Ergebnisse und Komplikationen nach endovaskulärem Coiling
Auch gedruckt in der BibliothekZ: J-H 14.360; W: W-H 12.806
Perez de Laborda-El Yousfi, Maria
Ressourcen- / MedientypDissertation, Text
Datum der Freischaltung2012-02-16
Objective: This retrospective study was conducted to compare the recanalization in previously coiled cerebral aneurysms, the outcome among endovascularly treated patients and the risk of rebleeding. Material and Methods: In this retrospective study 122 patients with 140 Aneurysms were included. They were treated endovascularly between 1999 and 2005 at the Neurosurgical Department of the University of Ulm/Günzburg. Patients were classified according to the Hunt & Hess and Fischer grading systems. There were 22 patients (18%) without subarachnoid haemorrhage (termed grade 0), 8 grade I (7%), 23 grade II (19%), 20 grade III (16%), 44 grade IV (36%) and 5 grade V (4%). The outcome was measured by the Glasgow Outcome Scale (GOS scores 1-5). There were 27 GOSs 1 patients (22%), 7 GOSs 2 (6%), 12 GOSs 3 (10%), 10 GOSs 4 (8%) and 58 GOSs 5 (48%). 8 patients (6%) were lost to follow-up. Results: 23 aneurysms exhibited residual perfusion, 10 therefore underwent surgical clipping after primary coiling. The other 13 were coiled in total 25 times. 6 patients presented with recurrent haemorrhage, 2 of them harboring incidental aneurysms and 4 because of subarachnoid haemorrhages (SAH). The bleeding was letal in all of the patients with prior SAH. The total mortality was 22%, the overall complication rate of this series was as high as 25%, the complication rate with clinical deficit was 7%. Conclusions: Recanalization seemed to be partially dependant on the primary coiling result. Localisation (internal carotid- and basilar artery), and aneurysm growth were decisive factors. With a reperfusion rate of 19% the need for continued follow-up remains and needs to be relayed to the patients. The 4% rate of recurrent haemorrhage, bears a high mortality rate, and likewise should not be neglected. Overall mortality after SAH was related to severe initial Fisher and Hunt & Hess grading.
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