高齢者における症候性脳血管攣縮治療の現状 ─WFNS grade再評価研究のデータベースを用いた二次解析研究─

抄録

From 1864 cases included in the database compiled for a prospective multi-institute study concerning reassessment of World Federation of Neurologiral Surgeons (WFNS) grades, 702 elderly patients (≥65 years old; E group) and 782 younger patients (≤64 years old; Y group) were found to meet the entry criteria for this study (1, open or intravascular surgery for aneurysmal obliteration performed within 72 hours after subarachnoid hemorrhage [SAH]; 2, assessment of severity of symptomatic vasospasm [SVS] was completed using SVS grade [Table 1]). Neurological grade on admission in the E group was significantly worse than that in the Y group, consequently causing a significantly worse overall outcome in the E group. Incidence of SVS was 22.8% in the E group and 22.2% in the Y group, which was not significantly difference between the two groups; however, the incidence of unsuccessful rescue therapy for SVS was significantly higher in the E group (72.5% of cases of rescue therapy for SVS) than in the Y group (44.8%), which strongly indicates the importance of preventive treatment regimens for SVS over rescue treatment after the development of SVS, especially for elderly patients. The usefulness of the SVS grade for precise evaluation of the result of rescue therapy for SVS was identified in this study.