파열뇌동맥류의 수술 후 조기 뇌혈관 조영술 : 유용성과 적응증 Cerebral angiography after aneurysm clipping for the early period in patients with subarachnoid hemorrhage ;Its usefulness and indications원문보기
OBJECTIVE: The objective of this study was to determine whether a postoperative angiography in the acute stage after aneurysm clipping is useful or not in patients with subarachnoid hemorrhage. METHODS: Between May, 2008 and November 2009, there were 57 patients with ruptured cerebral aneurysms, who...
OBJECTIVE: The objective of this study was to determine whether a postoperative angiography in the acute stage after aneurysm clipping is useful or not in patients with subarachnoid hemorrhage. METHODS: Between May, 2008 and November 2009, there were 57 patients with ruptured cerebral aneurysms, who were treated with surgical clipping. Among them, a consecutive series of 45 patients who underwent postoperative angiography were analyzed retrospectively. Parameters on postoperative angiography were categorized incomplete clipping, vasospasm, vascular compromise (vessel stenosis, occlusion), and another aneurysm. RESULTS: Average age was 49.2 years from 18 to 72. Average timing of postoperative angiography was 11.4 (1-32) days after the onset of hemorrhage. Complete aneurysm closure was achieved in 95% (43 patients) of patients, a neck remnant was discovered in 2 patients, and a fundus remnant was revealed in one patient. Twelve (27%) patients showed angiographic vasospasm and seven of them needed angioplasty. Four cases (9%) revealed parent artery stenosis or branch occlusions and two of them (4%) were clinically significant. Two cases showed aneurysms at another location, one of which was ruptured aneurysm. Overall, 21 (47%) patients showed meaningful findings in postoperative angiography. There were no significant complications associated with the angiographic procedures. CONCLUSION: Our retrospective analysis revealed that postoperative angiography might be valuable in patients with ruptured aneurysm, especially in the acute stage to find out vasospasm, incomplete clipping, vascular compromise, and another aneurysms which were missed at the initial cerebral angiography. This series, which had no selection bias, can be used as a basal data to compare the immediate results between surgical clipping and endovascular coiling.
OBJECTIVE: The objective of this study was to determine whether a postoperative angiography in the acute stage after aneurysm clipping is useful or not in patients with subarachnoid hemorrhage. METHODS: Between May, 2008 and November 2009, there were 57 patients with ruptured cerebral aneurysms, who were treated with surgical clipping. Among them, a consecutive series of 45 patients who underwent postoperative angiography were analyzed retrospectively. Parameters on postoperative angiography were categorized incomplete clipping, vasospasm, vascular compromise (vessel stenosis, occlusion), and another aneurysm. RESULTS: Average age was 49.2 years from 18 to 72. Average timing of postoperative angiography was 11.4 (1-32) days after the onset of hemorrhage. Complete aneurysm closure was achieved in 95% (43 patients) of patients, a neck remnant was discovered in 2 patients, and a fundus remnant was revealed in one patient. Twelve (27%) patients showed angiographic vasospasm and seven of them needed angioplasty. Four cases (9%) revealed parent artery stenosis or branch occlusions and two of them (4%) were clinically significant. Two cases showed aneurysms at another location, one of which was ruptured aneurysm. Overall, 21 (47%) patients showed meaningful findings in postoperative angiography. There were no significant complications associated with the angiographic procedures. CONCLUSION: Our retrospective analysis revealed that postoperative angiography might be valuable in patients with ruptured aneurysm, especially in the acute stage to find out vasospasm, incomplete clipping, vascular compromise, and another aneurysms which were missed at the initial cerebral angiography. This series, which had no selection bias, can be used as a basal data to compare the immediate results between surgical clipping and endovascular coiling.
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