뇌동맥류의 혈관내 Guglielmi Detachable Coil 치료
Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coil
소속 상세정보
신용삼/Yong Sam Shin
이규창/김동익/허승곤/주진양/김동익/Kyu Chang Lee/Dong Ik Kim/Seung Kon Huh/Jin Yang Joo/Dong Ik Kim
KMID : 0359819980270070960
Abstract
서론
동맥류내 Guglielmi detachable coil(GDC) 치료법이 뇌동맥류의 새로운 비수술적 치료법으
로 알려진 후, 세계적으로 15,000여명의 환자에서 시술되었으며, 평균 5년 이상 중기
(mid-term) 치료 성적이 발표되었다. 1996년 국내에 도입된 동맥류내 GDC 치료법은 주로
동맥류 수술 고위험군을 대상으로 시행되었다. 동맥류내 치료는 수술치료에 비하여 개두술
과 뇌견인을 피할 수 있는 장점이 있으나, 뇌동맥류 파열 및 혈전-색전증 등 심각한 합병증
을 일으킬 수 있고, 동맥류를 불완전하게 치료하든지 또는 치료하지 못할 수 있으며 장시일
에 걸친 coil 압축(compaction)으로 동맥류가 refill될 수 있으므로 큰 동맥류를 갖는 환자일
수록 재발 가능성이 많다. 또한 대상환자 선정 기준이 술자의 주관에 따라 모호하다. 본 연
구의 목적은 뇌동맥류내 GDC치료 대상이 되었던 환자에서 치료적응에 따른 임상 성적을
분석하여, 본 치료법의 초기(short-term) 치료 효능을 검토하여 치료 대상 환자 선정 지침을
마련하는데 있다.
#초록#
The purpose of the study was to evaluate short-term clinical results in 44 patients
who had cerebral aneurysms and underwent endovascular treatment with Guglielmi
detachable coil(GDC), and to establish selection criteria of the patients for this treatment.
From March 1996 to November 1997, we treated 258 patients either by surgery or
endovascular treatment, or by combination of both. Forty-four patients of them were
assigned to endovascular GDC embolization as an initial treatment rather than surgery
because of an anticipated technical difficulty for surgery due to anatomy of the
aneurysm on cerebral angiography(25 patients), patient's poor physical or neurological
condition(18 patients), or referring neurosurgeon's preference(one patient). Twenty
patients were presented with ruptured aneurysm, 13 with unruptured aneurysm, 6 with
mass effect, and 5 with initial incomplete clipping. Twenty-six patients had anterior
circulation aneurysm and 18 had posterior circulation aneurysm.
Among total of 44 patients, we were able to achieve 70 to 100% obliteration of the
aneurysm in 32 patients(72.7%) but failed in 12(27.3%). Causes of failure were 5 wide
neck, 4 vessel tortuosity, 2 difficult geometry, and a perforation of the distal basilar
aneurysm. Seven of the failed patients were treated by subsequent clipping.
Complications caused by the intra-aneurysmal endovascular treatment were a fatal
perforation of the aneurysm with guide wire and an occlusion of the parent artery from
over-packing of the coil, and distal migration of the coil in 2 patients, all of which could
be retrieved.
At an average 6-month follow-up, only one of six death was caused by the
endovascular treatment. Short-term clinical results of the endovascular treatment of
cerebral aneurysms indicate that this procedure is a useful alternative approach
especially in selected patients with high risk aneurysm.
키워드
Intracranial aneurysm; Endovascular treatment; Guglielmi detachable coil;
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