母血管に対する脳動脈瘤のサイズ比は5mm 以下の頭蓋内小型動脈瘤破裂の予測に有用な指標となる

富山大学・富生命博乙第8号・柏﨑大奈・2015/11/25・★論文非公開★富山大学201

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

Purpose: Previous reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. Methods: A total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. Results: Forty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6 %). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74 %). Cranial nerve paresis (CNP) was observed in 6 patients (8.21 %), spinal cord infarction in 2 patients (2.74 %) and a perforating artery ischemia was diagnosed in 7 patients (9.59 %); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. Conclusions: The results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3 months after initial treatment without rupture. CNPs were observed in 8.21 %, perforating ischemia in 9.59 %, and spinal cord infarction in 2.74 %. The former two are temporary, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome

Endovascular treatment for aneurysms of the posterior cerebral artery : 12 years' experience with 21 cases

Background and Purpose: To discuss and summarize the strategies and complications of endovascular embolization for aneurysms of the posterior cerebral artery (PCA). Methods: Data of patients with PCA aneurysms treated by an endovascular procedure were analyzed retrospectively (n = 21). Twenty patients with aneurysms were treated by detachable coil embolization, and 1 patient was treated with n-butyl cyanoacrylate. Of the 21 aneurysm embolization cases, 9 were treated by parent artery occlusion (PAO), and 12 were treated by selective occlusion of the aneurysm (SOA). Results: All 12 aneurysms treated by SOA showed complete occlusion. Two aneurysms became recanalized 6 months after the first embolization and were then re-embolized; complete healing was observed on follow-up angiography. All patients showed acceptable outcomes without any procedural complications, except 1 patient who died 2 days after treatment. PAO resulted in 100% occlusion of all aneurysms. Cerebral infarction was noted in most patients (78%). However, the area of infarction was small. Permanent neurological deficit was observed in 2 patients (22%), but their condition was not critical. Conclusions: Aneurysm embolization with SOA is well indicated for saccular aneurysms with well-defined necks, whereas PAO carries a risk of ischemic complications. Although the PCA is rich in collateral circulation, ischemic complications were noted in most patients after PAO, and it was difficult to predict occurrence of these complications. However, the area of cerebral infarction tended to be small, and the neurological deficits observed were not critical