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One-stage embolization in patients with acutely ruptured poor-grade aneurysm.

Authors
Shin, YS; Kim, SY; Kim, SH; Ahn, YH; Yoon, SH; Cho, KH; Cho, KG
Citation
Surgical neurology, 63(2):149-154, 2005
Journal Title
Surgical neurology
ISSN
0090-30191879-3339
Abstract
BACKGROUND: Early or ultra-early surgery for patients in poor neurological condition (Hunt and Hess grade IV or V) after ictus of aneurysmal subarachnoid hemorrhage is increasingly reported to prevent early rebleeding. To prevent any rebleeding after hospital admission, we have treated patients with poor-grade aneurysm during the same session as when diagnostic angiography is performed ("one-stage embolization"). The aim of the present study is to determine whether this treatment modality is a viable management option for this group of patients.



METHODS: We retrospectively reviewed 18 consecutive patients who presented with acutely ruptured aneurysms and were in very poor neurological condition and who were treated with one-stage embolization.



RESULTS: We observed 2 complications related to the endovascular procedure: partial occlusion of the parent artery and aneurysm rupture during the procedure. According to the Glasgow Outcome Scale, good recovery occurred in 8 patients, and moderate and severe disabilities occurred in 4 and 3 patients, respectively, and 3 patients died. No rebleeding occurred after the procedure. The mean follow-up of the surviving patients (those who were alive more than 30 days after embolization) was 13.7 months (4-25 months). Three patients had surgery after endovascular procedure: 2 surgical clipping of failed or partial aneurysm embolization and 1 emergency coil removal with clipping. A permanent ventriculoperitoneal shunt was placed in 11 patients.



CONCLUSIONS: We achieved promising results by using one-stage embolization to prevent ultra-early rebleeding followed by aggressive resuscitation. The active involvement of the endovascular team from the stage of diagnostic angiogram is a prerequisite for this treatment strategy.
MeSH terms
Acute DiseaseAdultAgedAneurysm, Ruptured/radiographyAneurysm, Ruptured/surgeryAneurysm, Ruptured/therapy*Cerebral AngiographyDecision TreesEmbolization, Therapeutic/methods*FemaleHumansIntracranial Aneurysm/classificationIntracranial Aneurysm/complications*Intracranial Aneurysm/surgeryMaleMiddle AgedRecurrence/prevention & controlRetrospective StudiesSubarachnoid Hemorrhage/radiographySubarachnoid Hemorrhage/surgerySubarachnoid Hemorrhage/therapy*Treatment OutcomeVentriculoperitoneal Shunt
DOI
10.1016/j.surneu.2004.03.021
PMID
15680657
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurosurgery
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
AJOU Authors
신, 용삼김, 선용김, 세혁안, 영환윤, 수한조, 기홍조, 경기
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