코일을 이용한 뇌동맥류의 혈판내 치료 :효용성과 한계점
Coil Embolization of Intracranial Aneurysms : The Effectiveness and Limitation
소속 상세정보
김종수/Jong Soo Kim
변홍식/김기준/이정일/홍승철/신형진/박관/어환/김종현/Hong Sik Byun/Ki Joon Kim/Jung Il Lee/Seung Chyul Hong/Hyung Jin Shin/Kwan Park/Whan Eoh/Jong Hyun Kim
KMID : 0359819980270060749
Abstract
서 론
현재까지 뇌동맥류의 치료원칙은 수술적 경부직접결찰술로 받이들여지고 있다. 그러나 코
일을 이용한 뇌동맥류 색전술이 널리 행해지면서 뇌동맥류 결찰술의 대체수단이 될수 있다
는 연구결과들이 많이 보고되고 있다. 특히 1990년 Guglielmi detachable coil(GDC)을 이용
한 뇌동맥류 색전술이 시작된 이후 전세계적으로 많은 병원에서 실제 임상적용이 이루어지
고 있다. 그러나 아직까지는 일부 선택적 경우에서만 색전술이 사용되고 있어서 수술적 결
찰술과 색전술의 직접적인 비교가 어려운 상황이고, 색전술의 장기적인 효과에 대한 연구도
미흡하다.
본 교실에서는 지난 3년간 코일을 이용한 뇌동맥류 색전술로 치료하였던 뇌동맥류 환자
25명을 대상으로 뇌동맥류 색전술의 치료효과와 합병증 및 한계점 등을 알아보고자 본 연구
를 시행하였다.
#초록#
This study was designed for the investigation of the effectiveness and limitation of
the endovascular coil embolization of intractranical aneurysms. From July 1995 to
October 1997. the authors treated 25 patients of intractanial aneurysm with endovascular
coil embolization. There 15 cases of reputured aneurysms and 10 cases of unruptured
aneurysms. The main reasons for the coil emboilzation were difficult anatomical location
and poor neurological condition. Total 28 aneurysms were tried to embolize with coil.
Among these. 12 aneurysms were occluded completely. 12 aneurysms partially. and 1
vertebral artery fusiform aneurysm was treated by coil occlusion of the proximal
vertebral artely. The complete occlusion was possible in 10 cases of 15small
aneurysms(66.7%). and in 2cases of 6 large aneurysms(33.3%). Only partial occlusion
achieved in all 3 giant aneurysms. Of 18 small neck aneurysms(≤4㎜). the complete
occusion was possible in 11 cases(61.1%). but only 1 case of 6 wide neck aneurysms(＞
4㎜) could be occluded completely. There were 3 cases of failure. 2 cases being
catherization failure because of the tortuous vessel and 1 case due to local vasospasm.
The complications related to the coil emboilzation were the perforation of the aneurysm
caused by the catheterrization in 2 cases. rebleeding after partial embolization of the
aneurysm 2 patients of Hunt-Hess grade 4 and 5. and infarction caused by parent
vessel occlusion by coil protrusion in 2 cases.
In conclusion. the coil embolization can be an alternative modality in the treatment of
intracranial ansurysms But the complete occlusion is not always possible in all cases.
and the risk of the rebleeding is still remained in the partially occluded aneurysms. The
long-term syudy is needed to confirm the effectiveness of the coil embolization in the
treatment of intracranial aneurysms.
키워드
Aneurysm; Coil; Embolization;
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