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Riccietti C, Schiavolin S, Caldiera V, Ganci G, Sgoifo A, Camarda G, Leonardi M, Ciceri E. Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review. AJNR Am J Neuroradiol 2023; 44:1282-1290. [PMID: 37827718 PMCID: PMC10631534 DOI: 10.3174/ajnr.a8007] [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: 05/03/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Interventional neuroradiology is a relatively recent discipline that diagnoses and treats cerebral vascular diseases. However, specific literature on cognitive and psychological domains of patients undergoing interventional neuroradiology procedures is limited. PURPOSE Our aim was to review the existent literature on cognitive and psychological domains in patients undergoing interventional neuroradiology procedures to raise clinicians' awareness of their mental status. DATA SOURCES Articles were searched in PubMed, EMBASE, and Scopus from 2000 to 2022 using terms such as "interventional neuroradiology," "psychology," and "cognition" according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION Of 1483 articles in English, 64 were included and analyzed. Twelve focused on psychological aspects; 52, on cognitive ones. DATA ANALYSIS Regarding psychological aspects, it appears that early psychological consultations and "nonpharmacologic" strategies can impact the anxiety and depression of patients undergoing endovascular procedures. Regarding cognitive aspects, it appears that endovascular treatment is safe and generates similar or even fewer cognitive deficits compared with analogous surgical procedures. DATA SYNTHESIS Among the 12 articles on psychological aspects, 6/12 were retrospective with one, while 6/12 were prospective. Among the 52 articles on cognitive aspects, 7/54 were retrospective, while 45/52 were prospective. LIMITATIONS The main limitation derives from the inhomogeneity of the cognitive and psychological assessment tools used in the articles included in our analysis. CONCLUSIONS Our review highlights the need to include cognitive and psychological assessments in clinical practice in case patients eligible for interventional neuroradiology procedures. In the future, much more research of and attention to cognitive and psychologic aspects of neurovascular disease is needed. Systematic incorporation of strategies and tools to access and address pre, peri-, and postprocedural psychological and cognitive components could have major benefits in patient satisfaction, recovery, and the success of endovascular practice.
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Affiliation(s)
- Chiara Riccietti
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Silvia Schiavolin
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Caldiera
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Ganci
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
| | - Annalisa Sgoifo
- Department of Neurology and Stroke Unit (A.S.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgia Camarda
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Department of Neurology (S.S., G.C., M.L.), Public Health and Disability Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Ciceri
- From the Imaging Radiology and Interventional Neuroradiology Unit (C.R., V.C., G.G., E.C.), Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto neurologico Carlo Besta, Milan, Italy
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Veet CA, Capone S, Panczykowski D, Parekh N, Smith KJ, Kim DH, Choi HA, Blackburn SL. Imaging versus Intervention in Managing Small Unruptured Intracranial Aneurysms: A Cost-Effectiveness Analysis. Cerebrovasc Dis 2021; 51:338-348. [PMID: 34758465 DOI: 10.1159/000519538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Current guidelines recommend active surveillance with serial magnetic resonance angiography (MRA) for management of small, asymptomatic unruptured anterior circulation aneurysms (UIAs). We sought to determine the cost-effectiveness of active surveillance compared to immediate surgery. METHODS We developed a Markov cost-effectiveness model simulating patients with small (<7 mm) UIAs managed by active surveillance via MRA, immediate surgery, or watchful waiting. Inputs for the model were abstracted from the literature and used to construct a comprehensive model following persons from diagnosis to death. Outcomes were quality-adjusted life-years (QALYs), lifetime medical costs (2015 USD), and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness, deterministic, and probabilistic sensitivity analyses were performed. RESULTS Immediate surgical treatment was the most cost-effective management strategy for small UIAs with ICER of USD 45,772 relative to active surveillance. Sensitivity analysis demonstrated immediate surgery was the preferred strategy, if rupture rate was >0.1%/year and if the diagnosis age was <70 years, while active surveillance was preferred if surgical complication risk was >11%. Probabilistic sensitivity analysis demonstrated that at a willingness-to-pay of USD 100,000/QALY, immediate surgical treatment was the most cost-effective strategy in 64% of iterations. CONCLUSION Immediate surgical treatment is a cost-effective strategy for initial management of small UIAs in patients <70 years of age. While more costly than MRA, surgical treatment increased QALY. The cost-effectiveness of immediate surgery is highly sensitive to diagnosis age, rupture rate, and surgical complication risk. Though there are a wide range of rupture rates and complications associated with treatment, this analysis supports the treatment of small, unruptured anterior circulation intracranial aneurysms in patients <70 years of age.
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Affiliation(s)
- Clark A Veet
- Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Stephen Capone
- St. George's University School of Medicine, Great River, New York, USA,
| | - David Panczykowski
- Queen's Health System, Honolulu, Hawaii, USA.,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Natasha Parekh
- Queen's Health System, Honolulu, Hawaii, USA.,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Kenneth J Smith
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburg, Pennsylvania, USA
| | - Dong H Kim
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - H Alex Choi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Spiros L Blackburn
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ben-Israel D, Belanger BL, Adibi A, Eesa M, Mitha AP, Spackman E. Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective? PLoS One 2021; 16:e0255870. [PMID: 34370777 PMCID: PMC8351982 DOI: 10.1371/journal.pone.0255870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased rupture risk. While a new health technology innovation (HTI) that reduces this recanalization rate would benefit patients, few advancements have been made. We aim to determine whether cost-effectiveness has been a barrier to HTI. Methods A probabilistic Markov model was constructed from the healthcare payer perspective to compare standard endovascular treatment of UIA to standard treatment plus the addition of a HTI adjunct. Costs were measured in 2018 USD and health outcomes were measured in quality-adjusted life-years (QALY). In the base case, the HTI was a theoretical mesenchymal stem cell therapy which reduced the aneurysm recanalization rate by 50% and cost $10,000 per procedure. All other model inputs were derived from the published scientific literature. Results Based on the model results, we found that for a given HTI price (y) and relative risk reduction of aneurysm recanalization (x), the HTI was always cost-effective if the following equation was satisfied: y ≤ 20268 ∙ x, using a willingness-to-pay threshold of $50,000 per QALY. The uncertainty surrounding whether an aneurysm would recanalize was a significant driver within the model. When the uncertainty around the risk of aneurysm recanalization was eliminated, the 10-year projected additional benefit to the United States healthcare system was calculated to be $113,336,994. Conclusion Cost-effectiveness does not appear to be a barrier to innovation in reducing the recanalization rate of UIA treated by endovascular coil embolization. Our model can now be utilized by academia and industry to accentuate economically feasible HTI and by healthcare payers to calculate their maximum willingness-to-pay for a new technology. Our results also indicate that predicting a patient’s baseline risk of aneurysm recanalization is a critical area of future research.
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Affiliation(s)
- David Ben-Israel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brooke L. Belanger
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amin Adibi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Muneer Eesa
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Alim P. Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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Dandurand C, Zhou L, Fitzmaurice G, Prakash S, Redekop G, Haw C, Gooderham P. Quality of life scores in patients with unruptured cerebral aneurysm: Prospective cohort study. J Clin Neurosci 2021; 91:350-353. [PMID: 34373051 DOI: 10.1016/j.jocn.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Living with the diagnosis of an unruptured cerebral aneurysm can understandably cause distress to a patient. The goal of preventive treatment is to increase the number of years with good quality of life (QoL). OBJECTIVE This study aimed to measure the effect of unruptured intracranial aneurysm treatment on change in QoL scores measured by the SF36 and EQ-5D-5L. METHODS We prospectively collected SF36 and EQ-5D-5L survey data for patients with unruptured intracranial aneurysms at two time-points over 1 year between 2 treatment groups: observation and intervention (microsurgical and endovascular). Multivariable linear regression was used to examine treatment group differences in the mean change in scores from baseline to 1 year when adjusted for covariates. RESULTS 92 patients were included in the observation group and 68 patients were included in the intervention group, for a total of 160 patients. The intervention group had lower SF36 total scores at baseline (p = 0.001). With multivariate linear regression models, the effect of treatment on mean change in SF36 total score from baseline to 1 year was not statistically significant (p = 0.4); similarly, there was no difference in mean change in EQ-5D-5L. CONCLUSION In this large prospective study, preventive aneurysm treatment was not associated with a significant change in QoL score at 1 year compared to observation as measured by the SF36 and EQ-5D-5L. Further studies are needed to explore the lower QoL scores in patients seeking treatment and its impact on management decision making.
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Affiliation(s)
- Charlotte Dandurand
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada; T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Lily Zhou
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; UBC, Faculty of Medicine, Division of Neurology, Vancouver, Canada
| | - Garrett Fitzmaurice
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Swetha Prakash
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada.
| | - Gary Redekop
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Charles Haw
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Peter Gooderham
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
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Tang WK, Wang L, Tsoi KKF, Kim JM, Lee SJ, Kim JS. Anxiety after subarachnoid hemorrhage: A systematic review and meta-analysis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Personality and anxiety are related to health-related quality of life in unruptured intracranial aneurysm patients selected for non-intervention: A cross sectional study. PLoS One 2020; 15:e0229795. [PMID: 32163437 PMCID: PMC7067413 DOI: 10.1371/journal.pone.0229795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Personality traits and mental health problems have been previously reported in unruptured intracranial aneurysm (UIA) patients; however, few studies have clarified the relations between these variables and health-related quality of life (HRQoL). This study was designed to characterize the personality traits, HRQoL and mental health of patients with UIA and to evaluate whether personality has an influence on HRQoL and whether this is mediated by the patients' emotional symptoms. Methods Sixty-three patients with UIAs (mean age 62.6 years, 83.9% women) answered questionnaires for depression, anxiety, HRQoL and personality traits between June 2016 and May 2019. Results Eight percent of the sample had depression, and 27.4% had anxiety. Participants showed high levels of responsibility, kindness and neuroticism and low levels of extraversion and openness. HRQoL scores were normal compared with the Colombian population. Structural equation analysis showed that patients' HRQoL was negatively affected by anxiety levels and that the latter are associated with the patient's personality, where neuroticism is directly associated with symptomatology and inversely associated with extraversion. Conclusions The results of this study showed the importance of personality and emotional symptoms in the HRQoL of UIA patients. These results are important for developing strategies for psychological counseling in patients with UIAs.
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Prioritization and Timing of Outcomes and Endpoints After Aneurysmal Subarachnoid Hemorrhage in Clinical Trials and Observational Studies: Proposal of a Multidisciplinary Research Group. Neurocrit Care 2020; 30:102-113. [PMID: 31123994 DOI: 10.1007/s12028-019-00737-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In studies on aneurysmal subarachnoid hemorrhage (SAH), substantial variability exists in the use and timing of outcomes and endpoints, which complicates interpretation and comparison of results between studies. The aim of the National Institute of Health/National Institute of Neurological Disorders and Stroke/National Library of Medicine Unruptured Intracranial Aneurysm (UIA) and SAH common data elements (CDE) Project was to provide a common structure for future UIA and SAH research. METHODS This article summarizes the recommendations of the UIA and SAH CDE Outcomes and Endpoints subgroup, which consisted of an international and multidisciplinary ad hoc panel of experts in clinical outcomes after SAH. Consensus recommendations were developed by review of previously published CDEs for other neurological diseases and the SAH literature. Recommendations for CDEs were classified by priority into "Core," "Supplemental-Highly Recommended," "Supplemental," and "Exploratory." RESULTS The subgroup identified over 50 outcomes measures and template case report forms (CRFs) to be included as part of the UIA and SAH CDE recommendations. None was classified as "Core". The modified Rankin Scale score and Montreal Cognitive Assessment were considered the preferred outcomes and classified as Supplemental-Highly Recommended. Death, Glasgow Outcome Scale score, and Glasgow Outcome Scale-extended were classified as Supplemental. All other outcome measures were categorized as "Exploratory". We propose outcome assessment at 3 months and at 12 months for studies interested in long-term outcomes. We give recommendations for standardized dichotomization. CONCLUSION The recommended outcome measures and CRFs have been distilled from a broad pool of potentially useful CDEs, scales, instruments, and endpoints. The adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.
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Malhotra A, Wu X, Forman HP, Matouk CC, Gandhi D, Sanelli P. Management of Tiny Unruptured Intracranial Aneurysms: A Comparative Effectiveness Analysis. JAMA Neurol 2019; 75:27-34. [PMID: 29159405 DOI: 10.1001/jamaneurol.2017.3232] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Unruptured intracranial aneurysms (UIAs) are relatively common in the general population and are being increasingly diagnosed; a significant proportion are tiny (≤3 mm) aneurysms. There is significant heterogeneity in practice and lack of clear guidelines on the management of incidental, tiny UIAs. It is important to quantify the implications of different management strategies in terms of health benefits to patients. Objective To evaluate the effectiveness of routine treatment (aneurysm coiling) vs 3 strategies for imaging surveillance compared with no preventive treatment or routine follow-up of tiny UIAs. Design, Setting, and Participants A decision-analytic model-based comparative effectiveness analysis was conducted from May 1 to June 30, 2017, using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included 10 000 iterations simulating adult patients with incidental detections of UIAs 3 mm or smaller and no history of subarachnoid hemorrhage. Interventions The following 5 management strategies for tiny UIAs were evaluated: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every 5 years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. Main Outcomes and Measures A Markov decision model for lifetime rupture was constructed from a societal perspective per 10 000 patients with incidental, tiny UIAs. Outcomes were assessed in terms of quality-adjusted life-years. Probabilistic, 1-way, and 2-way sensitivity analyses were performed. Results In this analysis of 10 000 iterations simulating adult patients with a mean age of 50 years, the base-case calculation shows that the management strategy of no treatment or preventive follow-up has the highest health benefit (mean [SD] quality-adjusted life-years, 19.40 [0.31]). Among the management strategies that incorporate follow-up imaging, MRA every 5 years is the best strategy with the next highest effectiveness (mean [SD] quality-adjusted life-years, 18.05 [0.62]). The conclusion remains robust in probabilistic and 1-way sensitivity analyses. No routine follow-up remains the optimal strategy when the annual growth rate and risk of rupture of growing aneurysms are varied. When the annual risk of rupture of nongrowing UIAs is less than 1.7% (0.23% in base case scenario), no follow-up is the optimal strategy. If annual risk of rupture is more than 1.7%, coiling should be performed directly. Conclusions and Relevance Given the current literature, no preventive treatment or imaging follow-up is the most effective strategy in patients with aneurysms that are 3 mm or smaller, resulting in better health outcomes. More aggressive imaging surveillance for aneurysm growth or preventive treatment should be reserved for patients with a high risk of rupture. Given these findings, it is important to critically evaluate the appropriateness of current clinical practices, and potentially determine specific guidelines to reflect the most effective management strategy for patients with incidental, tiny UIAs.
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Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, of Economics, of Management, and of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Charles C Matouk
- Department of Neurosurgery and of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Dheeraj Gandhi
- Interventional Neuroradiology, Radiology, Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Pina Sanelli
- Department of Radiology, Northwell Health, Long Island, New York
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Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien) 2015; 157:1449-58. [PMID: 26179382 DOI: 10.1007/s00701-015-2480-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines. METHODS To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized. RESULTS We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed. CONCLUSIONS This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.
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Affiliation(s)
- Antoinette E Zweifel-Zehnder
- Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, Inselspital Bern, Bern, Switzerland
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Patients Experience High Levels of Anxiety 2 Years Following Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2014; 83:1090-7. [PMID: 25535065 DOI: 10.1016/j.wneu.2014.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/16/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore anxiety levels during the first 2 years after rupture of aneurysmal subarachnoid hemorrhage. METHODS A consecutive sample of patients with aneurysmal subarachnoid hemorrhage (aSAH) (n = 88, 84.6% of eligible) from a Swedish neurosurgical clinic were followed-up with a prospective cohort design at 3 time points; 6 months, 1 year, and 2 years after the onset. Data were collected by postal questionnaires and telephone interviews: State trait anxiety inventory, Hospital anxiety and depression scales, Barthel index, Telephone interview for cognitive status, and a set of study-specific questions. RESULTS Most of the respondents scored above the State trait anxiety inventory Swedish norm value on anxiety levels at all 3 follow-up time points. About 59% (n = 52) of respondents scored above the cutoff value for clinical significant level of anxiety in at least 1 time point during the first 2 years after rupture of aSAH. There were no significant differences in levels of anxiety versus the observational period and the 3 follow-up time points. The most significant explanatory variable to high levels of anxiety at all 3 follow-up time points was low perceived recovery. CONCLUSIONS Levels of anxiety remained high and stable throughout the first 2 years after rupture of aSAH. High levels of anxiety may reduce health-related quality of life substantially. Identification of individuals with high levels of anxiety and supportive care could therefore potentially improve long-term outcome.
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Covey J, Noble AJ, Schenk T. Family and friends' fears of recurrence: impact on the patient's recovery after subarachnoid hemorrhage. J Neurosurg 2013; 119:948-54. [DOI: 10.3171/2013.5.jns121688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with subarachnoid hemorrhage (SAH) and their close friends and family may be excessively fearful that the patient will have a recurrence, and such fears could play a critical role in the poor recovery shown by many patients The authors examined whether these fears could account for significant variance in psychosocial outcomes.
Methods
The authors prospectively studied a sample of 69 patients with SAH alongside their spouse, other family member, and/or close friend identified as their significant other (SO). The patient/SO pairs were assessed at 13 months postictus for their fears of recurrence and for health-related quality of life on the 8 domains of the 36-Item Short Form Health Survey.
Results
The SOs were found to be significantly more fearful of SAH recurrence than the patients. The SO's fears also explained unique variance in the patient's recovery on 4 of the 36-Item Short Form Health Survey domains over and above the patient's own fears, demographic and/or neurological variables, and the patient's history of psychiatric or neurological problems. The domains affected reflected activity-based and functional aspects of the patient's quality of life as opposed to more general characteristics of their emotional well-being or physical health state.
Conclusions
The patient's recovery may be compromised if their spouse, close family, and/or friends are excessively fearful about their suffering a recurrence. Perhaps the SO's fears cause them to be overprotective of the patient and to restrict their day-to-day activities. Attention must therefore be given to the experience of having a loved one suffer from an SAH, and alleviating the caregiver's fears could help to promote a better outcome for the patient.
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Affiliation(s)
- Judith Covey
- 1Department of Psychology, Durham University, Stockton-on-Tees
| | - Adam J. Noble
- 2Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, United Kingdom; and
| | - Thomas Schenk
- 3Department of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany
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Quality of life and psychological impact in adult patients with hemorrhagic moyamoya disease who received no surgical revascularization. J Neurol Sci 2013; 328:32-6. [DOI: 10.1016/j.jns.2013.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/22/2013] [Accepted: 02/13/2013] [Indexed: 11/19/2022]
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Passier PECA, Visser-Meily JMA, Rinkel GJE, Lindeman E, Post MWM. Determinants of health-related quality of life after aneurysmal subarachnoid hemorrhage: a systematic review. Qual Life Res 2012; 22:1027-43. [PMID: 22956388 DOI: 10.1007/s11136-012-0236-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Many persons with subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm recover to functional independence but nevertheless experience reduced quality of life (QoL). The aim of this study was to summarize the evidence on determinants of reduced QoL in this diagnostic group. METHODS Databases PubMed, PsychINFO, and CINAHL were used to identify empirical studies reporting on quantitative relationships between possible determinants and QoL in persons with aneurysmal SAH and published in English. Determinants were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS Twenty studies met the inclusion criteria for this review, in which 13 different HRQoL questionnaires were used. Determinants related to Body Structure & Function (clinical condition at admission, fatigue, and disturbed mood), Activity limitations (physical disability and cognitive complaints), and Personal factors (female gender, higher age, neuroticism, and passive coping) are consistently related to worse HRQoL after aneurysmal SAH. Treatment characteristics were not consistently related to HRQoL. CONCLUSION This study identified a broad range of determinants of HRQoL after aneurysmal SAH. The findings provide clues to tailor multidisciplinary rehabilitation programs. Further research is needed on participation, psychological characteristics, and environmental factors as determinants of HRQoL after SAH.
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Affiliation(s)
- P E C A Passier
- Rudolf Magnus Institute of Neuroscience and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and Rehabilitation Centre De Hoogstraat, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Noble AJ, Baisch S, Covey J, Mukerji N, Nath F, Schenk T. Subarachnoid hemorrhage patients' fears of recurrence are related to the presence of posttraumatic stress disorder. Neurosurgery 2012; 69:323-32; discussion 332-3. [PMID: 21415779 DOI: 10.1227/neu.0b013e318216047e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) patients illustrate a chronic fear of recurrence. A third of patients develop posttraumatic stress disorder (PTSD) after SAH, and PTSD after other conditions is associated with a more negative outlook on life. OBJECTIVE We examined whether recurrence fears are related to PTSD and whether this is associated with the patients making more negative health appraisals. We also examined the helpfulness of current treatments. METHODS Two SAH samples were generated. Sample 1 (n = 82) was assessed 13 months after ictus for PTSD, cognition, fear of recurrence, and beliefs concerning future health. Sample 2 (n = 60) was assessed 18 months after ictus for PTSD and to determine how much current treatments increased their confidence about not having another SAH. RESULTS Thirty-four percent of sample 1 had PTSD. Although clinically and cognitively comparable, PTSD patients feared recurrence more and were comparatively more pessimistic about their chances of further SAH. Thirty-six percent of sample 2 had PTSD. These most fearful patients reported finding current treatments the least helpful. CONCLUSION Fear of recurrence after SAH is related to PTSD. Participants with PTSD were more pessimistic about their future health. Treatment for PTSD could alleviate fears of SAH recurrence and promote better outcome.
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Affiliation(s)
- Adam J Noble
- Institute of Psychiatry, King's College London, London, United Kingdom.
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15
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Ferns SP, Sprengers ME, van Rooij WJ, van Zwam WH, de Kort GA, Velthuis BK, Schaafsma JD, van den Berg R, Sluzewski M, Brouwer PA, Rinkel GJ, Majoie CB. Late Reopening of Adequately Coiled Intracranial Aneurysms. Stroke 2011; 42:1331-7. [DOI: 10.1161/strokeaha.110.605790] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sandra P. Ferns
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Marieke E.S. Sprengers
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Willem Jan van Rooij
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Wim H. van Zwam
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Gérard A.P. de Kort
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Birgitta K. Velthuis
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Joanna D. Schaafsma
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - René van den Berg
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Menno Sluzewski
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Patrick A. Brouwer
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Gabriël J.E. Rinkel
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
| | - Charles B.L.M. Majoie
- From the Department of Radiology (S.P.F., M.E.S.S., R.v.d.B., C.B.L.M.M.), Academic Medical Center, Amsterdam; Department of Radiology (W.J.v.R., M.S.), St Elisabeth Ziekenhuis, Tilburg; Department of Radiology (W.H.v.Z.), Maastricht University Medical Center; Department of Radiology (G.A.P.d.K., B.K.V.), University Medical Center, Utrecht; Department of Radiology (R.v.d.B.), VU Medical Center Amsterdam; Department of Radiology (P.A.B.), Leiden University Medical Center; Department of Neurology from
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Rinkel GJE, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10:349-56. [DOI: 10.1016/s1474-4422(11)70017-5] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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A Stijntje E Bor, Marieke JH Wermer, Gabriel JE Rinkel. Unruptured intracranial aneurysms: initial and follow-up screening. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a devastating disease that causes death or severe disability in half of patients. Intracranial aneurysms are not present at birth but develop during life. Actively searching and treating intracranial aneurysms before rupture may prevent SAH as a result of these aneurysms. The prevalence of intracranial aneurysms is approximately 2% in the general population, but higher in subgroups such as patients who have survived an episode of SAH, persons with a family history of SAH and patients with polycystic kidney disease. Screening for intracranial aneurysms should be considered in these high-risk groups. Some of the intracranial aneurysms detected with screening will be too small to be treated, and may therefore be followed over time, which can cause anxiety in the patient. In this article, we discuss current knowledge, remaining questions and future perspectives in screening and follow-up imaging for unruptured intracranial aneurysms.
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Dyer MTD, Goldsmith KA, Sharples LS, Buxton MJ. A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 2010; 8:13. [PMID: 20109189 PMCID: PMC2824714 DOI: 10.1186/1477-7525-8-13] [Citation(s) in RCA: 283] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/28/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. METHODS A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. RESULTS Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. CONCLUSIONS The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.
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Affiliation(s)
- Matthew TD Dyer
- Health Economics Research Group, Brunel University, Uxbridge, UK
- National Collaborating Centre for Mental Health, The Royal College of Psychiatrists, London, UK
| | - Kimberley A Goldsmith
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Linda S Sharples
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Martin J Buxton
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Molyneux AJ, Kerr RSC, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 8:427-33. [PMID: 19329361 PMCID: PMC2669592 DOI: 10.1016/s1474-4422(09)70080-8] [Citation(s) in RCA: 577] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Our aim was to assess the long-term risks of death, disability, and rebleeding in patients randomly assigned to clipping or endovascular coiling after rupture of an intracranial aneurysm in the follow-up of the International Subarachnoid Aneurysm Trial (ISAT). METHODS 2143 patients with ruptured intracranial aneurysms were enrolled between 1994 and 2002 at 43 neurosurgical centres and randomly assigned to clipping or coiling. Clinical outcomes at 1 year have been previously reported. All UK and some non-UK centres continued long-term follow-up of 2004 patients enrolled in the original cohort. Annual follow-up has been done for a minimum of 6 years and a maximum of 14 years (mean follow-up 9 years). All deaths and rebleeding events were recorded. Analysis of rebleeding was by allocation and by treatment received. ISAT is registered, number ISRCTN49866681. FINDINGS 24 rebleeds had occurred more than 1 year after treatment. Of these, 13 were from the treated aneurysm (ten in the coiling group and three in the clipping group; log rank p=0.06 by intention-to-treat analysis). There were 8447 person-years of follow-up in the coiling group and 8177 person-years of follow-up in the clipping group. Four rebleeds occurred from a pre-existing aneurysm and six from new aneurysms. At 5 years, 11% (112 of 1046) of the patients in the endovascular group and 14% (144 of 1041) of the patients in the neurosurgical group had died (log-rank p=0.03). The risk of death at 5 years was significantly lower in the coiling group than in the clipping group (relative risk 0.77, 95% CI 0.61-0.98; p=0.03), but the proportion of survivors at 5 years who were independent did not differ between the two groups: endovascular 83% (626 of 755) and neurosurgical 82% (584 of 713). The standardised mortality rate, conditional on survival at 1 year, was increased for patients treated for ruptured aneurysms compared with the general population (1.57, 95% CI 1.32-1.82; p<0.0001). INTERPRETATION There was an increased risk of recurrent bleeding from a coiled aneurysm compared with a clipped aneurysm, but the risks were small. The risk of death at 5 years was significantly lower in the coiled group than it was in the clipped group. The standardised mortality rate for patients treated for ruptured aneurysms was increased compared with the general population. FUNDING UK Medical Research Council.
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Affiliation(s)
- Andrew J Molyneux
- Neurovascular Research Unit, Nuffield Department of Surgery, University of Oxford and Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK.
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Alfieri A, Unterhuber V, Pircher M, Schwarz A, Gazzeri R, Reinert M, Widmer HR. Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-ε4 genotype: a prospective 5-year follow-up study. J Neurosurg 2008; 109:1019-26. [DOI: 10.3171/jns.2008.109.12.1019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this study, the authors prospectively evaluated long-term psychosocial and neurocognitive performance in patients suffering from nonaneurysmal, nontraumatic subarachnoid hemorrhage (SAH) and investigated the association between the APOE-ε4 genotype and outcome in these patients.
Methods
All patients admitted to the authors' institution between January 2001 and January 2003 with spontaneous nonaneurysmal SAH were prospectively examined (mean follow-up 59.8 months). The APOE genotype was determined in all patients by polymerase chain reaction from a blood sample. Of the 30 patients included in this study, 11 were carriers of the ε4 allele.
Results
All patients showed a good recovery and regained full independence with no persisting neurological deficits. The patients with the ε4 allele, however, scored significantly higher on the Beck Depression Inventory (22.1 ± 6.3 vs 14.1 ± 5.1). At follow-up, depression was more persistent in the group with the ε4 allele compared with the group that lacked the allele. This finding reached statistical significance (p < 0.05). Selective attention was impaired in all patients during the first year of follow-up, with an earlier recovery noted in the patients without the ε4 allele. Moreover, there was a tendency toward a linear relationship between the Beck Depression Inventory and the d2 Test of Attention. Two patients who carried the ε4 allele did not return to their employment even after 5 years.
Conclusions
The findings in this study suggest that the APOE genotypes may be associated with the psychosocial and neurocognitive performance after spontaneous nonaneurysmal SAH, even in the absence of neurological impairment. Physicians should consider patient genotype in assessing the long-term consequences of nonaneurysmal SAH.
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Affiliation(s)
- Alex Alfieri
- 1Department of Neurosurgery, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
- 2Departments of Neurosurgery and
| | | | | | | | - Roberto Gazzeri
- 4Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy and
| | - Michael Reinert
- 5Department of Neurosurgery, Bern Inselspital Hospital, University of Bern, Switzerland
| | - Hans R. Widmer
- 5Department of Neurosurgery, Bern Inselspital Hospital, University of Bern, Switzerland
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Abstract
Doing nothing can be a good treatment option in patients with an unruptured small cerebral aneurysm
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