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Santana LS, Yoshikawa MH, Ramos MB, Figueiredo EG, Telles JPM. Neuropsychological outcomes in patients with ruptured anterior communicating artery aneurysms treated by clipping versus coiling: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:196. [PMID: 38676753 DOI: 10.1007/s10143-024-02418-9] [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: 12/28/2023] [Revised: 02/14/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Ruptured anterior communicating artery (ACoA) aneurysms are frequently associated with neuropsychological deficits. This review aims to compare neuropsychological outcomes between surgical and endovascular approaches to ACoA. We systematically searched PubMed, Embase, and Web of Science for studies comparing the endovascular and surgical approaches to ruptured ACoA aneurysms. Outcomes of interest were the cognitive function, covered by memory, attention, intelligence, executive, and language domains, as well as motor and visual functions. Nine studies, comprising 524 patients were included. Endovascularly-treated patients showed better memory than those treated surgically (Standardized Mean Difference (SMD) = -2; 95% CI: -3.40 to -0.61; p < 0.01). Surgically clipped patients had poorer motor ability than those with coiling embolization (p = 0.01). Executive function (SMD = -0.20; 95% CI: -0.47 to 0.88; p = 0.55), language (SMD = -0.33; 95% CI: -0.95 to 0.30; p = 0.30), visuospatial function (SMD = -1.12; 95% CI: -2.79 to 0.56; p = 0.19), attention (SMD = -0.94; 95% CI: -2.79to 0.91; p = 0.32), intelligence (SMD = -0.25; 95% CI: -0.73 to 0.22; p = 0.30), and self-reported cognitive status (SMD = -0.51; 95% CI: -1.38 to 0.35; p = 0.25) revealed parity between groups. Patients with ACoA treated endovascularly had superior memory and motor abilities. Other cognitive domains, including executive function, language, visuospatial function, attention, intelligence and self-reported cognitive status revealed no statistically significant differences between the two approaches. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42023461283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461283.
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Affiliation(s)
| | | | - Miguel Bertelli Ramos
- Department of Neurosurgery, Instituto de Assistência Médica Ao Servidor Público Estadual, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Bae DW, Lee JH, Shin JH, Ihn YK, Sung JH. Detection of cerebral aneurysm and intracranial vertebral dissection using non-enhanced magnetic resonance imaging in emergency setting: Emphasis on magnitude image of susceptibility-weighted image. Interv Neuroradiol 2023; 29:665-673. [PMID: 35642276 PMCID: PMC10680967 DOI: 10.1177/15910199221104613] [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: 03/12/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate image features and diagnostic performance of susceptibility-weighted image (SWI) in detection of intracranial vertebral artery dissection (VAD) and unruptured intracranial aneurysm (UIA). MATERIALS AND METHODS From January 2015 to December 2021, symptomatic patients who underwent 3.0 T MR SWI were recruited. For study group, transfemoral cerebral angiography-proven lesions were included, while 1:1 matched control group with MR angiography were included. Image features of SWI were evaluated. Diagnostic performance and interobserver agreements were calculated for detecting VAD with stenosis and UIA greater than 7 mm. RESULTS Total of 110 patients (mean age: 60.92 years, female: 60/110) were included. In the study group (N = 55), 21 patients (38.2%) had VAD, while 34 patients (61.8%) had UIA. For SWI-detectable VAD, larger parent artery (PA)-dilatation ratio was observed (1.36 vs. 1.84, p = 0.034). For SWI-detectable UIA, larger PA-dome ratio (1.32 vs. 1.90, p = 0.020) and larger PA-height ratio (1.25 vs. 1.77, p = 0.005) were observed. The diagnostic performance and kappa values for VAD with stenosis were as follow: sensitivity: 91.7 (95% CI: 61.5-99.8); specificity: 93.9 (95% CI: 87.2-97.7); к: 0.80. The diagnostic performance for UIA larger than 7 mm were as follow: sensitivity: 87.5 (95% CI: 47.4-99.7); specificity: 95.1 (95% CI: 88.9-98.4); к: 0.73. CONCLUSION SWI-detectable lesions were VAD with larger PA-dilatation ratio, and UIA with larger PA-dome ratio, and PA-height ratio. SWI was able to accurately detect VAD with stenosis and UIA larger than 7 mm with substantial interobserver agreements.
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Affiliation(s)
- Dae Woong Bae
- Department of Neurology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Jong Heon Lee
- Department of Radiology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Jae Ho Shin
- Department of Radiology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Yon Kwon Ihn
- Department of Radiology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, The Catholic University of Korea, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
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Park H, Cho SW, Lee SH, Kim K, Kang HS, Kim JE, Shin A, Cho WS. Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case-Control Study from Korea. Thyroid 2023; 33:1483-1490. [PMID: 37842850 DOI: 10.1089/thy.2023.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background: Few risk factors for the development of intracranial aneurysms (IAs) are known. We investigated the potential role of thyroid diseases in IA development using nationwide real-world data. Methods: A nested case-control study within the National Health Insurance Service-National Sample Cohort data from 2002 to 2019 was performed. A total of 5335 patients with unruptured IA were matched by age and sex with 80,025 controls at a ratio of 1:15. We estimated the odds ratios (ORs) and corresponding confidence intervals [CIs] between thyroid diseases and unruptured IA using a multivariable conditional logistic regression model. Results: Tobacco smoking, use of antihypertensive medication, and hypothyroidism were significantly associated with an elevated risk for unruptured IA in univariate analysis. In multivariable analysis, a history of hypothyroidism was associated with unruptured IA (adjusted OR: 1.46 [CI: 1.26-1.69]). Among patients with hypothyroidism, long-term use of thyroid hormone for >5 years was associated with a reduced risk for unruptured IA (adjusted OR: 0.69 [CI: 0.48-0.99]). A history of hyperthyroidism was associated with a reduced risk for unruptured IAs (adjusted OR: 0.71 [CI: 0.54-0.93]). In secondary analyses of the data according to sex, the respective observed associations between hypothyroidism and hyperthyroidism and the risk of IAs were found to be statistically significant in females but not in males. Conclusions: Hypothyroidism is associated with an increased risk of unruptured IAs, whereas hyperthyroidism is associated with a reduced risk. Overall, the findings suggest that thyroid hormones may play a protective role in the development of unruptured IAs. Further studies are needed to clarify potential direct causality and the biologic mechanisms relating thyroid dysfunction and unruptured IA.
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Affiliation(s)
- Hyeree Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kangmin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lee J, Lee S, Kwon OK. Illness Uncertainty of the Patients With Unruptured Intracranial Aneurysms Treated by Coil Embolization. J Neurosci Nurs 2023; 55:150-156. [PMID: 37527950 DOI: 10.1097/jnn.0000000000000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT BACKGROUND: Patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization may experience illness uncertainty despite successful treatment. This study aimed to investigate illness uncertainty in patients with UIAs treated by coil embolization and to identify the factors affecting illness uncertainty. METHODS: This cross-sectional study involved data collected from 267 patients with UIAs who received coil embolization within 2 years at a tertiary hospital in South Korea. The data were collected through structured questionnaires and the patients' medical records. The questionnaires included information on sociodemographic characteristics, the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and Mishel Uncertainty in Illness Scale data. We collected clinical characteristics through the medical records. Data analysis was performed using descriptive statistics, an independent t test, a 1-way analysis of variance, and a Pearson correlation test. We used a multiple linear regression analysis with significant variables in the univariate analysis to determine which variables had a significant impact on illness uncertainty. RESULTS: The mean Mishel Uncertainty in Illness Scale score was 52.33 (12.93). We identified age ( P = .002), education level (high school graduation, P = .014; college or higher, P < .001), anxiety ( P < .001), and social support ( P < .001) as factors affecting illness uncertainty. CONCLUSION: Patients with UIAs who underwent coil embolization did not exhibit severe illness uncertainty. The factors affecting illness uncertainty were age, educational level, anxiety, and social support. This study provides insight into illness uncertainty in this patient population and may help develop appropriate nursing interventions.
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Li G, Chen S, Han J, Pan W, Ji P. Comparative study on the clinical outcomes and prognosis of endovascular embolization and craniotomy clipping for the treatment of cerebral aneurysms. Pak J Med Sci 2023; 39:1296-1300. [PMID: 37680810 PMCID: PMC10480711 DOI: 10.12669/pjms.39.5.7401] [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: 11/07/2022] [Revised: 11/28/2022] [Accepted: 05/25/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To investigate the safety and outcomes of endovascular embolization and craniotomy clipping in the treatment of cerebral aneurysms. Methods We collected the clinical data of 106 patients with cerebral aneurysm who underwent surgical treatment (endovascular embolization, Group-A, n=55; craniotomy clipping, Group-B, n=51) in the First People's Hospital of Yichang from January 2020 to May 2021. We compared surgical treatment indexes, treatment costs, neurological function before and after the treatment, incidence of postoperative complications and the prognosis after one-year follow-up between the two groups. Results Endovascular embolization (Group-A) was associated with a shorter mean operation time and hospital stay, a lower mean intraoperative bleeding amount, and a higher mean treatment cost than craniotomy clipping (Group-B) (P<0.05). Compared with the pre-operative neurological function scores, the scores of both groups decreased after the surgery, and the mean post-operative score of Group-A was significantly lower than that of Group-B (P<0.05). Compared with Group-B , patients in Group-A had a lower overall complication rate (P < 0.05. Higher proportion of patients in Group-A had a good prognosis (P < 0.05). Conclusion Endovascular embolization for the treatment of cerebral aneurysms is safe as it can shorten the operation time and hospital stay, reduce the incidence of neurological injury and complications, and have a favorable prognosis. However, the treatment is more expensive. Endovascular embolization can be selected for the treatment of cerebral aneurysms when economic conditions allow it.
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Affiliation(s)
- Gang Li
- Gang Li, Department of Neurosurgery, The First People’s Hospital of Yichang, People’s Hospital of Three Gorges University, Yichang 443000, Hubei Province, P.R. China
| | - Shaojun Chen
- Shaojun Chen, Department of Neurosurgery, The First People’s Hospital of Yichang, People’s Hospital of Three Gorges University, Yichang 443000, Hubei Province, P.R. China
| | - Jing Han
- Jing Han, Department of Neurosurgery, The First People’s Hospital of Yichang, People’s Hospital of Three Gorges University, Yichang 443000, Hubei Province, P.R. China
| | - Wanxi Pan
- Wanxi Pan, Department of Neurosurgery, The First People’s Hospital of Yichang, People’s Hospital of Three Gorges University, Yichang 443000, Hubei Province, P.R. China
| | - Ping Ji
- Ping Ji, The People’s Hospital of China Three Gorges University, The First People’s Hospital Of Yichang, Hubei Province, 443000, P.R. China
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Schüngel MS, Hoffmann KT, Weber E, Maybaum J, Bailis N, Scheer M, Nestler U, Schob S. Distal Flow Diversion with Anti-Thrombotically Coated and Bare Metal Low-Profile Flow Diverters—A Comparison. J Clin Med 2023; 12:jcm12072700. [PMID: 37048781 PMCID: PMC10095446 DOI: 10.3390/jcm12072700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023] Open
Abstract
Background and purpose: The establishment of low-profile flow diverting stents (FDS), for example, the Silk Vista Baby (SVB) and the p48MW, facilitated endovascular treatment of peripheral cerebral aneurysms. This study therefore aims to compare the performance and outcomes of the SVB with those of the p48MW HPC, with a special focus on hemodynamic aspects of peripheral segments and bifurcations. Materials and methods: The study cohort comprises 108 patients, who were either treated with the SVB or the p48MW HPC between June 2018 and April 2021. Results: Sixty patients received a SVB and forty-eight patients a p48MW HPC. The SVB was used predominantly in the AcomA-complex, and the p48MW HPC in the MCA bifurcation. Immediately after implantation, significant hemodynamic downgrading (OKM A2-A3, B1-B3, C3) was achieved in 60% in the SVB group vs. 75.1% in the p48MW HPC group. At the second follow-up, after an average of 8.8 and 10.9 months, respectively, OKM D1 was observed in 64.4% of the SVB group vs. 27.3% in the p48MW HPC group. Only 1.7% vs. 6.8% of the aneurysms remained morphologically unaltered (OKM A1). Adverse events with persisting neurologic sequalae at last follow-up were largely comparable in both groups (5.0% vs. 4.2%). Conclusion: Immediately after implantation, the p48MW HPC had a more profound hemodynamic impact than the SVB; however, early complete occlusions were achieved in a greater proportion of lesions after implantation of the uncoated SVB.
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Affiliation(s)
- Marie-Sophie Schüngel
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle, 06120 Halle (Saale), Germany
| | - Karl-Titus Hoffmann
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany
| | - Erik Weber
- Klinik für Anästhesie und Notfallmedizin, Universitätsklinikum Leipzig, 04103 Leipzig, Germany
| | - Jens Maybaum
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany
| | - Nikolaos Bailis
- Institut für Neuroradiologie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany
| | - Maximilian Scheer
- Abteilung für Neurochirurgie, Universitätsklinikum Halle, 06120 Halle (Saale), Germany
| | - Ulf Nestler
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, 04103 Leipzig, Germany
| | - Stefan Schob
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle, 06120 Halle (Saale), Germany
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Perry JJ, Sinclair J, Wakai A. Computed tomography angiography for acute headache may be more painful than lumbar puncture. CAN J EMERG MED 2022; 24:241-242. [PMID: 35403988 DOI: 10.1007/s43678-022-00294-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jeffrey J Perry
- Clinical Epidemiology Unit, Departments of Emergency Medicine and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa Hospital Research Institute, The Ottawa Hospital, F647, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - John Sinclair
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Abel Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin, and Emergency Care Research Unit (ECRU), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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Kim BS. Unruptured Intracranial Aneurysm: Screening, Prevalence and Risk Factors. Neurointervention 2021; 16:201-203. [PMID: 34689458 PMCID: PMC8561037 DOI: 10.5469/neuroint.2021.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Isolated aneurysms of the spinal circulation: a systematic review of the literature. Neurosurg Rev 2021; 45:989-1008. [PMID: 34541624 DOI: 10.1007/s10143-021-01645-8] [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: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different aspects of isolated spinal aneurysms using the PubMed, Ovid MEDLINE, and Google Scholar databases. Eighty-two papers reporting 107 individual patient cases were included. Most isolated spinal aneurysms have a fusiform morphology, and are most commonly found in the anterior spinal artery at the thoracic or cervical levels. Subarachnoid hemorrhage is the most common form of presentation, and sudden onset back pain is the most common initial symptom. The diagnosis of spinal aneurysms requires a high degree of clinical suspicion. Because of their small size, they can be missed on CT/MR angiography and spinal angiogram may be employed. Treatment of spinal aneurysms should be individualized on a case-by-case basis. Conservative management can be a valid option in spinal aneurysms where the risk of treatment is high. Surgical or endovascular intervention may be indicated in cases of significant or progressive neurologic decline due aneurysmal mass effect, or progressive growth of the aneurysm despite conservative treatment.
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Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations-A Short Overview. Int J Mol Sci 2021; 22:ijms22116141. [PMID: 34200256 PMCID: PMC8201350 DOI: 10.3390/ijms22116141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Aneurysms and vascular malformations of the brain represent an important source of intracranial hemorrhage and subsequent mortality and morbidity. We are only beginning to discern the involvement of microglia, the resident immune cell of the central nervous system, in these pathologies and their outcomes. Recent evidence suggests that activated proinflammatory microglia are implicated in the expansion of brain injury following subarachnoid hemorrhage (SAH) in both the acute and chronic phases, being also a main actor in vasospasm, considerably the most severe complication of SAH. On the other hand, anti-inflammatory microglia may be involved in the resolution of cerebral injury and hemorrhage. These immune cells have also been observed in high numbers in brain arteriovenous malformations (bAVM) and cerebral cavernomas (CCM), although their roles in these lesions are currently incompletely ascertained. The following review aims to shed a light on the most significant findings related to microglia and their roles in intracranial aneurysms and vascular malformations, as well as possibly establish the course for future research.
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Kim J, Kim JH, Lee HS, Suh SH, Lee KY. Association between longitudinal blood pressure and prognosis after treatment of cerebral aneurysm: A nationwide population-based cohort study. PLoS One 2021; 16:e0252042. [PMID: 34043701 PMCID: PMC8158927 DOI: 10.1371/journal.pone.0252042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND High blood pressure is a major risk factor for the development and rupture of cerebral aneurysm. Endovascular coil embolization and surgical clipping are established procedures to treat cerebral aneurysm. However, longitudinal data of blood pressure after the treatment of cerebral aneurysm and its impact on long-term prognosis are not well known. METHODS This retrospective cohort study included 1275 patients who underwent endovascular coil embolization (n = 558) or surgical clipping (n = 717) of cerebral aneurysm in 2002-2015 using the nationwide health screening database of Korea. Systolic and diastolic blood pressure of patients were repeatedly obtained from the nationwide health screening program. We performed a multivariate time-dependent Cox regression analysis of the primary composite outcome of stroke, myocardial infarction, and all-cause death. RESULTS During the mean follow-up period of 6.13 ± 3.41 years, 89 patients suffered the primary outcome. Among the total 3546 times of blood pressure measurement, uncontrolled high blood pressure (systolic ≥140 mmHg or diastolic ≥90 mmHg) was 22.9%. There was a significantly increased risk of primary outcome with high systolic (adjusted HR [95% CI] per 10 mmHg, 1.16 [1.01-1.35]) and diastolic (adjusted HR [95% CI] per 10 mmHg, 1.32 [1.06-1.64]) blood pressure. CONCLUSIONS High blood pressure is prevalent even in patients who received treatment for cerebral aneurysm, which is significantly associated with poor outcome. Strict control of high blood pressure may further improve the prognosis of patients with cerebral aneurysm.
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Affiliation(s)
- Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, CHA Bundang Medical Center, Seongnam, Korea
| | - Jang Hoon Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Oculomotor nerve palsy due to posterior communicating artery aneurysm: Clipping vs coiling. Neurochirurgie 2021; 68:86-93. [PMID: 33845117 DOI: 10.1016/j.neuchi.2021.03.012] [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: 11/22/2020] [Revised: 03/07/2021] [Accepted: 03/21/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Posterior communicating artery aneurysms (PCoAA) usually present with brain hemorrhage, but they might present with oculomotor nerve palsy (ONP) in about one out of five patients. Treatment options include endovascular coiling and surgical clipping. The present analysis aims to compare the two treatment options for ONP due to PCoAA in terms of complete recovery and related parameters. METHODS A comprehensive literature search was performed for studies published between 2000 and 2019 on ONP due to PCoAA. The included studies were divided into two categories-surgical clipping (group A) and endovascular coiling (group B). The collected data were statistically processed with SPSS version 25. RESULTS There was a significant difference between the two treatment groups regarding complete recovery of ONP (P<0.001), suggesting superiority of the surgical clipping. The correlation analysis showed no correlations for group A. Group B had negative and positive correlations, showing that endovascular coiling results in higher rates of complete ONP recovery for elderly patients. CONCLUSION Surgical clipping is superior to endovascular coiling in terms of complete recovery among patients with ONP due to PCoAAs. Endovascular coiling seems to benefit older patients. While no recommendations exist for the treatment of ONP due to intracranial aneurysms, an increasing number of studies imply the superiority of operative clipping.
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Mormina E, Musumeci O, Tessitore A, Ciranni A, Tavilla G, Pitrone A, Vinci SL, Caragliano AA, Longo M, Granata F, Toscano A. Intracranial aneurysm management in patients with late-onset Pompe disease (LOPD). Neurol Sci 2020; 42:2411-2419. [PMID: 33067680 DOI: 10.1007/s10072-020-04819-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Pompe disease is a rare hereditary metabolic disorder caused by α-glucosidase (GAA) deficiency. The late-onset form of the disease (LOPD) is considered a multisystemic disorder which could involve vascular system with cerebrovascular abnormalities such as intracranial aneurysms or dolichoectasia. Intracranial aneurysm rupture may represent a life-threatening emergency. A possible treatment of unruptured intracranial aneurysms (UIAs) should consider both aneurysm-related (aneurysmal size, shape, localization, numbers and hemodynamic factors) and patient-related risk factors (patient's age and sex, hypertension, smoke exposure). Moreover, UIAs management of LOPD patients needs also to take into account the altered blood vessels integrity and elasticity, whose consistency is likely weakened by the deficient GAA activity as a further potential risk factor. We herein present our approach for of UIAs management in three patients with LOPD. Among them, only one patient with a left saccular UIA of the anterior communicating artery, after careful consideration of risk factors, underwent the endovascular treatment. The other two patients were scheduled for a 1-year follow-up, according to radiological, clinical, and risk evaluation features. Finally, we would like to suggest some general recommendations for UIAs management. In particular, if no risk factors are identified, a cautious yearly follow-up is suggested; otherwise, if risk factors are present, endovascular treatment should be considered.
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Affiliation(s)
- Enricomaria Mormina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. .,Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Anna Ciranni
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Graziana Tavilla
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Armando Caragliano
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marcello Longo
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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14
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Hinojosa-Gonzalez DE, Ferrigno AS, Martinez HR, Farias JS, Caro-Osorio E, Figueroa-Sanchez JA. Aneurysms of the Lenticulostriate Artery: A Systematic Review. World Neurosurg 2020; 145:471-479.e10. [PMID: 32889194 DOI: 10.1016/j.wneu.2020.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lenticulostriate artery aneurysms (LSAs) are rare vascular aberrations. Despite the potentially catastrophic sequelae of aneurysmal rupture, the optimal management strategy for LSA aneurysms has not been determined. The aim of the present review is to provide an overview of the clinical presentation and treatment strategies for LSA aneurysms. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted in the PubMed, Cochrane, EBSCOhost, Scopus, Web of Science, and ProQuest search engines to identify reported studies of LSA aneurysms until July 1, 2020. A descriptive analysis was performed. RESULTS A total of 71 studies with 112 cases of LSA aneurysms were included. Patient age ranged from 2 months to 83 years (median, 44.5 years). Male and female patients were affected similarly (49% and 51%, respectively). The most common presentation was aneurysmal rupture (78%), and headache was the most frequently reported symptom (36%). Overall, 48% of the patients had undergone underwent surgical treatment, 30% conservative management, 21% endovascular treatment, and 1% radiosurgery. Four patients died, all of whom had presented with aneurysmal rupture. CONCLUSION We have summarized the reported cases of LSA aneurysms, with their clinical presentation, management, and outcomes, for physicians who may be confronted with this diagnosis. Future studies that use available classification systems and include as much detail as possible should be encouraged to fully elucidate the optimal management strategy for these patients.
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Affiliation(s)
| | - Ana S Ferrigno
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Hector R Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Enrique Caro-Osorio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Jose A Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico.
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15
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Gower MN, Ratner LR, Williams AK, Rossi JS, Stouffer GA, Lee CR. Clinical Utility of CYP2C19 Genotype-Guided Antiplatelet Therapy in Patients at Risk of Adverse Cardiovascular and Cerebrovascular Events: A Review of Emerging Evidence. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:239-252. [PMID: 32821149 PMCID: PMC7419635 DOI: 10.2147/pgpm.s231475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
In patients undergoing percutaneous coronary intervention (PCI), the standard of care is dual antiplatelet therapy with a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) and aspirin. Current clinical practice guidelines now recommend more potent P2Y12 inhibitors (prasugrel or ticagrelor) over clopidogrel in acute coronary syndrome (ACS). However, clopidogrel remains the most commonly prescribed P2Y12 inhibitor in the setting of PCI and is also the preferred agent in the treatment and secondary prevention of stroke. Clopidogrel is a prodrug that requires bioactivation by the CYP2C19 enzyme. It has been shown that clopidogrel use in patients who are CYP2C19 no function allele carriers are associated with impaired antiplatelet inhibition and a higher risk of major adverse cardiovascular and cerebrovascular events. Compared to clopidogrel, prasugrel and ticagrelor clinical response is not impacted by CYP2C19 genotype. Even with a demonstrated increased risk of adverse outcomes in CYP2C19 no function allele carriers treated with clopidogrel, routine implementation of CYP2C19 genotyping to guide antiplatelet therapy selection has remained controversial and has not been widely adopted. Recent results from multiple prospective randomized and nonrandomized clinical trials investigating the use of CYP2C19 genotype-guided antiplatelet therapy following PCI have advanced the evidence base demonstrating the clinical utility of this strategy. Multiple recent studies have examined the effects of CYP2C19 genotype on clopidogrel outcomes in the setting of stroke and neurointerventional procedures. In this review, we discern the clinical utility of using CYP2C19 genotype testing to guide antiplatelet therapy prescribing by evaluating the impact of CYP2C19 genotype-guided selection of antiplatelet therapy on clinical outcomes, summarizing emerging data from cardiovascular and neurology clinical studies, and discussing implications for clinical practice guidelines, remaining knowledge gaps and future research directions.
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Affiliation(s)
- Megan N Gower
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Lindsay R Ratner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Alexis K Williams
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Joseph S Rossi
- Division of Cardiology, UNC School of Medicine, Chapel Hill, NC, USA
| | - George A Stouffer
- Division of Cardiology, UNC School of Medicine, Chapel Hill, NC, USA.,UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA.,UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Mantripragada K, Echeverry N, Mansour S, Peterson EC, Snelling B. Treatment of Bilateral Giant Fusiform Petrocavernous Aneurysms. Cureus 2020; 12:e8662. [PMID: 32699662 PMCID: PMC7370658 DOI: 10.7759/cureus.8662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aneurysms of the petrous segment of the internal carotid artery (ICA) are exceedingly rare. They are thought to arise from traumatic, mycotic, or congenital etiologies. We present a case of bilateral giant fusiform aneurysms of the petrocavernous ICA treated with bilateral flow-diverting stent placement. An 18-year-old male presented to our institution with headaches, nausea, vomiting and blurry vision that had been present since the day prior. Visual exam revealed decreased visual acuity bilaterally and a temporal field cut superiorly and inferiorly of the left eye. CT and MR imaging revealed bilateral lesions of the petrous segment of the ICA bilaterally. Catheter angiography demonstrated bilateral giant fusiform aneurysm of the petrocavernous ICA. The patient was treated with aspirin 325 mg and clopidogrel 75 mg orally daily for one week prior to the exam. VerifyNow (Accriva; San Diego, CA) confirmed adequate platelet inhibition. The right ICA was treated first, with a multiple flow-diverting stent construct. No complications were noted and the patient was discharged to home two days later. He was brought back three weeks later, and the left ICA was treated with a multiple flow-diverting stent construct. Again, no complications were noted and the patient was discharged uneventfully. The patient returned for his six-month follow-up angiogram with improvement of his visual acuity and resolution of headaches. However, the patient had ceased taking both anti-platelet medications six weeks prior. Angiography revealed no filling of the aneurysm in the right ICA, however, the left ICA was occluded at the origin. The patient was resumed on daily aspirin 325 mg orally and will have follow-up catheter angiography at 12 months. Petrous segment ICA aneurysms are rare. Most are thought to arise from trauma, infection, or congenital etiologies. These aneurysms are typically fusiform in nature, and can extend into the cavernous segment of the ICA. The natural history of these aneurysms is not well understood given their rarity. Current literature advocates for asymptomatic patients to be treated conservatively given that the natural history is not well known. Treatment is recommended in symptomatic patients, who may present with symptoms of local mass effect or ischemic stroke due to emboli. Endovascular options include flow diverting stent or covered stent placement, coil embolization with or without stent-assistance, or ICA occlusion. Open surgical options include trapping and high-flow bypass. When bilateral lesions are present, the management algorithm must be amended. We elected to treat the asymptomatic side first (right ICA), due to the presence of a significant kink within the aneurysm on the left. Once the right side was treated successfully, the symptomatic side was treated with a multiple stent construct. The patient's six-month angiogram demonstrated occlusion of the left ICA, likely due to non-compliance with antiplatelet medications. This further reiterates the need for dual-antiplatelet therapy and patient education and compliance with flow diverting stents. We report a rare case of bilateral giant fusiform petrocavernous aneurysms treated with bilateral Pipeline embolization devices in multiple device construct, demonstrating the feasibility and safety of this treatment option for this pathology.
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Affiliation(s)
- Koushik Mantripragada
- Medicine, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, USA
| | - Nikolas Echeverry
- Neurosurgery, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, USA
| | - Samuel Mansour
- Medicine, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, USA
| | - Eric C Peterson
- Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - Brian Snelling
- Neurosurgery, Boca Raton Regional Hospital, Boca Raton, USA
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Cho WS, Lee SH, Kang HS, Kim JE. Management of incidentally found unruptured intracranial aneurysms. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.5.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Incidentally found unruptured intracranial aneurysms are increasing because of the popularity of medical checkups with cerebrovascular imaging and the recent growing interest in health. Accordingly, surgical or endovascular treatments are also increasing in prevalence to improve aneurysm-related symptoms or prevent the rupture of aneurysms causing devastating conditions. However, treatment plans should be carefully determined based on the natural history of aneurysms, comorbidities of the patients, and institutional situations because of the relatively low risk of rupture, no uncommon treatment-related complications, and considerable economical and psychological burdens. Recently, domestic and international clinical guidelines for unruptured intracranial aneurysms were introduced, and the guidelines have been continuously revised according to advancements in imaging and treatment techniques. Here, this review paper introduces the clinical characteristics of unruptured intracranial aneurysms including the epidemiology, risk factors of development, growth and rupture, natural course, symptoms and signs, imaging tools for diagnosis and follow-up, and treatment methods. This paper also includes recent international prospective trials, analytic reports with big data from national health insurance and health insurance review and assessment services, and the guidelines of Korea and other foreign countries.
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18
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Delpirou Nouh C, Samkutty DG, Chandrashekhar S, Santucci JA, Ford L, Xu C, Hollabaugh KM, Bohnstedt BN, Ray B. Management of Aneurysmal Subarachnoid Hemorrhage: Variation in Clinical Practice and Unmet Need for Follow-up among Survivors-A Single-Center Perspective. World Neurosurg 2020; 139:e608-e617. [PMID: 32339727 DOI: 10.1016/j.wneu.2020.04.067] [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: 03/11/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the present study is to investigate the existence and/or prevalence of clinical practice variation in management of aneurysmal subarachnoid hemorrhage (aSAH) and to determine the need for long-term follow-up. METHODS A single-center study was carried out of patients with aSAH over a 5-year period divided into 2 halves (2.5 years each) before and after addition of a dually trained cerebrovascular neurosurgeon. In-hospital clinical practice, clinical outcome (mortality and discharge destination) and long-term outcome (modified Rankin Scale score and Telephone Interview for Cognitive Status [TICS]) were compared using descriptive summaries and nonparametric tests. RESULTS Among 251 patients admitted with aSAH, 115 (45.8%) were before the index event, whereas 136 (54.2%) were during the later period. The aneurysm-securing procedure changed from coil embolization to clip ligation (12/115 [10.4%] vs. 84/136 [61.8%]; P < 0.0001) during the latter years. Interventional treatment for cerebral vasospasm has decreased (58/115 [50.4%] vs. 49/136 [36.0%]; P = 0.0002). Patients surviving hospitalization had more clinic follow-up after discharge during the latter period (42/85 [49.4%] vs. 76/105 [72.4%]; P = 0.0012) and ventriculoperitoneal shunt placement for delayed hydrocephalus (1/85 [1.2%] vs. 9/105 [8.6%]; P = 0.02). A subcohort of aSAH survivors (n = 46) had lower median TICS score during the earlier study period (31.5 [interquartile range, 22-36] vs. 33 [interquartile range, 27-38]; P = 0.038). Similarly, preictal smoking status and hyperlipidemia were associated with adverse TICS score in a multivariate model (P = 0.007). CONCLUSIONS Postdischarge clinical follow-up has improved facilitating recognition and treatment of delayed hydrocephalus. Existence of cognitive deficits among survivors calls for establishment of multidisciplinary clinics for long-term management of aSAH.
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Affiliation(s)
- Claire Delpirou Nouh
- Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Danny G Samkutty
- Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Swathy Chandrashekhar
- Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joshua A Santucci
- Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lance Ford
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kimberly M Hollabaugh
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bradley N Bohnstedt
- Department of Neurosurgery, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Bappaditya Ray
- Department of Neurology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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19
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Kim JJ, Cho KC, Jung WS, Suh SH. Endovascular Treatment for Intracranial Aneurysms: A Nationwide Survey in Korea. Neurointervention 2020; 15:18-24. [PMID: 31955548 PMCID: PMC7105091 DOI: 10.5469/neuroint.2019.00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose In Korea, endovascular treatment (EVT) for intracranial aneurysms (IAs) has increased steadily. We conducted a nationwide survey to evaluate the current status of EVT for IAs and to identify treatment preference in the real world. Materials and Methods A Google online survey was distributed to representative clinicians at hospitals treating IAs, where members of Korean Society of Interventional Neuroradiology (KSIN). The data was collected from October 2017 to December 2017. The responding hospitals were divided into 2 groups (tertiary and non-tertiary hospitals). And variable factors involved in decision making for treatment were evaluated. Results In total, 73 hospitals (tertiary: 37, non-tertiary: 36) responded to the survey. Most hospitals that responded had over 100 cases of diagnostic angiography (93%) and over 50 cases of EVT for IAs (74%) performed in 2016. The proportion of EVT for ruptured aneurysms in non-tertiary hospitals was significantly higher than tertiary hospitals (49% vs. 9%). The proportion of EVT for unruptured aneurysms at non-tertiary hospitals was significantly higher than tertiary hospitals (66% vs. 44%). Most physicians tended to make decision for treatment on location, shape, and size of unruptured IAs and patients’ age, more than the results from previous clinical trials for unruptured IAs. Although EVT was preferred for older patients (age >70) with unruptured IAs (99%), surgical clipping was still considered as the first treatment of choice for younger patients (age 30 to 50 years) at considerable rates (56%). Over two-thirds of respondents preferred surgical clipping for middle cerebral artery aneurysms, while EVT was preferred initially at other locations. Conclusion This nationwide survey showed that EVT is considered as the first treatment modality for IAs and there is a discrepancy between current guidelines and real-world practice for decision making of treatment options.
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Affiliation(s)
- Jung-Jae Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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Song TJ, Oh SH, Kim J. The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms. J Neurosurg 2019; 133:182-189. [PMID: 31125972 DOI: 10.3171/2019.3.jns183500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/08/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes. METHODS This was a retrospective cohort study using the National Health Insurance Service-National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed. RESULTS A total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14-0.85). CONCLUSIONS Consistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.
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Affiliation(s)
- Tae-Jin Song
- 1Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul
| | - Seung-Hun Oh
- 2Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam; and
| | - Jinkwon Kim
- 2Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam; and
- 3Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Clipping versus Coiling for Ruptured Intracranial Aneurysms: A Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2019; 127:e353-e365. [PMID: 30928577 DOI: 10.1016/j.wneu.2019.03.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The treatment strategies of ruptured intracranial aneurysms (RIAs) include surgical clipping and endovascular coiling, and the efficacy and safety of clipping versus coiling are yet controversial. OBJECTIVE To summarize the available randomized controlled trials to determine the optimal treatment method for patients with RIA. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials published up to September 5, 2017. The summary analysis was performed using a random-effects model. The primary outcomes included poor outcome, mortality, and rebleeding, whereas the secondary outcomes included complete occlusion, incomplete occlusion, severe disability, and vegetative state. RESULTS We identified 5 trials with data collected from 2883 patients. The summary results indicated that surgical clipping in patients was associated with a high incidence of poor outcome (relative risk [RR], 1.34; 95% confidence interval [CI], 1.18-1.51; P < 0.001), whereas no significant effect was observed on mortality (RR, 1.09; 95% CI, 0.79-1.49; P = 0.608) and rebleeding (RR, 0.65; 95% CI, 0.20-2.06; P = 0.460) compared with endovascular coiling. Furthermore, we noted that surgical clipping significantly increased the incidence of complete occlusion compared with endovascular coiling (RR, 1.30; 95% CI, 1.09 1.55; P = 0.004). Conversely, surgical clipping was associated with a low incidence of incomplete occlusion (RR, 0.67; 95% CI, 0.45-0.99; P = 0.044). No significant differences were noted between surgical clipping and endovascular coiling with respect to the outcomes of severe disability (RR, 1.39; 95% CI, 0.90-2.16; P = 0.140) and vegetative state (RR, 1.35; 95% CI, 0.84-2.17; P = 0.213). CONCLUSIONS This meta-analysis provides moderate evidence that surgical clipping has few benefits than endovascular coiling for the treatment of RIA.
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Hadi M, Maxwell AW, Hirsch JA, Gonzalez RG, Maza N, Romero JM. Clinico-radiologic factors in paraclinoid aneurysms associated with aneurysm rupture: A CTA study. Clin Imaging 2019; 53:225-229. [DOI: 10.1016/j.clinimag.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/03/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022]
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Abstract
Over the past 2 decades, a large number of guidelines for aneurysmal subarachnoid hemorrhage (aSAH) management have been proposed. The primary aim of these "evidence-based" guidelines is to improve the care of aSAH patients by summarizing and making current knowledge readily available to clinicians. However, an investigation into aSAH guidelines, their changes along time and their successful translation into clinical practice is still lacking.We performed a literature search of historical events and subarachnoid hemorrhage guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to November of 2016. Data were summarized for guidelines on aSAH management and cross-sectional studies of their application. A total of 11 guidelines and 10 cross-sectional studies on aSAH management were analyzed. The use of nimodipine for the treatment of SAH is the only recommendation that remained consistent across guidelines over time (r=0.82; P<0.05). A shift in the definitive treatment for aneurysms from open surgical clipping to endovascular coiling was also noted (r=-0.91; r=0.96; P<0.005). In addition, definitive treatment for aneurysm is being performed earlier. The use of triple-H therapy and the long-term administration of anticonvulsive therapy has decreased. Finally, written protocols for aSAH management were not consistently used across tertiary care institutions (r=-0.46; P=0.43; confidence interval, -0.95 to -0.70).We conclude that guidelines related to the management of patients with SAH have evolved from a consensus-based approach into an evidence-based approach. Nevertheless, the translation into clinical practice is limited, suggesting that personalized approaches to care is inherent, and perhaps necessary for aSAH management.
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Zou L, Hou Y, Yu B, Li S, Du Y. The effect of intravascular interventional embolization and craniotomy on MMP-2, MMP-9 and caspase3 in serum of intracranial aneurysm patients. Exp Ther Med 2018; 16:4511-4518. [PMID: 30542399 PMCID: PMC6257825 DOI: 10.3892/etm.2018.6740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/05/2018] [Indexed: 01/28/2023] Open
Abstract
The effect of intravascular interventional embolization and surgical operation on matrix metalloprotein (MMP)-2, MMP-9 and caspase3 in serum of intracranial aneurysms was analyzed to study the mechanisms. Seventy-nine patients of intracranial aneurysms from September 2011 to August 2014 were divided into the intervention group (n=41) and the craniotomy group (n=38) based on treatment methods, and 40 cases of normal volunteers with normal physical examination were selected as the control group. Patients in the intervention group were treated with intravascular interventional embolization, and the surgical group was treated with craniotomy and no treatment was performed in the control group. The survival rate and adverse reaction rate were calculated. ELISA kit was used to detect the level of reactive oxygen species (ROS), interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and IL-10 in serum; the mRNA and protein expression levels of MMP-2, MMP-9 and caspase3 in serum were detected by qPCR and western blotting; the protein expression levels of p-adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK), Bcl-2 and Bax were also detected. The survival rate of patients in the intervention group was significantly higher than that in the craniotomy group (P<0.05). The ROS level in the intervention and craniotomy groups was significantly higher than that in the control group (P<0.01), while the levels of IL-6 and TNF-α in the serum of the intervention group were lower than those in the craniotomy group (P<0.01). The mRNA and protein expression of MMP-2, MMP-9 and caspase3 of the intervention group was significantly lower than that of the craniotomy group (P<0.01). The protein expression of p-AMPK and Bcl-2/Bax in the intervention group were lower than that in the craniotomy group (P<0.01). Intravascular interventional surgery can significantly increase the patient's survival time, and effectively reduce the expression of MMP-2, MMP-9 and caspase3 in the serum of intracranial aneurysm patients. The mechanism may be through the impact of ROS levels, thereby affecting the p-AMPK and Bcl2/Bax expression.
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Affiliation(s)
- Liang Zou
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China.,Department of Neurosurgery, The Second Clinical Medical School of Inner Mongolia University for Nationalities, Hulunbuir, Inner Mongolia 022150, P.R. China
| | - Yanyan Hou
- Department of Hematology and Oncology, The Second Clinical Medical School of Inner Mongolia University for Nationalities, Hulunbuir, Inner Mongolia 022150, P.R. China
| | - Baixiang Yu
- Department of Neurosurgery, The Second Clinical Medical School of Inner Mongolia University for Nationalities, Hulunbuir, Inner Mongolia 022150, P.R. China
| | - Shuang Li
- Department of Neurosurgery, The Second Clinical Medical School of Inner Mongolia University for Nationalities, Hulunbuir, Inner Mongolia 022150, P.R. China
| | - Yanli Du
- Department of Neurosurgery, Hulunbeier People's Hospital, Hulunbuir, Inner Mongolia 021000, P.R. China
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Jia ZY, Jiang YY, Woo JM, Hwang SM, Lim OK, Kim TI, Park JC, Lee HS, Kim ES, Lee DH. In Vitro Evaluation of Fusiform-Shaped Stents for Wide-Neck Intracranial Aneurysm Treatment. Neurointervention 2018; 13:117-123. [PMID: 30196682 PMCID: PMC6132037 DOI: 10.5469/neuroint.2018.00976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Wide-neck aneurysms (WNAs) associated with a dilated parent artery (PA) are not uncommon morphological abnormalities and usually cause inappropriate wall apposition and incomplete neck coverage of a tubular stent in stent-assisted coiling of aneurysms. We aimed to introduce a fusiform-shaped stent (FSS) and test its effectiveness in treating intracranial WNAs associated with a dilated PA using a three-dimensional (3D) model. MATERIALS AND METHODS Two FSS types were designed with the middle one-third segment dilated by 10% (FSS10) and 20% (FSS20) and were compared with the tubular-shaped stent (TSS). A patient-specific 3D WNA model was prototyped and produced, and in vitro stent placement was performed. Angiographic images of the three stent types were analyzed and compared using predetermined parameters. RESULTS The stent lumens were significantly larger in FSS10 and FSS20 than in TSS in the middle segments (P=0.046), particularly FSS20 (P=0.018). The non-covered area at the ostium tended to be smaller in FSS10 and FSS20 than in TSS, but the difference was not significant (P>0.05). The stent length was significantly longer in FSS10 and FSS20 than in TSS. The stent cell size was significantly larger in FSS than in TSS. CONCLUSION Better vessel wall apposition and aneurysmal neck coverage was observed for FSS than for TSS. No significant difference was observed between FSS10 and FSS20.
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Affiliation(s)
- Zhen Yu Jia
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Yuan Jiang
- Department of Medical Biotechnology, Dongguk University, Goyang, Korea
| | - Jung Min Woo
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon Moon Hwang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ok Kyun Lim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Deok Hee Lee
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jung KH. New Pathophysiological Considerations on Cerebral Aneurysms. Neurointervention 2018; 13:73-83. [PMID: 30196677 PMCID: PMC6132027 DOI: 10.5469/neuroint.2018.01011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 12/12/2022] Open
Abstract
Cerebral aneurysm is a common cerebrovascular disease that is sometimes complicated by rupture or an enlarged mass. We are now aggressively evaluating and managing unruptured cerebral aneurysms based on a significant concern for the high morbidity and mortality related to its associated complications. However, the actual rupture rate is very low and the diagnostic and treatment modalities are expensive and invasive, which may lead to unnecessary costs and potential medical complications. This disproportionate situation is related to a poor understanding of the natural course and pathophysiology of cerebral aneurysms. In consideration of the concept that not all cerebral aneurysms must be removed, we need to examine their course and progression more accurately. Cerebral aneurysms may follow a variety of pathophysiological scenarios over their lifetime, from formation to growth and rupture. The disease course and the final outcome can differ depending on the timing and intensity of the pathological signals acting on the cerebral vessel wall. We should delineate a method of predicting the stability and risk of rupture of the lesion based on a comprehensive knowledge of the vessel wall integrity. This review deals with the basic knowledge and advanced concepts underlying the pathophysiology of cerebral aneurysms.
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Affiliation(s)
- Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Cho SH, Lee JY, Ryu KH, Suh DC. Diagnosis of Cerebral Aneurysm Via Magnetic Resonance Angiography Screening: Emphasis on Legal Responsibility Increases False Positive Rate. Neurointervention 2018. [PMID: 29535898 PMCID: PMC5847890 DOI: 10.5469/neuroint.2018.13.1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose False positive diagnoses of cerebral aneurysm via magnetic resonance angiography (MRA) screening may increase unnecessary cerebral catheter angiography. The purpose of this study was to investigate the effects of medical liability on medical decision-making during radiologic interpretation. Materials and Methods We included 56 consecutive patients who were referred with suspected aneurysm based on MRA or computed tomography angiography (CTA) and showed no aneurysm on subsequent digital subtraction angiography (DSA). MRA and CTA were reviewed twice by two neuroradiology fellows who were blind as to whether the suspected lesions were true aneurysms or not. The second review was repeated after proposing that their decision was subject to legal liability and they would be responsible for medico-legal problems related to their diagnoses. Diagnostic differences based on each review were analyzed, focusing on changes in false positive diagnosis rates. Results A total of 63 suspected aneurysmal lesions detected via MRA or CTA were found to be negative based on DSA. At first review, 32 lesions were diagnosed as true aneurysms by observer 1 and 27 by observer 2, corresponding to false positive rates of 51% and 43% respectively. At the second review, 39 lesions (62%) were diagnosed by observer 1, and 30 (48%) by observer 2. Thus, there was an overall increase in false positive aneurysm diagnosis of 11% for observer 1 and 5% for observer 2, after emphasizing their responsibilities in the context of medical litigation. Conclusion Concerns about medical liability could result in increased false positive diagnoses of cerebral aneurysms via MRA screening. Whether repeated follow-up of the suspected lesion or catheter angiographic confirmation is better with regard to long-term patient outcomes requires further study.
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Affiliation(s)
- Su-Hee Cho
- Department of Neurosurgery, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea
| | - Kyeong-Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Li Q, Yang Y, Pan Y, Duan L, Yang H. The quality assessment of clinical practice guidelines for intracranial aneurysms: a systematic appraisal. Neurosurg Rev 2017; 41:629-639. [PMID: 28905137 DOI: 10.1007/s10143-017-0905-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/17/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
Intracranial aneurysms are common in adults. The relevant guidelines for patients with intracranial aneurysms aim to standardize the clinical practice and decision making for these patients. However, their management is controversial, and the quality of the guidelines has not been assessed. We aim to evaluate the quality of the guidelines for intracranial aneurysms as well as to compare and analyze the recommendations between different guidelines. Systematic searches were conducted to identify the guidelines for intracranial aneurysms from general electronic and guideline databases. Two independent reviewers identified the guidelines and extracted the data, and four reviewers independently evaluated the eligible guidelines through the AGREE II tool. Agreement among reviewers was measured using the intraclass correlation coefficient. A total of 12 guidelines, which were published from 1997 to 2016, were included. The agreement among reviewers was high (intraclass correlation coefficient, 0.85 (95% CI: 0.8-0.89)). The mean scores of six domains ranged from 16.5 to 57.5% (scope and purpose 57.5% (39-68%); stakeholder 30.8% (19-46%); rigor 31.9% (19-52%); clarity 57.2% (42-79%); applicability 24.9% (16-42%); and editorial independence: 16.5% (0-58%)). Furthermore, 202 recommendations related to intracranial aneurysms were collected from the included guidelines. Of these, 143 reported the quality of evidence and/or strength, and 119 reported both the quality of evidence and the strength. Of the 119 recommendations, there were six class A and 20 class B recommendations based on level III evidence. There were 12 recommendations in which the contents were similar between different guidelines and two recommendations with the opposite contents. The AGREE II scores of the guidelines for intracranial aneurysms were relatively low. The majority of recommendations were rated as classes A and B and based on levels II and III evidence. Approximately a fifth of strong recommendations was based on a low quality of evidence without interpretation or explanation.
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Affiliation(s)
- Qiao Li
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China
| | - Yingchun Yang
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China
| | - Yawen Pan
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China.
| | - Lei Duan
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China
| | - Hu Yang
- Department of Neurosurgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen Road, Chengguan District, Lanzhou, 730030, China
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Choi JH, Park HS. The Incidence and Characteristics of Patients with Small Ruptured Aneurysms (<5 mm) in Subarachnoid Hemorrhage. J Korean Neurosurg Soc 2017; 60:424-432. [PMID: 28689391 PMCID: PMC5544372 DOI: 10.3340/jkns.2016.0910.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/10/2016] [Accepted: 04/19/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of patients with small ruptured aneurysms. METHODS We reviewed all patients admitted to our hospital with subarachnoid hemorrhage from January 2005 to December 2015. The patients were divided into two groups: those with aneurysms <5 mm (group S) and those with aneurysms ≥5 mm (group L). The patient's age and sex, size and location of aneurysms, and risk factors such as hypertension, diabetes, alcohol use, and smoking were compared between the two groups. RESULTS Eight-hundred eleven patients were diagnosed with ruptured aneurysms, and 337 (41.6%) were included in group S. The mean size of all aneurysms was 6.10±2.99 mm (range, 0.7-37.7); aneurysms with a diameter of 4-5 mm accounted for the largest subgroup of all aneurysms. Female sex was significantly associated with the incidence of small ruptured aneurysms (odds ratio [OR] 1.50, 95% confidence intervals [CI] 1.02-2.19, p=0.037). Despite female predominance in the incidence of small ruptured aneurysms, the proportion of small ruptured aneurysms in young (<50 years) men was high. In men, there were no significant differences regarding the location of the aneurysms between group S and group L (p=0.267), with the most frequent location being the anterior communicating artery (ACoA) in both group S (50.9%) and group L (51.4%). However, in women, there were significant differences regarding the location of the aneurysms between group S and group L (p=0.023), with the most frequent locations being the ACoA (33.0%) in group S, and the posterior communicating artery (30.6%) in group L. In women, two locations were significantly associated with small (<5 mm) ruptured aneurysms: the ACoA (OR 2.14, 95% CI 1.01-4.54, p=0.047) and anterior cerebral artery (OR 3.54, 95% CI 1.19-10.54, p=0.023). Multiplicity and smoking were significantly associated with large (≥5 mm) ruptured aneurysms in women. The use of alcohol was related to small ruptured aneurysms in men over 50 years of age (OR 2.23, 95% CI 1.03-4.84, p=0.042). CONCLUSION In this study, small (<5 mm) ruptured aneurysms exhibited different incidences by age, sex, location, and risk factors such as multiplicity, smoking, and alcohol use.
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Affiliation(s)
- Joon-Ho Choi
- Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun-Seok Park
- Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea
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Ahn JY, Kim ST, Yi KC, Lee WH, Paeng SH, Jeong YG. Superficial Temporal Artery-Sparing Mini-Pterional Approach for Cerebral Aneurysm Surgery. J Korean Neurosurg Soc 2016; 60:8-14. [PMID: 28061486 PMCID: PMC5223750 DOI: 10.3340/jkns.2016.0707.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/22/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach. METHODS Between June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications. RESULTS The mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was 20.5 mm±10.0 (standard deviation [SD]). The craniotomy size was 1051.6 mm2±206.5 (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case. CONCLUSION Our STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.
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Affiliation(s)
- Jun-Young Ahn
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Sung-Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Ki-Chang Yi
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Won-Hee Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
| | - Young-Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University, College of Medicine, Busan, Korea
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Surgically Clipping a Posterolaterally Projecting Posterior Communicating Artery Aneurysm With Anterior Petroclinoid Fold Fenestration. J Craniofac Surg 2016; 28:e47-e49. [PMID: 27893552 DOI: 10.1097/scs.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The anterior petroclinoid fold (APF) is a ligamentous structure consisting of collagen fiber and extends from the petrous apex to the anterior clinoid process. During the surgical clipping of some posterolaterally projecting posterior communicating artery aneurysms, it may pose a technical challenge due to obscuration of the aneurismal neck by the APF. Herein, the authors describe a simple and effective technique utilizing fenestration of the APF to facilitate visualization and surgical clipping of these aneurysms. To the best knowledge of us, this technique of the APF fenestration has been reported in only a few patients.
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Yue Q, Liu Y, Leng B, Xu B, Gu Y, Chen L, Zhu W, Mao Y. A Prognostic Model for Early Post-Treatment Outcome of Elderly Patients With Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2016; 95:253-261. [DOI: 10.1016/j.wneu.2016.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 11/29/2022]
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Chang HW, Shin SH, Suh SH, Kim BS, Rho MH. Cost-Effectiveness Analysis of Endovascular Coiling versus Neurosurgical Clipping for Intracranial Aneurysms in Republic of Korea. Neurointervention 2016; 11:86-91. [PMID: 27621944 PMCID: PMC5018553 DOI: 10.5469/neuroint.2016.11.2.86] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea. But it is a hospital-based study. So, the authors performed a nation-wide cost effective comparison in our country. MATERIALS AND METHODS This study was a retrospective analysis of healthcare big data open systems in Health Insurance Review & Assessment Service (HIRA). Hospital cost data of the recent 5 years (from January 2010 to December 2014) were analyzed according to patients' age and sex and the presence of subarachnoid hemorrhage. RESULTS When comparing the total hospital costs for NC of a UIA (n=13,756) and EC of a UIA (n=17,666), NC [mean±standard deviation (SD): ₩7,987,179±3,855,029] resulted in significantly lower total hospital costs than EC [₩10,201,645±5,001,626, p<0.0001], although a shorter hospital stay with EC of a UIA [8.6 ±7.4 days] vs. NC [15.0 ±8.3 days, p<0.0001]. When comparing the total hospital costs for NC of a RA (n=7,293) and EC of a RA (n=6,954), NC [₩13,914,993±6,247,914] resulted in significantly lower total hospital costs than EC [₩16,702,446±7,841,141, p<0.0001], although shorter hospital stays for EC of a RA [19.8 ±11.4] vs. NC [23.0 ±10.3, p<0.0001]. CONCLUSION The total hospital costs for the NC of both UIAs and RAs were found to be lower than those for EC in South Korea.
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Affiliation(s)
- Hyuk Won Chang
- Department of Radiology, Keimyung University, School of Medicine & Dongsan Medical Center, Daegu, Korea
| | - Shang Hun Shin
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Myung Ho Rho
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
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Abstract
Neurologists should be aware of specific urgent and emergent neuro-ophthalmic conditions, including giant cell arteritis, arterial dissection, intracranial aneurysm, pituitary apoplexy, and invasive sino-orbital fungal infection (eg, mucormycosis). Early recognition and treatment can greatly impact patient morbidity and mortality, including the preservation of vision and life. Neurologists should be cognizant of the key and differentiating clinical and radiographic features for these presentations.
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Affiliation(s)
- Stacy V Smith
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX 77030, USA
| | - Alec L Amram
- Department of Ophthalmology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Elsa M Rodarte
- Department of Neurobiology and Anatomy, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 7.420, Houston, TX 77030, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX 77030, USA; Department of Ophthalmology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA; Department of Ophthalmology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Ophthalmology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Department of Neurology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Department of Neurosurgery, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Section of Ophthalmology, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Natarajan SK, Mokin M, Sonig A, Levy EI. Neuroimaging of headaches associated with vascular disorders. Curr Pain Headache Rep 2015; 19:16. [PMID: 26017708 DOI: 10.1007/s11916-015-0489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Headaches from vascular causes need to be differentiated from primary headaches because a misdiagnosis may lead to dire consequences for the patient. Neuroimaging is critical in identifying patients with vascular headaches and identifying the nature of the pathologic disorder causing these headaches. In addition, the imaging findings guide the physician regarding the optimal treatment modality for these lesions. This review summarizes the nuances of differentiating patients with secondary headaches related to vascular disease and discusses pertinent neuroimaging studies.
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Affiliation(s)
- Sabareesh K Natarajan
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
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