出血発症椎骨動脈解離性動脈瘤の治療成績─血管内手術に伴う虚血性合併症について─

抄録

We analyzed the incidence and mechanism of ischemic complications after internal trapping of ruptured vertebral artery dissecting aneurysms (VADANs). Between April 2009 and January 2014, we identified seven patients who were diagnosed with ruptured VADANs and who underwent internal coil trapping. All cases were treated in the acute stage and were evaluated with magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), during the perioperative period. The incidence of ischemic complications was 71.4% (five cases), whereas the incidence of ischemia influencing the outcomes was 28.6% (two cases). Postoperative medullary infarctions were identified in two cases; one case was found before the surgery (possibly developed at the onset of dissection), while the other case was found postoperatively and was due to intentional obstruction of the perforator involved in the dissecting aneurysm. We conclude that careful internal coil trapping for VADANs can reduce, but not eliminate, the incidence of ischemia.