Kazuyuki Hayase

Treatment Results of Poor-grade (WFNS Grade V) Patients with Subarachnoid Hemorrhage

Although surgical treatment of poor-grade patients with ruptured cerebral aneurysms is still challenging, it is well known that some patients become independent after surgical intervention. Controversy is how to select patients with factors predictive of favorable outcome. The purpose of this paper is to extract factors predictive of favorable or poor outcome from analysis of our treatment results.

Local fibrinolysis for MCA and basilar artery embolism.

Purpose: We reviewed our clinical results of local fibrinolysis for Middle cerebral artery embolism (MCAE) and Basilar artery embolism (BAE) to discuss the propriety of our criteria for the indication of this treatment by comparing the results with conservative medical therapy.Materials and Methods: Since 1990.10 to 1999.11 we have had 75 cases of local fibrinolysis (MCAE 52 cases, BAE 19 cases and others 4 cases). Our criteria for the indication are 1) Cerebral embolism without any ischemic change at the initial CT, MRI and MRI-DWI. 2) Cerebral embolism within 6 hours from the onset (MCAE). 3) Preserving the residual CBF of ischemic territories over than 15 ml /100 g/min in 133 Xe-SPECT (MCAE). 4) No time limitation in BAE. Endovascular technique using microcatheter was applied for local fibrinolysis and rtPA (5-15 M units) or Urokinase (0.24-0.96 M units) were injected at the position of embolus or beyond the embolus.Results: Angiographical results were (MCAE/BAE) full reopening 17/12, partial reopening 23/4, embolus migration 4/1 and no change 7/2. Three months follow-up outcome evaluated by Glasgow Outcome Scale were (MCAE/BAE) good recovery 34/11, moderate disability 10/0, severe disability 4/1, persistent vegetative state 0/2 and death 4/5. In comparison with the conservative medical therapy group, local fibrinolysis is superior in GR and SD rate, and large infarction rate in MCAE and in GR rate in BAE.Conclusions: Local fibrinolysis with evaluation of residual CBF in MCAE could achieve angiographical and clinical improvements. And it is superior to the conservative medical therapy group in some points.