Korean Journal of Radiology

  • 제16권1호
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  • Pages.180-187
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  • 2015
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

  • Cho, Young Dae (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ahn, Jun Hyong (Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Jung, Seung Chai (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Chang Hun (Department of Neurology, Stroke Center, Myongji Hospital) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lim, Jeong Wook (Department of Neurosurgery, Sun Hospital)
  • 투고 : 2014.01.29
  • 심사 : 2014.09.20
  • 발행 : 2015.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. Materials and Methods: A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. Results: This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Conclusion: Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

키워드

참고문헌

  1. Murayama Y, Song JK, Uda K, Gobin YP, Duckwiler GR, Tateshima S, et al. Combined endovascular treatment for both intracranial aneurysm and symptomatic vasospasm. AJNR Am J Neuroradiol 2003;24:133-139
  2. Aburto-Murrieta Y, Marquez-Romero JM, Bonifacio-Delgadillo D, Lopez I, Hernandez-Curiel B. Endovascular treatment: balloon angioplasty versus nimodipine intra-arterial for medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Vasc Endovascular Surg 2012;46:460-465 https://doi.org/10.1177/1538574412454585
  3. Musahl C, Henkes H, Vajda Z, Coburger J, Hopf N. Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage. Neurosurgery 2011;68:1541-1547; discussion 1547 https://doi.org/10.1227/NEU.0b013e31820edd46
  4. Pierot L, Aggour M, Moret J. Vasospasm after aneurysmal subarachnoid hemorrhage: recent advances in endovascular management. Curr Opin Crit Care 2010;16:110-116 https://doi.org/10.1097/MCC.0b013e3283372ef2
  5. Brisman JL, Roonprapunt C, Song JK, Niimi Y, Setton A, Berenstein A, et al. Intentional partial coil occlusion followed by delayed clip application to wide-necked middle cerebral artery aneurysms in patients presenting with severe vasospasm. Report of two cases. J Neurosurg 2004;101:154-158 https://doi.org/10.3171/jns.2004.101.1.0154
  6. Le Roux PD, Newell DW, Eskridge J, Mayberg MR, Winn HR. Severe symptomatic vasospasm: the role of immediate postoperative angioplasty. J Neurosurg 1994;80:224-229 https://doi.org/10.3171/jns.1994.80.2.0224
  7. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  8. Cho WS, Kang HS, Kim JE, Kwon OK, Oh CW, Son YJ, et al. Intra-arterial nimodipine infusion for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Interv Neuroradiol 2011;17:169-178 https://doi.org/10.1177/159101991101700205
  9. Velat GJ, Kimball MM, Mocco JD, Hoh BL. Vasospasm after aneurysmal subarachnoid hemorrhage: review of randomized controlled trials and meta-analyses in the literature. World Neurosurg 2011;76:446-454 https://doi.org/10.1016/j.wneu.2011.02.030
  10. Fisher CM, Roberson GH, Ojemann RG. Cerebral vasospasm with ruptured saccular aneurysm--the clinical manifestations. Neurosurgery 1977;1:245-248 https://doi.org/10.1227/00006123-197711000-00004
  11. Heros RC, Zervas NT, Varsos V. Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol 1983;14:599-608 https://doi.org/10.1002/ana.410140602
  12. Cooke D, Seiler D, Hallam D, Kim L, Jarvik JG, Sekhar L, et al. Does treatment modality affect vasospasm distribution in aneurysmal subarachnoid hemorrhage: differential use of intra-arterial interventions for cerebral vasospasm in surgical clipping and endovascular coiling populations. J Neurointerv Surg 2010;2:139-144 https://doi.org/10.1136/jnis.2009.000919
  13. Conti A, Angileri FF, Longo M, Pitrone A, Granata F, La Rosa G. Intra-arterial nimodipine to treat symptomatic cerebral vasospasm following traumatic subarachnoid haemorrhage. Technical case report. Acta Neurochir (Wien) 2008;150:1197-1202; discussion 1202 https://doi.org/10.1007/s00701-008-0141-0
  14. Kim SS, Park DH, Lim DJ, Kang SH, Cho TH, Chung YG. Angiographic features and clinical outcomes of intra-arterial nimodipine injection in patients with subarachnoid hemorrhage-induced vasospasm. J Korean Neurosurg Soc 2012;52:172-178 https://doi.org/10.3340/jkns.2012.52.3.172
  15. Zubkov YN, Nikiforov BM, Shustin VA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien) 1984;70:65-79 https://doi.org/10.1007/BF01406044
  16. Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR. Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg 1989;71(5 Pt 1):654-660 https://doi.org/10.3171/jns.1989.71.5.0654
  17. Zwienenberg-Lee M, Hartman J, Rudisill N, Muizelaar JP. Endovascular management of cerebral vasospasm. Neurosurgery 2006;59(5 Suppl 3):S139-S147; discussion S3-S13
  18. Linskey ME, Horton JA, Rao GR, Yonas H. Fatal rupture of the intracranial carotid artery during transluminal angioplasty for vasospasm induced by subarachnoid hemorrhage. Case report. J Neurosurg 1991;74:985-990 https://doi.org/10.3171/jns.1991.74.6.0985

피인용 문헌

  1. Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization vol.17, pp.5, 2015, https://doi.org/10.3348/kjr.2016.17.5.801
  2. Efficacy of endovascular treatment and feasibility of stent-assisted coiling in the presence of severe and symptomatic vasospasm vol.9, pp.11, 2015, https://doi.org/10.1136/neurintsurg-2016-012734