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Wang C, Han Y, Li X. Plasma proteomics analysis reveals potential biomarkers for intracranial aneurysm formation and rupture. J Proteomics 2024; 303:105216. [PMID: 38849112 DOI: 10.1016/j.jprot.2024.105216] [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: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
The aim of this study was to investigate the plasma proteome in individuals with intracranial aneurysms (IAs) and identify biomarkers associated with the formation and rupture of IAs. Proteomic profiles (N = 1069 proteins) were assayed in plasma (N = 120) collected from patients with ruptured and unruptured intracranial aneurysms (RIA and UIA), traumatic subarachnoid hemorrhage (tSAH), and healthy controls (HC) using tandem mass tag (TMT) labeling quantitative proteomics analysis. Gene ontology (GO) and pathway analysis revealed that these relevant proteins were involved in immune response and extracellular matrix organization pathways. Seven candidate biomarkers were verified by ELISA in a completely separate cohort for validation (N = 90). Among them, FN1, PON1, and SERPINA1 can be utilized as diagnosis biomarkers of IA, with a combined area under the ROC curve of 0.891. The sensitivity was 93.33%, specificity was 75.86%, and accuracy was 87.64%. PFN1, ApoA-1, and SERPINA1 can serve as independent risk factors for predicting aneurysm rupture. The combined prediction of aneurysm rupture yielded an area under the ROC curve of 0.954 with a sensitivity of 96.15%, specificity of 81.48%, and accuracy of 88.68%. This prediction model was more effective than PHASES score. In conclusion, high-throughput proteomics analysis with population validation was performed to assess blood-based protein expression characteristics. This revealed the potential mechanism of IA formation and rupture, facilitating the discovery of biomarkers. SIGNIFICANCE: Although the annual rupture rate of small unruptured aneurysms is believed to be minimal, studies have indicated that ruptured aneurysms typically have an average size of 6.28 mm, with 71.8% of them being <7 mm in diameter. Hence, evaluating the possibility of rupture in UIA and making a choice between aggressive treatment and conservative observation emerges as a significant challenge in the management of UIA. No biomarker or scoring system has been able to satisfactorily address this issue to date. It would be significant to develop biomarkers that could be used for early diagnosis of IA as well as for prediction of IA rupture. After TMT proteomics analysis and ELISA validation in independent populations, we found that FN1, PON1, and SERPINA1 can be utilized as diagnostic biomarkers for IA, and PFN1, ApoA-1, and SERPINA1 can serve as independent risk factors for predicting aneurysm rupture. Especially, when combined with ApoA-1, SERPINA1, and PFN1 for predicting IA rupture, the area under the curve (AUC) was 0.954 with a sensitivity of 96.15%, specificity of 81.48%, and accuracy of 88.68%. This prediction model was more effective than PHASES score.
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Affiliation(s)
- Chenchen Wang
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Yuwei Han
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Xiaoming Li
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China.
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van der Kamp LT, Edjlali M, Naggara O, Matsushige T, Bulters DO, Digpal R, Zhu C, Saloner D, Hu P, Zhai X, Mossa-Basha M, Tian B, Sakamoto S, Fu Q, Ruigrok YM, Zhao H, Chen H, Rinkel GJE, van der Schaaf IC, Vergouwen MDI. Gadolinium-enhanced intracranial aneurysm wall imaging and risk of aneurysm growth and rupture: a multicentre longitudinal cohort study. Eur Radiol 2024; 34:4610-4618. [PMID: 38108888 DOI: 10.1007/s00330-023-10388-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES In patients with an unruptured intracranial aneurysm, gadolinium enhancement of the aneurysm wall is associated with growth and rupture. However, most previous studies did not have a longitudinal design and did not adjust for aneurysm size, which is the main predictor of aneurysm instability and the most important determinant of wall enhancement. We investigated whether aneurysm wall enhancement predicts aneurysm growth and rupture during follow-up and whether the predictive value was independent of aneurysm size. MATERIALS AND METHODS In this multicentre longitudinal cohort study, individual patient data were obtained from twelve international cohorts. Inclusion criteria were as follows: 18 years or older with ≥ 1 untreated unruptured intracranial aneurysm < 15 mm; gadolinium-enhanced aneurysm wall imaging and MRA at baseline; and MRA or rupture during follow-up. Patients were included between November 2012 and November 2019. We calculated crude hazard ratios with 95%CI of aneurysm wall enhancement for growth (≥ 1 mm increase) or rupture and adjusted for aneurysm size. RESULTS In 455 patients (mean age (SD), 60 (13) years; 323 (71%) women) with 559 aneurysms, growth or rupture occurred in 13/194 (6.7%) aneurysms with wall enhancement and in 9/365 (2.5%) aneurysms without enhancement (crude hazard ratio 3.1 [95%CI: 1.3-7.4], adjusted hazard ratio 1.4 [95%CI: 0.5-3.7]) with a median follow-up duration of 1.2 years. CONCLUSIONS Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not independent of aneurysm size. CLINICAL RELEVANCE STATEMENT Gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, since it appears to have no additional value to conventional predictors. KEY POINTS • Although aneurysm wall enhancement is associated with aneurysm instability in cross-sectional studies, it remains unknown whether it predicts risk of aneurysm growth or rupture in longitudinal studies. • Gadolinium enhancement of the aneurysm wall predicts aneurysm growth or rupture during short-term follow-up, but not when adjusting for aneurysm size. • While gadolinium-enhanced aneurysm wall imaging is not recommended for short-term prediction of growth and rupture, it may hold potential for aneurysms smaller than 7 mm.
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Affiliation(s)
- Laura T van der Kamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands.
| | - Myriam Edjlali
- Department of Radiology, APHP, Hôpitaux Raymond-Poincaré and Ambroise Paré, DMU Smart Imaging, Laboratoire d'imagerie Biomédicale Multimodale (BioMaps), GH Université Paris-Saclay, Université Paris-Saclay, CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Orsay, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, GHU Paris, Centre Hospitalier Sainte-Anne, Paris, France
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Diederik O Bulters
- Department of Neurosurgery, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ronneil Digpal
- Department of Neurosurgery, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Peng Hu
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Capital Medical University, Bejing, China
| | - Xiaodong Zhai
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Capital Medical University, Bejing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Shigeyuki Sakamoto
- Department of Neurosurgery and Interventional Neuroradiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Qichang Fu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
| | - Huilin Zhao
- Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijun Chen
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Bejing, China
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, University Medical Center Utrecht, room number G3-201, Postbox 85500, 3508, Utrecht, GA, The Netherlands
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3
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Kanning JP, Abtahi S, Schnier C, Klungel OH, Geerlings MI, Ruigrok YM. Prescribed Drug Use and Aneurysmal Subarachnoid Hemorrhage Incidence: A Drug-Wide Association Study. Neurology 2024; 102:e209479. [PMID: 38838229 DOI: 10.1212/wnl.0000000000209479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Current benefits of invasive intracranial aneurysm treatment to prevent aneurysmal subarachnoid hemorrhage (aSAH) rarely outweigh treatment risks. Most intracranial aneurysms thus remain untreated. Commonly prescribed drugs reducing aSAH incidence may provide leads for drug repurposing. We performed a drug-wide association study (DWAS) to systematically investigate the association between commonly prescribed drugs and aSAH incidence. METHODS We defined all aSAH cases between 2000 and 2020 using International Classification of Diseases codes from the Secure Anonymised Information Linkage databank. Each case was matched with 9 controls based on age, sex, and year of database entry. We investigated commonly prescribed drugs (>2% in study population) and defined 3 exposure windows relative to the most recent prescription before index date (i.e., occurrence of aSAH): current (within 3 months), recent (3-12 months), and past (>12 months). A logistic regression model was fitted to compare drug use across these exposure windows vs never use, controlling for age, sex, known aSAH risk factors, and health care utilization. The family-wise error rate was kept at p < 0.05 through Bonferroni correction. RESULTS We investigated exposure to 205 commonly prescribed drugs between 4,879 aSAH cases (mean age 61.4, 61.2% women) and 43,911 matched controls. We found similar trends for lisinopril and amlodipine, with a decreased aSAH risk for current use (lisinopril odds ratio [OR] 0.63, 95% CI 0.44-0.90, amlodipine OR 0.82, 95% CI 0.65-1.04) and an increased aSAH risk for recent use (lisinopril OR 1.30, 95% CI 0.61-2.78, amlodipine OR 1.61, 95% CI 1.04-2.48). A decreased aSAH risk in current use was also found for simvastatin (OR 0.78, 95% CI 0.64-0.96), metformin (OR 0.58, 95% CI 0.43-0.78), and tamsulosin (OR 0.55, 95% CI 0.32-0.93). By contrast, an increased aSAH risk was found for current use of warfarin (OR 1.35, 95% CI 1.02-1.79), venlafaxine (OR 1.67, 95% CI 1.01-2.75), prochlorperazine (OR 2.15, 95% CI 1.45-3.18), and co-codamol (OR 1.31, 95% CI 1.10-1.56). DISCUSSION We identified several drugs associated with aSAH, of which 5 drugs (lisinopril and possibly amlodipine, simvastatin, metformin, and tamsulosin) showed a decreased aSAH risk. Future research should build on these signals to further assess the effectiveness of these drugs in reducing aSAH incidence. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that some commonly prescribed drugs are associated with subsequent development of aSAH.
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Affiliation(s)
- Jos P Kanning
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Shahab Abtahi
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Christian Schnier
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Olaf H Klungel
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Mirjam I Geerlings
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Ynte M Ruigrok
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
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Repić Buličić A, Ozretić D, Radoš M, Ljevak J, Bazina Martinović A, Poljaković Skurić Z. A 5-Year Follow-Up after Endovascular Treatment of 402 Intracranial Aneurysms-A Single-Centre Experience. Biomedicines 2024; 12:1231. [PMID: 38927438 DOI: 10.3390/biomedicines12061231] [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: 04/02/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of our study was to evaluate the early and long-term clinical and morphological outcomes of the endovascular treatment of ruptured and non-ruptured intracranial aneurysms in a cohort of patients from a single centre. We retrospectively analysed the treatment outcomes of 402 endovascularly treated intracranial aneurysms with an average follow-up of 5.5 years. All included patients were treated with endovascular techniques (coil, stent or both). We analysed patient demographics, risk factors for an aneurysm rupture, aneurysm characteristics, and clinical and angiographic complications and outcomes. We analysed and compared the data from the two groups, ruptured aneurysms (RAs) and unruptured aneurysms (UAs), separately. Out of the 318 patients included, a good early clinical outcome was achieved in 78.5% of RAs and in 95.3% of UAs. No complications occurred in 87.71% of patients with UAs and in 80.45% with RAs. The periprocedural rupture rate for UAs and RAs was 0.8% and 2.2%, respectively. The rate of thromboembolic events was 4.8 and 8% for UAs and RAs, respectively. A retreatment due to the recanalisation was required in 9.21% of patients with UAs and in 16.66% of patients with RAs. The results from our centre showed an overall favourable clinical outcome with acceptable periprocedural complications for both RAs and UR aneurysms and proved the endovascular method as safe and effective in the treatment of intracranial aneurysms.
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Affiliation(s)
- Ana Repić Buličić
- Department of Neurology, University Hospital Split, 21000 Split, Croatia
| | - David Ozretić
- Department of Radiology, University Hospital Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Marko Radoš
- Department of Radiology, University Hospital Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Josip Ljevak
- Department of Neurology, University Hospital Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Antonela Bazina Martinović
- Department of Neurology, University Hospital Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Zdravka Poljaković Skurić
- Department of Neurology, University Hospital Zagreb, University of Zagreb School of Medicine, Kišpatićeva 12, 10000 Zagreb, Croatia
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Ali M, van Etten ES, Akoudad S, Schaafsma JD, Visser MC, Ali M, Cordonnier C, Sandset EC, Klijn CJM, Ruigrok YM, Wermer MJH. Haemorrhagic stroke and brain vascular malformations in women: risk factors and clinical features. Lancet Neurol 2024; 23:625-635. [PMID: 38760100 DOI: 10.1016/s1474-4422(24)00122-4] [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: 11/14/2023] [Revised: 01/18/2024] [Accepted: 03/14/2024] [Indexed: 05/19/2024]
Abstract
Haemorrhagic stroke is a severe condition with poor prognosis. Biological sex influences the risk factors, presentations, treatment, and patient outcomes of intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and vascular malformations. Women are usually older at onset of intracerebral haemorrhage compared with men but have an increased risk of aneurysmal subarachnoid haemorrhage as they age. Female-specific factors such as pregnancy, eclampsia or pre-eclampsia, postmenopausal status, and hormone therapy influence a woman's long-term risk of haemorrhagic stroke. The presence of intracranial aneurysms, arteriovenous malformations, or cavernous malformations poses unique clinical dilemmas during pregnancy and delivery. In the absence of evidence-based guidelines for managing the low yet uncertain risk of haemorrhagic stroke during pregnancy and delivery in women with vascular malformations, multidisciplinary teams should carefully assess the risks and benefits of delivery methods for these patients. Health-care providers should recognise and address the challenges that women might have to confront when recovering from haemorrhagic stroke.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Saloua Akoudad
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Joanna D Schaafsma
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Centre, Location AMC, Amsterdam, Netherlands
| | - Mahsoem Ali
- Department of Surgery, Amsterdam University Medical Centre, Location VUmc, Amsterdam, Netherlands
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, UMR-S1172, Lille Neuroscience and Cognition, Lille, France
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway; The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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6
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Kamphuis MJ, van der Kamp LT, Lette E, Rinkel GJE, Vergouwen MDI, van der Schaaf IC, de Jong PA, Ruigrok YM. Intracranial arterial calcification in patients with unruptured and ruptured intracranial aneurysms. Eur Radiol 2024:10.1007/s00330-024-10789-2. [PMID: 38806803 DOI: 10.1007/s00330-024-10789-2] [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: 12/19/2023] [Revised: 02/13/2024] [Accepted: 03/09/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Arterial calcification is thought to protect against rupture of intracranial aneurysms, but studies in a representative population of intracranial aneurysm patients have not yet been performed. The aim was to compare the prevalence of aneurysm wall calcification and intracranial carotid artery calcification (ICAC) between patients with an unruptured intracranial aneurysm (UIA) and a ruptured intracranial aneurysm (RIA). MATERIALS AND METHODS We matched 150 consecutive UIA patients to 150 RIA patients on age and sex. Aneurysm wall calcification and ICAC were quantified on non-contrast enhanced computed tomography images with the modified Agatston score. We compared the prevalence of aneurysm wall calcification, ICAC, and severe ICAC (defined as a modified Agatston score in the fourth quartile) between UIA and RIA patients using univariate and multivariate conditional logistic regression models adjusted for aneurysm characteristics and cardiovascular risk factors. RESULTS Aneurysm wall calcification was more prevalent in UIA compared to RIA patients (OR 5.2, 95% CI: 2.0-13.8), which persisted after adjustment (OR 5.9, 95% CI: 1.7-20.2). ICAC prevalence did not differ between the two groups (crude OR 0.9, 95% CI: 0.5-1.8). Severe ICAC was more prevalent in UIA patients (OR 2.0, 95% CI: 1.1-3.6), but not after adjustment (OR 1.0, 95% CI: 0.5-2.3). CONCLUSIONS Aneurysm wall calcification but not ICAC was more prevalent in UIAs than in RIAs, which corresponds to the hypothesis that calcification may protect against aneurysmal rupture. Aneurysm wall calcification should be further assessed as a predictor of aneurysm stability in prospective cohort studies. CLINICAL RELEVANCE STATEMENT Calcification of the intracranial aneurysm wall was more prevalent in unruptured than ruptured intracranial aneurysms after adjustment for cardiovascular risk factors. Calcification may therefore protect the aneurysm against rupture, and aneurysm wall calcification is a candidate predictor of aneurysm stability. KEY POINTS Aneurysm wall calcification was more prevalent in patients with unruptured than ruptured aneurysms, while internal carotid artery calcification was similar. Aneurysm wall calcification but not internal carotid artery calcification is a candidate predictor of aneurysm stability. Cohort studies are needed to assess the predictive value of aneurysm wall calcification for aneurysm stability.
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Affiliation(s)
- Maarten J Kamphuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Laura T van der Kamp
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Lette
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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7
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Ikawa F, Michihata N, Oya S, Yasunaga H, Horie N. Surgical Risk in Elderly Patients with Meningiomas in Japan. J Clin Med 2024; 13:2882. [PMID: 38792424 PMCID: PMC11122238 DOI: 10.3390/jcm13102882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: No guidelines indicate surgical risk factors for the elderly because of the lack of data from general neurosurgeons. To better understand the management of surgical risk in elderly patients with meningiomas based on a national database in Japan. Methods: Results of surgically treated meningiomas were explored in 8138 patients registered in the Diagnosis Procedure Combination database in Japan during 2010-2015. Age (<65, 65-74, and ≥75 years), sex, Barthel index (BI), medical history, tumor location, oral medication prescriptions on admission, and stroke complications were evaluated. Multivariate logistic regression analysis identified risk factors for stroke complications, BI deterioration between admission and discharge, and in-hospital mortality. Results: Advanced age was the prominent risk factor for BI deterioration (odds ratio: 3.26; 95% confidence interval: 2.69-3.95) but not for in-hospital mortality. Lower BI (60-80) on admission increased the risk of BI deterioration in all age groups; however, BI < 60 demonstrated a significant inverse risk (0.47; 0.32-0.69) in the elderly (≥75 years). Location (falx, parasagittal, and deep) and anticoagulants were not significant risk factors for BI deterioration in patients aged ≥ 75 years, despite being significant risk factors in patients aged <65 and/or 65-74 years. Conclusions: Although advanced age could lead to postoperative functional decline at discharge, it was not sufficiently significant enough to be associated with in-hospital mortality. Because of the possibility of recovery even in elderly patients with severe disabilities, appropriate surgical selection and optimal management may lead to favorable functional outcomes in elderly patients with meningiomas.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo 693-8555, Japan
| | - Nobuaki Michihata
- Department of Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba 260-8717, Japan
| | - Soichi Oya
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
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Tjoumakaris SI, Hanel R, Mocco J, Ali-Aziz Sultan M, Froehler M, Lieber BB, Coon A, Tateshima S, Altschul DJ, Narayanan S, El Naamani K, Taussky P, Hoh BL, Meyers P, Gounis MJ, Liebeskind DS, Volovici V, Toth G, Arthur A, Wakhloo AK. ARISE I Consensus Review on the Management of Intracranial Aneurysms. Stroke 2024; 55:1428-1437. [PMID: 38648283 DOI: 10.1161/strokeaha.123.046208] [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: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms. METHODS A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA. RESULTS Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast-enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care. CONCLUSIONS Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.
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Affiliation(s)
- Stavropoula I Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Ricardo Hanel
- Baptist Neurological Institute, Jacksonville, FL (R.H.)
| | - J Mocco
- Department of Neurosurgery, Mount Sinai University Hospital, New York, NY (J.M.)
| | - M Ali-Aziz Sultan
- Department of Neurosurgery, Harvard Medical School, Boston, MA (M.A.-A.S.)
| | - Michael Froehler
- Department of Neurology, Vanderbilt University, Nashville, TN (M.F.)
| | - Barry B Lieber
- Department of Neurology, Tufts School of Medicine, Boston, MA (B.B.L.)
| | - Alexander Coon
- Department of Neurosurgery, Carondelet Neurological Institute of St. Joseph's and St. Mary's Hospitals in Tucson, AZ (A.C.)
| | - Satoshi Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles
| | - David J Altschul
- Department of Neurological Surgery, Einstein Montefiore Medical Center, Bronx, NY (D.J.A.)
| | - Sandra Narayanan
- Department of Neurology, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Phil Taussky
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA (P.T.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville (B.L.H.)
| | - Philip Meyers
- Department of Radiology, Saint Luke's Clinic, Boise, ID (P.M.)
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts, Worcester (M.J.G.)
| | | | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands (V.V.)
| | - Gabor Toth
- Department of Neurosurgery, Cleveland Clinic, OH (G.T.)
| | - Adam Arthur
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN (A.A.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
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9
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Qu J, Niu H, Li Y, Chen T, Peng F, Xia J, He X, Xu B, Chen X, Li R, Liu A, Zhang X, Li C. A deep learning framework for intracranial aneurysms automatic segmentation and detection on magnetic resonance T1 images. Eur Radiol 2024; 34:2838-2848. [PMID: 37843574 DOI: 10.1007/s00330-023-10295-x] [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: 11/16/2022] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES To design a deep learning-based framework for automatic segmentation and detection of intracranial aneurysms (IAs) on magnetic resonance T1 images and test the robustness and performance of framework. METHODS A retrospective diagnostic study was conducted based on 159 IAs from 136 patients who underwent the T1 images. Among them, 127 cases were randomly selected for training and validation, and 32 cases were used to assess the accuracy and consistency of our algorithm. We developed and assembled three convolutional neural networks for the segmentation and detection of IAs. The segmentation and detection performance of the model were compared with the ground truth, and various metrics were calculated at the voxel level, IAs level, and patient level to show the performance of our framework. RESULTS Our assembled model achieved overall Dice, voxel-level sensitivity, specificity, balanced accuracy, and F1 score of 0.802, 0.874, 0.9998, 0.937, and 0.802, respectively. A coincidence greater than 0.7 between the aneurysms predicted by the model and the ground truth was considered as a true positive. For IAs detection, the sensitivity reached 90.63% with 0.58 false positives per case. The volume of IAs segmented by our model showed a high agreement and consistency with the volume of IAs labeled by experts. CONCLUSION The deep learning framework is achievable and robust for IAs segmentation and detection. Our model offers more clinical application opportunities compared to digital subtraction angiography (DSA)-based, CTA-based, and MRA-based methods. CLINICAL RELEVANCE STATEMENT Our deep learning framework effectively detects and segments intracranial aneurysms using clinical routine T1 sequences, showing remarkable effectiveness and offering great potential for improving the detection of latent intracranial aneurysms and enabling early identification. KEY POINTS •There is no segmentation method based on clinical routine T1 images. Our study shows that the proper deep learning framework can effectively localize the intracranial aneurysms. •The T1-based segmentation and detection method is more universal than other angiography-based detection methods, which can potentially reduce missed diagnoses caused by the absence of angiography images. •The deep learning framework is robust and has the potential to be applied in a clinical setting.
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Affiliation(s)
- Junda Qu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutang Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Ting Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiaxiang Xia
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxin He
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Boya Xu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuge Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China.
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Capital Medical University, Beijing, China.
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10
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Liang X, Tong X, Miao Y, Xue X, Liu A, Guan F. Effect of smoking cessation medications on intracranial aneurysm risk: A Mendelian randomization study. Tob Induc Dis 2024; 22:TID-22-70. [PMID: 38690207 PMCID: PMC11059939 DOI: 10.18332/tid/186171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION We aim to assess the association between smoking behavior and intracranial aneurysms (IAs) and the effect of smoking cessation medications on IAs at the genetic level. METHODS Causal effects of four phenotypes: 1) age at initiation of regular smoking, 2) cigarettes smoked per day, 3) smoking cessation, and 4) smoking initiation on IAs, were analyzed using two-sample inverse-variance weighted Mendelian randomization analyses. The effects of genes interacting with the smoking cessation medications were analyzed using cis-expression quantitative trait loci genetic instruments on IAs using summary statistics-based Mendelian randomization analyses. Colocalization analyses were then used to test whether the genes shared causal variants with IAs. The role of confounding phenotypes as potential causative mechanisms of IAs at these gene loci was tested. RESULTS Cigarettes smoked per day (OR=2.89; 95% CI:1.85-4.51) and smoking initiation on IAs (OR=4.64; 95% CI: 2.64-8.15) were significantly associated with IA risk. However, age at initiation of regular smoking (OR=0.54; 95% CI: 0.10-2.8) and smoking cessation (OR=6.80; 95% CI: 0.01-4812) had no overall effect on IAs. Of 88 genes that interacted with smoking cessation medications, two had a causal effect on IA risk. Genetic variants affecting HYKK levels showed strong evidence of colocalization with IA risk. Higher HYKK levels in the blood were associated with a lower IA risk. Gene target analyses revealed that cigarettes/day could be a main mediator of HYKK's effect on IA risk. CONCLUSIONS This study provides evidence supporting that smoking initiation on IAs and cigarettes/day may increase IA risk. Increased HYKK gene expression may reduce IA risk. This can be explained by the increased number of cigarettes consumed daily. HYKK could also reduce IA risk due to the positive effect of continuous abstinence and varenicline therapy on smoking cessation.
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Affiliation(s)
- Xin Liang
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Miao
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaopeng Xue
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Guan
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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11
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Matsukawa H, Uchida K, Sowlat MM, Elawady SS, Cunningham C, Alawieh A, Al Kasab S, Jabbour P, Mascitelli J, Levitt MR, Cuellar H, Brinjikji W, Samaniego E, Burkhardt JK, Kan P, Fox WC, Moss M, Ezzeldin M, Grandhi R, Altschul DJ, Spiotta AM, Yoshimura S. Impact of Race on Outcomes in the Endovascular and Microsurgical Treatment in Patients With Intracranial Aneurysms. Neurosurgery 2024:00006123-990000000-01138. [PMID: 38651917 DOI: 10.1227/neu.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/30/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The impact of race on outcomes in the treatment of intracranial aneurysm (IA) remains unclear. We aimed to investigate the relationship between race classified into White, Black, Hispanic, and other and treatment outcomes in patients with ruptured and unruptured IAs. METHODS The study population consisted of 2836 patients with IA with endovascular treatment or microsurgical treatment (MST) from 16 centers in the United States and Asia, all participating in the observational "STAR" registry. The primary outcome was a 90-day modified Rankin Scale of 0 to 2. Secondary outcomes included periprocedural cerebral infarction and intracranial hemorrhage, perioperative symptomatic cerebral vasospasm in ruptured IA and mortality, and all causes of mortality within 90 days. RESULTS One thousand fifty-three patients were White (37.1%), 350 were Black (12.3%), 264 were Hispanic (9.3%), and 1169 were other (41.2%). Compared with White patients, Hispanic patients had a significantly lower proportion of primary outcome (adjusted odds ratio [aOR] 0.36, 95% CI, 0.23-0.56) and higher proportion of the periprocedural cerebral infarction, perioperative mortality, and all causes of mortality (aOR 2.53, 95% CI, 1.40-4.58, aOR 1.84, 95% CI, 1.00-3.38, aOR 1.83, 95% CI, 1.06-3.17, respectively). Outcomes were not significantly different in Black and other patients. The subgroup analysis showed that Hispanic patients with age ≥65 years (aOR 0.19, 95% CI, 0.10-0.38, interaction P = .048), Hunt-Hess grades 0 to 3 (aOR 0.29, 95% CI, 0.19-0.46, interaction P = .03), and MST (aOR 0.24, 95% CI, 0.13-0.44, interaction P = .04) had a significantly low proportion of primary outcome. CONCLUSION This study demonstrates that Hispanic patients with IA are more likely to have a poor outcome at 90 days after endovascular treatment or MST than White patients. Physicians have to pay attention to the selection of treatment modalities, especially for Hispanic patients with specific factors to reduce racial discrepancies.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor Cunningham
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Hugo Cuellar
- Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, Louisiana, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edgar Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadlphia, Pennsylvania, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - W Christopher Fox
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark Moss
- Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, Arkansas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Houston, Texas, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, USA
| | - David J Altschul
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
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12
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Zeng L, Zhao XY, Wen L, Jing Y, Xu JX, Huang CC, Zhang D, Wang GX. Compare deep learning model and conventional logistic regression model for the identification of unstable saccular intracranial aneurysms in computed tomography angiography. Quant Imaging Med Surg 2024; 14:2993-3005. [PMID: 38617165 PMCID: PMC11007515 DOI: 10.21037/qims-23-1732] [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: 12/05/2023] [Accepted: 02/27/2024] [Indexed: 04/16/2024]
Abstract
Background It is crucial to distinguish unstable from stable intracranial aneurysms (IAs) as early as possible to derive optimal clinical decision-making for further treatment or follow-up. The aim of this study was to investigate the value of a deep learning model (DLM) in identifying unstable IAs from computed tomography angiography (CTA) images and to compare its discriminatory ability with that of a conventional logistic regression model (LRM). Methods From August 2011 to May 2021, a total of 1,049 patients with 681 unstable IAs and 556 stable IAs were retrospectively analyzed. IAs were randomly divided into training (64%), internal validation (16%), and test sets (20%). Convolutional neural network (CNN) analysis and conventional logistic regression (LR) were used to predict which IAs were unstable. The area under the curve (AUC), sensitivity, specificity and accuracy were calculated to evaluate the discriminating ability of the models. One hundred and ninety-seven patients with 229 IAs from Banan Hospital were used for external validation sets. Results The conventional LRM showed 11 unstable risk factors, including clinical and IA characteristics. The LRM had an AUC of 0.963 [95% confidence interval (CI): 0.941-0.986], a sensitivity, specificity and accuracy on the external validation set of 0.922, 0.906, and 0.913, respectively, in predicting unstable IAs. In predicting unstable IAs, the DLM had an AUC of 0.771 (95% CI: 0.582-0.960), a sensitivity, specificity and accuracy on the external validation set of 0.694, 0.929, and 0.782, respectively. Conclusions The CNN-based DLM applied to CTA images did not outperform the conventional LRM in predicting unstable IAs. The patient clinical and IA morphological parameters remain critical factors for ensuring IA stability. Further studies are needed to enhance the diagnostic accuracy.
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Affiliation(s)
- Lu Zeng
- Department of Radiology, Banan Hospital, Chongqing Medical University, Chongqing, China
| | - Xiao-Yan Zhao
- Department of Radiology, Banan Hospital, Chongqing Medical University, Chongqing, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yang Jing
- Huiying Medical Technology (Beijing), Beijing, China
| | - Jing-Xu Xu
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Chen-Cui Huang
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Guang-Xian Wang
- Department of Radiology, Banan Hospital, Chongqing Medical University, Chongqing, China
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13
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Chebib FT, Tawk RG. All Patients with ADPKD Should Undergo Screening for Intracranial Aneurysms: CON. KIDNEY360 2024; 5:495-498. [PMID: 37990377 PMCID: PMC11093549 DOI: 10.34067/kid.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, Florida
| | - Rabih G. Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida
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14
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Vigil IM, Sylvia M. Transforming Neurology Care Delivery Through a Population Health Data Strategy. Neurol Clin Pract 2024; 14:e200248. [PMID: 38585437 PMCID: PMC10996910 DOI: 10.1212/cpj.0000000000200248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 04/09/2024]
Abstract
Background With more than 30% of global data originating from health care, deriving usable insights that improve health requires population health analytics. In neurology, data-driven approaches have grown in significance because of digital health records and advanced analytics. A vital aspect of this evolution is adopting a population health data strategy (PHDS). Recent Findings Crafting a tailored PHDS for neurology involves cataloging data points and measures spanning demographics, clinical history, genetics, and social determinants. Neurologic outcomes include mortality rates, functional and cognitive abilities, and imaging results. A robust strategy relies on interoperability, advanced analytics, and transparent AI algorithms. Summary Neurology is embracing data-driven health care. The PHDS synthesizes diverse patient data to provide personalized care. It includes a wide range of outcome measures to address neurologic complexities. Advanced analytics and collaboration among neurologists, data scientists, and business leaders uncover hidden patterns and promote outcome-driven medicine in the 21st century.
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Affiliation(s)
- Ines M Vigil
- Clarify Health Solutions (IMV); and Medical University of South Carolina College of Nursing (MS)
| | - Martha Sylvia
- Clarify Health Solutions (IMV); and Medical University of South Carolina College of Nursing (MS)
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15
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Mendes Pereira V, Rice H, De Villiers L, Sourour N, Clarencon F, Spears J, Tomasello A, Hernandez D, Cancelliere NM, Liu XYE, Nicholson P, Costalat V, Gascou G, Mordasini P, Gralla J, Martínez-Galdámez M, Galvan Fernandez J, Killer-Oberpfalzer M, Liebeskind DS, Turner RD, Blanc R, Piotin M. Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms. J Neurointerv Surg 2024; 16:405-411. [PMID: 37793795 PMCID: PMC10958306 DOI: 10.1136/jnis-2023-020161] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. RESULTS The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. CONCLUSIONS This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. TRIAL REGISTRATION NUMBER NCT04236856.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hal Rice
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia De Villiers
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nader Sourour
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Frédéric Clarencon
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Tomasello
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - David Hernandez
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Nicole M Cancelliere
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Eileen Liu
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Raymond D Turner
- Division of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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16
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Padmanaban V, Benjamin WJ, Cohrs A, Jareczek FJ, Hazard SW, Zacko JC, Church EW, Simon SD, Cockroft KM, Leslie DL, Wilkinson DA. Nationwide trends in intensive care unit utilization in the elective endovascular treatment of unruptured intracranial aneurysms. Interv Neuroradiol 2024:15910199241233028. [PMID: 38454799 DOI: 10.1177/15910199241233028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE Multiple studies suggest routine post-operative intensive care unit (ICU) stays after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) is unnecessary, though rates of ICU utilization nationwide are unknown. We aim to evaluate rates and characteristics of ICU utilization in patients undergoing elective endovascular repair of UIAs. METHODS This is a retrospective cohort study utilizing a nationwide private-payer database in the United States to evaluate the ICU utilization in patients undergoing elective endovascular repair of UIAs between 2005 and 2019. Demographics and pre-operative comorbidities as well as post-procedural complications and discharge status were compared. An analysis of charges and costs was also performed. RESULTS Among 6218 patients who underwent elective EVT of a UIA, 4890 (78.6%) were admitted to the ICU post-operatively. There were no differences in age, sex, or Charlson comorbidity scores in patients admitted to the ICU post-operatively compared to those admitted elsewhere. ICU utilization was more common in urban locations compared to rural. 12.7% of patients had ICU-specific needs sufficient to be billed by a critical care provider. Total provider costs were significantly higher in patients utilizing the ICU post-operatively, even among uncomplicated patients with routine discharges. CONCLUSION Most patients undergoing elective endovascular UIA repair in the United States are admitted to the ICU postoperatively. Only 12.7% have ICU needs, and these patients are predictable from pre-operative characteristics or peri-operative complications. Reducing ICU use in this subgroup of patients may be an important target to improve healthcare value in this patient population.
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Affiliation(s)
- Varun Padmanaban
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Austin Cohrs
- Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Francis J Jareczek
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sprague W Hazard
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Anesthesia and Perioperative Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph Christopher Zacko
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ephraim W Church
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Scott D Simon
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Anesthesia and Perioperative Services, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Radiology, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Douglas L Leslie
- Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David Andrew Wilkinson
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Mori T, Kimura H, Fujita A, Hayashi K, Hori T, Sugihara M, Ikeuchi Y, Kohta M, Tomiyama A, Sasayama T. A vertebrobasilar junction aneurysm successfully treated with a combination of surgical clipping and flow diverter placement based on the results of computational fluid dynamics analysis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23736. [PMID: 38437674 PMCID: PMC10916842 DOI: 10.3171/case23736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The treatment of vertebrobasilar junction (VBJ) aneurysms is challenging. Although flow diverters (FDs) are a possible treatment option, geometrical conditions hinder intervention. VBJ aneurysms possess dual inflow vessels from the bilateral vertebral arteries (VAs), one of which is ideally occluded prior to FD treatment. However, it remains unclear which VA should be occluded. OBSERVATIONS A 75-year-old male with a growing VBJ complex aneurysm exhibiting invagination toward the brainstem and causing perifocal edema required intervention. Preoperative computational fluid dynamics (CFD) analysis demonstrated that left VA occlusion would result in more stagnant flow and less impingement of flow than right VA occlusion. According to the simulated strategy, surgical clipping of the left VA just proximal to the aneurysm was performed, followed by FD placement from the basilar artery trunk to the right VA. The patient demonstrated tolerance of the VA occlusion, and follow-up computed tomography angiography at 18 months after FD treatment confirmed the disappearance of the aneurysm. LESSONS Preoperative flow dynamics simulations using CFD analysis can reveal an optimal treatment strategy involving a hybrid surgery that combines FD placement and direct surgical occlusion for a VBJ complex aneurysm.
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Affiliation(s)
- Tatsuya Mori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Kosuke Hayashi
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Tatsuo Hori
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Masahiro Sugihara
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Yusuke Ikeuchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Masaaki Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
| | - Akio Tomiyama
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; and
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18
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Ishiguro T, Furukawa H, Polen K, Take Y, Sato H, Kudo D, Morgan J, Uchikawa H, Maeda T, Cisneros O, Rahmani R, Ai J, Eguchi S, Lawton M, Hashimoto T. Pharmacological Inhibition of Epidermal Growth Factor Receptor Prevents Intracranial Aneurysm Rupture by Reducing Endoplasmic Reticulum Stress. Hypertension 2024; 81:572-581. [PMID: 38164754 PMCID: PMC10922815 DOI: 10.1161/hypertensionaha.123.21235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Multiple pathways and factors are involved in the rupture of intracranial aneurysms. The EGFR (epidermal growth factor receptor) has been shown to mediate inflammatory vascular diseases, including atherosclerosis and aortic aneurysm. However, the role of EGFR in mediating intracranial aneurysm rupture and its underlying mechanisms have yet to be determined. Emerging evidence indicates that endoplasmic reticulum (ER) stress might be the link between EGFR activation and the resultant inflammation. ER stress is strongly implicated in inflammation and apoptosis of vascular smooth muscle cells, both of which are key components of the pathophysiology of aneurysm rupture. Therefore, we hypothesized that EGFR activation promotes aneurysmal rupture by inducing ER stress. METHODS Using a preclinical mouse model of intracranial aneurysm, we examined the potential roles of EGFR and ER stress in developing aneurysmal rupture. RESULTS Pharmacological inhibition of EGFR markedly decreased the rupture rate of intracranial aneurysms without altering the formation rate. EGFR inhibition also significantly reduced the mRNA (messenger RNA) expression levels of ER-stress markers and inflammatory cytokines in cerebral arteries. Similarly, ER-stress inhibition also significantly decreased the rupture rate. In contrast, ER-stress induction nullified the protective effect of EGFR inhibition on aneurysm rupture. CONCLUSIONS Our data suggest that EGFR activation is an upstream event that contributes to aneurysm rupture via the induction of ER stress. Pharmacological inhibition of EGFR or downstream ER stress may be a promising therapeutic strategy for preventing aneurysm rupture and subarachnoid hemorrhage.
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Affiliation(s)
- Taichi Ishiguro
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Hajime Furukawa
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Kyle Polen
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Yushiro Take
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Hiroki Sato
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Daisuke Kudo
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Jordan Morgan
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Hiroki Uchikawa
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Takuma Maeda
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Oscar Cisneros
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Redi Rahmani
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Jinglu Ai
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Satoru Eguchi
- Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, U.S.A
| | - Michael Lawton
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
| | - Tomoki Hashimoto
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, U.S.A
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19
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Uchida K, Matsukawa H, Sowlat MM, Elawady SS, Alawieh A, Jabbour P, Mascitelli J, Levitt MR, Cuellar H, Samaniego EA, Kan P, Moss M, Spiotta AM, Yoshimura S. Gender Differences in Procedural Clinical Complications and Outcomes of Intracranial Aneurysms: Analysis of the Stroke Thrombectomy and Aneurysm Registry. Neurosurgery 2024; 94:545-551. [PMID: 37747370 DOI: 10.1227/neu.0000000000002695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Some studies have shown that female patients had a poorer prognosis after endovascular treatment for ruptured intracranial aneurysm than male patients. However, data have been sparse regarding differences in the periprocedural and perioperative complication rate with ruptured and unruptured intracranial aneurysms. METHODS This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry, a database of 9 institutions in the United States, Europe, and Asia. The study presented intracranial aneurysms after microsurgical and/or endovascular treatment from January 1, 2013, to December 31, 2022. The primary outcome was incidence of periprocedural cerebral infarction. Secondary outcomes were periprocedural intracranial hemorrhage, periprocedural mortality, perioperative vasospasm, and functional outcome at 90 days after procedure. RESULTS Among 3342 patients with aneurysm, 2447 were female and 857 were male, and the mean age of female and male patients was 59.6 and 57.1 years, respectively. Current smoker, family history of aneurysm, and ruptured aneurysm were observed in 23.5% vs 35.7 %, 10.8 % vs 5.7%, and 28.2% vs 40.5% of female and male patients, respectively. In female patients, internal carotid artery aneurysms were more commonly observed (31.1% vs 17.3%); however, anterior cerebral artery aneurysms were less commonly observed (18.5% vs 33.8%) compared with male patients. Periprocedural cerebral infarction rate was lower in female than male patients (2.4% vs 4.4%; P = .002). The adjusted odds ratio of primary outcome of female to male patients was 0.72 (95% CI, 0.46-1.12). Incidence of periprocedural intracranial hemorrhage and periprocedural mortality and perioperative symptomatic vasospasm and functional outcome was similar in both groups. In subgroup analysis, periprocedural cerebral infarction due to microsurgical treatment occurred frequently in male patients while incidence in endovascular treatment was similar in both groups (interaction P = .005). CONCLUSION This large multicenter registry of patients undergoing intracranial aneurysm treatment found that female patients were not at increased risk of perioperative complications.
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Affiliation(s)
- Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya , Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya , Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya , Japan
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia , Pennsylvania , USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio , Texas , USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle , Washington , USA
| | - Hugo Cuellar
- Department of Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport , Louisiana , USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch-Galveston, Galveston , Texas , USA
| | - Mark Moss
- Department of Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville , Arkansas , USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya , Japan
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20
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Laukka D, Paturi J, Rahi M, Saraste A, Parkkola R, Kivelev J, Gardberg M, Kuhmonen J, Rinne J. PET imaging of unruptured intracranial aneurysm inflammation (PET-IA) study: a feasibility study protocol. BMJ Open 2024; 14:e076764. [PMID: 38382960 PMCID: PMC10882366 DOI: 10.1136/bmjopen-2023-076764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Positron emission tomography (PET) imaging can be used to evaluate arterial wall inflammation in extracranial vascular diseases. However, the application of PET imaging in unruptured intracranial aneurysms (UIA) remains unexplored. Our objective is to investigate feasibility of PET imaging using 18F-FDG and 68Ga-DOTANOC tracers to evaluate arterial wall inflammation in UIA. METHODS AND ANALYSIS This PET imaging feasibility study will enrol patients scheduled for surgical treatment of UIA. The study subjects will undergo PET imaging of the intracranial arteries within 1 month before planned surgery. The imaging protocol includes 18F-FDG PET MRI, MRA with gadolinium enhancement, and 68Ga-DOTANOC PET CT. The study will also involve preoperative blood samples, intraoperative cerebrospinal fluid (CSF) samples, and aneurysm sac biopsy. Planned sample size is at least 18 patients. Primary outcome is uptake of 18F-FDG or 68Ga-DOTANOC in intracranial arterial aneurysms compared with contralateral normal vessel as maximum standardised uptake value or target-to-blood pool ratio and correlation of uptake of 18F-FDG or 68Ga-DOTANOC to aneurysm histological findings. Secondary outcomes include estimating the correlations between uptake of 18F-FDG or 68Ga-DOTANOC and histological findings with blood and CSF miRNA-levels, arterial wall enhancement in gadolinium enhanced MRA, aneurysm size and shape, smoking, hypertension, and location of the aneurysm. ETHICS AND DISSEMINATION This study is approved by the Human Research Ethics Committee of the Hospital District of Southwest Finland, Finnish Medicines Agency Fimea, and Turku University Hospital. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT04715503.
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Affiliation(s)
- Dan Laukka
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jooa Paturi
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Melissa Rahi
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku, Turku, Finland
| | - Juri Kivelev
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Maria Gardberg
- Department of Pathology, Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Johanna Kuhmonen
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
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21
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Petkar S, Chakole V, Nisal R, Priya V. Cerebral Perfusion Unveiled: A Comprehensive Review of Blood Pressure Management in Neurosurgical and Endovascular Aneurysm Interventions. Cureus 2024; 16:e53635. [PMID: 38449959 PMCID: PMC10917124 DOI: 10.7759/cureus.53635] [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: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
This comprehensive review delves into the intricate dynamics of cerebral perfusion and blood pressure management within the context of neurosurgical and endovascular aneurysm interventions. The review highlights the critical role of maintaining a delicate hemodynamic balance, given the brain's susceptibility to fluctuations in blood pressure. Emphasizing the regulatory mechanisms of cerebral perfusion, particularly autoregulation, the study advocates for a nuanced and personalized approach to blood pressure control. Key findings underscore the significance of adhering to tailored blood pressure targets to mitigate the risks of ischemic and hemorrhagic complications in both neurosurgical and endovascular procedures. The implications for clinical practice are profound, calling for heightened awareness and precision in hemodynamic management. The review concludes with recommendations for future research, urging exploration into optimal blood pressure targets, advancements in monitoring technologies, investigations into long-term outcomes, and the development of personalized approaches. By consolidating current knowledge and charting a path for future investigations, this review aims to contribute to the continual enhancement of patient outcomes in the dynamic field of neurovascular interventions.
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Affiliation(s)
- Shubham Petkar
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vivek Chakole
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Nisal
- Anaesthesiology, awaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vishnu Priya
- Anaesthesiology, awaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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22
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Drexler R, Sauvigny T, Pantel TF, Ricklefs FL, Catapano JS, Wanebo JE, Lawton MT, Sanchin A, Hecht N, Vajkoczy P, Raygor K, Tonetti D, Abla A, El Naamani K, Tjoumakaris SI, Jabbour P, Jankowitz BT, Salem MM, Burkhardt JK, Wagner A, Wostrack M, Gempt J, Meyer B, Gaub M, Mascitelli JR, Dodier P, Bavinzski G, Roessler K, Stroh N, Gmeiner M, Gruber A, Figueiredo EG, da Silva Coelho ACS, Bervitskiy AV, Anisimov ED, Rzaev JA, Krenzlin H, Keric N, Ringel F, Park D, Kim MC, Marcati E, Cenzato M, Westphal M, Dührsen L. Global Outcomes for Microsurgical Clipping of Unruptured Intracranial Aneurysms: A Benchmark Analysis of 2245 Cases. Neurosurgery 2024; 94:369-378. [PMID: 37732745 PMCID: PMC10766286 DOI: 10.1227/neu.0000000000002689] [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: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. METHODS A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately. RESULTS Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients. CONCLUSION This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA. These benchmark cutoffs can serve as reference values for other centers, patient registries, and for comparing the benefit of other interventions or novel surgical techniques.
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Affiliation(s)
- Richard Drexler
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias F. Pantel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz L. Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Aminaa Sanchin
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kunal Raygor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel Tonetti
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Adib Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula I. Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian T. Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M. Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania Medicine, Philadelphia, Pennsylvania, USA
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Michael Gaub
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Justin R. Mascitelli
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Eberval G. Figueiredo
- Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Harald Krenzlin
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Dougho Park
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Eleonora Marcati
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hao L, Gao M, Guo W, Yao Z. Correlation Between Risk Factors, Degree of Vascular Restenosis, and Inflammatory Factors After Interventional Treatment for Stroke: A Two-center Retrospective Study. Neurologist 2024:00127893-990000000-00119. [PMID: 38251319 DOI: 10.1097/nrl.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To study the correlation between risk factors, degree of vascular restenosis, and inflammatory factors after interventional treatment for stroke. METHODS The clinical data of 96 stroke patients who received interventional therapy in our hospital from April 2020 to June 2021 were selected for retrospective study, and the postoperative follow-up was 1 year. Univariate and multivariate regression were used to analyze identified factors associated with interventional stroke efficacy. At the same time, the value of inflammatory factor levels in predicting vascular restenosis after interventional stroke was analyzed. RESULTS According to our findings, several risk factors, including body mass index ≥ 25.51 kg/m2, smoking, drinking, hypertension, and diabetes, were identified as contributors to poor postoperative efficacy following stroke intervention (P<0.05). Furthermore, a notable association was observed between the severity of vascular stenosis (P<0.001) and the levels of interleukin 6, interleukin 2, TNF-α, and C-reactive protein. The combined assessment of these serum inflammatory factors exhibited excellent predictive capability for postoperative vascular restenosis and stenosis severity, yielding a sensitivity of 84.30%, a specificity of 81.20%, and an area under the curve of 0.882. CONCLUSIONS Obesity, smoking, alcohol consumption, hypertension, and diabetes have been found to be associated with suboptimal outcomes following interventional treatment for stroke. The assessment of preoperative levels of inflammatory factors holds promise in predicting the likelihood of postoperative restenosis to a certain degree.
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Affiliation(s)
- Liang Hao
- Department of Neurosurgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
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24
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Sauvigny J, Drexler R, Pantel TF, Ricklefs FL, Catapano JS, Wanebo JE, Lawton MT, Sanchin A, Hecht N, Vajkoczy P, Raygor K, Tonetti D, Abla A, El Naamani K, Tjoumakaris SI, Jabbour P, Jankowitz BT, Salem MM, Burkhardt JK, Wagner A, Wostrack M, Gempt J, Meyer B, Gaub M, Mascitelli JR, Dodier P, Bavinzski G, Roessler K, Stroh N, Gmeiner M, Gruber A, Figueiredo EG, Coelho ACSDS, Bervitskiy AV, Anisimov ED, Rzaev JA, Krenzlin H, Keric N, Ringel F, Park D, Kim MC, Marcati E, Cenzato M, Krause L, Westphal M, Dührsen L, Sauvigny T. Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms-A Global Multicenter Investigation of Perioperative Outcomes. Neurosurgery 2024; 94:00006123-990000000-01023. [PMID: 38240568 PMCID: PMC11073773 DOI: 10.1227/neu.0000000000002829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/13/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Microsurgical aneurysm repair by clipping continues to be highly important despite increasing endovascular treatment options, especially because of inferior occlusion rates. This study aimed to present current global microsurgical treatment practices and to identify risk factors for complications and neurological deterioration after clipping of unruptured anterior circulation aneurysms. METHODS Fifteen centers from 4 continents participated in this retrospective cohort study. Consecutive patients who underwent elective microsurgical clipping of untreated unruptured intracranial aneurysm between January 2016 and December 2020 were included. Posterior circulation aneurysms were excluded. Outcome parameters were postsurgical complications and neurological deterioration (defined as decline on the modified Rankin Scale) at discharge and during follow-up. Multivariate regression analyses were performed adjusting for all described patient characteristics. RESULTS Among a total of 2192 patients with anterior circulation aneurysm, complete occlusion of the treated aneurysm was achieved in 2089 (95.3%) patients at discharge. The occlusion rate remained stable (94.7%) during follow-up. Regression analysis identified hypertension (P < .02), aneurysm diameter (P < .001), neck diameter (P < .05), calcification (P < .01), and morphology (P = .002) as preexisting risk factors for postsurgical complications and neurological deterioration at discharge. Furthermore, intraoperative aneurysm rupture (odds ratio 2.863 [CI 1.606-5.104]; P < .01) and simultaneous clipping of more than 1 aneurysm (odds ratio 1.738 [CI 1.186-2.545]; P < .01) were shown to be associated with an increased risk of postsurgical complications. Yet, none of the surgical-related parameters had an impact on neurological deterioration. Analyzing volume-outcome relationship revealed comparable complication rates (P = .61) among all 15 participating centers. CONCLUSION Our international, multicenter analysis presents current microsurgical treatment practices in patients with anterior circulation aneurysms and identifies preexisting and surgery-related risk factors for postoperative complications and neurological deterioration. These findings may assist in decision-making for the optimal therapeutic regimen of unruptured anterior circulation aneurysms.
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Affiliation(s)
- Jennifer Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Drexler
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias F. Pantel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz L. Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - John E. Wanebo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Aminaa Sanchin
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kunal Raygor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel Tonetti
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Adib Abla
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula I. Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian T. Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M. Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Michael Gaub
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Justin R. Mascitelli
- Department of Neurosurgery, University of Texas Health and Science Center at San Antonio, San Antonio, Texas, USA
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Nico Stroh
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Eberval G. Figueiredo
- Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Harald Krenzlin
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Dougho Park
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Eleonora Marcati
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Linda Krause
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Guimaraens L, Saldaña J, Vivas E, Cifuentes S, Balaguer E, Mon D, Macias-Gómez A, Ois A, Guisado-Alonso D, Cuadrado-Godia E, Jiménez-Balado J. Flow diverter stents for endovascular treatment of aneurysms: a comparative study of efficacy and safety between FREDX and FRED. J Neurointerv Surg 2024:jnis-2023-021103. [PMID: 38228386 DOI: 10.1136/jnis-2023-021103] [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: 10/07/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The FRED X flow diverter (FREDX), as the second generation in the FRED series, aims to improve the treatment of cerebral aneurysms. This study compares the efficacy and safety of FREDX with its predecessor, FRED. METHODS This prospective registry included patients treated with FRED and FREDX devices. Efficacy was assessed using digital subtraction angiography with 3D volumetric reconstruction at immediate and 1 year follow-ups. Safety was evaluated by recording complications, analyzed through univariate contrasts, generalized mixed models, and Bayesian network analyses. RESULTS We treated 287 patients with 385 aneurysms, with 77.9% receiving FRED and 22.1% FREDX. The median age was 55 years (IQR 47-65) and 78.4% were women. The FREDX group showed a higher prevalence of saccular-like aneurysms (70.6% vs 52.7%, P=0.012) and a higher rate of complete occlusion compared with FRED interventions (79.4% vs 59.3%, P=0.022). After adjusting for confounders, these differences represented a 3.04-fold increased likelihood (95% CI 1.44 to 6.41, P=0.003) of achieving complete occlusion at 1 year with FREDX interventions. Regarding safety, two (3.5%) complications (both non-symptomatic) were observed in the FREDX group and 23 (10.4%) in the FRED group (P=0.166). Bayesian network analysis suggested a trend towards fewer complications for FREDX, with a median reduction of 5.5% in the posterior distribution of the prevalence of complications compared with FRED interventions. CONCLUSIONS The FREDX device shows improved complete occlusion rates at 1 year compared with the FRED device while maintaining a favourable safety profile, indicating its potential advantage in the treatment of cerebral aneurysms.
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Affiliation(s)
- Leopoldo Guimaraens
- J.J. Merland Department of Therapeutic Neuroangiography, Hospital del Mar and Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Jesus Saldaña
- J.J. Merland Department of Therapeutic Neuroangiography, Hospital del Mar and Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Elio Vivas
- J.J. Merland Department of Therapeutic Neuroangiography, Hospital del Mar and Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Sebastián Cifuentes
- J.J. Merland Department of Therapeutic Neuroangiography, Hospital del Mar and Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Ernest Balaguer
- Department of Neurology, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Dunia Mon
- Department of Neurology, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Adrià Macias-Gómez
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Angel Ois
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Joan Jiménez-Balado
- Department of Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Ma J, Zheng Y, Li P, Zhou T, Sun Z, Ju T, Li A. Risk factors for the rupture of intracranial aneurysms: a systematic review and meta-analysis. Front Neurol 2023; 14:1268438. [PMID: 38146438 PMCID: PMC10749344 DOI: 10.3389/fneur.2023.1268438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The study aimed to identify potential risk factors for aneurysm rupture by performing a systematic review and meta-analysis. Materials and methods We systematically searched the PubMed, Embase, and Cochrane Library electronic databases for eligible studies from their inception until June 2023. Results Eighteen studies involving 17,069 patients with unruptured intracranial aneurysm (UIA) and 2,699 aneurysm ruptures were selected for the meta-analysis. Hyperlipidemia [odds ratio (OR): 0.47; 95% confidence interval (CI): 0.39-0.56; p < 0.001] and a family history of subarachnoid hemorrhage (SAH) (OR: 0.81; 95% CI: 0.71-0.91; p = 0.001) were associated with a reduced risk of aneurysm rupture. In contrast, a large-size aneurysm (OR: 4.49; 95% CI: 2.46-8.17; p < 0.001), ACA (OR: 3.34; 95% CI: 1.94-5.76; p < 0.001), MCA (OR: 2.16; 95% CI: 1.73-2.69; p < 0.001), and VABA (OR: 2.20; 95% CI: 1.24-3.91; p = 0.007) were associated with an increased risk of aneurysm rupture. Furthermore, the risk of aneurysm rupture was not affected by age, sex, current smoking, hypertension, diabetes mellitus, a history of SAH, and multiple aneurysms. Conclusion This study identified the predictors of aneurysm rupture in patients with UIAs, including hyperlipidemia, a family history of SAH, a large-size aneurysm, ACA, MCA, and VABA; patients at high risk for aneurysm rupture should be carefully monitored. Systematic Review Registration Our study was registered in the INPLASY platform (INPLASY202360062).
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Affiliation(s)
- Jinyuan Ma
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Yuehua Zheng
- Department of Neurosurgery, Weifang People’s Hospital Shandong Province, Weifang, China
| | - Puxian Li
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Tao Zhou
- Department of Neurosurgery, Weifang People’s Hospital Shandong Province, Weifang, China
| | - Zhen Sun
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Tongze Ju
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Aijun Li
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
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Song C, Xia S, Zhang L, Wang K, Li H, Guo W, Zhu L, Lu Q. A novel endovascular robotic-assisted system for endovascular aortic repair: first-in-human evaluation of practicability and safety. Eur Radiol 2023; 33:7408-7418. [PMID: 37338556 PMCID: PMC10597873 DOI: 10.1007/s00330-023-09810-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To assess the practicability and safety of a novel endovascular robotic system for performing endovascular aortic repair in human. METHODS A prospective observational study was conducted in 2021 with 6 months post-operative follow-up. Patients with aortic aneurysms and clinical indications for elective endovascular aortic repair were enrolled in the study. The novel developed robotic system is applicable for the majority of commercial devices and various types of endovascular surgeries. The primary endpoint was technical success without in-hospital major adverse events. Technical success was defined as the ability of the robotic system to complete all procedural steps based on procedural segments. RESULTS The first-in-human evaluation of robot-assisted endovascular aortic repair was performed in five patients. The primary endpoint was achieved in all patients (100%). There were no device- or procedure-related complications or no in-hospital major adverse events. The operation time and total blood loss in these cases were equal to those in the manual procedures. The radiation exposure of the surgeon was 96.5% lower than that in the traditional position while the radiation exposure of the patients was not significantly increased. CONCLUSIONS Early clinical evaluation of the novel endovascular aortic repair in endovascular aortic repair demonstrated practicability, safety, and procedural effectiveness comparable to manual operation. In addition, the total radiation exposure of the operator was significantly lower than that of traditional procedures. CLINICAL RELEVANCE STATEMENT This study applies a novel approach to perform the endovascular aortic repair in a more accurate and minimal-invasive way and lays the foundation for the perspective automation of the endovascular robotic system, which reflects a new paradigm for endovascular surgery. KEY POINTS • This study is a first-in-human evaluation of a novel endovascular robotic system for endovascular aortic repair (EVAR). • Our system might reduce the occupational risks associated with manual EVAR and contribute to achieving a higher degree of precision and control. • Early evaluation of the endovascular robotic system demonstrated practicability, safety, and procedural effectiveness comparable to that of manual operation.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Shibo Xia
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Kundong Wang
- Department of Instrument Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Haiyan Li
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Wenying Guo
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Longtu Zhu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, People's Republic of China.
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Nie X, Yang Y, Liu Q, Wu J, Chen J, Ma X, Liu W, Wang S, Chen L, He H. A deep-learning system to help make the surgical planning of coil embolization for unruptured intracranial aneurysms. Chin Neurosurg J 2023; 9:24. [PMID: 37691095 PMCID: PMC10494453 DOI: 10.1186/s41016-023-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Coil embolization is a common method for treating unruptured intracranial aneurysms (UIAs). To effectively perform coil embolization for UIAs, clinicians must undergo extensive training with the assistance of senior physicians over an extended period. This study aimed to establish a deep-learning system for measuring the morphological features of UIAs and help the surgical planning of coil embolization for UIAs. METHODS Preoperative computational tomography angiography (CTA) data and surgical data from UIA patients receiving coil embolization in our medical institution were retrospectively reviewed. A convolutional neural network (CNN) model was trained on the preoperative CTA data, and the morphological features of UIAs were measured automatically using this CNN model. The intraclass correlation coefficient (ICC) was utilized to examine the similarity between the morphologies measured by the CNN model and those determined by experienced clinicians. A deep neural network model to determine the diameter of first coil was further established based on the CNN model within the derivation set (75% of all patients) using neural factorization machines (NFM) model and was validated using a validation set (25% of all patients). The general match ratio (the difference was within ± 1 mm) between the predicted diameter of first coil by model and that used in practical scenario was calculated. RESULTS One-hundred fifty-three UIA patients were enrolled in this study. The CNN model could diagnose UIAs with an accuracy of 0.97. The performance of this CNN model in measuring the morphological features of UIAs (i.e., size, height, neck diameter, dome diameter, and volume) was comparable to the accuracy of senior clinicians (all ICC > 0.85). The diameter of first coil predicted by the model established based on CNN model and the diameter of first coil used actually exhibited a high general match ratio (0.90) within the derivation set. Moreover, the model performed well in recommending the diameter of first coil within the validation set (general match ratio as 0.91). CONCLUSION This study presents a deep-learning system which can help to improve surgical planning of coil embolization for UIAs.
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Affiliation(s)
- Xin Nie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050 China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050 China
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050 China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050 China
| | - Jingang Chen
- Unimed Technology (Beijing) Co., Ltd., Tsinghua Tongfang Science and Technology Mansion, Beijing, 100083 China
| | - Xuesheng Ma
- Unimed Technology (Beijing) Co., Ltd., Tsinghua Tongfang Science and Technology Mansion, Beijing, 100083 China
| | - Weiqi Liu
- Unimed Technology (Beijing) Co., Ltd., Tsinghua Tongfang Science and Technology Mansion, Beijing, 100083 China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100050 China
| | - Lei Chen
- Department of Neurosurgery, The First Dongguan Affiliated Hospital, Guangdong Medical University, No. 42 Jiaoping Road, Tangxia Town, Dongguan, Guangdong China
| | - Hongwei He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
- Beijing Neurosurgical Institution, Capital Medical University, Beijing, 100050 China
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Ding D, Yang Y, Jiang G, Peng Y. Relationship between hyperlipidemia and the risk of death in aneurysm: a cohort study on patients of different ages, genders, and aneurysm locations. Front Physiol 2023; 14:1081395. [PMID: 37408590 PMCID: PMC10318894 DOI: 10.3389/fphys.2023.1081395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Aims: The study aimed to assess the association of hyperlipidemia and the risk of death in the aneurysm population, focusing on age, gender, and aneurysm location differences. Methods: All patients' data on this retrospective cohort study were obtained from the Medical Information Mart for Intensive Care (MIMIC-III) database, and the baseline characteristics and laboratory parameters of all patients were collected. The COX regression model was established to explore the association of hyperlipidemia and the risk of death for patients with aneurysms. More importantly, subgroup analyses based on the age, gender, and aneurysm location differences were performed. Results: A total of 1,645 eligible patients were enrolled in this study. These patients were divided into the survival group (n = 1,098) and the death group (n = 547), with a total mortality rate of approximately 33.25%. The result displayed that hyperlipidemia was associated with a decreased death risk in aneurysm patients. In addition, we also found that hyperlipidemia was associated with a lower death risk of abdominal aortic aneurysm and thoracic aortic arch aneurysm among aneurysm patients aged ≥60 years; hyperlipidemia was only a protective factor for the death risk of male patients diagnosed with abdominal aortic aneurysm. For female patients diagnosed with abdominal aortic aneurysm and thoracic aortic arch aneurysm, hyperlipidemia was associated with a decreased death risk. Conclusion: The relationship of hyperlipidemia, hypercholesterolemia, and the risk of death for patients diagnosed with aneurysms was significantly associated with age, gender, and aneurysm location.
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Affiliation(s)
- Dianzhu Ding
- Department of Surgery, Hebei Medical University, Shijiazhuang, China
- Department of Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Yongbin Yang
- Department of Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Guangwei Jiang
- Department of Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Yanhui Peng
- Department of Surgery, Hebei Medical University, Shijiazhuang, China
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang, China
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30
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Liu Q, Li K, He H, Miao Z, Cui H, Wu J, Ding S, Wen Z, Chen J, Lu X, Li J, Zheng L, Wang S. The markers and risk stratification model of intracranial aneurysm instability in a large Chinese cohort. Sci Bull (Beijing) 2023; 68:1162-1175. [PMID: 37210332 DOI: 10.1016/j.scib.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/04/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
Intracranial aneurysm is the leading cause of nontraumatic subarachnoid hemorrhage. Evaluating the unstable (rupture and growth) risk of aneurysms is helpful to guild decision-making for unruptured intracranial aneurysms (UIA). This study aimed to develop a model for risk stratification of UIA instability. The UIA patients from two prospective, longitudinal multicenter Chinese cohorts recruited from January 2017 to January 2022 were set as the derivation cohort and validation cohort. The primary endpoint was UIA instability, comprising aneurysm rupture, growth, or morphology change, during a 2-year follow-up. Intracranial aneurysm samples and corresponding serums from 20 patients were also collected. Metabolomics and cytokine profiling analysis were performed on the derivation cohort (758 single-UIA patients harboring 676 stable UIAs and 82 unstable UIAs). Oleic acid (OA), arachidonic acid (AA), interleukin 1β (IL-1β), and tumor necrosis factor-α (TNF-α) were significantly dysregulated between stable and unstable UIAs. OA and AA exhibited the same dysregulated trends in serums and aneurysm tissues. The feature selection process demonstrated size ratio, irregular shape, OA, AA, IL-1β, and TNF-α as features of UIA instability. A machine-learning stratification model (instability classifier) was constructed based on radiological features and biomarkers, with high accuracy to evaluate UIA instability risk (area under curve (AUC), 0.94). Within the validation cohort (492 single-UIA patients harboring 414 stable UIAs and 78 unstable UIAs), the instability classifier performed well to evaluate the risk of UIA instability (AUC, 0.89). Supplementation of OA and pharmacological inhibition of IL-1β and TNF-α could prevent intracranial aneurysms from rupturing in rat models. This study revealed the markers of UIA instability and provided a risk stratification model, which may guide treatment decision-making for UIAs.
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Affiliation(s)
- Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China; Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China
| | - Ke Li
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China
| | - Hongwei He
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China
| | - Zengli Miao
- Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China
| | - Hongtu Cui
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China; Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China
| | - Shusi Ding
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China
| | - Zheng Wen
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China
| | - Jiyuan Chen
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China
| | - Xiaojie Lu
- Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China.
| | - Jiangan Li
- Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China.
| | - Lemin Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China; The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, State Key Laboratory of Vascular Homeostasis and Remodeling, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China.
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Advanced Innovation Center for Human Brain Protection, Beijing Institute of Brain Disorders, The Capital Medical University, Beijing 100070, China; Department of Neurosurgery and Emergency Medicine, Jiangnan University Medical Center, Wuxi 214001, China.
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Han J, Liu F, Chen J, Tong X, Han M, Peng F, Niu H, Liu L, Liu A. Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms. J Neurosurg 2023; 138:1503-1511. [PMID: 36401540 DOI: 10.3171/2022.10.jns221953] [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: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The authors undertook an evaluation of periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms (IVADAs) and assessed the relevant risk factors. METHODS The authors included a series of 195 patients who had undergone endovascular treatment for 198 IVADAs. Clinical data, morphological characteristics, treatment details, and periprocedural cerebrovascular complications including intraprocedural rupture, intraprocedural thrombosis, intracranial hemorrhage (ICH), transient ischemic attack (TIA), and ischemic stroke (IS) were recorded. After evaluation of the 30-day modified Rankin Scale (mRS) scores, the authors applied univariate and multivariate logistic regression analyses to identify the risk factors for complications and 30-day unfavorable clinical outcomes. RESULTS There were no intraprocedural ruptures, but the authors recorded intraprocedural thrombosis (n = 5), ICH (n = 3), TIA (n = 1), and IS (n = 13), comprising an 11.1% (22/198) complication rate. Multivariate logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.20-8.41, p = 0.020), IS history (OR 5.55, 95% CI 1.46-21.01, p = 0.012), and subarachnoid hemorrhage (SAH) (OR 4.48, 95% CI 1.52-13.20, p = 0.007) were risk factors for overall complications, whereas aneurysmal height (OR 0.77, 95% CI 0.61-0.98, p = 0.032) was a protective factor. SAH (OR 6.44, 95% CI 1.54-26.89, p = 0.011) and preprocedural mRS score > 2 (OR 5.07, 95% CI 1.01-25.59, p = 0.049) were independent risk factors for perforator occlusion stroke. Periprocedural cerebrovascular complications (OR 32.09, 95% CI 3.00-343.94, p = 0.004) and preprocedural mRS score > 2 (OR 319.92, 95% CI 30.28-3379.98, p < 0.001) were independent risk factors for 30-day unfavorable clinical outcomes. CONCLUSIONS Hyperlipidemia, IS history, and SAH were independent predictors for overall periprocedural cerebrovascular complications of endovascular treatment for IVADAs, but aneurysmal height was an independent protective factor. SAH and preprocedural mRS score > 2 were independent risk factors for perforator occlusion stroke. Preprocedural mRS score > 2 and periprocedural complications were independent risk factors for 30-day unfavorable clinical outcomes.
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Affiliation(s)
- Jiangli Han
- 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liu
- 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
- 2Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China; and
| | - Jigang Chen
- 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Peng
- 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Aihua Liu
- 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
- 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Sahoo A, Abdalkader M, Saatci I, Raymond J, Qiu Z, Huo X, Sun D, Weyland CS, Jia B, Zaidat OO, Hu W, Qureshi AI, Miao Z, Nguyen TN. History of Neurointervention. Semin Neurol 2023; 43:454-465. [PMID: 37549692 DOI: 10.1055/s-0043-1771455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
In this review article, we aim to provide a summary of the discoveries and developments that were instrumental in the evolution of the Neurointerventional field. We begin with developments in the advent of Diagnostic Cerebral Angiography and progress to cerebral aneurysm treatment, embolization in AVMs and ischemic stroke treatment. In the process we discuss many persons who were key in the development and maturation of the field. A pivotal aspect to rapid growth in the field has been the multidisciplinary involvement of the different neuroscience specialties and therefore we close out our discussion with excitement about ongoing and future developments in the field with a focus on treatments in the non-cerebrovascular disease realm.
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Affiliation(s)
- Anurag Sahoo
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mohamad Abdalkader
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Isil Saatci
- Department of Interventional Neuroradiology, Private Koru Hospitals, Ankara, Turkey
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, People's Republic of China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Charlotte S Weyland
- Department of Interventional Neuroradiology, Aachen University Hospital, Aachen, Germany
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Osama O Zaidat
- Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, Ohio
| | - Wei Hu
- Division of Life Sciences and Medicine, Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, People's Republic of China
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, Missouri
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Thanh N Nguyen
- Department of Neurology/Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Duan G, Zhang Y, Yin H, Wu Y, Zhang X, Zhao R, Yang P, Zuo Q, Feng Z, Zhang L, Dai D, Fang Y, Zhao K, Huang Q, Hong B, Xu Y, Zhou Y, Li Q, Liu J. Predictors of recurrence and complications for the endovascular treatment of unruptured middle cerebral artery aneurysm: A high-volume center experience over 12 years. Eur J Radiol 2023; 163:110833. [PMID: 37080061 DOI: 10.1016/j.ejrad.2023.110833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
OBJECT To assess the safety and efficacy of endovascular treatment (EVT) of unruptured middle cerebral artery (MCA) aneurysms in a retrospective cohort in a high-volume center. Predictors of complications and recurrence were determined. METHODS Retrospectively reviewed our database of prospectively collected information for all patients with unruptured MCA aneurysms that were treated by endovascular approach from March 2008 to December 2020. A multivariate analysis was conducted to identify predictors of complications and recurrence. RESULTS Three hundred and fifty-one patients with 370 unruptured MCA aneurysms underwent EVT were included in this study. Seventy-three aneurysms (19.7%) were treated by coiling without stent, 297 (80.3%) with stent-assisted coiling. The procedures were performed with a technical success rate of 100%. Procedure-related neurological complications occurred in 15 patients (4.1%), including 1 patient died from post-procedural stent thrombosis. Age ≥ 65 years (P = 0.039; OR = 3.400; 95% CI, 1.065-10.860) and aneurysm size ≥ 5 mm (P = 0.009; OR = 15.524; 95% CI, 1.988-121.228) were significantly associated with ischemic complications of EVT. Three hundred and six aneurysms were (87.2%) completed image follow-up (235 DSA and 71 CE-MRA). The median angiographic follow-up time were 7.0 ± 4.3 months (range from 1 to 88 months). Follow-up angiograms showed that 249 aneurysms (81.4%) were completed occluded, 29 aneurysms (9.5%) were improved, 17 aneurysms (5.6%) were stable, and 11 aneurysms (3.6%) were recanalized and 10 of them accepted retreatments. Aneurysm size ≥ 10 mm was a predictor of recanalization (P = 0.004; OR = 11.213; 95% CI, 2.127-59.098) and stent-assisted coiling can significantly reduce recanalization (P = 0.004; OR = 0.105; 95% CI, 0.023-0.479). CONCLUSIONS EVT is a safe and effective therapeutics for unruptured MCA aneurysms management, and provides durable aneurysm occlusion rate during follow-up. Large MCA aneurysms have higher recurrence and ischemic complications risk after EVT. Stent-assisted coiling can significantly reduce the recurrence rate without increasing the risk of complications.
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Affiliation(s)
- Guoli Duan
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Yuhang Zhang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Hongwei Yin
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Yina Wu
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Xiaoxi Zhang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Rui Zhao
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Qiao Zuo
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Zhengzhe Feng
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Dongwei Dai
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurovascular Center, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Kaijun Zhao
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurosurgery, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Qinghai Huang
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China; Department of Neurovascular Center, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Xu
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Yu Zhou
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
| | - Qiang Li
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
| | - Jianmin Liu
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China.
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Nguyen TN. Management of Unruptured Intracranial Aneurysms and Brain Arteriovenous Malformations. Continuum (Minneap Minn) 2023; 29:584-604. [PMID: 37039411 DOI: 10.1212/con.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Managing a patient with an unruptured brain aneurysm or brain arteriovenous malformation (AVM) can lead to uncertainty about preventive treatment. While the bleeding risks are low, the morbidity or mortality associated with a hemorrhagic event is not insignificant. The objective of this article is to review the natural history of these vascular entities, the risk factors for hemorrhage, preventive treatment options, and the risks of treatment. LATEST DEVELOPMENTS Randomized trials to inform preventive treatment strategies for unruptured intracranial aneurysms and brain AVMs are ongoing. Higher angiographic obliteration rates of unruptured intracranial aneurysms have been reported with the flow-diversion technique compared with alternative standard techniques. One randomized trial for unruptured brain AVMs showed a higher rate of morbidity and mortality in patients who underwent interventional treatment compared with observation. ESSENTIAL POINTS The decision to treat a patient with a brain aneurysm should consider patient factors, the patient's life expectancy, aneurysm anatomical factors, and treatment risks. Patients with unruptured brain AVMs should be observed in light of recent clinical trial data or enrolled in an ongoing clinical trial.
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35
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Costa M, Tataryn Z, Alobaid A, Pierre C, Basamh M, Somji M, Loh Y, Patel A, Monteith S. Robotically-assisted neuro-endovascular procedures: Single-Center Experience and a Review of the Literature. Interv Neuroradiol 2023; 29:201-210. [PMID: 35296166 PMCID: PMC10152820 DOI: 10.1177/15910199221082475] [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: 11/23/2021] [Revised: 01/21/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Robotics could expand treatment of rapidly progressive pathologies such as acute ischemic stroke, with the potential to provide populations in need prompt access to neuro-endovascular procedures. METHODS Robotically-assisted (RA) neuro-endovascular procedures (RANPs) performed at our institution were retrospectively examined (RA-group, RG). A control group of manual neuro-endovascular procedures was selected (manual group, MG). Total operating room (OR) time, procedural time, contrast media use, fluoroscopy time, conversion from RA to manual control, procedural success, and complication rates were compared. A learning curve was identified. RESULTS Forty-one (41) RANPs were analyzed. Ages ranged from 20-82 y.o. Indications included diagnostic cerebral angiography (37), extracranial carotid artery stenting (3), and transverse sinus stent (1). Total OR time was longer in RG (median 86 vs. 71 min, p < 0.01). Procedural time (median 56 vs. 45 min, p = 0.12), fluoroscopy time (median 12 vs. 12 min, p = 0.69) and contrast media usage (82 vs. 92 ml, p = 0.54) were not significantly different. Patient radiation exposure was similar, considering similar fluoroscopy times. Radiation exposure and lead apron use were virtually absent for the main surgeon in RG. Procedural success was 83% and conversion from RA to manual control was 17% in RG. No treatment-related complications occurred. A learning curve showed that, after the fifth procedure, procedural times reduced and stabilized. CONCLUSIONS This series may contribute to further demonstrating the safety and feasibility of RANPs. RANPs can potentially reduce radiation exposure and physical burden for health personnel, expand acute cerebrovascular treatment to underserved areas, and enhance telementoring. Prospective studies are necessary for results to be generalized.
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Affiliation(s)
- Matias Costa
- Swedish Neuroscience
Institute, Seattle, WA, USA
| | | | - Abdullah Alobaid
- National Neurosciences Institute, King
Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | | | - Yince Loh
- Swedish Neuroscience
Institute, Seattle, WA, USA
| | - Akshal Patel
- Swedish Neuroscience
Institute, Seattle, WA, USA
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Hall S, Birks J, Anderson I, Bacon A, Brennan PM, Bennett D, Chavredakis E, Critchley G, Dow G, Downer J, Galea J, Grover P, Gurusinghe N, Helmy A, Kounin G, Mukerji N, Patel H, Patel J, Ross N, St George J, Teo M, Tolias CM, Tzerakis N, Uff C, van Beijum J, Veighey K, White E, Whitfield P, Bulters DO. Risk of Aneurysm Rupture (ROAR) study: protocol for a long-term, longitudinal, UK multicentre study of unruptured intracranial aneurysms. BMJ Open 2023; 13:e070504. [PMID: 36927598 PMCID: PMC10030903 DOI: 10.1136/bmjopen-2022-070504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates. METHODS AND ANALYSIS The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study's aims. ETHICS AND DISSEMINATION Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN17658526.
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Affiliation(s)
- Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Ian Anderson
- Department of Neurosurgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Bacon
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | | | | | - Giles Critchley
- Department of Neurosurgery, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Graham Dow
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan Downer
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - James Galea
- Neurosurgical Department, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Patrick Grover
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nihal Gurusinghe
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Adel Helmy
- Department of neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gueorgui Kounin
- Department of Neurosurgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Nitin Mukerji
- Department of Neurosurgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Hiren Patel
- Department of Neurosurgery, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Jash Patel
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Ross
- Department of Neurosurgery, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jerome St George
- Department of Neurosurgery, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Mario Teo
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
| | | | - Nikolaos Tzerakis
- Department of Neurosurgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Christopher Uff
- Department of Neurosurgery, Barts Health NHS Trust, London, UK
| | - Janneke van Beijum
- Neurosurgical Department, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Kristin Veighey
- Department of Renal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Edward White
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Whitfield
- South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Diederik Oliver Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Huang Y, Cao H, Qi X, Guan C, Que S. Circular RNA hsa_circ_0000690 as a potential biomarker for diagnosis and prognosis of intracranial aneurysm: Closely relating to the volume of hemorrhage. Brain Behav 2023; 13:e2929. [PMID: 36879365 PMCID: PMC10097068 DOI: 10.1002/brb3.2929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE This study aimed to explore circular RNA (circRNA) hsa_circ_0000690 as a potential biomarker for diagnosis and prognosis of intracranial aneurysm (IA) and its relationship with clinical factors and complications of IA. MATERIAL/METHODS 216 IA patients admitted to the neurosurgery department of our hospital from January 2019 to December 2020 were selected as the experimental group, and 186 healthy volunteers were selected as the control group. The expression of hsa_circ_0000690 in peripheral blood was detected by quantitative real-time PCR, and its diagnostic value was assessed by receiver operating characteristic curve. Relationship between hsa_circ_0000690 and clinical factors of IA was assessed by chi-square test. Nonparametric test was used in univariate analysis, and regression analysis was used in multivariate analysis. Multivariate Cox proportional hazards regression analysis was used to analyze the survival time. RESULTS CircRNA hsa_circ_0000690 of IA patients was relatively lower than that in the control group (p < .001). The AUC of hsa_circ_0000690 was 0.752, the specificity was 0.780, and sensitivity was 0.620, with diagnostic threshold of 0.0449. In addition, hsa_circ_0000690 expression was correlated with Glasgow Coma Scale, the volume of subarachnoid hemorrhage, modified Fisher scale, Hunt-Hess levels and surgical type. For hydrocephalus and delayed cerebral ischemia, hsa_circ_0000690 was significant in univariate analysis, but nonsignificant in multivariate analysis. For prognosis, hsa_circ_0000690 was significantly associated with modified Rankin Scales after surgery for 3 months, but not associated with survival time. CONCLUSIONS The expression of hsa_circ_0000690 can act as a diagnostic marker for IA and predict the prognosis of 3 months after operation and is closely related to the volume of hemorrhage.
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Affiliation(s)
- Yanming Huang
- Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Huimin Cao
- Clinical Laboratory, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Xiaolong Qi
- Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Celin Guan
- Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
| | - Shuanglin Que
- Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China
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Lee KB, Suh CH, Song Y, Kwon B, Kim MH, Yoon JT, Lee DH. Trends of Expanding Indications of Woven EndoBridge Devices for the Treatment of Intracranial Aneurysms: A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:227-235. [PMID: 36036257 DOI: 10.1007/s00062-022-01207-5] [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: 04/04/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Woven EndoBridge (WEB) was introduced for the endovascular therapy of wide-neck intracranial aneurysms. The safety and efficacy have been evaluated through several meta-analyses. However, these reviews did not cover the expanding indications in detail. Therefore, we aimed to show the changing trends for intracranial aneurysm treatment using the WEB device. METHODS A systematic review and meta-analysis was conducted with PubMed, Embase, and Cochrane databases. We searched for studies that reported baseline characteristics of aneurysms and the WEB devices, which had treated more than 20 aneurysms consecutively. The pooled proportions of aneurysm indications and used WEB device types were obtained. To evaluate the changing indications for the treated aneurysm size, including the neck diameter, a trend line and linear regression model was measured. RESULTS A total of 27 cohorts were included encompassing 1831 aneurysms treated with the WEB. A total of 86% were used in the four major locations as on-label indications (middle cerebral artery bifurcation; 34%, anterior communicating artery; 26%, basilar tip; 18%, internal carotid artery terminus; 7%). Among off-label indications, the most common location was the posterior communicating artery (8%), followed by the anterior cerebral artery including the pericallosal artery (6%). The median aneurysm size and neck diameter was 7 mm and 4.6 mm, respectively. The WEB device has been used for the treatment of smaller aneurysms than the initial indication. Also, the proportion for ruptured aneurysm treatment was increased up to 15%. CONCLUSION The mechanical and technical development of the WEB resulted in expanding the indications for the treatment of intracranial aneurysms. The off-label indications accounted for 14% in total and an increasing number of small aneurysms are treated with WEB devices. Moreover, the proportion for ruptured aneurysm treatment was currently increased up to 14% more than in the beginning.
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Affiliation(s)
- Ki Baek Lee
- Department of Radiologic Technology, Chungbuk Health & Science University, Cheongju, Korea (Republic of)
| | - Chong Hyun Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Boseong Kwon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Mi Hyeon Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Jong-Tae Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Korea (Republic of).
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Bakker MK, Kanning JP, Abraham G, Martinsen AE, Winsvold BS, Zwart JA, Bourcier R, Sawada T, Koido M, Kamatani Y, Morel S, Amouyel P, Debette S, Bijlenga P, Berrandou T, Ganesh SK, Bouatia-Naji N, Jones G, Bown M, Rinkel GJ, Veldink JH, Ruigrok YM. Genetic Risk Score for Intracranial Aneurysms: Prediction of Subarachnoid Hemorrhage and Role in Clinical Heterogeneity. Stroke 2023; 54:810-818. [PMID: 36655558 PMCID: PMC9951795 DOI: 10.1161/strokeaha.122.040715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/17/2020] [Accepted: 11/28/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recently, common genetic risk factors for intracranial aneurysm (IA) and aneurysmal subarachnoid hemorrhage (ASAH) were found to explain a large amount of disease heritability and therefore have potential to be used for genetic risk prediction. We constructed a genetic risk score to (1) predict ASAH incidence and IA presence (combined set of unruptured IA and ASAH) and (2) assess its association with patient characteristics. METHODS A genetic risk score incorporating genetic association data for IA and 17 traits related to IA (so-called metaGRS) was created using 1161 IA cases and 407 392 controls from the UK Biobank population study. The metaGRS was validated in combination with risk factors blood pressure, sex, and smoking in 828 IA cases and 68 568 controls from the Nordic HUNT population study. Furthermore, we assessed association between the metaGRS and patient characteristics in a cohort of 5560 IA patients. RESULTS Per SD increase of metaGRS, the hazard ratio for ASAH incidence was 1.34 (95% CI, 1.20-1.51) and the odds ratio for IA presence 1.09 (95% CI, 1.01-1.18). Upon including the metaGRS on top of clinical risk factors, the concordance index to predict ASAH hazard increased from 0.63 (95% CI, 0.59-0.67) to 0.65 (95% CI, 0.62-0.69), while prediction of IA presence did not improve. The metaGRS was statistically significantly associated with age at ASAH (β=-4.82×10-3 per year [95% CI, -6.49×10-3 to -3.14×10-3]; P=1.82×10-8), and location of IA at the internal carotid artery (odds ratio=0.92 [95% CI, 0.86-0.98]; P=0.0041). CONCLUSIONS The metaGRS was predictive of ASAH incidence, although with limited added value over clinical risk factors. The metaGRS was not predictive of IA presence. Therefore, we do not recommend using this metaGRS in daily clinical care. Genetic risk does partly explain the clinical heterogeneity of IA warranting prioritization of clinical heterogeneity in future genetic prediction studies of IA and ASAH.
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Affiliation(s)
- Mark K. Bakker
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (M.K.B., J.P.K., G.J.E.R., Y.M.R., J.H.V.)
| | - Jos P. Kanning
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (M.K.B., J.P.K., G.J.E.R., Y.M.R., J.H.V.)
| | - Gad Abraham
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (G.A.)
- Department of Clinical Pathology, University of Melbourne, Parkville, VIC, Australia (G.A.)
| | - Amy E. Martinsen
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway (A.E.M., B.S.W., J.-A.Z.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.E.M., J.-A.Z.)
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (A.E.M., B.S.W., J.-A.Z.)
| | - Bendik S. Winsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (A.E.M., B.S.W., J.-A.Z.)
- Department of Neurology, Oslo University Hospital, Norway (B.S.W.)
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway (A.E.M., B.S.W., J.-A.Z.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.E.M., J.-A.Z.)
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (A.E.M., B.S.W., J.-A.Z.)
| | - Romain Bourcier
- Université de Nantes, CHU Nantes, INSERM, CNRS, l’institut du thorax, France (R.B.)
- CHU Nantes, Department of Neuroradiology, France (R.B.)
| | - Tomonobu Sawada
- Graduate School of Frontier Sciences, The University of Tokyo, Japan (T.S., Y.K.)
| | - Masaru Koido
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan (M.K.)
- Department of Cancer Biology, Institute of Medical Science, The University of Tokyo, Japan (M.K.)
| | - Yoichiro Kamatani
- Graduate School of Frontier Sciences, The University of Tokyo, Japan (T.S., Y.K.)
| | - Sandrine Morel
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Switzerland (P.B., S.M.)
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Switzerland (S.M.)
| | - Philippe Amouyel
- LabEx DISTALZ-U1167, RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille, Lille, France; Inserm U1167, Lille, France; Centre Hospitalier Universitaire Lille, Lille, France; Institut Pasteur de Lille, Lille, France (P.A.)
| | - Stéphanie Debette
- University of Bordeaux, INSERM, Bordeaux Population Health Center, UMR1219, Bordeaux, France (S.D.)
- Bordeaux University Hospital, Department of Neurology, Institute of Neurodegenerative Diseases, France (S.D.)
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Switzerland (P.B., S.M.)
| | | | - Santhi K. Ganesh
- Division of Cardiovascular Medicine, Department of Internal Medicine (S.K.G.), University of Michigan Medical School, Ann Arbor
- Department of Human Genetics (S.K.G.), University of Michigan Medical School, Ann Arbor
| | | | - Gregory Jones
- Department of Surgery, University of Otago, Dunedin, New Zealand (G.J.)
| | - Matthew Bown
- Department of Cardiovascular Sciences and National Institute for Health Research (M.B.)
- Leicester Biomedical Research Centre (M.B.)
- University of Leicester, Glenfield Hospital, United Kingdom (M.B.)
| | - Gabriel J.E. Rinkel
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (M.K.B., J.P.K., G.J.E.R., Y.M.R., J.H.V.)
| | - Jan H. Veldink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (M.K.B., J.P.K., G.J.E.R., Y.M.R., J.H.V.)
| | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, the Netherlands (M.K.B., J.P.K., G.J.E.R., Y.M.R., J.H.V.)
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Etminan N, Vergouwen MDI, Rinkel GJE. In reply. Eur Stroke J 2023; 8:602-603. [DOI: 10.1177/23969873231156064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mervyn DI Vergouwen
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriel JE Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht, The Netherlands
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Hu L, Quan K, Shi Y, Liu P, Song J, Tian Y, An Q, Liu Y, Li S, Yu G, Fan Z, Luo J, Gu Y, Xu B, Zhu W, Mao Y. Association of Preoperative Vascular Wall Imaging Patterns and Surgical Outcomes in Patients With Unruptured Intracranial Saccular Aneurysms. Neurosurgery 2023; 92:421-430. [PMID: 36637276 DOI: 10.1227/neu.0000000000002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND MR vascular wall imaging (VWI) may have prognostic value in patients with unruptured intracranial aneurysms (UIAs). OBJECTIVE To evaluate the value of VWI as a predictor of surgical outcome in patients with UIAs. METHODS This prospective cohort study evaluated surgical outcomes in consecutive patients with UIAs who underwent surgical clipping at a single center. All participants underwent high-resolution VWI and were followed for at least 6 months. The primary clinical outcome was modified Rankin scale (mRS) score 6 months after surgery. RESULTS The number of patients in the no wall enhancement, uniform wall enhancement (UWE), and focal wall enhancement (FWE) groups was 37, 145, and 154, respectively. Incidence of postoperative complications was 15.5% in the FWE group, 12.4% in the UWE group, and 5.4% in the no wall enhancement group. The proportion of patients with mRS score >2 at the 6-month follow-up was significantly higher in the FWE group than in the UWE group (14.3% vs 6.9%; P = .0389). In the multivariate analysis, FWE (odds ratio, 2.573; 95% CI 1.001-6.612) and positive proximal artery remodeling (odds ratio, 10.56; 95% CI 2.237-49.83) were independent predictors of mRS score >2 at the 6-month follow-up. CONCLUSION Preoperative VWI can improve the surgeon's understanding of aneurysm pathological structure. Type of aneurysmal wall enhancement on VWI is associated with clinical outcome and incidence of salvage anastomosis and surgical complications.
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Affiliation(s)
- Liuxun Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Kai Quan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Qingzhu An
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Sichen Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhiyuan Fan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
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Hanada H, Nii K, Sakamoto K, Inoue R, Hirata Y, Matsuda K, Tsugawa J, Takeshita S, Shirakawa S, Higashi T. Analysis of Cerebrovascular Events after Coil Embolization of Unruptured Cerebral Aneurysms in Patients Taking Anticoagulants. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:73-79. [PMID: 37502350 PMCID: PMC10370510 DOI: 10.5797/jnet.oa.2022-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/11/2022] [Indexed: 07/29/2023]
Abstract
Objective Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy. Methods Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents. Results Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045). Conclusion Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.
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Affiliation(s)
- Hayatsura Hanada
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
| | - Kouhei Nii
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
| | - Kimiya Sakamoto
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Ritsurou Inoue
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kodai Matsuda
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Jun Tsugawa
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Sho Takeshita
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Sachiko Shirakawa
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
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Yamaguchi T, Miyamoto T, Shikata E, Yamaguchi I, Shimada K, Yagi K, Tada Y, Korai M, Kitazato KT, Kanematsu Y, Takagi Y. Activation of the NLRP3/IL-1β/MMP-9 pathway and intracranial aneurysm rupture associated with the depletion of ERα and Sirt1 in oophorectomized rats. J Neurosurg 2023; 138:191-198. [PMID: 35594890 DOI: 10.3171/2022.4.jns212945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/14/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) due to intracranial aneurysm (IA) rupture is often a devastating event. Since the incidence of SAH increases especially in menopause, it is crucial to clarify the detailed pathogenesis of these events. The activation of vascular nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasomes has been studied in ischemic stroke and cardiovascular disease. However, the role of NLRP3 in IA rupture still needs to be explained. The authors sought to test their hypothesis that, under estrogen-deficient conditions, activation of NLRP3 inflammasomes via downregulation of the estrogen receptor (ER) facilitates IA rupture. METHODS Ten-week-old female Sprague Dawley rats with and without oophorectomy were subjected to hemodynamic changes and hypertension (OVX+/HT and OVX-/HT, respectively) and fed a high-salt diet. Separately, using human brain endothelial cells (HBECs) and human brain smooth muscle cells (HBSMCs), the authors tested the effect of NLRP3 under estrogen-free conditions and in the presence of estradiol or of ER agonists. RESULTS In OVX+/HT rats, the frequency of IA rupture was significantly higher than in OVX-/HT rats (p = 0.03). In the left posterior cerebral artery prone to rupture in OVX+/HT rats, the levels of the mRNAs encoding ERα and Sirt1, but not of that encoding ERβ, were decreased, and the levels of the mRNAs encoding NLRP3, interleukin-1β (IL-1β), and matrix metalloproteinase 9 (MMP-9) were elevated. Immunohistochemical analysis demonstrated that the expression profiles of these proteins correlated with their mRNA levels. Treatment with an ER modulator, bazedoxifene, normalized the expression profiles of these proteins and improved SAH-free survival. In HBECs and HBSMCs under estrogen-free conditions, the depletion of ERα and Sirt1 and the accumulation of NLRP3 were counteracted by exposure to estradiol or to an ERα agonist but not to an ERβ agonist. CONCLUSIONS To the authors' knowledge, this work represents the first demonstration that, in an aneurysm model under estrogen-deficient conditions, the depletion of ERα and Sirt1 may contribute to activation of the NLRP3/IL-1β/MMP-9 pathway, facilitating the rupture of IAs in the estrogen-deficient rat IA rupture model.
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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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