80歳以上の高齢者破裂脳動脈瘤に対するPlatinum Coilを用いた血管内治療

Endovascular Treatment of Ruptured Intracranial Aneurysms Using Platinum Coils in Patients over 80 Years of Age

I．はじめに

　近年，人口の高齢化に伴い高齢者破裂脳動脈瘤に遭遇する機会が増えてきている．しかし，80歳以上の高齢者では直達術による侵襲が高いため実際に外科的治療のなされる率は極めて少なく^10），その取り扱いに苦慮しているのが現状である．一方，脳動脈瘤に対してplatinum coilを用いた血管内治療が盛んに行われ良好な結果が得られてきているが^{1-3,5,13,20,23）}，この手技は直達術と比べ侵襲が少なく全身状態不良例にも適している．われわれは，80歳以上の高齢者破裂脳動脈瘤に対してもこの血管内治療を可能な限り行ってきたが，現時点で比較的良好な成果が得られている。高齢者脳動脈瘤を対象とした血管内治療のまとまった報告はなく，今回，80歳以上の破裂脳動脈瘤に対するplatinum coilを用いた血管内治療の有用性，適応，問題点につき検討し報告する．

Endovascular treatment of intracranial aneurysms using platinum coils was performed in 10 patients over80 years of age. The patients ranged in age from 81 to 96 years. Preoperative Hunt and Kosnik grading re-vealed one patient in grade I, 4 in grade II, 3 in grade III, and 2 in grade IV. The aneurysms were locatedin the internal carotid artery in 6 patients, in the anterior communicating artery in 1, and in the middlecerebral artery in 3 respectively. Intra-aneurysmal occlusion was accomplished in 8 patients with total orsubtotal occlusion in 6 and partial occlusion in 2. In one patient with a peripheral middle cerebral arteryaneurysm, the parent artery was occluded just proximal to the aneurysm. In the remaining one patient ingrade III, an aneurysm associated with wide neck could not be occluded because of coil protrusion into theparent artery. In 9 patients who were successfully treated, all five patients in grade I or II and one ingrade III resulted in good outcome, but the other three patients in grade III and IV showed poor outcome.No evidence of recurrent hemorrhage was noted during the follow-up period ranging from 2 months to 4 years.

Endovascular coil embolization is a useful therapeutic alternative for treating ruptured intracranialaneurysms in patients over 80 years of age, especially those in Grade I or II.