response in case of aneurysmal rupture. It is crucial to understand when and why intraoperative aneurysmal rupture occurs to reduce its mortality rate. In cases of intraoperative problems, never pull the microcatheter or coil when perforating an aneurysm; lowering blood pressure, administering protamine for the reversal of heparin, and occluding blood flow into an aneurysm by inflating balloon(s) will help in the treatment. It is our pleasure that this chapter will help in your daily care.