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One-stage embolization in patients with acutely ruptured poor-grade aneurysm
Yong Sam Shin1, Sun Yong Kim, Se-Hyuk Kim
1Department of Neurosurgery, School of Medicine, Ajou University, Suwon, Republic of Korea. nsshin@ajou.ac.kr
Surgical Neurology
|February 1, 2005
Summary
One-stage embolization effectively prevents rebleeding in poor-grade aneurysmal subarachnoid hemorrhage patients. This endovascular approach shows promising outcomes, with no rebleeding observed post-procedure.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Disease
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) carries a high risk of rebleeding, especially in patients with poor neurological status (Hunt and Hess grade IV-V).
- Ultra-early surgical intervention is increasingly employed to mitigate this risk.
- One-stage embolization, performed during diagnostic angiography, is explored as an alternative strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of one-stage embolization for managing poor-grade aneurysmal subarachnoid hemorrhage.
- To determine if this endovascular approach can prevent ultra-early rebleeding.
Main Methods:
- Retrospective review of 18 consecutive patients with ruptured aneurysms and poor neurological condition.
- Treatment involved one-stage embolization during the diagnostic angiography session.
Main Results:
- No rebleeding occurred after the endovascular procedure.
- Good recovery (Glasgow Outcome Scale) was observed in 8 patients; 4 had moderate disability, 3 severe disability, and 3 died.
- Two complications occurred: parent artery occlusion and intraprocedural aneurysm rupture. Mean follow-up was 13.7 months.
Conclusions:
- One-stage embolization is a promising strategy for preventing ultra-early rebleeding in poor-grade aSAH patients.
- Aggressive resuscitation and early involvement of the endovascular team are crucial for successful implementation.