破裂脳動脈瘤クリッピング後の残存動脈瘤に塞栓術を行い結果良好であった2例

Two Cases with Coil Embolization Following Incomplete Neck Clipping

I．はじめに

　脳動脈瘤の治療法として，近年開発された離脱型コイルによる塞栓術は，動脈瘤の部位，年齢，臨床的重症度によっては，直達手術よりも第一選択とされ^1,8,9,15），さらに，これら単独の治療法では根治困難な動脈瘤に対しても，両者を組み合わせて加療する試みがなされている^{2,5,6,10,11,13,14）}．脳動脈瘤に対し両者を併用して治療する方法の1つとして，直達手術後にやむなく動脈瘤の一部が残存し，それに対し塞栓術を行った，との報告がある^{2,5,6,11,14）}．

　今回われわれは，脳動脈瘤に対するクリッピング術後の残存動脈瘤に対し塞栓術を行い，良好な結果を得た2症例を経験した．本例を含めて，残存動脈瘤に対する治療方針について考察する．

We report two cases with embolization (coil embolization) using Guglielumi detachable coils of residual aneurysms following incomplete neck clipping. The first case, a 75-year-old woman suffered from a sub-arachnoid hemorrhage due to the rupture of a left internal carotid posterior communicating aneurysm in June, 1997. Neck clipping of the aneurysm was performed at day 1. Follow-up angiogram at day 7 showed a residual aneurysm involving the dome of the initial aneurysm. We performed coil embolization of the re-sidual aneurysm following the angiogram. Almost complete obliteration of the aneurysm lasted during the follow-up period of two and a half years. The second case, a 71-year-old woman suffered from a subarach-noid hemorrhage clue to the rupture of a right internal carotid posterior communicating aneurysm in May, 1999. Neck clipping of the aneurysm was performed at clay 1. Follow-up angiogram at day 7 showed a re-sidual aneurysm involving only a part of the initial aneurysm near the neck. Because no spontaneous thrombosis of the residual aneurysm was obtained after 2 months, we performed coil embolization of the residual aneurysm. Almost complete obliteration of the aneurysm lasted during the follow-up period of 7 months. These patients were discharged with good performance status. We consider the morphologic fea-ture of the residural aneurysm to be most important for determining when to perform coil embolization of such residual aneurysms.