2018 年 12 巻 3 号 p. 109-116
Objective: We examined the current status of ruptured cerebral aneurysm treatment and results of coil embolization in a district.
Methods: We conducted a prospective, multicenter, cooperative observational study involving 169 patients with ruptured cerebral aneurysms who were treated in the acute phase between September 2013 and March 2016. Predictive factors for poor outcome (90-day modified Rankin Scale 3–6) were investigated, and the results were compared between craniotomy and coil embolization.
Results: Coil embolization was performed for 39 patients (23.1%). In all, 63 (37.3%) patients had poor outcome. Univariate analysis showed that predictive factors for poor outcome included an advanced age, pre-onset disability, history of cerebral infarction, poor grade on admission, modified Fisher grade 4, acute hydrocephalus, cerebrospinal fluid drainage, craniotomy, craniotomy-related complications, the absence of fasudil hydrochloride administration, delayed cerebral ischemia, delayed cerebral infarction, shunting, pneumonia, and heart failure. On multivariate analysis, predictive factors for poor outcome included pre-onset disability, poor grade on admission, modified Fisher grade 4, delayed cerebral infarction, and heart failure, whereas the prophylactic administration of intravenous fasudil hydrochloride and coil embolization were independent factors associated with good outcome. In patients who underwent craniotomy, the incidences of cerebral vasospasm and cerebral infarction were significantly higher than in those who underwent coil embolization.
Conclusion: This was an observational study, and the indication of treatment or strategies differed among institutions, which was a limitation. However, coil embolization was an independent factor associated with good outcome.