scholarly journals Evaluation of Safety and Successfulness of the Coil Embolization of Intracranial Aneurysms

2019 ◽  
Vol 20 (2) ◽  
pp. 17-22
Author(s):  
Snezana Lukic ◽  
Milan Mijailovic ◽  
Vojin Kovacevic ◽  
Valentina Opancina
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Interventional Procedure ◽  
Case Series ◽  
Interventional Neuroradiology ◽  
Endovascular Coiling ◽  
Minimal Invasiveness ◽  
Clinical Center ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms

Abstract Intracranial aneurisms are ongoing problem for neurosurgeons and especially for interventional neuroradiologists due to its morbidity and mortality. The method of choice for treatment of the unruptured and ruptured intracranial aneurysms is endovascular coiling on account of its minimal invasiveness and high effectiveness. The aim of our study was to evaluate the safety and successfulness of endovascular coiling procedure in unruptured and ruptured intracranial aneurysms. Our study was designed as case series and consisted of patients older than 18 years, who underwent endovascular coiling of unruptured and ruptured intracranial aneurysms and follow-up examination 6 months after the interventional procedure. The procedures were performed from December 2010 to December 2016, by experienced interventional neuroradilogists (more than 400 performed embolizations each) at the Department for Interventional Neuroradiology, Clinical Center Kragujevac, Serbia. There were 681 patients (average age 47.5 ± 11.2 years) treated with endovascular coiling, out of them 324 (234 females, 90 males) had unruptured intracranial aneurysm and 357 (138 females, 219 males) had ruptured intracranial aneurysm. In our series, total complication rate was 11.71 %. Analysis of the results after first endovascular procedure has shown that complete aneurysm occlusion was accomplished in 546 patients (80.3%), near-complete in 81 patients (11.8%), and incomplete in 54 patients (7.9 %). Our results were satisfying regarding the procedure’s success, safety, outcomes and study material. However, further technical development of the materials and constant training of the interventional radiologists, are a necessity in order to improve treatment outcomes and patients’ benefit.

scholarly journals Prevalence of thunderclap headache in patients with ruptured intracranial aneurysms: series of 60 cases

2019 ◽  
pp. 189-192
Author(s):  
Bruno Bertoli Esmanhotto ◽  
Elcio Juliato Piovesan ◽  
Marcos Christiano Lange
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Thunderclap Headache ◽  
Head Pain ◽  
Ruptured Intracranial Aneurysm ◽  
One Year ◽  
Time Of Admission ◽  
Ruptured Intracranial Aneurysms

Thunderclap headache (TCH) is a head pain that begins suddenly and is severe at onset. TCH might be the first sign of subarachnoid hemorrhage. This study was conducted to evaluate the presence of thunderclap headache (TCH) in patients with ruptured intracranial aneurysm (RIA) and endovascular treatment (EVT). We evaluated the pattern of headache in 60 patients who suffered a RIA and EVT at time of admission and prospectively evaluated the characteristics of previous headache within one year before the rupture. Thirty-one patients (51,7 %) had TCH related to the rupture. Aneurysm size does not affect the occurrence of thunderclap headache (p=0,08). The vascular aneurysm territory is not related to presence of TCH (p=0,527). The prevalence of TCH in this cohort was similar to previous studies. All patients with acute thunderclap headache should be evaluated for subarachnoid hemorrhage.

scholarly journals Factors associated with outcomes in ruptured aneurysmal patients: Clinical Study of 80 Patients

2015 ◽  
Vol 22 (1) ◽  
pp. 104-111
Author(s):  
Gobran Taha Ahmed Alfotih ◽  
Fang-Cheng Li ◽  
Xin-Ke Xu ◽  
Shang-Yi Zhang
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Surgical Intervention ◽  
Optimal Timing ◽  
Strong Impact ◽  
Neurological Condition ◽  
Ruptured Intracranial Aneurysm ◽  
Outcome Scores ◽  
Age Range ◽  
Ruptured Intracranial Aneurysms

Abstract Background: Due to insufficient data in the literature, the optimal timing for surgical intervention for ruptured intracranial aneurysms is still controversial. Some practitioners advocate early surgery, but others not. It is important to identify other factors that can be used to predict poor prognosis in ruptured intracranial aneurysm patients. Objective: To determine the influence of timing of clipping surgery, and other factors on the outcomes of ruptured intracranial aneurysms in Hunt & Hess I~III grade patients. Method: We have performed a retrospective study involving 80 patients who were surgically treated for ruptured intracranial aneurysm between 2007 and 2012. The patient population consisted of 50(62.5%) females and 30(37.5%) males, with an age range of 12 to 75 years old, mean age 52.33 ± 10.63 years. We measured association between the Glasgow Outcome Scores and Sex, timing of clipping surgery, aneurysm location and pre-operative patient's neurological condition using famous Hunt and Hess grade system. Results: We did not find any correlation between the outcomes of ruptured intracranial aneurysm patients and timing (early, intermediate, late stage) of clipping, sex, aneurysm location. Whereas there is a significant correlation between patients outcomes and pre-operative patient neurological condition (Hunt & Hess grade). Conclusion: Timing of Surgery (early, intermediate, late) does not affect outcomes in low Hunt and Hess grade patients I~III. Whereas neurological condition (Hunt & Hess) has strong impact on postoperative outcomes. Others factors like sex, Age, Aneurysm location have no effect on outcomes in ruptured intracranial aneurysms.

scholarly journals Evaluation of clinical and anatomical outcome of staged stenting after acute coiling of ruptured intracranial aneurysms

2019 ◽  
Vol 26 (3) ◽  
pp. 260-267 ◽  
Author(s):  
Benjamin Mine ◽  
Thomas Bonnet ◽  
Juan Carlos Vazquez-Suarez ◽  
Noémie Ligot ◽  
Boris Lubicz
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Status ◽  
Long Term Stability ◽  
Ruptured Intracranial Aneurysm ◽  
Improved Stability ◽  
Ruptured Intracranial Aneurysms ◽  
Anatomical Outcome

Introduction Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone.

scholarly journals Early Institutional Experience of Management of Ruptured Intracranial Aneurysms: Our Team Approach

2019 ◽  
Vol 9 (1) ◽  
pp. 39-43
Author(s):  
Md Al Amin Salek ◽  
Rajib Shariar ◽  
Md Hasnain Faisal ◽  
Md Abdul Hye Manik ◽  
Ahmed Ul Mursalin Choudhury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Previous History ◽  
Military Hospital ◽  
Team Approach ◽  
Combined Approach ◽  
Microsurgical Clipping ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms

Introduction: Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Rupture of an intracranial aneurysm (IA) causing subarachnoid haemorrhage (SAH) is a devastating event that is still associated with a 50% case fatality rate, despite major improvements in surgical techniques, diagnosis and interventional treatment. While patient subgroups may clearly qualify for either surgical or endovascular treatment some patients could benefit from multimodal therapy. In this article we will show our team approach experience of management of ruptured intracranial aneurysms. Methods: Cross-sectional descriptive study of 52 patients of ruptured intracranial aneurysm who got admitted into Combined Military Hospital, Dhaka in the period from Jan 2016 to Dec 2018. Patients were evaluated according to their demographic data, analysis of risk factors, radiological location of aneurysms, World Federation of Neurological Surgeon (WFNS) scale, procedural options for aneurysm treatment, post procedural complications. We excluded unruptured cases and those patients who were treated conservatively. General outcome was assessed through the Glasgow out-come (GOS) scale. Data analysis was done by using computer software SPSS version 25.0. Patients studied were mainly middle-aged with mean age 44 ±5.2 years and predominantly female. Most of the patients had previous history of hypertension 45 (86.53%). WFNS scale 2 was observed in 34 (65.38%). Anterior communicating (Acom) artery aneurysm was more frequent which is found in 16 (30.77%) cases. 37 (71.15%) patients underwent microsurgical clipping whereas 13 (25%) patients underwent endovascular intervention and 2 (3.85%) patients needed combined approach. Complications were more in microsurgical clipping group 38 (73.08%) in comparison to endovascular group 13 (25%). GOS scale 5 was observed in 30 (57.70%) cases. Conclusion: Our experience of management of ruptured intracranial aneurysms together with their outcome have been reflected in this small study. For better outcome of ruptured intracranial aneurysms decision can be made on an individual case by case basis. Hybrid treatment option of staged endovascular and open microsurgical proceduresare sometimes needed as a combined approach. Bang. J Neurosurgery 2019; 9(1): 39-43

scholarly journals Secular pattern of aneurismal rupture with the lunar cycle and season

2016 ◽  
Vol 23 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Jillian C Banfield ◽  
Mohamed Abdolell ◽  
Jai S Shankar
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Full Moon ◽  
Lunar Cycle ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
The Moon ◽  
Moon Phases ◽  
Ruptured Intracranial Aneurysm ◽  
New Moon

Background The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. Materials and methods We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period. We included only cases with a known rupture date. We used the degree of illumination of the moon to quantitatively code the lunar cycle. Results A total of 212 cases were included in our analyses. The odds of aneurysm rupture were significantly greater ( p < 0.001) when the moon was least (new moon) and most (full moon) illuminated, as compared to the middle of the lunar cycle. The odds of rupture tended to be higher ( p = 0.059) in the summer, compared to autumn. Conclusions The odds of aneurysm rupture were greater when the moon was least illuminated (new moon) and most illuminated (full moon), compared to the middle of the lunar cycle.

Anesthetic Management of Intracranial Aneurysms

2018 ◽  
Author(s):  
Matthew J Hammer ◽  
Laura B Hemmer
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Motor Evoked Potentials ◽  
Anesthetic Management ◽  
Endovascular Coiling ◽  
Key Words Adenosine ◽  
The Past ◽  
Surgical Clip ◽  
Complex Patients ◽  
Grading Scales

Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.   This review contains 2 tables and 59 references.  Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials

Cerebral circulation time with ruptured intracranial aneurysms

1974 ◽  
Vol 41 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Shige-Hisa Okawara ◽  
Jun Kimura ◽  
Joo Y. Hahn
Keyword(s):  
Intracranial Aneurysms ◽  
Blood Circulation ◽  
Circulation Time ◽  
Arterial Phase ◽  
Preoperative Treatment ◽  
Content Type ◽  
Arterial Perfusion ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Cerebral Blood Circulation

✓ The cerebral blood circulation time (CT), including the length of the arterial phase, was obtained from rapid serial angiograms in 114 patients with ruptured intracranial aneurysms. The average CT of 7.2 sec, with a mean arterial phase of 3.1 sec, was much longer than the normal average CT of 5.4 sec with its 2.4 sec arterial phase. Longer circulation times were observed with the higher Botterell grades of clinical condition, high arterial perfusion and CSF pressures, and in cases with angiographic evidence of arterial spasm, hematoma, or hydrocephalus. Values of CT greater than 8.0 sec were associated with increased mortality and morbidity and vice versa. The value of the cerebral blood circulation time as a guide to preoperative treatment and to the prognosis of cases of ruptured intracranial aneurysm is suggested.

scholarly journals Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms

2015 ◽  
Vol 122 (1) ◽  
pp. 128-135 ◽  
Author(s):  
Christopher J. Stapleton ◽  
Brian P. Walcott ◽  
William E. Butler ◽  
Christopher S. Ogilvy
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Endovascular Coiling ◽  
Neurological Outcomes ◽  
Symptomatic Vasospasm ◽  
Increased Risk ◽  
Ruptured Intracranial Aneurysms

OBJECT Intraprocedural rerupture (IPR) of intracranial aneurysms during coil embolization is associated with significant periprocedural disability and death. However, whether this morbidity and mortality are secondary to an increased risk of vasospasm and hydrocephalus is unknown. The authors undertook this study to determine the in-hospital and long-term neurological outcomes for patients with aneurysmal subarachnoid hemorrhage (SAH) treated with coil embolization who suffer aneurysm rerupture during treatment. METHODS The records of 156 patients admitted with SAH from previously untreated, ruptured, intracranial aneurysms and treated with endovascular coiling between January 2007 and January 2014 were retrospectively reviewed. Twelve patients (7.7%) experienced IPR during coil embolization. RESULTS Compared with the cohort of patients with uncomplicated coil embolization procedures, patients with aneurysm rerupture were more likely to require external ventricular drain (EVD) placement (91.7% vs 58.3%, p = 0.02) and postprocedural EVD placement (36.4% vs 7.1%, p = 0.01), to undergo permanent ventriculoperitoneal shunt placement (50.0% vs 18.8%, p = 0.02), to develop symptomatic vasospasm (50.0% vs 18.1%, p = 0.02), and to have longer lengths of hospital stay (median 21.5 days vs 15.0 days, p = 0.04). Admission Hunt and Hess, modified Fisher, and Barrow Neurological Institute grades did not differ between the 2 cohorts, nor did long-term functional neurological outcomes as assessed by the modified Rankin Scale. CONCLUSIONS Intraprocedural rerupture during coil embolization for ruptured intracranial aneurysms is associated with an increased risk of symptomatic vasospasm and need for temporary and permanent cerebrospinal fluid diversion for hydrocephalus.

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