脳脊髄血管障害に対するハイブリッド手術室を活用した複合治療

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  • Combination Therapy with Hybrid OR for Cerebrovascular Disease
  • ノウ セキズイ ケッカン ショウガイ ニ タイスル ハイブリッド シュジュツシツ オ カツヨウ シタ フクゴウ チリョウ

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Objective : With advent of an endovascular suite in the operating room (hybrid OR), it has been reported recently that combination therapy with surgical and endovascular procedures in hybrid OR for complex cerebrovascular diseases is feasible. / Materials and methods : We analyzed the 15 consecutive cases who underwent combination therapy with hybrid OR in our hospital from October 2014 to September 2017 (8 Aneurysms, 3 carotid artery stenosis, and 4 dural arteriovenous fistulas (DAVF)). / Results : All procedures were performed successfully. We performed bypass surgery and endovascular trapping with endovascular procedure for all aneurysm cases. In 3 cases of carotid artery stenosis, we performed carotid artery stenting (CAS) with direct puncture of common carotid artery for 2 cases and rescue stenting with carotid endarterectomy for 1 case. Perioperative antiplatelet therapy was performed in all cases of unruptured aneurysms and carotid artery stenosis. In the cases of DAVF, we performed transarterial or transvenous embolization combined with craniotomy, or shunt ligation with selective indocyanine green videoangiography using microcatheter. Systemic full heparinization was performed during all endovascular procedures. There was no symptomatic hemorrhagic and ischemic complication. There was no neurological deterioration of modified Rankin scale at discharge except for the case of symptomatic hyperperfusion after CAS. / Conclusion : Combination therapy with hybrid OR for complex cerebrovascular disease is safe and feasible.

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