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Opancina V, Zdravkovic N, Jankovic S, Masulovic D, Ciceri E, Jaksic B, Nukovic JJ, Nukovic JA, Adamovic M, Opancina M, Prodanovic N, Nukovic M, Prodanovic T, Doniselli F. Predictors of Intrahospital Mortality in Aneurysmal Subarachnoid Hemorrhage after Endovascular Embolization. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1134. [PMID: 39064563 PMCID: PMC11278789 DOI: 10.3390/medicina60071134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Aneurysmal subarachnoid hemorrhage (ASAH) is defined as bleeding in the subarachnoid space caused by the rupture of a cerebral aneurysm. About 11% of people who develop ASAH die before receiving medical treatment, and 40% of patients die within four weeks of being admitted to hospital. There are limited data on single-center experiences analyzing intrahospital mortality in ASAH patients treated with an endovascular approach. Given that, we wanted to share our experience and explore the risk factors that influence intrahospital mortality in patients with ruptured intracranial aneurysms treated with endovascular coil embolization. Materials and Methods: Our study was designed as a clinical, observational, retrospective cross-sectional study. It was performed at the Department for Radiology, University Clinical Center Kragujevac in Kragujevac, Serbia. The study inclusion criteria were ≥18 years, admitted within 24 h of symptoms onset, acute SAH diagnosed on CT, aneurysm on DSA, and treated by endovascular coil embolization from January 2014 to December 2018 at our institution. Results: A total of 66 patients were included in the study-48 (72.7%) women and 18 (27.3%) men, and 19.7% of the patients died during hospitalization. After adjustment, the following factors were associated with in-hospital mortality: a delayed ischemic neurological deficit, the presence of blood in the fourth cerebral ventricle, and an elevated urea value after endovascular intervention, increasing the chances of mortality by 16.3, 12, and 12.6 times. Conclusions: Delayed cerebral ischemia and intraventricular hemorrhage on initial head CT scan are strong predictors of intrahospital mortality in ASAH patients. Also, it is important to monitor kidney function and urea levels in ASAH patients, considering that elevated urea values after endovascular aneurysm embolization have been shown to be a significant risk factor for intrahospital mortality.
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Affiliation(s)
- Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Nebojsa Zdravkovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Slobodan Jankovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dragan Masulovic
- Department of Radiology, Medical Faculty, University of Belgrade, 11120 Belgrade, Serbia
| | - Elisa Ciceri
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Bojan Jaksic
- Faculty of Medicine, University of Kosovska Mitrovica, 11000 Belgrade, Serbia
| | - Jasmin J. Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
| | - Jusuf A. Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
| | - Miljan Adamovic
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Pharmacy Institution “Zdravlje Lek”, Prvomajska 100, 11000 Belgrade, Serbia
| | - Miljan Opancina
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Faculty of Medicine, Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Nikola Prodanovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Merisa Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Tijana Prodanovic
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Fabio Doniselli
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Siller S, Briegel J, Kunz M, Liebig T, Forbrig R, Tonn JC, Schichor C, Thorsteinsdottir J. Improved rates of postoperative ischemia, completeness of aneurysm occlusion and neurological deficits in elective clipping of anterior circulation aneurysms over the past 20 years - association with technical improvements. Acta Neurochir (Wien) 2024; 166:253. [PMID: 38847921 PMCID: PMC11161420 DOI: 10.1007/s00701-024-06150-7] [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: 04/10/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND/PURPOSE Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits. METHODS Patients undergoing microsurgical clip occlusion for unruptured anterior circulation aneurysms between 2000 and 2019 were included, with ICG-VAG since 2009 and iCT-A/-P (for selected cases) since 2016. Baseline characteristics and treatment-related morbidity/outcome focusing on differences between the three distinct cohorts (cohort-I: pre-ICG-VAG-era, cohort-II: ICG-VAG-era, cohort-III: ICG-VAG&iCT-A/-P-era) were analyzed. RESULTS 1391 patients were enrolled (n = 74 were excluded), 779 patients were interventionally treated, 538 patients were surgically clipped by a specialized vascular team (cohort-I n = 167, cohort-II n = 284, cohort-III n = 87). Aneurysm size was larger in cohort-I (8.9 vs. 7.5/6.8 mm; p < 0.01) without differences concerning age (mean:55years), gender distribution (m: f = 1:2.6) and aneurysm location (MCA:61%, ICA:18%, ACA/AcomA:21%). There was a stepwise improvement in the rate of radiologically detected postoperative ischemia (16.2vs.12.0vs.8.0%; p = 0.161), complete aneurysm occlusion (68.3vs.83.6vs.91.0%; p < 0.01) and postoperative new deficits (10.8vs.7.7vs.5.7%; p = 0.335) from cohort-I to -III. After a mean follow-up of 12months, a median modified Rankin scale of 0 was achieved in all cohorts. DISCUSSION Associated with periprocedural technical achievements, surgical outcome in elective anterior circulation aneurysm surgery has improved in our service during the past 20 years.
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Affiliation(s)
- Sebastian Siller
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
- Department of Neurosurgery, University Hospital, University of Regensburg, Franz-Josef-Strauss-Allee 11, D-93053, Regensburg, Germany.
| | - Josef Briegel
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Robert Forbrig
- Department of Neuroradiology, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
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Carvalho V, Vilarinho A, Polónia P, Silva ML, Vaz R, Alberto Silva P. The impact of selection bias in the treatment for ruptured anterior communicating artery aneurysms: different results or different patients? World Neurosurg X 2024; 21:100255. [PMID: 38169854 PMCID: PMC10758962 DOI: 10.1016/j.wnsx.2023.100255] [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: 10/09/2022] [Revised: 06/15/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Anterior communicating artery is one of the most frequent locations for the development of intracranial aneurysm. The availability and advances of different treatments modalities allows for case-specific selection, but potentially impacts our ability to assess equipoise among them. Objective Investigate and compare clinical and morphological variables among surgical and endovascular treatment groups with ruptured anterior communicating artery aneurysms. Methods Data from patients from a single university hospital treated for ruptured anterior communicating aneurysms after multidisciplinary discussion in a period from January 2009 to January 2020 were retrospectively reviewed. Demographics, clinical status, aneurysm morphologic features and in-hospital complications were registered for each treatment (endovascular coiling vs. microsurgical clipping). Clinical assessment was made from outpatient evaluation at 1-year follow-up. Results A total of 119 patients was obtained adding surgical (n = 80) and endovascular (n = 39) treatment groups. No significant changes between groups were detected regarding gender, age of treatment or other risk factors. Global complication rate (p = 0.335, p = 0.225, p = 0.428) and clinical outcome (p = 0.802) was similar among both groups. Univariate and multivariate analysis revealed statistically significant differences between endovascular and surgical treatment groups regarding dome orientation (p = 0.011), aneurysm height (p < 0.001) and maximum diameter (p < 0.001), aspect-ratio (p < 0.001), dome-to-neck ratio (p < 0.001) and dome diameter (p = 0.014). Conclusions Despite similar clinical outcomes and rate of complications, morphological differences highlight the presence of a selection bias and high heterogeneity, which hampers inferential analysis when comparing both techniques.
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Affiliation(s)
- Vasco Carvalho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - António Vilarinho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Patrícia Polónia
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Maria Luís Silva
- Neuroradiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Pedro Alberto Silva
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
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Zhang J, He L, Xia X, Zhang L, Yu K. Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms. Clinics (Sao Paulo) 2023; 78:100202. [PMID: 37130488 PMCID: PMC10172744 DOI: 10.1016/j.clinsp.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/04/2023] Open
Abstract
PURPOSES Braided and laser-cut stents both are efficacious and safe for coiling intracranial aneurysms. The study aimed to compare outcomes following braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in 266 patients who were diagnosed with unruptured intracranial aneurysms of different types and locations. METHODS Patients with unruptured complex intracranial aneurysms underwent braided (BSE cohort, n = 125) or laser engraved (LSE cohort, n = 141) stent-assisted embolization. RESULTS The deployment success rate was higher for patients of the LSE cohort than those of the BSE cohort (140 [99%] vs. 117 [94%], p = 0.0142). Seventy-one (fifty-seven percentages) and 73 (52%) were coil embolization procedure success rates of the BSE and the LSE cohorts. Periprocedural intracranial hemorrhage was higher in patients of the BSE cohort than those of the LSE cohort (8 [6%] vs. 1 [1%], p = 0.0142). Four (three percentages) patients from the LSE cohort and 3 (2%) patients from the BSE cohort had in-stent thrombosis during embolization. Permanent morbidities were higher in patients of the LSE cohort than those of the BSE cohort (8 [6%] vs. 1 [1%], p = 0.0389). Higher successful procedures (76% vs. 68%) and fewer postprocedural intracranial hemorrhage (0% vs. 5%) and mortality (0% vs. 5%) were reported for patients of the BSE cohort in posterior circulation aneurysmal location than those of the LSE cohort. Laser engraved stent has fewer problems with deployment and may have better periprocedural and follow-up outcomes after embolization. CONCLUSIONS Braided stent-assisted embolization should be preferred when the aneurysm is present in the posterior circulation.
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Affiliation(s)
- Jie Zhang
- The First Affiliated Hospital of Chengdu Medical College, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Ling He
- The First Affiliated Hospital of Chengdu Medical College, Department of Hematology, Chengdu, Sichuan, China
| | - Xun Xia
- The First Affiliated Hospital of Chengdu Medical College, Department of Neurosurgery, Chengdu, Sichuan, China.
| | - Lie Zhang
- The First Affiliated Hospital of Chengdu Medical College, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Kai Yu
- The First Affiliated Hospital of Chengdu Medical College, Department of Neurosurgery, Chengdu, Sichuan, China
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Carvalho V, Moreira M, Vilarinho A, Cerejo A, Vaz R, Silva PA. Selection bias in patients proposed for neurosurgical versus endovascular treatment of aneurysms of the posterior communicating artery. Interv Neuroradiol 2022; 28:675-681. [PMID: 34787020 PMCID: PMC9706261 DOI: 10.1177/15910199211057738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/25/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Microsurgical clipping and endovascular coiling are viable treatment options for posterior communicating artery (PComA) aneurysms, but there are still major limitations to evidence-based decisions regarding standard-of-care treatment. In this study, we aimed at assessing potential selection biases that may influence our ability to extract conclusions about the comparative effectiveness or efficacy of the aneurysm treatment. OBJECTIVE To study the patient/aneurysm characteristics as possible biases in the option for endovascular or neurosurgical treatment of PComA aneurysms. METHODS A single-center, retrospective cohort study was performed, including all patients with treated PComA aneurysms with neurosurgical clipping or endovascular coiling between January 2010 and January 2021. Clinical and morphological data were collected from electronic records, and statistical analysis was performed. RESULTS A total of 64 patients was eligible for inclusion; 24 (37.5%) patients were proposed for neurosurgical treatment, while 40 (62.5%) for endovascular treatment; 10 patients (25%) crossed over to the clipping group whereas none crossed over to the coiling side. Actual treatment analysis showed significantly higher diameters of mother vessel (t-test, p = 0.034) and aneurysm neck (Mann-Whitney, p = 0.029) in the clipping group and higher aspect and dome-to-neck ratios in the endovascular group (Mann-Whitney, p = 0.008). A significantly higher vasospasm frequency was found in the clipping group but only in the intention-to-treat analysis (Chi-square, p = 0.032). CONCLUSION Significant morphological differences between effective endovascular and surgical groups and differences in intention-to-treat analysis may limit the validity of a direct comparison between treatment options and suggest the presence of a possible selection bias.
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Affiliation(s)
- Vasco Carvalho
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Marta Moreira
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - António Vilarinho
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - António Cerejo
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Pedro Alberto Silva
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
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Huang X, Xiong Y, Guo X, Kang X, Chen C, Zheng H, Pan Z, Wang L, Zheng S, Stavrinou P, Goldbrunner R, Stavrinou L, Hu W, Zheng F. Transradial versus transfemoral access for endovascular therapy of intracranial aneurysms: a systematic review and meta-analysis of cohort studies. Neurosurg Rev 2022; 45:3489-3498. [PMID: 36129583 DOI: 10.1007/s10143-022-01868-3] [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: 05/21/2022] [Revised: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Endovascular treatment is widely used in the treatment of intracranial aneurysms. However, neurosurgeons are sceptical about endovascular access via the radial artery. We performed a systematic review and meta-analysis to compare the effectiveness and safety of transradial and transfemoral artery access in patients with intracranial aneurysms. We systematically searched the PubMed, Embase, and Cochrane databases for studies comparing the two approaches. The primary outcome was total complications, and the secondary outcomes were access site complications, intracranial haemorrhage, stroke, thromboembolism, silent infarct, re-treatment rate, mortality, complete occlusion of intracranial aneurysms, procedure duration, and length of hospital stay. A random-effects model was used to assess the pooled data. Of the 100 identified studies, 6 were eligible (a total of 3764 participants). There were no significant differences in total complications(odds ratio [OR] = 0.69, 95% confidence interval [CI] [0.33, 1.45], p = 0.32), complete occlusion of intracranial aneurysms (OR = 1.02, 95%CI [0.77,1.37], p = 0.87), procedure duration (mean difference [MD] = - 6.24, 95%CI [- 14.75, - 1.54], p = 0.95), or length of hospital stay (MD = 2.204, 95%CI [- 0.05, 4.45], p = 0.95), access site complications (OR = 0.49, 95%CI [0.16, 1.52], p = 0.22), intracranial haemorrhage (OR = 1.07, 95%CI [0.49, 2.34], p = 0.86), stroke (OR = 0.59, 95%CI [0.20, 1.77], p = 0.35), thromboembolism (OR = 0.85, 95%CI [0.33, 2.17], p = 0.74), silent infarct (OR = 0.69, 95%CI [0.04, 11.80], p = 0.80), retreatment rate (OR = 1.32, 95%CI [0.70, 2.48], p = 0.39), mortality (OR = 1.41, 95%CI [0.06, 5.20], p = 0.61), immediate occlusion (OR = 0.99, 95%CI [0.64, 1.51], p = 0.95), and occlusion during follow-up (OR = 1.10, 95%CI [0.56, 2.16], p = 0.74) between the transradial and transfemoral groups. This study showed comparable safety and efficacy outcomes between transradial and transfemoral access in patients with intracranial aneurysms treated endovascularly. Future large randomised trials are warranted to confirm these findings.
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Affiliation(s)
- Xinyue Huang
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Yu Xiong
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Xiumei Guo
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China.,Department of Neurology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, China
| | - Xiaodong Kang
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Chunhui Chen
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Hanlin Zheng
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Zhigang Pan
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China
| | - Lingxing Wang
- Department of Neurology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, China
| | - Shuni Zheng
- Division of Public Management, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, 362000, China
| | - Pantelis Stavrinou
- Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.,Metropolitan Hospital, Athens, Greece
| | - Roland Goldbrunner
- Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lampis Stavrinou
- 2Nd Department of Neurosurgery, Athens Medical School, Attikon" University Hospital, National and Kapodistrian University, Athens, Greece
| | - Weipeng Hu
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China.
| | - Feng Zheng
- Department of Neurosurgery, the Second Affiliated Hospital, Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, China.
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Clinical Usage of Different Doses of Cis-Atracurium in Intracranial Aneurysm Surgery and Its Effect on Motor-Evoked Potentials. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5910019. [PMID: 35799657 PMCID: PMC9256351 DOI: 10.1155/2022/5910019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
The objective of this work was to investigate the effect of different doses of cis-atracurium on patients undergoing general anesthesia induction (GAI) during intracranial aneurysm surgery (ICAS). In this work, 90 patients who underwent ICAS under the elective motor-evoked potential (MEP) monitoring in the First Affiliated Hospital of Northwest University (Xi'an No. 1 Hospital) from January 2021 to May 2022 were enrolled as the research objects. Randomly, they were rolled into a S1 group (30 cases, 2 times 95% effective dose (ED95) cis-atracurium), a S2 group (30 cases, 3 times ED95 cis-atracurium), and a S3 group (30 cases, 4 times ED95 cis-atracurium). The endotracheal intubation conditions, the train-of-four (TOF) rate (TOFR), body movement, and spontaneous breathing were compared among the three groups of patients. The results showed that the MEP inhibition time of the patients in the S3 group was much longer than that of the S1 and S2 groups, but it showed no significant difference between the S1 group and S2 group (P > 0.05). The good rates of endotracheal intubation conditions in the S2 group (100%) and S3 group (100%) were obviously higher than the rate in the S1 group (43.33%). The TOFRs of patients in S2 and S3 groups at time t2 and t3 were lower obviously to that at time t0, while the TOFRs of patients in S3 group at time t2 and t3 were still lower in contrast to the S2 group (P < 0.05). The mean arterial pressure (MAP) and heart rate (HR) of patients in all groups were lower at t1, t2, and t3 than at t0 (P < 0.05), while the differences among different groups were not remarkable (P > 0.05). Finally, using 3 times ED95 cis-atracurium for GAI could reduce the risk of intraoperative body movement and spontaneous breathing, as well as the residual degree of muscle relaxation, in patients with ICAS, without affecting MEP monitoring, improving endotracheal intubation conditions, and increasing safety during open neurosurgery operations.
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Song J, Mao Y. Giant Aneurysm Management. Adv Tech Stand Neurosurg 2022; 44:133-160. [PMID: 35107677 DOI: 10.1007/978-3-030-87649-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The treatment of giant aneurysms has always been a challenge in the field of neurovascular disease. Giant aneurysms are larger in size and are associated with thrombosis development and the calcification of the aneurysmal wall and neck, which often interfere with direct clipping. Most giant aneurysms have a wide neck with an incomplete thrombus, making complete embolization almost impossible. Giant aneurysms of different sites have entirely different hemodynamic characteristics. Moreover, aneurysms at the same site may exhibit very different hemodynamics among different individuals. Therefore, careful assessment of each case is required before and during treatment to develop and carry out an individualized treatment plan.
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Affiliation(s)
- Jianping Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China. .,Neurosurgical Institute of Fudan University, Shanghai, China. .,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China. .,National Center for Neurological Disorders, Shanghai, China.
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Li W, Ye M, Cimpoca A, Henkes H, Wang H, Xu X, Gu Y, Shi H, Ji H, Wang F, Zhao Y, Guo G, Zhang H, Li Y. Avenir® vs. AxiumTM Coils for the Treatment of Intracranial Aneurysms: Results of a Multicenter Randomized Controlled Trial With Short-Term Follow-Up. Front Neurol 2022; 12:817989. [PMID: 35153992 PMCID: PMC8825471 DOI: 10.3389/fneur.2021.817989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Endovascular coil occlusion is a successful and rapidly evolving strategy used to treat patients who present with intracranial aneurysms. This study aimed to compare the safety and efficacy of the Avenir® and AxiumTM passive mechanically detachable coil systems. Methods A prospective, multicenter, randomized controlled study was carried out at ten medical centers from March 2018 to December 2019. A series of consecutive patients diagnosed with intracranial aneurysms were randomly assigned to undergo endovascular treatment with either the Avenir® or the AxiumTM mechanically detachable coil systems. The short-term outcomes from the two groups were compared with a focus on treatment efficacy and safety. Results A total of 162 and 161 patients were enrolled in the Avenir and Axium groups, respectively. The rate of successful coil detachment was 100% for the Avenir group and 99.38% for the Axium group. At the six-month follow-up visit, the overall aneurysm occlusion rate was 94.66% for the Avenir group and 96.95% for the Axium group (p > 0.05). We observed no statistically significant differences in clinical condition (as per the modified Rankin Scale) or the degree of aneurysm occlusion (as determined by digital subtraction angiography [DSA] and Raymond-Roy Occlusion Classification). Surgical complications were reported in 27 subjects in the Avenir group and 22 in the Axium group (p > 0.05). DSA performed at 6 months revealed complete aneurysm occlusion in 84 and 86% of patients in the Avenir and Axium groups, respectively. Conclusion We observed no significant short-term differences with respect to efficacy or safety when using either Avenir® or AxiumTM coils for the treatment of intracranial aneurysms.
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Affiliation(s)
- Wei Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Neurosurgery Department, The Second Affiliated Hospital of Xingtai Medical College, Xingtai, China
| | - Ming Ye
- Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Honglei Wang
- The First Hospital of Jilin University, Jilin, China
| | - Xiang Xu
- Tangshan Worker's Hospital, Tangshan, China
| | - Yuxiang Gu
- Huashan Hospital of Fudan University, Beijing, China
| | - Huaizhang Shi
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongming Ji
- Shanxi Provincial People's Hospital, Taiyuan, China
| | - Feng Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuanli Zhao
- Peking University International Hospital, Beijing, China
| | - Geng Guo
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongqi Zhang
- Xuanwu Hospital of Capital Medical University, Beijing, China
- *Correspondence: Hongqi Zhang
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Tiantan Hospital of Capital Medical University, Beijing, China
- Youxiang Li
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10
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You L, Huang J, Zhang J, Jiang Z. Multiple overlapping stent-assisted coiling improves efficacy and safety of treatment for complex intracranial aneurysms: a randomized trial. Biomed Eng Online 2021; 20:100. [PMID: 34627265 PMCID: PMC8501645 DOI: 10.1186/s12938-021-00936-x] [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: 06/15/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intracranial aneurysm rupture is the main cause of subarachnoid hemorrhage, leading to high disability and mortality. This study aimed to evaluate the clinical treatment effects of multiple overlapping stent-assisted coiling for complex intracranial aneurysms. METHODS We conducted a randomized, controlled, single-blinded clinical trial among 168 patients diagnosed with complex intracranial aneurysms. Treatment allocation to either single stent (SS) group or multiple stent (MS) group was randomized at 1:1 ratio using a Web-based platform. The O'Kelly-Marotta (OKM) grading scale was used to evaluate the degree of aneurysm occlusion after operation and during follow-up. Good aneurysm occlusion was defined as OKM grade C-D. The modified Rankin Scale (mRS) was used to evaluate the neurological status and the clinical outcome of patients. RESULTS Efficacy comparative analysis demonstrated that major recurrence of aneurysms was significantly reduced in the MS group (P = 0.012). In addition, the MS group displayed significantly reduced number of patients with mRS between 3 and 6 (P = 0.007) and increased number of patients with mRS between 0 and 1 (P = 0.034). Furthermore, the MS group showed increased percentage of patients with OKM grade C-D (P = 0.041). Compared with the SS group, the MS group exhibited decreased mortality (P = 0.037) and morbidity (P = 0.035). CONCLUSIONS Multiple overlapping stent-assisted coiling significantly improved the clinical treatment effects and provided a new method for complex intracranial aneurysms.
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Affiliation(s)
- Lingtong You
- Inpatient Department District N13, Quanzhou First Hospital Affiliated to Fujian Medical University, Chendong Branch of Quanzhou 1st Hospital, Quanzhou, 362000, Fujian, China
| | - Jiaxin Huang
- Inpatient Department District N13, Quanzhou First Hospital Affiliated to Fujian Medical University, Chendong Branch of Quanzhou 1st Hospital, Quanzhou, 362000, Fujian, China
| | - Jinning Zhang
- Inpatient Department District N13, Quanzhou First Hospital Affiliated to Fujian Medical University, Chendong Branch of Quanzhou 1st Hospital, Quanzhou, 362000, Fujian, China
| | - Zhixian Jiang
- Inpatient Department District N13, Quanzhou First Hospital Affiliated to Fujian Medical University, Chendong Branch of Quanzhou 1st Hospital, Quanzhou, 362000, Fujian, China.
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11
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Nouri M, Schneider JR, Shah K, White TG, Katz JM, Dehdashti AR. Cerebral Bypass for Aneurysms in the Era of Flow Diversion: Single-Surgeon Case Series. Oper Neurosurg (Hagerstown) 2021; 21:303-311. [PMID: 34245142 DOI: 10.1093/ons/opab215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With recent advances in endovascular treatments of brain aneurysms such as flow diverters, the role of cerebral revascularization needs to be re-evaluated. OBJECTIVE To evaluate the contemporary indications and outcomes of cerebral revascularization for brain aneurysms. METHODS A retrospective evaluation of a prospectively maintained database was performed to review clinical and imaging data of all the patients who underwent cerebral revascularization for brain aneurysms over the past 10 yr. RESULTS Among 174 cerebral revascularizations, 40 (in 36 patients) were done for the treatment of aneurysms. In total, 9 patients underwent combined endovascular treatment and surgical revascularization. Immediate aneurysm occlusion was achieved in 30 patients (83.3%). Immediate postoperative bypass patency was confirmed in 33 patients (92%). Postoperative neurological deficit was observed in 4 patients (11.1%). There were 2 mortalities in the postoperative period. Aneurysm total occlusion rate was 91% at 1 yr. Thirty patients had 1 yr clinical and radiological follow-up. Clinical evaluations showed modified Rankin Scale 2 or less in 25 patients at 1 yr. Bypass patency was confirmed in 27 (90%). Patients with fair/poor outcome were all in the subarachnoid hemorrhage group. Twenty-one patients had follow-up studies for 3 yr or beyond with no evidence of stroke or aneurysm recurrence. CONCLUSION Our results support that cerebral revascularization can be regarded as a viable and durable treatment option for these challenging aneurysms with acceptable morbidity. Cerebral bypass should be offered in selected cases where standard endovascular or surgical treatment is not efficacious or curative.
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Affiliation(s)
- Mohsen Nouri
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Julia R Schneider
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Kevin Shah
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Timothy G White
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Jeffrey M Katz
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
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12
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Ding X, Wang X, Han L, Zhao Z, Jia S, Tuo Y. CircRNA DOCK1 Regulates miR-409-3p/MCL1 Axis to Modulate Proliferation and Apoptosis of Human Brain Vascular Smooth Muscle Cells. Front Cell Dev Biol 2021; 9:655628. [PMID: 34109173 PMCID: PMC8181129 DOI: 10.3389/fcell.2021.655628] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background Intracranial aneurysm is an abnormal expansion in the intracranial arteries, which is associated with growth and apoptosis of vascular smooth muscle cells. Circular RNAs (circRNAs) have implicated in the progression of intracranial aneurysms. The purpose of this paper is to study the function and mechanism of circRNA dedicator of cytokinesis 1 (circ_DOCK1) in regulating proliferation and apoptosis of human brain vascular smooth muscle cells (HBVSMCs). Methods HBVSMCs were exposed to hydrogen peroxide (H2O2). Cell proliferation and apoptosis were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and flow cytometry, respectively. Circ_DOCK1, microRNA (miR)-409-3p, and myeloid cell leukemia sequence 1 (MCL1) levels were examined by quantitative reverse transcription polymerase chain reaction or western blotting. The target association was assessed by dual-luciferase reporter, RNA pull-down, and RNA immunoprecipitation assays. Results Exposure to H2O2 decreased proliferation and increased apoptosis of HBVSMCs. Circ_DOCK1 expression was reduced in H2O2-treated HBVSMCs. Circ_DOCK1 overexpression rescued H2O2-caused reduction of proliferation and PCNA expression and attenuated H2O2-induced apoptosis and expression of Bcl-2, Bax, and cleaved PARP. MiR-409-3p was targeted by circ_DOCK1 and upregulated in H2O2-treated HBVSMCs. MiR-409-3p upregulation mitigated the role of circ_DOCK1 in proliferation and apoptosis of H2O2-treated HBVSMCs. MCL1 was targeted via miR-409-3p and downregulated via H2O2 treatment. Circ_DOCK1 overexpression enhanced MCL1 expression via modulating miR-409-3p. MiR-409-3p knockdown weakened H2O2-induced proliferation reduction and apoptosis promotion via regulating MCL1. Conclusion Circ_DOCK1 overexpression mitigated H2O2-caused proliferation inhibition and apoptosis promotion in HBVSMCs by modulating miR-409-3p/MCL1 axis.
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Affiliation(s)
- Xinmin Ding
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaolong Wang
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Li Han
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhiyu Zhao
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuai Jia
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuanzhao Tuo
- Department of Neurosurgery, Shanxi Bethune Hospital, The Third Hospital of Shanxi Medical University, Taiyuan, China
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13
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Jiang Z, Huang J, You L, Zhang J, Li B. Pharmacological inhibition of STAT3 by BP-1-102 inhibits intracranial aneurysm formation and rupture in mice through modulating inflammatory response. Pharmacol Res Perspect 2021; 9:e00704. [PMID: 33474811 PMCID: PMC7817916 DOI: 10.1002/prp2.704] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/28/2022] Open
Abstract
As an inhibitor of STAT3, BP-1-102 can regulate the inflammation response caused by vascular smooth muscle cells (VSMCs) by inhibiting the JAK/STAT3/NF-κB pathway, thereby attenuating the symptoms of intracranial aneurysm (IA). IA mouse model was established by stereotactic injection of elastase to evaluate the effect of BP-1-102. The expression levels of smooth muscle markers and matrix metalloproteinases (MMPs) were detected by qRT-PCR, and the levels of inflammatory factors were detected by ELISA and qRT-PCR. The protein levels of the NF-κB signaling pathway factors were examined by Western blot. BP-1-102 reduced blood pressure in aneurysm mice, up-regulated smooth muscle cell markers MHC, SMA, and SM22, and down-regulated the expression of MMP2 and MMP9 in vascular tissues. At the same time, BP-1-102 also down-regulated the expression levels of inflammatory response factors and the NF-κB pathway proteins. In the IA model, BP-1-102 can reduce the expression of inflammatory factors and MMPs bound to NF-κB by inhibiting the activation of the JAK/STAT3/NF-κB pathway proteins, and then restore the vascular wall elastin to reduce blood pressure, thereby treating aneurysm.
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Affiliation(s)
- Zhixian Jiang
- Inpatient Department District N13Chendong Branch of Quanzhou First HospitalQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Jiaxin Huang
- Inpatient Department District N13Chendong Branch of Quanzhou First HospitalQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Lingtong You
- Inpatient Department District N13Chendong Branch of Quanzhou First HospitalQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Jinning Zhang
- Inpatient Department District N13Chendong Branch of Quanzhou First HospitalQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Bingyu Li
- Geriatrics Department District 7Dongjie Branch of Quanzhou First HospitalQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
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