1
|
Lim J, Aguirre AO, Baig AA, Levy BR, Ladner LR, Crider C, Garay-Morales S, Yu Alfonzo S, Galloza D, Jaikumar V, Monteiro A, Kuo CC, Vakharia K, Lai PMR, Snyder KV, Davies JM, Siddiqui AH, Levy EI. Global Disparities in the Presentation and Management of Aneurysmal Subarachnoid Hemorrhage: A Review and Analysis. World Neurosurg 2024; 187:202-210.e4. [PMID: 38750883 DOI: 10.1016/j.wneu.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality rates. There is a significant gap in the literature describing global disparities in demographics, management, and outcomes among patients with aSAH. We aimed to conduct a systematic review and meta-analysis to assess global disparities in aSAH presentation and management. METHODS PubMed and Embase databases were queried from earliest records to November 2022 for aSAH literature. Presentation, demographics, comorbidities, treatment methods, and outcomes data were collected. Articles that did not report aSAH-specific patient management and outcomes were excluded. Pooled weighted prevalence rates were calculated. Random effects model rates were reported. RESULTS After screening, 33 articles representing 10,553 patients were included. The prevalence of Fisher grade 3 or 4 aSAH in high- and lower-income countries (HIC and LIC), respectively, was 79.8% (P < 0.01) and 84.1 (P < 0.01). Prevalence of male aSAH patients in HIC and LIC, respectively, was 35.8% (P < 0.01) and 45.0% (P < 0.01). Prevalence of treatment in aSAH patients was 99.5% (P < 0.01) and 99.4% (P = 0.16) in HIC and LIC, respectively. In HIC, 35% (P < 0.01) of aneurysms in aSAH patients were treated with coiling. No LIC reported coiling for aSAH treatment; LIC only reported rates of surgical clipping, with a total prevalence of 92.4% (P < 0.01) versus 65.6% (P < 0.01) in HIC. CONCLUSION In this analysis, we found similar rates of high-grade SAH hemorrhages in HIC and LIC but a lack of endovascular coil embolization treatments reported in LIC. Additional research and discussion are needed to identify reasons for treatment disparities and intervenable societal factors to improve aSAH outcomes worldwide.
Collapse
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Bennett R Levy
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Liliana R Ladner
- School of Medicine, Virginia Tech Carilion, Roanoke, Virginia, USA
| | - Corianne Crider
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Steven Garay-Morales
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Sabrina Yu Alfonzo
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Daniel Galloza
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| |
Collapse
|
2
|
Hoh BL, Ko NU, Amin-Hanjani S, Chou SHY, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2023; 54:e314-e370. [PMID: 37212182 DOI: 10.1161/str.0000000000000436] [Citation(s) in RCA: 128] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Collapse
|
3
|
Özdemir Ö, Diren F, Boyalı O, Baysoy B, Kabataş S. Factors Associated with Clinical Outcomes in Spontaneous Subarachnoid Hemorrhage. JOURNAL OF ACADEMIC RESEARCH IN MEDICINE 2022. [DOI: 10.4274/jarem.galenos.2022.98704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
4
|
Puri S, Mahajan S, Jangra K, Chauhan R, Kumar S, Aggarwal A, Vyas S, Bhagat H. Effect of Comorbidities on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Study. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1756431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background The pathophysiological changes following aneurysmal subarachnoid hemorrhage (aSAH) lead to a varied degree of neurological deficit and cognitive decline. The presence of comorbidities can contribute to the progression and course of the disease resulting in high morbidity and mortality.
Methods A total of 140 patients with aSAH, scheduled for surgical clipping or endovascular coiling were included. The patients' comorbidities were recorded. The postoperative outcome was evaluated using Glasgow Outcome Scale at 1 month following discharge. Multiple logistic regression analysis was performed to identify variables predicting poor outcome, taking into consideration those variables which were significant in univariate analysis.
Results Sixty-six percent of these patients with aSAH had associated comorbidities. In our patient cohort, we found that smoking and hypertension were associated with worse outcome (odds ratio [OR] = 4.63 [confidence interval [CI] = 1.83–11.7] and OR = 2.92 [CI = 1.41–6.01], respectively). Hypothyroidism, diabetes mellitus, coronary artery disease, and asthma did not influence the neurological outcome because of their small number.
Conclusion Presence of comorbidities like smoking and hypertension significantly worsen the outcome of these patients with aSAH.
Collapse
Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalvi Mahajan
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Jangra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Intervention Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hemant Bhagat
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Kumar V, Agrawal M, Sharma V, Purohit D. Surgical Clipping of Ruptured Intracranial Aneurysm: Experience of a Tertiary Centre in Western India. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1743400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background Surgical clipping has been a gold standard procedure for management of intracranial aneurysms. Outcome studies of surgical clipping at institutional level are important to identify modifiable factors and further improve the results. These are even more important in areas where resources are limited, and patient presents late due to ignorance and lack of education. This study is a review of our institutional experience in microsurgical clipping of ruptured intracranial aneurysms.
Methods A retrospective study of patients who underwent surgical clipping for ruptured intracranial aneurysms from January 2014 to February 2020. The medical records of patients were reviewed for demographic data, clinical presentation, radiological investigations, surgery performed and neurological outcome. Outcome at discharge and outcome at follow-up were measured by modified Rankin scale (mRS).
Results In this study of 289 patients, 194 patients (67.13%) had good outcome at discharge (mRS0–2), while 95 patients (32.87%) had poor outcome at discharge (mRS 3–6) and 50 patients (17.30%) expired during hospital stay. Out of 289 patients, 208 patients (71.97%) were admitted after more than 3 days of ictus. Significant factors affecting outcome were neurological status determined by Glasgow coma scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) grade or Hunt and Hess Grade, time interval from onset of subarachnoid hemorrhage to admission, and time interval from admission to surgery.
Conclusion The present study identifies factors for improving outcome in patients of ruptured aneurysm at institutional and community level. Time from ictus to admission and admission to surgery are important modifiable factors in our study.
Collapse
Affiliation(s)
- Vijay Kumar
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Manish Agrawal
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Vinod Sharma
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - D.K. Purohit
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
6
|
Rehman S, Phan HT, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Breslin M, Callisaya ML, Vemmos K, Parmar P, Krishnamurthi RV, Barker-Collo S, Feigin V, Chausson N, Olindo S, Cabral NL, Carolei A, Marini C, Degan D, Sacco S, Correia M, Appelros P, Kõrv J, Vibo R, Minelli C, Sposato L, Pandian JD, Kaur P, Azarpazhooh MR, Morovatdar N, Gall S. Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT). J Stroke Cerebrovasc Dis 2021; 31:106201. [PMID: 34794031 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types. METHODS We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. RESULTS Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. CONCLUSION Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.
Collapse
Affiliation(s)
- Sabah Rehman
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy
| | | | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita V Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicolas Chausson
- Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Stephane Olindo
- Stroke Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Norberto L Cabral
- Deceased. Formerly Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy
| | - Diana Degan
- Struttura Complessa di Neurologia, Ospedale Michele e Pietro Ferrero, Verduno (Cuneo), ASL CN2, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Manuel Correia
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
| | - Peter Appelros
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Cesar Minelli
- Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation, Matão, SP, Brazil
| | - Luciano Sposato
- Department of Neurology, Western University, London, Ontario, Canada
| | | | - Paramdeep Kaur
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
| | - M Reza Azarpazhooh
- Department of Clinical Neurological Sciences, University of Western, London, Ontario, Canada
| | - Negar Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seana Gall
- Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
7
|
Bhagat H, Sharma T, Mahajan S, Kumar M, Saharan P, Bhardwaj A, Sachdeva N, Gandhi K, Jangra K, Panda NB, Singla N, Kishore K, Singh N. Intravenous versus inhalational anesthesia trial for outcome following intracranial aneurysm surgery: A prospective randomized controlled study. Surg Neurol Int 2021; 12:300. [PMID: 34221630 PMCID: PMC8247687 DOI: 10.25259/sni_342_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background For maintenance of anesthesia for intracranial aneurysmal neck clipping, both intravenous and inhalational anesthetics are in vogue. We aimed to evaluate the superiority of one agent over the other for long-term neurological outcomes in these patients. Methods This prospective assessor-blind randomized study was conducted in 106 patients of 18-65 years of age with World Federation of Neurosurgeons Grade I-II of subarachnoid hemorrhage. After written informed consent, the patients were randomized into - intravenous group (Propofol) and inhalational group (Desflurane). The primary outcome was to study neurological outcome using Glasgow outcome scale (GOS) at 3 months following discharge while secondary outcomes included intraoperative brain condition, intraoperative hemodynamics, duration of hospital stay, Modified Rankin Score (MRS) at discharge, MRS, and Barthel's index at 3 months following discharge and estimation of perioperative biomarkers of brain injury. Results The GOS at 3 months was 5 (5.00-5.00) in the propofol group and 5 (4.00-5.00) in the desflurane group (P = 0.24). Both the anesthetics were similar in terms of intraoperative hemodynamics, brain relaxation, duration of hospital stay, MRS at discharge and 3 months, and Barthel Index at 3 months (P > 0.05). The perioperative serum interleukin-6 and S100B were comparable among the groups (P > 0.05). Conclusion The long-term neurological outcome of good grade aneurysm patients undergoing craniotomy and clipping remains comparable with the use of either propofol or desflurane. The effect of the two anesthetic agents on the various clinical parameters and the biomarkers of brain injury is also similar.
Collapse
Affiliation(s)
- Hemant Bhagat
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Tanavi Sharma
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Shalvi Mahajan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Munish Kumar
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Poonam Saharan
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Avanish Bhardwaj
- Department of Anesthesia and Critical Care, Command Hospital (Airforce), Bengaluru, Karnataka, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Gandhi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kiran Jangra
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Nidhi Bidyut Panda
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Navneet Singla
- Department of Neurosurgery Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Singh
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh
| |
Collapse
|
8
|
Altun I, Hu J, Albadawi H, Zhang Z, Salomao MA, Mayer JL, Jamal L, Oklu R. Blood-Derived Biomaterial for Catheter-Directed Arterial Embolization. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2005603. [PMID: 33174305 PMCID: PMC7769968 DOI: 10.1002/adma.202005603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/05/2020] [Indexed: 05/05/2023]
Abstract
Vascular embolization is a life-saving minimally invasive catheter-based procedure performed to treat bleeding vessels. Through these catheters, numerous metallic coils are often pushed into the bleeding artery to stop the blood flow. While there are numerous drawbacks to coil embolization, physician expertise, availability of these coils, and their costs further limit their use. Here, a novel blood-derived embolic material (BEM) with regenerative properties, that can achieve instant and durable intra-arterial hemostasis regardless of coagulopathy, is developed. In a large animal model of vascular embolization, it is shown that the BEM can be prepared at the point-of-care within 26 min using fresh blood, it can be easily delivered using clinical catheters to embolize renal and iliac arteries, and it can achieve rapid hemostasis in acutely injured vessels. In swine arteries, the BEM increases cellular proliferation, angiogenesis, and connective tissue deposition, suggesting vessel healing and durable vessel occlusion. The BEM has significant advantages over embolic materials used today, making it a promising new tool for embolization.
Collapse
Affiliation(s)
- Izzet Altun
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Jingjie Hu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Zefu Zhang
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Marcela A. Salomao
- Division of Anatomic Pathology & Laboratory Medicine, Department of Pathology, Mayo Clinic, 5777 East Mayo Blvd., Phoenix, Arizona 85054, USA
| | - Joseph L. Mayer
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Leila Jamal
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| |
Collapse
|
9
|
Nichols L, Gall S, Stankovich J, Stirling C. Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage. Intern Med J 2020; 51:2095-2103. [PMID: 32893943 DOI: 10.1111/imj.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aims to understand early (< 24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. METHODS A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010-2014 utilising multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. RESULTS From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status but rural geographical location was associated with a non-significant increase in death (HR 1.22 95% CI 0.85-1.75) along with hypertension (HR 1.78 95% CI 1.07-2.98) and hypercholesterolemia (HR 1.70 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81 95% CI 1.08-3.03) and hypercholesterolemia (HR 1.71 95% CI 1.00-2.94) but not socioeconomic status or geographic location. CONCLUSION We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Linda Nichols
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania
| | - Jim Stankovich
- Department of Neuroscience, Central Clinical School, Monash University
| | - Christine Stirling
- School of Nursing, University of Tasmania, 71 Brooker Ave Glebe, 7001, Hobart, Tasmania, Australia
| |
Collapse
|
10
|
Chai CL, Pyeong Jeon J, Tsai YH, Whittaker P, Macdonald RL, Lindgren AE, Ayling OG, Acioly MA, Cohen-Gadol A, Huang YH. Endovascular Intervention Versus Surgery in Ruptured Intracranial Aneurysms in Equipoise. Stroke 2020; 51:1703-1711. [DOI: 10.1161/strokeaha.120.028798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently, published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials.
Methods—
We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews. Primary outcomes were posttreatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3 to 6 and 12 months, delayed cerebral ischemia, and seizures.
Results—
Rebleeding was more frequent after endovascular intervention (Peto OR, 2.18 [95% CI, 1.29–3.70]; 3104 participants; 15 studies; I
2
=0%, Grading of Recommendations, Assessment, Development and Evaluation: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR, 0.71 [95% CI, 0.53–0.95]; 1661 participants; 11 studies; I
2
=14%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence). Three to six months dependency (RR, 0.82 [95% CI, 0.73–0.93]; 4081 participants; 18 studies; I
2
=15%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) and 12-month dependency (RR, 0.76 [95% CI, 0.66–0.86]; 1981 participants; 10 studies; I
2
=0%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) were lower after endovascular intervention.
Conclusions—
This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared with surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence.
Registration—
URL:
https://www.crd.york.ac.uk/PROSPERO
. Unique identifier: CRD42018090396.
Collapse
Affiliation(s)
- Chung Liang Chai
- From the School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, United Kingdom (C.L.C., P.W.)
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan (C.L.C.)
| | - Jin Pyeong Jeon
- Institute of New Frontier Stroke Research, Chuncheon, Republic of Korea (J.P.J.)
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Republic of Korea (J.P.J.)
- Genetic and Research Incorporation, Chuncheon, Republic of Korea (J.P.J.)
| | - Yi-Hsin Tsai
- Neurointensive Care Unit, Division of Neurosurgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan (Y.-H.T.)
| | - Paula Whittaker
- From the School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, United Kingdom (C.L.C., P.W.)
| | - R. Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, ON, Canada (R.L.M.)
| | - Antti E. Lindgren
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (A.E.L.)
| | - Oliver G.S. Ayling
- Division of Neurosurgery, The University of British Columbia, Vancouver, Canada (O.G.S.A.)
| | - Marcus André Acioly
- Universidade Federal Fluminense, Division of Neurosurgery, Rio de Janeiro, Brazil (M.A.A.)
- Universidade Federal do Rio de Janeiro, Brazil (M.A.A.)
| | - Aaron Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis (A.C.-G.)
| | | |
Collapse
|
11
|
Dhandapani S, Singh A, Singla N, Praneeth K, Aggarwal A, Sodhi HB, Pal SS, Goudihalli S, Salunke P, Mohindra S, Kumar A, Gupta V, Chhabra R, Mukherjee KK, Tewari MK, Khandelwal N, Mathuriya SN, Khosla VK, Gupta SK. Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services? Stroke 2019; 49:2890-2895. [PMID: 30571395 DOI: 10.1161/strokeaha.118.022865] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose- Though reports suggest decreasing fatality rates of subarachnoid hemorrhage with time, trends in outcome are not reported much especially from developing countries. This study was to analyze changes in outcome across 2 decades and elucidate probable factors. Methods- Prospective databases during 1996 to 2015 were reviewed for neurological outcome at 3 months in relation to demographics, Hunt and Hess grade, Fisher grade, and definitive treatment; and compared between 2 decades, contrasted by establishment of intensive care unit with continuous monitoring and other advancements. Univariate and multivariate analyses were performed. Results- Of the total 2039 patients, 1035 were managed in the former and 1004 in the recent decades. Compared with the former decade, there is delayed age at presentation (46 versus 49 years, P<0.001), poorer Fisher grades (81% versus 87%, P<0.001), and more patients with Hunt and Hess grade 2 (24% versus 39%, P<0.001) in the recent decade. While all patients in databases of the former decade had undergone clipping, 6% in the recent decade underwent coiling. 11% in the recent decade could not undergo definitive treatment. Despite this, there was significantly higher overall favorable outcome (50% versus 60%; odds ratio, 1.5; P<0.001) in recent decade. Favorable outcome of surgical clipping per se improved significantly from 50% to 67% (odds ratio 2.0; P<0.001). Though the improvement was across subgroups, it was more marked among Hunt and Hess grade 3 and Fisher grades 3 and 4. In multivariate analyses, both overall outcome (adjusted odds ratio, 1.7; 95% CI, 1.4-2.1; P<0.001) and surgical outcome (adjusted odds ratio, 1.8; 95% CI, 1.5-2.2; P<0.001) were significantly better in recent decade, independent of known prognostic factors. Conclusions- This is probably the first report to show independent improvement in outcome of subarachnoid hemorrhage with betterment in neurosurgical services from developing country. Dedicated intensive care unit care and focused management protocols could be the likely causes for improvement. Resource-constrained institutions may target patients in Hunt and Hess grade 3 and Fisher grades 3 and 4 for optimal intensive care unit utilization.
Collapse
Affiliation(s)
- Sivashanmugam Dhandapani
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Navneet Singla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kokkula Praneeth
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashish Aggarwal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harsimrat B Sodhi
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sudhir S Pal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sachin Goudihalli
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ajay Kumar
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vivek Gupta
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanchan K Mukherjee
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Manoj K Tewari
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Suresh N Mathuriya
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Virender K Khosla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| |
Collapse
|
12
|
Nikolov V, Jelenković B, Andjelković-Apostolović M, Milošević P. SELECTION OF TREATMENT METHODS FOR BLEEDING ANEURYSMS. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
13
|
Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H, Morcos JJ, Park KB. Estimating the Global Incidence of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review for Central Nervous System Vascular Lesions and Meta-Analysis of Ruptured Aneurysms. World Neurosurg 2018; 115:430-447.e7. [DOI: 10.1016/j.wneu.2018.03.220] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
|
14
|
Buell TJ, Ding D. Optimizing the management of aneurysmal subarachnoid hemorrhage: Lessons learned and future directions. J Neurosci Rural Pract 2014; 5:109-10. [PMID: 24966542 PMCID: PMC4064169 DOI: 10.4103/0976-3147.131643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Thomas J Buell
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States
| |
Collapse
|
15
|
Guth J. The clinical profile, management, and overall outcome of aneurysmal subarachnoid hemorrhage at the neurosurgical unit of a tertiary care center in India. J Neurosci Rural Pract 2014; 5:113-4. [PMID: 24966544 PMCID: PMC4064171 DOI: 10.4103/0976-3147.131646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- James Guth
- Department of Neurology, Division of Vascular and Critical Care Neurology, Northwestern University, Chicago, IL
| |
Collapse
|
16
|
Marafioti V, Pasqualin A. Commentary. J Neurosci Rural Pract 2014; 5:126-7. [PMID: 24966548 PMCID: PMC4064175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vincenzo Marafioti
- Department of Cardiovascular and Thoracic, Institute of Cardiology, Verona, Italy,Address for correspondence: Dr. Vincenzo Marafioti, Department of Cardiovascular and Thoracic, Institute of Cardiology, University Hospital of Verona, P. Stefani 1, Verona - 37126, Italy. E-mail:
| | - Alberto Pasqualin
- Institute of Neurosurgery, University Hospital of Verona, Verona, Italy
| |
Collapse
|