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Burlakoti A, Kumaratilake J, Taylor J, Henneberg M. Trend of cerebral aneurysms over the past two centuries: need for early screening. BMJ Open 2024; 14:e081290. [PMID: 38417954 PMCID: PMC10900367 DOI: 10.1136/bmjopen-2023-081290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE Cerebral aneurysms (CAs) are linked to variations in the cerebral basal arterial network (CBAN). This study aimed to find the optimal age for screening to detect brain arterial variations and predict aneurysms before rupture. DESIGN An observational, quantitative and retrospective research. SETTING The study analysed 1127 cases of CAs published from 1761 to 1938. Additionally, CT angiography images of 173-patients at the Royal Adelaide Hospital (RAH), South Australia between 2011 and 2019 were examined for the presence and the location of aneurysms in CBAN. PARTICIPANTS The data were collected from patients at RAH and 407 published sources, including males and females across the entire age range, up to 100 years old. OUTCOME MEASURES AND RESULTS Data, CAs cases, from 1761 to 1938 included (526 males, 573 females and 28 unknown sexes). The age of these patients varied from 18 months to 89 years (mean age=42, SD=18). Approximately 11.5% of the CAs occurred in patients aged <20 years. Among the 1078 aneurysms whose location was reported, 76% were located in the internal carotid (IC), middle cerebral (MC) and anterior communicating artery complex (AcomAC) regions, while the remaining 24% were in the vertebrobasilar region. Among 173 patients from RAH aged between 18 and 100 years (male=83 and female=90, mean age=60, SD=16), 94% of the CAs were found in the IC, MC and AcomAC regions. The pattern of aneurysm occurrence, as indicated by values at the 25th, 50th and 75th percentiles, along with the minimum and maximum patient ages, has remained consistent from 1761 to 2019. CONCLUSION The distribution pattern of CAs in relation to sex, age and locations in the CBAN, remained steady over the last 260 years resulting in risk of strokes early in life. Therefore, early screening for CBAN segment variations is advised for stroke prevention if possible.
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Affiliation(s)
- Arjun Burlakoti
- Human Anatomy, University of South Australia, Adelaide, South Australia, Australia
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jaliya Kumaratilake
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jamie Taylor
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maciej Henneberg
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Institute of Evolutionary Medicine, The University of Zurich, Zürich, Switzerland
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Goertz L, Simões Corrêa Galendi J, Kabbasch C, Schlamann M, Pennig L, Froelich MF, Timmer M, Liebig T, Stock S, Mueller D, Große Hokamp N. Cost-effectiveness of WEB Embolization, Coiling and Stent-assisted Coiling for the Treatment of Unruptured Intracranial Aneurysms. Clin Neuroradiol 2023; 33:1075-1086. [PMID: 37368089 PMCID: PMC10654202 DOI: 10.1007/s00062-023-01311-0] [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: 10/13/2022] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Information about the cost-effectiveness of a certain treatment is relevant for decision-making and healthcare providers. This study compares the cost-effectiveness of the novel Woven Endobridge (WEB) for intracranial aneurysm treatment with conventional coiling and stent-assisted coiling (SAC) from the perspective of the German Statutory Health Insurance. METHODS A patient-level simulation was constructed to simulate 55-year-old patients with an unruptured middle cerebral artery aneurysm (size: 3-11 mm) considering WEB treatment, coiling or SAC in terms of morbidity, angiographic outcome, retreatment, procedural and rehabilitation costs and rupture rates. Incremental cost-effectiveness ratios (ICERs) were calculated as costs per quality-adjusted life years (QALYs) and costs per year with neurologic morbidity avoided. Uncertainty was explored with deterministic and probabilistic sensitivity analyses. The majority of data were obtained from prospective multi-center studies and meta-analyses of non-randomized studies. RESULTS In the base case, lifetime QALYs were 13.24 for the WEB, 12.92 for SAC and 12.68 for coiling. Lifetime costs were 20,440 € for the WEB, 23,167 € for SAC, and 8200 € for coiling. Compared to coiling, the ICER for the WEB was 21,826 €/QALY, while SAC was absolutely dominated by WEB. Probabilistic sensitivity analysis revealed that at a willingness-to-pay of ≥ 30,000 €/QALY, WEB was the preferred treatment. Deterministic sampling showed that the discount rate, material costs and retreatment rates had the largest impact on the ICERs. CONCLUSION The novel WEB showed at least comparable cost-effectiveness to SAC for treatment of broad-based unruptured aneurysms. Considering all three modalities, coiling had the least costs; however this modality is often not appropriate for the treatment of wide-necked aneurysms.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Julia Simões Corrêa Galendi
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marc Schlamann
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lenhard Pennig
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Marco Timmer
- Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thomas Liebig
- Faculty of Medicine and University Hospital, Department of Neuroradiology, University of Munich (LMU), Marchioninistraße 15, 81377, Munich, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Dirk Mueller
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nils Große Hokamp
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Ishikawa T, Ikawa F, Ichihara N, Yamaguchi K, Funatsu T, Nakatomi H, Shiokawa Y, Sorimachi T, Murayama Y, Suzuki K, Kurita H, Fukuda H, Ueba T, Shimamura N, Ohkuma H, Morioka J, Nakahara I, Uezato M, Chin M, Kawamata T. Superiority of Endovascular Coiling Over Surgical Clipping for Clinical Outcomes at Discharge in Patients With Poor-Grade Subarachnoid Hemorrhage: A Registry Study in Japan. Neurosurgery 2023:00006123-990000000-00980. [PMID: 38038438 DOI: 10.1227/neu.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The differences in clinical outcomes between endovascular coiling (EC) and surgical clipping (SC) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) are controversial. Therefore, this study aimed to evaluate whether EC is superior to SC and identify risk factors in patients with poor-grade aSAH. METHODS We used data from the "Predict for Outcome Study of aneurysmal SubArachnoid Hemorrhage." World Federation of Neurological Societies (WFNS) grade III-V aSAH was defined as poor-grade aSAH, and unfavorable clinical outcomes (modified Rankin Scale scores 3-6) were compared between SC and EC after propensity score matching (PSM). In-hospital mortality was similarly evaluated. Predictors of unfavorable clinical outcomes were identified using multivariable analysis. RESULTS Ultimately, 1326 (SC: 847, EC: 479) and 632 (SC: 316, EC: 316) patients with poor-grade aSAH were included before and after PSM, respectively. Unfavorable clinical outcomes at discharge were significantly different between SC and EC before (72.0% vs 66.2%, P = .026) and after PSM (70.6% vs 63.3%, P = .025). In-hospital mortality was significantly different between groups before PSM (10.5% vs 16.1%, P = .003) but not after PSM (10.4% vs 12.7%, P = .384). Predictors of unfavorable clinical outcomes in both SC and EC were WFNS grade V, older than 70 years, and Fisher computed tomography (CT) grade 4. Predictors of unfavorable clinical outcomes only in SC were WFNS grade IV (odds ratio: 2.46, 95% CI: 1.22-4.97, P = .012) and Fisher CT grade 3 (4.90, 1.42-16.9, P = .012). Predictors of unfavorable clinical outcome only in EC were ages of 50s (3.35, 1.37-8.20, P = .008) and 60s (3.28, 1.43-7.52, P = .005). CONCLUSION EC resulted in significantly more favorable clinical outcomes than SC in patients with poor-grade aSAH, without clear differences in in-hospital mortality. The benefit of EC over SC might be particularly remarkable in patients with WFNS grade IV and Fisher CT grade 3.
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Affiliation(s)
- Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
- Department of Cardiovascular Surgery, Jikei University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | | | | | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Norihito Shimamura
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University, Hirosaki, Aomori, Japan
- Department of Neurosurgery, Hirosaki General Medical Center, National Hospital Organization, Hirosaki, Aomori, Japan
| | - Jun Morioka
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University, Toyoake, Aichi, Japan
| | - Minami Uezato
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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Güresir E, Gräff I, Seidel M, Bauer H, Coch C, Diepenseifen C, Dohmen C, Engels S, Hadjiathanasiou A, Heister U, Heyer I, Lampmann T, Paus S, Petzold G, Pöhlau D, Putensen C, Schneider M, Schuss P, Textor J, Velten M, Wach J, Welchowski T, Vatter H. Aneurysmal Subarachnoid Hemorrhage during the Shutdown for COVID-19. J Clin Med 2022; 11:jcm11092555. [PMID: 35566681 PMCID: PMC9104869 DOI: 10.3390/jcm11092555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022] Open
Abstract
The aim was to evaluate hospitalization rates for aneurysmal subarachnoid hemorrhage (SAH) within an interdisciplinary multicenter neurovascular network (NVN) during the shutdown for the COVID-19 pandemic along with its modifiable risk factors. In this multicenter study, admission rates for SAH were compared for the period of the shutdown for the COVID-19 pandemic in Germany (calendar weeks (cw) 12 to 16, 2020), the periods before (cw 6–11) and after the shutdown (cw 17–21 and 22–26, 2020), as well as with the corresponding cw in the years 2015–2019. Data on all-cause and pre-hospital mortality within the area of the NVN were retrieved from the Department of Health, and the responsible emergency medical services. Data on known triggers for systemic inflammation, e.g., respiratory viruses and air pollution, were analyzed. Hospitalizations for SAH decreased during the shutdown period to one-tenth within the multicenter NVN. There was a substantial decrease in acute respiratory illness rates, and of air pollution during the shutdown period. The implementation of public health measures, e.g., contact restrictions and increased personal hygiene during the shutdown, might positively influence modifiable risk factors, e.g., systemic inflammation, leading to a decrease in the incidence of SAH.
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Affiliation(s)
- Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
- Correspondence: ; Tel.: +49-228-287-16500
| | - Ingo Gräff
- Emergency Department, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (I.G.); (M.S.)
| | - Matthias Seidel
- Emergency Department, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (I.G.); (M.S.)
| | - Hartmut Bauer
- Department of Neurology, Marien-Hospital Euskirchen, Gottfried-Disse Strasse 40, 53879 Euskirchen, Germany;
| | - Christoph Coch
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Christian Diepenseifen
- Emergency Medical Service Rhein-Sieg-Kreis, Kaiser-Wilhelm-Platz 1, 53721 Siegburg, Germany;
| | - Christian Dohmen
- Department of Neurology, LVR-Clinic Bonn, Kaiser-Karl-Ring 20, 53111 Bonn, Germany;
| | - Susanne Engels
- Department of Health City of Bonn, Berliner Platz 2, 53103 Bonn, Germany; (S.E.); (I.H.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
| | - Ulrich Heister
- Emergency Medical Service City of Bonn, Berliner Platz 2, 53103 Bonn, Germany;
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.P.); (M.V.)
| | - Inge Heyer
- Department of Health City of Bonn, Berliner Platz 2, 53103 Bonn, Germany; (S.E.); (I.H.)
| | - Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
| | - Sebastian Paus
- Department of Neurology, St. Johannes-Hospital Troisdorf, Wilhelm-Busch-Strasse 9, 53844 Troisdorf, Germany;
| | - Gabor Petzold
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Dieter Pöhlau
- Department of Neurology, DRK-Kamillus-Clinic Asbach, Hospitalstraße 6, 53567 Asbach, Germany;
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.P.); (M.V.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
| | - Jochen Textor
- Department of Radiology, Gemeinschaftskrankenhaus Bonn, Prinz-Albert-Straße 40, 53113 Bonn, Germany;
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (C.P.); (M.V.)
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
| | - Thomas Welchowski
- Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (A.H.); (T.L.); (M.S.); (P.S.); (J.W.); (H.V.)
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Donnelly P, McMillen J, Raman V, Jiwrajka M. Intracranial aneurysms: The era of endovascular intervention in Australia. J Clin Neurosci 2022; 97:127-135. [DOI: 10.1016/j.jocn.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/11/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
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Bruns N, Trocchi P, Felderhoff-Müser U, Dohna-Schwake C, Stang A. Hospitalization and Morbidity Rates After Pediatric Traumatic Brain Injury: A Nation-Wide Population-Based Analysis. Front Pediatr 2021; 9:747743. [PMID: 34660495 PMCID: PMC8515415 DOI: 10.3389/fped.2021.747743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Even though traumatic brain injury (TBI) is a major cause of morbidity and mortality in children around the globe, population-based and nation-wide data to assess the burden of TBI is scarce. Methods:Based on diagnosis related groups from nation-wide hospital data, we extracted data on all TBI-related hospitalizations in children <18 years in Germany between 2014 and 2018. We calculated crude, age-specific and standardized incidence rates for hospitalizations, imaging, intracranial injury, neurosurgery, and mortality. Results:Out of 10.2 million hospitalizations, we identified 458,844 cases with TBI as primary or secondary diagnosis, resulting in a crude incidence rate of 687/100,000 child years (CY). Age-specific rates of computed tomography were below 30/100,000 CY until the age of 10 years and increased to 162/100,000 CY until 17 years of age. Intracranial injury was diagnosed in 2.7%, neurosurgery was performed in 0.7% of patients, and 0.7% were mechanically ventilated. Mortality was 0.67/100,000 CY (0.1%). Conclusions:Despite substantial hospitalization rates for pediatric TBI in Germany, the rates of imaging, the need for mechanical ventilation, neurosurgery and mortality were overall very low. Reasons for hospitalization and measures to reduce unnecessary admissions warrant further investigation.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational and Behavioural Neurosciences (TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Pietro Trocchi
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational and Behavioural Neurosciences (TNBS), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Pediatric Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
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Lam J, Ravina K, Rennert RC, Russin JJ. Cerebrovascular bypass for ruptured aneurysms: A case series. J Clin Neurosci 2021; 85:106-114. [PMID: 33581780 DOI: 10.1016/j.jocn.2020.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
In patients with aneurysmal subarachnoid hemorrhage (aSAH) unfavorable for endovascular or traditional open surgical techniques, surgical revascularization strategies comprise one of remaining limited options. There is nonetheless a paucity of data on the safety and efficacy of bypass in aSAH. In this study, we aimed to investigate complications and outcomes in a cohort of patients with aSAH treated with bypass. A prospective single-surgeon database of consecutive patients treated for aSAH between 2013 and 2018 was retrospectively analyzed. Complications and functional status at discharge were recorded and analyzed for the patients that underwent bypass surgery. Forty patients with aSAH were treated with bypass surgery (23 extracranial-intracranial; 17 intracranial-intracranial). All-cause perioperative mortality was 13% (6 patients). At discharge and at mean 14-month follow up, respectively, 16/40 (40%) and 16/25 (64%) of patients achieved a Glasgow Outcome Score of 4-5. All-cause, in-hospital complications occurred in 28 patients (70%), of which any ischemic complication occurred in 20 patients (50%), 7 (18%) being open surgical complications. This work represents the largest modern series of bypass for aSAH to date. In cases of aSAH unfavorable for endovascular intervention or traditional open surgical techniques, bypass remains a viable option in this complex group of patients.
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Affiliation(s)
- Jordan Lam
- Neurorestoration Centre, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, 1333 San Pablo Street, Room B51 McKibben Hall, Los Angeles, CA 90033, USA
| | - Kristine Ravina
- Neurorestoration Centre, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, 1333 San Pablo Street, Room B51 McKibben Hall, Los Angeles, CA 90033, USA
| | - Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Jonathan J Russin
- Neurorestoration Centre, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, 1333 San Pablo Street, Room B51 McKibben Hall, Los Angeles, CA 90033, USA.
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Poor blood pressure control following subarachnoid hemorrhage in patients with sleep apnea. Sleep Breath 2020; 25:777-785. [PMID: 32926343 DOI: 10.1007/s11325-020-02184-0] [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: 04/26/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE Retrospective studies indicate that obstructive sleep apnea occurs often after aneurysmal subarachnoid hemorrhage. We aim to investigate if obstructive sleep apnea is associated with impaired blood pressure control early after subarachnoid hemorrhage. METHODS Patients with subarachnoid hemorrhage were recruited and screened for sleep apnea using cardiorespiratory polygraphy within 48 h after intensive care unit admission, and 6 months after hospital discharge at home. Blood pressure was continuously measured using intra-arterial catheter within the first 24 h after admission. Time between hospital admission and first blood pressure below 140 mmHg, and time with elevated blood pressure within the first 24 h after admission were compared between patients with and without obstructive sleep apnea. RESULTS Of 60 patients, 55 successfully completed the study. Obstructive sleep apnea (AHI > 5/h) was diagnosed in 32% of men and 24% of women. While the time to reach a blood pressure of 140 mmHg did not differ (60.0 ± 26.2 min vs. 49.7 ± 16.4 min; p = 0.74), obstructive sleep apnea patients spent more time with blood pressure above 140 mmHg (292.0 ± 114.0 vs. 96.9 ± 28.3 min per 24 h; p = 0.025, CI 95 -363.6 to -26.5) within the observational period. Only AHI and diagnosed hypertension were significant predictors for elevated blood pressure (R2 0.42; p = 0.03). CONCLUSION Obstructive sleep apnea is associated in our study with poor blood pressure control early after subarachnoid hemorrhage. These patients may need advanced management for blood pressure including management for OSA following subarachnoid hemorrhage. Screening for sleep apnea in patients with subarachnoid hemorrhage is recommended. TRIAL REGISTRATION ClincalTrials.gov identifier: NCT02724215, registered on March 31, 2016.
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Lindgren A, Turner EB, Sillekens T, Meretoja A, Lee JM, Hemmen TM, Koivisto T, Alberts M, Lemmens R, Jääskeläinen JE, Vergouwen MDI, Rinkel GJE. Outcome After Clipping and Coiling for Aneurysmal Subarachnoid Hemorrhage in Clinical Practice in Europe, USA, and Australia. Neurosurgery 2019; 84:1019-1027. [PMID: 29846713 PMCID: PMC8764701 DOI: 10.1093/neuros/nyy223] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/02/2018] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Within randomized clinical trials (RCTs), coiling of the ruptured aneurysm to prevent rebleeding results in better outcomes than clipping in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE To study the association of coiling and clipping with outcome after aSAH in daily clinical practice. METHODS In this controlled, nonrandomized study, we compared outcomes after endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in an administrative dataset of 7658 aSAH patients (22 tertiary care hospitals from Europe, USA, Australia; 2007-2013). Because the results contradicted those of the randomized trials, findings were further explored in a large clinical dataset from 2 European centers (2006-2016) of 1501 patients. RESULTS In the administrative dataset, the crude 14-d case-fatality rate was 6.4% (95% confidence interval [CI] 5.6%-7.2%) after clipping and 8.2% (95% CI 7.4%-9.1%) after coiling. After adjustment for age, sex, and comorbidity/severity, the odds ratio (OR) for 14-d case-fatality after coiling compared to clipping was 1.32 (95% CI 1.10-1.58). In the clinical dataset crude 14-d case fatality rate was 5.7% (95% CI 4.2%-7.8%) for clipping and 9.0% (95% CI 7.3%-11.2%) for coiling. In multivariable logistic regression analysis, the OR for 14-d case-fatality after coiling compared to clipping was 1.7 (95% CI 1.1-2.7), for 90-d case-fatality 1.28 (95% CI 0.91-1.82) and for 90-d poor functional outcome 0.78 (95% CI 0.6-1.01). CONCLUSION In clinical practice, coiling after aSAH is associated with higher 14-d case-fatality than clipping and nonsuperior outcomes at 90 d. Both options need to be considered in aSAH patients. Further studies should address the reasons for the discrepancy between current data and those from the RCTs.
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Affiliation(s)
- Antti Lindgren
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | | | - Tomas Sillekens
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jin-Moo Lee
- Department of Neurology, and the Hope Center for Neurological disorders, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas M Hemmen
- Department of Neurosciences, University of California, San Diego, California
| | - Timo Koivisto
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mark Alberts
- Department of Neurology, Hartford Hospital, Hartford, Connecticut
| | - Robin Lemmens
- KU Leuven – University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Juha E Jääskeläinen
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Ikawa F, Michihata N, Matsushige T, Abiko M, Ishii D, Oshita J, Okazaki T, Sakamoto S, Kurogi R, Iihara K, Nishimura K, Morita A, Fushimi K, Yasunaga H, Kurisu K. In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:655-667. [PMID: 30941595 DOI: 10.1007/s10143-019-01096-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
There has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based on the nationwide databases published from 2007 to 2018. According to this propensity score-matched analysis, no significant association for poor outcome of mRS > 2 was shown between surgical clipping and endovascular coiling (47.7% vs 48.3%, p = 0.48). However, significantly lower in-hospital mortality was revealed after surgical clipping than endovascular coiling (7.1% vs 12.2%, p < 0.001). Meta-analysis of propensity score-matched analysis in the nationwide database showed no significant association for poor outcome at discharge between them (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.93 to 1.26; p = 0.31). Meta-analysis of propensity score-matched analysis for in-hospital mortality was lower after surgical clipping than after endovascular coiling, however, without significant difference (OR, 0.74; 95% CI, 0.52 to 1.04; p = 0.08). Further prospective randomized controlled study with all grade aSAH should be necessary to validate the in-hospital mortality and poor outcome.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaru Abiko
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Jumpei Oshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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11
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Zaremba S, Albus L, Schuss P, Vatter H, Klockgether T, Güresir E. Increased risk for subarachnoid hemorrhage in patients with sleep apnea. J Neurol 2019; 266:1351-1357. [DOI: 10.1007/s00415-019-09265-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 01/05/2023]
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12
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Observational study of treated non-traumatic subarachnoid hemorrhage in nonagenarians. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Reinacher PC, Coenen VA, Kraeutle R, Scheiwe C, Jabbarli R, Roelz R. Feasibility of stereotactic catheter ventriculocisternostomy for cisternal lavage therapy in patients with subarachnoid hemorrhage. Clin Neurol Neurosurg 2017; 163:94-102. [PMID: 29096139 DOI: 10.1016/j.clineuro.2017.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Delayed cerebral infarction (DCI) confers considerable morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Available prevention strategies are insufficient. Cisternal blood clearance by stereotactic catheter ventriculocisternostomy (STX-VCS) and cisternal lavage therapy is a novel concept for DCI prevention. Here, we assess the general feasibility, pitfalls and imaging requirements of STX-VCS after aSAH. PATIENTS AND METHODS 73 aSAH patients admitted between 2008 and 2015 with appropriate imaging for simulation of stereotactic procedures were included. Surgical feasibility of a transventricular trajectory to the basal cisterns was assessed. RESULTS Transventricular catheter access to the basal cisterns was feasible in 94% of cases. In 6% vascular obstacles precluded a transventricular approach and access to the basal cisterns could be simulated via a transparenchymal trajectory. CT-artifacts that interfered with stereotactic planning were observed in 58% after coiling and 5% after clipping. In these cases stereotactic planning was enabled by MRI. Logistic regression of aneurysm size and distance-to-target allowed for precise prediction whether MRI was required for stereotactic planning of STX-VCS after coiling. CONCLUSIONS Stereotactic catheter access to the basal cisterns after aSAH appears to be generally feasible. Coil artifacts compromising CT-based planning can be precisely anticipated and planning enabled by MRI.
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Affiliation(s)
- Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Rainer Kraeutle
- Department of Nursing-IT, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45147, Germany
| | - Roland Roelz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
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14
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Roelz R, Coenen VA, Scheiwe C, Niesen WD, Egger K, Csok I, Kraeutle R, Jabbarli R, Urbach H, Reinacher PC. Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage: A Matched Cohort Study. Stroke 2017; 48:2704-2709. [PMID: 28904239 DOI: 10.1161/strokeaha.117.018397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/29/2017] [Accepted: 08/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral infarction (DCI) is a major source of morbidity and mortality after aneurysmal subarachnoid hemorrhage. We report a novel intervention-stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy-for DCI prevention. Outcomes of 20 consecutive patients are compared with 60 matched controls. METHODS On the basis of individual treatment decisions, STX-VCS was performed in 20 high-risk aneurysmal subarachnoid hemorrhage patients admitted to our department between September 2015 and October 2016. Three controls matched for age, sex, aneurysm treatment method, and admission Hunt and Hess grade were assigned to each case treated by STX-VCS. DCI was the primary outcome. Mortality and mRS at rehabilitation discharge were secondary outcome parameters. The association between STX-VCS and DCI, mortality, and mRS was assessed by conditional logistic regression. RESULTS Stereotactic procedures were performed without surgical complications. Continuous cisternal lavage was feasible in 17 of 20 patients (85%). One adverse event because of cisternal lavage was without sequelae. DCI occurred in 25 of 60 (42%) controls and 3 of 20 (15%) patients with STX-VCS (odds ratio, 0.15; 95% confidence interval, 0.04-0.64). Mortality occurred in 20 of 60 (33%) controls and 1 of 20 (5%) patients with STX-VCS, respectively (odds ratio, 0.08; 95% confidence interval, 0.01 - 0.66). Favorable outcome (mRS≤3) at rehabilitation discharge was observed in 12 of 20 patients with STX-VCS (60%) versus 21 of 60 (35%) matched controls (odds ratio, 0.26; 95% confidence interval, 0.8-0.86). CONCLUSIONS STX-VCS was feasible and safe in patients with severe aneurysmal subarachnoid hemorrhage. Initial results indicate that DCI and mortality can be reduced, and neurological outcome may be improved with this method.
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Affiliation(s)
- Roland Roelz
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.).
| | - Volker A Coenen
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Christian Scheiwe
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Wolf-Dirk Niesen
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Karl Egger
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Istvan Csok
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Rainer Kraeutle
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Ramazan Jabbarli
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Horst Urbach
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
| | - Peter C Reinacher
- From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.)
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Walendy V, Stang A. Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005-2009). BMJ Open 2017; 7:e012294. [PMID: 28096250 PMCID: PMC5253577 DOI: 10.1136/bmjopen-2016-012294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our aim was to provide nationwide age-standardised rates (ASR) on the usage of endovascular coiling and neurosurgical clipping for unruptured intracranial aneurysm (UIA) treatment in Germany. SETTING Nationwide observational study using the Diagnosis-Related-Groups (DRG) statistics for the years 2005-2009 (overall 83 million hospitalisations). PARTICIPANTS From 2005 to 2009, overall 39 155 hospitalisations with a diagnosis of UIA occurred in Germany. PRIMARY OUTCOME MEASURES Age-specific and age-standardised hospitalisation rates for UIA with the midyear population of Germany in 2007 as the standard. RESULTS Of the 10 221 hospitalisations with UIA during the observation period, 6098 (59.7%) and 4123 (40.3%) included coiling and clipping, respectively. Overall hospitalisation rates for UIA increased by 39.5% (95% CI 24.7% to 56.0%) and 50.4% (95% CI 39.6% to 62.1%) among men and women, respectively. In 2005, the ASR per 100 000 person years for coiling was 0.7 (95% CI 0.62 to 0.78) for men and 1.7 (95% CI 1.58 to 1.82) for women. In 2009, the ASR was 1.0 (95% CI 0.90 to 1.10) and 2.4 (95% CI 2.24 to 2.56), respectively. Similarly, the ASR for clipping in 2005 amounted to 0.6 (95% CI 0.52 to 0.68) for men and 1.1 (95% CI 1.00 to 1.20) for women. These rates increased in 2009 to 0.8 (95% CI 0.72 to 0.88) and 1.7 (95% CI 1.58 to 1.82), respectively. We observed a marked geographical variation of ASR for coiling and less pronounced for clipping. For the federal state of Saarland, the ASR for coiling was 5.64 (95% CI 4.76 to 6.52) compared with 0.68 (95% CI 0.48 to 0.88; per 100 000 person years) in Saxony-Anhalt, whereas, ASR for clipping were highest in Rhineland-Palatinate (2.48, 95% CI 2.17 to 4.75) and lowest in Saxony-Anhalt (0.52, 95% CI 0.34 to 0.70). CONCLUSIONS To the best of our knowledge, we presented the first representative, nationwide analysis of the clinical management of UIA in Germany. The ASR increased markedly and showed substantial geographical variation among federal states for all treatment modalities during the observation period.
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Affiliation(s)
- Victor Walendy
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
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16
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Falk Delgado A, Andersson T, Falk Delgado A. Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta-analysis of randomized and non-randomized trials with short- and long-term follow-up. J Neurointerv Surg 2016; 9:264-277. [PMID: 27053705 DOI: 10.1136/neurintsurg-2016-012292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Two randomized trials have evaluated clipping and coiling in patients with ruptured aneurysms. Aggregated evidence for management of ruptured and unruptured aneurysms is missing. OBJECTIVE To conduct a meta-analysis evaluating clinical outcome after aneurysm treatment. METHODS PubMed, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched for studies evaluating aneurysm treatment. The primary outcome measure was an independent clinical outcome (modified Rankin scale 0-2, Glasgow Outcome Scale 4-5, or equivalent). Secondary outcomes were poor outcome and mortality. ORs were calculated on an intention-to-treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I2 (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant. RESULTS Searches yielded 18 802 articles. All titles were assessed, 403 abstracts were evaluated, and 183 full-text articles were read. One-hundred and fifty articles were qualitatively assessed and 85 articles were included in the meta-analysis. Patients treated with coiling (randomized controlled trials (RCTs)) had higher independent outcome at short-term follow-up (OR=0.67, 95% CI 0.57 to 0.79). Independent outcome was favored for coiling at intermediate and long-term follow-up (RCTs and observational studies combined-OR=0.80, 0.68 to 0.94 and OR=0.81, 0.71 to 0.93, respectively). Independent outcome and lower mortality was favored after coiling in unruptured aneurysms (database registry studies) at short-term follow-up (OR=0.34, 0.29 to 0.41 and OR=1.74, 1.52 to 1.98, respectively). CONCLUSIONS This meta-analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiling.
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Affiliation(s)
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Stranjalis G, Loufardaki M, Koutsarnakis C, Kalamatianos T. Trends in the Management and Hospital Outcome of Spontaneous Subarachnoid Hemorrhage in the Post-International Subarachnoid Aneurysm Trial Era in Greece: Analysis of 719 Patients During a 13-Year Period. World Neurosurg 2016; 88:327-332. [DOI: 10.1016/j.wneu.2015.11.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 11/24/2022]
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