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Diana F, Romoli M, Raz E, Agid R, Albuquerque FC, Arthur AS, Beck J, Berge J, Boogaarts HD, Burkhardt JK, Cenzato M, Chapot R, Charbel FT, Desal H, Esposito G, Fifi JT, Florian S, Gruber A, Hassan AE, Jabbour P, Jadhav AP, Korja M, Krings T, Lanzino G, Meling TR, Morcos J, Mosimann PJ, Nossek E, Pereira VM, Raabe A, Regli L, Rohde V, Siddiqui AH, Tanikawa R, Tjoumakaris SI, Tomasello A, Vajkoczy P, Valvassori L, Velinov N, Walsh D, Woo H, Xu B, Yoshimura S, van Zwam WH, Peschillo S. Complex intracranial aneurysms: a DELPHI study to define associated characteristics. Acta Neurochir (Wien) 2024; 166:294. [PMID: 38990336 DOI: 10.1007/s00701-024-06182-z] [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: 04/15/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Intracranial aneurysms present significant health risks, as their rupture leads to subarachnoid haemorrhage, which in turn has high morbidity and mortality rates. There are several elements affecting the complexity of an intracranial aneurysm. However, criteria for defining a complex intracranial aneurysm (CIA) in open surgery and endovascular treatment could differ, and actually there is no consensus on the definition of a "complex" aneurysm. This DELPHI study aims to assess consensus on variables defining a CIA. METHODS An international panel of 50 members, representing various specialties, was recruited to define CIAs through a three-round Delphi process. The panelists participated in surveys with Likert scale responses and open-ended questions. Consensus criteria were established to determine CIA variables, and statistical analysis evaluated consensus and stability. RESULTS In open surgery, CIAs were defined by fusiform or blister-like shape, dissecting aetiology, giant size (≥ 25 mm), broad neck encasing parent arteries, extensive neck surface, wall calcification, intraluminal thrombus, collateral branch from the sac, location (AICA, SCA, basilar), vasospasm context, and planned bypass (EC-IC or IC-IC). For endovascular treatment, CIAs included giant size, very wide neck (dome/neck ratio ≤ 1:1), and collateral branch from the sac. CONCLUSIONS The definition of aneurysm complexity varies by treatment modality. Since elements related to complexity differ between open surgery and endovascular treatment, these consensus criteria of CIAs could even guide in selecting the best treatment approach.
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Affiliation(s)
- Francesco Diana
- Interventional Neuroradiology, University Hospital Vall d'Hebron, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Scienze della Vita, Della Salute e delle Professioni Sanitarie Link Campus University, Rome, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Eytan Raz
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Ronit Agid
- Division of Neuroradiology, JDMI, University Health Network, Toronto, Canada
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Adam S Arthur
- University of Tennessee, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN, USA
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jerome Berge
- Interventional Neuroradiology Department, CHRU, Bordeaux, France
| | | | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, USA
| | - Marco Cenzato
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - René Chapot
- Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Andreas Gruber
- Department of Neurosurgery, Johannes Kepler University, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist - University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - Ashutosh P Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Krings
- Interventional and Diagnostic Neuroradiology, University of Toronto & Toronto Western Hospital, Toronto, ON, Canada
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jaques Morcos
- Vivian L. Smith Department of Neurosurgery, UTHealth Houston Neurosciences, Houston, TX, USA
| | - Pascal J Mosimann
- Interventional and Diagnostic Neuroradiology, University of Toronto & Toronto Western Hospital, Toronto, ON, Canada
| | - Erez Nossek
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Departments of Surgery & Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Andreas Raabe
- Department of Neurosurgery Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | | | - Alejandro Tomasello
- Interventional Neuroradiology, University Hospital Vall d'Hebron, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nikolay Velinov
- Clinics of Neurosurgery, Vascular and Endovascular Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria
| | - Daniel Walsh
- King's College Hospital NHS Foundation Trust, London, UK
| | - Henry Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, School for Cardiovascular Diseases (CARIM), Maastricht UMC+, Maastricht, The Netherlands
| | - Simone Peschillo
- Endovascular Neurosurgery, Guido Guglielmi Endowed Chair in Endovascular Neurosurgery, Unicamillus International University of Health Sciences, Rome, Italy.
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Inuzuka N, Shobayashi Y, Tateshima S, Sato Y, Ohba Y, Ekdahl KN, Nilsson B, Teramura Y. Stent coating containing a charged silane coupling agent that regulates protein adsorption to confer antithrombotic and cell-adhesion properties. Sci Rep 2024; 14:15178. [PMID: 38987553 DOI: 10.1038/s41598-024-65832-5] [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: 01/27/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
The evolution of endovascular therapies, particularly in the field of intracranial aneurysm treatment, has been truly remarkable and is characterized by the development of various stents. However, ischemic complications related to thrombosis or downstream emboli pose a challenge for the broader clinical application of such stents. Despite advancements in surface modification technologies, an ideal coating that fulfills all the desired requirements, including anti-thrombogenicity and swift endothelialization, has not been available. To address these issues, we investigated a new coating comprising 3-aminopropyltriethoxysilane (APTES) with both anti-thrombogenic and cell-adhesion properties. We assessed the anti-thrombogenic property of the coating using an in vitro blood loop model by evaluating the platelet count and the level of the thrombin-antithrombin (TAT) complex, and investigating thrombus formation on the surface using scanning electron microscopy (SEM). We then assessed endothelial cell adhesion on the metal surfaces. In vitro blood tests revealed that, compared to a bare stent, the coating significantly inhibited platelet reduction and thrombus formation; more human serum albumin spontaneously adhered to the coated surface to block thrombogenic activation in the blood. Cell adhesion tests also indicated a significant increase in the number of cells adhering to the APTES-coated surfaces compared to the numbers adhering to either the bare stent or the stent coated with an anti-fouling phospholipid polymer. Finally, we performed an in vivo safety test by implanting coated stents into the internal thoracic arteries and ascending pharyngeal arteries of minipigs, and subsequently assessing the health status and vessel patency of the arteries by angiography over the course of 1 week. We found that there were no adverse effects on the pigs and the vascular lumens of their vessels were well maintained in the group with APTES-coated stents. Therefore, our new coating exhibited both high anti-thrombogenicity and cell-adhesion properties, which fulfill the requirements of an implantable stent.
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Affiliation(s)
- Naoki Inuzuka
- R&D Department, Japan Medical Device Startup Incubation Program, 3-7-2 Nihonbashihon-cho, Chuo-ku, Tokyo, 103-0023, Japan
- R&D Department, N.B. Medical Inc., 3-7-2 Nihonbashihon-cho, Chuo-ku, Tokyo, 103-0023, Japan
| | - Yasuhiro Shobayashi
- R&D Department, N.B. Medical Inc., 3-7-2 Nihonbashihon-cho, Chuo-ku, Tokyo, 103-0023, Japan
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2129, Los Angeles, CA, 90095, USA
| | - Yuya Sato
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Yoshio Ohba
- Cellular and Molecular Biotechnology Research Institute (CMB), National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 5, 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8565, Japan
| | - Kristina N Ekdahl
- Department of Immunology, Genetics and Pathology (IGP), Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Bo Nilsson
- Department of Immunology, Genetics and Pathology (IGP), Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Yuji Teramura
- Cellular and Molecular Biotechnology Research Institute (CMB), National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 5, 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8565, Japan.
- Department of Immunology, Genetics and Pathology (IGP), Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden.
- Master's/Doctoral Program in Life Science Innovation (T-LSI), University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
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Yapici F, Maus V, Weber W, Acikel C, Berlis A, Fischer S. Exploring the relationship between case volume and intracranial aneurysm treatments with flow-diverters and flow-disruptors: Insights from the 2020 to 2021 Database of the German Society for Interventional Radiology National Registry in Germany. Interv Neuroradiol 2024:15910199241249509. [PMID: 38710214 DOI: 10.1177/15910199241249509] [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: 05/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysm treatment using flow-diverters and flow-disruptors requires a higher level of expertise when compared to more traditional methods. Our hypothesis was that the procedural success and the rate of complications are dependent on the annual case load of a center. MATERIALS AND METHODS Conducting a retrospective analysis on the Database of the German Society for Interventional Radiology for the years 2020 to 2021, we examined flow-diverter and flow-disruptor procedures. We categorized centers into four groups according to their annual case load and proceeded to analyze success rates, complication rates, and fluoroscopy times across these centers. RESULTS No statistically significant differences were observed among the groups in both flow-diverter and flow-disruptor cases concerning fluoroscopy time and the incidence of technical complications. However, within the subgroup of flow-disruptor cases, centers with lower case load exhibited significantly higher rates of hemorrhagic and clinically relevant complications. Additionally, it was noted that the rate of therapeutic success in the flow-diverter group significantly increased in centers with higher case volumes. CONCLUSION Our findings support the intention towards centralization of medical care especially for complex neuroendovascular procedures. Furthermore, our findings are an argument to further develop a standardized educational and procedural algorithm based on defined case numbers and training modules for complex neurovascular procedures as already implemented by the Database of the German Society for Interventional Radiology.
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Affiliation(s)
- Furkan Yapici
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinik, Bochum, Germany
| | - Volker Maus
- Institut für Radiologie und Neuroradiologie, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Werner Weber
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinik, Bochum, Germany
| | - Cengizhan Acikel
- Department of Biostatistics, ClinCompetence Cologne GmbH, Cologne, Germany
| | - Ansgar Berlis
- Klinik für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Sebastian Fischer
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Knappschaftskrankenhaus Bochum-Universitätsklinik, Bochum, Germany
- Klinik für Radiologie und Neuroradiologie, Klinikum Siegen, Siegen, Germany
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Cole TS. Correspondence on 'Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019' by Haverkamp et al. J Neurointerv Surg 2024; 16:430. [PMID: 37696597 DOI: 10.1136/jnis-2023-020786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Tyler S Cole
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kaier K, Haverkamp C, Meckel S. Response to: Correspondence on "Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019" by Cole. J Neurointerv Surg 2024; 16:430-431. [PMID: 37696595 DOI: 10.1136/jnis-2023-020927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Department of Methods in Clinical Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian Haverkamp
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Stephan Meckel
- Neuroradiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Diagnostic and Interventional Neuroradiology, RKH Hospital Ludwigsburg, Ludwigsburg, Germany
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Jin J, Chen M, Wang H, Li S, Ma L, Wang B. Schizandrin A attenuates early brain injury following subarachnoid hemorrhage through suppressing neuroinflammation. Mol Biol Rep 2024; 51:236. [PMID: 38285214 DOI: 10.1007/s11033-023-08956-7] [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: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Early brain injury (EBI) is the vital factor in determining the outcome of subarachnoid hemorrhage (SAH). Schizandrin A (Sch A), the bioactive ingredient extracted from Schisandra chinensis, has been proved to exert beneficial effects in multiple human diseases. However, the effect of Sch A on SAH remains unknown. The current study was designed to explored role and mechanism of Sch A in the pathophysiological process of EBI following SAH. METHOD A total of 74 male C57BL/6 J mice were subjected to endovascular perforation to establish the SAH model. Different dosages of Sch A were administrated post-modeling. The post-modeling assessments included neurological test, brain water content, RT-PCR, immunofluorescence, Nissl staining. Oxygenated hemoglobin was introduced into microglia to establish a SAH model in vitro. RESULT Sch A significantly alleviated SAH-induced brain edema and neurological impairment. Moreover, application of Sch A remarkably inhibited SAH-induced neuroinflammation, evidenced by the decreased microglial activation and downregulated TNF-α, IL-1β and IL-6 and expression. Additionally, Sch A, both in vivo and in vitro, protected neurons against SAH-induced inflammatory injury. Mechanismly, administration of Sch A inhibited miR-155/NF-κB axis and attenuated neuroinflammation, as well as alleviating neuronal injury. CONCLUSION Our data suggested that Sch A could attenuated EBI following SAH via modulating neuroinflammation. The anti-inflammatory effect was exerted, at least partly through the miR-155/NF-κB axis, which may shed light on a possible therapeutic target for SAH.
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Affiliation(s)
- Jianxiang Jin
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China
| | - Maosong Chen
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China
| | - Hongcai Wang
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China
| | - Shiwei Li
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China
| | - Lei Ma
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China
| | - Boding Wang
- Department of Neurosurgery, Li Huili Hospital, Ningbo Medical Center, Xingning Road 57th, Yinzhou District, Ningbo, 315000, China.
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Dissanayake AS, Ho KM, Phillips TJ, Honeybul S, Hankey GJ. Pre-treatment re-bleeding following aneurysmal subarachnoid hemorrhage: A systematic review of published prediction models with risk of bias and clinical applicability assessment. J Clin Neurosci 2024; 119:102-111. [PMID: 37995407 DOI: 10.1016/j.jocn.2023.10.020] [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: 08/27/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Pre-treatment rebleeding following aneurysmal subarachnoid hemorrhage (aSAH) increases the risk of death and a poor neurological outcome. Current guidelines recommend aneurysm treatment "as early as feasible after presentation, preferably within 24 h of onset" to mitigate this risk, a practice termed ultra-early treatment. However, ongoing debate regarding whether ultra-early treatment is independently associated with reduced re-bleeding risk, together with the recognition that re-bleeding occurs even in centres practicing ultra-early treatment due to the presence of other risk-factors has resulted in a renewed need for patient-specific re-bleed risk prediction. Here, we systematically review models which seek to provide patient specific predictions of pre-treatment rebleeding risk. METHODS Following registration on the International prospective register of systematic reviews (PROSPERO) CRD 42023421235; Ovid Medline (Pubmed), Embase and Googlescholar were searched for English language studies between 1st May 2002 and 1st June 2023 describing pre-treatment rebleed prediction models following aSAH in adults ≥18 years. Of 763 unique records, 17 full texts were scrutinised with 5 publications describing 4 models reviewed. We used the semi-automated template of Fernandez-Felix et al. incorporating the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and the Prediction model Risk Of Bias ASsessment Tool (PROBAST) for data extraction, risk of bias and clinical applicability assessment. To further standardize risk of bias and clinical applicability assessment, we also used the published explanatory notes for the PROBAST tool and compared the aneurysm treatment practices each prediction model's formulation cohort experienced to a prespecified benchmark representative of contemporary aneurysm treatment practices as outlined in recent evidence-based guidelines and published practice pattern reports from four developed countries. RESULTS Reported model discriminative performance varied between 0.77 and 0.939, however, no single model demonstrated a consistently low risk of bias and low concern for clinical applicability in all domains. Only the score of Darkwah Oppong et al. was formulated using a patient cohort in which the majority of patients were managed in accordance with contemporary, evidence-based aneurysm treatment practices defined by ultra-early and predominantly endovascular treatment. However, this model did not undergo calibration or clinical utility analysis and when applied to an external cohort, its discriminative performance was substantially lower that reported at formulation. CONCLUSIONS No existing prediction model can be recommended for clinical use in centers practicing contemporary, evidence-based aneurysm treatment. There is a pressing need for improved prediction models to estimate and minimize pre-treatment re-bleeding risk.
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Affiliation(s)
- Arosha S Dissanayake
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Kwok M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia; School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Timothy J Phillips
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Nedlands, Perth, Western Australia, Australia
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Siller S, Kunz M, Lauseker M, Dimitriadis K, Dorn F, Tonn JC, Schichor C. The impact of initial counselling for patients' decision-making and the accuracy of interdisciplinary neurovascular board evaluation in elective treatment of unruptured intracranial aneurysms - a German single-centre retrospective study. Clin Neurol Neurosurg 2023; 232:107896. [PMID: 37454599 DOI: 10.1016/j.clineuro.2023.107896] [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: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Interdisciplinary-neurovascular-boards (INVB) are deemed to find the patient's optimum treatment-modality in elective unruptured intracranial aneurysm-repair (EUIAR). If INVB judges risk/success estimation similar for microsurgical/endovascular EUIAR, the choice for either modality is up to the informed patient. However, it is unknown if the patients' decision-making might be biased by the discipline of initial counselling prior to INVB and if INVB's equal risk/success estimation is finally accurate. METHODS We analysed all our patients with EUIAR after INVB-discussion between 2007 and 2017 and identified those patients where INVB-recommendation estimated similar risk/success rates for both treatment-modalities. We investigated the procedural/outcome parameters and determined if the mode of initial counselling prior to INVB influenced the patients' choice of EUIAR and if INVB's equal risk/success estimation was accurate. RESULTS Within altogether 572 patients with EUIAR during our study period, we identified 99 patients (agemean:58 yrs; m:f=1:2) in whom pre-treatment INVB-discussion estimated risk/success rates for both modalities of EUIAR to be similar. Prior to INVB-discussion, 80 of the 99 patients had been initially counselled in the neurosurgical discipline and 19 patients in the endovascular discipline. The final patients' decision rates for surgical vs. endovascular EUIAR (after secondary consultation of each patient in both disciplines after INVB-discussion) were 67% vs. 33% in the first and 58% vs. 42% in the latter group (no significant difference: p = 0.345). Uni- and multivariate analysis did not show any hints for a bias in patients' decision-making caused by the discipline of initial counselling prior to INVB/secondary bilateral consultations. Clinical and procedural outcome at last follow-up (median:18mos) did not differ between those 66 patients that eventually decided for microsurgical and those 33 patients that eventually decided for endovascular EUIAR, underlining the high accuracy of INVB's pre-treatment risk/success estimations. CONCLUSION Only in a small number of patients, INVB estimates both disciplines to be of equal value for EUIAR which proves to be highly accurate at long-term outcome measures. Initial contact to one or the other neurovascular discipline does not appear to play a significant role in the final patient's decision-making process.
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Affiliation(s)
- Sebastian Siller
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Mathias Kunz
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry and Epidemiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Konstantinos Dimitriadis
- Neurological Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Franziska Dorn
- Institute for Medical Information Processing, Biometry and Epidemiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, University Hospital of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Joerg-Christian Tonn
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Schichor
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neuroradiology, Clinic of the University of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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