脳卒中の外科研究会講演集
Online ISSN : 2187-185X
Print ISSN : 0387-8031
ISSN-L : 0387-8031
破裂脳動脈瘤急性期の脳血管撮影
-とくに撮影中の再出血について-
重森 稔川場 知幸川崎 建作小林 清吉中山 顕児倉本 進賢
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1986 年 14 巻 p. 151-155

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Ten cases of ruptured cerebral aneurysms who developed rebleeding during cerebral angiography (CAG) in acute stage were presented and clinical characteristics of these cases were studied. Among 445 cases of ruptured aneurysms admitted to our department in the last 8 years, 10 cases with rebleeding of the aneurysm during or immediately after CAG were found as an incidence of 2.2%. CAG had been performed within 12 hours after the last subarachnoid hemorrhage (SAH) in all instances and the incidence of rebleeding in 108 cases who had CAG within 12 hours after the last SAH was 9.3%. Female and male ratio was 6 to 4 and the aneurysms were most frequently located at the anterior communicating artery (40%), followed by the internal carotid-posterior communicating, vertebro-basilar and anterior or middle cerebral arteries. Extravasation of the contrast medium from the ruptured aneurysm was found in 3 cases. The surgical risk grade (Hunt and Hess) was grade III or IV in 80% of the cases and the time interval from the last SAH to CAG was 5 hours or less in 70% of the cases. The mortality and morbidity of these 10 cases were poor and the mortality rate was high as 50% although an immediate emergency care was undertaken in all cases. Only two cases who had an emergency radical operation for the ruptured aneurysms showed good recovery.
From these results, it is suggested that the CAG must be performed with great care for the patients with recent SAH within 12 hours, especially within 5 hours after the last SAH, and with high surgical risk grade.

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