脳卒中の外科
Online ISSN : 1880-4683
Print ISSN : 0914-5508
ISSN-L : 0914-5508
原  著
コイル塞栓術を第一選択とした80歳以上の急性期破裂脳動脈瘤の治療成績─周術期の現状と超高齢者の問題点─
松本 博之武本 英樹西山 弘一鐵尾 佳章中尾 直之
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2017 年 45 巻 4 号 p. 276-282

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Purpose: The treatment outcomes of subarachnoid hemorrhage in patients aged >80 years are considered poor. We analyzed the clinical results of endovascular coil embolization for ruptured cerebral aneurysm in patients over 80 years old.
Materials and Methods: Between 2000 and 2015, 43 patients over 80 years old were treated with coil embolization as the first choice for ruptured aneurysm. All the patients were women and the ages ranged from 80 to 91 (average 84 years). The aneurysms involved the internal carotid artery in 28 patients, the anterior communicating artery in 5, the middle cerebral artery in 2, and the vertebrobasilar artery in 8 (including one vertebral artery dissection). The Hunt and Kosnik grade on admission was 1 in 6 patients, 2 in 6 patients, 3 in 12 patients, 4 in 13 patients, and 5 in 6 patients. We assessed angiographic results, complications, and the association between perioperative conditions and outcome at discharge.
Results: Embolization results immediately after treatment showed complete occlusion in 17 patients (40%), dome filling in 10 (23%), neck remnant in 15 (35%), and parent artery occlusion in 1 patient. Fourteen patients (33%) had emergency ventricular drainage for acute hydrocephalus. Procedure-related complications occurred in 4 patients (9%), with a negative impact on the outcome. Eleven patients underwent shunt surgery in the chronic stage. There was no case with rebleeding during the follow-up period. The modified Rankin Scale score at discharge was 0-2 in 11 patients (26%), 3 in 2 (5%), 4-5 in 24 (56%), and 6 in 6 (14%). Patients with mild or moderate disability on admission had relatively good outcomes. Patients with a poor score on admission had very poor outcomes, primarily because of brain damage or poor general condition. However, some patients with mild or moderate disability showed functional decline during hospitalization because of disuse syndrome and dementia.
Conclusion: The outcomes of coil embolization for patients over 80 years old with ruptured cerebral aneurysms are poor. However, this minimally invasive treatment option may be useful to enable early rehabilitation.

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© 2017 一般社団法人 日本脳卒中の外科学会
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