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. 2004 Dec 24;10 Suppl 2(Suppl 2):35-40.
doi: 10.1177/15910199040100S208. Epub 2008 May 15.

Early treatment for ruptured cerebral aneurysms. Location of aneurysms and choice of treatments

S Kobayashi  1 , Y Koguchi, A Fujikawa, M Wada, H Oish, A Miysta, H Nakamura, T Yagishita
Affiliations

Early treatment for ruptured cerebral aneurysms. Location of aneurysms and choice of treatments

S Kobayashi et al. Interv Neuroradiol. .

Abstract

The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcomes of subarachnoid haemorrhage (SAH) patients of poor grades and high ages for each location of aneurysms. Between 1990 and 2003, 529 SAH cases underwent angiograghy as candidates of early aggressive treatment in our hospital. For the 299 cases in 1990-96 (Group 1), treatment options were early and intensively delayed craniotomy surgery and conservative management, while for the 230 cases in 1997-2003 (Group 2), GDG embolization at acute stage was added to these three treatment options. We compared clinical courses and outcomes of the poor grade (Hunt & Kosnik Grade 4-5) patients and high age (>=70 years old) patients between two groups for each location of aneurysms. Introduction of GDC embolization expanded the indication for early treatment in the poor grade patients with anterior communicating artery aneurysm (A-Comm An), the high age patients with internal carotid artery aneurysm (IC An) and all patients with Basilar bifurcation aneurysm (BA-Top An), and has contributed to improvement of their outcomes. To the poor grade patients with middle cerebral artery aneurysm (MCA An), GDC embolization was hardly indicated, because haematoma evacuation concomitantly performed with aneurysm occlusion would be necessary for those patients. In conclusion, results of treatment with GDC embolization at an acute stage are desirable for poor grade patients with A-Comm An, aged patients with IC An and all patients with BA-Top An. The indication of GDC embolization for the patients with MCA An is limited.

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Figures

Figure 1
Figure 1
Bar graph shows the difference in the proportion of early treatments (upper) and GOS (bottom) between two periods in the poor grade cases with A-Comm An. GR indicates good recovery: MD = moderately disabled;SD = severely disabled; V = vegetative state; D = dead.
Figure 2
Figure 2
Bar graph shows the difference in the proportion of early treatments (upper) and GOS (bottom) between two periods in the high age cases with A-Comm An.
Figure 3
Figure 3
Bar graph depicting the difference in the proportion of early treatments (upper) and GOS (bottom) between two periods in the poor grade cases with IC An.
Figure 4
Figure 4
Bar graph depicting the difference in the proportion of early treatments (upper) and GOS (bottom) between two periods in the high age cases with IC An.
Figure 5
Figure 5
Bar graph shows the difference in the proportion of early treatments (upper) and GOS (bottom) between two periods in the cases with BA-Top An.
Figure 6
Figure 6
Location of aneurysm and incidence of accompanied intracerebral haematoma in the case with H&K Grade IV and V.
See this image and copyright information in PMC

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