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Goertz L, Hohenstatt S, Vollherbst DF, Weyland CS, Nikoubashman O, Styczen H, Gronemann C, Weiss D, Kaschner M, Pflaeging M, Siebert E, Zopfs D, Kottlors J, Pennig L, Schlamann M, Bohner G, Liebig T, Turowski B, Dorn F, Deuschl C, Wiesmann M, Möhlenbruch MA, Kabbasch C. Safety and efficacy of coated flow diverters in the treatment of ruptured intracranial aneurysms: a retrospective multicenter study. J Neurointerv Surg 2024:jnis-2024-021516. [PMID: 38569886 DOI: 10.1136/jnis-2024-021516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND This multicenter study evaluated the safety and efficacy of coated flow diverters (cFDs) for the treatment of ruptured intracranial aneurysms. METHODS Consecutive patients treated with different cFDs for ruptured aneurysms under tirofiban at eight neurovascular centers between 2016 and 2023 were retrospectively analyzed. The majority of patients were loaded with dual antiplatelet therapy after the treatment. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading scale. Primary outcome measures were major procedural complications and aneurysmal rebleeding during hospitalization. RESULTS The study included 60 aneurysms (posterior circulation: 28 (47%)) with a mean size of 5.8±4.7 mm. Aneurysm morphology was saccular in 28 (47%), blister-like in 12 (20%), dissecting in 13 (22%), and fusiform in 7 (12%). Technical success was 100% with a mean of 1.1 cFDs implanted per aneurysm. Adjunctive coiling was performed in 11 (18%) aneurysms. Immediate contrast retention was observed in 45 (75%) aneurysms. There was 1 (2%) major procedural complication (a major stroke, eventually leading to death) and no aneurysmal rebleeding. A good outcome (modified Rankin Scale 0-2) was achieved in 40 (67%) patients. At a mean follow-up of 6 months, 27/34 (79%) aneurysms were completely occluded (OKM D), 3/34 (9%) had an entry remnant (OKM C), and 4/34 (12%) had residual filling (OKM A or B). There was 1 (3%) severe in-stent stenosis during follow-up that was treated with balloon angioplasty. CONCLUSIONS Treatment of ruptured aneurysms with cFDs was reasonably safe and efficient and thus represents a valid treatment option, especially for complex cases.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Sophia Hohenstatt
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Daniel Weiss
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marius Kaschner
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Muriel Pflaeging
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - David Zopfs
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jonathan Kottlors
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Georg Bohner
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Goertz L, Pflaeging M, Gronemann C, Zopfs D, Kottlors J, Schlamann M, Dorn F, Liebig T, Kabbasch C. Aneurysm Treatment With the Pipeline Vantage Embolization Device in Retrospective Evaluation: Periprocedural Results from the Pipe-VADER Study. World Neurosurg 2024; 183:e210-e217. [PMID: 38101543 DOI: 10.1016/j.wneu.2023.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The Pipeline Vantage Embolization Device is a fourth-generation flow diverter with an antithrombotic coating and a reduced profile compared to previous Pipeline versions. The objective of this study was to evaluate the procedural feasibility, safety, and efficacy of this device. METHODS The Pipe-VADER study was designed as a retrospective, observational study of consecutive patients treated with the Vantage at 3 neurovascular centers. Patient and aneurysm characteristics, procedural parameters, early complications, and extent of postinterventional contrast retention were analyzed on an intention-to-treat basis. RESULTS Twenty-eight patients with 31 aneurysms (median size: 5.0 mm, posterior circulation: 4 [12.9%], ruptured: 5 [16.1%]) were included. The technical success rate was 100%, with multiple stents used in 4/30 (13.3%) procedures. Of the 30 procedures, adjunctive coiling was performed in 3 (10.0%) and balloon angioplasty in 2 (6.7%). Median procedure time was 62 minutes. Procedural ischemic stroke occured in 4 (13.3%) cases, whereof 2 were major strokes (6.6%). There were no hemorrhagic complications. Initial contrast retention was observed in 29/31 (93.5%) aneurysms. All 27 overstented side vessels were patent at the end of the procedure. Short-term follow-up (median: 5 months) showed complete and favorable occlusion rates of 70% (14/20) and 80% (16/20), respectively. CONCLUSIONS The new Pipeline Vantage appears to be safe and feasible for the treatment of intracranial aneurysms and warrants further evaluation.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
| | - Muriel Pflaeging
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | | | - David Zopfs
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jonathan Kottlors
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Goertz L, Liebig T, Siebert E, Pflaeging M, Forbrig R, Pennig L, Celik E, Abdullayev N, Schlamann M, Dorn F, Kabbasch C. Stent-assisted WEB embolization: aneurysm characteristics, outcome and case report of a WEB delivered through a stent. Acta Neurochir (Wien) 2022; 164:2181-2190. [PMID: 35037115 PMCID: PMC9337996 DOI: 10.1007/s00701-022-05115-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/31/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Woven Endobridge (WEB) embolization has become a well-established endovascular treatment option for wide-necked bifurcation aneurysms. The objective was to analyse cases that required additional stent-implantation. METHODS Images of 178 aneurysms ≤ 11 mm treated by WEB only or by WEB plus stent were retrospectively reviewed, evaluating aneurysm characteristics, procedural specifics, adverse events and angiographic results. Moreover, we report a case of a WEB delivered through a previously implanted stent. RESULTS Additional stent implantation was performed in 15 patients (8.4%). Baseline patient and aneurysm characteristics were comparable between both groups. A single stent was used in 12 cases and 2 stents in Y-configuration in 3. Thromboembolic complications occurred more often with stent assistance (33.3% vs. 8.0%, p = 0.002), while ischemic stroke rates were comparable between both groups (0% vs. 1.8%, p = 1.0). Six-month angiographic follow-up showed complete occlusion, neck remnants and aneurysm remnants in 73.4%, 19.4% and 7.3% after WEB only, respectively, and in 66.7%, 20.0% and 16.7% after WEB plus stent, respectively (p = 0.538). A case report shows that WEB deployment through the struts of a previously implanted standard microstent is feasible, even if a VIA 33 microcatheter is needed. CONCLUSION In the present study, stent-assisted WEB embolization had a comparable safety and efficacy profile compared to treatment by WEB only. However, stent-assisted WEB embolization requires long-term anti-platelet medication, which annihilates the advantages of the WEB as a purely intrasaccular device. CLINICAL TRIAL REGISTRATION NUMBER N/A.
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Pflaeging M, Goertz L, Smyk MA, Turowski B, Mpotsaris A, Pennig L, Borggrefe J, Krischek B, Kabbasch C. Treatment of recurrent and residual aneurysms with the low-profile Acandis Acclino stent: Multi-center review of 19 patients. J Clin Neurosci 2021; 90:199-205. [PMID: 34275549 DOI: 10.1016/j.jocn.2021.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the low-profile Acandis Acclino microstent for embolization of recurrent and residual intracranial aneurysms. METHODS Consecutive patients treated with the Acclino for aneurysm remnants at three German neurovascular centers were enrolled. The technical success, complications, angiographic and clinical outcome were investigated. RESULTS Nineteen patients (median age: 53 years) with 19 aneurysm remnants (median size: 5 mm, anterior circulation: 14) were included. Initial aneurysm treatment consisted of stand-alone coiling in 14 cases, stent-assisted coiling in 4 and clipping in 1. Acclino stent-assisted coil embolization was performed technically successfully in all patients. Morbidity occurred in one patient (5.3%) due to aneurysm perforation. At the angiographic follow-up with a median follow-up duration of 21 months (range: 5-37 months), complete occlusion was obtained in 76.9%. The retreatment rate was 7.7%. CONCLUSIONS Retreatment of aneurysm remnants with the Acclino microstent was associated with high aneurysm occlusion rates and acceptable morbidity. Further studies will be necessary to draw a definite conclusion.
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Affiliation(s)
- Muriel Pflaeging
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Lukas Goertz
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Michael Artur Smyk
- Department of Neuroradiology, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
| | - Anastasios Mpotsaris
- Department of Neuroradiology, University Hospital of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Lenhard Pennig
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Boris Krischek
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg.
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
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Goertz L, Liebig T, Siebert E, Pflaeging M, Forbrig R, Pennig L, Schlamann M, Dorn F, Kabbasch C. Intrasaccular Flow Disruption with the Woven EndoBridge for Narrow-Necked Aneurysms: A Safety and Feasibility Study. World Neurosurg 2021; 151:e278-e285. [PMID: 33866026 DOI: 10.1016/j.wneu.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The Woven EndoBridge (WEB) received U.S. Food and Drug Administration approval for endovascular treatment of wide-necked bifurcation aneurysms. We evaluated the feasibility, safety, and efficacy of the WEB for treatment of narrow-necked aneurysms. METHODS This multicenter study included 17 narrow-necked aneurysms, defined by a neck width <4 mm and a dome-to-neck ratio >2. Aneurysm characteristics, treatment strategies, technical success, complications, and angiographic outcomes were retrospectively assessed. RESULTS Aneurysm locations included the internal carotid artery (7 cases), anterior communicating artery (4 cases), middle cerebral artery (4 cases), and basilar artery (2 cases). The median aneurysm size was 7.4 mm with a median neck width of 2.3 mm. The technical success rate was 100%. There were no neurological complications. Angiographic control revealed complete and adequate occlusion in 13 of 15 (86.7%) and 14 of 15 (93.3%) cases, respectively, after 6 months and in 6 of 7 (85.6%) and 7 of 7 (100%) cases, respectively, after a median of 13 months. Two aneurysms were retreated with flow diverters. CONCLUSIONS WEB embolization of narrow-necked aneurysms was technically feasible and safe and might be considered as an alternative treatment option to conventional coiling in selected cases.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, Charité University Hospital Berlin, Berlin, Germany
| | - Muriel Pflaeging
- Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Robert Forbrig
- Department of Neuroradiology, Charité University Hospital Berlin, Berlin, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Munich, Ludwig Maximilian University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Goertz L, Kabbasch C, Pflaeging M, Pennig L, Laukamp KR, Timmer M, Styczen H, Brinker G, Goldbrunner R, Krischek B. Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms. Acta Neurochir (Wien) 2021; 163:783-791. [PMID: 33403431 PMCID: PMC7886827 DOI: 10.1007/s00701-020-04689-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND The "weekend effect" describes the assumption that weekend and/or on-call duty admission of emergency patients is associated with increased morbidity and mortality rates. For aneurysmal subarachnoid hemorrhage, we investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome. METHODS This is a retrospective review of consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at our institution between 2010 and 2019. Patients admitted during (1) regular working hours (Monday-Friday, 08:00-17:59) and (2) on-call duty and microsurgical clipping performed during (a) daytime (Monday-Sunday, 08:00-17:59) and (b) nighttime were compared regarding the following outcome parameters: operation time, treatment-related complications, vasospasm, functional outcome, and angiographic results. RESULTS Among 157 enrolled patients, 104 patients (66.2%) were admitted during on-call duty and 48 operations (30.6%) were performed at nighttime. Admission out of regular hours did not affect cerebral infarction (p = 0.545), mortality (p = 0.343), functional outcome (p = 0.178), and aneurysm occlusion (p = 0.689). Microsurgical clipping at nighttime carried higher odds of unfavorable outcome at discharge (OR: 2.3, 95%CI: 1.0-5.1, p = 0.039); however, there were no significant differences regarding the remaining outcome parameters. After multivariable adjustment, clipping at nighttime did not remain as independent prognosticator of short-term outcome (OR: 2.1, 95%CI: 0.7-6.2, p = 0.169). CONCLUSIONS Admission out of regular working hours and clipping at nighttime were not independently associated with poor outcome. The adherence to standardized treatment protocols might mitigate the "weekend effect."
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Affiliation(s)
- Lukas Goertz
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Christoph Kabbasch
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Muriel Pflaeging
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Lenhard Pennig
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Marco Timmer
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Department of Neurosurgery , Hôpitaux Robert Schuman , 9 Rue Edward Steichen, 2540, Luxembourg, Luxembourg
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Pflaeging M, Kabbasch C, Schlamann M, Pennig L, Juenger ST, Grunz JP, Timmer M, Brinker G, Goldbrunner R, Krischek B, Goertz L. Microsurgical Clipping versus Advanced Endovascular Treatment of Unruptured Middle Cerebral Artery Bifurcation Aneurysms After a "Coil-First" Policy. World Neurosurg 2021; 149:e336-e344. [PMID: 33607288 DOI: 10.1016/j.wneu.2021.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of unruptured MCA bifurcation aneurysms treated at a neurovascular center following a "coil-first" policy. METHODS This single-center study included 148 patients treated for 160 unruptured MCA bifurcation aneurysms. Technical success, complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS Microsurgical clipping was performed for 120 MCA aneurysms (75%) and endovascular treatment for 40 (25%; conventional coiling: 8, stent-assisted coiling: 16, balloon-assisted coiling: 3, and flow-disruption: 13). Technical treatment success was higher in the clipping group (100%) than in the endovascular group (92.5%, P = 0.015). Overall, complications occurred in 16.7% for clipping and in 20.0% for endovascular treatment (P = 0.631). Major ischemic stroke rates were 4.2% in the clipping group and 7.5% in the endovascular group (P = 0.414). At 6 months, a favorable outcome was obtained by 99.2% after clipping and 95.0% after endovascular treatment (P = 0.154). The 6-month complete aneurysm occlusion rates were by trend higher in the clipping group (89.2%) than in the endovascular group (75.9%, P = 0.078). CONCLUSIONS Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.
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Affiliation(s)
- Muriel Pflaeging
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Theresa Juenger
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Institute for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marco Timmer
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Lukas Goertz
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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Goertz L, Pflaeging M, Hamisch C, Kabbasch C, Pennig L, von Spreckelsen N, Laukamp K, Timmer M, Goldbrunner R, Brinker G, Krischek B. Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome. J Neurosurg 2020; 134:1182-1189. [PMID: 32302985 DOI: 10.3171/2020.2.jns20148] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Timely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome. METHODS In this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics. RESULTS Among 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03). CONCLUSIONS DHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.
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Affiliation(s)
- Lukas Goertz
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Muriel Pflaeging
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Christina Hamisch
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Christoph Kabbasch
- 2Institute for Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, University of Cologne, Germany
| | - Lenhard Pennig
- 2Institute for Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, University of Cologne, Germany
| | - Niklas von Spreckelsen
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and.,3Department of Neurosurgery, Harvey Cushing Neuro-Oncology Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Kai Laukamp
- 2Institute for Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, University of Cologne, Germany.,4Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marco Timmer
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Roland Goldbrunner
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Gerrit Brinker
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
| | - Boris Krischek
- 1University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, and
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Goertz L, Pflaeging M, Hamisch C, Kabbasch C, von Spreckelsen N, Laukamp K, Pennig L, Wetzel C, Brinker G, Goldbrunner R, Krischek B. Identifying Predictors for Aneurysm Remnants After Clipping by Morphometric Analysis and Proposal of a Novel Risk Score. World Neurosurg 2019; 136:e300-e309. [PMID: 31901493 DOI: 10.1016/j.wneu.2019.12.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Although the risk of aneurysm remnants after microsurgical clipping is generally low, complete aneurysm occlusion is not always guaranteed. We performed a morphometric analysis of intracranial aneurysms to identify predictors for aneurysm remnants and to propose a novel risk score. METHODS This is a retrospective, single-center analysis of consecutive patients with ruptured and unruptured aneurysms who underwent microsurgical clipping and postoperative digital subtraction angiography between 2010 and 2018. Based on preoperative rotational angiography, distinct morphologic aneurysm characteristics were determined and correlated with postoperative angiographic results. Factors predictive in the univariate and multivariate analyses were determined to establish a risk score for postoperative remnants after aneurysm clipping. RESULTS Among 140 patients with 166 clipped aneurysms, aneurysm remnants were present in 19.9%. In the multivariate analysis, ruptured aneurysm status (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.7-36; P < 0.01) and increased aspect ratio (OR, 1.9; 95% CI, 1.0-4.0; P = 0.07) were associated with postoperative aneurysm remnants. Anterior communicating artery location (P = 0.02), internal carotid artery location (P = 0.06), increased aneurysm inclination angle (P < 0.01), and irregular aneurysm shape (P = 0.07) were further predictors for aneurysm remnants in the univariate analysis. These factors were weighted and included into a risk sum score for postoperative aneurysm remnants (range, 0-8 points), which performed with good accuracy (area under the curve = 0.807). CONCLUSIONS After external validation of the proposed risk score, it could help identify cases requiring angiographic control after aneurysm surgery.
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Affiliation(s)
- Lukas Goertz
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany.
| | - Muriel Pflaeging
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Christina Hamisch
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Christoph Kabbasch
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Niklas von Spreckelsen
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany; Harvey Cushing Neuro-Oncology Laboratories, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai Laukamp
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany; Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Department of Radiology, Case Western Reserve University Cleveland, Ohio, USA
| | - Lenhard Pennig
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Christian Wetzel
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Gerrit Brinker
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Roland Goldbrunner
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
| | - Boris Krischek
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Cologne, Germany
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Goertz L, Hamisch C, Pflaeging M, Kabbasch C, Borggrefe J, Timmer M, Stravrinou P, Goldbrunner R, Brinker G, Mpotsaris A, Krischek B. Angiographic Characteristics of Lobulated Intracranial Aneurysms. World Neurosurg 2019; 131:e353-e361. [DOI: 10.1016/j.wneu.2019.07.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/31/2022]
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