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Salih M, Salem MM, Moore JM, Ogilvy CS. Optimal Cost-Effective Screening Strategy for Unruptured Intracranial Aneurysms in Female Smokers. Neurosurgery 2023; 92:150-158. [PMID: 36222540 DOI: 10.1227/neu.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of intracranial aneurysms among female cigarette smokers was shown to be high in previous studies, yet the cost-effectiveness of screening them has never been explored. OBJECTIVE To explore the most cost-effective screening strategy for female smokers. METHODS A decision analytical study was performed with a Markov model to compare different screening strategies with no screening and to explore the most optimal screening strategy for female smokers. Input data for the model were extracted from literature. A single screening at different ages and multiple screening every 15 years, 10 years, 5 years, and 2 years were performed for female smokers in different age ranges. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the model. Finally, value of information analysis was performed to investigate the value of collecting additional data. RESULTS Screening female smokers for unruptured intracranial aneurysm is cost-effective. All screening strategies yield extra quality-adjusted life years. Screening at younger age brings more health benefit at lower cost. Frequent screening strategies decrease rupture rate of aneurysms more with higher costs per quality-adjusted life year. Screening after age 70 years and frequent screening (every 2 years) after age 60 years is not optimal. Among all the parameters in the model, collecting additional data on utility of the unscreened population would be most valuable. CONCLUSION Screening female smokers for intracranial aneurysms once at younger age is most optimal. However, in clinical practice, the duration and intensity of exposure to cigarettes should be taken into consideration.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA
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Zhao J, Xu T, Zhou S, Zhang J, Wu Y, Zhou C, Sun J, Gao X, Huang Y. DNA methylation of the MAP3K10 gene may participate in the development of intracranial aneurysm. Gene X 2023; 851:147024. [DOI: 10.1016/j.gene.2022.147024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/04/2022] Open
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Hou K, Lv X, Guo Y, Yu J. Endovascular treatment of posterior inferior cerebellar artery trunk aneurysm. Acta Neurol Belg 2022; 122:1405-1417. [PMID: 34677822 DOI: 10.1007/s13760-021-01826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The posterior inferior cerebellar artery (PICA) generally originates from the vertebral artery (VA) and is the most complex cerebellar artery. Aneurysms can occur at any site along the PICA trunk. Although most PICA aneurysms are located at the VA-PICA junction, a small proportion is located at the PICA trunk. Endovascular treatment (EVT) of aneurysms in the PICA trunk may be difficult and complex. METHODS We performed a review to expound upon EVT of PICA trunk aneurysms. RESULTS The PICA can be divided into five segments (p1-5); the p1-3 segments are proximal segments, and the p4-5 segments are distal segments. Most PICA trunk aneurysms are dissecting aneurysms. Sometimes, the PICA can give rise to flow-related aneurysms in association with cerebellar arteriovenous malformations. Most aneurysms of the PICA trunk require aggressive treatment, especially those that have ruptured. Currently, the EVT mainly includes selective coiling with/without stent assistance and parent artery occlusion. Recently, some new devices, such as flow diversion and Barricade and Kaneka ED coils, can be used to treat PICA trunk aneurysms. The risk of complications with EVT seems to be higher; however, most complications are only transient or mild, and some are even clinically silent. In addition, open surgery is still an important option. CONCLUSION For PICA trunk aneurysms, the treatment choice should be assessed on a case-by-case basis. The rate of permanent morbidity of the EVT is low. EVT is an effective method for treating PICA trunk aneurysms.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yunbao Guo
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, 130021, China.
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Stent-assisted Coiling vs. Flow Diverter for Treating Blood Blister-like Aneurysms : A Proportion Meta-analysis. Clin Neuroradiol 2022; 32:889-902. [PMID: 35403855 DOI: 10.1007/s00062-022-01160-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Blood blister-like aneurysms (BBAs) are rare vascular lesions and a therapeutic challenge. Although endovascular treatment of BBA is a promising approach, the optimal treatment remains controversial. The purpose of this study was to compare the safety and efficacy of stent-assisted coiling (SAC) and flow diverter (FD) in the management of BBAs. METHODS A proportion meta-analysis including a published series of BBAs treated with endovascular approaches from 2009 to 2020 including SAC and FD was performed by searching English language studies via MEDLINE and EMBASE. RESULTS The 32 studies included 16 based on SAC and 16 involving FD. The long-term complete occlusion rate was higher in FD (89.26%, 95% confidence interval, CI 82.93-94.26%, I2 = 14.42%) than in SAC (70.26%, 95% CI 56.79-82.13%, I2 = 70.60%). The rate of aneurysm recanalization was lower in FD (4.54%, 95% CI 1.72-8.16%, I2 = 0%) than in SAC (25.38%, 95% CI 14.44-38.19%, I2 = 67.31%). Rates of mortality, favorable functional outcome, procedural complications, and rebleeding showed no differences between the two procedures. CONCLUSION In a proportion meta-analysis comparing FD with SAC, the FD was associated with more favorable angiographic outcomes but similar complications and clinical outcomes.
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Wu Q, Li T, Li L, Chang K, Shao Q. Spontaneous healing and complete disappearance of an intracranial vertebral artery dissecting aneurysm: A case report. Medicine (Baltimore) 2022; 101:e31444. [PMID: 36451392 PMCID: PMC9704907 DOI: 10.1097/md.0000000000031444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Intracranial vertebrobasilar dissecting aneurysms (VBDAs) are associated with a greater tendency to rupture and a greater risk of worse outcomes than anterior circulation aneurysms. Spontaneous healing of a VBDA is very rare, and there have been very few case reports of spontaneous healing of an aneurysm. We describe a case of intracranial vertebral artery dissecting aneurysm that healed spontaneously and disappeared completely on follow-up images. PATIENT CONCERNS A 40-years-old woman was referred to the neurology department because of a persistent headache, especially in the left occiput. DIAGNOSES Magnetic resonance angiography and computed tomography angiography showed a left vertebral artery dissection-like aneurysm (4.5 × 2.0 × 2.5 mm in size) with proximal parent artery mild stenosis (40%). INTERVENTIONS Flunarizine hydrochloride was administered for symptomatic treatment and follow-up angiography was performed. OUTCOMES Digital subtraction angiography and magnetic resonance angiography showed that the aneurysm had completely disappeared at 3 months follow-up. High-resolution magnetic resonance vessel wall imaging revealed intimal thickening and mild stenosis in the left intracranial vertebral artery without an aneurysm signal. In addition, enhancement scanning revealed that the aneurysm area was moderately enhanced. MR-vessel wall imaging at 7 months follow-up showed that the enhancement was slightly reduced compared with the previous time. LESSONS This case illustrates the relatively plastic nature of a vertebral dissecting aneurysm, indicating that spontaneous healing remains possible.
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Affiliation(s)
- Qiaowei Wu
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianxiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Kaitao Chang
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Qiuji Shao
- Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- * Correspondence: Qiuji Shao, Cerebrovascular Department of Interventional Center, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, No 7, Weiwu Road, Zhengzhou, Henan 450003, China (e-mail: )
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Algra AM, Greving JP, de Winkel J, Kurtelius A, Laban K, Verbaan D, van den Berg R, Vandertop W, Lindgren A, Krings T, Woo PYM, Wong GKC, Roozenbeek B, van Es ACGM, Dammers R, Etminan N, Boogaarts H, van Doormaal T, van der Zwan A, van der Schaaf IC, Rinkel GJE, Vergouwen MDI. Development of the SAFETEA Scores for Predicting Risks of Complications of Preventive Endovascular or Microneurosurgical Intracranial Aneurysm Occlusion. Neurology 2022; 99:e1725-e1737. [PMID: 36240099 DOI: 10.1212/wnl.0000000000200978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preventive unruptured intracranial aneurysm (UIA) occlusion can reduce the risk of subarachnoid hemorrhage, but both endovascular and microneurosurgical treatment carry a risk of serious complications. To improve individualized management decisions, we developed risk scores for complications of endovascular and microneurosurgical treatment based on easily retrievable patient, aneurysm, and treatment characteristics. METHODS For this multicenter cohort study, we combined individual patient data from patients with UIA aged 18 years or older undergoing preventive endovascular treatment (standard, balloon-assisted or stent-assisted coiling, Woven EndoBridge-device, or flow-diverting stent) or microneurosurgical clipping at one of the 10 participating centers from 3 continents between 2000 and 2018. The primary outcome was death from any cause or clinical deterioration from neurologic complications ≤30 days. We selected predictors based on previous knowledge about relevant risk factors and predictor performance and studied the association between predictors and complications with logistic regression. We assessed model performance with calibration plots and concordance (c) statistics. RESULTS Of the 1,282 included patients, 94 (7.3%) had neurologic symptoms that resolved <30 days, 140 (10.9%) had persisting neurologic symptoms, and 6 died (0.5%). At 30 days, 52 patients (4.1%) were dead or dependent. Predictors of procedural complications were size of aneurysm, aneurysm location, familial subarachnoid hemorrhage, earlier atherosclerotic disease, treatment volume, endovascular modality (for endovascular treatment) or extra aneurysm configuration factors (for microneurosurgical treatment, branching artery from aneurysm neck or unfavorable dome-to-neck ratio), and age (acronym: SAFETEA). For endovascular treatment (n = 752), the c-statistic was 0.72 (95% CI 0.67-0.77) and the absolute complication risk ranged from 3.2% (95% CI 1.6%-14.9%; ≤1 point) to 33.1% (95% CI 25.4%-41.5%; ≥6 points). For microneurosurgical treatment (n = 530), the c-statistic was 0.72 (95% CI 0.67-0.77) and the complication risk ranged from 4.9% (95% CI 1.5%-14.9%; ≤1 point) to 49.9% (95% CI 39.4%-60.6%; ≥6 points). DISCUSSION The SAFETEA risk scores for endovascular and microneurosurgical treatment are based on 7 easily retrievable risk factors to predict the absolute risk of procedural complications in patients with UIAs. The scores need external validation before the predicted risks can be properly used to support decision-making in clinical practice. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that SAFETEA scores predict the risk of procedural complications after endovascular and microneurosurgical treatment of unruptured intracranial aneurysms.
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Affiliation(s)
- Annemijn M Algra
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jacoba P Greving
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jordi de Winkel
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arttu Kurtelius
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kamil Laban
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dagmar Verbaan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - René van den Berg
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - William Vandertop
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Antti Lindgren
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Timo Krings
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Y M Woo
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bob Roozenbeek
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Adriaan C G M van Es
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruben Dammers
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nima Etminan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hieronymus Boogaarts
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tristan van Doormaal
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert van der Zwan
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irene C van der Schaaf
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gabriël J E Rinkel
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mervyn D I Vergouwen
- From the Departments of Neurology and Neurosurgery (A.M.A., K.L., T.v.D., A.v.d.Z., G.J.E.R., M.D.I.V.) and Radiology (I.C.v.d.S.), UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Departments of Neurology (J.d.W., B.R.), Radiology and Nuclear Medicine (A.C.G.M.v.E.), and Neurosurgery (R.D.), Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Departments of Neurosurgery (A.K., A.L.) and Clinical Radiology (A.L.), Kuopio University Hospital, Finland; Departments of Neurosurgery (D.V., W.V.) and Radiology and Nuclear Medicine (R.v.d.B.), Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, the Netherlands; Division of Neuroradiology (T.K.), Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Ontario, Canada; Department of Neurosurgery (P.Y.M.W.), Kwong Wah Hospital, Hong Kong, China; Division of Neurosurgery (G.K.C.W.), Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (N.E.), University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; and Department of Neurosurgery (H.B.), Radboud University Medical Center, Nijmegen, the Netherlands
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Algra AM, Greving JP, Wermer MJH, van Walderveen MAA, van der Schaaf IC, van der Zwan A, Visser-Meily JMA, Rinkel GJE, Vergouwen MDI. Quality of Life Outcomes Over Time in Patients With Unruptured Intracranial Aneurysms With and Without Preventive Occlusion: A Prospective Cohort Study. Neurology 2022; 99:e1715-e1724. [PMID: 35790419 DOI: 10.1212/wnl.0000000000200831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In counseling patients with an unruptured intracranial aneurysm (UIA), quality of life (QoL) outcomes are important for informed decision making. We evaluated QoL outcomes in patients with and without preventive aneurysm occlusion at multiple time points during the first year after UIA diagnosis and studied predictors of QoL outcomes. METHODS We performed a prospective cohort study in patients aged ≥18 years with a newly diagnosed UIA in 2 tertiary referral centers in the Netherlands between 2017 and 2019. Patients were sent QoL questionnaires at 7 (aneurysm occlusion) or 5 (no occlusion) moments during the first year after diagnosis. We collected baseline data on patient and aneurysm characteristics, passive coping style (Utrecht Coping List), occlusion modality, and neurologic complications. We assessed health-related QoL (HRQoL) with the EuroQol 5 dimensions (EQ-5D), emotional functioning with the Hospital Anxiety and Depression Scale (HADS), and restrictions in daily activities with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). We used a linear mixed-effects model to assess the course of QoL over time and to explore predictors of QoL outcomes. RESULTS Of 153 eligible patients, 99 (65%) participated, of whom 30/99 (30%) underwent preventive occlusion. Patients undergoing occlusion reported higher baseline levels of passive coping, anxiety and depression, and restrictions than patients without occlusion. During recovery after occlusion, patients reported more restrictions compared with baseline (adjusted USER-P decrease 1 month post occlusion: -12.8 [95% CI -23.8 to -1.9]). HRQoL and emotional functioning gradually improved after occlusion (EQ-5D increase at 1 year: 8.6 [95% CI 0.1-17.0] and HADS decrease at 1 year: -5.4 [95% CI -9.4 to -1.5]). In patients without occlusion, the largest HRQoL improvement occurred directly after visiting the outpatient aneurysm clinic (EQ-5D increase: 9.2 [95% CI 5.5-12.8]). At 1 year, QoL outcomes were comparable in patients with and without occlusion. Factors associated with worse QoL outcomes were a passive coping style in all patients, complications in patients with occlusion, and higher rupture risks in patients without occlusion. DISCUSSION After UIA diagnosis, QoL improves gradually after preventive occlusion and directly after counseling at the outpatient clinic in patients without occlusion, resulting in comparable 1-year QoL outcomes. A passive coping style is an important predictor of poor QoL outcomes in all patients with UIA.
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Affiliation(s)
- Annemijn M Algra
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Jacoba P Greving
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marieke J H Wermer
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marianne A A van Walderveen
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Irene C van der Schaaf
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Albert van der Zwan
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Johanna M A Visser-Meily
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Gabriël J E Rinkel
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Mervyn D I Vergouwen
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
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Tian Z, Li W, Feng X, Sun K, Duan C. Prediction and analysis of periprocedural complications associated with endovascular treatment for unruptured intracranial aneurysms using machine learning. Front Neurol 2022; 13:1027557. [PMID: 36313499 PMCID: PMC9596813 DOI: 10.3389/fneur.2022.1027557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background The management of unruptured intracranial aneurysm (UIA) remains controversial. Recently, machine learning has been widely applied in the field of medicine. This study developed predictive models using machine learning to investigate periprocedural complications associated with endovascular procedures for UIA. Methods We enrolled patients with solitary UIA who underwent endovascular procedures. Periprocedural complications were defined as neurological adverse events resulting from endovascular procedures. We incorporated three machine learning algorithms into our prediction models: artificial neural networks (ANN), random forest (RF), and logistic regression (LR). The Shapley Additive Explanations (SHAP) approach and feature importance analysis were used to identify and prioritize significant features associated with periprocedural complications. Results In total, 443 patients were included. Forty-eight (10.83%) procedure-related complications occurred. In the testing set, the ANN model produced the largest value (0.761) for area under the curve (AUC). The RF model also achieved an acceptable AUC value of 0.735, while the AUC value of the LR model was 0.668. SHAP and feature importance analysis identified distal aneurysm, aneurysm size and treatment modality as most significant features for the prediction of periprocedural complications following endovascular treatment for UIA. Conclusion Periprocedural complications after endovascular treatment for UIA are not negligible. Prediction of periprocedural complications via machine learning is feasible and effective. Machine learning can serve as a promising tool in the decision-making process for UIA treatment.
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Affiliation(s)
- Zhongbin Tian
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Feng
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaijian Sun
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuanzhi Duan
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Chen F, Wang J, Zhao X, Lv XQ. Interaction of basic diseases and low red blood cell count as critical murderer of wound infection after osteosarcoma resection: Wound infection after osteosarcoma resection. Medicine (Baltimore) 2022; 101:e31074. [PMID: 36221384 PMCID: PMC9542657 DOI: 10.1097/md.0000000000031074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Surgical wound infection is one of the common complications in patients after osteosarcoma resection. It is imperative to grasp the risk factors comprehensively. Therefore, this study aimed to explore the risk factors of wound infection and deeply analyze the correlation between risk factors and wound infection. METHODS The study subjects were 101 patients who underwent osteosarcoma resection between April 2018 and August 2021. The diagnosis of postoperative wound infection was confirmed by postoperative observation of the incision, ultrasound imaging, and pathogenic examination. This study included a series of potential factors, mainly laboratory examination indicators and patients' general information. The statistical methods had Pearson Chi-square test, Spearman-rho correlation test, multifactorial linear regression model, logistic regression analysis, and receiver operating characteristic (ROC) curve. RESULTS Pearson Chi-square test and Spearman correlation test showed that red blood cell (RBC) count (P = .033) and basic diseases (P = .020) were significantly correlated with a surgical wound infection after osteosarcoma resection. Logistic regression analysis manifested that basic disease (OR = 0.121, 95% CI: 0.015-0.960, P = .046) and RBC (OR = 0.296, 95% CI: 0.093-0.944, P = .040) have a clear correlation with whether the patients have surgical wound infection after osteosarcoma resection. And the interaction of basic diseases and RBC could diagnose the surgical wound infection sensitively and accurately (AUC = 0.700, P = .014, 95% CI = 0.564-0.836) via the ROC analysis. CONCLUSION Patients with basic diseases and low RBC were risk factors for surgical wound infection after osteosarcoma resection.
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Affiliation(s)
- Fei Chen
- The Second Department of Orthopedics, Hangzhou Fuyang District First People’s Hospital, Hangzhou, PR China
- * Correspondence: Fei Chen, The Second Department of Orthopedics, Hangzhou Fuyang District First People’s Hospital, No. 429 Beihuan Road, Fuyang District, Hangzhou 311499, PR China (e-mail: )
| | - Jie Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
| | - Xin Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
| | - Xian-qiang Lv
- Department of Urology, The Fourth Hospital of Hebei Medical University, Hebei Province, PR China
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60
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Salih M, Salem M, Moore J, Thomas AJ, Ogilvy CS. Cost-effectiveness analysis on small (< 5 mm) unruptured intracranial aneurysm follow-up strategies. J Neurosurg 2022; 138:1366-1373. [PMID: 36208436 DOI: 10.3171/2022.8.jns221053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Unruptured intracranial aneurysms are frequently detected during routine clinical diagnostic processes. A significant portion are small aneurysms less than 5 mm in diameter. While follow-up of patients with small aneurysms has been advocated, the cost-effectiveness of such care and the optimal follow-up interval remain unknown. This study aimed to explore the most cost-effective follow-up interval for small (< 5 mm) unruptured intracranial aneurysms.
METHODS
A decision analysis study was performed using a Markov model with Monte Carlo simulations to simulate patients undergoing follow-up by MRA at different time intervals (1-, 2-, 3-, 5-, and 7-year intervals) for small (< 5 mm) unruptured intracranial aneurysms. Input data for the model were extracted from the current literature, primarily meta-analyses. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model.
RESULTS
Given the current literature and the model in this study, following up every 2 years with noninvasive imaging is the most cost-effective strategy (cost $126,996, effectiveness 21.9 quality-adjusted life-years), showing the highest net monetary benefit. The conclusion remains robust in probabilistic and deterministic sensitivity analyses. As the annual growth risk of small aneurysms and annual rupture risk of growing aneurysms increase, following up every year is optimal. When the cost for follow-up with MRA is less than $2223, following up every year is cost-effective.
CONCLUSIONS
The most cost-effective follow-up strategy for small (< 5 mm) unruptured aneurysms using MRA is following up every 2 years. More frequent follow-up strategies or prompt preventive treatment would be more appropriate in patients with higher risk factors for growth and aneurysm rupture.
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Affiliation(s)
- Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Justin Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Ajith J. Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher S. Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts
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Turhon M, Maimaiti A, Gheyret D, Axier A, Rexiati N, Kadeer K, Su R, Wang Z, Chen X, Cheng X, Zhang Y, Aisha M. An immunogenic cell death-related regulators classification patterns and immune microenvironment infiltration characterization in intracranial aneurysm based on machine learning. Front Immunol 2022; 13:1001320. [PMID: 36248807 PMCID: PMC9556730 DOI: 10.3389/fimmu.2022.1001320] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immunogenic Cell Death (ICD) is a novel way to regulate cell death and can sufficiently activate adaptive immune responses. Its role in immunity is still emerging. However, the involvement of ICD in Intracranial Aneurysms (IA) remains unclear. This study aimed to identify biomarkers associated with ICDs and determine the relationship between them and the immune microenvironment during the onset and progression of IA Methods The IA gene expression profiles were obtained from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) in IA were identified and the effects of the ICD on immune microenvironment signatures were studied. Techniques like Lasso, Bayes, DT, FDA, GBM, NNET, RG, SVM, LR, and multivariate analysis were used to identify the ICD gene signatures in IA. A consensus clustering algorithm was used for conducting the unsupervised cluster analysis of the ICD patterns in IA. Furthermore, enrichment analysis was carried out for investigating the various immune responses and other functional pathways. Along with functional annotation, the weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI) network and module construction, identification of the hub gene, and co-expression analysis were also carried out. Results The above techniques were used for establishing the ICD gene signatures of HMGB1, HMGN1, IL33, BCL2, HSPA4, PANX1, TLR9, CLEC7A, and NLRP3 that could easily distinguish IA from normal samples. The unsupervised cluster analysis helped in identifying three ICD gene patterns in different datasets. Gene enrichment analysis revealed that the IA samples showed many differences in pathways such as the cytokine-cytokine receptor interaction, regulation of actin cytoskeleton, chemokine signaling pathway, NOD-like receptor signaling pathway, viral protein interaction with the cytokines and cytokine receptors, and a few other signaling pathways compared to normal samples. In addition, the three ICD modification modes showed obvious differences in their immune microenvironment and the biological function pathways. Eight ICD-regulators were identified and showed meaningful associations with IA, suggesting they could severe as potential prognostic biomarkers. Conclusions A new gene signature for IA based on ICD features was created. This signature shows that the ICD pattern and the immune microenvironment are closely related to IA and provide a basis for optimizing risk monitoring, clinical decision-making, and developing novel treatment strategies for patients with IA.
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Affiliation(s)
- Mirzat Turhon
- Department of Neurointerventional Surgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Surgery, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Aierpati Maimaiti
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dilmurat Gheyret
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aximujiang Axier
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Nizamidingjiang Rexiati
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kaheerman Kadeer
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Riqing Su
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zengliang Wang
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaohong Chen
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaojiang Cheng
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- *Correspondence: Maimaitili Aisha, ; Yisen Zhang, ; Xiaojiang Cheng,
| | - Yisen Zhang
- Department of Neurointerventional Surgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Surgery, Beijing Tiantan hospital, Capital Medical University, Beijing, China
- *Correspondence: Maimaitili Aisha, ; Yisen Zhang, ; Xiaojiang Cheng,
| | - Maimaitili Aisha
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- *Correspondence: Maimaitili Aisha, ; Yisen Zhang, ; Xiaojiang Cheng,
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Song C, Xia S, Zhang H, Zhang L, Li X, Wang K, Lu Q. Novel Endovascular Interventional Surgical Robotic System Based on Biomimetic Manipulation. MICROMACHINES 2022; 13:mi13101587. [PMID: 36295940 PMCID: PMC9611341 DOI: 10.3390/mi13101587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 05/14/2023]
Abstract
Endovascular therapy has emerged as a crucial therapeutic method for treating vascular diseases. Endovascular surgical robots have been used to enhance endovascular therapy. However, to date, there are no universal endovascular surgical robots that support molds of different types of devices for treating vascular diseases. We developed a novel endovascular surgical robotic system that can independently navigate the intravascular region, advance and retract devices, and deploy stents. This robot has four features: (1) The bionic design of the robot can fully simulate the entire grasping process; (2) the V-shaped relay gripper waived the need to redesign special guidewires and catheters for continuous rotation; (3) the handles designed based on the feedback mechanism can simulate push resistance and reduce iatrogenic damage; and (4) the detachable design of the grippers can reduce cross-infection risk and medical costs. We verified its performance by demonstrating six different types of endovascular surgeries. Early evaluation of the novel endovascular robotic system demonstrated its practicability and safety in endovascular surgeries.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Shibo Xia
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Hao Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Xiaoye Li
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Kundong Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Correspondence: (K.W.); (Q.L.)
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200433, China
- Correspondence: (K.W.); (Q.L.)
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Jin H, Wang J, Meng X, Li Y, He H. Intervals of endovascular treatment for coincidental non-adjacent unruptured aneurysms in patients with symptomatic intracranial atherosclerotic stenosis. Front Neurol 2022; 13:1004536. [PMID: 36212635 PMCID: PMC9539807 DOI: 10.3389/fneur.2022.1004536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background and purpose To explore the safety of endovascular therapy for concomitant non-adjacent unruptured intracranial aneurysms (UIAs) which is incidentally found in severe patients with symptomatic intracranial atherosclerotic stenosis at the same session and different sessions. Methods Patients between January 2019 to December 2020 were retrospectively reviewed at our institution. Patients with concomitant non-adjacent incidental UIA in severe symptomatic intracranial atherosclerotic stenosis, who underwent endovascular treatment for both lesions were included. They were divided into two groups according to the intervals (The aneurysm was treated at the same session as stenosis or at separated sessions). The demographics, procedure details, complications, and clinical outcomes were compared between groups. Results A total of 22 patients were involved. In total, ten patients underwent endovascular treatment for UIA and stenosis at one session and 12 patients at separate sessions. In total, three (13.6%) patients experienced procedural related complications, including 2 (20%) in the one session group and 1(8.3%) in the separate sessions group. Follow-up (Range 6–12, mean = 8.5 months) results showed good clinical outcome in all the patients. There is no statistical significance in terms of complication rate and unfavorable clinical outcome between groups. Conclusions Non-adjacent concomitant UIA and severe symptomatic intracranial atherosclerotic stenosis will not pose additional endovascular treatment risks. Both simultaneous endovascular management and short intervals between separated procedures are technically feasible and safe.
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Affiliation(s)
- Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, The 4th Hospital of Handan, Handan, China
| | - Xiangyu Meng
- Neurosurgery Department, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Youxiang Li
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Hongwei He
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Etminan N, de Sousa DA, Tiseo C, Bourcier R, Desal H, Lindgren A, Koivisto T, Netuka D, Peschillo S, Lémeret S, Lal A, Vergouwen MDI, Rinkel GJE. European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms. Eur Stroke J 2022; 7:V. [PMID: 36082246 PMCID: PMC9446328 DOI: 10.1177/23969873221099736] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 07/30/2023] Open
Abstract
Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Diana Aguiar de Sousa
- Stroke Centre, Centro Hospitalar
Universitário Lisboa Central, Lisbon, Portugal
- CEEM and Institute of Anatomy,
Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Cindy Tiseo
- Department of Neurology and Stroke
Unit, SS Filippo e Nicola Hospital, Avezzano, Italy
| | - Romain Bourcier
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Hubert Desal
- Department of Diagnostic and
Therapeutic Neuroradiology, University Hospital of Nantes, INSERM, CNRS, Université
de Nantes, l’institut du thorax, France
| | - Anttii Lindgren
- Department of Clinical Radiology,
Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio
University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School
of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - David Netuka
- Department of Neurosurgery and
Neurooncology, 1st Medical Faculty, Charles University, Praha, Czech Republic
| | - Simone Peschillo
- Department of Surgical Medical
Sciences and Advanced Technologies ‘G.F. Ingrassia’ - Endovascular Neurosurgery,
University of Catania, Catania, Italy
- Endovascular Neurosurgery, Pia
Fondazione Cardinale Giovanni Panico Hospital, Tricase, LE, Italy
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Mervyn DI Vergouwen
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurosurgery, University
Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
- Department of Neurology and
Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
University, Utrecht, The Netherlands
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Shu Z, Chen S, Wang W, Qiu Y, Yu Y, Lyu N, Wang C. Machine Learning Algorithms for Rupture Risk Assessment of Intracranial Aneurysms: A Diagnostic Meta-Analysis. World Neurosurg 2022; 165:e137-e147. [PMID: 35690311 DOI: 10.1016/j.wneu.2022.05.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Several machine learning algorithms have been increasingly applied to predict the rupture risk of intracranial aneurysms. We performed the present diagnostic meta-analysis to comprehensively evaluate the diagnostic value of machine learning algorithms for assessing the rupture risk of intracranial aneurysms. METHODS We systematically searched 3 electronic databases, including Medline (via PubMed), the Cochrane Register of Controlled Trials (via Ovid), and Embase (via Elsevier), to retrieve eligible studies from the databases' inception through March 2021. The latest update was performed in June 2021. StataMP, version 14, was used to estimate all pooled diagnostic values. RESULTS A total of 4 studies involving 6 reports were considered to meet the inclusion criteria. Our diagnostic meta-analysis generated the following pooled diagnostic values: sensitivity, 0.84 (95% confidence interval [CI], 0.75-0.90); specificity, 0.78 (95% CI, 0.68-0.85); positive likelihood ratio, 3.8 (95% CI, 2.4-5.9); negative likelihood ratio, 0.21 (95% CI, 0.12-0.35), diagnostic odd ratio, 18 (95% CI, 7-46), and area under the summary receiver operating characteristic curve, 0.88 (95% CI, 0.85-0.90). CONCLUSIONS Our findings have demonstrated that the diagnostic performance of machine learning algorithms for the rupture risk assessment of AIs is excellent. Considering that the negative effects resulted from the limited number of eligible studies, we suggest developing more well-designed studies with larger sample sizes to validate our findings.
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Affiliation(s)
- Zhang Shu
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang, China
| | - Song Chen
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang, China
| | - Wei Wang
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang, China
| | - Yufa Qiu
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang, China
| | - Ying Yu
- Department of Neurosurgery, Changhai Hospital of Shanghai, Shanghai, China
| | - Nan Lyu
- Department of Neurosurgery, Changhai Hospital of Shanghai, Shanghai, China
| | - Chi Wang
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang, China.
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Liu Q, Leng X, Yang J, Yang Y, Jiang P, Li M, Mo S, Yang S, Wu J, He H, Wang S. Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment. J Neurosurg 2022; 137:675-684. [PMID: 35061990 DOI: 10.3171/2021.10.jns211709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The probable stability of the lesion is critical in guiding treatment decisions in unruptured intracranial aneurysms (IAs). The authors aimed to develop multidimensional predictive models for the stability of unruptured IAs. METHODS Patients with unruptured IAs in the anterior circulation were prospectively enrolled and regularly followed up. Clinical data were collected, IA morphological features were assessed, and adjacent hemodynamic features were quantified with patient-specific computational fluid dynamics modeling. Based on multivariate logistic regression analyses, nomograms incorporating these factors were developed in a primary cohort (patients enrolled between January 2017 and February 2018) to predict aneurysm rupture or growth within 2 years. The predictive accuracies of the nomograms were compared with the population, hypertension, age, size, earlier rupture, and site (PHASES) and earlier subarachnoid hemorrhage, location, age, population, size, and shape (ELAPSS) scores and validated in the validation cohort (patients enrolled between March and October 2018). RESULTS Among 231 patients with 272 unruptured IAs in the primary cohort, hypertension, aneurysm location, irregular shape, size ratio, normalized wall shear stress average, and relative resident time were independently related to the 2-year stability of unruptured IAs. The nomogram including clinical, morphological, and hemodynamic features (C+M+H nomogram) had the highest predictive accuracy (c-statistic 0.94), followed by the nomogram including clinical and morphological features (C+M nomogram; c-statistic 0.89), PHASES score (c-statistic 0.68), and ELAPSS score (c-statistic 0.58). Similarly, the C+M+H nomogram had the highest predictive accuracy (c-statistic 0.94) in the validation cohort (85 patients with 97 unruptured IAs). CONCLUSIONS Hemodynamics have predictive values for 2-year stability of unruptured IAs treated conservatively. Multidimensional nomograms have significantly higher predictive accuracies than conventional risk prediction scores.
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Affiliation(s)
- Qingyuan Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xinyi Leng
- 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junhua Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Yi Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Pengjun Jiang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Maogui Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shaohua Mo
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuzhe Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Jun Wu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Hongwei He
- 3Department of Neurointervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and
| | - Shuo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
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Alkhars H, Haq W, Al-Tayeb A, Sigounas D. Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 165:e110-e127. [PMID: 35654332 DOI: 10.1016/j.wneu.2022.05.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. METHODS PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. RESULTS Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). CONCLUSIONS Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.
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Affiliation(s)
- Hussain Alkhars
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Waqas Haq
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Al-Tayeb
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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Cras TY, Hunink MMG, Dammers R, van Es ACGM, Volovici V, Burke JF, Kremers FCC, Dippel DWJ, Roozenbeek B. Surveillance of Unruptured Intracranial Aneurysms: Cost-Effectiveness Analysis for 3 Countries. Neurology 2022; 99:e890-e903. [PMID: 35654593 DOI: 10.1212/wnl.0000000000200785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES No consensus exists on adequate surveillance of conservatively managed unruptured intracranial aneurysms (UIAs). We aimed to determine optimal MRI surveillance strategies for the growth of UIAs using cost-effectiveness analysis. A secondary aim was to develop a clinical tool for personalizing UIA surveillance. METHODS We designed a microsimulation model from a health care perspective simulating 100,000 55-year-old women to estimate costs and quality-adjusted life years (QALYs) over a lifetime horizon in the United States, the United Kingdom, and the Netherlands, using literature-derived model parameters. Country-specific costs and willingness-to-pay thresholds ($100,000/QALY for the United States, £30,000/QALY for the United Kingdom, and €80,000/QALY for the Netherlands) were used. Lifetime costs and QALYs were annually discounted at 3% for the United States, 3.5% for the United Kingdom, or 4% (costs) and 1.5% (QALYs) for the Netherlands. Strategies were no follow-up surveillance, follow-up with MRI in the first and fifth year after UIA discovery, every 5 years, every 2 years, or annually, or immediate intervention (i.e., clipping or coiling). Using the microsimulation model, we developed a tool for personalizing UIA surveillance for men and women, with different ages and varying aneurysm characteristics. Uncertainty in the input parameters was modeled with probabilistic sensitivity analysis. RESULTS Among 55-year-old women, 2,222 individuals in the United States, 1,910 in the United Kingdom, and 2,040 in the Netherlands needed to undergo an annual MRI scan to prevent 1 case of subarachnoid hemorrhage per year. No surveillance MRI was most cost-effective in the United States (in 47% of the simulations) and United Kingdom (in 54% of simulations), whereas annual MRI was most cost-effective in the Netherlands (in 53% of simulations). In the United States and United Kingdom, annual surveillance or surveillance in the first and fifth year after discovery was cost-effective in patients <60 years and at increased risk of aneurysm growth. The optimal, personalized, surveillance strategies were summarized in a look-up table for use in clinical practice. DISCUSSION Generally, the US and UK physicians should refrain from assigning patients, particularly older patients and those with few risk factors for aneurysm growth or rupture, to frequent MRI surveillance. In the Netherlands, annual follow-up is generally most cost-effective.
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Affiliation(s)
- Tim Yannick Cras
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Myriam M G Hunink
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Ruben Dammers
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Adriaan C G M van Es
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Victor Volovici
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - James F Burke
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Femke C C Kremers
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Diederik W J Dippel
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Bob Roozenbeek
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
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Krueger EM, Farhat H. Elective Endovascular Treatment of Unruptured Intracranial Aneurysms. Cureus 2022; 14:e27515. [PMID: 36060362 PMCID: PMC9424830 DOI: 10.7759/cureus.27515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background Elective endovascular treatment (EVT) of unruptured intracranial aneurysms (UIA) is a commonly used treatment modality. However, the appropriate post-procedure management is not well-defined. Methods This was a single-center, retrospective review of all adults undergoing EVT of UIA performed between January 1, 2010, and March 31, 2020. Patients with any current intracranial hemorrhage or clinical symptoms severe enough to warrant emergent intervention were excluded. Results Sixty-seven UIA were treated on 58 patients. The mean dome diameter was 6.6 mm (2-20, ±3.9), the most common parent vessel was the internal carotid artery (43.2%, 29/67), and sole flow diverter stents were the most common device used (46.2%, 31/67). Post-treatment, 43.2% (29/67) patients went to the neurocritical care unit (NCCU). The mean NCCU length of stay (LOS) was 1.07 days (range 1-4, ±0.5), and 96.6% (28/29) only spent one day in the NCCU.
There were no (0%, 0/67) anesthesia-related procedural complications. One (1.5%, 1/67) intra-procedural complication was an aneurysm rupture during attempted coiling. There were five (7.4%, 5/67) post-procedural complications: two (3.0%, 2/67) groin hematomas, two (3.0%, 2/67) permanent neurologic events (left lower extremity hypoesthesia and left upper extremity hemiparesis), and one (1.5%, 1/67) temporary neurologic event (aphasia). Post-procedural complications were associated with longer hospital LOS (p=0.02), but not with longer NCCU LOS. No acute management changes occurred for the five patients that developed post-procedural complications. There were no (0%, 0/67) 30-day readmissions. Conclusion The overall incidence of post-procedure complications was low. In the future, a possible viable way to reduce hospital costs may involve utilizing a hospital unit that could closely monitor patients but only for a short period of time post-procedure.
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Hara T, Satow T, Hamano E, Hashimura N, Sumi M, Ikedo T, Ohta T, Takahashi JC, Kataoka H. Aspect Ratio Is Associated with Recanalization after Coiling of Unruptured Intracranial Aneurysms. Neurol Med Chir (Tokyo) 2022; 62:377-383. [PMID: 35831123 PMCID: PMC9464477 DOI: 10.2176/jns-nmc.2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3%-49%. This study aims to investigate the factors that influence the recanalization after coil embolization for UIAs in our institution. We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent-used cases were excluded. Cerebral angiography and 3D time-of-flight magnetic resonance angiography (TOF MRA) were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. The mean follow-up period ranged from 6 to 172 months (mean: 79.0 ± 39.8 months). Recanalization was noted in 78 (25.4%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p < 0.001), AR (p = 0.003), and VER (p = 0.012) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. To summarize, a higher AR and a lower VER could lead to recanalization after coil embolization of UIAs. Careful follow-up is required for coiled aneurysms with these features.
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Affiliation(s)
- Takeshi Hara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Tetsu Satow
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Naoki Hashimura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Masatake Sumi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
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de Araújo LX, Perez da Silva Pereira P, Cantanhêde de Deus J, Oliveira Pontes D, Tavares Hang A, Gadelha Freitas JL, Moreira da Silva V, de Paula Paiva K, Moura de Souza CJ, Suaris Meireles CV, Delfino Rodrigues M, da Silva Tavares DT, Sanches Rosa MM. Fatores de risco nas neurocirurgias: um estudo de coorte no norte do Brasil. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: Pacientes neurocirúrgicos apresentam elevado risco de complicações locais e sistêmicas que podem aumentar o tempo de internação e o risco de morte. Este estudo tem como objetivo avaliar a incidência de infecções relacionadas à assistência à saúde e os fatores de risco associados em pacientes submetidos às neurocirurgias. Materiais e Métodos: Estudo de coorte prospectiva, realizado em um Hospital de grande porte do estado de Rondônia, no período de 2018 a 2019, incluindo 36 pacientes. Resultados: A incidência de infecções relacionada à assistência à saúde foi 19,4 a cada 100 pacientes (IC95%: 8,19 – 36,02). Ter utilizado sonda nasoenteral aumentou em 6,5 vezes o risco de IRAS (IC 95%: 1,26 – 33,5), a ventilação mecânica aumentou 5,52 vezes o risco (IC95%: 1,23 – 24,6), a presença de traqueostomia aumentou seis vezes (IC95%: 1,34 – 26,8) e realização de exame invasivo aumentou o risco em 6,79 para ter infecção (IC95%: 1,31 – 35,05). Na análise ajustada as variáveis não apresentaram significância estatística. Discussão: A incidência de infecções foi maior do que em regiões com melhores condições socioeconômicas o que pode estar relacionado à menor adesão de boas práticas na assistência. Conclusão: Nas neurocirurgias além das infecções de sítio cirúrgico outras topografias também devem ser consideradas para investigação de infecção. O uso de dispositivos invasivos foi associado à ocorrência de infecções relacionadas à assistência à saúde, portanto as boas práticas no seu uso são essenciais no momento da indicação e uso destes dispositivos.
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Wu Q, Li T, Jiang W, Hernesniemi JA, Li L, He Y. Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9682507. [PMID: 35770042 PMCID: PMC9236797 DOI: 10.1155/2022/9682507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Background Intracranial vertebrobasilar trunk large (≥10 mm) aneurysms (IVBTLAs) are rare and challenging to manage. In this study, we describe the natural prognosis and evaluate the safety and efficacy of endovascular treatment of IVBTLAs compared with conservative therapy. Methods This prospective multicenter cohort study included patients with IVBTLAs, who chose either endovascular treatment (endovascular group) or conservative therapy (conservative group) after discussion with their doctors. The primary endpoint was the incidence of serious adverse events (SAEs) related to the target vessel, while secondary endpoints included target vessel-related mortality, major stroke, other serious adverse events, and aneurysm occlusion rate. Results In total, 258 patients were referred to our two centers for the management of vertebrobasilar aneurysms, and 69 patients had IVBTLAs. Among them, 51 patients underwent endovascular treatment, and 18 patients received conservative therapy. The incidence of target vessel-related SAEs was 15.7% (8/51) in the endovascular group and 44.4% (8/18) in the conservative group (P = 0.031). The target vessel-related mortality was 2.0% (1/51) in the endovascular group and 38.9% (7/18) in the conservative group (P < 0.001). The cumulative survival rates in the endovascular group and conservative group within 1-year, 3-year, and 5-year were 98.0% vs. 83.3%, P = 0.020; 98.0% vs. 66.7%, P = 0.001; and 98.0% vs. 35.6%, P < 0.001, respectively. Multivariate analysis revealed conservative therapy, giant aneurysm, and ischemic onset as risks factor for SAEs. Conclusions Compared with conservative treatment, endovascular treatment of the IVBTLAs may be associated with a lower incidence of SAEs, with higher 1-year, 3-year, and 5-year survival rates. Conservative therapy, giant aneurysm, and ischemic onset were associated with a high risk of SAEs.
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Affiliation(s)
- Qiaowei Wu
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianxiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Weijian Jiang
- Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Juha Antero Hernesniemi
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Wu Q, Li C, Xu S, Wang C, Ji Z, Qi J, Li Y, Sun B, Shi H, Wu P. Flow Diversion vs. Stent-Assisted Coiling in the Treatment of Intradural Large Vertebrobasilar Artery Aneurysms. Front Neurol 2022; 13:917002. [PMID: 35785346 PMCID: PMC9242619 DOI: 10.3389/fneur.2022.917002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare the safety, angiographic, and long-term clinical outcomes of intradural large vertebrobasilar artery (VBA) aneurysms following flow diversion (FD) or conventional stent-assisted coiling (SAC).MethodsWe performed a retrospective study of 66 consecutive patients with intradural large VBA aneurysms between 2014 and 2021 who underwent FD or SAC. Patients' characteristics, postprocedural complications, and clinical and angiographic outcome details were reviewed.ResultsA total of 66 intradural large VBA aneurysms were included, including 42 (63.6%), which were treated with SAC (SAC group) and 24 (36.4%), which were treated with FD (FD group). Clinical follow-up was obtained at the median of 24.0 [interquartile range (IQR) 12.0–45.0] months, with 34 (81.0%) patients achieved the modified Rankin Scale (mRS) ≤ 2 in the SAC group and 21 (87.5%) patients in the FD group. Thirteen (19.7%) patients experienced neurological complications, of which 9 (13.6%) patients first occurred during the periprocedural phase and 4 (6.1%) patients first occurred during follow-up. The overall complication rate and periprocedural complication rate were both higher in the SAC group, but did not reach statistical significance (23.8 vs. 12.5%, P = 0.430; 16.7 vs. 8.3%, P = 0.564). The mortality rates were similar between the groups (11.9 vs. 12.5%). Angiographic follow-up was available for 46 patients at the median of 7 (IQR 6–14) months, with a numerically higher complete occlusion rate in the SAC group (82.1 vs. 55.6%, P = 0.051) and similar adequate aneurysm occlusion rates between the groups (85.7 vs. 83.3%, P = 1.000). In the multivariate analysis, ischemic onset (P = 0.019), unilateral vertebral artery sacrifice (P = 0.008), and older age (≥60 years) (P = 0.031) were significantly associated with complications.ConclusionThere was a trend toward lower complication rate and lower complete occlusion rate for intradural large VBA aneurysms following FD as compared to SAC. FD and SAC have comparable mortality rates and favorable outcomes. Ischemic onset, unilateral vertebral artery sacrifice, and older age could increase the risk of complications.
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Peng Q, Zhou Y, Li W, Wang C, Dong L, Mu S, Zhang Y. Reconstructive Endovascular Treatment of Basilar Trunk and Vertebrobasilar Junction Aneurysms: A Review of 77 Consecutive Cases. Front Neurol 2022; 13:885776. [PMID: 35645957 PMCID: PMC9133804 DOI: 10.3389/fneur.2022.885776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/04/2022] [Indexed: 12/05/2022] Open
Abstract
Background Basilar trunk and vertebrobasilar junction (BTVBJ) aneurysms have a poor prognosis and are challenging to treat. Objective This study aimed to evaluate the efficacy of reconstructive endovascular treatment for BTVBJ aneurysms and explore a treatment selection paradigm. Methods Clinical and angiographic data from 77 patients with 80 BTVBJ aneurysms who underwent endovascular treatment with flow diverters (FDs) or conventional stent-assisted coiling between January 2016 and December 2020 were retrospectively analyzed. Aneurysm characteristics and treatment outcomes were compared between treatment groups. Results Among the 77 study patients, 34 (44.2%) were treated with FDs and 43 (55.8%) with conventional stent-assisted coiling. Overall, 72.7% of patients achieved favorable clinical outcome at follow-up. The rate of procedure-related complications was 23.4%. The aneurysm occlusion rate at last follow-up did not differ between the FD and conventional stent groups (79.2% vs. 77.1%, p = 0.854). Although the occlusion rate immediately after the procedure was lower in the FD group (29.4%), incidence of progressive occlusion was significantly higher (62.5 vs. 5.7%; p < 0.001). The proportion of patients with large and giant aneurysms (≥10 mm) was significantly higher in the FD group (70.6 vs. 34.8%; p = 0.002). In patients with large or giant aneurysms, favorable clinical outcome at last follow-up was achieved in 75% of patients in the FD group but only 43.8% of patients in the conventional stent group (p = 0.046). Moreover, the complication rate was lower in the FD group, but the difference was not significant (20.8 vs. 37.5%; p = 0.247). The same analyses were performed for patients with small aneurysms (<10 mm) but no significant differences between the two groups were observed. Conclusion Endovascular treatment of small BTVBJ aneurysms using either FDs or conventional stents was feasible and effective. In patients with large or giant aneurysms, treatment using FDs achieved higher rates of occlusion and favorable clinical outcome at last follow-up than conventional stent-assisted coiling.
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Affiliation(s)
- Qichen Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yangyang Zhou
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shiqing Mu
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Yisen Zhang
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75
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Tian Z, Li X, Wang C, Feng X, Sun K, Tu Y, Su H, Yang X, Duan C. Association Between Aneurysmal Hemodynamics and Rupture Risk of Unruptured Intracranial Aneurysms. Front Neurol 2022; 13:818335. [PMID: 35528737 PMCID: PMC9068966 DOI: 10.3389/fneur.2022.818335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Assessing rupture risk in patients with unruptured intracranial aneurysms (UIAs) remains challenging. Hemodynamics plays an important role in the natural history of intracranial aneurysms. This study aimed to compare aneurysmal hemodynamic features between patients with different rupture risk as determined by PHASES score. Methods We retrospectively examined 238 patients who harbored a solitary saccular UIA. Patients were stratified by rupture risk into low-, intermediate-, and high-risk groups according to PHASES score. Flow simulations were performed to compare differences in hemodynamics among the groups. Results Aneurysmal time-averaged wall shear stress (WSSa) and normalized WSS (WSSn) decreased progressively as PHASES score increased. WSSa and WSSn significantly differed among the low-, intermediate-, and high-risk groups (p < 0.001). WSSa was significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.004). WSSn was also significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.001). Conclusions Low WSS was significantly associated with higher risk of intracranial aneurysm rupture as determined by PHASES score, indicating that hemodynamics may play an important role in aneurysmal rupture. In the future, a multidimensional rupture risk prediction model that includes hemodynamic parameters should be investigated.
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Affiliation(s)
- Zhongbin Tian
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xifeng Li
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chao Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Xin Feng
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaijian Sun
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Tu
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hengxian Su
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chuanzhi Duan
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Waqas M, Monteiro A, Cappuzzo JM, Tutino VM, Levy EI. Evolution of the patient-first approach: a dual-trained, single-neurosurgeon experience with 2002 consecutive intracranial aneurysm treatments. J Neurosurg 2022; 137:1751-1757. [PMID: 35364567 DOI: 10.3171/2022.2.jns22105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The paradigm for intracranial aneurysm (IA) treatment is shifting toward a hybrid approach involving open and endovascular techniques. The authors chronicled the evolution of IA treatment by retrospectively examining a large series of IA cases treated by a single dual-trained neurosurgeon, focusing on evolving technology relative to the choice of treatment options, perioperative morbidity, and mortality. METHODS The aneurysm database at the authors' institution was searched to identify consecutive patients treated with endovascular or open microsurgical approaches by one neurosurgeon during an 18-year time span. Patients were included regardless of IA rupture status, location or morphology, or treatment modality. Data collected were baseline clinical characteristics, aneurysm size, treatment modality, operative complications, in-hospital mortality, and retreatment rate. RESULTS A total of 1858 patients with 2002 IA treatments were included in the study. Three-hundred fifty IAs (17.5%) were ruptured. Open microsurgery was performed in 504 aneurysms (25.2%) and endovascular surgery in 1498 (74.8%). Endovascular IA treatments trended toward a growing use of flow diversion during the last 11 years. In-hospital mortality was 1.7% overall, including 7.0% in ruptured and 0.5% in unruptured cases. The overall complication rate was 3.3%, including 3.4% for microsurgical cases and 3.3% for endovascular cases. The rate of retreatment was 3.6% after clipping and 10.7% for endovascular treatment. CONCLUSIONS This study demonstrates complementary use of open and endovascular approaches for IA treatment. By customizing treatment to the patient, comparable rates of procedural complications, mortality, and retreatment were achieved for both endovascular and microsurgical approaches.
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Affiliation(s)
- Muhammad Waqas
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Andre Monteiro
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Justin M Cappuzzo
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo
| | - Vincent M Tutino
- Departments of1Neurosurgery and.,3Department of Biomedical Engineering and.,4Department of Pathology and Anatomical Sciences, University at Buffalo, State University of New York, Buffalo; and.,5Canon Stroke and Vascular Research Center, University at Buffalo
| | - Elad I Levy
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo.,5Canon Stroke and Vascular Research Center, University at Buffalo.,6Jacobs Institute, Buffalo, New York.,7Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
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77
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Koji T, Kubo Y, Matsumoto Y, Akamatsu Y, Chida K, Kashimura H, Ogasawara K. Intracranial hemorrhage associated with direct oral anticoagulant after clipping for an unruptured cerebral aneurysm: A report of two cases. Surg Neurol Int 2022; 13:104. [PMID: 35399887 PMCID: PMC8986724 DOI: 10.25259/sni_1223_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/03/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Two cases of patients who developed intracranial hemorrhage associated with direct oral anticoagulant (DOAC) use after clipping of an unruptured cerebral aneurysm (uAN) are presented. These cases will help neurosurgeons assess the risks of patients with atrial fibrillation or deep venous thrombosis receiving DOACs who require craniotomy. Case Description: Case 1 was a 65-year-old man on apixaban 10 mg/day who underwent clipping for a left middle cerebral artery uAN. Apixaban was discontinued 72 h before surgery. During surgery, a thin and pial artery bled slightly at 1 point of the frontal lobe, and hemostasis was easily achieved. Computed tomography (CT) 19 h after surgery showed no evidence of intracranial hemorrhage. He was treated with a heparin-apixaban bridge from 29 h to 41 h after surgery. CT showed a left subarachnoid hematoma 24 h later. Case 2 was a 73-year-old woman on dabigatran 110 mg/day who underwent clipping for a right MCA uAN. Dabigatran was discontinued 48 h before surgery. During surgery, a thin and pial artery bled slightly at 2 points of the temporal lobe, and hemostasis was easily achieved. CT 19 h after surgery showed no evidence of intracranial hemorrhage. Dabigatran (110 mg/day) was restarted 29 h after surgery. CT then showed a right subarachnoid hematoma 94 h later, and dabigatran was discontinued, and it was then restarted 38 h later. However, 31 h later, CT showed an additional slight subarachnoid hemorrhage. Finally, she developed a right chronic subdural hematoma. Conclusion: In patients undergoing neurosurgical procedures, discontinuation of DOACs should be individualized based on neurosurgical bleeding risk and patient renal function. Restarting of DOACs could be considered after at least 48 h when hemostasis has been achieved. Bridging of DOACs cannot be recommended.
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78
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A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps. Neurosurg Rev 2022; 45:2077-2085. [PMID: 35290550 DOI: 10.1007/s10143-022-01768-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are a significant cause of anxiety and depression. Though the annual rupture rate is relatively low, ensuing mortality and morbidity may be high. Most published studies have focused on functional outcomes; however, limited studies have explored and reported on psychiatric outcomes, which are equally important. We aimed to review existing data on anxiety and depression in patients with UIAs. We systematically searched the databases of Pubmed, Cochrane, Scopus, EBSCOHOST, and ClinicalTrials.gov for studies that reported on anxiety and depression in patients with UIAs. Where available, we also reported data on aneurysm characteristics, treatment modalities, and functional outcomes of these populations. We performed a meta-analysis of proportions by random-effects modeling to compute the prevalence of anxiety and depression in patients with UIAs. Eighteen studies reporting a total of 1413 patients with UIAs were included in the systematic review. The mean age was 57.8 (range 27-79); 64% of whom were female. Random-effect modeling analysis showed an overall estimated prevalence of 28% [95% CI: 0.17-0.42] for anxiety and 21% [95% CI: 0.13-0.33] for depression among patients with UIAs. No significant difference was found in the prevalence of these conditions between treated vs untreated aneurysms. Our review highlights the heterogeneity of data from existing studies and the lack of standardized methodologies in determining psychiatric outcomes in patients with UIAs. It was also limited by the small sample sizes and patient counseling bias in the included studies. Larger, well-designed epidemiologic studies on patients with UIA should include more representative samples, assess for predictors of psychological outcomes, and explore the most optimal psychiatric assessment tools.
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79
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Timmins K, Kuijf H, Vergouwen M, Ruigrok Y, Velthuis B, van der Schaaf I. Relationship between 3D Morphologic Change and 2D and 3D Growth of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2022; 43:416-421. [PMID: 35144935 PMCID: PMC8910794 DOI: 10.3174/ajnr.a7418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Untreated unruptured intracranial aneurysms are usually followed radiologically to detect aneurysm growth, which is associated with increased rupture risk. The ideal aneurysm size cutoff for defining growth remains unclear and also whether change in morphology should be part of the definition. We investigated the relationship between change in aneurysm size and 3D quantified morphologic changes during follow-up. MATERIALS AND METHODS We performed 3D morphology measurements of unruptured intracranial aneurysms on baseline and follow-up TOF-MRAs. Morphology measurements included surface area, compactness, elongation, flatness, sphericity, shape index, and curvedness. We investigated the relation between morphologic change between baseline and follow-up scans and unruptured intracranial aneurysm growth, with 2D and 3D growth defined as a continuous variable (correlation statistics) and a categoric variable (t test statistics). Categoric growth was defined as ≥1-mm increase in 2D length or width. We assessed unruptured intracranial aneurysms that changed in morphology and the proportion of growing and nongrowing unruptured intracranial aneurysms with statistically significant morphologic change. RESULTS We included 113 patients with 127 unruptured intracranial aneurysms. Continuous growth of unruptured intracranial aneurysms was related to an increase in surface area and flatness and a decrease in the shape index and curvedness. In 15 growing unruptured intracranial aneurysms (12%), curvedness changed significantly compared with nongrowing unruptured intracranial aneurysms. Of the 112 nongrowing unruptured intracranial aneurysms, 10 (9%) changed significantly in morphology (flatness, shape index, and curvedness). CONCLUSIONS Growing unruptured intracranial aneurysms show morphologic change. However, nearly 10% of nongrowing unruptured intracranial aneurysms change in morphology, suggesting that they could be unstable. Future studies should investigate the best growth definition including morphologic change and size to predict aneurysm rupture.
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Affiliation(s)
- K.M. Timmins
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - H.J. Kuijf
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - M.D.I. Vergouwen
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Y.M. Ruigrok
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - B.K. Velthuis
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - I.C. van der Schaaf
- Department of Radiology (B.K.V., I.C.v.d.S.), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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80
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Rahmani R, Baranoski JF, Albuquerque FC, Lawton MT, Hashimoto T. Intracranial aneurysm calcification – A narrative review. Exp Neurol 2022; 353:114052. [DOI: 10.1016/j.expneurol.2022.114052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
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81
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Wu Q, Xu S, Wang C, Ji Z, Li Y, Sun B, Meng Y, Shi H, Wu P. Endovascular Management of Vertebrobasilar Trunk Artery Large Aneurysms: Complications and Long-Term Results. Front Neurol 2022; 13:839219. [PMID: 35250840 PMCID: PMC8894876 DOI: 10.3389/fneur.2022.839219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/19/2022] [Indexed: 12/11/2022] Open
Abstract
Objective To analyze the complications and long-term results of endovascular management of vertebrobasilar trunk large (≥10 mm) aneurysms (VBTLAs) and identify predictors of outcomes. Methods Between 2014 and 2020, 6,987 patients with intracranial aneurysms were referred to our center for aneurysm management and 2,224 patients have undergone the endovascular procedures. We retrospectively reviewed the database and identify all the patients with VBTLAs. Results A total of 62 VBTLAs were identified. The median aneurysm size was 13.4 mm [interquartile range (IQR) 11.5–18.7]. Among them, 24 aneurysms were treated with overlapping stent techniques, 18 aneurysms were treated with flow diversion, 14 aneurysms were treated with single stent-assisted coiling, and 6 aneurysms were treated with coiling alone. Ten patients were treated with parent artery occlusion or unilateral vertebral artery occlusion. Periprocedural complications were occurred in 7 (11.3%) patients. Clinical follow-up was obtained at the median of 27.5 months (IQR 15.3–58.5). The overall complication rate was 16.1% (10/62), including nine ischemic events and one hemorrhagic event. The combined disability and neurological mortality rate was 12.9% (8/62), with 4 (6.5%) deaths. The favorable outcome rate at follow-up was 87.1% (54/62). The complication-free cumulative survival rates at 1 and 5 years were 86.8 and 82.0%, respectively. The overall cumulative survival rates at 1 and 5 year were 96.5 and 89.8%, respectively. In the multivariate Cox regression analysis, longer procedure time (>115 min) (P = 0.037) and ischemic onset (P = 0.005) predict complications. Angiography follow-up was available for 36 patients at the median of 6.0 months (IQR 6–12), with a complete occlusion rate of 77.8% (28/36). Two (5.6%) aneurysms were recanalized and subsequently received the retreatment. Subgroup analysis did not find any differences in the complete occlusion rate between endovascular strategies. Conclusion Endovascular management of VBTLAs has a reasonable safety profile with favorable 5-year cumulative survival rates and imaging outcomes at follow-up. Prolonged procedure and ischemic onset are associated with a high risk of overall complications.
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82
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Nussbaum ES, Touchette JC, Madison MT, Goddard JK, Lassig JP, Meyers ME, Torok CM, Carroll JJ, Lowary J, Janjua T, Nussbaum LA. Procedural complications in patients undergoing microsurgical treatment of unruptured intracranial aneurysms: a single-center experience with 1923 aneurysms. Acta Neurochir (Wien) 2022; 164:525-535. [PMID: 34562151 DOI: 10.1007/s00701-021-04996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the growing use of endovascular therapy (EVT) to manage unruptured intracranial aneurysms (IAs), detailed information regarding periprocedural complication rates of microsurgical clipping and EVT becomes increasingly important in determining the optimal treatment for individual cases. We report the complication rates associated with open microsurgery in a large series of unruptured IAs and highlight the importance of maintaining surgical skill in the EVT era. METHODS We reviewed all cases of unruptured IAs treated with open microsurgery by a single neurosurgeon between July 1997 and June 2019. We analyzed surgical complications, deaths, and patient-reported outcomes. RESULTS A total of 1923 unruptured IAs in 1750 patients (mean age 44 [range: 6-84], 62.0% [1085/1750] female) were treated surgically during the study period. Of the aneurysms treated, 84.9% (1632/1923) were small, 11.1% (213/1923) were large, and 4.1% (78/1923) were giant. Aneurysm locations included the middle cerebral artery (44.2% [850/1923]), internal carotid artery (29.1% [560/1923]), anterior cerebral artery (21.0% [404/1923]), and vertebrobasilar system (5.7% [109/1923]). The overall mortality rate was 0.3% (5/1750). Surgical complications occurred in 7.4% (129/1750) of patients, but only 0.4% (7/1750) experienced permanent disability. The majority of patients were able to return to their preoperative lifestyles with no modifications (95.9% [1678/1750]). CONCLUSIONS At a high-volume, multidisciplinary center, open microsurgery in carefully selected patients with unruptured IAs yields favorable clinical outcomes with low complication rates. The improvement of EVT techniques and the ability to refer cases for EVT when a high complication rate with open microsurgery was expected have contributed to an overall decrease in surgical complication rates. These results may serve as a useful point of reference for physicians involved in treatment decision-making for patients with unruptured IAs.
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83
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Endo H, Mori N, Mugikura S, Niizuma K, Omodaka S, Takase K, Tominaga T. Quantitative assessment of microstructural evolution of intracranial aneurysm wall by vessel wall imaging. Neuroradiology 2022; 64:1343-1350. [PMID: 34997283 DOI: 10.1007/s00234-021-02877-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate new quantitative parameters of aneurysm wall enhancement (AWE) on magnetic resonance vessel wall imaging (VWI) in differentiating between the stable and evolving unruptured intracranial aneurysms (UIAs). METHODS Thirty-eight consecutive patients with UIAs (27 stable and 11 evolving) underwent VWI with contrast-enhanced 3D T1 volume isotropic turbo spin echo acquisition. The voxel-based enhancement maps were created using pre- and post-contrast images. The aneurysmal lumen with signal suppression by black-blood method was segmented. Then, one voxel outer and inner layers of the lumen contour were automatically segmented. The shape features of the aneurysms and AWE of the two layers were compared between stable and evolving groups. RESULTS The shape features, including aneurysm volume, surface, and compacity were significantly different between the stable and evolving groups (P = 0.024, 0.028, and 0.033, respectively). Stable and evolving groups also differed significantly in the AWE at the union of outer and inner layers of the aneurysm wall (P = 0.0082) but not in that of the outer or inner layer alone. Multivariate logistic regression analysis revealed significant differences in aneurysm volume, surface, and AWE at the union of outer and inner layers between the two groups (P = 0.0029, 0.0092, and 0.0033, respectively). Receiver operating characteristics curve analysis revealed that the area under the curve of the logistic regression model was 0.89. CONCLUSION Quantitative combined analysis of aneurysm shape features and AWE of the union of outer and inner layers were effective for differentiating between stable and evolving UIAs.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.,Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunsuke Omodaka
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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84
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Three-dimensional printing-assisted precision microcatheter shaping in intracranial aneurysm coiling. Neurosurg Rev 2022; 45:1773-1782. [PMID: 34993691 DOI: 10.1007/s10143-021-01703-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Optimal microcatheter shaping is essential for successful endovascular coiling procedures which is sometimes challenging. Our aim was not only to introduce a new shaping method using three-dimensional (3D) printed vessel models but also to prove its feasibility, efficiency and superiority. This was a retrospective cohort study. From September 2019 to March 2021, 32 paraclinoid aneurysms managed with endovascular coiling were retrospectively included and identified. Sixteen aneurysms were coiled using 3D microcatheter shaping method (3D shaping group), and traditional manual shaping method using shaping mandrels was adopted for another 16 patients (control group). The cost and angiographical and clinical outcomes between the two groups were compared, and the feasibility and effectiveness of the new 3D shaping method were evaluated and described in detail. With technical success achieved in 93.75%, most of the 16 shaped microcatheters using new shaping method could be automatically navigated into the target aneurysms without the assistance of microguidewires and could be assessed with favorable accessibility, positioning and stability. Twenty-seven out of 32 aneurysms (84.38%) were completely occluded with the rate of perioperative complications being 12.50%. Although there was no significant difference between the occlusion rates and complication rates of the two groups, the new shaping method could dramatically decrease the number of coils deployed and reduce the overall procedure time. Patient specific shaping of microcatheters using 3D printing may facilitate easier and safer procedures in coil embolization of intracranial aneurysms with shorter surgery time and less coils deployed.
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85
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Zuurbier CCM, Molenberg R, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, Jääskeläinen JE, Koivisto T, Yamazaki T, Uyttenboogaart M, van Dijk JMC, Aalbers MW, Morita A, Tominari S, Arai H, Nozaki K, Murayama Y, Ishibashi T, Takao H, Gondar R, Bijlenga P, Rinkel GJE, Greving JP, Ruigrok YM. Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis. Stroke 2022; 53:362-369. [PMID: 34983236 PMCID: PMC8785514 DOI: 10.1161/strokeaha.121.035187] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. Methods: We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. Results: We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89–1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58–0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07–1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02–1.90). Conclusions: Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.
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Affiliation(s)
- Charlotte C M Zuurbier
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Liselore A Mensing
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Finland (S.J.)
| | - Antti E Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Juha E Jääskeläinen
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Timo Koivisto
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.)
| | - Maarten Uyttenboogaart
- Department of Neurology and Medical Imaging Center, University Medical Center Groningen, the Netherlands. (M.U.)
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Akio Morita
- Medical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.)
| | - Shinjiro Tominari
- Department of Health Informatics, School of Public Health, Kyoto University, Japan (S.T.)
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University- Medical School, Tokyo, Japan (H.A.)
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Japan (K.N.)
| | - Yuichi Murayama
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Toshihiro Ishibashi
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Hiroyuki Takao
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Renato Gondar
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Gabriel J E Rinkel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. (J.P.G.)
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
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86
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Dandurand C, Zhou L, Prakash S, Redekop G, Gooderham P, Haw CS. Cost-effectiveness analysis in patients with an unruptured cerebral aneurysm treated with observation or surgery. J Neurosurg 2021; 135:1608-1616. [PMID: 33962376 DOI: 10.3171/2020.11.jns202892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main goal of preventive treatment of unruptured intracranial aneurysms (UIAs) is to avoid the morbidity and mortality associated with aneurysmal subarachnoid hemorrhage. A comparison between the conservative approach and the surgical approach combining endovascular treatment and microsurgical clipping is currently lacking. This study aimed to conduct an updated evaluation of cost-effectiveness comparing the two approaches in patients with UIA. METHODS A decision tree with a Markov model was developed. Quality-adjusted life-years (QALYs) associated with living with UIA before and after treatment were prospectively collected from a cohort of patients with UIA at a tertiary center. Other inputs were obtained from published literature. Using Monte Carlo simulation for patients aged 55, 65, and 75 years, the authors modeled the conservative management in comparison with preventive treatment. Different proportions of endovascular and microsurgical treatment were modeled to reflect existing practice variations between treatment centers. Outcomes were assessed in terms of QALYs. Sensitivity analyses to assess the model's robustness and completed threshold analyses to examine the influence of input parameters were performed. RESULTS Preventive treatment of UIAs consistently led to higher utility. Models using a higher proportion of endovascular therapy were more cost-effective. Models with older cohorts were less cost-effective than those with younger cohorts. Treatment was cost-effective (willingness to pay < 100,000 USD/QALY) if the annual rupture risk exceeded a threshold between 0.8% and 1.9% in various models based on the proportion of endovascular treatment and cohort age. A higher proportion of endovascular treatments and younger age lowered this threshold, making the treatment of aneurysms with a lower risk of rupture more cost-effective. CONCLUSIONS Preventive treatment of aneurysms led to higher utility compared with conservative management. Models with a higher proportion of endovascular treatment and younger patient age were most cost-effective.
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Affiliation(s)
- Charlotte Dandurand
- Faculty of Medicine, Divisions of1Neurosurgery and
- 2T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Lily Zhou
- 2T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- 3Neurology, University of British Columbia, Vancouver, Canada; and
| | | | - Gary Redekop
- Faculty of Medicine, Divisions of1Neurosurgery and
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87
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van der Kamp LT, Rinkel GJE, Verbaan D, van den Berg R, Vandertop WP, Murayama Y, Ishibashi T, Lindgren A, Koivisto T, Teo M, St George J, Agid R, Radovanovic I, Moroi J, Igase K, van den Wijngaard IR, Rahi M, Rinne J, Kuhmonen J, Boogaarts HD, Wong GKC, Abrigo JM, Morita A, Shiokawa Y, Hackenberg KAM, Etminan N, van der Schaaf IC, Zuithoff NPA, Vergouwen MDI. Risk of Rupture After Intracranial Aneurysm Growth. JAMA Neurol 2021; 78:1228-1235. [PMID: 34459846 DOI: 10.1001/jamaneurol.2021.2915] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Unruptured intracranial aneurysms not undergoing preventive endovascular or neurosurgical treatment are often monitored radiologically to detect aneurysm growth, which is associated with an increase in risk of rupture. However, the absolute risk of aneurysm rupture after detection of growth remains unclear. Objective To determine the absolute risk of rupture of an aneurysm after detection of growth during follow-up and to develop a prediction model for rupture. Design, Setting, and Participants Individual patient data were obtained from 15 international cohorts. Patients 18 years and older who had follow-up imaging for at least 1 untreated unruptured intracranial aneurysm with growth detected at follow-up imaging and with 1 day or longer of follow-up after growth were included. Fusiform or arteriovenous malformation-related aneurysms were excluded. Of the 5166 eligible patients who had follow-up imaging for intracranial aneurysms, 4827 were excluded because no aneurysm growth was detected, and 27 were excluded because they had less than 1 day follow-up after detection of growth. Exposures All included aneurysms had growth, defined as 1 mm or greater increase in 1 direction at follow-up imaging. Main Outcomes and Measures The primary outcome was aneurysm rupture. The absolute risk of rupture was measured with the Kaplan-Meier estimate at 3 time points (6 months, 1 year, and 2 years) after initial growth. Cox proportional hazards regression was used to identify predictors of rupture after growth detection. Results A total of 312 patients were included (223 [71%] were women; mean [SD] age, 61 [12] years) with 329 aneurysms with growth. During 864 aneurysm-years of follow-up, 25 (7.6%) of these aneurysms ruptured. The absolute risk of rupture after growth was 2.9% (95% CI, 0.9-4.9) at 6 months, 4.3% (95% CI, 1.9-6.7) at 1 year, and 6.0% (95% CI, 2.9-9.1) at 2 years. In multivariable analyses, predictors of rupture were size (7 mm or larger hazard ratio, 3.1; 95% CI, 1.4-7.2), shape (irregular hazard ratio, 2.9; 95% CI, 1.3-6.5), and site (middle cerebral artery hazard ratio, 3.6; 95% CI, 0.8-16.3; anterior cerebral artery, posterior communicating artery, or posterior circulation hazard ratio, 2.8; 95% CI, 0.6-13.0). In the triple-S (size, site, shape) prediction model, the 1-year risk of rupture ranged from 2.1% to 10.6%. Conclusion and Relevance Within 1 year after growth detection, rupture occurred in approximately 1 of 25 aneurysms. The triple-S risk prediction model can be used to estimate absolute risk of rupture for the initial period after detection of growth.
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Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yuichi Murayama
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Antti Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neuroradiology, Joint Department of Medical Imaging and Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Junta Moroi
- Department of Surgical Neurology, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Keiji Igase
- Department of Advanced Neurosurgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
| | | | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Johanna Kuhmonen
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - George K C Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong, China
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Basement, Yue Kong Pao Centre for Cancer and the Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Hong Kong, China
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolaas P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
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88
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De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam W, Stockx L. The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center. Interv Neuroradiol 2021; 27:594-601. [PMID: 33745363 PMCID: PMC8493345 DOI: 10.1177/15910199211003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. MATERIALS AND METHODS Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37-80). RESULTS Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3-13 mm).In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01-6.5%) and mortality was 0% (0 of 93, 95%CI 0.0-4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7-13.6%). CONCLUSION WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.
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Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Wim van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - Luc Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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89
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Al Saiegh F, Velagapudi L, Khanna O, Sweid A, Mouchtouris N, Baldassari MP, Theofanis T, Tahir R, Schunemann V, Andrews C, Philipp L, Chalouhi N, Tjoumakaris SI, Hasan D, Gooch MR, Herial NA, Rosenwasser RH, Jabbour P. Predictors of aneurysm occlusion following treatment with the WEB device: systematic review and case series. Neurosurg Rev 2021; 45:925-936. [PMID: 34480649 DOI: 10.1007/s10143-021-01638-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
The Woven EndoBridge (WEB) device is becoming increasingly popular for treatment of wide-neck aneurysms. As experience with this device grows, it is important to identify factors associated with occlusion following WEB treatment to guide decision making and screen patients at high risk for recurrence. The aim of this study was to identify factors associated with adequate aneurysm occlusion following WEB device treatment in the neurosurgical literature and in our case series. A systematic review of the present literature was conducted to identify studies related to the prediction of WEB device occlusion. In addition, a retrospective review of our institutional data for patients treated with the WEB device was performed. Demographics, aneurysm characteristics, procedural variables, and 6-month follow-up angiographic outcomes were recorded. Seven articles totaling 450 patients with 456 aneurysms fit our criteria. Factors in the literature associated with inadequate occlusion included larger size, increased neck width, partial intrasaccular thrombosis, irregular shape, and tobacco use. Our retrospective review identified 43 patients with 45 aneurysms. A total of 91.1% of our patients achieved adequate occlusion at a mean follow-up time of 7.32 months. Increasing degree of contrast stasis after WEB placement on the post-deployment angiogram was significantly associated with adequate occlusion on follow-up angiogram (p = 0.005) and with Raymond-Roy classification (p = 0.048), but not with retreatment (p = 0.617). In our systematic review and case series totaling 450 patients with 456 aneurysms, contrast stasis on post-deployment angiogram was identified as a predictor of adequate aneurysm occlusion, while morphological characteristics such as larger size and wide neck negatively impact occlusion.
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Affiliation(s)
- Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lohit Velagapudi
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikolaos Mouchtouris
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael P Baldassari
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thana Theofanis
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rizwan Tahir
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Victoria Schunemann
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carrie Andrews
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lucas Philipp
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | | | - David Hasan
- Department of Neurological Surgery, University of Iowa Hospitals, Iowa City, IA, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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90
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Heo YJ, Jeong HW, Kim D, Baek JW, Han JY, Choo HJ, Kim ST, Jeong YG, Jin SC. Usefulness of pointwise encoding time reduction with radial acquisition sequence in subtraction-based magnetic resonance angiography for follow-up of the Neuroform Atlas stent-assisted coil embolization for cerebral aneurysms. Acta Radiol 2021; 62:1193-1199. [PMID: 32867507 DOI: 10.1177/0284185120952784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although time-of-flight magnetic resonance angiography (TOF-MRA) is widely used, it has limited usefulness for follow-up after stent-assisted coil embolization. Contrast-enhanced MRA (CE-MRA) and ultrashort echo time MRA have been suggested as alternative methods for visualization after this procedure. PURPOSE To compare efficacy and usefulness of pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA), TOF-MRA, and CE-MRA during the follow-up after Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. MATERIAL AND METHODS This retrospective study included 23 patients with 24 aneurysms who underwent Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. All patients were evaluated with PETRA qMRA, TOF-MRA, and CE-MRA at the same follow-up session. The flow within stents, occlusion status, and presence of pseudo-stenosis were evaluated; inter-observer and intermodality agreements for the three methods were also graded. RESULTS The mean score for flow visualization within the stents was significantly higher for PETRA qMRA and CE-MRA than for TOF-MRA (although no significant difference was found between PETRA qMRA and CE-MRA). Good inter-observer agreement was observed for each modality. PETRA qMRA and CE-MRA were more consistent with digital subtraction angiography (DSA) than TOF-MRA for aneurysm occlusion status. The intermodality agreement was better between PETRA qMRA and DSA, and between CE-MRA and DSA, than between DSA and TOF-MRA. Pseudo-stenosis was most frequently observed in TOF-MRA, followed by CE-MRA and PETRA qMRA. CONCLUSION PETRA qMRA is useful for evaluating the parent artery patency and occlusion status of aneurysms after Neuroform Atlas stent-assisted coil embolization.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hae Woong Jeong
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jin Wook Baek
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Ji-yeon Han
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hye Jung Choo
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Young Gyun Jeong
- Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
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91
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Timmins KM, Kuijf HJ, Vergouwen MDI, Otten MJ, Ruigrok YM, Velthuis BK, van der Schaaf IC. Reliability and Agreement of 2D and 3D Measurements on MRAs for Growth Assessment of Unruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2021; 42:1598-1603. [PMID: 34210663 DOI: 10.3174/ajnr.a7186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reliable and reproducible measurement of unruptured intracranial aneurysm growth is important for unruptured intracranial aneurysm rupture risk assessment. This study aimed to compare the reliability and reproducibility of 2D and 3D growth measurements of unruptured intracranial aneurysms. MATERIALS AND METHODS 2D height, width, and neck and 3D volume measurements of unruptured intracranial aneurysms on baseline and follow-up TOF-MRAs were performed by two observers. The reliability of individual 2D and 3D measurements and of change (growth) between paired scans was assessed (intraclass correlation coefficient) and stratified for aneurysm location. The smallest detectable change on 2D and 3D was determined. Proportions of growing aneurysms were compared, and Bland-Altman plots were created. RESULTS Seventy-two patients with 84 unruptured intracranial aneurysms were included. The interobserver reliability was good-to-excellent for individual measurements (intraclass correlation coefficient > 0.70), poor for 2D change (intraclass correlation coefficient < 0.5), and good for 3D change (intraclass correlation coefficient = 0.76). For both 2D and 3D, the reliability was location-dependent and worse for irregularly shaped aneurysms. The smallest detectable changes for 2D height, width, and neck and 3D volume measurements were 1.5 , 2.0, and 1.9 mm and 0.06 mL, respectively. The proportion of growing unruptured intracranial aneurysms decreased from 10% to 2%, depending on the definition of growth (1 mm or the smallest detectable changes for 2D and 3D). CONCLUSIONS The interobserver reliability of the size measurements of individual 2D and 3D unruptured intracranial aneurysms was good-to-excellent but lower for 2D and 3D growth measurements. For growth assessment, 3D measurements are more reliable than 2D measurements. The smallest detectable change for 2D measurements was larger than 1 mm, the current clinical definition of unruptured intracranial aneurysm growth.
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Affiliation(s)
- K M Timmins
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | - H J Kuijf
- From the Image Sciences Institute (K.M.T., H.J.K.)
| | | | - M J Otten
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Y M Ruigrok
- Department of Neurology and Neurosurgery (M.D.I.V., Y.M.R.)
| | - B K Velthuis
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
| | - I C van der Schaaf
- , UMC Utrecht Brain Center, and Department of Radiology (M.J.O., B.K.V., I.C.v.d.S), University Medical Center Utrecht, Utrecht, the Netherlands
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92
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Feghali J, Gami A, Rapaport S, Patel J, Khalafallah AM, Huq S, Mukherjee D, Tamargo RJ, Huang J. Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms. J Neurosurg 2021; 136:456-463. [PMID: 34388727 DOI: 10.3171/2021.2.jns204420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. METHODS A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006-2017). RESULTS The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (β = 0.6 and p = 0.009 for mFI-5; β = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p < 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p < 0.001 for mFI-5; c-statistic = 0.610 and p < 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003). CONCLUSIONS mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.
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93
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Hong N, Cho WS, Pang CH, Choi YH, Bae JW, Ha EJ, Lee SH, Kim KM, Kang HS, Kim JE. Treatment outcomes of 1-stage clipping of multiple unruptured intracranial aneurysms via keyhole approaches. J Neurosurg 2021; 136:475-484. [PMID: 34388719 DOI: 10.3171/2021.1.jns204078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complete exclusion of multiple unruptured intracranial aneurysms (UIAs) in one session of intervention may be ideal. However, such situations are not always feasible in terms of treatment modalities and outcomes. The authors aimed to analyze their experience with 1-stage clipping of multiple UIAs. METHODS Medical records between March 2013 and December 2018 were retrospectively reviewed, and 111 1-stage keyhole approaches in 110 patients with 261 multiple UIAs were ultimately included in this study. Clinical and radiological outcomes were analyzed, as well as postoperative complications up to 1 month after the surgery and their risk factors. RESULTS Keyhole approaches included unilateral supraorbital in 87 operations (78.4%), bilateral supraorbital in 12 (10.8%), and others in 12. The mean operative duration was 169.6 minutes (range 80-490 minutes). The highest numbers of aneurysms clipped at once were 2 (73.9%) and 3 (18.9%). Complete exclusion and residual neck of the clipped aneurysms were achieved in 89.3% and 7.3%, respectively. There was no significant difference between pre- and postoperative 1-month neurological states (p = 0.14). The permanent morbidity rate was 1.8% (n = 2), and there were no deaths. Postoperative transient neurological deterioration (TND) with no radiological and electrophysiological abnormalities occurred in 8 operations (7.2%). Hypertension was the only significant risk factor for postoperative TND (adjusted odds ratio 17.03, 95% confidence interval 1.99-2232.24, p = 0.01). CONCLUSIONS One-stage clipping of multiple UIAs via keyhole approaches showed satisfactory treatment outcomes with a low permanent morbidity. Patients with chronic hypertension had a high risk of postoperative TND.
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94
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Dandurand C, Zhou L, Fitzmaurice G, Prakash S, Redekop G, Haw C, Gooderham P. Quality of life scores in patients with unruptured cerebral aneurysm: Prospective cohort study. J Clin Neurosci 2021; 91:350-353. [PMID: 34373051 DOI: 10.1016/j.jocn.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Living with the diagnosis of an unruptured cerebral aneurysm can understandably cause distress to a patient. The goal of preventive treatment is to increase the number of years with good quality of life (QoL). OBJECTIVE This study aimed to measure the effect of unruptured intracranial aneurysm treatment on change in QoL scores measured by the SF36 and EQ-5D-5L. METHODS We prospectively collected SF36 and EQ-5D-5L survey data for patients with unruptured intracranial aneurysms at two time-points over 1 year between 2 treatment groups: observation and intervention (microsurgical and endovascular). Multivariable linear regression was used to examine treatment group differences in the mean change in scores from baseline to 1 year when adjusted for covariates. RESULTS 92 patients were included in the observation group and 68 patients were included in the intervention group, for a total of 160 patients. The intervention group had lower SF36 total scores at baseline (p = 0.001). With multivariate linear regression models, the effect of treatment on mean change in SF36 total score from baseline to 1 year was not statistically significant (p = 0.4); similarly, there was no difference in mean change in EQ-5D-5L. CONCLUSION In this large prospective study, preventive aneurysm treatment was not associated with a significant change in QoL score at 1 year compared to observation as measured by the SF36 and EQ-5D-5L. Further studies are needed to explore the lower QoL scores in patients seeking treatment and its impact on management decision making.
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Affiliation(s)
- Charlotte Dandurand
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada; T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Lily Zhou
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; UBC, Faculty of Medicine, Division of Neurology, Vancouver, Canada
| | - Garrett Fitzmaurice
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Swetha Prakash
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada.
| | - Gary Redekop
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Charles Haw
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Peter Gooderham
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
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95
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Padmanaban V, Gigliotti M, Majid S, Jareczek FJ, Fritch C, Hazard SW, Zacko JC, Simon SD, Kalapos P, Church EW, Wilkinson DA, Cockroft KM. Risk Factors Associated with ICU-Specific Care in Patients Undergoing Endovascular Treatment of Unruptured Intracranial Aneurysms. Neurocrit Care 2021; 36:39-45. [PMID: 34309785 DOI: 10.1007/s12028-021-01306-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple studies suggest routine postoperative intensive care unit (ICUs) stays in presumed high-risk neurosurgical procedures may be unnecessary. Our objective was to evaluate the risk factors associated with ICU-specific needs in patients undergoing elective endovascular treatment of unruptured intracranial aneurysms. METHODS A retrospective review of consecutive patients undergoing elective endovascular treatment of unruptured aneurysms was performed between January 2010 and January 2020 in a single academic medical center. Patient demographic information, aneurysm and treatment characteristics, intraoperative and postoperative complications, as well as ICU-specific needs, were abstracted. The primary outcome was ICU-specific needs. RESULTS A total of 382 patient encounters in 344 unique patients were abstracted. 13.6% (52 of 382) of patient encounters had an ICU-specific need. Multivariate analysis revealed that age [adjusted odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, p = 0.03], procedure duration greater 200 min (adjusted OR 2.75, 95% CI 1.34-5.88, p = 0.007), and any intraoperative complication (adjusted OR 20.41, CI 7.97-56.57, p < 0.001) were independent predictors of postoperative ICU-specific needs. The majority of ICU-specific needs (94%, 49 of 52) occurred within 6 h of surgery. CONCLUSIONS Our results show that age, procedure duration greater than or equal to 200 min, and intraoperative complication were independent predictors of postoperative ICU-specific needs in patients presenting for elective endovascular treatment of unruptured intracranial aneurysms. The majority of ICU-specific needs and associated complications occurred in the immediate postoperative period. This data can be used to help decide the appropriate postoperative level of care in this patient population.
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Affiliation(s)
- Varun Padmanaban
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Michael Gigliotti
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Sonia Majid
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Francis J Jareczek
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Chanju Fritch
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Sprague W Hazard
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.,Department of Anesthesia and Perioperative Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - J Christopher Zacko
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Scott D Simon
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Paul Kalapos
- Department of Radiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ephraim W Church
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Kevin M Cockroft
- Department of Neurosurgery - EC110, 30 Hope Drive, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA. .,Department of Radiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. .,Department of Public Health Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
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96
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Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc 2021; 96:1970-2000. [PMID: 33992453 DOI: 10.1016/j.mayocp.2021.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
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Affiliation(s)
- Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
| | - Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport
| | | | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL
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97
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Abstract
Background Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after aneurysmal subarachnoid hemorrhage, prevention of aneurysmal subarachnoid hemorrhage has the highest potential to prevent poor outcome from aneurysmal subarachnoid hemorrhage. Aim In this review, we describe the groups at high risk of aneurysmal subarachnoid hemorrhage who may benefit from preventive screening for unruptured intracranial aneurysms followed by preventive treatment of unruptured intracranial aneurysms found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening. Summary of review Modeling studies show that persons with two or more affected first-degree relatives with aneurysmal subarachnoid hemorrhage and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for unruptured intracranial aneurysms. One modeling study also suggests that persons with only one affected first-degree relative with aneurysmal subarachnoid hemorrhage are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of aneurysmal subarachnoid hemorrhage of up to 7%, but the prevalence of unruptured intracranial aneurysms in such persons and the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening –such as risk of incidental findings, very small unruptured intracranial aneurysms that require regular follow-up, preventive treatment with inherent risk of complications and anxiety – should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged. Conclusions Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all aneurysmal subarachnoid hemorrhage patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of unruptured intracranial aneurysm become available, the groups of persons who may benefit from screening could increase considerably.
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Affiliation(s)
- Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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98
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Rutledge C, Raper DMS, Jonzzon S, Raygor KP, Pereira MP, Winkler EA, Zhang L, Lawton MT, Abla AA. Sensitivity of the Unruptured Intracranial Aneurysm Treatment Score (UIATS) in the Elderly: Retrospective Analysis of Ruptured Aneurysms. World Neurosurg 2021; 152:e673-e677. [PMID: 34129975 DOI: 10.1016/j.wneu.2021.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The prevalence of intracranial aneurysms, as well as the incidence of subarachnoid hemorrhage (SAH), increase with age, and the elderly have poor outcomes after SAH. Age is a key factor in the unruptured intracranial aneurysm treatment score (UIATS),but the sensitivity of the UIATS model in detecting risk of SAH among the elderly is unknown. METHODS We retrospectively analyzed 153 consecutive cases of ruptured aneurysms between 2012 and 2018. We used Fisher's exact test, analysis of variance, and multivariate logistic regression to compare outcomes between those >65 years of age and those younger. We then applied the UIATS model and evaluated the sensitivity of the model as a predictor of SAH in the elderly compared with younger patients. RESULTS Elderly patients made up 32% (n = 49 of 153) of our cohort. They had significantly higher in-hospital mortality (19 of 49, 39%) than younger patients (14 of 104, 13%) (P < 0.01). In a multivariate logistic regression, controlling for Hunt-Hess grade and comorbidities, age >65 years remained a significant predictor of unfavorable outcome at discharge (P = 0.03). The UIATS model had low sensitivity in the elderly compared with younger patients: 63% (59 of 136) of younger patients would have been recommended aneurysm repair had their aneurysm been detected unruptured, compared with only 12% (5 of 42) of elderly patients >65 years (P < 0.01). CONCLUSIONS Elderly patients >65 years in age have far worse outcomes after SAH. The sensitivity of the UIATS model for detecting those at risk of SAH was significantly lower in elderly patients. The UIATS model may lead to undertreatment of elderly patients at risk of SAH.
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Affiliation(s)
- Caleb Rutledge
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Daniel M S Raper
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Soren Jonzzon
- School of Medicine, University of California, San Francisco, California, USA
| | - Kunal P Raygor
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael T Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, California, USA.
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99
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Daou BJ, Muhlestein WE, Palmateer G, Thompson BG, Pandey AS. Clipping of unruptured intracranial aneurysms in patients older than sixty: An age-based analysis. Clin Neurol Neurosurg 2021; 207:106737. [PMID: 34134009 DOI: 10.1016/j.clineuro.2021.106737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The diagnosis of unruptured intracranial aneurysms (UIAs) is being made more frequently in elderly patients. The goal of this study is to evaluate complications and clinical outcome in patients ≥ 60 years-old who underwent clipping of UIAs. METHODS We performed a retrospective cohort study. Clinical outcome (modified Rankin scale score) was determined at the latest clinical follow-up. Complications and outcomes were compared between age groups (60-69, 70-80) and subgroups (60-64, 65-69, 70-74, and >75). RESULTS The study population consisted of 255 patients (range 60-80 years-old) who underwent 262 clipping procedures for UIAs. Mean follow-up duration was 15.6 months (± 27.5). Major complications occurred in 20 patients (7.6%) and mortality in 3 patients (1.1%). Medical complications occurred in 26 patients (10%). Mean length of hospital-stay was 4.7 days (± 5.8). 89.6% were discharged to home. 87.8% had a favorable clinical outcome. The 70-80 age group had significantly more complications (P = 0.03) than the 60-69 group and a significantly longer hospital stay (6.02 vs. 4.3 days, P = 0.04). The older group was less likely to discharge to home and more likely to require rehabilitation (P = 0.002). Favorable clinical outcome did not significantly differ between the two groups (85.7% vs. 88.4%, P = 0.56). There was a trend for increasing complications from the younger to older subgroups (P = 0.008) and a reduction in the likelihood to discharge to home (P < 0.0001). The rate of ultimate favorable clinical outcome did not differ significantly between subgroups (P = 0.79). CONCLUSION Although complications, length of hospital-stay, and discharge to non-home destinations increase with older age, the majority of patients ≥ 60 may have favorable clinical outcomes.
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Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Gregory Palmateer
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States.
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100
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Allgaier M, Neyazi B, Preim B, Saalfeld S. Distance and force visualisations for improved simulation of intracranial aneurysm clipping. Int J Comput Assist Radiol Surg 2021; 16:1297-1304. [PMID: 34053014 PMCID: PMC8295166 DOI: 10.1007/s11548-021-02413-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022]
Abstract
Purpose The treatment of cerebral aneurysms shifted from microsurgical to endovascular therapy. But for some difficult aneurysm configurations, e.g. wide neck aneurysms, microsurgical clipping is better suited. From this combination of limited interventions and the complexity of these cases, the need for improved training possibilities for young neurosurgeons arises. Method We designed and implemented a clipping simulation that requires only a monoscopic display, mouse and keyboard. After a virtual craniotomy, the user can apply a clip at the aneurysm which is deformed based on a mass–spring model. Additionally, concepts for visualising distances as well as force were implemented. The distance visualisations aim to enhance spatial relations, improving the navigation of the clip. The force visualisations display the force acting on the vessel surface by the applied clip. The developed concepts include colour maps and visualisations based on rays, single objects and glyphs. Results The concepts were quantitatively evaluated via an online survey and qualitatively evaluated by a neurosurgeon. Regarding force visualisations, a colour map is the most appropriate concept. The necessity of distance visualisations became apparent, as the expert was unable to estimate distances and to properly navigate the clip. The distance rays were the only concept supporting the navigation appropriately. Conclusion The easily accessible surgical training simulation for aneurysm clipping benefits from a visualisation of distances and simulated forces.
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Affiliation(s)
- Mareen Allgaier
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Belal Neyazi
- University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Bernhard Preim
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.,Forschungscampus STIMULATE, Magdeburg, Germany
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