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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Abe Y, Ishibashi T, Otani K, Kan I, Murayama Y. Virtual coil images can optimize the visualization of the neckline of intracranial aneurysms during coil embolization: A technical note. Surg Neurol Int 2023; 14:349. [PMID: 37810302 PMCID: PMC10559515 DOI: 10.25259/sni_675_2023] [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: 08/10/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023] Open
Abstract
Background During coil embolization of intracranial aneurysms, the aneurysmal neck needs to be evaluated because coil protrusion into the parent artery may lead to ischemic complications. However, the neck cannot always be clearly visualized due to the limitation of the angiography system and due to the structure of the aneurysm. As a visual aid, we propose a color-coded fusion imaging method that generates "virtual coil" images using preoperative three-dimensional digital subtraction angiography (3D-DSA) images. Case Description Coil embolization for intracranial aneurysms was performed using the working angles determined from the preoperative 3D-DSA. The aneurysms were located at the middle cerebral artery, anterior communicating artery (A-com), and posterior communicating artery (P-com). The A-com and P-com aneurysms were recurrent. During the later phase of the procedure, physicians could not judge whether coils protruded into the parent artery on two-dimensional digital subtraction angiography (2D-DSA) images because an optimal working angle could not be realized. Virtual coil images were displayed on the angiography system's monitor to show the expected completed embolization, which could be compared to the current 2D-DSA images as a visual aid. Conclusion Virtual coil images can provide visual aid to the treating physician during aneurysm coil embolization, which is useful when an accurate working angle cannot be reached.
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Affiliation(s)
- Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Minato City, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Minato City, Tokyo, Japan
| | | | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Minato City, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato City, Tokyo, Japan
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Brockmann C, Dillinger D, Mpotsaris A, Spreer A, Maus V, Waldeck S, Othman AE, Altmann S, Ringel F, Kerz T, Brockmann MA. Safety Profile and Complication Rates in Emergency Off-label Use of Tirofiban in Interventional Neuroradiology : An Observational Dual Center Study. Clin Neuroradiol 2022; 33:427-433. [PMID: 36269346 DOI: 10.1007/s00062-022-01223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Tirofiban has been approved for the treatment of acute coronary syndrome. Meanwhile, tirofiban is frequently applied in emergency situations in interventional neuroradiology (INR). The objective of this study was to analyze the risk profile for the off-label use of tirofiban in INR patients. METHODS Data of 86 patients, who underwent neurointerventional therapy and were treated with tirofiban at 2 neuroendovascular centers between January 2016 and July 2017 were retrospectively analyzed. Despite off-label use, recent stroke (< 30 days), recent hemorrhage, thrombocytopenia (< 150,000/µl), activated partial thromboplastin time (aPTT) > 1.3-fold, internation normalised ratio (INR) < 1.5, severe liver insufficiency (Child-Pugh C), and preceding intravenous thrombolysis were considered as contraindications. RESULTS Median patient age was 62 years (range 26-88 years). Patients received tirofiban for extracranial (n = 35) or intracranial stenting (n = 35), coiling of ruptured cerebral aneurysms (n = 6), continuous intra-arterial nimodipine infusion via microcatheters for subarachnoid hemorrhage (SAH)-related vasospasm (n = 5), or thrombotic complications during neuroendovascular procedures (n = 5). The desired effect of preventing thrombotic complications when applying tirofiban off-label was achieved in 81 of 86 patients (94.2%). Relevant tirofiban-associated complications occurred in 14 patients (16.3%), of which 9 patients received i.v. thrombolysis for treatment of acute ischemic stroke shortly before starting therapy with tirofiban. Of the 86 patients 12 died, while the overall tirofiban-related mortality was 2.3% (2 patients died due to ICH). Logistic regression analysis revealed age to be the only parameter significantly associated with development of tirofiban-associated complications (p = 0.026). CONCLUSION Whereas the safety profile of tirofiban when applied off-label in INR is acceptable, the highest risk for relevant tirofiban-associated complications is observed in older patients treated by emergency stenting for acute stroke.
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Affiliation(s)
- Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Daniel Dillinger
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Anastasios Mpotsaris
- Department of Neuroradiology, Munich Klinik, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Annette Spreer
- Department of Neurology, Klinikum Braunschweig, Salzdahlumer Straße 90, 38126, Braunschweig, Germany
- Department of Neurology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Stephan Waldeck
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Kerz
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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