Results of endovascular treatment of aneurysms depending on their size,volume and coil packing density

Background and purposeIn contrast to neurosurgery, which is more efficient, endovascular treatment (EVT) is less invasive. The main purpose of EVT is complete occlusion of the aneurysm and protection from subarachnoid haemorrhage. Accurate measurements of the aneurysm (size, volume) obtained using a 3D digital subtraction angiography (DSA) workstation can assist in the proper assessment of coil packing density (CPD), which affects possible distant recanalization. The main disadvantage of endovascular treatment of intracranial aneurysms compared to neurosurgery is the high recurrence rate. We evaluated the results of endovascular treatment of aneurysms depending on their size, volume and coil packing density.Material and methodsThirty-five patients with intracranial aneurysms underwent endovascular embolization with bare platinum coils. Three-dimensional DSA was used to evaluate aneurysms’ morphology. Eighteen patients underwent 3D DSA follow-up 6-45 months after treatment. Initial and follow-up results of embolization were assessed with the Raymond-Montreal scale. The impact of aneurysms’ morphology, volume and initial CPD on endovascular treatment was evaluated.ResultsAmong 35 patients, complete initial embolization was achieved in 74%. Mean initial aneurysm volume in 3D DSA was 0.517 mL and decreased significantly after embolization. Initial CPD varied from 74% to 2% depending on aneurysm diameter (12.1% for aneurysms ≥ 10 mm, 22.5% for aneurysms < 10 mm). Results of embolization on the Raymond-Montreal scale significantly depended on aneurysms’ CPD. Aneurysms’ recanalization rate on 3D DSA follow-up was 36%, with complete recanalization in 3.3%.ConclusionsWe can achieve a better outcome if size and volume of the aneurysm sac is smaller and if CPD is higher.     

Detection of intracranial aneurysms with unenhanced and echo contrast enhanced transcranial power Doppler

OBJECTIVE: To assess transcranial power Doppler and the effect of an intravenous ultrasonic contrast agent for detecting intracranial aneurysms in patients admitted with a subarachnoid haemorrhage METHODS: 203 patients with subarachnoid haemorrhage were examined with the operator blind to the results of the admission CT and subsequent digital subtraction angiogram (DSA). In 98 cases patients were imaged using unenhanced transcranial power Doppler, and in 105 cases, patients were imaged both using unenhanced and echo contrast enhanced (Levovist, Schering AG) transcranial power Doppler. RESULTS: DSA detected 168 intracranial aneurysms in 128 patients (24 patients had multiple lesions) and 75 patients had an aneurysm negative DSA. There was agreement between DSA and transcranial power Doppler in 87 intracranial aneurysms of which 20 were only detected after infusion of contrast agent. Without contrast infusion, transcranial power Doppler showed a sensitivity of 40% and specificity of 91%. A significant increase in detection was noted when using a contrast agent (chi(2) = 9.49, p<0.001). With a contrast study the sensitivity increase to 55% with a specificity of 83%. Intracranial aneurysm detection by transcranial power Doppler was significantly dependent on position using a contrast infusion (chi(2) = 15.87, p<0.05). A positive correlation was also found between the size of intracranial aneurysms measured by transcranial power Doppler and DSA (r = 0.55, p<0.05). The transcranial power Doppler sensitivity and specificity increased with larger aneurysms and reached 100% for intracranial aneurysms greater than 12 mm diameter. Detection by transcranial power Doppler was also dependent on morphology (chi(2) = 14.46, p<0.001). CONCLUSIONS: The detection of intracranial aneurysm by transcranial power Doppler is dependent on aneurysm location, size, and morphology and is enhanced with the use of an intravenous contrast agent.     

Three-dimensional digital subtraction angiography vs two-dimensional digital subtraction angiography for detection of ruptured intracranial aneurysms: a study of 86 aneurysms

AIMS: Three-dimensional reconstruction of intracranial vessels is of interest for evaluation of aneurysms. This study determined diagnostic difference of three-dimensional digital subtraction angiography (3D-DSA, volume-rendering image) versus 2D-DSA for evaluating ruptured intracranial aneurysms, particularly focusing on the size of aneurysms as depicted in both images. SETTINGS AND DESIGN: Sixty-nine patients underwent 3D-DSA and 2D-DSA. The relative size of an aneurysm, which is the ratio of the maximal diameter of an aneurysm to the diameter of a major vessel, was compared between imaging techniques. In addition, relative sizes of smaller aneurysms (< 5 mm) were compared with those of larger aneurysms (>10 mm). Statistical analysis used: For comparison of aneurysm size and location of aneurysm, statistical analysis was performed with the Yates chi square test; statistical significance was set with a P value of less than 0.05. RESULTS: Sixty-three (73.3%) of the 86 total aneurysms were bigger when measured with 3D-DSA versus 2D-DSA. When measured with 3D-DSA, 28 (84.8%) of the 33 smaller aneurysms were bigger, and 50% of the larger aneurysms were bigger versus measurements of 2D-DSA images (P < 0.05). In ACA and ICA territories, which tended to have smaller mean aneurysmal size, relative size of the aneurysm was bigger when measured with 3D-DSA (81.5% and 81.0%, respectively). In MCA, where the mean aneurysmal size was the largest, relative size of aneurysms was bigger when measured with 3D-DSA in 15 cases (53.6%, P < 0.05). In the posterior circulation, aneurysm size was similar between 3D-DSA and 2D-DSA measurements. CONCLUSIONS: 3D-DSA, especially volume-rendering images, tends to depict ruptured intracranial aneurysms bigger than 2D-DSA. This is particularly true with cerebral aneurysms that are < 5 mm in size and are located in the anterior circulation, especially ICA and ACA territories.     

Which unruptured cerebral aneurysms should be treated? A cost-utility analysis.

OBJECTIVE: To determine which unruptured cerebral aneurysms should be treated considering the risks. benefits, and costs. BACKGROUND: Asymptomatic unruptured cerebral aneurysms are commonly treated by surgical clipping or endovascular coil embolization to prevent subarachnoid hemorrhage (SAH). METHODS: We performed a cost-utility analysis comparing surgical clipping and endovascular coil embolization with no treatment for unruptured aneurysms. Eight clinical scenarios were defined based on aneurysm size, symptoms, and history of SAH from a different aneurysm. Health outcomes of a hypothetical cohort of 50-year-old women were modeled over the projected lifetime of the cohort. Costs were assessed from the societal perspective. We compared net quality-adjusted life years (QALYs) and cost per QALY of each therapy to no treatment. RESULTS: For an asymptomatic unruptured aneurysm less than 10 mm in diameter in patients with no history of SAH from a different aneurysm, both procedures resulted in a net loss in QALYs, and confidence intervals (CI) were not compatible with a benefit from treatment (clipping, loss of 1.6 QALY [95% CI 1.1 to 2.1]; coiling, loss of 0.6 QALY [95% CI 0.2 to 0.8]). For larger aneurysms (> or = 10 mm), those producing symptoms by compressing neighboring nerves and brain structures, or in patients with a history of SAH from a different aneurysm, treatment was cost-effective. Coiling appeared more effective and cost-effective than clipping but these differences depended on relatively uncertain model parameters. CONCLUSIONS: Treatment of small, asymptomatic, unruptured cerebral aneurysms in patients without a history of SAH worsens clinical outcomes, and thus is neither effective nor cost-effective. For aneurysms that are > or = 10 mm or symptomatic, or in patients with a history of SAH, treatment appears to be cost-effective.     

Unruptured cerebral aneurysms: clinical analysis of 80 cases and its new classification

We experienced 94 unruptured cerebral aneurysms in 80 patients in our clinic between April 1979 and March 1985, and analyzed them in the light of the symptomatological factor, diagnostical factor, significance of aneurysm itself and its treatment. Based on these clinical analysis, unruptured cerebral aneurysms were classified into the following 4 groups; Group 1: intact aneurysm in multiple aneurysms in patients with subarachnoid hemorrhage, Group 2: asymptomatic aneurysm discovered incidentally during the investigation of various diseases other than cerebral aneurysm, Group 3: symptomatic aneurysm with compression or ischemic clinical signs, or subjective symptoms due to aneurysm, Group 4: asymptomatic aneurysm screened by a noninvasive method in healthy humans, or in patients with a risk factor for cerebrovascular diseases, with diseases predisposed to aneurysm, and with minor subjective symptoms unrelated to aneurysm. Group 1 included 36 aneurysms in 31 patients, with internal carotid aneurysms being predominant; the size of 3 mm was most frequently found and those smaller than 10 mm formed in 92%. An operation for aneurysm was performed in 17 patients without operative morbidity and mortality. Among 14 unoperated patients one died of hemorrhage from an unruptured cerebral aneurysm. Indication for operation in Group 1 is determined depending on the patient's severity due to initial SAH. Group 2 was composed of 13 aneurysms in 12 patients; internal carotid aneurysm and anterior cerebral aneurysm, 5 each, being dominant. The size of 3 mm was most frequently seen and all were smaller than 7 mm. An operation was performed in 5 patients all showing a favorable course.(ABSTRACT TRUNCATED AT 250 WORDS)     

Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后分析

目的研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后。方法回顾性分析收治的2011年1月至2015年12月100例颈内动脉眼动脉段动脉瘤患者的临床和影像学资料,总结研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤患者的长期预后。结果 100例患者中,共计104个颈内动脉眼动脉段动脉瘤,其中77个小动脉瘤(直径≤15mm),27个大动脉瘤(直径15mm至≤25mm)。根据颈内动脉眼动脉段动脉瘤的分类,36个动脉瘤属眼动脉瘤(Ⅰ型),68个动脉瘤属垂体上动脉动脉瘤(Ⅱ型)。94%患者完成临床随访[平均随访时间(28.89±17.63)个月],随访患者中97.8%患者远期预后良好(m RS 0~2分);82%患者完成影像学随访[平均随访时间(12.34±7.69)个月],其中7个动脉瘤出现颈部残留,4个动脉瘤复发再通。手术并发症发生率为8.0%,血栓形成3例、弹簧圈脱出2例、血管痉挛2例、动脉瘤破裂出血1例。单因素回归分析提示动脉瘤大小(P=0.000)与动脉瘤不完全栓塞相关;多因素回归分析提示动脉瘤不完全栓塞(P=0.038)与动脉瘤复发相关。结论 Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,动脉瘤体积越大难以完全栓塞,复发率相对更高。     

Size and Location of Ruptured Intracranial Aneurysms

Objective

The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location.

Methods

We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital.

Results

There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was 5.47±2.536 mm in anterior cerebral artery (ACA), 6.84±3.941 mm in ICA, 7.09±3.652 mm in MCA and 6.21±3.697 mm in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA.

Conclusion

Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.     

血管内栓塞治疗基底动脉顶端动脉瘤

目的报告基底动脉顶端动脉瘤的血管内栓塞治疗结果，以探讨基底动脉顶端动脉瘤血管内栓塞治疗的安全性和有效性：方法回顾性分析48例基底动脉顶端动脉瘤的血管内治疗效果。未破裂动脉瘤11例，蛛网膜下腔出血14d以上动脉瘤37例。动脉瘤直径小于12mm者31例，12～25mm者14例，大于25mm者3例。临床随访43例，平均随访时间19．5个月。脑血管造影随访33例，平均随访时间8．2个月。结果48例均行血管内栓塞治疗，其中17例应用”再塑形”技术栓塞治疗。动脉瘤100％栓塞29例(60．4％)，90％以上栓塞14例(29．2％)，90％1)2下栓塞5例(10．4％)。缺血性并发症2例，无死亡。33例造影复查：25例同栓塞当时相比无变化，8例复发，其中7例是由于弹簧圈发生回缩而复发，4例再次行栓塞治疗。8例复发动脉瘤中，7例动脉瘤直径大于12mm，1例小于12mm。临床随访过程中无动脉瘤再破裂。结论血管内栓塞治疗是基底动脉顶端动脉瘤安全有效的治疗方法；动脉瘤的大小和动脉瘤颈是影响治疗效果的重要因素。     

Risk factors for multiple intracranial aneurysms rupture: A retrospective study

Background and purpose

The presence of predicting the rupture risk of intracranial aneurysms has recently generated considerable controversy. We retrospectively investigated the risk factors for multiple intracranial aneurysms related to rupture.

Methods

Between July 2007 and July 2011, 134 patients with 294 aneurysms were identified after review. Every patient had two or more aneurysms. Univariate and multivariate logistic regression models were used to analyze the risk factors for multiple intracranial aneurysms with age, gender, site and size.

Results

134 patients were divided into three groups according to patient age category (<45, 45–65, >65 years of age). The incidence of aneurysms ruptured in the second group was significantly higher. Three groups showed significant difference (P = 0.001 versus >65 years of age). Thirteen of 35 AComA aneurysms were ruptured, accounting for 26% of all ruptured aneurysms, and the rate of rupture at AComA aneurysms in patients was 37.1%. The rate of aneurysm rupture in the AComA was significantly higher than that in other sites (P = 0.001). In all 294 aneurysms, 88.1% of the aneurysms were 5 mm or less, of which 58.2% were less than 3 mm. In the ruptured aneurysms, 68% were 5 mm or less.

Conclusions

Our study reveals the pattern of ruptured multiple intracranial aneurysms, in terms of age, size and location of aneurysms. Age, size, and site of aneurysm should be considered in the decision whether to treat an unruptured aneurysm or not. Especially, in cases of multiple aneurysm, the AComA aneurysm is most prone to hemorrhage.     

不同直径颅内动脉瘤行介入栓塞治疗效果的对比观察

目的 比较不同直径颅内动脉瘤行介入栓塞治疗的临床效果。方法 选择本院收治的颅内动脉瘤颅内未破裂动脉瘤42例,根据直径不同分为2组:小型动脉瘤组(最大直径≤5 mm)19例和中大型动脉瘤组23例; 所有患者均采用介入栓塞治疗,出院3个月和6个月进行门诊和电话随访,并通过本院DSA随访,比较2组患者栓塞率、并发症发生率、复发率等。结果 2组栓塞情况对比,小型瘤完全栓塞率(95.7%)高于中大型组(91.3%)(P<0.05); 治疗后小型组并发症发生率(13.0%)低于对照组(43.5%)(P<0.05); 术后小型组复发率(8.7%)低于中大型组(43.5%); 小型组GOS评分(2.1±0.9)分高于中大型组(1.1±0.5)分(P<0.05)。结论 两种不同直径、不同大小的动脉瘤采用介入栓塞治疗的效果均较好,但治疗小型动脉瘤效果更佳。     

Evaluation of the angiographic outcomes after clipping of intracranial aneurysms: determination of predisposing factors for occurrence of aneurysm remnants

ABSTRACT

Objectives: Aneurysm remnants after microsurgical clipping have a risk of regrowth and rupture and have not been validated in the era of three-dimensional angiography. Therefore, this study aimed to evaluate the angiographic outcome using three-dimensional rotational images and determine the predictors for remnants after microsurgical clipping.

Methods: Between January 2014 and May 2017, 139 aneurysms in 106 patients who were treated with microsurgical clipping, were eligible for this study. For the determination of aneurysm remnants after microsurgical clipping, the angiographic outcomes were evaluated using follow-up digital subtraction angiography within 7 days for unruptured aneurysms or within 2 weeks for ruptured aneurysms. According to the Sindou classification, the aneurysm remnants were dichotomized, and subgroup analysis was performed to identify the predictors of aneurysm remnants after clipping with various imaging parameters and clinical information.

Results: The overall rate of aneurysm remnants was 29.5% (41/139), in which retreatments were needed in 6.5% (9/139). The neck size and maximum diameter of aneurysms were independent predisposing factors for the aneurysm remnants that need retreatment (OR: 2.30; p < 0.001; OR: 1.38; p < 0.001, respectively).

Conclusions: This study demonstrated a low incidence of aneurysm remnants after microsurgical clipping which need to retreatment. However, selective postoperative angiography could provide us clear information of surgical result and evidence for long-term follow-up for some aneurysms with larger neck size (>5.7 mm) and maximum diameter (>7.1 mm).     

颅内外动脉狭窄合并颅内无症状动脉瘤的血管内治疗策略研究

目的 探索颅内外动脉狭窄合并颅内无症状动脉瘤的安全和有效的血管内治疗策略。 方法 回顾性分析北京天坛医院急诊介入科2012年9月～2013年8月收住的因颅内外动脉狭窄拟行支 架治疗且合并颅内无症状动脉瘤的患者26例。对其临床、影像学资料、治疗措施及结果、并发症及预 后等进行分析。 结果 26例患者共发现≥70%的狭窄或闭塞病变54处,动脉瘤30枚（非同流域16枚,狭窄后7枚,狭窄 处3枚,狭窄前4枚）。26例患者中21例实施了狭窄病变的支架置入术,共干预25个狭窄/闭塞病变,技 术成功率100%。选择个体化的动脉瘤干预措施：16例患者的17枚动脉瘤（非同流域、直径＜5 mm、 夹层）建议随访观察;2例患者的2枚动脉瘤（直径＞5 mm、形状不规则）择期行栓塞术;5例患者的 6枚动脉瘤（狭窄后、狭窄处、多发性、直径＞5 mm、后交通段）同期行栓塞术或支架覆盖;3例患者 的5枚动脉瘤（狭窄后、分叶状、多发性、直径＞5 mm）建议介入治疗但因家属拒绝手术等原因选择随 访观察。术后发生脑室出血1例。临床随访10～21个月,所有患者均预后良好,仅发现无症状性支架内 再狭窄1例。 结论 颅内外动脉狭窄合并颅内无症状动脉瘤时根据动脉瘤与狭窄病变的位置关系,动脉瘤大小、 形态、位置、数量和患者情况等综合分析后给予个体化血管内治疗安全、有效。     

3.0T磁共振MRA在蛛网膜下腔出血颅内动脉瘤筛查中的应用价值

目的探讨3.0T磁共振MRA在蛛网膜下腔出血颅内动脉瘤筛查中的应用价值。方法利用3.0T磁共振对31例因蛛网膜下腔出血而筛查出脑动脉瘤患者进行回顾性分析,31例脑动脉瘤患者均行常规T1WI、T2WI及3D TOF MRA检查,对检查的信息进行MIP、MPR及VR后处理并结合原始薄层图像进行分析诊断。所有病例均由DSA最后确诊后治疗。结果小动脉瘤(<5 mm)11个,中动脉瘤(>5 mm)13个,大动脉瘤(>10 mm)9个。动脉瘤的分布:大脑中动脉瘤8个,大脑前动脉瘤7个,大脑后动脉瘤3个,前交通动脉瘤5个,后交通动脉瘤6个,基底动脉瘤1个,颈内动脉海绵窦段动脉瘤2个,椎动脉瘤1个。结论 3.0T磁共振MRA可成为蛛网膜下腔出血颅内动脉瘤筛查的有效检查方法,值得临床推广。     

Postoperative Clipping Status after a Pterional versus Interhemispheric Approach for High-Positioned Anterior Communicating Artery Aneurysms

ObjectiveWhen treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. MethodsTwenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. ResultsThe pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. ConclusionFor high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.     

Unruptured intracranial aneurysms

Between 3.6 and 6% of the population harbour an unruptured intracranial aneurysm. Risk of rupture is related to aneurysm site and size and whether or not the patient has already had a subarachnoid haemorrhage (SAH) from another aneurysm. In ISUIA 2, the rupture rate for anterior circulation aneurysms<7mm was 0% per year in patients with no prior SAH, and 0.3% per year in patients with previous SAH; 7-12mm aneurysms, 0.5% per year (both groups); 13-24mm aneurysms, 3% per year; and giant aneurysms 8% per year. Rupture rate for posterior circulation aneurysms is higher at all sizes:<7mm was 0.5% per year in subjects with no prior SAH, 0.7% in those with prior SAH; 7-12mm, 3% per year; 13-24mm, 3.7% per year; and giant aneurysms, 10% per year. Non-invasive tests like contrast enhanced magnetic resonance angiography (MRA) and multislice computed tomographic angiography (CTA) are alternatives to intra-arterial digital subtraction angiography (IADSA) to detect aneurysms. Although these are promising techniques, the quality of data testing their accuracy remains limited and single slice CTA and time-of-flight MRA are poorer at detecting aneurysms<5mm diameter, which account for up to 1/3 of unruptured aneurysms. For ruptured aneurysms, the only large scale randomised controlled trial comparing surgical and endovascular treatment (ISAT) by coiling, resulted in an absolute 8.8% reduction (updated figure as of June 2003 for 1888 patients) in death or dependency at 1 year compared with surgical clipping. For unruptured aneurysms, the best available data so far comparing coiling and clipping is from the prospective (but non-randomised) arm of ISUIA. Elective surgical clipping had combined morbidity and mortality at 1 year of 12.2% versus 9.5% for coiling, although the groups were not matched with more high risk patients in the endovascular treatment cohort. Nevertheless these data are encouraging for future randomised trials of elective coiling versus clipping for asymptomatic aneurysms, in particular as the unproven long-term durability of coiling treatment and the fact that complete aneurysm occlusion is not always achieved remain obstacles to its wider use in unruptured aneurysms. There is an increased risk of SAH in relatives of patients with SAH (highest in those with two or more first degree relatives affected), but most SAH is sporadic and therefore the balance of available evidence indicates that mass screening for aneurysms is not cost effective. There may be a limited role for investigation of high-risk subgroups and ideally such screening should be tested in a randomised trial. The avoidance and active management of vascular risk factors should also be part of the management of at risk subjects.     

Unruptured intracranial aneurysm and transient focal cerebral ischemia: a follow-up study

Transient focal cerebral ischemia may occasionally be due to distal embolization of a clot from an unruptured intracranial aneurysm. Follow-up data in 12 such patients revealed no ischemic strokes, subarachnoid or parenchymal hemorrhages in a mean follow-up period of 6.5 years. The aneurysms ranged in size from 2 to 12 mm in diameter, and only two were larger than 10 mm. Two patients had clip ligation of the aneurysm, five patients were given platelet antiaggregation therapy, one was given oral anticoagulants after aortic valve surgery, and four had no specific therapy. The prognosis for unruptured aneurysms presenting with transient focal ischemia was good, regardless of therapy.     

Epidemiologic and anatomic aspects comparing incidental and ruptured intracranial aneurysms: A single centre experience

The feasibility of multicentric international data such as integrated in the PHASES score for patient counseling in unruptured intracranial aneurysms has recently been challenged. To determine, whether this data is applicable to local populations in a restricted catchment area, we performed a retrospective mono-centric analysis comparing patients with ruptured aneurysms to patients with incidental aneurysms. 200 patients with unruptured aneurysms and 197 patients after aneurysmal subarachnoid hemorrhage were analyzed for risk factors differing between the groups and to the general German population. Subgroup analysis was performed for 25 patients harboring multiple aneurysms, in 19 patients with intracavernous aneurysms and in 77 women of childbearing potential. While the preponderance of female patients was confirmed, significantly more men figured in the patient group with subarachnoid hemorrhage (36.4%) than among unruptured aneurysms (25%). Patients with bleeding events were significantly younger (51.6 years) than patients with incidental aneurysms (57.8 years). The rupture risk prediction of the PHASES score concerning aneurysm size below 7 mm and patient age over 70 years could not be confirmed, instead score points correlated to the clinical outcome after rupture. In our population, pregnant women were not overrepresented. Intracavernous carotid aneurysms contributed to the low risk profile of giant aneurysms. Thus, recommendations from pooled international data have to be adapted cautiously to local circumstances. We retained seven items with predictive value for outpatient counseling: age, smoking, hypertonus and concurrent vascular aberrations as patient characteristics and irregular shape, (increasing) largest diameter and the harboring vessel for the aneurysm.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.     

颅内动脉瘤术中破裂危险因素分析

目的 分析颅内动脉瘤显微外科手术术中破裂的相关因素.方法 回顾性分析106例开颅显微手术治疗的颅内动脉瘤病人,对可能影响其破裂的因素,如性别、年龄、高血压病史、Hunt-Hess分级、CT-Fisher分级、动脉瘤部位、大小、瘤颈宽窄、手术时机、临时阻断夹应用与否、是否存在假性动脉瘤等,进行单因素和多因素logistic回归分析,寻找影响术中破裂的危险因素.结果 术中破裂动脉瘤的发生率是26.13%;Hunt-Hess分级、动脉瘤瘤颈宽窄、临时阻断与否、是否存在假性动脉瘤是术中动脉瘤破裂的危险因素;宽颈动脉瘤(OR=10.791,P=0.000),存在假性动脉瘤(OR=32.752,P=0.002),Hunt-Hess分级(OR=0.073,P=0.002)是术中动脉瘤破裂独立危险因素;术中临时阻断技术的应用(OR=0.055,P=0.001)是术中动脉瘤破裂独立保护因素.结论 颅内动脉瘤显微外科手术术中破裂主要与宽颈动脉瘤、存在假性动脉瘤、Hunt-Hess分级有关.临时阻断技术的应用为保护因素.