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Ishida F, Tsuji M, Tanioka S, Tanaka K, Yoshimura S, Suzuki H. Computational Fluid Dynamics for Cerebral Aneurysms in Clinical Settings. Acta Neurochir Suppl 2021; 132:27-32. [PMID: 33973025 DOI: 10.1007/978-3-030-63453-7_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hemodynamics is thought to play an important role in the pathogenesis of cerebral aneurysms and recent development of computer technology makes it possible to simulate blood flow using high-resolution 3D images within several hours. A lot of studies of computational fluid dynamics (CFD) for cerebral aneurysms were reported; therefore, application of CFD for cerebral aneurysms in clinical settings is reviewed in this article.CFD for cerebral aneurysms using a patient-specific geometry model was first reported in 2003 and it has been revealing that hemodynamics brings a certain contribution to understanding aneurysm pathology, including initiation, growth and rupture. Based on the knowledge of the state-of-the-art techniques, this review treats the decision-making process for using CFD in several clinical settings. We introduce our CFD procedure using digital imaging and communication in medicine (DICOM) datasets of 3D CT angiography or 3D rotational angiography. In addition, we review rupture status, hyperplastic remodeling of aneurysm wall, and recurrence of coiled aneurysms using the hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), aneurysmal inflow rate coefficient (AIRC), and residual flow volume (RFV).
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Affiliation(s)
- Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan.
| | - Masanori Tsuji
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | - Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | - Katsuhiro Tanaka
- Department of Neurosurgery, Mie Chuo Medical Center, NHO, Tsu, Japan
| | | | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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152
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Brunasso L, Alotta G, Zingales M, Iacopino DG, Graziano F. Can biomechanical analysis shed some light on aneurysmal pathophysiology? Preliminary study on ex vivo cerebral arterial walls. Clin Biomech (Bristol, Avon) 2021; 81:105184. [PMID: 33309932 DOI: 10.1016/j.clinbiomech.2020.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The pathophysiology of cerebral aneurysm is complex and poorly understood, and it can have the most catastrophic clinical presentation. Flow dynamics is a key player in the initiation and progression of aneurysm. Better understanding the interaction between hemodynamic loading and biomechanical wall responses can help to add the missing piece on aneurysmal pathophysiology. In this laboratory study we aimed to analyze the effect of the application of a mechanical force to cerebral arterial walls. METHODS Displacement control tests were performed on five porcine cerebral arteries. The test machine was the T150 Nanotensile. The stiffness variation with the increment of the strain level is modeled as the outcome of an isotropic hyperelastic material model. FINDINGS Through the application of an axial force we obtained Stress/Strain curves that showed a marked isotropic hyperelastic behavior, characterized by an increasing of stiffness with the level of strain. This behavior of the cerebral arterial wall is different from the well-established behavior of other arterial vessel (as the aortic vessel) characterized by a marked anisotropic behavior. Additionally, the data scattering observed for higher values of the applied stress are related to different individual packing of collagen fibers that represent the load-bearing mechanics at higher level of the strain. INTERPRETATION The data obtained by test in this paper represent a first step in our ongoing research about the mechanics of multi-axial loads on cerebral arterial walls, and in producing more comprehensive patient-specific calculations for potential applications on cerebral aneurysm management.
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Affiliation(s)
- L Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - G Alotta
- Dipartimento di Ingegneria Civile, dell'Energia, dell'Ambiente, e dei Material, Università degli Studi "Mediterranea" di Reggio Calabria, Via Graziella-Vito, 89122 Reggio Calabria, RC, Italy
| | - M Zingales
- Bio/NanoMechanics for Medical Sciences Laboratory, ATeN-Center, Università degli Studi di Palermo, Viale delle Scienze ed.18, Palermo, Italy; Dipartimento di Ingegneria, Viale delle Scienze, Università degli Studi di Palermo,ed.8, 90128 Palermo, Italy.
| | - D G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy
| | - F Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy; Azienda ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS), "G. Garibaldi", Piazza S. Maria di Gesù n.5, 95124 Catania, Italy
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153
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Bender MT, Young RW, Zarrin DA, Campos JK, Caplan JM, Huang J, Tamargo RJ, Lin LM, Colby GP, Coon AL. Twisting: Incidence and Risk Factors of an Intraprocedural Challenge Associated With Pipeline Flow Diversion of Cerebral Aneurysms. Neurosurgery 2020; 88:25-35. [PMID: 32658958 DOI: 10.1093/neuros/nyaa309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pipeline Embolization Device (PED; Medtronic) "twisting" manifests with the appearance of a "figure 8" in perpendicular planes on digital subtraction angiography. This phenomenon has received little attention in the literature, requires technical precision to remediate, and has potential to cause ischemic stroke if not properly remediated. OBJECTIVE To report incidence, risk factors, and sequelae of PED twisting and to discuss techniques to remediate a PED twist. METHODS Case images were reviewed for instances of twisting from a prospectively-maintained, Institutional Review Board-approved cohort of patients undergoing flow diversion for cerebral aneurysm. RESULTS From August 2011 to December 2017, 999 PED flow diverting stents were attempted in 782 cases for 653 patients. A total of 25 PED twists were observed while treating 20 patients (2.50%, 25/999). Multivariate analysis revealed predictors of twisting to be: Large and giant aneurysms (odds ratio (OR) = 9.66, P = .005; OR = 27.47, P < .001), increased PED length (OR = 1.14, P < .001), and advanced patient age (OR = 1.07, P = .002). Twisted PEDs were able to be remediated 75% of the time, and procedural success was achieved in 90% of cases. PED twisting was not found to be a significant cause of major or minor complications. However, at long-term follow-up, there was a trend towards poor occlusion outcomes for the cases that encountered twisting. CONCLUSION Twisting is a rare event during PED deployment that was more likely to occur while treating large aneurysms with long devices in older patients. While twisting did not lead to major complications in this study, remediation can be challenging and may be associated with inferior occlusion outcomes.
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Affiliation(s)
- Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Robert W Young
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David A Zarrin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica K Campos
- Department of Neurosurgery, University of California Irvine, Orange, California
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Li-Mei Lin
- Department of Neurosurgery, University of California Irvine, Orange, California
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California
| | - Alexander L Coon
- Department of Neurosurgery, Carondelet Neurological Institute, Tucson, Arizona
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154
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Nicolás-Cruz CF, Mondragón-Soto MG, Calderón JRA, Melo-Guzmán G. Manejo bimodal de aneurismas asociados a malformaciones arteriovenosas cerebrales. Reporte de caso y breve revisión de la literatura. CIR CIR 2020; 88:79-83. [PMID: 33284274 DOI: 10.24875/ciru.20000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La patogénesis de los aneurismas intracraneales asociados a malformaciones arteriovenosas cerebrales no es bien entendida y es aún objeto de discusión. Las decisiones sobre cuándo y cómo tratar los aneurismas intracraneales de estas características siempre han sido un reto terapéutico tanto para neurocirujanos vasculares como para terapistas endovasculares neurológicos. Reportamos el caso de una paciente de 51 años con aneurismas múltiples asociados a una malformación arteriovenosa, así como su manejo neuroquirúrgico, con un análisis comparativo con lo publicado en la literatura médica y científica en los últimos 10 años. The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; the decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular neurosurgeons and endovascular neurological therapists. We report the case of a 51-year-old patient with multiple aneurysms associated with arteriovenous malformation, as well as her neurosurgical management, with a comparative analysis what has been published in the medical and scientific literature in the last 10 years.
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Affiliation(s)
- Carlos F Nicolás-Cruz
- Servicio de Cirugía General, Instituto Mexicano del Seguro Social (IMSS). Ciudad de México, México
| | - Michel G Mondragón-Soto
- Servicio de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez. Ciudad de México, México
| | - José R Aguilar Calderón
- Servicio de Neurocirugía, Hospital Central Sur de Alta Especialidad, Petróleos Mexicanos (PEMEX). Ciudad de México, México
| | - Gustavo Melo-Guzmán
- Unidad de Terapia Endovascular Neurológica, Servicio de Neurocirugía, Hospital Juárez de México, Secretaría de Salud. Ciudad de México, México
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Nishikawa A, Kakizawa Y, Wada N, Yamamoto Y, Katsuki M, Uchiyama T. Usefulness of Pointwise Encoding Time Reduction with Radial Acquisition and Subtraction-Based Magnetic Resonance Angiography after Cerebral Aneurysm Clipping. World Neurosurg X 2020; 9:100096. [PMID: 33426517 PMCID: PMC7776957 DOI: 10.1016/j.wnsx.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Time-of-flight magnetic resonance angiography (MRA) is limited by clip-induced artifacts after cerebral aneurysmal clipping. Recently, ultrashort echo time was shown to reduce metal artifacts. We assessed the pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA as an ultrashort echo time method during follow-up for clipping surgery. Methods We retrospectively evaluated 114 branches of 63 aneurysms in 56 patients treated with titanium clips using MRA and 3-dimensional computed tomography angiography. The appearance using each method was compared, and the associations between visibility on PETRA-MRA, clip number and shape, and amount of hematoma were examined. Furthermore, the visibility of the aneurysm remnants and 2 clipping cases with cobalt-chromium-nickel-molybdenum clips were evaluated. Results No branches were visible using time-of-flight-MRA, but 79 of 114 branches (69.3%) were visible on PETRA-MRA. PETRA-MRA was effective for follow-up imaging in 33 of 63 aneurysms (52.4%). The median vessel diameters were 1.67 mm (interquartile range, 1.24–2.62 mm) and 0.96 mm (interquartile range, 0.59–1.53 mm) in the visible and invisible groups, respectively. Only the vessel diameter correlated significantly (P < 0.001) with the visibility on PETRA-MRA. A receiver operating characteristic curve for the association between the vessel diameter and visibility on PETRA-MRA showed a cutoff value of 1.26 mm for vessel diameter. Cobalt-chromium-nickel-molybdenum clips produced a strong artifact, even on PETRA-MRA. All 4 residual aneurysms were visible on PETRA-MRA. Conclusions PETRA-MRA can be useful for follow-up aneurysm imaging when the diameter of vessels adjacent to the clip exceeds 1.26 mm. However, its usefulness is limited to titanium clips.
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Affiliation(s)
- Akihiro Nishikawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
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156
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Sato K, Matsumoto Y, Kanoke A, Ito A, Fujimura M, Tominaga T. Y-Configuration Stenting for Coil Embolization of Complex Intracranial Aneurysms: Distinguishing Between Use of Crossing-Y and Kissing-Y. World Neurosurg 2020; 146:e1054-e1062. [PMID: 33246177 DOI: 10.1016/j.wneu.2020.11.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Coil embolization with Y stenting is recognized as a suitable treatment for complex wide-necked aneurysms. Y stenting comprises crossing-Y stenting, in which a stent is passed through the interstices of another stent, and kissing-Y stenting, in which 2 stents are arranged in parallel. The purpose of this study was to elucidate how to distinguish between use of the 2 Y-stenting techniques. METHODS Clinical and angiographic data of patients who underwent coil embolization with Y stenting at our department from 2015 to 2019 were retrospectively analyzed. Basic characteristics, endovascular procedure, complications, and outcomes were compared between kissing-Y and crossing-Y stenting groups. RESULTS Thirty-eight intracranial aneurysms in 38 consecutive patients were included in this study. Nineteen patients (50%) were treated with coil embolization with kissing-Y stenting and 19 (50%) with crossing-Y. Endovascular procedures were successfully performed in all but 1 patient, in the kissing-Y group, who had stent migration. One hemorrhage (2.6%) recurred 12 months after coiling with kissing-Y stenting. Angiographic follow-up (mean, 15.8 months) was available in 35 patients. Adequate occlusion was shown in 14 patients (77.8%) and 13 patients (76.5%) in the kissing-Y and crossing-Y groups, respectively. Larger, wider-necked, and more proximal aneurysms were treated with kissing-Y stenting than with crossing-Y stenting, although there were no significant differences between the groups in complication rates or clinical outcomes. CONCLUSIONS Kissing-Y and crossing-Y stenting of intracranial aneurysms were both feasible and yielded reasonable angiographic and clinical results. The choice between the kissing-Y or crossing-Y-stenting technique should be decided according to the angioarchitecture of targeted aneurysms.
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Affiliation(s)
- Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Atsushi Kanoke
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ito
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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157
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Maragkos GA, Dmytriw AA, Salem MM, Tutino VM, Meng H, Cognard C, Machi P, Krings T, Mendes Pereira V. Overview of Different Flow Diverters and Flow Dynamics. Neurosurgery 2020; 86:S21-S34. [PMID: 31838536 DOI: 10.1093/neuros/nyz323] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/30/2019] [Indexed: 12/16/2022] Open
Abstract
Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical evidence base. However, flow diversion has not yet been directly compared to surgical aneurysm clipping or other endovascular procedures. The oldest and most well-studied device is the Pipeline Embolization Device (PED; Medtronic), recently transitioned to the Pipeline Flex (Medtronic), which still has sparse data regarding outcomes. To date, other flow diverting devices have not been shown to outperform the PED, although information comes primarily from retrospective studies with short follow-up, which are not always comparable. Because of this lack of high-quality outcome data, no reliable recommendations can be made for choosing among flow diversion devices yet. Moreover, the decision to proceed with flow diversion should be individualized to each patient. In this work, we wish to provide a comprehensive overview of the technical specifications of all flow diverter devices currently available, accompanied by a succinct description of the evidence base surrounding each device.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam A Dmytriw
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medical Imaging, Toronto Western Hospital and St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, New York
| | - Hui Meng
- Canon Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, New York
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Centre Hopitalier de Toulouse, Toulouse, France
| | - Paolo Machi
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Timo Krings
- Department of Medical Imaging, Toronto Western Hospital and St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Vitor Mendes Pereira
- Department of Medical Imaging, Toronto Western Hospital and St. Michael's Hospital, University of Toronto, Toronto, Canada
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158
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Hanaoka Y, Koyama JI, Fujii Y, Ogiwara T, Ito K, Horiuchi T. Bilateral Transradial Approach for Coil Embolization of Basilar Artery Aneurysms Associated with an Unfavorable Vertebral Artery Anatomy : Initial Experience with Role-sharing Technique. Clin Neuroradiol 2020; 31:699-707. [PMID: 33201247 DOI: 10.1007/s00062-020-00971-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE An unfavorable vertebral artery (VA) anatomy occasionally inhibits a successful VA cannulation due to flow stagnation after catheterization. To preserve antegrade VA flow, we developed bilateral transradial catheter systems, referred to as the role-sharing technique, for coil embolization of basilar artery (BA) aneurysms associated with an unfavorable VA anatomy. This study aimed to evaluate the feasibility and safety of coil embolization using the role-sharing technique for BA aneurysms. METHODS We retrospectively analyzed an institutional database of consecutive patients with BA aneurysm who underwent coil embolization using the role-sharing technique between July 2019 and January 2020. The study included seven consecutive patients. Bilateral transradial VA cannulation was performed using 3.2F catheters (TACTICS; Technocrat Corporation, Aichi, Japan) via 4F guiding sheaths placed in the subclavian artery. The following catheter systems were used: the triaxial system (4F guiding sheath/TACTICS/coil or stent delivery microcatheter) that has a specialized role in embolization and the biaxial system (4F guiding sheath/TACTICS) that has a specialized role in contrast injection during embolization procedure. The procedural success and procedure-related or vascular access site complications were assessed. RESULTS All patients underwent a successful embolization procedure using the bilateral transradial catheter systems and none of them presented with flow stagnation, system instability, or other complications. CONCLUSION The role-sharing technique was shown to be a feasible and safe method for coil embolization of BA aneurysms associated with an unfavorable VA anatomy. This method may increase the success rate of transradial coil embolization for BA aneurysms.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
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Melinosky C, Kincaid H, Claassen J, Parikh G, Badjatia N, Morris NA. The Modified Fisher Scale Lacks Interrater Reliability. Neurocrit Care 2021; 35:72-8. [PMID: 33200331 DOI: 10.1007/s12028-020-01142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The modified Fisher scale (mFS) is a critical clinical and research tool for risk stratification of cerebral vasospasm. As such, the mFS is included as a common data element by the National Institute of Neurological Disorders and Stroke SAH Working Group. There are few studies assessing the interrater reliability of the mFS. METHODS We distributed a survey to a convenience sample with snowball sampling of practicing neurointensivists and through the research survey portion of the Neurocritical Care Society Web site. The survey consisted of 15 scrollable CT scans of patients with SAH for mFS grading, two questions regarding the definitions of the scale criteria and demographics of the responding physician. Kendall's coefficient of concordance was used to determine the interrater reliability of mFS grading. RESULTS Forty-six participants (97.8% neurocritical care fellowship trained, 78% UCNS-certified in neurocritical care, median 5 years (IQR 3-6.3) in practice, treating median of 80 patients (IQR 50-100) with SAH annually from 32 institutions) completed the survey. By mFS criteria, 30% correctly identified that there is no clear measurement of thin versus thick blood, and 42% correctly identified that blood in any ventricle is scored as "intraventricular blood." The overall interrater reliability by Kendall's coefficient of concordance for the mFS was moderate (W = 0.586, p < 0.0005). CONCLUSIONS Agreement among raters in grading the mFS is only moderate. Online training tools could be developed to improve mFS reliability and standardize research in SAH.
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160
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Liang ES, Mahady K, Coulthard A, Winter C. Treatment of a middle cerebral artery aneurysm in the setting of Loeys-Dietz syndrome: Case report and review of literature. Radiol Case Rep 2020; 16:48-50. [PMID: 33163133 PMCID: PMC7607204 DOI: 10.1016/j.radcr.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022] Open
Abstract
Loeys-Dietz syndrome (LDS) is a connective tissue disorder with associated systemic vasculopathies including intracranial arterial aneurysm formation and dissections. LDS is a relatively less well-known entity compared with other connective tissue disorders, such as Ehlers-Danlos or Marfan syndrome, and consequently experience in the management of the associated intracranial aneurysms is suboptimal. We present a case of surgical clipping of a middle cerebral artery aneurysm in a patient with LDS. A 46-year-old female with LDS (type III) was found to have a right middle cerebral artery (MCA) bifurcation aneurysm following vascular screening. The decision was made to surgically clip the aneurysm after consultation in our neurovascular multidisciplinary team meeting. A standard right pterional craniotomy was performed and the aneurysm was secured with 2 straight Sugita clips. The temporal M2 branch was noted to be thin walled and this prompted application of the second tandem clip, rather than risk re-positioning the initial clip. In our case, the MCA aneurysm neck was robust enough to take a clip without any complications, and therefore we suggest that the presence of LDS is not an absolute contra-indication to perform open craniotomy and clipping.
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Affiliation(s)
- Ee Shern Liang
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Corner of Butterfield Street and Bowen Bridge Road, Herston, 4029, Queensland, Australia
- Corresponding author.
| | - Kate Mahady
- Department of Interventional Neuroradiology, Royal Brisbane and Women's Hospital, Herston, 4029, Queensland, Australia
- University of Queensland, Herston, 4029, Queensland, Australia
| | - Alan Coulthard
- Department of Interventional Neuroradiology, Royal Brisbane and Women's Hospital, Herston, 4029, Queensland, Australia
- University of Queensland, Herston, 4029, Queensland, Australia
| | - Craig Winter
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Corner of Butterfield Street and Bowen Bridge Road, Herston, 4029, Queensland, Australia
- University of Queensland, Herston, 4029, Queensland, Australia
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161
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Abstract
Atraumatic subarachnoid hemorrhage represents a small proportion of strokes, but is a true medical emergency that results in significant morbidity and mortality. Making the diagnosis can be challenging and misdiagnosis can result in devastating consequences. There are several time-dependent diagnostic and management considerations for emergency physicians and other frontline providers. This article reviews the most up-to-date literature on the diagnostic workup of subarachnoid hemorrhage, avoiding misdiagnosis, and initial emergency department management recommendations.
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Affiliation(s)
- Nicole M Dubosh
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, One Deaconess Road, Rosenburg 2, Boston, MA 02115, USA.
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, One Deaconess Road, Rosenburg 2, Boston, MA 02115, USA
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Cherednychenko Y, Engelhorn T, Miroshnychenko A, Zorin M, Dzyak L, Tsurkalenko O, Cherednychenko N. Endovascular treatment of patient with multiple extracranial large vessel stenosis and coexistent unruptured wide-neck intracranial aneurysm using a WEB device and Szabo-technique. Radiol Case Rep 2020; 15:2522-2529. [PMID: 33072231 PMCID: PMC7548423 DOI: 10.1016/j.radcr.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
The coexistence of severe extracranial large vessel stenosis and unruptured intracranial aneurysms is not rare. There are different treatment approaches for these conditions, such as initial treatment of the aneurysm before revascularization of the stenosis; single-stage endovascular treatment of both lesions; stenosis eliminating followed by treatment of the aneurysm, or without treating the aneurysm. But, taking into account the risk of aneurysm rupture on the one hand and the risk of ischemic stroke on the other, it is sometimes difficult to choose the right management strategy. Despite this fact, there are still no guidelines or consensus on the management of these coexistent lesions. The article describes a clinical case of endovascular treatment of multiple extracranial stenosis and coexistent unruptured wide-neck aneurysm of the middle cerebral artery. The endovascular treatment of the carotid stenosis and aneurysm using a woven endobridge device was performed in one session; endovascular treatment of vertebral artery stenosis with Szabo technique was performed in another session.
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Affiliation(s)
- Yurii Cherednychenko
- Communal Institution "Dnipropetrovsk Regional Clinical Hospital named by I.I.Mechnikov", Dnipro, Ukraine
| | - Tabias Engelhorn
- Neuroradiological Department, Erlangen University Hospital, Erlangen, Germany
| | - Andrii Miroshnychenko
- Communal Institution "Dnipropetrovsk Regional Clinical Hospital named by I.I.Mechnikov", Dnipro, Ukraine
| | - Mikola Zorin
- State Institution "Dnipropetrovsk Medical Academy" Ministry of Health of Ukraine", Sobornaya squ.14, Dnipro 49027, Ukraine
| | - Liudmila Dzyak
- State Institution "Dnipropetrovsk Medical Academy" Ministry of Health of Ukraine", Sobornaya squ.14, Dnipro 49027, Ukraine
| | - Olena Tsurkalenko
- State Institution "Dnipropetrovsk Medical Academy" Ministry of Health of Ukraine", Sobornaya squ.14, Dnipro 49027, Ukraine
| | - Natalia Cherednychenko
- State Institution "Dnipropetrovsk Medical Academy" Ministry of Health of Ukraine", Sobornaya squ.14, Dnipro 49027, Ukraine
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163
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Florez WA, García-Ballestas E, Maeda F, Joaquim A, Pavlov O, Moscote-Salazar LR, Tsimpas A, Martinez-Perez R. Relationship between aspirin use and subarachnoid hemorrhage: A systematic Review and meta-analysis. Clin Neurol Neurosurg 2020; 200:106320. [PMID: 33268193 DOI: 10.1016/j.clineuro.2020.106320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aspirin has been associated with a decreasing risk of subarachnoid hemorrhage due to its anti-inflammatory mechanism of action and potential protective properties against aneurysm growth. OBJECTIVE To determine the association between aneurysmal subarachnoid hemorrhage and aspirin use. METHODS A systematic review of the literature and a meta-analysis were performed across the PubMed database. The following keywords were used: "aspirin, acetylsalicylic acid, 2-acetyloxy-benzoic acid, ruptured intracranial aneurysm, aneurysmal subarachnoid hemorrhage, spontaneous subarachnoid hemorrhage, intracerebral hemorrhage, spontaneous aneurysmal hemorrhage, spontaneous intracerebral bleeding". Studies that were performed with animals or analyzed patients with traumatic brain injury were excluded. A total of five studies were included in our meta-analysis, with a total of 19,222 patients evaluated. Statistical analysis was performed to determine the association between the use of aspirin and the risk of subarachnoid hemorrhage. RESULTS Aspirin use reduce the risk of subarachnoid hemorrhage (odds ratio [OR] 0.51, 95 % confidence interval [CI] 0.34-0.76). CONCLUSION Although some previous studies suggested that aspirin may potentially reduce the risk of subarachnoid hemorrhage, our meta-analysis found an association between the reduction of risk of aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- William A Florez
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Faculty of Health, Programa Medicina, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Ezequiel García-Ballestas
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Fernando Maeda
- Department of Neurosurgery, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Andrei Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Orlin Pavlov
- Departament of Neurosurgery, Klinikum Fulda gAG, Fulda, Germany
| | - Luis Rafael Moscote-Salazar
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Asterios Tsimpas
- Section of Neurosurgery, Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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164
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Wajima D, Hourani S, Dodd W, Patel D, Jones C, Motwani K, Fazal HZ, Hosaka K, Hoh BL. Interleukin-6 Promotes Murine Estrogen Deficiency-Associated Cerebral Aneurysm Rupture. Neurosurgery 2020; 86:583-592. [PMID: 31264696 PMCID: PMC7317988 DOI: 10.1093/neuros/nyz220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/08/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Estrogen deficiency is associated with cerebral aneurysm rupture, but the precise mechanism is unknown. OBJECTIVE To test the hypothesis that IL-6 is required for the increase in aneurysm rupture rate observed in estrogen-deficient mice. METHODS We analyzed IL-6 expression in human cerebral aneurysms. We induced cerebral aneurysms in estrogen-deficient female C57BL/6 mice that had undergone 4-vinylcyclohexene diepoxide (VCD) treatment or bilateral ovariectomy (OVE). Mice were blindly randomized to selective IL-6 inhibition (IL-6 receptor [IL-6R] neutralizing antibody, n = 25) or control (isotype-matched IgG, n = 28). Murine cerebral arteries at the circle of Willis were assessed for aneurysm rupture and macrophage infiltration. RESULTS IL-6 is expressed in human cerebral aneurysms, but not in control arteries. Serum IL-6 is elevated in ovariectomized female mice compared to sham control (14.3 ± 1.7 pg/mL vs 7.4 ± 1.5 pg/mL, P = .008). Selective IL-6R inhibition suppressed cerebral aneurysm rupture in estrogen-deficient mice compared with control (VCD: 31.6% vs 70.0%, P = .026; OVE: 28.6% vs 65.2%, P = .019). IL-6R inhibition had no effect on formation or rupture rate in wild-type mice. IL-6R neutralizing antibody significantly reduced macrophage infiltration at the circle of Willis (1.9 ± 0.2 vs 5.7 ± 0.6 cells/2500 μm2; n = 8 vs n = 15; P < .001). CONCLUSION IL-6 is increased in the serum of estrogen-deficient mice and appears to play a role in promoting murine estrogen deficiency-associated cerebral aneurysm rupture via enhanced macrophage infiltration at the circle of Willis. Inhibition of IL-6 signaling via IL-6 receptor neutralizing antibody inhibits aneurysm rupture in estrogen-deficient mice. IL-6 receptor inhibition had no effect on aneurysm formation or rupture in wild-type animals.
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Affiliation(s)
- Daisuke Wajima
- Department of Neurosurgery, University of Florida, Gainesville, Florida.,Department of Neurosurgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Siham Hourani
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - William Dodd
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Devan Patel
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Chad Jones
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Kartik Motwani
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Hanain Z Fazal
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Koji Hosaka
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida
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165
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Sokolowski JD, Chen CJ, Soldozy S, Mastorakos P, Burke RM, Nguyen JM, Myers KM, Kalani MYS, Park MS. Nimodipine after aneurysmal subarachnoid hemorrhage: Fourteen-day course for patients that meet criteria for early hospital discharge. Clin Neurol Neurosurg 2021; 200:106299. [PMID: 33092929 DOI: 10.1016/j.clineuro.2020.106299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Randomized-controlled trials and meta-analyses showed nimodipine use after aneurysmal subarachnoid hemorrhage (aSAH) leads to reduction in incidence of cerebral infarction, persistent neurological deficits, and poor outcomes. Trials administered it for 21 days; however, we assessed whether a shorter duration might be reasonable for a subset of patients. METHODS We performed a retrospective single-center study to compare outcomes between patients who received ≤14 days, 15-20 days or ≥21 days of nimodipine. Primary outcome was defined as rate of good functional outcome at final follow-up, assessed using dichotomized modified Rankin Score (mRS). Secondary outcomes included median mRS at follow-up, discharge disposition, and readmission for stroke or vasospasm. RESULTS 195 patients were included: 101 patients received nimodipine for ≤14 days, 72 patients for 15-20 days, and 22 patients for ≥21 days. There were differences in baseline characteristics of the groups. The shorter duration groups had higher admission GCS score (GCS 15 for ≤14 days, GCS 13 for 15-20 days, GCS 8 for ≥21 days, p = 0.003) and lower Hunt-Hess grade (2 for ≤14 days, 3 for 15-20 days, 4 for ≥21 days, p = 0.001). Of the group of patients that received ≤14 days of nimodipine, 3 patients (3%) were readmitted for concerns for possible stroke or vasospasm, but they did not experience worsening of their functional status related to this. CONCLUSION Our data suggests a more limited 14-day course of nimodipine therapy after aSAH may be reasonable and efficacious in patients with higher GCS and lower Hunt-Hess grade on presentation.
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Futami K, Misaki K, Uno T, Kamide T, Nakada M. Effect of Neck Size on the Inflow Magnitude Evaluated on 4D Flow MRI in Unruptured Internal Carotid Artery Aneurysms. J Stroke Cerebrovasc Dis 2020; 29:105116. [PMID: 32912568 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND A neck size >4.0 mm is a risk factor for recanalization after coil embolization. The high inflow magnitude of pretreatment wide-neck aneurysms may be correlated to recanalization. We aimed to elucidate the effect of the neck size on the inflow magnitude evaluated on four-dimensional (4D) flow magnetic resonance imaging (MRI) in pretreatment unruptured internal carotid artery (ICA) aneurysms. METHODS Thirty-three untreated ICA aneurysms were subjected to 4D flow MRI to evaluate the inflow magnitude parameters including the maximum spatially-averaged inflow velocity (MSAIV), maximum inflow velocity, maximum inflow rate (MIR), and their ratios to each corresponding flow parameter in the parent artery. RESULTS The neck size was linearly correlated to all inflow parameters investigated in this study. A strong correlation was observed between the neck size and the following: MSAIV (r = .755, p < .0001), MIR (r = .715, p < .0001), MSAIV ratio (r = .724, p < .0001), and MIR ratio (r = .741, p < .0001). The predicted value of MIR ratio of an aneurysm with the neck size of 4.0 mm was 23.0% and 20.6%, based on the linear regression equation of all aneurysms and on that of aneurysms with the neck size >4.0 mm, respectively. CONCLUSIONS The neck size was linearly correlated with the inflow magnitude of unruptured ICA aneurysms. Inflow magnitude evaluation using 4D flow MRI may help to hemodynamically identify aneurysms with a high risk of recanalization after endovascular coil embolization.
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Affiliation(s)
- Kazuya Futami
- Department of Neurosurgery, Hokuriku Central Hospital, 123 Nodera, Oyabe, 932-8503 Toyama, Japan.
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
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167
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Intarakhao P, Thiarawat P, Tewaritrueangsri A, Pojanasupawun S. Low-dose adenosine-induced transient asystole during intracranial aneurysm surgery. Surg Neurol Int 2020; 11:235. [PMID: 32874738 PMCID: PMC7451161 DOI: 10.25259/sni_79_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background Few studies have evaluated the adenosine dose that induces cardiac arrest during intracranial aneurysm surgery. We present our experiences with adenosine-induced transient asystole (AiTA) during intracranial aneurysm surgery and dosage recommendations. Methods We retrospectively reviewed the medical records of all patients who underwent intracranial aneurysm surgery between July 2016 and December 2018. Patients who experienced AiTA during intracranial aneurysm surgery were included in the study. Results Our study included nine intracranial aneurysm surgeries performed in eight patients. Thirteen episodes of AiTA were reported. Five of these were performed to facilitate bleeding control due to intraoperative aneurysm rupture (IAR), and adenosine doses were 9 mg (0.20 mg/kg), 12 mg (0.25 mg/kg), 12 mg (0.26 mg/kg), 18 mg (0.34 mg/kg), and 18 mg (0.39 mg/kg), resulted in transient asystole for 12, 14, 9, 44, and 18 s, respectively. For episodes without IAR, adenosine doses ranging from 6 to 18 mg (0.11-0.39 mg/kg) caused asystole for 8-33 s. In five episodes without IAR, low-dose adenosine (lower than 0.2 mg/kg) was used and caused asystole ranging from 8 to 12 s. Postoperatively, two patients had elevated cardiac troponin T levels but normal electrocardiograms. Conclusion AiTA can facilitate the clipping of intracranial aneurysms at low-risk of serious cardiac complications. An adenosine dose of 0.2-0.4 mg/kg is safe and effective in both IAR and non IAR situations. In non IAR cases, we propose that low-dose AiTA is an option to facilitate aneurysm clipping. A starting dose of 6 mg or 0.1-0.2 mg/kg can adequately induce brief asystole by softening the aneurysmal sac during clip application.
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Affiliation(s)
- Patcharin Intarakhao
- Departments of Anesthesiology, Naresuan University, Tambon Thapho, Muang Phitsanulok, Thailand
| | - Peeraphong Thiarawat
- Departments of Surgery, Naresuan University, Tambon Thapho, Muang Phitsanulok, Thailand
| | - Apirak Tewaritrueangsri
- Departments of Anesthesiology, Naresuan University, Tambon Thapho, Muang Phitsanulok, Thailand
| | - Surachart Pojanasupawun
- Departments of Anesthesiology, Naresuan University, Tambon Thapho, Muang Phitsanulok, Thailand
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Enomoto Y, Egashira Y, Matsubara H, Yoshimura S, Iwama T. Long-Term Outcome of Endovascular Therapy for Large or Giant Thrombosed Intracranial Aneurysms. World Neurosurg 2020; 144:e507-12. [PMID: 32891840 DOI: 10.1016/j.wneu.2020.08.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Large or giant thrombosed intracranial aneurysms (LGTIAs) are highly associated with poor prognosis and remain a challenging disease to treat by either surgery or endovascular treatment (EVT). EVT is considered more difficult for complicated aneurysm like LGTIAs. To understand long-term clinical and angiographic outcomes of EVT for LGTIAs, we retrospectively analyzed our single-center data on multimodality EVT for patients with LGTIAs. METHODS From the data of 35 EVT procedures performed in 31 consecutive patients with LGTIAs at our institution between December 2004 and December 2018, the rate of periprocedural complications, clinical outcomes at 12 months after EVT, and the rate of aneurysm recurrence were analyzed, and their related factors were evaluated. RESULTS Initial EVTs were performed by deconstructive (n = 10) or reconstructive (n = 21) techniques. Although 5 patients (16%) died during the periprocedural period, 23 (74%) had good outcome at 12 months after the procedures. Among 26 patients with long-term follow-up, aneurysm recurrence was observed in 6 patients (23.1%; median time from treatment, 33.2 months). Aneurysm recurrence was significantly higher in patients with basilar artery aneurysm (P = 0.0421) and stroke (P = 0.0307); however, there was no significant difference between the procedures and devices used. CONCLUSIONS Multimodality EVT for LGTIAs was performed with similar clinical outcomes and better radiologic outcomes compared with previous reports. New innovative techniques and devices are expected to be helpful for long-term aneurysm occlusion.
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169
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Kubo Y, Koji T, Murakami T, Yoshida K, Matsumoto Y, Ogasawara K. Long-Term Outcomes of Cerebral Blood Flow and Neurotransmitter Receptor Function on Iodine-123-Iomazenil Single-Photon Emission Computed Tomography and Cognitive Assessments After Parent Artery Occlusion Combined with Cerebral Revascularization for Internal Carotid Artery Aneurysms. World Neurosurg 2020; 143:e199-e205. [PMID: 32810631 DOI: 10.1016/j.wneu.2020.07.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many studies of external-internal carotid artery (EC-IC) bypass as cerebral revascularization for unclippable internal carotid artery (ICA) aneurysms have reported surgical outcomes, including bypass patency and aneurysm resolution. However, no previous studies have assessed the long-term outcomes of cerebral blood flow (CBF), brain neural density, and cognition. The purpose of the present study was to evaluate the long-term outcomes of CBF and neurotransmitter receptor function using early and late images of iodine-123 (123I)-iomazenil (IMZ) single-photon emission computed tomography (SPECT) and the cognitive function of patients who had undergone EC-IC bypass for symptomatic aneurysms in the cavernous portion of the ICA. METHODS We performed a prospective observational study of 11 patients who had undergone superficial temporal artery-middle cerebral artery bypass or bypass using a saphenous vein graft for symptomatic aneurysms in the cavernous portion of the ICA. One patient experienced extensive infarction and, therefore, did not undergo postoperative testing. 123I-IMZ SPECT was performed with scanning at 23 minutes (early) and 180 minutes (late) after tracer administration before and after surgery. The preoperative and follow-up neuropsychological test scores from 6 patients were also analyzed. RESULTS None of 10 patients who had undergone EC-IC bypass showed reductions in CBF and brain neural density. In addition, the neuropsychological test scores had not changed significantly from preoperatively to postoperatively. CONCLUSION Using early and late 123I-IMZ SPECT, the present study has demonstrated that patients undergoing uncomplicated cerebral revascularization for unclippable ICA aneurysms will not experience reductions in CBF or neurotransmitter receptor function, and their cognitive function was not impaired.
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Affiliation(s)
- Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
| | - Takahiro Koji
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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Imahori T, Mizobe T, Fujinaka T, Miura S, Sugihara M, Aihara H, Kohmura E. An Aneurysm at the Origin of a Duplicated Middle Cerebral Artery Treated by Stent-Assisted Coiling Using the "Wrapped-Candy" Low-Profile Visualized Intraluminal Support (LVIS) Technique: A Technical Case Report and Review of the Literature. World Neurosurg 2020; 143:353-359. [PMID: 32791218 DOI: 10.1016/j.wneu.2020.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysms at the origin of a duplicated middle cerebral artery (DMCA) are quite rare. Here, we report a patient with such an aneurysm successfully treated endovascularly using our novel "wrapped-candy" low-profile visualized intraluminal support (LVIS) technique. CASE DESCRIPTION A 44-year-old woman underwent endovascular treatment for an unruptured wide-necked aneurysm at the origin of a DMCA that incorporated the origin of the DMCA into its neck. Stent-assisted coiling was performed using our newly developed "wrapped-candy" LVIS technique. To protect the origin of the DMCA and increase the stent metal density at the neck, an LVIS blue 3.5-mm × 22-mm stent was deployed by pushing the delivery wire aggressively to transform the visible wire components of the LVIS into a shape like "wrapped candy," maximizing the strut compaction at the neck of the aneurysm. Subsequently, the aneurysm component was coiled using a jailed microcatheter. The final procedural angiography demonstrated almost complete aneurysm occlusion with DMCA preservation. CONCLUSIONS Stent-assisted coiling can be a feasible treatment for an unruptured, usually wide-necked, aneurysm at the origin of a DMCA. The wrapped-candy LVIS technique may be useful in more challenging morphologies such as wide-necked aneurysms that incorporate the branch origin into the aneurysm neck.
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Affiliation(s)
- Taichiro Imahori
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan.
| | - Takashi Mizobe
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shinichi Miura
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Masahiro Sugihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Katsuki M, Narita N, Ozaki D, Sato Y, Iwata S, Tominaga T. Three tesla magnetic resonance angiography with ultrashort echo time describes the arteries near the cerebral aneurysm with clip and the peripheral cerebral arteries. Surg Neurol Int 2020; 11:224. [PMID: 32874727 PMCID: PMC7451165 DOI: 10.25259/sni_329_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The assessment of the clipped cerebral aneurysm and the cerebral arteries after the treatment of subarachnoid hemorrhage (SAH) is important to find aneurysm regrowth or postoperative cerebral vasospasm. Usually, contrast-enhanced computed tomography angiography is performed for the evaluation of the arteries, but it has side effects of contrast medium. Time-of-flight magnetic resonance angiography (MRA) is a fast and non-invasive method, but clip-induced artifact limits assessment of the artery in the vicinity of the clip. 1.5T MRA with ultrashort echo time (UTE) reduces metal artifact, but the obtained image is too rough to evaluate the aneurysm remnant, and the description range is too narrow to assess the cerebral vasospasm. We routinely use SIGNA Pioneer 3.0T (GE Healthcare Life Sciences, Buckinghamshire, England) and perform SILENT SCAN with UTE-MRA for the postoperative assessment of the clipped aneurysm and cerebral arteries for SAH patients treated by clipping. It has better image quality and describes arteries with a wide description range, so it possesses the potential to overcome the disadvantages of 1.5T UTE-MRA. Case Description: We presented a representative SAH patient who postoperatively underwent 3.0T UTE- MRA after clipping. The artery near the clipped aneurysm was evaluated in detail, and the cerebral arteries were described from the main trunk to the peripheral parts with a wide description range, which enabled the assessment of cerebral vasospasm. Conclusion: 3.0T UTE-MRA may be helpful for the usual assessment of the arteries after clipping and cerebral vasospasm in the future.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi
| | - Dan Ozaki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi
| | - Yoshimichi Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi
| | - Saki Iwata
- Department of Radiological Technology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
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Patel NV, Ligas B, Gandhi S, Ellis J, Ortiz R, Costantino P, Qato K, Langer DJ. Internal Maxillary to Middle Cerebral Artery Bypass Using an Anterior Tibial Artery Graft, Performed Using a 3-Dimensional Exoscope: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E187. [PMID: 31811302 DOI: 10.1093/ons/opz379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/13/2019] [Indexed: 11/12/2022] Open
Abstract
Fusiform aneurysms remain challenging entities to treat, as maintenance of flow and prevention of branch occlusion are concerns. Use of endovascular stents may risk nearby branch occlusion. We present a 31-yr-old male with a prior subarachnoid hemorrhage from a left middle cerebral artery (MCA) M1 aneurysm. Informed consent for use of the operative video and information was obtained from the patient. Initially, open clipping was performed with noted residual because of risk of nearby branches. On angiography, a growing fusiform segment distal to the initial aneurysm was noted. The patient was referred to our institution for this finding, and a multidisciplinary team reviewed the case. Endovascular treatment was felt to be risky, as stenting could jail nearby MCA branches. Clipping would also risk occlusion because of scaring from previous hemorrhage. Sufficient flow would be needed, and because the ipsilateral superficial temporal artery was sacrificed in the initial craniotomy, the internal maxillary artery (IMAX) was chosen as the bypass source. A cerebrovascular neurosurgeon, skull base otolaryngologist, and vascular surgeon worked together to perform a left-side IMAX to MCA bypass using an anterior tibial artery graft under 3-dimensional exoscopic visualization. Specifically, a 9-0 nylon suture on a BV-130 needle along with straight and tying forceps were used along with heparinized saline. The bypass was noted to be of robust flow, and the patient did very well on postoperative follow-up. The utilization of an anterior tibial artery graft, IMAX exposure, and corresponding bypass provides educational value, as there are only a limited number of videos on this topic.
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Affiliation(s)
- Nitesh V Patel
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Barbara Ligas
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Shashank Gandhi
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Jason Ellis
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Rafael Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Peter Costantino
- Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - Khalil Qato
- Department of Surgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine, Hofstra/Northwell, New York, New York
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Chen CT, Chen CC, Wang AYC, Wu YM, Chin SC, Hsieh PC, Yeap MC, Hsu SY, Lin YJ. Early strategy of scepter XC balloon angioplasty and simultaneous Nimodipine infusion for vasospasm following ruptured aneurysm. BMC Neurol 2020; 20:271. [PMID: 32635892 PMCID: PMC7339531 DOI: 10.1186/s12883-020-01856-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/02/2020] [Indexed: 12/26/2022] Open
Abstract
Background Cerebral vasospasm still results in high morbidity and mortality rates in patients after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to establish a protocol for the management of vasospasm and demonstrate our experience of angioplasty using the Scepter XC balloon catheter. Methods In this retrospective study, a computed tomography angiography and perfusion image was arranged if early symptoms occurred or on the 7th day following aneurysmal SAH. In patients with clear consciousness, balloon angioplasties were performed for symptomatic vasospasms, which were not improved within 6–12 h after maximal medical treatments. In unconscious patients, balloon angioplasties were performed for all patients with angiographic vasospasms. Results Fifty patients underwent Scepter XC balloon angioplasty among 396 consecutive patients who accepted endovascular or surgical treatments for ruptured aneurysms. All angioplasty procedures were successful without complications. 100% angiographic improvement and 94% clinical improvement were reached immediately after the angioplasties. A favorable functional outcome (modified Rankin Score of ≤2) could be achieved in 82% of patients. Even in patients with poor clinical grading (Hunt–Hess grade 4–5), a clinical improvement rate of 87.5% and favorable outcome rate was 70.8% could be achieved. Conclusion Balloon angioplasty with Scepter XC balloon catheter is safe and effective for post-SAH vasospasm. This device’s extra-compliant characteristics could considerably improve the quality of angioplasty procedures. For all patients, even those with poor neurological status, early treatment with combined protocol of nimodipine and angioplasty can have good clinical outcomes.
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Affiliation(s)
- Chun-Ting Chen
- Department of Neurosurgery, Stroke Center & Neurointervention, Chang Gung Memorial Hospital, Chang Gung Medical Center and University, 5, Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan, 333, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Stroke Center & Neurointervention, Chang Gung Memorial Hospital, Chang Gung Medical Center and University, 5, Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan, 333, Taiwan.
| | - Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yi-Ming Wu
- Department of Radiology, Division of Neuroradiology, Linkou Chang Gung Memorial Hospital & Chang Gung University, Taoyuan City, Taiwan
| | - Shy-Chyi Chin
- Department of Radiology, Division of Neuroradiology, Linkou Chang Gung Memorial Hospital & Chang Gung University, Taoyuan City, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Stroke Center & Neurointervention, Chang Gung Memorial Hospital, Chang Gung Medical Center and University, 5, Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan, 333, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Stroke Center & Neurointervention, Chang Gung Memorial Hospital, Chang Gung Medical Center and University, 5, Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan, 333, Taiwan
| | - Shih-Yuan Hsu
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ya-Jui Lin
- Department of Neurosurgery, Stroke Center & Neurointervention, Chang Gung Memorial Hospital, Chang Gung Medical Center and University, 5, Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan, 333, Taiwan
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Al Saiegh F, Hasan D, Mouchtouris N, Zanaty M, Sweid A, Khanna O, Chalouhi N, Ghosh R, Tjoumakaris S, Gooch MR, Rosenwasser R, Jabbour P. Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge Device: Experience Post-FDA Approval. Neurosurgery 2020; 87:E16-E22. [PMID: 32357228 PMCID: PMC8929032 DOI: 10.1093/neuros/nyaa092] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/30/2020] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an alternative self-expanding 3D mesh that does not require antiplatelet agents. However, its use has been mostly reserved for unruptured aneurysms. OBJECTIVE To assess the safety and feasibility of ruptured aneurysm treatment with the WEB. METHODS Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval. RESULTS Hunt and Hess grades were III and IV in 4 (44%) each and V in 1 (11%). All patients were treated within 24 h of hospitalization, and a single WEB was used in all but one aneurysm. Aneurysms treated were 3 basilar tip, 2 anterior communicating artery, 2 posterior inferior cerebellarartery, 1 middle cerebral artery, 1 carotid-ophthalmic artery, 1 posterior communicating artery, and 1 vertebrobasilar junction. Mean aneurysm height and width were 6.2 ± 2.2 mm (range: 3-10) and 5.6 ± 3.0 mm (range: 3.3-14), respectively. Mean dome-to-neck ratio was 1.7 ± 0.8 (range: 1.0-3.8). There was one intraoperative rupture that occurred because of device dislodgement and was managed with embolization. There were no treatment-related mortalities and no re-rupture after securement of the aneurysms with the WEB. CONCLUSION Our preliminary experience indicates that the WEB device can be used safely for ruptured aneurysms of various sizes in the anterior and posterior circulation. Larger series with long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurological Surgery, University of Iowa Hospitals, Iowa City, Iowa
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mario Zanaty
- Department of Neurological Surgery, University of Iowa Hospitals, Iowa City, Iowa
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ritam Ghosh
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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175
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English SW, Saigle V, McIntyre L, Chassé M, Fergusson D, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, Wiens EJ, Hu V, Dutta P, Boun V, van Walraven C. External validation demonstrated the Ottawa SAH prediction models can identify pSAH using health administrative data. J Clin Epidemiol 2020; 126:122-130. [PMID: 32619751 DOI: 10.1016/j.jclinepi.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the study is to externally validate three primary subarachnoid hemorrhage (pSAH) identification models. STUDY DESIGN AND SETTING We evaluated three models that identify pSAH using recursive partitioning (A), logistic regression (B), and a prevalence-adjusted logistic regression(C), respectively. Blinded chart review and/or linkage to existing registries determined pSAH status. We included all patients aged ≥18 in four participating center registries or whose discharge abstracts contained ≥1 administrative codes of interest between January 1, 2012 and December 31, 2013. RESULTS A total of 3,262 of 193,190 admissions underwent chart review (n = 2,493) or registry linkage (n = 769). A total of 657 had pSAH confirmed (20·1% sample, 0·34% admissions). The sensitivity, specificity, and positive predictive value (PPV) were as follows: i) model A: 98·3% (97·0-99·2), 53·5% (51·5-55·4), and 34·8% (32·6-37·0); ii) model B (score ≥6): 98·0% (96·6-98·9), 47·4% (45·5-49·4), and 32·0% (30·0-34·1); and iii) model C (score ≥2): 95·7% (93·9-97·2), 85·5% (84·0-86·8), and 62·3 (59·3-65·3), respectively. Model C scores of 0, 1, 2, 3, or 4 had probabilities of 0·5% (0·2-1·5), 1·5% (1·0-2·2), 24·8% (21·0-29·0), 90·0% (86·8-92·0), and 97·8% (88·7-99·6), without significant difference between centers (P = 0·86). The PPV of the International Classification of Diseases code (I60) was 63·0% (95% confidence interval: 60·0-66·0). CONCLUSIONS All three models were highly sensitive for pSAH. Model C could be used to adjust for misclassification bias.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute (OHRI), Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
| | - Victoria Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Michaël Chassé
- Division of Critical Care, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montreal, Quebec H2X 0A9, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Alexis F Turgeon
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - François Lauzier
- Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, and Department of Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Allan Garland
- Sections of Critical Care and Respirology, Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Almunder Algird
- Department of Neurosurgery, McMaster University, Hamilton Health Sciences, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Evan J Wiens
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Vivien Hu
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Pallavi Dutta
- Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Vincent Boun
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada
| | - Carl van Walraven
- Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada; ICES-uOttawa, Administrative Services, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada
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176
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Nasi D, Meletti S, Tramontano V, Pavesi G. Intraoperative neurophysiological monitoring in aneurysm clipping: Does it make a difference? A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 196:105954. [PMID: 32526486 DOI: 10.1016/j.clineuro.2020.105954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
The use of intraoperative neurophysiological monitoring (IOM) has been proposed to prevent new neurological deficit during aneurysm clipping. The purpose of this meta-analysis was to evaluate if IOM can prevent neurological injury during clipping of intracranial aneurysm. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological deficit in patients who had a surgical clipping with and without IOM. Of the 268 citations screened, four studies (including 873 patients) met the inclusion criteria and were included in the meta-analysis. Patients who received surgery with IOM had less new neurological deficit than those who underwent surgery without it (p = 0,04). This finding was more significant in the subgroup analysis of two studies focused on middle cerebral artery (MCA) aneurysm (p = 0,02). However, a specific analysis of the three studies reporting the results of IOM to prevent permanent deficit revealed that there is only a trend for less neurological events in monitored patients without statistically significance (p = 0,05). The use of IOM during clipping of intracranial aneurysm was associated with less new neurological deficit with the obtained evidence of the included studies. However, at long-term follow-up the use of IOM did not correlate with a significant improvement in neurological outcome.
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Affiliation(s)
- Davide Nasi
- Neurosurgery Unit, Department of Biomedical, Metabolic, and Neuroscience, University of Modena and Reggio Emilia, AOU, Modena, Italy.
| | - Stefano Meletti
- Neurology Unit, Department of Biomedical, Metabolic, and Neuroscience, University of Modena and Reggio Emilia, AOU Modena, Italy
| | - Vincenzo Tramontano
- Neurology Unit, Department of Biomedical, Metabolic, and Neuroscience, University of Modena and Reggio Emilia, AOU Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Department of Biomedical, Metabolic, and Neuroscience, University of Modena and Reggio Emilia, AOU, Modena, Italy
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177
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Chen G, Wei X, Lei H, Liqin Y, Yuxin L, Yakang D, Daoying G. Automated computer-assisted detection system for cerebral aneurysms in time-of-flight magnetic resonance angiography using fully convolutional network. Biomed Eng Online 2020; 19:38. [PMID: 32471439 PMCID: PMC7257213 DOI: 10.1186/s12938-020-00770-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background As the rupture of cerebral aneurysm may lead to fatal results, early detection of unruptured aneurysms may save lives. At present, the contrast-unenhanced time-of-flight magnetic resonance angiography is one of the most commonly used methods for screening aneurysms. The computer-assisted detection system for cerebral aneurysms can help clinicians improve the accuracy of aneurysm diagnosis. As fully convolutional network could classify the image pixel-wise, its three-dimensional implementation is highly suitable for the classification of the vascular structure. However, because the volume of blood vessels in the image is relatively small, 3D convolutional neural network does not work well for blood vessels. Results The presented study developed a computer-assisted detection system for cerebral aneurysms in the contrast-unenhanced time-of-flight magnetic resonance angiography image. The system first extracts the volume of interest with a fully automatic vessel segmentation algorithm, then uses 3D-UNet-based fully convolutional network to detect the aneurysm areas. A total of 131 magnetic resonance angiography image data are used in this study, among which 76 are training sets, 20 are internal test sets and 35 are external test sets. The presented system obtained 94.4% sensitivity in the fivefold cross-validation of the internal test sets and obtained 82.9% sensitivity with 0.86 false positive/case in the detection of the external test sets. Conclusions The proposed computer-assisted detection system can automatically detect the suspected aneurysm areas in contrast-unenhanced time-of-flight magnetic resonance angiography images. It can be used for aneurysm screening in the daily physical examination.
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Affiliation(s)
- Geng Chen
- Academy for Engineering and Technology, Fudan University, 20 Handan Road, Shanghai, 200433, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, 88 Keling Road, Suzhou, 215163, China
| | - Xia Wei
- Academy for Engineering and Technology, Fudan University, 20 Handan Road, Shanghai, 200433, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, 88 Keling Road, Suzhou, 215163, China
| | - Huang Lei
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yang Liqin
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Li Yuxin
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Dai Yakang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, 88 Keling Road, Suzhou, 215163, China.
| | - Geng Daoying
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Tsukiyama A, Nozaki T, Matsumoto S, Uekusa T, Tsuchiya A, Nomura M. Morphological Change of Cerebral Aneurysm with Possible Pseudoaneurysm at A2/3 of the Anterior Cerebral Artery on Three-dimensional Computed Tomographic Angiography. Asian J Neurosurg 2020; 15:394-396. [PMID: 32656139 PMCID: PMC7335138 DOI: 10.4103/ajns.ajns_23_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/15/2020] [Accepted: 04/18/2020] [Indexed: 11/13/2022] Open
Abstract
Intracranial pseudoaneurysm formation due to a ruptured nontraumatic aneurysm is rare. We describe a case of ruptured aneurysm, which showed morphological change on radiological examinations. An 83-year-old woman developed subarachnoid hemorrhage (SAH) with ventricular rupture and intracerebral hematoma in the corpus callosum. Contrast-enhanced computed tomography (CE-CT) demonstrated an aneurysm at the right A2/3 junction of the anterior cerebral artery. CE-CT repeated 17 h after the initial one showed shortening of the lesion on both three-dimensional and raw images. The aneurysm was surgically clipped. In cases of SAH with a hematoma or thick SAH, there is a possibility that a pseudoaneurysm will form at the tip of the true aneurysm in an adjacent thrombus or existence of intraluminal thrombus. The morphology may change during the period between initial radiological evaluation and the operation in these cases. We should be aware that the intraoperative findings or subsequent radiological findings might be different from those observed on preoperative radiological examinations.
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Affiliation(s)
- Atsushi Tsukiyama
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.,Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Toshiki Nozaki
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.,Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Shutaro Matsumoto
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.,Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | | | | | - Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.,Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
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179
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Saqr KM. Computational fluid dynamics simulations of cerebral aneurysm using Newtonian, power-law and quasi-mechanistic blood viscosity models. Proc Inst Mech Eng H 2020; 234:711-719. [PMID: 32423286 DOI: 10.1177/0954411920917531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral aneurysm is a fatal neurovascular disorder. Computational fluid dynamics simulation of aneurysm haemodynamics is one of the most important research tools which provide increasing potential for clinical applications. However, computational fluid dynamics modelling of such delicate neurovascular disorder involves physical complexities that cannot be easily simplified. Recently, it was shown that the Newtonian simplification used to close the shear stress tensor of the Navier-Stokes equation is not sufficient to explore aneurysm haemodynamics. This article explores the differences between the latter simplification, non-Newtonian power-law model and a newly proposed quasi-mechanistic model. The modified Krieger model, which treats blood as a suspension of plasma and particles, was implemented in computational fluid dynamics context here for the first time and is made available to the readers in a C# code in the supplementary material of this article. Two middle-cerebral artery and two anterior-communicating artery aneurysms, all ruptured, were utilized here as case studies. It was shown that the modified Krieger model had higher sensitivity for wall shear stress calculations in comparison with the other two models. The modified Krieger model yielded lower wall shear stress values consistently in comparison with the other two models. Moreover, the modified Krieger model has generally predicted higher pressure in the aneurysm models. Based on published aneurysm rupture studies, it is believed that ruptured aneurysms are usually correlated with lower wall shear stress values than unruptured ones. Therefore, this work concludes that the modified Krieger model is a potential candidate for providing better clinical relevance to aneurysm computational fluid dynamics simulations.
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Affiliation(s)
- Khalid M Saqr
- Mechanical Engineering Department, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alexandria, Egypt
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180
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Katsuki M, Suzuki Y, Kunitoki K, Sato Y, Sasaki K, Mashiyama S, Matsuoka R, Allen E, Saimaru H, Sugawara R, Hotta A, Tominaga T. Temporal muscle thickness and area with various characteristics data of the patients with aneurysmal subarachnoid hemorrhage who underwent endovascular coiling. Data Brief 2020; 31:105715. [PMID: 32462071 PMCID: PMC7243052 DOI: 10.1016/j.dib.2020.105715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/04/2022] Open
Abstract
These data present the characteristics of patients with subarachnoid hemorrhage who underwent endovascular coiling. We retrospectively collected data from the medical records of Iwaki City Medical Center including physiological symptoms, laboratory data, radiological data on admission, and modified Rankin Scale scores at 6 months. Our article entitled “Temporal Muscle as an Indicator of Sarcopenia is Independently Associated with Hunt and Kosnik Grade on Admission and the Modified Rankin Scale at 6 Month of Patients with Subarachnoid Hemorrhage Treated by Endovascular Coiling” was based on these data [1]. We previously reported similar small dataset of elderly patients with subarachnoid hemorrhage who underwent surgical clipping [2], [3]. However, remarkably, this is the largest and the first dataset on temporal muscle thickness or area of patients of all ages with subarachnoid hemorrhage who underwent endovascular coiling, not surgical clipping.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Yasuhiro Suzuki
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Keiko Kunitoki
- Harvard School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Yoshimichi Sato
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Keisuke Sasaki
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Shoji Mashiyama
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Ryo Matsuoka
- Resident, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Elissa Allen
- Resident, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Hibiki Saimaru
- Resident, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Ryota Sugawara
- Resident, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Akinori Hotta
- Resident, Iwaki City Medical Center, 16 Kuzehara, Mimayamachi, Uchigo, Iwaki, Fukushima 973-8555, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, Miyagi, 980-8574, Japan
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181
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Wu TC, Tsui YK, Chen TY, Ko CC, Lin CJ, Chen JH, Lin CP. Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm. Interv Neuroradiol 2020; 26:733-740. [PMID: 32423318 DOI: 10.1177/1591019920925706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. MATERIALS AND METHODS Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: "Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?"; Question 2: "Is it achievable to secure the aneurysm with pure simple coiling?" The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. RESULTS In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. CONCLUSIONS Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.
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Affiliation(s)
- Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei.,Department of Medical Sciences Industry, Chang Jung Christian University, Tainan
| | - Yu-Kun Tsui
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,The Center of Humanities and Society, Chia-Nan University of Pharmacy and Science, Tainan
| | - Chien-Jen Lin
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung.,Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, CA, USA
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei.,Institute of Neuroscience, School of Life Science, National Yang-Ming University, Taipei
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182
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Sato R, Mikami T, Suzuki H, Yamamura A, Kimura Y, Ukai R, Tamada T, Kawata Y, Akiyama Y, Mikuni N. Natural Y-shaped radial artery graft bypass for a complex middle cerebral artery aneurysm: A case report. J Stroke Cerebrovasc Dis 2020; 29:104853. [PMID: 32389556 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 11/16/2022] Open
Abstract
Giant thrombosed middle cerebral artery (MCA) aneurysms are difficult to treat and sometimes require complex revascularization using allografts. We describe a technical method using revascularization with a natural Y-shaped graft that provides a normal variation for a complex MCA aneurysm. A 65-year-old man with a giant thrombosed MCA aneurysm presented with right hemiparesis and aphasia. The patient had a history of clipping surgery for the ipsilateral side of the MCA aneurysm 25 years before, and a de novo aneurysm developed over the previous 18 years. For the giant thrombosed aneurysm, trapping and revascularization were performed. A natural radial artery Y-graft was used as the graft and anastomosed to both M2 trunks. The symptoms improved after surgery, and the patient was discharged 3 weeks later. This is the first report of a double-barrel bypass using a natural Y-graft. This method attained a normal variation, and the flow of the Y-graft was physiological. For the radical cure of giant thrombosed MCA aneurysms, multiple revascularizations might be required. With this natural Y-graft, complex transpositions could be avoided.
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Affiliation(s)
- Ryota Sato
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan
| | - Akinori Yamamura
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan; Department of Neurosurgery, Shinsapporo Neurosurgical Hospital, Sapporo, Japan.
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Ryo Ukai
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Tomoaki Tamada
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Yuka Kawata
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan.
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183
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Luecking H, Struffert T, Goelitz P, Engelhorn T, Brandner S, Kuramatsu JB, Lang S, Schmidt M, Doerfler A. Stent-Assisted Coiling Using Leo+ Baby Stent : Immediate and Mid-Term Results. Clin Neuroradiol 2021; 31:409-16. [PMID: 32385517 DOI: 10.1007/s00062-020-00904-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022]
Abstract
Background Stent-assisted coiling is well-established for treatment of cerebral aneurysms. The technique enables treatment of wide-neck, bifurcation and recurrent aneurysms with high packing rates. While described in extenso for laser cut stents, the results of patients treated with the Leo+ Baby (Balt, Montmorency, France) braided microstent are presented. Material and Methods Patients were included if treated with a Leo+ Baby and with digital subtraction angiography (DSA) follow-up available of at least 6 months. Data were evaluated for successful deployment, aneurysm occlusion according to the modified Raymond-Roy classification (MRRC), stent patency and procedure-related morbidity and mortality. Results A total of 81 patients were included and Leo+ Baby deployment was successful in all cases. Coils were used in 80 cases. In 1 case 2 stents were used stent-in-stent without additional coiling. Initial aneurysm occlusion rates were MRRCi1 51.9%, MRRCi2 11.1%, MRRCi3a 24.7% and MRRCi3b 12.3%. Occlusion rates after 6 months were MRRC6m1 78.9%, MRRC6m2 3.9%, MRRC6m3a 6.6% and MRRC6m3b 10.5%. Procedure-related morbidity was 1 case of acute stent thrombosis successfully treated with tirofiban and 1 case with transient hemiparesis due to stent thrombosis after 4 months. There was 1 case of coil-associated subarachnoid hemorrhage (SAH) which caused prolonged hospitalization. No procedure-related mortality was observed. Conclusion The results confirm that stent-assisted coiling with the Leo+ Baby stent is safe and efficient for treatment of wide neck or recurrent cerebral aneurysms. Spontaneous progressive aneurysm occlusion over 6 months supports the theory of considerable flow-modulating effects of Leo+ Baby.
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184
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Lee JH, Lee SW, Choi CH, Ko JK. Does Systemic Lupus Erythematosus Increase the Risk of Procedure-Related Complication in Endovascular Treatment of Intracranial Aneurysm? Yonsei Med J 2020; 61:441-444. [PMID: 32390369 PMCID: PMC7214111 DOI: 10.3349/ymj.2020.61.5.441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022] Open
Abstract
Cerebral aneurysms associated with systemic lupus erythematosus (SLE) are more likely to grow rapidly and rupture, compared to those found in the general population. The main underlying pathology of intracranial aneurysm and its rupture is presumed to be SLE-related intracranial vasculitis and fragility of blood vessels due to prolonged use of steroid. For these reasons, both surgical and endovascular options are challenging. On the other hand, given the possibility that SLE may predispose to growth and rupture of intracranial aneurysm, early intervention for cerebral aneurysms associated with SLE may be more necessary and beneficial than other cerebral aneurysms in the general population. Here we would like to report on the unexpected complications that occurred during or after endovascular treatment of an SLE patient with multiple aneurysms. The complications include intraprocedural rupture of unruptured aneurysm, coil stretching, contrast-induced encephalopathy, and delayed ipsilateral intraparenchymal hemorrhage after stent-assisted coiling. Our unique case highlights that the SLE patient with multiple intracranial aneurysms had a higher risk of endovascular procedure-related complications, which might be due to the increased bleeding tendency and fragility of blood vessels.
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Affiliation(s)
- Jung Hwan Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
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185
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Saqr KM, Rashad S, Tupin S, Niizuma K, Hassan T, Tominaga T, Ohta M. What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. J Cereb Blood Flow Metab 2020; 40:1021-1039. [PMID: 31213162 PMCID: PMC7181089 DOI: 10.1177/0271678x19854640] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD simulations. We have traced the historical origins of simplified CFD models which impede the progress of comprehending IA pathology. We also delve into the debate concerning the Newtonian fluid assumption used to represent blood flow computationally. We evidently demonstrate that the Newtonian assumption, used in almost 90% of studies, might be insufficient to describe IA hemodynamics. In addition, some fundamental properties of the Navier-Stokes equation are revisited in supplementary material to highlight some widely spread misconceptions regarding wall shear stress (WSS) and its derivatives. Conclusively, our study draws a roadmap for next-generation IA CFD models to help researchers investigate the pathophysiology of IAs.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Department of Mechanical Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
| | - Sherif Rashad
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
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186
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Katsuki M, Kakizawa Y, Yamamoto Y, Nishikawa A, Wada N, Uchiyama T. Magnetic resonance angiography with ultrashort echo time evaluates cerebral aneurysm with clip. Surg Neurol Int 2020; 11:65. [PMID: 32363060 PMCID: PMC7193191 DOI: 10.25259/sni_59_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Contrast-enhanced computed tomography angiography is usually valuable for the evaluation of clipped cerebral aneurysm, but it has side effects of contrast medium. Time-of-flight magnetic resonance angiography (MRA) is a non-invasive and fast method. However, clip-induced artifact limits assessment of the artery in the vicinity of a clip. MRA with ultrashort echo time (TE) reduces metal artifact. We use MAGNETOM Aera 1.5T (SIEMENS, München, Germany) and perform pointwise encoding time reduction with radial acquisition (PETRA)-MRA using ultrashort TE for the assessment of the cerebral aneurysm after clipping. We, herein, presented two representative cases with a clipped aneurysm which could be evaluated by PETRA- MRA. Especially in one of them, the neck remnant was revealed by PETRA-MRA. PETRA-MRA can reduce the time and the invasiveness and may be helpful for the usual follow-up of the clipped aneurysm with the development of MRA technology in the future.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
| | - Akihiro Nishikawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Kogandori, Suwa, Nagano, Japan
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187
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Acik V, Matyar S, Arslan A, İstemen İ, Olguner SK, Arslan B, Gezercan Y, Ökten Aİ. Relationshıp of spontaneous subarachnoid haemorrhage and cerebral aneurysm to serum Visfatin and Nesfatin-1 levels. Clin Neurol Neurosurg 2020; 194:105837. [PMID: 32311618 DOI: 10.1016/j.clineuro.2020.105837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Visfatin and nesfatin are recently discovered peptides that play a role in various metabolic reactions exhibiting inflammatory and neuroprotective effects, and their levels are known to increase in cerebral ischaemia and haematomas. Inflammation plays a role in the development of aneurysm, and spontaneous subarachnoid haemorrhage (SAH) is typically caused by rupture of the aneurysmal sac because of the increased inflammation. In the present study, we investigated the relationship between serum visfatin and nesfatin levels and the clinical and radiological findings in patients with SAH. PATIENTS AND METHOD Overall, 62 patients with spontaneous SAH who were followed-up in our clinic between September 2018 and July 2019 and 35 healthy patients who presented to our outpatient clinic with complaints of back, lumbar and neck pain were included in the study. ELISA method was used to study the visfatin and nesfatin levels in the serum samples of both groups. The visfatin and nesfatin levels of patients with spontaneous SAH were compared with the healthy population. In addition, the relationship between visfatin and nesfatin levels and the radiological and clinical findings of patients with spontaneous SAH were also investigated. All findings were evaluated statistically. RESULTS The median nesfatin and mean visfatin levels were higher in patients with SAH compared with the control group. The median nesfatin and mean visfatin levels were higher in patients with aneurysm than those without aneurysm. A positive correlation was observed between aneurysm length and nesfatin and visfatin levels. In patients with perimesencephalic haemorrhage, the mean visfatin level was determined to be lower compared with patients with classical aneurysmatic SAH, and the median nesfatin level did not differ significantly. The cut-off value of nesfatin for predicting SAH in patients compared with controls was >598.4 with 82.8 % sensitivity and 80 % specificity (P < 0.001). The cut-off value of visfatin for predicting SAH was >10.3 with 85.3 % sensitivity and 91.4 % specificity (P < 0.001). The diagnostic performance of visfatin and nesfatin levels was similar in predicting SAH. CONCLUSION In the present study, we demonstrated that the presence of aneurysm, size of aneurysm, number of aneurysms correlate with visfatin and nesfatin levels in patients with SAH, and visfatin and nesfatin may be biomarkers for predicting SAH and presence of aneurysm. Nonetheless, future studies can include patients with unruptured aneurysm and investigate their serum visfatin and nesfatin levels to prove whether visfatin and nesfatin can serve as biomarkers in the follow-up of these patients.
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Affiliation(s)
- Vedat Acik
- Department of Neurosurgery, Adana City Training and Research Hospital, Turkey.
| | - Selcuk Matyar
- Department of Biochemistry Central Laboratory, Adana City Training and Research Hospital, Turkey.
| | - Ali Arslan
- Department of Neurosurgery, Adana City Training and Research Hospital, Turkey.
| | - İsmail İstemen
- Department of Neurosurgery, Adana City Training and Research Hospital, Turkey.
| | | | - Baris Arslan
- Department of Anesthesia Adana City Training and Research Hospital, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No:1 Yuregir, ADANA, Turkey.
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Turkey.
| | - Ali İhsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Turkey.
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188
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Kwon HJ, You SH, Lim JW, Byoun HS, Gu BS, Cho SH, Koh HS. Simultaneous neck coverage and branch preservation using the proximal portion of a self-expandable open-cell stent for embolization of distal internal carotid artery aneurysms: multi-center, long-term results. Neuroradiology 2020; 62:883-90. [PMID: 32248268 DOI: 10.1007/s00234-020-02411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We report the long-term results of a modified stent-assisted coil embolization technique using the far proximal part of a self-expanding open-cell stent. The technique was used to cover the neck of the aneurysm while simultaneously preserving the branches of the distal internal carotid artery in patients with aneurysms of the posterior communicating (Pcom) and anterior choroidal arteries (AchA). METHODS We performed a retrospective review of the prospectively maintained databases at two tertiary neurosurgical centers to identify all patients who underwent embolization of Pcom or AchA aneurysms using this technique between January 2014 and July 2019. Postoperative and follow-up clinical and radiological results for initial (n = 16) or re-do (n = 4) embolizations were analyzed. RESULTS We identified 19 patients with 20 (16 Pcom and 4 AchA) unruptured (n = 19) or ruptured (n = 1) aneurysms. Eighteen among 20 stents (90.0%) were deployed successfully, and complete occlusions were initially attained in 18 aneurysms (90.0%). At follow-up examinations 8 to 56 months later, 6 of 14 aneurysms (42.8%) showed neck remnants. All of the branches were saved and no thromboembolic event, rupture, or sequelae were noted during or after the procedures. CONCLUSION These results suggest that this modified stent-assisted technique is a feasible and reasonable alternative to conventional stent deployment for coil embolization of wide-necked sidewall aneurysms in the distal ICA.
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189
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Abstract
Cortical spreading depolarizations (SD) are strongly associated with worse tissue injury and clinical outcomes in the setting of aneurysmal subarachnoid hemorrhage (SAH). Animal studies have suggested a causal relationship, and new therapies to target SDs are starting to be tested in clinical studies. A recent set of single-center randomized trials assessed the effect of the phosphodiesterase inhibitor cilostazol in patients with SAH. Cilostazol led to improved functional outcomes and SD-related metrics in treated patients through a putative mechanism of improved cerebral blood flow. Another promising therapeutic approach includes attempts to block SDs with, for example, the NMDA receptor antagonist ketamine. SDs have emerged not only as a therapeutic target but also as a potentially useful biomarker for brain injury following SAH. Additional clinical and preclinical experimental work is greatly needed to assess the generalizability of existing therapeutic trials and to better delineate the relationship between SDs, SAH, and functional outcome.
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Affiliation(s)
- Kazutaka Sugimoto
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6403, Charlestown, MA, 02129, USA
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan
| | - David Y Chung
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, 6403, Charlestown, MA, 02129, USA.
- Division of Neurocritical Care, Department of Neurology, Boston Medical Center, Boston, MA, USA.
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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190
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Wilkinson DA, Heung M, Deol A, Chaudhary N, Gemmete JJ, Thompson BG, Pandey AS. Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Comparison of Management Approaches. Neurosurgery 2020; 84:E352-E361. [PMID: 30060240 DOI: 10.1093/neuros/nyy336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/23/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a risk factor for formation of intracranial aneurysms (IAs), though the ideal screening and treatment strategies in this population are unclear. OBJECTIVE To report outcomes of observation, open surgical, or endovascular management of ruptured and unruptured aneurysms in patients with ADPKD. METHODS We performed a retrospective analysis of all patients with ADPKD and IAs at a single center from 2000 to 2016. RESULTS Forty-five patients with ADPKD harboring 71 aneurysms were identified, including 11 patients with subarachnoid hemorrhage (SAH). Of 22 aneurysms managed with observation, none ruptured in 136 yr of clinical follow-up. Thirty-five aneurysms were treated with open surgery and 14 with an endovascular approach. Among treated aneurysms, poor neurologic outcome (modified Rankin scale >2) was seen only in patients presenting with SAH (17% SAH vs 0% elective, P = .06). Acute kidney injury (AKI) was also significantly associated with SAH presentation (22% SAH vs 0% elective, P = .05). Neither procedural complications nor AKI were associated with treatment modality. Among 175 yr of radiographic follow-up in patients with known IAs, 8 de novo aneurysms were found, including 3 that were treated. Of 11 patients with SAH, 7 ruptured in the setting of previously known ADPKD, including 2 with prior angiographic screening and 5 without screening. CONCLUSION Poor outcomes occurred only with ruptured presentation but were equivalent between treatment modalities. Screening is performed only selectively, and 64% (7 of 11) of patients presenting with SAH had previously known ADPKD.
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Affiliation(s)
| | - Michael Heung
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amrit Deol
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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191
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Olubajo F, Kaliaperumal C, Choudhari KA. Vascular Ehlers-Danlos Syndrome: Literature review and surgical management of intracranial vascular complications. Clin Neurol Neurosurg 2020; 193:105775. [PMID: 32197145 DOI: 10.1016/j.clineuro.2020.105775] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Vascular Ehlers-Danlos (vEDS) is a rare form of the Ehlers-Danlos Syndrome (EDS) where arterial fragility results from mutations in the gene that encodes type III collagen. The disease can lead to major neurological complications including carotico-cavernous fistulae (CCF), aneurysms of the Circle of Willis and endovascular procedures have an increased risk profile due to the delicate vasculature. Management of intracranial disease in vEDS requires an intricate understanding of the syndrome but is still associated with significant complications that lead to morbidity and mortality. As well as providing an approach to the management of neurovascular complications in vEDS, the relevant literature regarding nosology, aetiology and genetics of the condition is summarised here. Particular emphasis is placed on the two most common intracranial complications, namely carotico-cavernous fistulas and and cerebral aneurysms. Pros and cons of surgical and endovascular interventions are discussed and a technical discussion is concentrated on the surgical aspects of management.
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Affiliation(s)
- Farouk Olubajo
- Department of Neurosurgery, The Walton Centre, Lower Ln, Liverpool, L9 7LJ, United Kingdom.
| | | | - Kishor A Choudhari
- Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom
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192
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Vollherbst DF, Hohenstatt S, Schönenberger S, Bendszus M, Möhlenbruch MA. WEB as a combined support and embolization device in a giant partially thrombosed donut-shaped aneurysm. J Clin Neurosci 2020; 75:210-212. [PMID: 32209274 DOI: 10.1016/j.jocn.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giant partially thrombosed aneurysms are challenging lesions for which treatment can be difficult due to their unfavourable anatomical configuration and abnormal flow conditions. CASE DESCRIPTION The patient presented in this report suffered from a symptomatic giant partially thrombosed donut-shaped aneurysm of the left-sided supraophthalmic internal carotid artery. Due to the location and the size of the aneurysm, endovascular treatment was performed. Navigation of the microcatheter-microwire-system distal to the aneurysm for stent deployment was technically not possible due to limited support, caused by the large aneurysm. Therefore, a WEB device was placed in the distal leg of the donut-shaped aneurysm. Additionally to the occlusion of this part of the aneurysm, the WEB device enabled enough support to navigate the microcatheter-microwire-system distal to the aneurysm. After deployment of a flow-diverting stent, coiling of the aneurysm was performed. Follow-up angiography showed complete occlusion of the aneurysm. The patient suffered from severe headaches which were no longer present 6 months after treatment. CONCLUSIONS The WEB intraaneurysmal flow diverter can be effectively used as combined support and embolization device for the treatment of complex aneurysms in selective cases where other catheterization and embolization strategies have failed.
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Affiliation(s)
- Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Sophia Hohenstatt
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Silvia Schönenberger
- Department of Neurology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany.
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193
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Esfahani SS, Zhai X, Chen M, Amira A, Bensaali F, AbiNahed J, Dakua S, Younes G, Baobeid A, Richardson RA, Coveney PV. Lattice-Boltzmann interactive blood flow simulation pipeline. Int J Comput Assist Radiol Surg 2020; 15:629-639. [PMID: 32130645 DOI: 10.1007/s11548-020-02120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cerebral aneurysms are one of the prevalent cerebrovascular disorders in adults worldwide and caused by a weakness in the brain artery. The most impressive treatment for a brain aneurysm is interventional radiology treatment, which is extremely dependent on the skill level of the radiologist. Hence, accurate detection and effective therapy for cerebral aneurysms still remain important clinical challenges. In this work, we have introduced a pipeline for cerebral blood flow simulation and real-time visualization incorporating all aspects from medical image acquisition to real-time visualization and steering. METHODS We have developed and employed an improved version of HemeLB as the main computational core of the pipeline. HemeLB is a massive parallel lattice-Boltzmann fluid solver optimized for sparse and complex geometries. The visualization component of this pipeline is based on the ray marching method implemented on CUDA capable GPU cores. RESULTS The proposed visualization engine is evaluated comprehensively and the reported results demonstrate that it achieves significantly higher scalability and sites updates per second, indicating higher update rate of geometry sites' values, in comparison with the original HemeLB. This proposed engine is more than two times faster and capable of 3D visualization of the results by processing more than 30 frames per second. CONCLUSION A reliable modeling and visualizing environment for measuring and displaying blood flow patterns in vivo, which can provide insight into the hemodynamic characteristics of cerebral aneurysms, is presented in this work. This pipeline increases the speed of visualization and maximizes the performance of the processing units to do the tasks by breaking them into smaller tasks and working with GPU to render the images. Hence, the proposed pipeline can be applied as part of clinical routines to provide the clinicians with the real-time cerebral blood flow-related information.
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Affiliation(s)
| | - Xiaojun Zhai
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Minsi Chen
- Department of Computer Science, University of Huddersfield, Huddersfield, UK
| | - Abbes Amira
- Faculty of Computing, Engineering and Media, De Montfort University, Leicester, UK.
| | | | - Julien AbiNahed
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sarada Dakua
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Georges Younes
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Baobeid
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Peter V Coveney
- Centre for Computational Science, University College London, London, UK
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Detmer FJ, Mut F, Slawski M, Hirsch S, Bijlenga P, Cebral JR. Incorporating variability of patient inflow conditions into statistical models for aneurysm rupture assessment. Acta Neurochir (Wien) 2020; 162:553-566. [PMID: 32008209 DOI: 10.1007/s00701-020-04234-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hemodynamic patterns have been associated with cerebral aneurysm instability. For patient-specific computational fluid dynamics (CFD) simulations, the inflow rates of a patient are typically not known. The aim of this study was to analyze the influence of inter- and intra-patient variations of cerebral blood flow on the computed hemodynamics through CFD simulations and to incorporate these variations into statistical models for aneurysm rupture prediction. METHODS Image data of 1820 aneurysms were used for patient-specific steady CFD simulations with nine different inflow rates per case, capturing inter- and intra-patient flow variations. Based on the computed flow fields, 17 hemodynamic parameters were calculated and compared for the different flow conditions. Next, statistical models for aneurysm rupture were trained in 1571 of the aneurysms including hemodynamic parameters capturing the flow variations either by defining hemodynamic "response variables" (model A) or repeatedly randomly selecting flow conditions by patients (model B) as well as morphological and patient-specific variables. Both models were evaluated in the remaining 249 cases. RESULTS All hemodynamic parameters were significantly different for the varying flow conditions (p < 0.001). Both the flow-independent "response" model A and the flow-dependent model B performed well with areas under the receiver operating characteristic curve of 0.8182 and 0.8174 ± 0.0045, respectively. CONCLUSIONS The influence of inter- and intra-patient flow variations on computed hemodynamics can be taken into account in multivariate aneurysm rupture prediction models achieving a good predictive performance. Such models can be applied to CFD data independent of the specific inflow boundary conditions.
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Affiliation(s)
- Felicitas J Detmer
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Fernando Mut
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Martin Slawski
- Statistics Department, George Mason University, Fairfax, VA, USA
| | - Sven Hirsch
- Institute of Applied Simulation, ZHAW University of Applied Sciences, Wädenswil, Switzerland
| | - Philippe Bijlenga
- Neurosurgery, Clinical Neurosciences Department, Geneva University Hospital and Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Juan R Cebral
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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Szmuda T, Słoniewski P, Ali S, Dzierżanowski J, Kamieniecki A, Siedlecki K. Can sectioning the posterior communicating artery be predicted with computed tomography angiography in the microsurgical clipping of basilar apex aneurysms? Acta Neurochir (Wien) 2020; 162:567-579. [PMID: 31748903 DOI: 10.1007/s00701-019-04138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Microsurgical clipping is a viable option for managing high-riding basilar apex aneurysms (BAXs) using a transsylvian approach. Cutting the posterior communicating artery (PCoA) at the perforator-free zone provides sufficient exposure of BAX, although it is not always safe. The aim was to qualitatively predict sectioning of the interfering PCoA by using preoperative computed tomographic angiography (CTA). METHODS A virtual trajectory from the lesser sphenoid wing to the neck of the aneurysm was simulated on CTA in 19 consecutive patients operated on BAX aneurysms from 2013 to 2018. The angles on CTA resembled the typical view through the extended pterional craniotomy. Next, the ipsilateral PCoA was tracked from the internal carotid to its end at the posterior cerebral artery in the trajectory. RESULTS The opticocarotid and carotid-oculomotor window served as the corridors for entering the interpeduncular fossa in 16 patients (84.2%) and in 3 patients (15.8%), respectively. The PCoA was intentionally cut during nine surgeries and preserved in 10 of them. The PCoA was cut more often when positioned toward the cranial base and more medially in the corridor; both the Kernel density analysis and the data points representing the position of the PCoA supported this finding (p < 0.01). The CTA-based position of either ends of the PCoA in the trajectory did not differ between cut and not-cut groups (p = 0.19-0.96). Aneurysm projection, rupture, size, PCoA diameter, length, and other distances on CTA were not related to the sectioning of PCoA (p > 0.05). CONCLUSIONS The probability of PCoA sectioning is higher when the PCoA is positioned medially and closer to the cranial base. If the anatomical course of the PCoA is recognized beforehand, it can contraindicate surgery. Preoperative CTA-based planning facilitates the surgery of BAX aneurysms. Therefore, CTA can make microsurgical clipping planning more predictable for the neurosurgeon and safer for the patient.
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196
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Munich SA, Vakharia K, McPheeters MJ, Tso MK, Waqas M, Snyder KV, Siddiqui AH, Davies JM, Levy EI. Make Clipping Great Again: Microsurgery for Cerebral Aneurysms by Dual-Trained Neurosurgeons. World Neurosurg 2020; 137:e454-e461. [PMID: 32058116 DOI: 10.1016/j.wneu.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Despite an increasing focus on endovascular treatment of cerebral aneurysms, microsurgical clipping remains an integral part of management. We evaluated the safety and effectiveness of microsurgical clipping performed by dual-trained neurosurgeons at our institute, which has adopted an endovascular first approach. METHODS We retrospectively reviewed clinical and radiographic data of 412 aneurysms in 375 patients treated with microsurgical clipping. Univariate and multivariate analyses were performed to identify predictive outcome factors. We defined favorable outcome as a modified Rankin Scale (mRS) score of 0-2 at last clinical follow-up; unfavorable outcome was an mRS score of 3-6. We compared outcomes in our series with those of seminal aneurysm clipping series. RESULTS Clipping of 330 of 351 unruptured aneurysms (94.01%) was associated with favorable outcome during the follow-up period (mean, 26.5 months). On univariate analysis, older patient age, intraoperative rupture, and higher baseline mRS scores were associated with unfavorable outcome in the unruptured cohort. On multivariate analysis, older age, higher baseline mRS scores, and posterior circulation aneurysm location were predictive of unfavorable outcome. Clipping of 46 of 61 ruptured aneurysms (75.4%) was associated with favorable outcome during the follow-up period (mean, 23.1 months). On univariate analysis, left-sided aneurysms, intraoperative rupture, and large aneurysm size were associated with unfavorable outcome in the ruptured cohort. On multivariate analysis, female sex was predictive of unfavorable outcome. CONCLUSIONS Our ruptured and unruptured cohort results compared favorably with those in seminal series. Treatment by neurosurgeons adept at both endovascular and microsurgical techniques may improve clinical outcomes.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Matthew J McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Michael K Tso
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
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197
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Katsuki M, Suzuki Y, Kunitoki K, Sato Y, Sasaki K, Mashiyama S, Matsuoka R, Allen E, Saimaru H, Sugawara R, Hotta A, Tominaga T. Temporal Muscle as an Indicator of Sarcopenia is Independently Associated with Hunt and Kosnik Grade on Admission and the Modified Rankin Scale Score at 6 Months of Patients with Subarachnoid Hemorrhage Treated by Endovascular Coiling. World Neurosurg 2020; 137:e526-e534. [PMID: 32061954 DOI: 10.1016/j.wneu.2020.02.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Sarcopenia is defined as the loss of skeletal muscle mass and is considered an important factor for clinical outcomes in various diseases. Recent studies have shown that temporal muscle thickness (TMT) and area (TMA) can be novel indicators of sarcopenia. We examined clinical characteristics, including TMT and TMA, of patients with subarachnoid hemorrhage (SAH) treated by endovascular coiling. METHODS A retrospective analysis of 298 patients with SAH who were treated with endovascular coiling from 2009 to 2019 was conducted. Their premorbid modified Rankin Scale (mRS) score was 0-2. The association between the factors and Hunt and Kosnik (H-K) grades on admission and that between the clinical variables and mRS scores 6 months after the operation were analyzed. RESULTS In all 298 patients with SAH, Fisher group 4 and TMA <200 mm2 were independently associated with H-K grade III-V on admission in the multivariate analysis. In 254 patients with H-K grades I-III on admission, age, H-K grade III, presence of ventriculoperitoneal shunt, presence of postoperative complications, and TMA <200 mm2 were independent factors related to poor outcomes in the multivariate analysis. CONCLUSIONS The H-K grade on admission was independently associated with TMA. The mRS score 6 months after aneurysm treatment in patients with H-K grades I-III was also independently associated with TMA. Sarcopenia could be one of a few modifiable factors that prevent severe symptoms of SAH and improve outcomes after coiling by strengthened nutrition and physical activity.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Miyagi, Japan.
| | - Yasuhiro Suzuki
- Department of Neurosurgery, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Keiko Kunitoki
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Yoshimichi Sato
- Department of Neurosurgery, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Keisuke Sasaki
- Department of Neurosurgery, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Shoji Mashiyama
- Department of Neurosurgery, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Ryo Matsuoka
- Resident, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Elissa Allen
- Resident, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Hibiki Saimaru
- Resident, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Ryota Sugawara
- Resident, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Akinori Hotta
- Resident, Iwaki City Medical Center, Mimayamachi, Uchigo, Iwaki, Fukushima, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Miyagi, Japan
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Han Y, Liu J, Tian Z, Lv M, Yang X, Wu Z, Gao BL. Factors affecting recurrence and management of recurrent cerebral aneurysms after initial coiling. Interv Neuroradiol 2020; 26:300-308. [PMID: 31992106 DOI: 10.1177/1591019919901037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate factors affecting recurrence and effects and safety of endovascular retreatment for aneurysms recurrent after embolization. METHODS Among 815 aneurysms treated with embolization, recurrence was in 114 aneurysms (14.0%). Forty-three recurrent aneurysms were managed with re-embolization. Procedural complications, angiographic, and clinical results of retreatment were analyzed. RESULTS Patients with recurrent aneurysms were significantly (P < 0.01) younger than without recurrence (51.09 ± 10.46 vs. 53.88 ± 9.61 years). Recurrent aneurysms (n = 114) were significantly (P = 0.00) greater (11.12 ± 8.35 vs. 5.81 ± 3.44 mm) with a significantly (P = 0.00) greater neck (4.34 ± 2.26 vs. 2.90 ± 1.44 mm) than without recurrence. The rupture status of aneurysms significantly (P = 0.00) affected recurrence at follow-up. Significantly (P = 0.00) more aneurysms without recurrence were treated with advanced embolization techniques (81.0% vs. 62.3%) and got complete occlusion at the first embolization than those with recurrence (93.7% vs. 36.8%). In treating 43 recurrent aneurysms, stent-assisted recoiling was used in 48.8% in the first retreatment and 50% in the second and third retreatment procedures. Angiographic follow-up in 38 (88.4%) cases showed complete or near complete occlusion in 30 aneurysms, with the rest eight aneurysms experiencing a second recurrence (21.1%). Of the eight aneurysms with the second recurrence, five underwent the second endovascular retreatment, with complete aneurysm occlusion achieved in three cases (60%), near-complete occlusion in one (20%), and incomplete occlusion in one case at immediate angiography and six-month follow-up. Procedure-related complications occurred in three patients. CONCLUSIONS Endovascular retreatment of recurrent previously coiled aneurysms is safe and effective even though advanced embolization techniques are frequently involved especially for large and giant aneurysms.
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Affiliation(s)
- Yongfeng Han
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Shijiazhuang First Hospital, Shijiazhuang, Hebei, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang First Hospital, Shijiazhuang, Hebei, China
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Gao BL, Li TX, Zhang XJ, Zhang DH, Hao WL, Fan QY, Li CH. Cerebral arterial infundibula are preaneurysmal lesions caused by direct flow impact. World Neurosurg 2020:S1878-8750(20)30045-0. [PMID: 31954894 DOI: 10.1016/j.wneu.2019.12.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate whether arterial infundibular widening is a preaneurysmal lesion or not. METHODS Two hundred and nine patients with cerebral angiography were enrolled. The morphology, size and location of infundibula and cerebral aneurysms were studied in two-dimensional angiography and three-dimensional software space. Computational fluid dynamics (CFD) analysis was performed. RESULTS 234 infundibula and 129 infundibulum-like aneurysms (IFAs) were detected. In two-dimensional space, the typical morphology of an infundibulum was a symmetric dilatation at the arterial branch origin with a small vessel branch emanating from the tip and a wide base connecting the parent artery. In three-dimensional space, the infundibulum was dissymmetric with always one side longer than the other side. Furthermore, the infundibulum tilted upstream rather than downstream, with the longer side located downstream and the shorter side upstream in all cases. All the 129 IFAs occurred on the distal wall of the vessel branch origin, and no IFAs grew from the proximal wall of the branch origin. The possible development process of an infundibulum to an IFA was described in four development stages. The CFD analysis revealed that these lesions were associated with direct flow impingement in all cases. All the hemodynamic parameters on the distal wall of infundibula and IFAs were significantly (P<0.0001 or P<0.05) decreased compared with on the distal wall after virtual lesion removal. CONCLUSION The infundibulum is a preaneurysmal lesion associated with high total pressure and high wall shear stress resulted from direct flow impingement and will progress to an aneurysm with time.
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Affiliation(s)
- Bu-Lang Gao
- Henan Provincial People's Hospital, Zhengzhou University; Shijiazhuang First Hospital, Hebei Medical University.
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Zhengzhou University
| | | | | | - Wei-Li Hao
- Shijiazhuang First Hospital, Hebei Medical University
| | - Qiong-Ying Fan
- Qinzhou Municipal Hospital For Maternal and Children's Health Care
| | - Cong-Hui Li
- The First Hospital of Hebei Medical University
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Wong GKC, Daly JJ, Rhoney DH, Broderick J, Ogilvy C, Roos YB, Siddiqui A, Torner J; Unruptured Intracranial Aneurysm and SAH CDE Project Investigators. Common Data Elements for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage Clinical Research: Recommendations from the Working Group on Long-Term Therapies. Neurocrit Care 2019; 30:79-86. [PMID: 31077078 DOI: 10.1007/s12028-019-00727-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The goal for the long-term therapies (LTT) working group (WG) of the Unruptured Intracranial Aneurysm (UIA) and Subarachnoid Hemorrhage (SAH) common data elements (CDEs) was to develop a comprehensive set of CDEs, data definitions, case report forms, and guidelines for use in UIA and SAH LTT clinical research, as part of a new joint effort between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Library of Medicine of the US National Institutes of Health. These UIA and SAH CDEs will join other neurological disease-specific CDEs already developed and available for use by research investigators. METHODS The eight LTT WG members comprised international UIA, and SAH experts reviewed existing NINDS CDEs and instruments, created new elements when needed, and provided recommendations for future LTT clinical research. The recommendations were compiled, internally reviewed by the all UIA and SAH WGs and steering committee members. The NINDS CDE team also reviewed the final version before posting the SAH Version 1.0 CDE recommendations on the NINDS CDE website. RESULTS The NINDS UIA and SAH LTT CDEs and supporting documents are publicly available on the NINDS CDE ( https://www.commondataelements.ninds.nih.gov/#page=Default ) and NIH Repository ( https://cde.nlm.nih.gov/home ) websites. The subcommittee members discussed and reviewed various parameters, outcomes, and endpoints in UIA and SAH LTT studies. The following meetings with WG members, the LTT WG's recommendations are incorporated into the disease/injury-related events, assessments and examinations, and treatment/intervention data domains. CONCLUSIONS Noting gaps in the literature regarding medication and rehabilitation parameters in UIA and SAH clinical studies, the current CDE recommendations aim to arouse interest to explore the impact of medication and rehabilitation treatments and therapies and encourage the convergence of LTT clinical study parameters to develop a harmonized standard.
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