Current Status of Ruptured Cerebral Aneurysm Treatment in Regional Hospitals and Results of Coil Embolization

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  • Nakatsuka Yoshinari
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
  • Terashima Mio
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
  • Kawakita Fumihiro
    Department of Neurosurgery, Saiseikai Matsusaka General Hospital, Matsusaka, Mie, Japan
  • Nishikawa Hirofumi
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
  • Fujimoto Masashi
    Department of Neurosurgery, Saiseikai Matsusaka General Hospital, Matsusaka, Mie, Japan
  • Yasuda Ryuta
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
  • Shiba Masato
    Department of Innovative Neuro-Intervention Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan Center for Vessels and Heart, Mie University Hospital, Tsu, Mie, Japan
  • Toma Naoki
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
  • Sakaida Hiroshi
    Department of Innovative Neuro-Intervention Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan Center for Vessels and Heart, Mie University Hospital, Tsu, Mie, Japan
  • pSEED group
    Members along with their affiliations are listed in appendix
  • Suzuki Hidenori
    Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan

Bibliographic Information

Published
2018
Resource Type
journal article
DOI
  • 10.5797/jnet.oa.2017-0060
Publisher
The Japanese Society for Neuroendovascular Therapy

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<p>Objective: We examined the current status of ruptured cerebral aneurysm treatment and results of coil embolization in a district.</p><p>Methods: We conducted a prospective, multicenter, cooperative observational study involving 169 patients with ruptured cerebral aneurysms who were treated in the acute phase between September 2013 and March 2016. Predictive factors for poor outcome (90-day modified Rankin Scale 3–6) were investigated, and the results were compared between craniotomy and coil embolization.</p><p>Results: Coil embolization was performed for 39 patients (23.1%). In all, 63 (37.3%) patients had poor outcome. Univariate analysis showed that predictive factors for poor outcome included an advanced age, pre-onset disability, history of cerebral infarction, poor grade on admission, modified Fisher grade 4, acute hydrocephalus, cerebrospinal fluid drainage, craniotomy, craniotomy-related complications, the absence of fasudil hydrochloride administration, delayed cerebral ischemia, delayed cerebral infarction, shunting, pneumonia, and heart failure. On multivariate analysis, predictive factors for poor outcome included pre-onset disability, poor grade on admission, modified Fisher grade 4, delayed cerebral infarction, and heart failure, whereas the prophylactic administration of intravenous fasudil hydrochloride and coil embolization were independent factors associated with good outcome. In patients who underwent craniotomy, the incidences of cerebral vasospasm and cerebral infarction were significantly higher than in those who underwent coil embolization.</p><p>Conclusion: This was an observational study, and the indication of treatment or strategies differed among institutions, which was a limitation. However, coil embolization was an independent factor associated with good outcome.</p>

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