Therapie rupturierter zerebraler Aneurysmen: Behandlungsoptionen und derzeitige Studienlage // Ruptured Intracranial Aneurysms: Treatment Options and Data from Recent Trials

نویسندگان

  • A. Gruber
  • E. Knosp
چکیده

Ruptured Intracranial Aneurysms: Treatment Options and Data from Recent Trials. Several therapeutic options are available for the treatment of ruptured intracranial aneurysms. Generally speaking, these procedures can be reconstructive (ie, selective aneurysm occlusion) or deconstructive (ie, parent artery occlusion in conjunction with aneurysm occlusion) in nature. In view of the higher ischemic complication rate of deconstructive methods reconstructive procedures are the preferred techniques in the acute phase after aneurysmal subarachnoid haemorrhage. The role of the preferred reconstructive techniques for the management of ruptured intracranial aneurysms (ie, microsurgical clipping and endovascular coiling) is in the process of being defined. Recent publications of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT) allow for a more precise discussion of the role of these treatment options. The ISAT long-term follow-up indicates a declining but still measurable advantage of endovascular over surgical treatment in a selected group of aneurysm patients. If preoperative fatal aneurysm re-ruptures in ISAT, however, were excluded from analysis, the difference between embolization and surgery with respect to management morbidity and mortality lost its statistical significance. The BRAT results demonstrate a 5-fold increase in treatment morbidity for surgical vs endovascular management of ruptured posterior circulation aneurysms, whereas no such differences were encountered in ruptured anterior circulation aneurysms. Although aneurysm re-ruptures were infrequent with both treatment forms, patients receiving endovascular therapy suffered re-ruptures more frequently. The morbidity of both surgical and endovascular treatment of aneurysms recurring after initial endovascular treatment is low. In view of these findings, endovascular treatment is recommended for all ruptured posteriorcirculation aneurysms feasible for coil embolization, whereas management of ruptured anterior circulation aneurysms can be individualised using both endovascular and microsurgical treatment options. J Neurol Neurochir Psychiatr 2016; 17 (3): 90–100.

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تاریخ انتشار 2016