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Affiliation(s)
- Zongli Han
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanli Du
- Shenzhen Polytechnic University, Shenzhen, China
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2
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Shen JD, Yuan B, Zhang A, Zhou XM, Chen SJ, Deng JL, Zhang X, Jiang HY, Yu Q, Wu Q. Fecal calprotectin is a novel biomarker to predict the clinical outcomes of patients with ruptured intracranial aneurysm. J Stroke Cerebrovasc Dis 2024; 33:107634. [PMID: 38342274 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107634] [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: 08/28/2023] [Revised: 01/25/2024] [Accepted: 02/09/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Intracranial aneurysm (IA) is a common cerebrovascular disease and the leading cause of spontaneous subarachnoid hemorrhage. Recent evidence suggests that gut microbiota is involved in the pathophysiological process of IA through the gut-brain axis. However, the role of gut inflammation in the development of IA has yet to be clarified. Our study aimed to investigate whether fecal calprotectin (FC) level, a sensitive marker of gut inflammation, is correlated with the development of IA and the prognosis of patients with ruptured IA (RIA). METHODS 182 patients were collected from January 2022 to January 2023, including 151 patients with IA and 31 healthy individuals. 151 IA patients included 109 patients with unruptured IA (UIA) and 42 patients with RIA. The FC level was measured by enzyme-linked immunosorbent assay. Other detailed information was obtained from an electronic medical record system. RESULTS Compared with healthy controls, the FC levels in patients with IA were increased (P < 0.0001). Patients with RIA had significantly higher FC levels than UIA patients (P < 0.0001). Moreover, the FC level in RIA patients with unfavorable outcomes was higher than in RIA patients with favorable outcomes. Logistic regression analysis showed that the elevated FC level was an independent risk factor for a 3-month poor prognosis in patients with RIA (OR=1.005, 95% CI = 1.000 -1.009, P = 0.044). CONCLUSION Fecal calprotectin level is significantly elevated in IA patients, especially those with RIA. FC is a novel biomarker of 3-month poor outcomes in RIA patients.
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Affiliation(s)
- Jun-Da Shen
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Bin Yuan
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - An Zhang
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Xiao-Ming Zhou
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Shu-Juan Chen
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Jin-Long Deng
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
| | - Hai-Yang Jiang
- Department of Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Yu
- Department of Clinical Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing 210002, China.
| | - Qi Wu
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, China; Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China.
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Rantamo A, Gallé C, Numminen J, Virta J, Tanskanen P, Lindroos AC, Resendiz-Nieves J, Lehecka M, Niemelä M, Haeren R, Raj R. Flow diversion of ruptured intracranial aneurysms: a single-center study with a standardized antithrombotic treatment protocol. Acta Neurochir (Wien) 2024; 166:130. [PMID: 38467916 PMCID: PMC10927838 DOI: 10.1007/s00701-024-06029-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol. METHODS We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015-2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS). RESULTS Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% post-group). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0-2 between the groups at 6 months. CONCLUSION We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.
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Affiliation(s)
- Anni Rantamo
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland.
| | - Camille Gallé
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jussi Numminen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Jyri Virta
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Päivi Tanskanen
- Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ann-Christine Lindroos
- Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Roel Haeren
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
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Wang C, Han Y, Li X. Glypican-1 may be a plasma biomarker for predicting the rupture of small intracranial aneurysms. J Proteomics 2024; 293:105060. [PMID: 38154549 DOI: 10.1016/j.jprot.2023.105060] [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: 08/28/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023]
Abstract
Currently, there are no effective methods for predicting the rupture of asymptomatic small intracranial aneurysms (IA) (<7 mm). In this study the aim was to identify early warning biomarkers in peripheral plasma for predicting IA rupture. Four experimental groups were included: ruptured intracranial aneurysm (RIA), unruptured intracranial aneurysm (UIA), traumatic subarachnoid hemorrhage control (tSAHC), and healthy control (HC) groups. Plasma proteomics of these four groups were detected using iTRAQ combined LC-MS/MS. Differentially expressed proteins (DEPs) were identified in RIA, UIA, tSAHC compared with HC. Target proteins associated with aneurysm rupture were obtained by comparing the DEPs of the RIA and UIA groups after filtering out the DEPs of the tSAHC group. The plasma concentrations of target proteins were validated using enzyme-linked immunosorbent assay (ELISA). The iTRAQ analysis showed a significant increase in plasma GPC1 concentration in the RIA group compared to the UIA group, which was further validated among the IA patients. Logistic regression analysis identified GPC1 as an independent risk factor for predicting aneurysm rupture. The ROC curve indicated that the GPC1 plasma cut-off value for predicting aneurysms rupture was 4.99 ng/ml. GPC1 may be an early warning biomarker for predicting the rupture of small intracranial aneurysms. SIGNIFICANCE: The current management approach for asymptomatic small intracranial aneurysms (<7 mm) is limited to conservative observation and surgical intervention. However, the decision-making process regarding these options poses a dilemma due to weighing their respective advantages and disadvantages. Currently, there is a lack of effective diagnostic methods to predict the rupture of small aneurysms. Therefore, our aim is to identify early warning biomarkers in peripheral plasma that can serve as quantitative detection markers for predicting intracranial aneurysm rupture. In this study, four experimental populations were established: small ruptured intracranial aneurysm (sRIA) group, small unruptured intracranial aneurysm (sUIA) group, traumatic subarachnoid hemorrhage control (tSAHC) group, and healthy control (HC) group. The tSAH group was the control group of spontaneous subarachnoid hemorrhage caused by ruptured aneurysm. Compared with patients with UIA, aneurysm tissue and plasma GPC1 in patients with RIA is significantly higher, and GPC1 may be an early warning biomarker for predicting the rupture of intracranial small aneurysms.
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Affiliation(s)
- Chenchen Wang
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Yuwei Han
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Xiaoming Li
- Institute of Neurology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China.
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Racman M, Kafol J, Jug B, Stankovic M, Piljic D, Ksela J. Rapidly Growing and Ruptured Great Saphenous Vein Aneurysm in a Liver Transplant Patient. Medicina (Kaunas) 2024; 60:290. [PMID: 38399577 PMCID: PMC10890480 DOI: 10.3390/medicina60020290] [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] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Venous aneurysms are rare vascular malformations that can lead to significant clinical complications, including thrombosis, pulmonary embolism, rupture, and even fatal outcomes when not promptly and adequately managed. This case report presents a liver transplant patient under immunosuppressive therapy who developed a rapidly progressing great saphenous vein aneurysm, ultimately requiring urgent surgical intervention due to acute bleeding from the ruptured aneurysm. Immunosuppression emerges as a potential key factor in the formation and rapid growth of the aneurysm, with the pathophysiological mechanism potentially involving increased expression of specific matrix metalloproteinases. Further research is warranted to gain a better understanding of the role of immunosuppression in the development of venous aneurysms.
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Affiliation(s)
- Mark Racman
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jan Kafol
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Borut Jug
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Milenko Stankovic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Dragan Piljic
- Department of Cardiovascular Surgery, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Lim ET, Khanafer A. An open approach to a ruptured common iliac artery aneurysm with resultant ilio-iliac arteriovenous fistula. Vascular 2024; 32:25-27. [PMID: 36053668 DOI: 10.1177/17085381221124703] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Presentations of a spontaneous ilio-iliac arteriovenous fistula are considered a rare occurrence and warrant urgent intervention. They are usually a result following trauma, previous surgery or uncommonly from a ruptured aneurysm. METHOD We describe a case of a patient presenting with general malaise who examined to have a pulsatile abdominal mass with an associated bruit. He was found to have an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm that was treated successfully with open surgical repair. RESULT The patient was brought forward for open surgical repair due to haemodynamic instability as well as likely predicted difficulties with endovascular repair. Intra-operatively, his sigmoid colon was adherent to the aneurysm prompting the need for a Hartmann's procedure to allow for better visualisation of the aneurysm. A combination of external digital compression and Prolene suture was used to close the arteriovenous fistula. CONCLUSION Open surgical repair of an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm appears to be safe and feasible approach. The advancement of medical technology does open up the possibility of an endovascular approach; however, in a small subset of patients, open repair would appear to be better.
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Affiliation(s)
- Eric Ta Lim
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
| | - Adib Khanafer
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
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Takimura H, Tajima E, Taniguchi R, Tsuzuki I, Makino K, Yamaguchi Y, Kawano M, Takimura Y, Nishio S, Nakano M, Tsukahara R. Early and Late Ruptured Aneurysm After Endovascular Therapy With Paclitaxel-Coated Balloon. JACC Cardiovasc Interv 2023; 16:3041-3044. [PMID: 37804291 DOI: 10.1016/j.jcin.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
| | - Emi Tajima
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Ippei Tsuzuki
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Kenji Makino
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Mami Kawano
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Yukako Takimura
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Satoru Nishio
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | | | - Reiko Tsukahara
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
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Shin J, Hong HP, Kim YW. Ruptured Pancreaticoduodenal Artery Aneurysm in a Patient With Celiac Artery Dissection: A Case Report. Vasc Endovascular Surg 2023; 57:768-770. [PMID: 36999613 DOI: 10.1177/15385744231168713] [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] [Indexed: 04/01/2023]
Abstract
Unlike other visceral artery aneurysms, pancreaticoduodenal artery aneurysms (PDAAs) should be treated regardless of their size. There are no reports on PDAA associated with celiac artery (CA) dissection. We, here, report the case of a patient with a ruptured PDAA with concomitant CA dissection. A 44-year-old Korean man presented to the emergency room of another hospital 29 days ago due to a sudden onset of abdominal pain. Contrast-enhanced abdominal computed tomography (CT) revealed a large right retroperitoneal hematoma and CA dissection. Subsequently, aortography revealed no specific bleeding focus. He underwent conservative treatment for 16 days, including a transfusion, and then was referred to us. His abdominal CT angiography revealed a diminishing retroperitoneal hematoma, a 7 mm × 8 mm PDAA at the anterior inferior pancreaticoduodenal artery aneurysm (PDA), and CA dissection. Selective celiac angiography revealed sluggish and diminished blood flow to the true lumen of the CA, and the hepatic, gastroduodenal, and splenic arteries were supplied by collaterals arising from the superior mesenteric artery (SMA). We performed elective coil embolization of the anterior PDA using the right femoral approach.We believe that postprocedural surveillance is required after CA dissection because of the potential risk of recurrent PDAA. Additionally, we suggest that hidden PDAA rupture should be considered for spontaneous retroperitoneal bleeding.
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Affiliation(s)
- Jiyoung Shin
- Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Wook Kim
- Vascular Surgery, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Lim J, Monteiro A, Cortez GM, Benalia VH, Baig AA, Jacoby WT, Donnelly BM, Levy BR, Jaikumar V, Davies JM, Snyder KV, Siddiqui AH, Hanel RA, Levy EI, Vakharia K. Early Termination versus Standard Regimen Duration of Dual Antiplatelet Therapy in Intracranial Aneurysm Patients Treated With Pipeline Embolization Device Flex With Shield Technology: Preliminary Experience of 3 U.S. Centers. World Neurosurg 2023; 178:e465-e471. [PMID: 37506841 DOI: 10.1016/j.wneu.2023.07.101] [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: 04/10/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Pipeline Flex Embolization Device with Shield Technology (PED-Shield) is a third-generation flow diverter with reduced thromboembolic potential. However, safety profile and dual antiplatelet therapy (DAPT) recommendations with PED-Shield is not well -established. We aim to assess the safety and complication profile with early termination of DAPT with use of PED-Shield. METHODS Databases of 3 high-volume cerebrovascular centers were retrospectively reviewed. We identified patients with unruptured and ruptured intracranial aneurysms treated with PED-Shield. Patient demographics, aneurysm characteristics, complications, and angiographic outcomes were extracted. All patients who had early termination of DAPT, defined as <180 days, as well as standard duration were included. RESULTS A total of 37 patients, totaling 37 aneurysms, had early termination of DAPT and 24 patients with 24 aneurysms received standard duration (>180 days) of DAPT. There was no difference in pre-procedural DAPT regimens between the groups (P = 0.503). Following DAPT termination, o1ne major thromboembolic complication was observed in the early termination group while no major or minor thromboembolic or hemorrhagic complication was noted in the standard duration group. Time of angiographic follow-up was not statistically different (P = 0.063) between the early termination (343 days, interquartile range [IQR] 114-371 days) and the standard duration (175 days, IQR 111-224.5 days) groups. There were no statistically significant differences in complete aneurysm occlusion (P = 0.857), residual neck (P = 0.582), and aneurysm remnant (P = 0.352) rates between the groups on angiography. CONCLUSIONS Early termination of DAPT proves safe after PED-Shield treatment of intracranial aneurysms with comparable complete occlusion rates.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gustavo M Cortez
- Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Victor H Benalia
- Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Wady T Jacoby
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Bennett R Levy
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ricardo A Hanel
- Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
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Diestro JDB, Li Y, Kishore K, Omar AT, Montanera W, Sarma D, Marotta TR, Spears J, Bharatha A. A shift from open to endovascular repair in the treatment of ruptured middle cerebral artery aneurysms: a single institution experience. Neuroradiology 2023; 65:1353-1361. [PMID: 37480480 DOI: 10.1007/s00234-023-03195-w] [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: 03/02/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Middle cerebral aneurysms were underrepresented in the two largest trials (BRAT and ISAT) for the treatment of ruptured intracranial aneurysms. Recent institutional series addressing the choice between endovascular or open repair for this subset of aneurysms are few and have not yielded a definitive conclusion. We compare clinical outcomes of patients presenting with acute subarachnoid hemorrhage from ruptured middle cerebral artery aneurysms undergoing either open or endovascular repair. METHODS We conducted a retrospective review of 138 consecutive patients with ruptured middle cerebral artery aneurysms admitted into our institution from January 2008 to March 2019 to compare endovascular and open surgical outcomes. RESULTS Of the ruptured middle cerebral artery aneurysms, 57 underwent endovascular repair while 81 were treated with open surgery. Over the study period, there was a notable shift in practice toward more frequent endovascular treatment of ruptured MCA aneurysms (31% in 2008 vs. 91% in 2018). At discharge (49.1% vs 29.6%; p = .002) and at 6 months (84.3% vs 58.6%; p = 0.003), patients who underwent endovascular repair had a higher proportion of patients with good clinical outcomes (mRS 0-2) compared to those undergoing open surgery. Long-term follow-up data (endovascular 54.9 ± 37.9 months vs clipping 18.6 ± 13.4 months) showed no difference in rebleeding (1.8% vs 3.7%, p = 0.642) and retreatment (5.3% vs 3.7%, p = 0.691) in both groups. CONCLUSION Our series suggests equipoise in the treatment of ruptured middle cerebral artery aneurysms and demonstrates endovascular repair as a potentially feasible treatment strategy. Future randomized trials could clarify the roles of these treatment modalities.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Yangmei Li
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kislay Kishore
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Abdelsimar T Omar
- Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Walter Montanera
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Dipanka Sarma
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Julian Spears
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Aditya Bharatha
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Canada
- Department of Surgery, Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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11
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Pichugin A, Danilov G, Pashaev B, Shayakhmetov N, Danilov V, Alekseev А. Supraorbital eyebrow approach and pterional approach in surgical treatment of ruptured and unruptured aneurysms: a propensity score-matched analysis. Neurosurg Rev 2023; 46:179. [PMID: 37468681 DOI: 10.1007/s10143-023-02093-2] [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: 04/30/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/21/2023]
Abstract
The aim of this study is to reveal efficacy and efficiency of the supraorbital eyebrow approach (SEA) in clipping ruptured and unruptured aneurysms where both SEA and pterional approach (PA) are considered feasible by comparing SEA and PA using propensity score matching. A total of 229 patients who underwent surgical clipping of an aneurysm from 2013 to 2022 and met inclusion criteria were recruited in the study. A study group of 67 patients treated via the SEA and a comparison group of 162 patients treated via the PA were formed. Then, the subgroups of 66 patients each, with balanced incoming factors, were analyzed using the propensity score technique. The safety and efficacy endpoints were compared. Successful clipping was achieved in all cases of both groups. There were no patients in the SEA group who required conversion to the standard craniotomy. There were no procedure-related deaths in this series. No patient experienced early or late rebleeding in either group. Mean blood loss volume in the SEA group was lower than in the PA group by approximately 77.5 ml (p < 0.001). There were favorable differences in the SEA group regarding postoperative neurological deficit (p = 0.016), postoperative epileptic seizure rate (p = 0.013), ischemic and hemorrhagic complications (p = 0.028 and 0.0009, respectively), and outcomes (p < 0.001). Patients' satisfaction with cosmetic results measured by the visual analog scale was rated highly in both groups (p = 0.081). For patients where SEA provides adequate exposure, it results in safety and cosmetic outcomes not inferior to the PA.
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Affiliation(s)
- Arseniy Pichugin
- Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia.
- Department of Neurosurgery, Interregional Clinical and Diagnostic Center, Kazan, Russia.
| | - Gleb Danilov
- Scientific Secretary, Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Bakhtiyar Pashaev
- Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia
- Department of Neurosurgery, Interregional Clinical and Diagnostic Center, Kazan, Russia
| | - Nail Shayakhmetov
- Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia
| | - Valeriy Danilov
- Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia
- Department of Neurosurgery, Interregional Clinical and Diagnostic Center, Kazan, Russia
| | - Аndrey Alekseev
- Department of Neurology and Neurosurgery, Kazan State Medical University, Kazan, Russia
- Department of Neurosurgery, Interregional Clinical and Diagnostic Center, Kazan, Russia
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12
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Mizowaki T, Fujita A, Tanaka H, Takaishi Y, Kondoh T. Ruptured giant serpentine aneurysm of anterior cerebral artery long after Gamma Knife radiosurgery for cerebral arteriovenous malformation. Neurochirurgie 2023; 69:101447. [PMID: 37146509 DOI: 10.1016/j.neuchi.2023.101447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan.
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2 Chuo-ku, Kusunoki-cho, 650-0017 Hyogo, Kobe, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
| | - Yoshiyuki Takaishi
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, 654-0048 Hyogo, Kobe, Japan
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13
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Kawakatsu T, Kamio Y, Makino H, Hokamura K, Imai R, Sugimura S, Kimura T, Hiramatsu H, Umemura K, Hashimoto T, Kurozumi K. Dietary Iron Restriction Protects against Aneurysm Rupture in a Mouse Model of Intracranial Aneurysm. Cerebrovasc Dis 2023; 53:191-197. [PMID: 37290410 DOI: 10.1159/000531431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Iron accumulation in vessel walls induces oxidative stress and inflammation, which can cause cerebrovascular damage, vascular wall degeneration, and intracranial aneurysmal formation, growth, and rupture. Subarachnoid hemorrhage from intracranial aneurysm rupture results in significant morbidity and mortality. This study used a mouse model of intracranial aneurysm to evaluate the effect of dietary iron restriction on aneurysm formation and rupture. METHODS Intracranial aneurysms were induced using deoxycorticosterone acetate-salt-induced hypertension and a single injection of elastase into the cerebrospinal fluid of the basal cistern. Mice were fed an iron-restricted diet (n = 23) or a normal diet (n = 25). Aneurysm rupture was detected by neurological symptoms, while the presence of intracranial aneurysm with subarachnoid hemorrhage was confirmed by post-mortem examination. RESULTS The aneurysmal rupture rate was significantly lower in iron-restricted diet mice (37%) compared with normal diet mice (76%; p < 0.05). Serum oxidative stress, iron accumulation, macrophage infiltration, and 8-hydroxy-2'-deoxyguanosine in the vascular wall were lower in iron-restricted diet mice (p < 0.01). The areas of iron positivity were similar to the areas of CD68 positivity and 8-hydroxy-2'-deoxyguanosine in both normal diet and iron-restricted diet mouse aneurysms. CONCLUSIONS These findings suggest that iron is involved in intracranial aneurysm rupture via vascular inflammation and oxidative stress. Dietary iron restriction may have a promising role in preventing intracranial aneurysm rupture.
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Affiliation(s)
- Toru Kawakatsu
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshinobu Kamio
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Makino
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuya Hokamura
- Department of Medical Education, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Pharmacology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Imai
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Sugimura
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuro Kimura
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hisaya Hiramatsu
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuo Umemura
- Department of Pharmacology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoki Hashimoto
- Departments of Neurosurgery and Neurobiology, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kazuhiko Kurozumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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14
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Lim J, Nyabuto E, Aguirre AO, Waqas M, Vakharia K, Cappuzzo JM, Siddiqui AH. Management of saccular superior cerebellar artery aneurysms: The Buffalo experience case series and systematic review. Interv Neuroradiol 2023; 29:148-156. [PMID: 35188828 PMCID: PMC10152825 DOI: 10.1177/15910199221080234] [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: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Results of the management of superior cerebellar artery (SCA) aneurysms are typically reported in combination with those for all posterior circulation aneurysms. We report our experience with the management of SCA aneurysms and a systematic review of the endovascular management of these rare aneurysms. METHODS Patients with saccular SCA aneurysms that were not associated with arteriovenous malformations and who presented to our institute between 2000 and 2017 were identified. Patient demographics, aneurysm characteristics, interventions, and follow-up data were collected, compared, and analyzed. For the review, data including number of aneurysm treated, outcomes, follow-up, and occlusion rates were collected. RESULTS Mean age of the 31 identified patients was 57.4 ± 12.3 years; 19.4% were men. Mean aneurysm size was 5.1 ± 2.9 mm. Seven of 21 patients with unruptured aneurysms were managed conservatively. Ten patients (32.3%) presented with ruptured aneurysms (mean aneurysm size, 6.2 ± 3.2 mm). Treatment was successfully completed in 22 patients: 13-primary coiling, 7-stent-assisted coiling, and 2-microsurgical clipping. Complete angiographic aneurysm occlusion after primary treatments was achieved in 19 (86.4%) patients. The total complication rate among treated patients was 4.2% (1 of 24 treated aneurysms). No minor complications occurred. However, in 2 patients, coil embolization was attempted but aborted due to coil protrusion into the parent artery. Clinical and angiographic follow-up data were available for 26 observed or treated patients. Mean follow-up duration was 5.3 ± 4.5 years. Six articles met our review inclusion criteria and demonstrated similar mean treated aneurysm sizes ranging from 4.6-7.7 mm, and follow-up from these articles ranged from 15.3-50 months. CONCLUSIONS Endovascularly treated patients with ruptured and unruptured SCA aneurysms, of which most were <7 mm, had good clinical outcomes with minimal complications.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
| | - Elizabeth Nyabuto
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
| | - Muhammed Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Gates Vascular Institute, Buffalo General Medical Center/Kaleida Health, Buffalo, New
York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research
Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York,
USA
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15
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Zhang Y, Bai J, Kang F, Li W, Xiao Z, Ma Y, Chai E. A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population. Neurosurg Rev 2023; 46:42. [PMID: 36707467 DOI: 10.1007/s10143-023-01952-2] [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: 10/27/2022] [Revised: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
The occurrence of bleeding events after stent-assisted embolization of a ruptured artery requiring continuous double antiplatelet therapy may seriously affect the prognosis of this group of patients. A nomogram can provide a personalized, more accurate risk estimate based on predictors. We, therefore, developed a nomogram to predict the probability of bleeding events in patients with stent-assisted ruptured aneurysm embolization. We performed a single-center retrospective analysis of data collected from patients undergoing stent-assisted ruptured aneurysm embolization between January 2018 and December 2021. Forward stepwise logistic regression was performed to identify independent predictors of adverse events of bleeding after stent-assisted embolization and to establish nomograms. Discrimination and calibration of this model were performed using the area under the ROC curve (AUC-ROC) and the calibration plot. The model is internally validated by using resampling (1000 replicates). A total of 131 patients were identified, and a total of 118 patients met the study criteria. The predictors included in the nomogram were body mass index (BMI), AAi, and MA-ADP. The model showed good resolving power with a ROC area of 0.893 (95% CI: 0.834 ~ 0.952) for this model with good calibration. The nomogram can be used to individualize, visualize, and accurately predict the risk probability of bleeding events after stent-assisted embolization of ruptured aneurysms.
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Affiliation(s)
- Yichuan Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Jinbo Bai
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Fu Kang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Wei Li
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
| | - Zaixing Xiao
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
| | - Yong Ma
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Erqing Chai
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China.
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, Gansu, 730000, China.
- Emergency General Hospital, Beijing, China.
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16
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Poppenberg KE, Chien A, Santo BA, Chaves L, Veeturi SS, Waqas M, Monteiro A, Dmytriw AA, Burkhardt JK, Mokin M, Snyder KV, Siddiqui AH, Tutino VM. Profiling of Circulating Gene Expression Reveals Molecular Signatures Associated with Intracranial Aneurysm Rupture Risk. Mol Diagn Ther 2023; 27:115-127. [PMID: 36460938 PMCID: PMC9924426 DOI: 10.1007/s40291-022-00626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Following detection, rupture risk assessment for intracranial aneurysms (IAs) is critical. Towards molecular prognostics, we hypothesized that circulating blood RNA expression profiles are associated with IA risk. METHODS We performed RNA sequencing on 68 blood samples from IA patients. Here, patients were categorized as either high or low risk by assessment of aneurysm size (≥ 5 mm = high risk) and Population, Hypertension, Age, Size, Earlier subarachnoid hemorrhage, Site (PHASES) score (≥ 1 = high risk). Modified F-statistics and Benjamini-Hochberg false discovery rate correction was performed on transcripts per million-normalized gene counts. Protein-coding genes expressed in ≥ 50% of samples with a q value < 0.05 and an absolute fold-change ≥ 2 were considered significantly differentially expressed. Bioinformatics in Ingenuity Pathway Analysis was performed to understand the biology of risk-associated expression profiles. Association was assessed between gene expression and risk via Pearson correlation analysis. Linear discriminant analysis models using significant genes were created and validated for classification of high-risk cases. RESULTS We analyzed transcriptomes of 68 IA patients. In these cases, 31 IAs were large (≥ 5 mm), while 26 IAs had a high PHASES score. Based on size, 36 genes associated with high-risk IAs, and two were correlated with the size measurement. Alternatively, based on PHASES score, 76 genes associated with high-risk cases, and nine of them showed significant correlation to the score. Similar ontological terms were associated with both gene profiles, which reflected inflammatory signaling and vascular remodeling. Prediction models based on size and PHASES stratification were able to correctly predict IA risk status, with > 80% testing accuracy for both. CONCLUSIONS Here, we identified genes associated with IA risk, as quantified by common clinical metrics. Preliminary classification models demonstrated feasibility of assessing IA risk using whole blood expression.
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Affiliation(s)
- Kerry E Poppenberg
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Aichi Chien
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Briana A Santo
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lee Chaves
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Sricharan S Veeturi
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Andre Monteiro
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA.
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA.
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17
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Pla Sanchez F, Volo Perez G. Ruptured True Left Hepatic Artery Aneurysm After Thyroid Surgery. Eur J Vasc Endovasc Surg 2023; 65:130. [PMID: 36229015 DOI: 10.1016/j.ejvs.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Ferran Pla Sanchez
- Department of Angiology and Vascular Surgery, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Guido Volo Perez
- Department of Angiology and Vascular Surgery, Dr Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
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18
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Sun K, Zhang X, Li X, Li X, Su S, Luo Y, Tian H, Zeng M, Wang C, Xie Y, Zhang N, Cao Y, Zhu Z, Ni Q, Liu W, Xia F, He X, Shi Z, Duan C, Sun H. Plasma metabolic signatures for intracranial aneurysm and its rupture identified by pseudotargeted metabolomics. Clin Chim Acta 2023; 538:36-45. [PMID: 36347333 DOI: 10.1016/j.cca.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/07/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS The vital metabolic signatures for IA risk stratification and its potential biological underpinnings remain elusive. Our study aimed to develop an early diagnosis model and rupture classification model by analyzing plasma metabolic profiles of IA patients. MATERIALS AND METHODS Plasma samples from a cohort of 105 participants, including 75 IA patients in unruptured and ruptured status (UIA, RIA) and 30 control participants were collected for comprehensive metabolic evaluation using ultra-high-performance liquid chromatography-mass spectrometry-based pseudotargeted metabolomics method. Furthermore, an integrated machine learning strategy based on LASSO, random forest and logistic regression were used for feature selection and model construction. RESULTS The metabolic profiling disturbed significantly in UIA and RIA patients. Notably, adenosine content was significantly downregulated in UIA, and various glycine-conjugated secondary bile acids were decreased in RIA patients. Enriched KEGG pathways included glutathione metabolism and bile acid metabolism. Two sets of biomarker panels were defined to discriminate IA and its rupture with the area under receiver operating characteristic curve of 0.843 and 0.929 on the validation sets, respectively. CONCLUSIONS The present study could contribute to a better understanding of IA etiopathogenesis and facilitate discovery of new therapeutic targets. The metabolite panels may serve as potential non-invasive diagnostic and risk stratification tool for IA.
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Affiliation(s)
- Kaijian Sun
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Xin Zhang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Xin Li
- Clinical Biobank Centre, Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Xifeng Li
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Shixing Su
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Yunhao Luo
- Clinical Biobank Centre, Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Hao Tian
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Meiqin Zeng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Cheng Wang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Yugu Xie
- Clinical Biobank Centre, Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Nan Zhang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Ying Cao
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Zhaohua Zhu
- Clinical Research Centre, Orthopedic Centre, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Qianlin Ni
- Wuhan Metware Biotechnology Co., Ltd., Wuhan 430000, China
| | - Wenchao Liu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Fangbo Xia
- Clinical Biobank Centre, Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Xuying He
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Zunji Shi
- State Key Laboratory of Herbage Improvement and Grassland Agro-ecosystems, Center for Grassland Microbiome, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China.
| | - Chuanzhi Duan
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China.
| | - Haitao Sun
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, The National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Neurosurgery Institute of Guangdong Province, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China; Clinical Biobank Centre, Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China; Key Laboratory of Mental Health of the Ministry of Education, Guangdong-Hong Kong-Macao Greater Bay Area Centre for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou 510515, Guangdong, China.
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19
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Nambu I, Misaki K, Uno T, Yoshikawa A, Uchiyama N, Mohri M, Nakada M. Recurrence pattern predicts aneurysm rupture after coil embolization. PLoS One 2022; 17:e0261996. [PMID: 36129919 PMCID: PMC9491535 DOI: 10.1371/journal.pone.0261996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction
Hemorrhage from a recurrent aneurysm is a major concern after coiling for intracranial aneurysms. We aimed to identify aneurysm recurrence patterns associated with hemorrhage.
Material and methods
We investigated radiological data of patients who underwent coiling for intracranial aneurysms in 2008–2016 and were followed-up for at least 6 months. Aneurysm recurrence patterns were classified as: type Ⅰ, enlargement of aneurysm neck; type Ⅱ, recurrent cavity within the coil mass; type Ⅲ, recurrent cavity along the aneurysm wall; and type Ⅳ, formation of a daughter sac. We evaluated the incidence of various recurrence patterns with or without hemorrhage.
Results
Of the 173 aneurysms included in the study (mean follow-up period, 32 months; range, 6–99 months), 22 (13%) recurred and required re-treatment. The recurrence patterns included type Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 7 (4%), 4 (2%), 9 (5%), and 2 (1%) cases, respectively. Most of the type Ⅰ, Ⅱ, and Ⅲ recurrences occurred within 1 year, and type Ⅳ occurred at 7 years after coiling. Three aneurysms exhibited hemorrhage, one with type Ⅲ and two with type Ⅳ pattern. The two aneurysms with type Ⅳ recurrence initially occurred as type Ⅰ; however, the recurrent neck enlarged gradually, resulting in new sac formation.
Conclusions
We recommend prompt re-treatment for aneurysms recurring with type Ⅲ or Ⅳ patterns, as such patterns were associated with hemorrhage. Furthermore, we need a special care to type Ⅰ recurrence with enlargement of recurrent neck because this specific pattern may develop to type Ⅳ.
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Affiliation(s)
- Iku Nambu
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
- * E-mail:
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Akifumi Yoshikawa
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan
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20
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Feng Y, Ji M, Ren Y, Liu Z, Xin Z, Wang L. Repeated intracerebral hemorrhage after craniotomy for a distal middle cerebral artery aneurysm: A case report. Medicine (Baltimore) 2022; 101:e29223. [PMID: 35512081 PMCID: PMC9276195 DOI: 10.1097/md.0000000000029223] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Distal middle cerebral artery aneurysms are very rare in the clinic, and craniotomy clipping is the better treatment after diagnosis. However, patients can also have repeated acute intracerebral hemorrhage after craniotomy for aneurysm, which has not been previously reported. PATIENT CONCERNS A 24-year-old male patient was admitted to our hospital with headache, nausea, and vomiting. He was well before, had no family history of cerebrovascular disease or hypertension, and had no history of trauma. DIAGNOSES Computer tomography and digital subtraction angiography of the brain revealed intracranial hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery. INTERVENTIONS The patient underwent 2 surgeries to treat the aneurysm, followed by 2 operations for acute cerebral hemorrhage. OUTCOMES Despite repeated surgical treatments, the patient had a poor prognosis and eventually died of respiratory and circulatory failure after repeated brain bleeding. LESSONS Briefly, it is of great importance to consider the risk factors of cerebral hemorrhage, and provide individualized treatment and psychological counseling for patients with intracerebral hemorrhage.
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Affiliation(s)
- Yan Feng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shi Jiazhuang, Hebei, China
| | - MingJun Ji
- Department of Critical Care Medical, Linxi County People's Hospital, Xing Tai, Hebei, China
| | - Yufeng Ren
- Department of Critical Care Medical, Linxi County People's Hospital, Xing Tai, Hebei, China
| | - Ziqian Liu
- Department of Critical Care Medical, Linxi County People's Hospital, Xing Tai, Hebei, China
| | - Zhenxue Xin
- Department of Neurosurgery, The Second People's Hospital of Liaocheng, Liaocheng, Shandong, China
| | - Liqun Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shi Jiazhuang, Hebei, China
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21
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Vieira E, Guimarães TC, Pontes ECA, Silva ACV, Carneiro MC, Netto AU, Pereira L, Cezar AB, Faquini I, Almeida NS, Griz MFL, Azevedo-Filho HRC. Initial experience in the microsurgical treatment of ruptured brain aneurysms in the endovascular era: characteristics and safety of the learning curve in the first 300 consecutively treated patients. Acta Neurochir (Wien) 2022; 164:973-984. [PMID: 35239013 DOI: 10.1007/s00701-022-05165-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Currently, there is an increasing tendency to refer only complex aneurysms for microsurgery. The formation of new neurosurgeons dedicated to open vascular neurosurgery becomes challenging in a situation in which complex aneurysms must be dealt with early in the career, raising questions about the safety of the learning curve. METHODS We analyzed the characteristics and surgical results of the first 300 consecutively treated patients after subarachnoid hemorrhage by a single neurosurgeon. The incidence of surgical complications and clinical outcomes during the learning curve were analyzed, looking for critical periods regarding patient safety. Microsurgical operative times were also studied. RESULTS A high frequency of wide-necked aneurysms was observed (70.3%), and, as a result, large (> 10 mm), MCA and paraclinoid aneurysms were overrepresented. A statistically significant correlation between surgical experience and clinical outcomes was observed, with progressive surgical experience resulting in a lower incidence of unfavorable outcomes. We also observed a higher frequency of major surgical complications, unfavorable clinical outcomes, and lower complete occlusion rates among the first 40 patients. Microsurgical operative times progressively and significantly decreased during the learning curve. CONCLUSIONS We observed a high prevalence of wide-necked aneurysms. Young neurosurgeons must be trained and prepared to deal with these aneurysms early in their careers. Although we observed a decrease in unfavorable results with cumulative surgical experience, the first 40 cases were associated with higher rates of major surgical complications, worse clinical outcomes, and lower complete occlusion rates, indicating that this period may be more critical to patient safety.
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Affiliation(s)
- Eduardo Vieira
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil.
| | - Thiago C Guimarães
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Erton C A Pontes
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Ana C V Silva
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | | | - Arlindo U Netto
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Lívio Pereira
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Auricélio B Cezar
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Igor Faquini
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Nivaldo S Almeida
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Maria F L Griz
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
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22
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Darsaut TE, Keough MB, Boisseau W, Findlay JM, Bojanowski MW, Chaalala C, Iancu D, Weill A, Roy D, Estrade L, Lejeune JP, Januel AC, Carlson AP, Sauvageau E, Al-Jehani H, Orlov K, Aldea S, Piotin M, Gaberel T, Gevry G, Raymond J. Middle Cerebral Artery Aneurysm Trial (MCAAT): A randomized care trial comparing surgical and endovascular management of MCA aneurysm patients. World Neurosurg 2021; 160:e49-e54. [PMID: 34971833 DOI: 10.1016/j.wneu.2021.12.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/05/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether the best management of middle cerebral artery (MCA) aneurysm patients is surgical or endovascular remains uncertain, with little evidence to guide decision-making. A randomized care trial offering MCA aneurysm patients a 50% chance of surgical and a 50% chance of endovascular management may optimize outcomes in the presence of uncertainty. METHODS The Middle Cerebral Artery Aneurysm Trial (MCAAT) is an investigator-initiated, multi-center, parallel group, prospective, 1:1 randomized controlled clinical trial. All adult patients with MCA aneurysms, ruptured or unruptured, amenable to surgical and endovascular treatment can be included. The composite primary outcome is 'Treatment Success': i) occlusion or exclusion of the aneurysm using the allocated treatment modality; ii) no intracranial hemorrhage during follow-up; iii) no retreatment of the target aneurysm during follow-up, iv) no residual aneurysm on angiographic follow-up and v) independence (mRS <3) at 1 year. The trial tests two versions of the same hypothesis (one for ruptured and one for unruptured MCA aneurysm patients): Surgical management will lead to a 15% absolute increase in the proportion of patients reaching Treatment Success from 55% to 70% (ruptured) or from 75% to 90% (unruptured aneurysm patients) compared to endovascular treatment (any method). In this pragmatic trial, outcome evaluations are by treating physicians, except for 1 year angiographic results which will be core lab assessed. The trial will be monitored by an independent data safety monitoring committee to assure safety of participants. MCAAT is registered at clinicaltrials.gov: NCT05161377. CONCLUSION Patients with MCA aneurysms can be optimally managed within a care trial protocol.
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Affiliation(s)
- Tim E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - Michael B Keough
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - William Boisseau
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - J Max Findlay
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Canada
| | - Michel W Bojanowski
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Chiraz Chaalala
- Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniela Iancu
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Alain Weill
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Daniel Roy
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Laurent Estrade
- Department of Interventional Neuroradiology, CHU de Lille, Hôpital Salengro, Lille, France
| | - Jean-Paul Lejeune
- Department of Neurosurgery, CHU de Lille, Hôpital Salengro, Lille, France
| | - Anne-Christine Januel
- Department of Interventional Neuroradiology, CHU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Health, Jacksonville, Florida, USA
| | - Hosam Al-Jehani
- Department of Neurosurgery and Radiology, King Fahad University Hospital, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Kirill Orlov
- Endovascular Neurosurgery Research Center, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | | | - Guylaine Gevry
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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23
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Bourhis-Guizien F, Dissaux B, Boulouis G, Ben Salem D, Gentric JC, Ognard J. The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure. Tomography 2021; 7:792-800. [PMID: 34842852 PMCID: PMC8628901 DOI: 10.3390/tomography7040066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76; 11.76] vs. 0.78 [0.32; 1.25], respectively, p < 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p < 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43; 6.92] vs. 3.08 [1.79; 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24; 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p < 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.
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Affiliation(s)
- Fanny Bourhis-Guizien
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
| | - Brieg Dissaux
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Grégoire Boulouis
- Neuroradiology Unit, Department of Radiology, Saint-Anne Hospital, INSERM UMR 894, 75674 Paris, France;
| | - Douraied Ben Salem
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
| | - Jean-Christophe Gentric
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Western Brittany Thrombosis Study Group GETBO EA3878, 29609 Brest, France
| | - Julien Ognard
- Department of Radiology, University Hospital of Brest, 29609 Brest, France; (F.B.-G.); (B.D.); (D.B.S.); (J.-C.G.)
- Laboratory of Medical Information Processing, LaTIM INSERM UMR 1101, 29200 Brest, France
- Correspondence:
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24
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Kim YS, Joo SP, Song DJ, Lee TK, Kim TS. Correlation between high hair cortisol level and intracranial aneurysm rupture. Medicine (Baltimore) 2021; 100:e26193. [PMID: 34087887 PMCID: PMC8183786 DOI: 10.1097/md.0000000000026193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
Measurement of cortisol in hair is a reliable method for determining long-term cortisol exposure reflecting chronic stress. Research using hair cortisol concentration has been limited to mainly cardiometabolic diseases. The association between hair cortisol concentration and aneurysmal rupture has not yet been studied. We aimed to investigate the relationship between the degree of chronic stress as measured by hair cortisol concentration and aneurysmal rupture.Sixty-eight patients diagnosed with intracranial aneurysms were included in this study (ruptured group, 30; unruptured group, 38). Hair cortisol was measured in 3-cm hair segments, reflecting roughly 3 months of hair growth. For a risk factor analysis, patient-specific factors and aneurysm-specific factors as well as hair cortisol concentration were investigated.Hair cortisol concentrations were significantly higher in the ruptured group than in the unruptured group (55.8 ± 22.0 ng/dL vs. 19.1 ± 6.4 ng/dL; P < .001). High hair cortisol concentration was found to be an independent risk factor for aneurysmal rupture (odds ratio [OR]: 2.245, 95% confidence interval [CI]: 1.825-2.753; P = .013). Additionally, a history of cerebrovascular disease was significantly associated with an increased risk of aneurysmal rupture (OR: 1.577, 95% CI: 1.099-2.262; P = .040).Based on our results, we suggest that chronic stress as measured by hair cortisol concentration could be an independent risk factor for intracranial aneurysmal rupture.
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25
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Hoover C, Kondo Y, Shao B, McDaniel MJ, Lee R, McGee S, Whiteheart S, Bergmeier W, McEver RP, Xia L. Heightened activation of embryonic megakaryocytes causes aneurysms in the developing brain of mice lacking podoplanin. Blood 2021; 137:2756-2769. [PMID: 33619517 PMCID: PMC8138551 DOI: 10.1182/blood.2020010310] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/06/2021] [Indexed: 12/29/2022] Open
Abstract
During early embryonic development in mammals, including humans and mice, megakaryocytes (Mks) first originate from primitive hematopoiesis in the yolk sac. These embryonic Mks (eMks) circulate in the vasculature with unclear function. Herein, we report that podoplanin (PDPN), the ligand of C-type lectin-like receptor (CLEC-2) on Mks/platelets, is temporarily expressed in neural tissue during midgestation in mice. Loss of PDPN or CLEC-2 resulted in aneurysms and spontaneous hemorrhage, specifically in the lower diencephalon during midgestation. Surprisingly, more eMks/platelets had enhanced granule release and localized to the lower diencephalon in mutant mouse embryos than in wild-type littermates before hemorrhage. We found that PDPN counteracted the collagen-1-induced secretion of angiopoietin-1 from fetal Mks, which coincided with enhanced TIE-2 activation in aneurysm-like sprouts of PDPN-deficient embryos. Blocking platelet activation prevented the PDPN-deficient embryo from developing vascular defects. Our data reveal a new role for PDPN in regulating eMk function during midgestation.
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MESH Headings
- Aneurysm, Ruptured/embryology
- Aneurysm, Ruptured/etiology
- Angiopoietin-1/metabolism
- Animals
- Brain/blood supply
- Brain/embryology
- Cells, Cultured
- Cerebral Hemorrhage/embryology
- Cerebral Hemorrhage/etiology
- Collagen/pharmacology
- Diencephalon/blood supply
- Diencephalon/embryology
- Gene Expression Regulation, Developmental
- Gestational Age
- Intracranial Aneurysm/embryology
- Intracranial Aneurysm/etiology
- Intracranial Aneurysm/genetics
- Intracranial Aneurysm/pathology
- Lectins, C-Type/deficiency
- Lectins, C-Type/genetics
- Lectins, C-Type/physiology
- Megakaryocytes/metabolism
- Megakaryocytes/pathology
- Membrane Glycoproteins/deficiency
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/physiology
- Mice
- Mice, Knockout
- Neovascularization, Pathologic/genetics
- Neovascularization, Pathologic/physiopathology
- Neovascularization, Physiologic/physiology
- Platelet Activation
- Platelet Aggregation/drug effects
- Platelet Aggregation Inhibitors/pharmacology
- Receptor, TIE-2/metabolism
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Affiliation(s)
- Christopher Hoover
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Yuji Kondo
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Bojing Shao
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Michael J McDaniel
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Robert Lee
- Department of Biochemistry and Biophysics-UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Samuel McGee
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
| | - Sidney Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY
| | - Wolfgang Bergmeier
- Department of Biochemistry and Biophysics-UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Rodger P McEver
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Lijun Xia
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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26
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Huang X, Yan G, Qin Z, Zhu G. To clip or to coil for unruptured intracranial aneurysm?: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24692. [PMID: 33725939 PMCID: PMC7982220 DOI: 10.1097/md.0000000000024692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Microsurgical clipping and endovascular coiling are the main methods against unruptured intracranial aneurysm (UIA). The craniotomy of surgical clipping may increase the risk of cerebrospinal fluid leakage and infection, damage the brain tissue, produce excessive stimulation to the nerves and blood vessels around the aneurysm, and cause the corresponding neurological deficit. Endovascular coiling could significantly reduce the mortality and disability rate than surgical clipping technique, which made endovascular coiling to become the first choice for the treatment of UIA. However, the long-term results showed attenuated favorable outcomes of coiling over clipping, so it is still in debate whether to clip or to coil. Therefore, we try to conduct a randomized, controlled, prospective trial to assess the long term safety of endovascular coiling therapy against UIA compared with microsurgical clipping technique. METHODS Parallel-group randomization (1:1) is generated through the random number generator in Microsoft Excel 2010. In this trial, blinding to patients, physicians, and outcome assessors is not possible. Endovascular coiling or surgical clipping will be performed once for each patient in treatment group or control group, respectively. The mRS, overall mortality rate, disability rate, morbidity rate, and occurrence of a major aneurysm recurrence measured at 6 month and 1 year will be recorded. CONCLUSIONS The findings will be helpful for the choice of endovascular coiling or surgical clipping by assessing the long term efficacy and safety of both operations against UIA. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/QYE9F.
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27
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Lee W, Han HJ, Kim J, Choi JY, Park KY, Kim YB, Chung J. Ruptured Infundibular dilatation of the posterior communicating artery. Acta Neurochir (Wien) 2021; 163:797-803. [PMID: 33527210 DOI: 10.1007/s00701-021-04716-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An infundibulum of the posterior communicating artery (PcomA) or infundibular dilatation (ID) is considered to be a benign anatomical variant. However, some evidence suggests that ID is a pre-aneurysmal state. This case series presents cases of ruptured IDs and aneurysms originating from the IDs. METHODS Between April 2002 and June 2020, 1337 patients were treated for aneurysmal subarachnoid hemorrhage (SAH). Among them, 7 patients with ruptured PcomA IDs were identified. Rupture IDs of the PcomA were categorized into 1) direct rupture of IDs, and 2) rupture of aneurysms originating from IDs. The clinical and radiographic factors were retrospectively reviewed. RESULTS Two patients experienced direct rupture of IDs, while the other 5 patients presented with ruptured aneurysms originating from IDs. The 2 patients with direct rupture of IDs at presentation were relatively younger (< 50 years), while the other 5 patients with ruptured aneurysms originating from IDs were over 70 and had a history of aneurysmal SAH due to other intracranial aneurysms. Ruptured IDs were treated with microsurgery or endovascular treatment. There were no complications related to the procedure for securing ruptured IDs. Five (71.4%) patients showed favorable outcomes. One patient with initial Hunt and Hess grade 4 died due to initial brain damage with cerebral vasospasm and medical complications. CONCLUSIONS ID of the PcomA rarely causes SAH with or without aneurysm formation. Thus, patients with IDs of the PcomA should be carefully followed up for a long period, especially those with a history of aneurysmal SAH.
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Affiliation(s)
- Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Choi
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Tamimi AF, Al Ryalat NT, Juweid ME, Doudeen RM, Al-Soub Q, Kanaan TM, Tamimi IA. Rupture of De Novo Middle Cerebral Artery Aneurysm 8 Years After the Clipping of Ruptured M1 Middle Cerebral Artery Aneurysm. Am J Case Rep 2021; 22:e929194. [PMID: 33551447 PMCID: PMC7883815 DOI: 10.12659/ajcr.929194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/27/2020] [Accepted: 12/05/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Development and rupture of a de novo intracranial aneurysm is rare. Little is known regarding its etiology and the appropriate timing of follow-up angiograms after surgical clipping or coiling. CASE REPORT We present a case report of a 39-year-old male smoker with history of hypertension who developed a de novo aneurysm 8 years after surgical clipping of an aneurysm in the middle cerebral artery in the same segment. He presented with neck rigidity and drowsiness. Laboratory analysis did not show blood dyscrasia. Brain computerized tomography showed right temporal lobe hematoma and 4-vessel angiogram demonstrated de novo aneurysm in the same segment of the M1 middle cerebral artery, which was confirmed by intraoperative microsurgical findings. We review the literature on such cases and discuss the pathophysiology, diagnosis, and treatment of this condition. De novo aneurysm, although rare, can develop within days to as long as 10 years after surgical clipping or coiling. CONCLUSIONS This rare case of de novo aneurysm supports follow-up imaging of patients after initial surgical clipping for up to 10 years.
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Affiliation(s)
- Ahmad F. Tamimi
- Department of Neurosurgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Nosaiba T. Al Ryalat
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Malik E. Juweid
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Rahmah M. Doudeen
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Qutada Al-Soub
- Department of Neurosurgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Tareq M.A. Kanaan
- Department of Neurosurgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Iskandar A. Tamimi
- Department of Orthopedic Surgery, Malaga University Hospital Carlos Haya, Malaga, Spain
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Zahdi O, El Bhali H, Taous H, Jdar A, El Khloufi S, Sefiani Y, El Mesnaoui A, Lekehal B. [Giant ruptured common femoral artery aneurysm revealing Behçet's disease]. Ann Cardiol Angeiol (Paris) 2021; 70:59-61. [PMID: 33303184 DOI: 10.1016/j.ancard.2020.11.003] [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: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
Vascular involvement in Behçet's disease is rare. Aneurysmal arterial involvement is the severe form of the disease, it constitutes a therapeutic challenge given its severity, and frequent secondary complications, especially at anastomosis. The systematic immunosuppressive drug treatment and surgical technique thoroughness can reduce relapse rate. We report the case of a young man in whom a ruptured false aneurysm of the common femoral artery revealed Behçet's disease. He underwent an open repair, with prosthetic arterial reconstruction, and anastomosis reinforcement with teflon.
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Affiliation(s)
- O Zahdi
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc.
| | - H El Bhali
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - H Taous
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - A Jdar
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - S El Khloufi
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - Y Sefiani
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - A El Mesnaoui
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
| | - B Lekehal
- Université Mohammed-V de Rabat, Rabat, Maroc; Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn-Sina, 10104 Souissi, Rabat, Maroc
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Wang JM, Chen QX. Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms. J Korean Med Sci 2020; 35:e430. [PMID: 33316863 PMCID: PMC7735914 DOI: 10.3346/jkms.2020.35.e430] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intraprocedural rupture (IPR) is a devastating complication in endovascular treatment of ruptured intracranial aneurysms, but its risk factors have not been fully assessed. This study was performed to explore the risk factors for IPR during embolization of ruptured cerebral aneurysms. METHODS A total of 1,494 patients with ruptured intracranial aneurysms who underwent endovascular interventional embolization were enrolled. Clinical characteristics were collected for each patient. Univariate and multivariate logistic regression analysis was employed to identify the factors independently associated with IPR. A receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff values of continuous variables predicting IPR. RESULTS Forty-one patients suffered from IPR (2.7%). Multivariate logistic regression analysis indicated that aneurysm size (odds ratio [OR], 0.819; 95% confidence interval [CI], 0.732-0.916), aneurysms with irregular morphology (OR, 2.162; 95% CI, 1.143-4.091), time from symptom onset to intervention (OR, 1.615; 95% CI, 1.207-2.161), and vasospasm during embolization (OR, 2.021; 95% CI, 1.038-3.934) were the independent risk factors of IPR. ROC curve analysis showed that the area under the curve for aneurysm size and time from onset to intervention were 0.697 (cutoff value, 3.4 mm; sensitivity, 78.8%; and specificity, 53.7%) and 0.659 (cutoff value, 2 days; sensitivity, 78.0%; and specificity, 45.2%), respectively. CONCLUSION Aneurysms with irregular morphology, aneurysms ≤ 3.4 mm in diameter, time from onset to intervention > 2 days and cerebral vasospasm during embolization are independent risk factors for IPR during coil embolization of ruptured aneurysms. More attention should be paid to the factors increasing the risk of IPR in patients with ruptured aneurysms so as to minimize this complication.
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Affiliation(s)
- Jun Min Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Xue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
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Savić D, Alsheikh TM, Alhaj AK, Lazovic L, Alsarraf L, Bosnjakovic P, Yousef W. Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report. Acta Neurochir (Wien) 2020; 162:2725-2729. [PMID: 32720013 PMCID: PMC7383120 DOI: 10.1007/s00701-020-04510-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022]
Abstract
The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.
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MESH Headings
- Adolescent
- Aortic Dissection/diagnostic imaging
- Aortic Dissection/etiology
- Aortic Dissection/surgery
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/surgery
- Angiography, Digital Subtraction
- Ascites/etiology
- Betacoronavirus
- Brain Edema/diagnostic imaging
- Brain Edema/etiology
- COVID-19
- Cerebral Angiography
- Cerebral Hemorrhage/diagnostic imaging
- Cerebral Hemorrhage/etiology
- Cerebral Hemorrhage/surgery
- Computed Tomography Angiography
- Coronavirus
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Craniotomy
- Disease Progression
- Female
- Hepatomegaly/etiology
- Humans
- Kidney Diseases/etiology
- Middle Cerebral Artery
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Respiratory Distress Syndrome/etiology
- SARS-CoV-2
- Splenic Infarction/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- Dragan Savić
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait.
| | - Tarik M Alsheikh
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ahmad Kh Alhaj
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Lazar Lazovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Lamya Alsarraf
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Petar Bosnjakovic
- Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Waleed Yousef
- Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
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Brown P, Fulks D. An unusual ischaemic presentation of thrombosed intracranial mycotic aneurysm with subsequent subarachnoid haemorrhage. BMJ Case Rep 2020; 13:e237044. [PMID: 33040039 PMCID: PMC7552799 DOI: 10.1136/bcr-2020-237044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Accepted: 09/06/2020] [Indexed: 11/03/2022] Open
Abstract
We present an unusual case of acute ischaemic stroke secondary to thrombosed mycotic aneurysm with subsequent early aneurysmal rupture and subarachnoid haemorrhage, successfully treated with endovascular coil embolisation of the thrombosed segment. Imaging correlates are presented demonstrating successful endovascular management despite vessel occlusion precluding angiographic visualisation of the aneurysmal segment. Imaging and clinical follow-up is provided demonstrating durable occlusion and excellent clinical outcome with full functional recovery.
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Affiliation(s)
- Patrick Brown
- Radiology and Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Daniel Fulks
- Radiology, The University of Tennessee Medical Center, Knoxville, Tennessee, USA
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33
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Pellenc Q, Sacre K. An Uncommon Cause of Innominate Artery Rupture. Eur J Vasc Endovasc Surg 2020; 60:179. [PMID: 32600785 DOI: 10.1016/j.ejvs.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Quentin Pellenc
- Vascular Surgery Department, Bichat Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; Internal Medecine Department, Bichat Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France.
| | - Karim Sacre
- Internal Medecine Department, Bichat Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France; Université de Paris, Paris, France
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Powezka K, Khan T, Narlawar R, Antoniou GA. Ruptured Popliteal Artery Aneurysm Complicated with Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection. Ann Vasc Surg 2020; 66:24-27. [PMID: 32422287 PMCID: PMC7227508 DOI: 10.1016/j.avsg.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022]
Abstract
We herein report a rare case of the ruptured popliteal artery aneurysm in an 89-year-old man, whose recovery after surgical treatment was complicated with acute respiratory distress syndrome secondary to confirmed infection with SARS-CoV-2. Presenting symptoms, patient's comorbidities, and postoperative course complicated with cardiac and respiratory failure leading to adverse outcome are discussed in this case report.
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Affiliation(s)
- Katarzyna Powezka
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom.
| | - Taha Khan
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - Ranjeet Narlawar
- Department of Radiology, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - George A Antoniou
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
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Mozaffar M, Shahrbaf MA, Arabzadeh A, Shojaei R, Azimi B. Urinary Tract Bleeding as a Rare Manifestation of Uterine Artery Pseudoaneurysm. Ann Vasc Surg 2020; 68:570.e5-570.e8. [PMID: 32339681 DOI: 10.1016/j.avsg.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/19/2022]
Abstract
Pseudoaneurysm of the uterine artery is a rare condition, which usually occurs after a traumatic birth, cesarean section, dilatation and curettage, and hysterectomy. This case is a 28-year-old female patient that presented with the chief complaint of severe urinary tract bleeding and hypovolemic shock. This patient underwent cesarean section 2 months before the first presentation. After the primary examination, the patient was sent to the hybrid operation room with the primary diagnosis of uterine artery pseudoaneurysm and coil embolization was done for treating the pseudoaneurysm. Considering continued bleeding, open surgery was performed and the internal iliac artery was ligated.
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Affiliation(s)
- Mohammad Mozaffar
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirahmad Arabzadeh
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shojaei
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Azimi
- Department of General and Vascular Surgery, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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36
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Ting W, Richard SA, Changwei Z, Chaohua W, Xiaodong X. Delayed spontaneous rupture of cavernous segment of the internal carotid artery following dual ophthalmic segment aneurysms treatment with pipeline embolization device: A case report. Medicine (Baltimore) 2019; 98:e18420. [PMID: 31876716 PMCID: PMC6946193 DOI: 10.1097/md.0000000000018420] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/31/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
RATIONALE The incidence of double aneurysms on the ophthalmic segment of the internal carotid artery (ICA) is very rare. Nevertheless, delayed rupture of a parent artery instead of the aneurysmal sac following pipeline embolization device (PLED) is unusual. PATIENT CONCERNS We present a 72-year-old female who was admitted at our facility with gradual onset of nonspecific visual changes. DIAGNOSIS Conventional angiography revealed 2 aneurysms located at the ophthalmic segment of the left ICA. INTERVENTIONS Both aneurysms were successfully treated with PLED. OUTCOMES Two months after discharge, the patient was rushed into the emergency with bilateral conjunctival congestion. Computed tomography revealed intracranial hemorrhage at left temporal lobe while digital subtraction angiography established a left direct carotid cavernous fistula. We utilized stent (Solitaire 6*30) assisted coils to occlude the fistula. The patient is well and go about her normal duties. LESSIONS Manipulation of the tortuous parent artery resulted in a focal traumatic weakness in the artery and subsequently a delay tear. We are of the view that, endovascular surgeons should be on the lookout for this complication following flow deviation treatment modalities.
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Affiliation(s)
- Wang Ting
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China
- Department of Medicine, Princefield University, Ghana West Africa
| | - Zhang Changwei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Wang Chaohua
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xie Xiaodong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, P.R. China
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Dominguez L, Saway B, Benko MJ, Guilliams E, Marvin EA, Entwistle JJ. Ruptured Distal Superior Cerebellar Artery Aneurysm After Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Case Report and Review of the Literature. World Neurosurg 2019; 135:2-6. [PMID: 31734428 DOI: 10.1016/j.wneu.2019.10.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/07/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracranial aneurysm formation after Gamma Knife radiosurgery (GKRS) is a rare complication that has only recently been reported in the literature. We report the case of a fatal distal superior cerebellar artery (SCA) aneurysm rupture in a woman treated twice with GKRS for trigeminal neuralgia along with a review of the literature regarding radiation-induced aneurysms. CASE DESCRIPTION A 77-year-old white woman with a history of refractory right-sided trigeminal neuralgia treated with GKRS in 2001, and again in 2006 after a relapse, presented to our emergency department with complaints of a sudden-onset severe headache associated with vomiting, right eye vision loss, left-sided facial droop, and left-sided weakness with no history of hypertension or smoking prior to presentation. Initial head computed tomography scan without contrast demonstrated an intraparenchymal hemorrhage centered in the right middle cerebellar peduncle with subarachnoid hemorrhage in the basal cisterns and extension into the fourth ventricle causing early hydrocephalus. Head computed tomography angiography (CTA) demonstrated a distal right SCA aneurysm adjacent to the hemorrhage. The patient's mental status deteriorated into coma after suspected rerupture during the CTA requiring immediate intubation, external ventricular drain placement, and emergent cerebral angiogram with coil embolization. Ultimately, the patient never recovered despite medical and surgical management; therefore, care was withdrawn in accordance with her known wishes. CONCLUSIONS The pathophysiologic association of aneurysm formation after GKRS remains to be elucidated, but given the potentially fatal consequences of aneurysm rupture, we advocate for further research and propose serial vascular imaging during the postradiosurgery follow-up period for iatrogenic aneurysm formation surveillance.
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Affiliation(s)
- Lisette Dominguez
- Mayo Clinic School of Graduate Medical Education, Jacksonville, Florida, USA.
| | - Brian Saway
- Department of Surgery, Division of Neurosurgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia, USA
| | - Michael J Benko
- Department of Surgery, Division of Neurosurgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia, USA
| | - Evin Guilliams
- Department of Surgery, Division of Neurosurgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia, USA
| | - Eric A Marvin
- Department of Surgery, Division of Neurosurgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia, USA
| | - John J Entwistle
- Department of Surgery, Division of Neurosurgery, Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia, USA
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Abstract
INTRODUCTION Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.
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Ng R, Eliezer D, Vilain R, Kamien B, Deshpande AV. Fatal Exsanguination Following Rupture of an Iliac Artery Aneurysm in an Infant With Menkes Disease. Pediatr Dev Pathol 2019; 22:486-491. [PMID: 30935272 DOI: 10.1177/1093526619841152] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Menkes disease (MD) usually presents in infancy with respiratory and neurological complications. Severe isolated vasculo-connective tissue involvement in infancy is rare, and hence the precise and timely diagnosis is difficult. We report a case of an 8-week-old male infant who succumbed to acute, severe exsanguination, and hemorrhagic shock secondary to a large retroperitoneal hematoma due to rupture of a right iliac artery aneurysm. Perimortem musculoskeletal findings raised suspicion of nonaccidental injury. However, postmortem review of facial traits raised the suspicion of MD. MD was subsequently confirmed on genetic testing. Child health clinicians must remain aware of MD as a rare cause of infant vasculopathy or atypical skeletal abnormalities.
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Affiliation(s)
- Rachel Ng
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Dilharan Eliezer
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Pathology North - Hunter, NSW Health Pathology, Newcastle, Australia
| | - Benjamin Kamien
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Hunter Genetics, Waratah, Australia
| | - Aniruddh V Deshpande
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Priority Research Centre GrowUpWell, University of Newcastle, Newcastle, Australia
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Abstract
OBJECTIVE Aneurysm rupture is often a fatal complication of giant intradural aneurysm (GIA) treatments. The purpose of this study was to review aneurysm rupture in GIA treatment. MATERIALS AND METHODS We performed a systematic review on aneurysm rupture related to GIA treatment. For each reported case, we collected the following information: aneurysm location, size and rupture status, the mode of treatment, timing of the hemorrhage, anatomical, and hemodynamic factors. RESULTS We identified 56 aneurysm ruptures related to treatment in 38 published studies. Of the nine intraoperative ruptures, eight occurred during endovascular procedures and one in surgical treatment. Of the 47 delayed ruptures, 72.3% occurred within 2 weeks. The prognosis of intraoperative and delayed ruptures was poor, with 83.9% experiencing death. Of these aneurysms, 75% were initially unruptured. Of the delayed ruptured aneurysms, 21.3% had prior surgical treatment, 74.4% had prior endovascular treatment, and 4.3% had prior combined surgical and endovascular treatments. Vertebrobasilar artery (VBA) location was significantly associated with aneurysm rupture after treatment, occurring at 57.2%. Flow diverter (FD) treatment seemed to elevate the delayed rupture proportion of giant paraclinoid internal carotid artery (ICA) aneurysms from 22.0% to 42.9%. FD treatment did not lower the rupture risk of giant VBA aneurysms and the corresponding death rate. CONCLUSION Intraoperative and delayed aneurysm ruptures were the most challenging in endovascular treatment of GIAs. Giant VBA aneurysm had the highest rupture risk after treatment. FD seemed to elevate the delayed rupture proportion of giant paraclinoid aneurysms.
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Affiliation(s)
- Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhiyong Chen
- Department of Neurosurgery, Qinhunangdao Jungong Hospital, Qinhuangdao, China
| | - Liguo Liu
- Department of Neurosurgery, Jikuang Hospital, Jixi, Heilongjiang, China
| | - Chuhan Jiang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Ismaili M, Mvumbi F, Akach I, Alami B, Boubbou M, Lahmidani N, El Youssfi M, Maâroufi M, Lamrani YA. [A jejunal artery pseudoaneurysm ruptured in the jejunal lumen: A rare vascular complication of severe pancreatitis]. J Med Vasc 2019; 44:336-339. [PMID: 31474344 DOI: 10.1016/j.jdmv.2019.06.006] [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] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Jejunal pseudoaneurysm is a rare complication of pancreatitis, usually manifested by digestive bleeding when it ruptures into the digestive lumen. This complication is extremely rare and may be life-threatening. The diagnosis is based on abdominal angiographic computed tomography. Radiology allows therapeutic management through arterial embolization. This case report describes a pseudoaneurysm of jejunal artery that developed as the result of pancreatitis: A 77-year-old man seen in early September 2015 at the emergency department for acute pancreatitis had a pseudocyst infected and spontaneously fistulized into the jejunum lumen. His condition responded initially to symptomatic therapy, and he was discharged. He returned two years later, with digestive bleeding from jejunal pseudoaneurysm that had ruptured into the jejunal lumen. Angiographic embolization was performed as first-line treatment with good outcome. Bleeding more than two years after acute pancreatitis due to rupture of a jejunal pseudoaneurysm is an exceptional complication. Here we report a rare case of digestive hemorrhage caused by jejunal pseudoaneurysm, complicating acute pancreatitis.
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Affiliation(s)
- M Ismaili
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc.
| | - F Mvumbi
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - I Akach
- Service de gastro-entérologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - B Alami
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - M Boubbou
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - N Lahmidani
- Service de gastro-entérologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - M El Youssfi
- Service de gastro-entérologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - M Maâroufi
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
| | - Y A Lamrani
- Service de radiologie, CHU Hassan II, Fès, faculté de médecine et de pharmacie, université Sidi Mohammed ben Abdallah, Fès, Maroc
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Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Marques M, Nalli D, Carrete H, Caldas JG, Frudit ME, Moret J, Spelle L. The PHASES score: To treat or not to treat? Retrospective evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. J Neuroradiol 2019; 47:349-352. [PMID: 31400432 DOI: 10.1016/j.neurad.2019.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 04/24/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The PHASES score was formulated to predict the 5-year risk of rupture for intracranial aneurysms. We retrospectively analyzed all patients treated in our institution for aneurysmal SAH and applied the PHASES score to estimate the probable predicted risk of bleeding in this group of patients. METHODS Between February 2015 and August 2018, all patients with aneurysmal SAH were retrospectively analyzed and the PHASES score was applied. A total of 155 patients were included with a mean age of 53.8years, including 60 males and 95 females. RESULTS Of our patients 110 (70.9%) had a PHASES score of below or equal to 5, with a hemorrhagic risk of up to 1.3% over 5years. If we analyze the patients with a risk of below 2% this figure increases to 122 patients (78.7%). Of these 99.3% were European and 0.6% were Japanese (1 patient). In 86 patients (55.4%), the aneurysm was smaller than 5mm and in 10 patients (6.4%) the aneurysm was located in the posterior circulation. CONCLUSION Of our patients 78.7% had less than a 2% 5-year rupture risk based on their PHASES score, highlighting the discrepancy of the rupture risk calculated with the PHASES score when hypothetically applied to this group of patients. In the hypothetical scenario that our patients had unruptured aneurysms, our retrospective analysis shows that the PHASES score may only provide a weak tool for clinicians to use in the decision-making process as to whether or not to treat these aneurysms.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil.
| | - Cristian Mihalea
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marta Iacobucci
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marcio Marques
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Darcio Nalli
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Henrique Carrete
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Universidade de São Paulo, São Paulo SP, Brazil
| | - Michel Eli Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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43
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Kuruma S, Kikuyama M, Kamisawa T, Chiba K. Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome. Clin J Gastroenterol 2019; 12:473-478. [PMID: 30997671 DOI: 10.1007/s12328-019-00968-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
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Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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44
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AlNuaimi D, AlKetbi R, AlFalahi A, AlBastaki U, Pierre-Jerome C. Ruptured Berry Aneurysm as the initial presentation of Polycystic Kidney Disease: A case report and review of literature. J Radiol Case Rep 2019; 12:1-8. [PMID: 30651918 DOI: 10.3941/jrcr.v12i9.3448] [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] [Indexed: 11/15/2022] Open
Abstract
Intra-cranial saccular aneurysms, also known as Berry aneurysms, have a well-known association with autosomal dominant polycystic kidney disease (ADPKD). Aneurysmal rupture can be the initial presentation of the disease. ADPKD has two types of gene mutations: PKD1 and PKD2. The latter one is of a milder form presenting later in life. Imaging plays a crucial role in the diagnosis and assessment in order to provide adequate management of these patients however, there are no official standardized guidelines established for screening of these intracranial aneurysms.
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MESH Headings
- Aneurysm, Ruptured/complications
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/surgery
- Cerebral Angiography
- Contrast Media
- Diagnosis, Differential
- Embolization, Therapeutic
- Endovascular Procedures
- Humans
- Intracranial Aneurysm/complications
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/etiology
- Intracranial Aneurysm/surgery
- Male
- Middle Aged
- Mutation
- Polycystic Kidney, Autosomal Dominant/complications
- Polycystic Kidney, Autosomal Dominant/diagnostic imaging
- Polycystic Kidney, Autosomal Dominant/genetics
- Subarachnoid Hemorrhage/diagnostic imaging
- Subarachnoid Hemorrhage/etiology
- Subarachnoid Hemorrhage/surgery
- TRPP Cation Channels/genetics
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Dana AlNuaimi
- Department of Radiology, Rashid hospital, Dubai, UAE
| | - Reem AlKetbi
- Department of Radiology, Rashid hospital, Dubai, UAE
| | - Afra AlFalahi
- Department of Radiology, Rashid hospital, Dubai, UAE
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45
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Oleszak F, Desai CK, Khan S, Sheikh M, Stys T, Stys A. Post-Complex Myocardial Infarct Pseudoaneurysm Rupture and Subsequent Complications. S D Med 2019; 72:16-18. [PMID: 30849223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ventricular pseudoaneurysm is an uncommonly encountered complication of myocardial infarction (MI) in the era of percutaneous coronary intervention. Its presentation can be very non-specific, and diagnosis requires a high index of suspicion. Urgent surgical repair is generally warranted to prevent potentially catastrophic complications. We present a case of patient who presented several days after his index MI. He was ultimately diagnosed with a ruptured pseudoaneurysm, and despite best efforts had a complicated hospital course.
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Affiliation(s)
| | - Chirag K Desai
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Shahjahan Khan
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Maryam Sheikh
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tomasz Stys
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Adam Stys
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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46
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Roberts K, Fan B, Brightwell R. Spontaneous Accessory Renal Artery Aneurysm Rupture in a Patient With Neurofibromatosis Type 1: A Case Report. Vasc Endovascular Surg 2018; 53:150-153. [PMID: 30223725 DOI: 10.1177/1538574418800557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022]
Abstract
True renal artery aneurysms are rare. Ruptured aneurysms are even rarer but can have devastating consequences. Renal artery aneurysms most commonly occur in patients with hypertension, atherosclerosis, or fibromuscular dysplasia. Treatment options can range from embolization to nephrectomy. We describe an interesting case of spontaneous accessory renal artery aneurysm rupture in a 44-year-old female with neurofibromatosis type 1 (NF1) who otherwise had no medical problems. She was successfully treated with selective coil embolization, recovered without complications, and maintained preoperative renal function.
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Affiliation(s)
- Kallie Roberts
- 1 Vascular surgery, OhioHealth Doctors Hospital, Columbus, OH, USA
| | - Betty Fan
- 1 Vascular surgery, OhioHealth Doctors Hospital, Columbus, OH, USA
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47
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Germans MR, Kulcsar Z, Regli L, Bozinov O. Clipping of Ruptured Aneurysm of Lateral Spinal Artery Associated with Anastomosis to Distal Posterior Inferior Cerebellar Artery: A Case Report. World Neurosurg 2018; 117:186-189. [PMID: 29935320 DOI: 10.1016/j.wneu.2018.06.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/18/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Arteries that anastomose with the posterior inferior cerebellar artery (PICA) can harbor aneurysms. CASE DESCRIPTION We present a case of a patient who suffered a subarachnoid hemorrhage as a result from an aneurysm on the left lateral spinal artery (LSA) that anastomosed to the PICA. The aneurysm was treated surgically, and the flow between the LSA and PICA was disrupted. The activated anastomotic network created a new anastomosis between the LSA and PICA, which was seen at 6 months' follow-up. CONCLUSIONS Careful follow-up is warranted in patients who have an activated anastomotic network because they can potentially develop aneurysms on newly created anastomoses.
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Affiliation(s)
- Menno R Germans
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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48
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Rodrigues R, Anacleto G, Lima P, Gonçalves A, Gonçalves Ó. Rupture of a true brachial artery aneurysm in a kidney transplant patient after arteriovenous fistula ligation: A rare presentation of an unusual disease. J Vasc Access 2018; 20:107-108. [PMID: 29843551 DOI: 10.1177/1129729818776900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Roger Rodrigues
- Department of Angiology and Vascular Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Gabriel Anacleto
- Department of Angiology and Vascular Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Pedro Lima
- Department of Angiology and Vascular Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Anabela Gonçalves
- Department of Angiology and Vascular Surgery, Coimbra University Hospital, Coimbra, Portugal
| | - Óscar Gonçalves
- Department of Angiology and Vascular Surgery, Coimbra University Hospital, Coimbra, Portugal
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49
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Kar H, Çakır V, Tanyeli HF, Çelik SC, Akgül Ö. Spontaneous True Gastroduodenal Artery Aneurysm Rupture after an Inguinal Hernia Operation. Chirurgia (Bucur) 2018; 113:261-265. [PMID: 29733020 DOI: 10.21614/chirurgia.113.2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 11/23/2022]
Abstract
Gastroduodenal artery aneurysms are a very rare subtype of visceral artery aneurysms. These are divided into two groups as true and pseudoaneurysms. Pseudogastroduodenal artery aneurysms, which develops secondary to pancreatitis, is seen more frequently, whereas the true aneurysms are much less common. Spontaneous rupture may be fatal. Sudden onset of abdominal pain and hypotension are the most important clinical findings. Endovascular interventions are the gold standard for diagnosis. Regardless of their sizes, GDA aneurysms should be treated as soon as possible. In patients diagnosed with gastroduodenal artery aneurysm rupture, endovascular embolization is recommended if the hemodynamics is stable and surgical treatment, if not. Aneurysm ruptures, especially from the GDA divisions, are deeply localized in the pancreas parenchyma and are difficult to detect during the operation. In such cases, the earliest postoperative diagnosis with endovascular intervention and applying embolization are life-saving. The purpose of this study to present a true rupture of gastroduodenal artery aneurysm case causing hemorrhagic shock after the inguinal hernia operation and diagnosed by endovascular intervention after emergency surgical exploration.
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50
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Peng Q, Zhang W. Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta: A case report and review of literature. Medicine (Baltimore) 2018; 97:e9896. [PMID: 29561462 PMCID: PMC5895301 DOI: 10.1097/md.0000000000009896] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Placenta accreta is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy. Several hemostatic techniques have been performed in patients with placenta accreta to prevent PPH and reserve fertility. Abdominal aorta and pelvic arteries balloon occlusion are the only techniques which could be performed before cesarean section (CS) in patients who want to keep the fetus and reserve fertility. However, abdominal aorta and pelvic arteries balloon occlusion might lead to severe complications such as formation and rupture of pseudoaneurysm, angiorrhexis, etc. PATIENT CONCERNS We report a case diagnosed with pernicious placenta previa (PPP) combined with Rh(D) negative blood type, who was performed with bilateral common iliac arteries (CIA) balloon occlusion during CS. However, on the first day after CS, the patient caught sudden left-side lumbago and backache accompanied with palpitation and shortness of breath. DIAGNOSES Formation and rupture of multiple pseudoaneurysms in left CIA. INTERVENTIONS Covered stent was inserted into the proximal part of the left CIA and the ipsilateral internal iliac artery was embolized by coil to prevent endoleak. OUTCOMES The patient recovered and discharged from hospital in stable condition without other complications 9 days after CS. LESSONS It is of paramount importance that obstetricians and radiologists correctly estimate the appropriate occlusion volume and pressure of pelvic arteries before CS to avoid formation and rupture of a pseudoaneurysm. And if the rupture of a pseudoaneurysm occurred, it should be quickly identified and treated with endovascular intervention.
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