The Importance of Long Term Follow-up Angiography after Clipping for the Cerebral Aneurysms: Focusing on "de novo" and Enlarged Unruptured Aneurysms.

OBJECTIVE With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6–90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1–23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.

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Endovascular Treatment of Anterior Circulation Aneurysms With the p64 Flow Modulation Device: Mid- and Long-Term Results in 617 Aneurysms From a Single Center

Operative Neurosurgery ◽

10.1093/ons/opaa425 ◽

2021 ◽

Author(s):

Marta Aguilar Pérez ◽

Elina Henkes ◽

Victoria Hellstern ◽

Carmen Serna Candel ◽

Christina Wendl ◽

...

Keyword(s):

Intracranial Aneurysms ◽

High Rate ◽

Long Term Results ◽

Effective Treatment Option ◽

Anterior Circulation ◽

Acute Hemorrhage ◽

Unruptured Aneurysms ◽

Long Term Follow Up

Abstract BACKGROUND Flow diverters have become an important tool in the treatment of intracranial aneurysms, especially when dealing with difficult-to-treat or complex aneurysms. The p64 is the only fully resheathable and mechanically detachable flow diverter available for clinical use. OBJECTIVE To evaluate the safety and effectiveness of p64 for the treatment of intracranial saccular unruptured aneurysms arising from the anterior circulation over a long-term follow-up period. METHODS We retrospectively reviewed our prospectively maintained database to identify all patients who underwent treatment for an intracranial saccular (unruptured or beyond the acute hemorrhage phase) aneurysm arising from the anterior circulation with ≥1 p64 between December 2011 and December 2019. Fusiform aneurysms and dissections were excluded. Aneurysms with prior or concomitant saccular treatment (eg, coiling and clipping) were included. Aneurysms with parent vessel implants other than p64 were excluded. Anatomic features, intraprocedural complications, clinical outcome, as well as clinical and angiographic follow-ups were all recorded. RESULTS In total, 530 patients (388 females; median age 55.9 yr) with 617 intracranial aneurysms met the inclusion criteria. The average number of devices used per aneurysm was 1.1 (range 1-3). Mean aneurysm dome size was 4.8 mm (range 1-27 mm). Treatment-related morbimortality was 2.4%. Early, mid-term, and long-term angiographic follow-up showed complete or near-complete aneurysm occlusion in 76.8%, 89.7%, and 94.5%, respectively. CONCLUSION Treatment of intracranial saccular unruptured aneurysms of the anterior circulation using p64 is a safe and effective treatment option with high rate of occlusion at long-term follow-up and low morbimortality.

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Long‐Term Follow‐Up of a Patient with a De Novo p. Arg769Cys Mutation in the ATP1A3 Gene

Movement Disorders Clinical Practice ◽

10.1002/mdc3.13332 ◽

2021 ◽

Author(s):

Anjali Chouksey ◽

Asish Vijayaraghavan ◽

Sony Mohan ◽

Srija Inturi ◽

A.T. Prabhakar ◽

...

Keyword(s):

De Novo ◽

Long Term Follow Up ◽

Atp1a3 Gene

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Risk of hemorrhage from de novo cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2012.9.jns111512 ◽

2013 ◽

Vol 118 (1) ◽

pp. 58-62 ◽

Cited By ~ 22

Author(s):

William J. Kemp ◽

Daniel H. Fulkerson ◽

Troy D. Payner ◽

Thomas J. Leipzig ◽

Terry G. Horner ◽

...

Keyword(s):

Risk Factors ◽

De Novo ◽

Patient Age ◽

Patient Âgé ◽

Long Term Follow Up ◽

De Novo Aneurysm ◽

The Mean ◽

Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

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Long Term Angiographical Follow-up of Cerebral Aneurysms after Coil Embolization

Interventional Neuroradiology ◽

10.1177/15910199010070s122 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 149-154 ◽

Cited By ~ 4

Author(s):

Y. Kaku ◽

K. Hayashi ◽

M. Sawada ◽

N. Sakai

Keyword(s):

Special Reference ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Complete Obliteration ◽

Long Term Follow Up ◽

Platinum Coils

We evaluated long-term angiographical follow-up of cerebral aneurysms treated with detachable platinum coils with special reference to the long-term morphological outcomes of incompletely obliterated aneurysms. Serial long-term follow-up cerebral angiograms (>1 year) were obtained in 47 cases out of 134 cases treated with GDCs or IDCs from 1994 to 1999. In 47 patients, intial angiographical results demonstrated ten complete aneurysmal occlusion, seven aneurysms with a small neck remnant, twenty aneurysms with body filling and ten aneurysms with both of neck remnant and body filling. In the ten completely obliterated aneurysms, follow-up angiograms revealed no aneurysmal recanalization. In seven aneurysms with neck remnant, three remained unchanged, four showed enlargement of contrast filling in the part of the neck of the aneurysm. In twenty aneurysms with body filling, five had developed into complete obliteration, three remained unchanged, 11 had recanalization, and one aneurysm displayed regrowth. In ten aneurysms with both of neck remnant and body filling, two remained unchanged, five had recanalization, and three aneurysms displayed regrowth. Long-term angiographical follow-up results are less satisfactory in cases involving incompletely obliterated lesions. A higher incidence of recanalizations were promoted in cases with neck remnant and/or body filling. Strict follow-up angiography is mandatory when a complete obliteration is not achieved.

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56 Use of sirolimus coated balloon in de novo small vessel coronary lesions; long-term follow-up from a single centre registry

10.1136/heartjnl-2021-bcs.56 ◽

2021 ◽

Author(s):

Bhagya Harindi Loku Waduge ◽

Harkaran Kalkat ◽

Ameenathul Mazaya Fawzy ◽

Abdullah Saif ◽

Sampath Athukorala ◽

...

Keyword(s):

De Novo ◽

Small Vessel ◽

Single Centre ◽

Long Term Follow Up ◽

Coronary Lesions

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Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991001600301 ◽

2010 ◽

Vol 16 (3) ◽

pp. 231-239 ◽

Cited By ~ 5

Author(s):

L.M. Pyysalo ◽

L.H. Keski-Nisula ◽

T.T. Niskakangas ◽

V.J. Kähärä ◽

J.E. Öhman

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Bleeding Rate ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Follow Up Study ◽

Long Term Follow Up ◽

Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

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Long-term follow-up until early adulthood in autosomal dominant, complex SPG30 with a novel KIF1A variant: a case report

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0752-5 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 3

Author(s):

Carlotta Spagnoli ◽

Susanna Rizzi ◽

Grazia Gabriella Salerno ◽

Daniele Frattini ◽

Carlo Fusco

Keyword(s):

Autosomal Dominant ◽

De Novo ◽

Current Knowledge ◽

Brain Mri ◽

Early Adulthood ◽

Cerebellar Atrophy ◽

Mild Intellectual Disability ◽

Long Term Follow Up

Abstract Background Pathogenic variants in KIF1A (kinesin family member 1A) gene have been associated with hereditary spastic paraplegia (HSP) type 30 (SPG30), encopassing autosomal dominant and recessive, pure and complicated forms. Case presentation We report the long-term follow-up of a 19 years-old boy first evaluated at 18 months of age because of toe walking and unstable gait with frequent falls. He developed speech delay, mild intellectual disability, a slowly progressive pyramidal syndrome, microcephaly, bilateral optic subatrophy and a sensory axonal polyneuropathy. Brain MRI showed cerebellar atrophy, stable along serial evaluations (last performed at 18 years of age). Targeted NGS sequencing disclosed the de novo c.914C > T missense, likely pathogenic variant on KIF1A gene. Conclusions We report on a previously unpublished de novo heterozygous likely pathogenic KIF1A variant associated with slowly progressive complicated SPG30 and stable cerebellar atrophy on long-term follow-up, adding to current knowledge on this HSP subtype.

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