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Sample records for traumatic intracranial aneurysms

  1. Unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Backes, D

    2016-01-01

    Rupture of an intracranial aneurysm results in aneurysmal subarachnoid hemorrhage (SAH), a subtype of stroke with an incidence of 9 per 100,000 person-years and a case-fatality around 35%. In order to prevent SAH, patients with unruptured intracranial aneurysms can be treated by neurosurgical or

  2. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    International Nuclear Information System (INIS)

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. BSCTA is easily accessible, less time consuming, and most importantly, a non

  3. The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage

    Science.gov (United States)

    Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

    2014-01-01

    Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. Conclusions: BSCTA is

  4. Endovascular treatment of intracranial aneurysm

    International Nuclear Information System (INIS)

    Wang Zhigang; Li Guoxin; Qu Yuanming; Tang Jun; Liu Zuoqin

    2001-01-01

    Objective: To setup an endovascular treatment of intracranial aneurysm with detachable balloon and micro-coil. Methods: Trans-femoral artery Seldinger's catheterization was used. Balloons and free MDS, GDC micro-coils were pushed into the aneurysm or carrying arteries. Results: No mortality occurred in authors' group. Internal carotid arteries (ICA) were occluded with detachable balloons in 5 aneurysms at sinus segment of ICA and 4 traumatic pseudo-aneurysms. No complications occurred. 9 aneurysms were completely occluded with micro-coils and 2 were partly (95%) occluded. 2 patients got mild paralysis due to vasospasm or mal detaching of MDS coils. Conclusions: Balloon occlusion of ICA for treatment of aneurysm at sinus segment is safe and effective in case of having abundant collateral circulation. Coil occlusion of intracranial aneurysm is a promising method of endovascular treatment. Compared with MDS, GDC coil is safer but expensive. Free coil is not very safe theoretically, but can be used with careful consideration as it is much cheaper

  5. Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Raymond, J.; Guillemin, F.; Proust, F.; Molyneux, A.J.; Fox, A.J.; Claiborne, J.S.; Meder, J.-F.; Rouleau, I.

    2008-01-01

    Summary The preventive treatment of unruptured aneur­ysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blin­ding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem. PMID:20557790

  6. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies.

  7. Phase contrast MRI in intracranial aneurysms

    NARCIS (Netherlands)

    van Ooij, P.

    2012-01-01

    Intracranial aneurysms are outpouchings of intracranial arteries that cause brain hemorrhage after rupture. Unruptured aneurysms can be treated but the risk of treatment may outweigh the risk of rupture. Local intra-aneurysmal hemodynamics can contribute substantially to the rupture risk estimation

  8. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms....... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated...

  9. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  10. Endovascular Treatment of Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Yue, W.

    2011-01-01

    Summary We report the clinical and angiographic results of endovascular treatment of unruptured intracranial aneurysms. Over a three-year period, 80 unruptured aneurysms in 74 patients were electively treated with endovascular management. One aneurysm was diagnosed during investigations for a second ruptured aneurysm, 54 aneurysms were incidentally discovered, 18 aneurysms presented with symptoms of mass effect and seven aneurysms presented with symptoms of brain stem ischemia. Mean size of the 80 unruptured aneurysms was 12.5±8.0 mm (range, 2-39 mm). Thirty-six aneurysms (45%) were small (<10 mm), 38 aneurysms (47.5%) were large (10-25 mm), and six aneurysms (7.5%) were giant (25-39 mm). Forty-eight wide-necked aneurysms (60%) were coiled with the aid of a supporting device. The mortality rate was 1.25%, and the overall morbidity was 1.25%. Of these, one of the patients suffered a stroke, leading to severe disability (1.25%). In one patient, the aneurysm ruptured during treatment, resulting in death. Initial aneurysm occlusion was complete (100%) in 76.25% aneurysms, nearly complete (90%-98%) in 10% aneurysms and incomplete (60%-85%) in 13.75% aneurysms. Follow-up angiography was available in 67 patients with 73 treated aneurysms (91.25%) from one to 36 months (mean 9.3 months); partial reopening occurred in 7.5%, mainly large and giant aneurysms (5.5%). Additional coiling was performed in four aneurysms. There were no complications in additional treatments. At 14.1-month clinical follow-up (range, 2 to 36 months), mRS score was 0 in 78.75% patients, 1 in 10% patients, 2 in 8.75% and 3 in 1.25%. There was no aneurysmal rupture during the follow-up period. Endovascular treatment of unruptured intracranial aneurysms has low procedural mortality and morbidity rates. PMID:22192544

  11. MR angiography after coiling of intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion

  12. Delayed Rebleeding of Cerebral Aneurysm Misdiagnosed as Traumatic Subarachnoid Hemorrhage

    OpenAIRE

    Song, Seung-Yoon; Kim, Dae-Won; Park, Jong-Tae; Kang, Sung-Don

    2016-01-01

    An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head traum...

  13. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  14. The radiological appearance of intracranial aneurysms in adults ...

    African Journals Online (AJOL)

    2014-04-04

    %. Limited literature is available on intracranial aneurysms in HIV-infected patients. Objectives: To describe the radiological appearance of intracranial aneurysms in HIV- positive adults. Method: In this retrospective analysis of ...

  15. CONTEMPORARY ENDOVASCULAR TREATMENT OF INTRACRANIAL ANEURYSMS

    Directory of Open Access Journals (Sweden)

    Dragan Stojanov

    2015-06-01

    Full Text Available In the past twenty years we have witnessed a revolution in the treatment of intracranial aneurysms. Endovascular technique and materials have rapidly developed since the approval of Guglielmi detachable coils in 1995 which now allow successful treatment of most aneurysms. The development of intracranial stents and balloons for stent-assisted coiling and balloon-remodeling technique further expanded the spectrum of aneurysms treatable with endovascular technique. For these reasons, the aim of this review was to describe endovascular technique and materials which we use in our daily practice, to show benefits of endovascular treatment and to discus complications of endovascular treatment and surgical treatment of intracranial aneurysms. Endovascular treatment is more comfortable for the patient not only because it is minimally invasive but also because it does not require long hospitalization equal to that after surgical treatment. It is a fact that with further development of endovascular materials, this a procedure will have even a more significant place in the treatment of intracranial aneurysms.

  16. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  17. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Caranci, F.; Briganti, F.; Cirillo, L.; Leonardi, M.; Muto, M.

    2013-01-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  18. Genetics of intracranial aneurysms and related diseases

    NARCIS (Netherlands)

    van 't Hof, F.N.G.

    2017-01-01

    Intracranial aneurysms (IA) are dilatations of the vessel walls of cerebral arteries. Some can rupture and result in a subarachnoid hemorrhage (SAH), a severe subtype of stroke. This thesis is set out to elucidate the pathophysiology of IA from a genetic perspective. The main conclusions are: 1.

  19. Genetic Determinants of Unruptured Intracranial Aneurysms in the General Population.

    Science.gov (United States)

    Peymani, Abbas; Adams, Hieab H H; Cremers, Lotte G M; Krestin, Gabriel; Hofman, Albert; van Duijn, Cornelia M; Uitterlinden, André G; van der Lugt, Aad; Vernooij, Meike W; Ikram, M Arfan

    2015-10-01

    Genome-wide association studies have identified single-nucleotide polymorphisms (SNPs) for intracranial aneurysms in clinical samples. In addition, SNPs have been discovered for blood pressure, one of the strongest risk factors for intracranial aneurysms. We studied the role of these genetic variants on occurrence and size of unruptured intracranial aneurysms, discovered incidentally in a general community-dwelling population. In 4890 asymptomatic participants from the Rotterdam Study, 120 intracranial aneurysms were identified on brain imaging and segmented for maximum diameter and volume. Genetic risk scores (GRS) were calculated for intracranial aneurysms (10 SNPs), systolic blood pressure (33 SNPs), and diastolic blood pressure (41 SNPs). The GRS for intracranial aneurysms was not statistically significantly associated with presence of aneurysms in this population (OR, 1.16; 95% CI, 0.96-1.40; P=0.119), but showed a significant association with both maximum diameter (difference in log-transformed mm per SD increase of GRS, 0.10; 95% CI, 0.02-0.19; P=0.018) and volume (difference in log-transformed µL per SD increase of GRS, 0.21; 95% CI, 0.01-0.41; P=0.040) of aneurysms. GRSs for blood pressures were associated with neither presence nor size of aneurysms. Genetic variants previously identified for intracranial aneurysms in clinical studies relate to the size rather than the presence of incidentally discovered, unruptured intracranial aneurysms in the general population. © 2015 American Heart Association, Inc.

  20. Shared genetic risk factors of intracranial, abdominal, and thoracic aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    Background--Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and

  1. Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

    NARCIS (Netherlands)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Lee, Cue Hyunkyu; Ripke, Stephan; Anderson, Graig; de Andrade, Mariza; Baas, Annette F; Blankensteijn, Jan D; Böttinger, Erwin P; Bown, Matthew J; Broderick, Joseph; Bijlenga, Philippe; Carrell, David S; Crawford, Dana C; Crosslin, David R; Ebeling, Christian; Eriksson, Johan G; Fornage, Myriam; Foroud, Tatiana; von Und Zu Fraunberg, Mikael; Friedrich, Christoph M; Gaál, Emília I; Gottesman, Omri; Guo, Dong-Chuan; Harrison, Seamus C; Hernesniemi, Juha; Hofman, Albert; Inoue, Ituro; Jääskeläinen, Juha E; Jones, Gregory T; Kiemeney, Lambertus A L M; Kivisaari, Riku; Ko, Nerissa; Koskinen, Seppo; Kubo, Michiaki; Kullo, Iftikhar J; Kuivaniemi, Helena; Kurki, Mitja I; Laakso, Aki; Lai, Dongbing; Leal, Suzanne M; Lehto, Hanna; LeMaire, Scott A; Low, Siew-Kee; Malinowski, Jennifer; McCarty, Catherine A; Milewicz, Dianna M; Mosley, Thomas H; Nakamura, Yusuke; Nakaoka, Hirofumi; Niemelä, Mika; Pacheco, Jennifer; Peissig, Peggy L; Pera, Joanna; Rasmussen-Torvik, Laura; Ritchie, Marylyn D; Rivadeneira, Fernando; van Rij, Andre M; Santos-Cortez, Regie Lyn P; Saratzis, Athanasios; Slowik, Agnieszka; Takahashi, Atsushi; Tromp, Gerard; Uitterlinden, André G; Verma, Shefali S; Vermeulen, Sita H; Wang, Gao T; Han, Buhm; Rinkel, Gabriël J E; de Bakker, Paul I W

    2016-01-01

    BACKGROUND: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. METHODS AND

  2. Lifetime Effects of Small Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Aishima, Kaoru; Shimizu, Tatsuya; Aihara, Masanori; Yoshimoto, Yuhei

    2016-11-01

    Recent prospective multicenter studies have shown that the probability of rupture of unruptured aneurysms with maximal diameter <7 mm is rather low. However, the overall risks and long-term impact of unruptured aneurysms on lifetime quality of life are still unknown. A mathematical model of the natural history of intracranial aneurysms was constructed, in which the hypothetical individuals with or without unruptured aneurysm transit between discrete health states. The annual rupture rate of small aneurysms was assumed to be 0.5% in the baseline analysis, followed by the subsequent sensitivity analysis. The analyses were continued until cumulative death rate from subarachnoid hemorrhage or other causes reached 1.0. Age-specific ratios of death of subarachnoid hemorrhage in the individuals harboring unruptured aneurysm, if dying at 60 years old, were 25% in men and 43% in women. These ratios decreased rapidly with higher age. Most (more than 90%) patients with small aneurysms were expected to die of diseases other than subarachnoid hemorrhage. In the baseline analysis (60-year-old individuals), lifetime lost to small aneurysms could be estimated as 3.8% for men and 4.2% for women, but a somewhat larger impact could be identified in the young and/or female individuals compared with in the elderly and/or male individuals. Lifetime effects of small unruptured aneurysms without risk factors increasing the probability of rupture are relatively small, and most patients were expected to die of diseases other than subarachnoid hemorrhage. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The radiological appearance of intracranial aneurysms in adults ...

    African Journals Online (AJOL)

    2014-04-04

    Apr 4, 2014 ... has been described in young adults and affects predominantly the extracranial blood vessels.2. Intracranial aneurysms in HIV-positive adults are described infrequently. About 22 case reports of HIV-infected adult patients who presented with intracranial aneurysms could be located in the literature. Isolated ...

  4. Unruptured intracranial aneurysms: initial and follow-up screening

    NARCIS (Netherlands)

    Bor, A.S.E.

    2014-01-01

    Unruptured intracranial aneurysms may rupture, causing subarachnoid haemorrhage (SAH). SAH is a devastating subtype of stroke, resulting in death or severe disability in half the patients. This thesis has a focus on initial and follow-up screening for unruptured intracranial aneurysms, and consists

  5. Intracranial aneurysms: risk factors for development and rupture

    NARCIS (Netherlands)

    Kleinloog, R.

    2017-01-01

    Intracranial aneurysms occur in approximately 3% of the population. The pathogenesis of aneurysms is largely unknown, and is thought to be a complex process in which both genetic and environmental factors are involved. Aneurysms can rupture and give rise to subarachnoid haemorrhage, a devastating

  6. Epidemiological and imaging features of intracranial aneurysms in young adults

    Directory of Open Access Journals (Sweden)

    WANG Huan-yu

    2013-03-01

    Full Text Available Background Nowadays, the epidemiological report and study about the intracranial aneurysms in young adults are very rare, especially in China. This paper aims to investigate the epidemiological and imaging features of intracranial aneurysms in young adults with the age of 16-29 years old. Methods Clinical data of 2119 patients with intracranial aneurysms admitted from January 2010 to October 2012 were retrospectively analyzed. Results Intracranial aneurysms in young adults (16-29 years old accounted for 1.93% of all intracranial aneurysms (41/2119 treated in the same period, and the gender ratio (male : female was 2.15 : 1. A total of 42 intracranial aneurysms were found in 41 patients, including 35 located in the anterior circulation and 7 in the posterior circulation, of which 13 aneurysms (30.95% in the anterior communicating artery, 6 aneurysms (14.29% each in the middle cerebral artery and the distal of anterior cerebral artery, and 2 aneurysms (4.76% in the posterior communicating artery. There were almost 34 aneurysms (80.95% located in bifurcation of Willis circle and proximal aorta and 8 aneurysms (19.05% in the branches of artery. The diameter of aneurysms were ≤5 mm in 19 aneurysms (45.24%, 6-10mm in 13 (30.95%, 11-24 mm in 3 (7.14% and ≥25mm in 7 (16.67%. Conclusion Young men are much more susceptible to intracranial aneurysms than young women, but the incidence in women increases as they grow old. The anterior communicating artery is the predilection site of intracranial aneurysms in young adults (16-29 years old, and the occurence of giant aneurysms and the aneurysms in the posterior circulation and the distal of anterior cerebral artery is common. The epidemiological and imaging features and gender ratio of intracranial aneurysms in young adults (16-29 years old are similar to those in children and adolesents, but much different from adult patients.

  7. Predictive risk factors for multiple intracranial aneurysms rupture

    International Nuclear Information System (INIS)

    Wang Jue; Zhao Yuwu; Li Minghua; Lu Haitao

    2014-01-01

    Objective: To analyze the risk factors inducing the rupture of multiple intracranial aneurysms. Methods: Between July 2007 and July 2011, a total of 134 patients with 294 aneurysms were admitted to the hospital. Of the 294 aneurysms, 50 were ruptured and 244 were unruptured. Every patient had two or more aneurysms. Univariate and multivariate logistic regression analysis methods were used to analyze the risk factors, including age, gender, site and size, for multiple intracranial aneurysms. Results: The 134 patients were divided into three groups according to patient's age, including <4.5 group, (45-6.5) group and > 65 group. The rupture incidence of aneurysm in the (4.5-65) group was highest in the three groups. The difference was significant (P=0.001). Of 35 patients with anterior communicating arterial aneurysms, 13 (37.1%) were ruptured, accounting for 26% of all ruptured aneurysms, and the rupture rate of anterior communicating arterial aneurysms was significantly higher than that of the aneurysms located at other sites (P= 0.001). Of all 294 aneurysms, 88.1% were <5 mm, 58.2% were <3 mm. Of the ruptured aneurysms, 680-/o were <5 mm. Conclusion: This study indicates that the rupture of multiple intracranial aneurysm is closely related to the patient's age, the size and location of aneurysm. Therefore, patient's age, the size and location of aneurysm should be taken into consideration when to make the therapeutic plan. In multiple intracranial aneurysms, the anterior communicating arterial aneurysm is most prone to bleeding. (authors)

  8. RNA Sequencing Analysis of Intracranial Aneurysm Walls Reveals Involvement of Lysosomes and Immunoglobulins in Rupture

    NARCIS (Netherlands)

    Kleinloog, Rachel; Verweij, Bon H.; van der Vlies, Pieter; Deelen, Patrick; Swertz, Morris A.; de Muynck, Louis; Van Damme, Philip; Giuliani, Fabrizio; Regli, Luca; van der Zwan, Albert; van der Sprenkel, Jan W. Berkelbach; Han, K. Sen; Gosselaar, Peter; van Rijen, Peter C.; Korkmaz, Emine; Post, Jan A.; Rinkel, Gabriel J. E.; Veldink, Jan H.; Ruigrok, Ynte M.

    Background and Purpose-Analyzing genes involved in development and rupture of intracranial aneurysms can enhance knowledge about the pathogenesis of aneurysms, and identify new treatment strategies. We compared gene expression between ruptured and unruptured aneurysms and control intracranial

  9. Genome screen in familial intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Langefeld Carl

    2009-01-01

    Full Text Available Abstract Background Individuals with 1st degree relatives harboring an intracranial aneurysm (IA are at an increased risk of IA, suggesting genetic variation is an important risk factor. Methods Families with multiple members having ruptured or unruptured IA were recruited and all available medical records and imaging data were reviewed to classify possible IA subjects as definite, probable or possible IA or not a case. A 6 K SNP genome screen was performed in 333 families, representing the largest linkage study of IA reported to date. A 'narrow' (n = 705 definite IA cases and 'broad' (n = 866 definite or probable IA disease definition were used in multipoint model-free linkage analysis and parametric linkage analysis, maximizing disease parameters. Ordered subset analysis (OSA was used to detect gene × smoking interaction. Results Model-free linkage analyses detected modest evidence of possible linkage (all LOD Conclusion These data suggest it is unlikely that there is a single common variant with a strong effect in the majority of the IA families. Rather, it is likely that multiple genetic and environmental risk factors contribute to the susceptibility for intracranial aneurysms.

  10. Diagnosis of ruptured intracranial aneurysm in acute stage

    International Nuclear Information System (INIS)

    Yoshiyama, Masataka; Nakagawa, Toshifumi

    1980-01-01

    Subarachnoid hemorrhage at an acute stage within one day from the onset to the first CT scan was classified into subarachnoid hemorrhage secondary to intracranial aneurysm, subarachnoid hemorrhage of unknown origin and subarachnoid hemorrhage of which angiography could not be carried out, and the first CT findings, the severity, and the prognosis of these subarachnoid hemorrhage were compared and discussed. CT findings of subarachnoid hemorrhage secondary to intracranial aneurysm showed various changes according to progress in the severity with time, and intracranial hematoma, intraventricular clots and ventricular dilatation increased according to progress in the severity. Ruptured intracranial aneurysm in middle cerebral artery, anterior cerebral artery and anterior communicating artery could be found easily by CT, but that in internal carotid artery and vertabral basilar artery was difficult to be detected by CT. When cerebral angiography was carried out repeatedly for ruptured intracranial aneurysm of unknown origin, the time of performance must be consifered with attention to angiospasms or hematoma. (Tsunoda, M.)

  11. Traumatic and alternating delayed intracranial hematomas

    International Nuclear Information System (INIS)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-01-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma. (orig.)

  12. Traumatic and alternating delayed intracranial hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-11-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  13. Treatment of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms by neurosurgeons in Colombia: A survey

    Science.gov (United States)

    Alcalá-Cerra, Gabriel; Gutiérrez Paternina, Juan J.; Buendía de Ávila, María E.; Preciado Mesa, Edgar I.; Barrios, Rubén Sabogal; Niño-Hernández, Lucía M.; Jaramillo, Keith Suárez

    2011-01-01

    Background: Trends in management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms among neurosurgeons is very variable and had not been previously described in any Latin American country. This study was conducted to determine the preferences of Colombian neurosurgeons in pharmacologic, surgical, and endovascular management of patients with aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysms. Methods: A survey-based descriptive study was performed in a sample of members from the Colombian Association of Neurosurgery. Questions about pharmacologic, surgical, and endovascular management of aneurysmal subarachnoid hemorrhage and unruptured intracranial aneurysm were carried out. We calculated the mean and the standard deviation of the results obtained from the continuous variables. The results of the categorical variables are presented as percentages. Results: The preference of medication with poor clinical evidence, such as magnesium sulfate, aspirin, statins, and anti-fibrinolytics was lower than 10%. The use of intravenous nimodipine and systemic glucocorticoids was as high as 31%. The availability of endovascular therapy was 69%. The indication for treatment of patients with unruptured intracranial aneurysms that required intervention was less than 13.8%. In patients with ruptured or unruptured intracranial aneurysms, coiling was the preferred method for exclusion. Conclusions: Reported compliance of evidence-based clinical guidelines was similar to that described in developed countries, and even better. However, there is little agreement in treating patients with unruptured intracranial aneurysms. For other issues, the conducts reported by Colombian neurosurgeons are in accordance with the current guidelines. PMID:22059120

  14. Intracranial Infectious Aneurysm in Orbital Cellulitis.

    Science.gov (United States)

    Lee, Brian; Kim, Charles; Carrasco, Jacqueline

    2015-01-01

    Infectious intracranial aneurysm and cavernous sinus thrombosis are rare complications of orbital cellulitis. We report the case of a 46-year-old male presenting with sinusitis and orbital cellulitis complicated by the development of an orbital mass. Following orbitotomy with debulking, the patient underwent bony orbital decompression for increasing proptosis postoperatively. While his exam stabilized, the patient developed complete ptosis and extraocular motor palsy in the contralateral eye after undergoing bilateral sinus debridement. Imaging was notable for the presence of a pseudoaneurysm of the internal carotid artery, which was treated with a stent. This report demonstrates rare complications of orbital cellulitis. These patients should be monitored carefully with noninvasive imaging studies, such as cerebral angiography, for early detection of vascular abnormalities that can progress rapidly.

  15. Unruptured intracranial aneurysms : development, rupture and preventive management

    NARCIS (Netherlands)

    Etminan, Nima; Rinkel, Gabriel J.|info:eu-repo/dai/nl/085712000

    2016-01-01

    Saccular unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population, and are being increasingly detected because of improved quality and higher frequency of cranial imaging. Large amounts of data, providing varying levels of evidence, have been published on aneurysm

  16. Mannitol-induced rebleeding from intracranial aneurysm. Case report

    DEFF Research Database (Denmark)

    Rosenørn, J; Westergaard, L; Hansen, P H

    1983-01-01

    A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across...

  17. Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography

    International Nuclear Information System (INIS)

    Young, N.; Kingston, R.J.; Markson, G.; Dorsch, N.W.C.; McMahon, J.

    2001-01-01

    The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms. (orig.)

  18. Individualized management for intracranial vertebral artery dissecting aneurysms

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-02-01

    Full Text Available Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling, 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

  19. History, Evolution, and Continuing Innovations of Intracranial Aneurysm Surgery.

    Science.gov (United States)

    Lai, Leon T; O'Neill, Anthea H

    2017-06-01

    Evolution in the surgical treatment of intracranial aneurysms is driven by the need to refine and innovate. From an early application of the Hunterian carotid ligation to modern-day sophisticated aneurysm clip designs, progress has been made through dedication and technical maturation of cerebrovascular neurosurgeons to overcome challenges in their practices. The global expansion of endovascular services has challenged the existence of aneurysm surgery, changing the complexity of the aneurysm case mix and volume that are referred for surgical repair. Concepts of how to best treat intracranial aneurysms have evolved over generations and will continue to do so with further technological innovations. As with the evolution of any type of surgery, innovations frequently arise from the criticism of current techniques. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Recanalization and rupture after intracranial aneurysm treatment.

    Science.gov (United States)

    Costa, Emmanuel; Vaz, Geraldo R; Finet, Patrice; Goffette, Pierre; Docquier, Marie A; Raftopoulos, Christian

    2016-11-25

    Treatment of intra cranial aneurysm (ICA) can sometimes required several procedures. The aim of this study is to analyze the risk of recanalization and rupture recurrence after ICA treatment by endovascular coiling (EVC) or surgical clipping (SC) on a very long follow-up. Clinical data of 373 consecutive patients treated in our group between January 1996 and December 2006 as well by EVC as by SC for ruptured (RIA) or unruptured intracranial aneurysm (UIA), were reviewed. Patients were followed up at least to August 2009. First radiologic follow-up done six months after EVC and between three and five years after SC (median time: 5 years)). All patients underwent a clinical follow-up after treatment, at least by telephonic communication (median time: 6 years). Out of 197 patients with 198 RIAs, 82 (42 %) patients underwent an endovascular treatment and 115 (58%) were allocated to surgical treatment. From a total of 176 patients with 229 UIAs, 66 (37.5%) patients were treated by 74 EVC; and 110 (62.5%) patients were treated with 124 surgical procedures. Fifteen recanalizations of coiled RIAs were detected and only one in the surgical group (27% vs. 2%; p= 0.0008). Of the 15 recanalizations in the EVC group, 6 (40%) were initially completely occluded. We observed two rebleedings, one in each group (1.4% for EVC; 1% for SC; p=0.8). Our findings during the longest reported follow-up confirm a greater risk of recanalization for RIA treated by EVC without so far a significant difference in the rerupture risk.

  1. CT and angiography evaluation in ruptured intracranial aneurysm clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Sik; Kim, Byung Young; Kim, Hong; Woo, Seong Ku; Zeon, Seok Kil; Park, Sam Kyoon [Keimyung University School of Medicine, Taegu (Korea, Republic of)

    1984-09-15

    CT has been become one of the most important diagnostic method in the evaluation of ruptured intracranial aneurysm with direct detection of subarachnoid, intracerebral and intraventricular hemorrhage, and identification of complications such as recurrent bleeding, hydrocephalus and infarction secondary to arterial spam. Angiography gives precise information on the location, size of aneurysm and presence of arterial spasm. Authors attempted to predict the location of ruptured aneurysm in the CT by distribution of blood in subarachnoid spaces and brain parenchyme in comparison with angiographic findings, and also predict the prognosis of the patients by relationship between the extent of blood and clinical grade. Authors analysed 40 cases of ruptured intracranial aneurysm confirmed by CT and angiography at Keimyung University Hospital for last 2 year. The results were as follows: 1. The age and sex distribution; the most prevalent age group was 5th to 6th decades (70%), and female patient was slightly more than male patient (57.5% : 42.5%). 2. The location of aneurysms were; posterior communicating artery group 17 cases (42.2%), middle cerebral artery group 10 cases (25.0%), anterior communicating artery group 7 cases (17.5%), basilar artery bifurcation 1 case (2.5%), posterior inferior cerebellar artery 1 cases (2.5%), and multiple aneurysms 4 cases (10%) in order to frequency. 3. Characteristic distribution of intracranial hemorrhage in CT were as follows; 1) In 6 cases (85.7%) of anterior communicating artery aneurysm, interhemispheric fissure hemorrhage was noted. 2) The ipsilateral sylvian fissure hemorrhage was noted in all cases of middle cerebral artery aneurysm (10 cases) and 12 cases (70.6%) of posterior communicating artery aneurysm. 3) Localized hematoma in frontal lobe near interhemispheric fissure (2 cases; 28.6%), septum pellucidum (1 case; 14.3%) and corpus callosm (1 case; 14.3%) were characteristic in anterior communicating artery aneurysm. 4) Comma

  2. Endovascular treatment of intracranial aneurysms: diversity in treatment techniques of varying anatomical presentations.

    Science.gov (United States)

    Putu, Patriawan; Firman, Sitanggang; Ismail, Mohd Redzuan; Nik-Ismail, Nik Azuan; Yaacob, Nur Yazmin; Muda, Ahmad Sobri

    2014-01-01

    We discuss and illustrate various endovascular treatment options for intracranial aneurysms, to reflect common technique used in endovascular treatment of brain aneurysm. We select five cases of various aneurysm types to show assortments of endovascular treatment (EVT) are performed. Selective catheterization of the intracranial aneurysms and endovascular treatments are technically feasible, offering a viable alternative to the surgical approach. We discuss the radiographic features, clinical presentation, and strategies of endovascular treatment of intracranial aneurysms.

  3. Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts : Differences in multiplicity and location

    NARCIS (Netherlands)

    Mackey, Jason; Brown, Robert D; Moomaw, Charles J; Sauerbeck, Laura; Hornung, Richard; Gandhi, Dheeraj; Woo, Daniel; Kleindorfer, Dawn; Flaherty, Matthew L; Meissner, Irene; Anderson, Craig; Connolly, E Sander; Rouleau, Guy; Kallmes, David F; Torner, James; Huston, John; Broderick, Joseph P; Groen, Rob

    OBJECT: Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their

  4. Retina findings in intracranial aneurysm patients

    Directory of Open Access Journals (Sweden)

    Sung Il Kang

    2017-07-01

    Full Text Available AIM: To evaluate fundus findings in patients with intracranial aneurysm(ICAto determine the relation between ICA and distinguishable retinal features.METHODS: We analyzed the medical records and ocular images of 46 patients with previously diagnosed ICA referred from the Neurosurgical Department. All patients underwent ophthalmologic evaluation including fluorescein angiography(FAG. Furthermore, the presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, A-V crossing signs, arm-to-retina time, and A-V transit time were evaluated. The results of ICA patients(Group 1were compared with those of 22 idiopathic epiretinal membrane patients with unaffected eyes(Group 2.RESULTS: Mean ages were 60.02y(Group 1and 60.68y(Group 2respectively(P=0.70. The prevalence of hypertension was similar in both groups. No case with retinal macroaneurysm was found in either group. The presence of drusen, macular degeneration, cotton wool spot, hard exudates, retinal hemorrhage, arteriolar attenuation, and A-V crossing sign was not significantly different between the two groups. Mean arm-to-retina time was not significantly different in two groups, either.CONCLUSION: We cannot find any evidence that the patients with ICA shows specific changes in the FAG and fundus.

  5. Clinical, radiological, and flow-related risk factors for growth of untreated, unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Bor, A. Stijntje E|info:eu-repo/dai/nl/314109080; Tiel Groenestege, Andreas T.; terBrugge, Karel G.; Agid, Ronit; Velthuis, Birgitta K.|info:eu-repo/dai/nl/176956301; Rinkel, Gabriel J E|info:eu-repo/dai/nl/085712000; Wermer, Marieke J H

    2015-01-01

    BACKGROUND AND PURPOSE: Unruptured intracranial aneurysms are frequently followed to monitor aneurysm growth. We studied the yield of follow-up imaging and analyzed risk factors for aneurysm growth. METHODS: We included patients with untreated, unruptured intracranial aneurysms and ≥6 months of

  6. The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Wei Ting Chiu

    Full Text Available The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT, which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.Medical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH and symptomatic ICH after r-tPA. The differences were analyzed using Fisher's exact or Mann-Whitney U tests, and p < 0.05 was defined as the statistical significance.A total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%. No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively. The bleeding risk was not significant different between aneurysm group (2 out of 11, 18% with nonaneurysm group (7 out of 133, 5.3% (p = 0.14. None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.The presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they

  7. Intracranial arterial aneurysm vasculopathies: targeting the outer vessel wall

    International Nuclear Information System (INIS)

    Krings, Timo; Piske, Ronie L.; Lasjaunias, Pierre L.

    2005-01-01

    The pathogenesis of intracranial arterial aneurysms (AA) remains unclear, despite their clinical importance. An improved understanding of this disease is important in choosing therapeutic options. In addition to the ''classical'' berry-type aneurysm, there are various other types of intracranial AA such as infectious, dissecting or giant, partially-thrombosed aneurysms. From the clinician's perspective, the hypothesis that some of these intracranial AA might be due to abluminal factors has been proposed for several years. Indeed, this hypothesis and the empirical use of anti-inflammatory drugs in giant intracranial aneurysms have been confirmed by recent studies reporting that an enzyme involved in the inflammatory cascade (5-lipoxygenase or 5-LO) promotes the pathogenesis of specific aneurysms in humans. 5-LO generates different forms of leukotrienes which are potent mediators of inflammation. Adventitial inflammation leads to a weakening of the media from the abluminal part of the vessel wall due to the release of proinflammatory factors that invade the media, thereby degrading the extracellular matrix, the elastic lamina of the vascular wall, and, finally, the integrity of the vessel lumen. This in turn results in a dilation of the vessel and aneurysm formation. Moreover, neoangiogenesis of vasa vasorum is found in close proximity to 5-LO activated macrophages. In addition to this biological cascade, we argue that repeated subadventitial haemorrhages from the new vasa vasorum play an important role in aneurysm pathogenesis, due to a progressive increase in size mediated by the apposition of new layers of intramural haematoma within the vessel wall. Intracranial giant AA can therefore be regarded as a proliferative disease of the vessel wall induced by extravascular activity. (orig.)

  8. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  9. Unruptured intracranial aneurysms: development, rupture and preventive management.

    Science.gov (United States)

    Etminan, Nima; Rinkel, Gabriel J

    2016-12-01

    Saccular unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population, and are being increasingly detected because of improved quality and higher frequency of cranial imaging. Large amounts of data, providing varying levels of evidence, have been published on aneurysm development, progression and rupture, but less information is available on the risks and efficacy of preventive treatment. When deciding how to best manage UIAs, clinicians must consider the age and life expectancy of the patient, the estimated risk of rupture, the risk of complications attributed to preventive treatment, and the level of anxiety caused by the awareness of having an aneurysm. This Review highlights the latest human data on the formation, progression and rupture of intracranial aneurysms, as well as risks associated with preventive treatment. Considering these we discuss the implication for clinical management. Furthermore, we highlight pivotal questions arising from current data on intracranial aneurysms and the implications the data have for future experimental or clinical research. We also discuss data on novel radiological surrogates for rupture for those aneurysms that do not require preventive occlusion. Finally, we provide guidance for clinicians who are confronted with patients with incidentally detected UIAs.

  10. Fourier analysis of intracranial aneurysms: towards an objective and quantitative evaluation of the shape of aneurysms

    International Nuclear Information System (INIS)

    Rohde, Stefan; Lahmann, Katharina; Nafe, Reinhold; Yan, Bernard; Berkefeld, Joachim; Beck, Juergen; Raabe, Andreas

    2005-01-01

    Shape irregularities of intracranial aneurysms may indicate an increased risk of rupture. To quantify morphological differences, Fourier analysis of the shape of intracranial aneurysms was introduced. We compared the morphology of 45 unruptured (UIA) and 46 ruptured intracranial aneurysms (RIA) in 70 consecutive patients on the basis of 3D-rotational angiography. Fourier analysis, coefficient of roundness and qualitative shape assessment were determined for each aneurysm. Morphometric analysis revealed significantly smaller coefficient of roundness (P<0.02) and higher values for Fourier amplitudes numbers 2, 3 and 7 (P<0.01) in the RIA group, indicating more complex and irregular morphology in RIA. Qualitative assessment from 3D-reconstructions showed surface irregularities in 78% of RIA and 42% of UIA (P<0.05). Our data have shown significant differences in shape between RIA and UIA, and further developments of Fourier analysis may provide an objective factor for the assessment of the risk of rupture. (orig.)

  11. Treatment of unruptured intracranial aneurysms with the pipeline embolization device.

    Science.gov (United States)

    Murthy, Santosh B; Shah, Shreyansh; Venkatasubba Rao, Chethan P; Bershad, Eric M; Suarez, Jose I

    2014-01-01

    The pipeline embolization device (PED; ev3 Endovascular, Plymouth, MN, USA) is a flow-diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations. It causes progressive flow redirection leading to aneurysm thrombosis. This study aimed to present a systematic review of the published literature on the clinical outcomes of PED. A Medline search of the English language literature was performed using the keywords "intracranial aneurysms" and "pipeline embolization device" or "flow diverters". The inclusion criteria were: n>10 patients; unruptured aneurysms; documentation of complications; and at least 3 months of follow-up. A total of 13 studies, with 905 patients and 1043 aneurysms, were included. The mean age was 53.8 years, with women comprising 76.3% of patients. The mean aneurysm diameter was 11.1mm with 37% classed as large aneurysms and 10% classed as giant. The cumulative mortality rate was 2.3%. Seventeen patients had a stroke (1.9%), while 19 (2.0%) had a transient ischemic attack and 21 patients (2.3%) had an intracranial hemorrhage. The two outcome measures were the cumulative event rate (16.7%) and the 6 month aneurysm occlusion rate (79.7%). A funnel plot with study size plotted against the two outcome measures revealed publication bias. Data from recent studies suggest that complication and mortality rates associated with PED may be similar to other contemporary endovascular techniques, with a better 6 month aneurysm occlusion rate. More prospective clinical trials are warranted to further validate these results. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Is Marfan syndrome associated with symptomatic intracranial aneurysms?

    NARCIS (Netherlands)

    van den Berg, J. S.; Limburg, M.; Hennekam, R. C.

    1996-01-01

    BACKGROUND AND PURPOSE: Marfan syndrome is a heritable disorder of connective tissue caused by a deficiency of the glycoprotein fibrillin. In several publications and neurological textbooks, a relationship between Marfan syndrome and intracranial aneurysms has been assumed. METHODS: The records of

  13. Natural history of untreated unruptured intracranial aneurysms in the elderly.

    Science.gov (United States)

    Rinaldo, Lorenzo; Shepherd, Daniel L; Murphy, Meghan E; Vine, Roanna L; Brown, Robert D; Rabinstein, Alejandro A; Lanzino, Giuseppe

    2016-11-16

    The effect of age on risk of intracranial aneurysm rupture is not well understood. We investigated the clinical course of patients 65 years and older with conservatively managed unruptured intracranial aneurysms (UIA) and determined risk factors for rupture in this population. We reviewed prospectively collected data on baseline characteristics and long- term follow-up for patients aged 65 years and older with an UIA that were initially managed with observation. The association between patient and aneurysmal characteristics and risk of rupture was performed using a multivariate Cox proportional hazard regression model. There were 214 patients (mean age: 74.7 years, SD: 6.0) included in our study. The median follow-up time was 3.7 years, with a cumulative follow-up time of 883.7 person-years. During the study period, seven patients (3.3%) received interventional treatment of their UIA and eight patients (3.7%) experienced aneurysmal subarachnoid hemorrhage, yielding an annual risk of rupture of 0.9%. All aneurysms that ruptured were at least 10 mm in size. Increasing patient age [unit relative risk (RR) 1.19, 95% CI 1.07-1.36, p = 0.002], larger aneurysmal size (unit RR 1.10, 95% CI 1.02-1.17, p = 0.021), and increasing PHASES score (unit RR 1.62, 95% CI 1.32-2.06, p 10 mm in diameter) and low risk of interventional procedure.

  14. Usefulness of MR angiography in patients with non-traumatic intracranial hemorrhagic diseases

    International Nuclear Information System (INIS)

    Chung, Hyun Ung; Seo, Jeong Jin; Kim, Yun Hyeon; Moon, Woong Jae; Kim, Jae Kyu; Kang, Heoung Keun

    1994-01-01

    We assessed the usefulness of magnetic resonance angiography(MRA) and its techniques for differential diagnosis of hemorrhagic causes in patients with non-traumatic intracranial hemorrhagic diseases. We retrospectively reviewed 74 patients with non-traumatic intracranial hemorrhagic diseases, which were confirmed by radiological examinations(36 cases) and operations(38 cases). We compared the usefulness of magnetic resonance imaging(MRI) alone from MRI with MRA in evaluation of hemorrhagic causes. MRA was obtained by Time-of-Flight(TOF) and Phase Contrast(PC) technique. We investigated the usefulness of TOF and PC technique. MRI with MRA for detection of hemorrhagic causes(89%, 66 cases) was better than MRI only (64%, 47 cases). PC was better than TOF for evaluation of arteriovenous malformation and aneurysm due to subtraction of background noise(hemorrhage). MRI with MRA is more useful than MRI alone for evaluation of non-traumatic intracranial hemorrhagic causes

  15. Morphology parameters for intracranial aneurysm rupture risk assessment.

    Science.gov (United States)

    Dhar, Sujan; Tremmel, Markus; Mocco, J; Kim, Minsuok; Yamamoto, Junichi; Siddiqui, Adnan H; Hopkins, L Nelson; Meng, Hui

    2008-08-01

    The aim of this study is to identify image-based morphological parameters that correlate with human intracranial aneurysm (IA) rupture. For 45 patients with terminal or sidewall saccular IAs (25 unruptured, 20 ruptured), three-dimensional geometries were evaluated for a range of morphological parameters. In addition to five previously studied parameters (aspect ratio, aneurysm size, ellipticity index, nonsphericity index, and undulation index), we defined three novel parameters incorporating the parent vessel geometry (vessel angle, aneurysm [inclination] angle, and [aneurysm-to-vessel] size ratio) and explored their correlation with aneurysm rupture. Parameters were analyzed with a two-tailed independent Student's t test for significance; significant parameters (P 41; 95% confidence interval, 1.03-1.92) and undulation index (odds ratio, 1.51; 95% confidence interval, 1.08-2.11) had the strongest independent correlation with ruptured IA. From the receiver operating characteristic analysis, size ratio and aneurysm angle had the highest area under the curve values of 0.83 and 0.85, respectively. Size ratio and aneurysm angle are promising new morphological metrics for IA rupture risk assessment. Because these parameters account for vessel geometry, they may bridge the gap between morphological studies and more qualitative location-based studies.

  16. Surgical treatment of patients with unruptured intracranial aneurysms.

    Science.gov (United States)

    Chen, S F; Kato, Y; Sinha, R; Kumar, A; Watabe, T; Imizu, S; Oda, J; Oguri, D; Sano, H; Hirose, Y

    2015-01-01

    We present our experience with elective microsurgical clipping of unruptured intracranial aneurysms (UIA) and analyze this management. A total of 150 patients with UIA were reviewed and data were collected with regard to age, sex, presence of symptoms, location and size of the aneurysms, surgical complications and postoperative 1 year outcomes. Aneurysm size was assessed either by three-dimensional CT angiography or digital subtraction angiogram. Glasgow Outcome Scale was used to assess clinical outcomes. One hundred and fifty patients with 165 aneurysms were treated in this series. The mean size of the UIA was 5.6mm. Eighty aneurysms (48.5%) were less than 5mm in size, and 73 (44.2%) were from 5 to 10mm. Ten (6.1%) of the aneurysms were large and two (1.2%) were giant. One hundred and forty-three were asymptomatic and seven were symptomatic before surgery. The outcome was good in 147 patients (98%), and only three patients (2%) had a treatment-related unfavorable outcome. Five patients experienced transient neurological deficits and one patient experienced permanent neurological deficits. Overall 98.7% of the treated aneurysms were satisfactorily obliterated. Wound complications were seen only in three patients. In conclusion, UIA pose a significant challenge for neurosurgeons, where a delicate balance between benefits and possible risks must be weighed. If the requisite expertise is available, they can be treated surgically with low morbidity and a good outcome at specialized neurovascular centers. Copyright © 2014. Published by Elsevier Ltd.

  17. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel; Varble, Nicole; Xiang, Jianping; Meng, Hui

    2013-11-01

    Intracranial aneurysms (IAs) are potentially devastating pathological dilations of arterial walls that affect 2-5% of the population. In our previous CFD study of 119 IAs, we found that ruptured aneurysms were correlated with complex flow pattern and statistically predictable by low wall shear stress and high oscillatory shear index. To understand flow mechanisms that drive the pathophysiology of aneurysm wall leading to either stabilization or growth and rupture, we aim at exploring vortex dynamics of aneurysmal flow and provide insight into the correlation between the previous predictive morphological parameters and wall hemodynamic metrics. We adopt the Q-criterion definition of coherent structures (CS) and analyze the CS dynamics in aneurysmal flows for both ruptured and unruptured IA cases. For the first time, we draw relevant biological conclusions concerning aneurysm flow mechanisms and pathophysiological outcome. In pulsatile simulations, the coherent structures are analyzed in these 119 patient-specific geometries obtained using 3D angiograms. The images were reconstructed and CFD were performed. Upon conclusion of this work, better understanding of flow patterns of unstable aneurysms may lead to improved clinical outcome.

  18. Screening for intracranial aneurysms? Prevalence of unruptured intracranial aneurysms in Hong Kong Chinese.

    Science.gov (United States)

    Chan, David Y C; Abrigo, Jill M; Cheung, Tom C Y; Siu, Deyond Y W; Poon, Wai S; Ahuja, Anil T; Wong, George K C

    2016-05-01

    OBJECT The objective of this study was to generate data on the local prevalence of unruptured intracranial aneurysms (UIAs) in asymptomatic Hong Kong Chinese individuals. First-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH) were recruited as surrogates of the general population and to explore the potential role of screening in this locality. METHODS The authors identified first-degree relatives of consecutive patients with subarachnoid hemorrhage from a ruptured aneurysm who were admitted to a university hospital in Hong Kong from June 2008 to December 2010. Magnetic resonance angiography (MRA) was the imaging modality used to screen the cerebral vasculature of these asymptomatic individuals. If MRA showed abnormal findings, CT angiography was performed to confirm the MRA findings. RESULTS In total, 7 UIAs were identified from the 305 MR angiograms obtained. The prevalence of UIAs in first-degree relatives of patients with aSAH in the Hong Kong Chinese population was 2.30% (95% CI1.02%-4.76%). This percentage was lower than the prevalence rate of 3.2% from a meta-analysis of the literature. The sizes of the UIAs detected ranged from 1.4 mm to 7.5 mm; 85.7% of the UIAs detected in this study were < 5 mm, in contrast to 66% noted in the literature. One of the UIAs identified underwent endovascular stent placement with a flow diverter. None of the UIAs identified ruptured or became symptomatic during a median follow-up period of 3.5 years. CONCLUSIONS The prevalence of UIAs in first-degree relatives of patients with aSAH in the Hong Kong Chinese population was lower than that in Caucasians. At the same time, most of the UIAs detected in this study were small (85.7% were < 5 mm, vs 66% in a meta-analysis). With a similar incidence of aSAH in Hong Kong (7.5 per 100,000 person-years) as compared with data cited in the literature, the hypothesis that UIA rupture risk size threshold is different in Chinese patients should be further

  19. Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall.

    Science.gov (United States)

    Cebral, J; Ollikainen, E; Chung, B J; Mut, F; Sippola, V; Jahromi, B R; Tulamo, R; Hernesniemi, J; Niemelä, M; Robertson, A; Frösen, J

    2017-01-01

    Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall. Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies. More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation. Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

  20. Clinical value of diagnosing intracranial aneurysms with fly-around of multislice helical

    International Nuclear Information System (INIS)

    Zhu Yusen; Huang Yanling; Li Songbai; Han Min; Fu Qiang; Wang Yali; Xu Ke

    2002-01-01

    Objective: To exploring the clinical value of multislice helical CT fly-around as a new method for diagnosing micro intracranial aneurysms (≤2 mm in diameter). Methods: In this retrospective study, the authors compared the usefulness of multislice helical computed tomographic three dimensional angiography (MS 3D-CTA), digital subtraction angiography (DSA) and surgery for the detection and assessment of clinical suspected intracranial aneurysms in 104 patients, 86 patients who presented with acute, non-traumatic SAH. Row data was acquired by Multislice helical CT-Aquilion (Toshiba). The parameters of scanning and images reconstructing were: slice thickness 1.0 mm, helical pitch 3.5, scan speed was 0.5 s per rotation, delay time was 15 - 23 s; Nonionic contrast medium was injected intravenously (2.0 ml/kg) at speed of 3.0 - 5.0 ml/s. Source images were processed using a workstation SGI-O2, images post-processing software was Alatoview, ver: 1.42. The reconstructed images were then processed into fly-around and shaded volume rendering (SVR) and maximal intensity projection (MIP), and Entire brain DSA was performed. Images of MS 3D-CTA and DSA were analyzed by 3 radiologists at double blinded. Results: 70 aneurysms were proved at DSA and surgery, largest aneurysms was 24.0 mm in diameter and smallest aneurysms was 1.0 mm in diameter. Five of 70 aneurysms was large aneurysms, 40 was small aneurysms and 25 was micro aneurysms: fly-around found out 25 micro aneurysms, SVR and MIP found out 23 of them, DSA found out only 21 of them. For detected micro aneurysm, accuracy of fly-around was 95.71%, sensitivity was 100.0% and specificity was 93.33%, positive predictive value was 89.29, negative predictive value was 100.0%, accuracy of SVR and MIP was 95.71%, sensitivity was 92.0% and specificity was 97.78%, positive predictive value was 95.83%, negative predictive value was 95.65%, accuracy of DSA was 94.29%, sensitivity was 84.0% and specificity was 100.0%, positive

  1. Surgical treatment of multiple intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Nelson Martelli

    1988-06-01

    Full Text Available A retrospective study was conducted on 42 patients with multiple aneurysms surgically treated from 1975 to 1986. Thirty one of them had 2 aneurysms 6 had 3, 3 had 4 and 2 had 5 (62 in the internal carotid, 27 in the middle cerebral artery, 11 in the anterior cerebral and 3 in the basilar artery. All patients had subarachnoid hemorrhage and were classified as follows upon admission: 11, grade I; 12, grade II; 15, grade III, and 4, grade IV, and most of them improved before surgery (29, grade I, 7, grade II, and 6, grade III. In most cases, surgery was delayed and the 42 patients needed 57 craniotomies for clipping the aneurysms. Of the 24 patients with bilateral aneurysms, 15 were operated on both sides (11 are asymptomatic, 1 has hemiparesis, and 3 died later. Of the 9 patients submitted to unilateral craniotomy, 4 died and 5 are alive and well. Of the 18 patients with unilateral aneurysms, 11 are asymptomatic, 2 have hemiparesis, 1 has diplegia and behavioral disorders, and 4 died. Overall mortality was 26.1%, intraoperative mortality was 11.9%, and no mortality occurred among the patients operated over the last 5 years. The management of the these patients is discussed.

  2. Treatment of unruptured intracranial aneurysms: a review.

    Science.gov (United States)

    Ambekar, Sudheer; Khandelwal, Priyank; Bhattacharya, Pallab; Watanabe, Mitsuyoshi; Yavagal, Dileep R

    2016-10-01

    Unruptured brain aneurysms (UIAs) present a challenge due to the lack of definitive understanding of their natural history and treatment outcomes. As the treatment of UIAs is aimed at preventing the possibility of rupture, the immediate risk of treatment must be weighed against the risk of rupture in the future. As such, treatment for a large proportion of UIAs is currently individualized. In this article, we discuss the important natural history studies of UIAs and discuss the existing scientific evidence and recent advances that help identify the rupture risk guide management of UIAs. We also address the recent advances in pharmacological therapy of UIAs. Expert commentary: In the recent years, there have been great advances in understanding the pathophysiology of UIAs and determining the rupture risk going beyond the traditional parameter of aneurysm size. Aneurysm morphology and hemodynamics play a pivotal role in growth and rupture. A true randomized trial for the management of UIAs is the need of the hour.

  3. Endovascular treatment of unruptured posterior circulation intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xianli Lv

    2016-01-01

    Full Text Available Background and Purpose: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA. The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. Materials and Methods: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10-78 years of age, mean: 45.5 ± 14.3/92 UPCIAs. Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke. Results: A clinical improvement or stable outcome was achieved in 84 patients (94.4%. The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005 and mass effect presentation (P = 0.029 were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4% with a mean of 6.8 months (range: 1-36 months. Recanalization in six patients (7.9% at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients. Conclusion: Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation.

  4. Neonatal intracranial aneurysms: case report and review of the literature.

    Science.gov (United States)

    Mohotti, Jeewaka E; Carter, Nicole S; Zhang, Victor Jia Wei; Lai, Leon T; Xenos, Christopher; Asadi, Hamed; Chandra, Ronil V

    2018-03-02

    Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2-30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

  5. Wall Mechanical Properties and Hemodynamics of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Cebral, J R; Duan, X; Chung, B J; Putman, C; Aziz, K; Robertson, A M

    2015-09-01

    Aneurysm progression and rupture is thought to be governed by progressive degradation and weakening of the wall in response to abnormal hemodynamics. Our goal was to investigate the relationship between the intra-aneurysmal hemodynamic conditions and wall mechanical properties in human aneurysms. A total of 8 unruptured aneurysms were analyzed. Computational fluid dynamics models were constructed from preoperative 3D rotational angiography images. The aneurysms were clipped, and the domes were resected and mechanically tested to failure with a uniaxial testing system under multiphoton microscopy. Linear regression analysis was performed to explore possible correlations between hemodynamic quantities and the failure characteristics and stiffness of the wall. The ultimate strain was correlated negatively to aneurysm inflow rate (P = .021), mean velocity (P = .025), and mean wall shear stress (P = .039). It was also correlated negatively to inflow concentration, oscillatory shear index, and measures of the complexity and instability of the flow; however, these trends did not reach statistical significance. The wall stiffness at high strains was correlated positively to inflow rate (P = .014), mean velocity (P = .008), inflow concentration (P = .04), flow instability (P = .006), flow complexity (P = .019), wall shear stress (P = .002), and oscillatory shear index (P = .004). In a study of 8 unruptured intracranial aneurysms, ultimate strain was correlated negatively with aneurysm inflow rate, mean velocity, and mean wall shear stress. Wall stiffness was correlated positively with aneurysm inflow rate, mean velocity, wall shear stress, flow complexity and stability, and oscillatory shear index. These trends and the impact of hemodynamics on wall structure and mechanical properties should be investigated further in larger studies. © 2015 by American Journal of Neuroradiology.

  6. Late Reopening of Adequately Coiled Intracranial Aneurysms Frequency and Risk Factors in 400 Patients With 440 Aneurysms

    NARCIS (Netherlands)

    Ferns, Sandra P.; Sprengers, Marieke E. S.; van Rooij, Willem Jan; van Zwam, Wim H.; de Kort, Gerard A. P.; Velthuis, Birgitta K.; Schaafsma, Joanna D.; van den Berg, Rene; Sluzewski, Menno; Brouwer, Patrick A.; Rinkel, Gabriel J. E.; Majoie, Charles B. L. M.

    Background and Purpose-In aneurysms that are adequately occluded 6 months after coiling, the risk of late reopening is largely unknown. We assessed the occurrence of late aneurysm reopening and possible risk factors. Methods-From January 1995 to June 2005, 1808 intracranial aneurysms were coiled in

  7. Intracranial aneurysms in twins: case report and review of the literature.

    Science.gov (United States)

    Leung, H K; Lam, Y; Cheng, K M; Chan, C M; Cheung, Y L

    2011-04-01

    Intracranial aneurysm in twins is a rare clinical disease entity. Only 15 cases have been described in the literature. We report on a pair of identical twins with intracranial aneurysms. One presented with subarachnoid haemorrhage; digital subtraction angiography showed a left posterior communicating artery aneurysm, which was treated by coiling. The patient's twin sister was called for screening, whereupon digital subtraction angiography revealed a right ophthalmic internal carotid artery aneurysm that was treated conservatively.

  8. Rerupture of intracranial aneurysms: a clinicoanatomic study

    NARCIS (Netherlands)

    Hijdra, A.; Vermeulen, M.; van Gijn, J.; van Crevel, H.

    1987-01-01

    In a series of 176 prospectively studied patients who survived for at least 24 hours after aneurysmal subarachnoid hemorrhage, 39 had at least one computerized tomography (CT)-proven rebleed within 4 weeks after the first rupture. There were peaks in the incidence of rebleeding at the end of the 2nd

  9. Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location

    Science.gov (United States)

    Mackey, Jason; Brown, Robert D.; Moomaw, Charles J.; Sauerbeck, Laura; Hornung, Richard; Gandhi, Dheeraj; Woo, Daniel; Kleindorfer, Dawn; Flaherty, Matthew L.; Meissner, Irene; Anderson, Craig; Connolly, E. Sander; Rouleau, Guy; Kallmes, David F.; Torner, James; Huston, John; Broderick, Joseph P.

    2014-01-01

    Object Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their characteristics with a large cohort of nonfamilial IAs. Methods The Familial Intracranial Aneurysm (FIA) study is a multicenter international study with the goal of identifying genetic and other risk factors for formation and rupture of IAs in a highly enriched population. The authors compared the FIA study cohort with the International Study of Unruptured Intracranial Aneurysms (ISUIA) cohort with regard to patient demographic data, IA location, and IA multiplicity. To improve comparability, all patients in the ISUIA who had a family history of IAs or subarachnoid hemorrhage were excluded, as well as all patients in both cohorts who had a ruptured IA prior to study entry. Results Of 983 patients enrolled in the FIA study with definite or probable IAs, 511 met the inclusion criteria for this analysis. Of the 4059 patients in the ISUIA study, 983 had a previous IA rupture and 657 of the remainder had a positive family history, leaving 2419 individuals in the analysis. Multiplicity was more common in the FIA patients (35.6% vs 27.9%, p < 0.001). The FIA patients had a higher proportion of IAs located in the middle cerebral artery (28.6% vs 24.9%), whereas ISUIA patients had a higher proportion of posterior communicating artery IAs (13.7% vs 8.2%, p = 0.016). Conclusions Heritable structural vulnerability may account for differences in IA multiplicity and location. Important investigations into the underlying genetic mechanisms of IA formation are ongoing. PMID:22540404

  10. Multiple intracranial aneurysms in polyarteritis nodosa: MRI and angiography

    International Nuclear Information System (INIS)

    Oran, I.; Memis, A.; Parildar, M.; Yunten, N.

    1999-01-01

    In polyarteritis nodosa involvement of the central nervous system is infrequent; small cerebral infarcts are the most common neuroradiological finding. We report a 10-year-old boy with polyarteritis nodosa and intracranial haemorrhage. MRI showed an intracerebral haemorrhage. Angiography revealed two peripheral aneurysms in the posterior cerebral circulation, previously reported on only two occasions, and multiple microaneurysms in the hepatic, renal, mesenteric and even the lumbar arteries. (orig.)

  11. Computed tomographic findings of traumatic intracranial lesions

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    Jeong, Seong Wook; Kim, Il Young; Lee, Byung Ho; Kim, Ki Jeoung; Yoon, Il Gyu [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1985-10-15

    Traumatic intracranial lesion has been one of the most frequent and serious problem in neurosurgical pathology. Computed tomography made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospital for 15 months from October 1983 to December 1984. We have reviewed the computed tomographic scans of 264 patients which showed traumatic intracranial lesion. The result were as follows: 1. Head trauma was the most frequent diagnosed disease using computed tomographic scans (57.8%) and among 264 cases the most frequent mode of injury was traffic accident (73.9%). 2. Skull fracture was accompanied in frequency of 69.7% and it was detected in CT in 38.6%: depression fracture was more easily detected in 81%. 3. Conutercoup lesion (9.5%) was usually accompanied with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling (24.6%), subdural hematoma (22.3%), epidural hematoma (20.8%), intracerebral hematoma (6.1%), and subarachnoid hemorrhage (3.0%). 5. The shape of hematoma was usually biconvex (92.7%) in acute epidural hematoma and cresentic (100%) in acute subdural hematoma, but the most chronic the case became, they showed planoconvex and bicconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin level as single factor.

  12. The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Loewenstein, Joshua E.; Gayle, Shaneze C.; Duffis, E. Jesus; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2012-01-01

    Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper. PMID:22500236

  13. The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Joshua E. Loewenstein

    2012-01-01

    Full Text Available Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs. However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

  14. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  15. Unruptured intracranial aneurysms in children with sickle cell disease: analysis of 18 aneurysms in 5 patients.

    Science.gov (United States)

    Saini, Surbhi; Speller-Brown, Barbara; Wyse, Emily; Meier, Emily R; Carpenter, Jessica; Fasano, Ross M; Pearl, Monica S

    2015-05-01

    Intracranial aneurysms (IAs) are rare in the general pediatric population and account for <2% of all cerebral aneurysms. Only 7 children with sickle hemoglobinopathy and IAs have been reported, the majority of which were discovered after rupture. To report the prevalence of unruptured IAs in a selected population of children with sickle cell disease (SCD) and to describe the aneurysm morphology, hematologic characteristics, and management in this patient population. A retrospective review of the electronic database for all children with SCD who underwent brain magnetic resonance imaging or angiography from January 2002 to August 2013 at a single institution was performed. Records were reviewed for IA, age, sex, sickle cell genotype, neurological symptoms, hematologic indexes, transcranial Doppler findings, and management. Five of 179 children (2.8%) with SCD imaged by brain magnetic resonance imaging or angiography were diagnosed with IAs. None presented with subarachnoid hemorrhage. Four patients (80%) had HbSS disease, and 1 patient had hemoglobin sickle cell HbSC disease. A total of 18 aneurysms were detected; the majority of patients had multiple aneurysms (80%) and bilateral involvement (60%). Children with SCD are at risk for developing multiple intracranial aneurysms, and a high index of suspicion must be maintained during the interpretation of routine magnetic resonance imaging or angiography of the brain.

  16. Surgical Treatment of Unruptured Intracranial Middle Cerebral Artery Aneurysms: Angiographic and Clinical Outcomes in 143 Aneurysms

    Science.gov (United States)

    Choi, Seung Won; Park, Jung Cheol; Kwon, Do Hoon; Kwun, Byung Duk; Kim, Chang Jin

    2012-01-01

    Objective The purpose of this study was to determine the outcomes of surgical clipping in patients with unruptured middle cerebral artery (MCA) aneurysms. Methods A retrospective single-center database of 125 consecutive patients with 143 small MCA aneurysms (< 10 mm) who underwent surgical clipping was reviewed from January 2007 to December 2010. Clinical outcomes were assessed based on surgery-related complications and follow-up (mean: 17 months) using the modified Rankin scale (mRS). Angiographic outcomes were evaluated by conventional angiography (N = 96) or computed tomography angiography (N = 29) at postoperative weeks 1 and 6. Results There were no cases of mortality. There were three surgery-related complications (intracranial hemorrhage, meningitis and wound infection, respectively). The hemorrhagic event caused transient neurological deficits. All patients showed good clinical outcomes during follow-up (mRS 0-1). There was angiographic evidence of complete occlusion in 137 aneurysms (95.8%), a small residual neck in three aneurysms (2.2%) and partial for three aneurysms. In the three cases with partial clipping, the decision was made preoperatively to leave the residual sac to maintain distal flow, and muscular wrapping was performed. Conclusion Our study demonstrates that surgical clipping of unruptured small MCA aneurysms yields favorable clinical and angiographic outcomes. Aneurysmal clipping can be safely recommended for patients with small unruptured MCA aneurysms. PMID:23346544

  17. Onyx combined with coiling embolization for endovascular treatment of complex intracranial ruptured aneurysms

    International Nuclear Information System (INIS)

    Wu Yongfa; Huang Qinghai; Yang Pengfei; Zhang Lei; Li Qiang; Liu Jianmin

    2011-01-01

    Objective: To study the therapeutic effect of Onyx combined with stent-assisted coiling in embolizing complex intracranial ruptured aneurysms. Methods: Onyx combined with stent-assisted coiling embolization was conducted in two patients with complex intracranial ruptured aneurysms. The clinical data were retrospectively analyzed. The related literature concerning intracranial complex aneurysm treated with Onyx was reviewed. Results: Two intracranial complex aneurysms were embolized with Onyx together with coils. The lesions were located at internal carotid arterial bifurcation (n=1) and at the anterior wall of internal carotid artery (n=1). Complete embolization of the aneurysms was achieved immediately after the procedure while the parent arteries remained patent. Conclusion: For the treatment of complex intracranial ruptured aneurysms Onyx combined with coiling embolization is safe, effective and feasible. This technique can improve the degree of embolization. To make the evaluation of the long-term efficacy further study is needed. (authors)

  18. The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV

    Directory of Open Access Journals (Sweden)

    Gerrit Blignaut

    2014-04-01

    Full Text Available Background: The global prevalence of intracranial aneurysms is estimated at 2.3%. Limited literature is available on intracranial aneurysms in HIV-infected patients.Objectives: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults.Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 106/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography.Results: Fifteen (65.2% patients had a single aneurysm, of which 12 (80.0% had a saccular appearance. Seven (46.7% of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 106 /L. Eight patients (34.8% had multiple aneurysms, with a total of 26 aneurysms (range 2–6 aneurysms per patient, of which 13 (50.0% had a complex appearance. Twenty-four (92.3% of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 106/L.Conclusion: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes.

  19. Treatment of unruptured intracranial aneurysms using internally expanding coils

    Science.gov (United States)

    Suri, M. Fareed K.; Memon, Muhammad Zeeshan; Qureshi, Adnan I.

    2008-01-01

    Background and Purpose The International Subarachnoid Aneurysm Trial (ISAT) showed that patients with intracranial aneurysms treated with coil embolization have better clinical outcomes than those undergoing neurosurgical clipping. However some patients treated endovascularly have recurrence of aneurysms. Low packing density is often cited as a reason for recurrence. Coiling with hydrogel covered coils significantly improves the packing density. We report our initial experience in using a newly introduced design of hydrogel coils. Methods: Three consecutive patients with unruptured aneurysms were treated with hydrogel coated coils. During embolization, a stable framework was first established with bare metal coils, and gel coated coils were used subsequently to increase the packing density. After the procedure, packing density was estimated by calculating the compaction ratio using an online calculator. Results: Successful coil embolization was achieved in all 3 patients. Hydrogel coated coils comprised 11, 63 and 72% of the total coils deployed. One patient had coil herniation that required stent deployment. All patients remained neurologically intact during and after the procedure. Follow-up angiography in 2 patients at 6 months revealed aneurysm stability without any residual neck remnant. Conclusions: The softness of the hydrogel allowed us to deploy coated coils with good packing density. A slight expansion of these coils at the neck can be expected to reduce any neck remnant and potentially inhibit recurrence. PMID:22518218

  20. Prevalence of extracranial carotid artery aneurysms in patients with an intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    V E C Pourier

    Full Text Available Aneurysms in various arterial beds have common risk- and genetic factors. Data on the correlation of extracranial carotid artery aneurysms (ECAA with aneurysms in other vascular territories are lacking. We aimed to investigate the prevalence of ECAA in patients with an intracranial aneurysm (IA.We used prospectively collected databases of consecutive patients registered at the University Medical Center Utrecht with an unruptured intracranial aneurysm (UIA or aneurysmal Subarachnoid hemorrhage (SAH. The medical files of patients included in both databases were screened for availability of radiological reports, imaging of the brain and of the cervical carotid arteries. All available radiological images were then reviewed primarily for the presence of an ECAA and secondarily for an extradural/cavernous carotid or vertebral artery aneurysm. An ECAA was defined as a fusiform dilation ≥150% of the normal internal or common carotid artery or a saccular distention of any size.We screened 4465 patient records (SAH database n = 3416, UIA database n = 1049, of which 2931 had radiological images of the carotid arteries available. An ECAA was identified in 12/638 patients (1.9%; 95% CI 1.1-3.3 with completely imaged carotid arteries and in 15/2293 patients (0.7%; 95% CI 0.4-1.1 with partially depicted carotid arteries. Seven out of 27 patients had an additional extradural (cavernous or vertebral artery aneurysm.This comprehensive study suggests a prevalence for ECAA of approximately 2% of patients with an IA. The rarity of the disease makes screening unnecessary so far. Future registry studies should study the factors associated with IA and ECAA to estimate the prevalence of ECAA in these young patients more accurately.

  1. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population

    International Nuclear Information System (INIS)

    Abruzzo, Todd A.; Aeron, Gunjan; Jones, Blaise V.

    2013-01-01

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  2. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population.

    Science.gov (United States)

    Aeron, Gunjan; Abruzzo, Todd A; Jones, Blaise V

    2012-01-01

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10%-15% of hemorrhagic strokes during the first 2 decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first 2 decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80% of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. RSNA, 2012

  3. Outcome After Clipping of Unruptured Intracranial Aneurysms Depends on Caseload.

    Science.gov (United States)

    Jabbarli, Ramazan; Wrede, Karsten H; Pierscianek, Daniela; Dammann, Philipp; El Hindy, Nicolai; Özkan, Neriman; Müller, Oliver; Stolke, Dietmar; Forsting, Michael; Sure, Ulrich

    2016-05-01

    Although most neurovascular centers currently have a coil first policy, the percentage of coiled versus clipped aneurysms, as well as treatment outcomes, varies strongly between these centers. This study evaluates the impact of an increase in clipping caseload on treatment outcome in a large single-center series. All consecutive patients who underwent microsurgical clipping of unruptured intracranial aneurysms between January 2003 and April 2014 in our department were analyzed retrospectively. According to the change of the chairman in the neurosurgical department (1 September 2008) with a subsequent increase in the clipping volume, the entire cohort was divided into 2 groups with equal time intervals (historic and current cohorts). There were 94 clipped unruptured intracranial aneurysms in the historic cohort and 252 in the current cohort. Unfavorable outcome at 6 months postoperatively (defined as modified Rankin Score >2) was observed in 8 cases (8.5%) in the historic cohort and 7 cases (2.8%) in the current cohort (P < 0.0001). The surgical mortality decreased from 3.2% to 0%. Cerebral infarction on postoperative computed tomography scan was observed in 25 cases (26.6%) in the historic cohort and 19 cases (7.5%) in the current cohort (P < 0.0001). Within the current cohort, there was a progressive improvement of surgical outcome over the time. The improvement of the surgical outcome after increasing the clipping caseload underlines the importance of sufficient surgical volume for maintenance of competitive treatment results. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. "Microbleeding" from intracranial aneurysms: Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms.

    Science.gov (United States)

    Nussbaum, Eric S; Defillo, Archie; Zelensky, Andrea; Pulivarthi, Swaroopa; Nussbaum, Leslie

    2014-01-01

    During elective surgery for unruptured aneurysms, we have identified a group of patients with hemosiderin staining of the pial surface immediately adjacent to the aneurysm dome suggesting a remote and unrecognized history of microbleeding from the aneurysm. These cases form the basis for this report. Medical records of 421 unruptured cerebral aneurysm patients treated surgically between January 2003 and September 2010 were retrospectively reviewed. Patients with a history of prior subarachnoid hemorrhage, craniotomy, or significant closed head injury were excluded from review. Records were reviewed for intraoperative descriptions of hemosiderin deposition in the vicinity of the aneurysm as well as history of headaches, time to presentation, comorbidities, aneurysm characteristics, procedures, and radiologic imaging. Local hemosiderin staining immediately adjacent to the aneurysm was identified intraoperatively in 13 cases. Each of these patients had a history of remote atypical headache prior to presentation. Eight of these patients (62%) had aneurysms described as particularly "thin-walled" at the time of surgery. Aneurysm locations included the internal carotid artery (ICA) (54%), middle cerebral artery (MCA) (23%), anterior communicating artery (ACOMMA) (15%), and the anterior cerebral artery (ACA) (8%). More than half (54%) of these patients had a history of smoking, while 31% had hypertension, and 23% had a history of alcohol abuse. Dyslipidemia and family history of aneurysms were present in 15% and hypercholesterolemia was noted in one patient (8%). We suggest this group of patients had suffered a "microbleed" resulting in local hemosiderin deposition next to the aneurysm. The origins and clinical implications of such microbleeds are unknown and warrant further investigation.

  5. Comparison of CT angiography and digital subtraction angiography in the evaluation of intracranial aneurysmal neck

    International Nuclear Information System (INIS)

    Kim, Yoo Kyung; Baik, Seung Kug; Shin, Mi Jeong; Choi, Han Yong

    2001-01-01

    To compare the usefulness of three-dimensional multislice CT angiography(CTA) and digital subtraction angiography (DSA) in the evaluation of intracranial aneurysmal neck. Nineteen patients with intracranial aneurysm (23 cases) underwent DSA and subsequent CTA. Using a multislice CT scanner and the SSD(shaded surface display) technique, clipping, cutting and the MPR technique, three-dimensional images were obtained. These were (a) external, (b) internal, from the direction of the parent artery, (c) internal, from the direction of the aneurysmal dome, and (d) an aneurysmal cutting image. The CTA findings were retrospectively compared with the DSA images. Twenty aneurysms were small and three were large. In eleven cases aneurysm neck was small, in nine it was wide, and in three it was relatively wide. For aneurysmal neck evaluation, CTA was superior to DSA in six of nine wide-neck aneurysms and all three large-sized wide-neck aneurysms. In small neck aneurysms 8 of 11 cases and in relatively wide neck all 3 cases showed similarly good images by both modalities. Of the 23 cases demonstrated by four different images, 14 cases showed the best image in internal image from parent artery direction and 6 cases showed similarly good image in both aneurysmal cutting image and internal image from parent artery direction. In the evaluation of wide neck aneurysms, 7 of 9 cases showed the best image at internal image from parent artery direction, compared with other three different images. In two cases of aneurysms, calcification was visible in the aneurysmal wall, so it was difficult to evaluate the aneurysmal neck. CTA was superior to DSA in the evaluating the intracranial aneurysmal neck. CTA maybe an additional available modality to evaluate the aneurysmal neck which is difficult to detect by the DSA. And the information of intracranial aneurysmal neck through CTA will be of value in surgical and endovascular treatment

  6. Extended intracranial applications for ethylene vinyl alcohol copolymer (Onyx): mycotic and dissecting aneurysms. Technical note.

    Science.gov (United States)

    La Barge, Donald V; Ng, Perry P; Stevens, Edwin A; Friedline, Nathan K; Kestle, John R; Schmidt, Richard H

    2009-07-01

    The authors describe the off-label use of Onyx for embolization of fusiform mycotic and dissecting intracranial aneurysms based on their experience with 3 patients treated at the University of Utah Hospital from 2006 through 2007. Technical success in occluding the parent artery/aneurysm was achieved in all patients. There were no complications. The authors conclude that Onyx can be used to achieve occlusion of fusiform mycotic and dissecting intracranial aneurysms in conjunction with parent artery occlusion.

  7. Differences in Morphologic and Hemodynamic Characteristics for "PHASES-Based" Intracranial Aneurysm Locations.

    Science.gov (United States)

    Varble, N; Rajabzadeh-Oghaz, H; Wang, J; Siddiqui, A; Meng, H; Mowla, A

    2017-11-01

    Several recent prospective studies have found that unruptured intracranial aneurysms at various anatomic locations have different propensities for future rupture. This study aims to uncover the lack of understanding regarding rupture-prone characteristics, such as morphology and hemodynamic factors, associated with different intracranial aneurysm location. We investigated the characteristics of 311 unruptured aneurysms at our center. Based on the PHASES study, we separated and compared morphologic and hemodynamic characteristics among 3 aneurysm location groups: 1) internal carotid artery; 2) middle cerebral artery; and 3) anterior communicating, posterior communicating, and posterior circulation arteries. A mixed model statistical analysis showed that size ratio, low wall shear stress area, and pressure loss coefficient were different between the intracranial aneurysm location groups. In addition, a pair-wise comparison showed that ICA aneurysms had lower size ratios, lower wall shear stress areas, and lower pressure loss coefficients compared with MCA aneurysms and compared with the group of anterior communicating, posterior communicating, and posterior circulation aneurysms. There were no statistical differences between MCA aneurysms and the group of anterior communicating, posterior communicating, and posterior circulation aneurysms for morphologic or hemodynamic characteristics. ICA aneurysms may be subjected to less rupture-prone morphologic and hemodynamic characteristics compared with other locations, which could explain the decreased rupture propensity of intracranial aneurysms at this location. © 2017 by American Journal of Neuroradiology.

  8. Remission of migraine after clipping of saccular intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, E R; Busygina, A V; Kolotvinov, V S

    2015-01-01

    BACKGROUND: Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches...... was greater in patients with SIA after clipping than in controls. METHODS: We prospectively studied 87 SIA patients with migraine or other recurrent headaches. They were interviewed about headaches in the preceding year before and 1 year after clipping using a validated semi-structured neurologist conducted...... interview. The remission rates of migraine and tension-type headache (TTH) in these patients were compared to 92 patients from a headache center. Diagnoses were made according to the ICHD-2. RESULTS: During 1 year preceding rupture 51 patients with SIA had migraine. During the year after clipping...

  9. Treatment of unruptured intracranial aneurysms-Current perspective.

    Science.gov (United States)

    Ambekar, Sudheer; Pandey, Paritosh

    2015-01-01

    Unruptured intracranial aneurysms (UIAs) present a unique challenge due to the lack of a clear understanding of their natural history and outcome. As the treatment of UIAs is aimed at preventing the possibility of rupture, the immediate risk of treatment must be weighed against the risk of rupture in the future. As such, no specific guidelines exist for a large proportion of UIAs, and treatment is currently individualized. It is also of paramount importance that the physicians be aware of the recent advances in the therapy of UIAs. The present article focuses on the recent advances in the understanding of UIAs.

  10. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  11. Interdisciplinary treatment of unruptured intracranial aneurysms: impact of intraprocedural rupture and ischemia in 563 aneurysms.

    Science.gov (United States)

    Kunz, Mathias; Bakhshai, Yasmin; Zausinger, Stefan; Fesl, Gunther; Janssen, Hendrik; Brückmann, Hartmut; Tonn, Jörg Christian; Schichor, Christian

    2013-05-01

    This study was conducted to determine the risk factors and the clinical impact of intraprocedural aneurysm rupture (IAR) and periprocedural ischemia in the treatment of symptomatic and asymptomatic unruptured intracranial aneurysms (UIAs). A single-center retrospective data analysis of 563 UIAs treated between 2000 and 2010 was conducted. Treatment assignment was made on the basis of individual aneurysmal criteria in an interdisciplinary neurovascular conference with attending neurosurgeons, neuroradiologists and neurologists. In 363 microsurgical and 200 endovascular procedures, the permanent morbidity rate was 4.9 and 6 %. The overall mortality rate was 0.7 %-no procedure-related death occurred in microsurgery, and four patients had fatal outcomes after endovascular treatment. IAR occurred in 34 (9.4 %) microsurgical and 8 (4 %) endovascular procedures (p = 0.03). Risk factors for IAR were age, aneurysm diameter, symptomatic aneurysms, hypertension and smoking in microsurgery. IAR was associated with significantly worse outcome at discharge after microsurgical and at discharge and follow-up after endovascular procedures and was followed by fatal outcome in four endovascular cases. Periprocedural ischemia (12.1 vs. 9 %) resulted in significantly worse outcome in both groups. Risk factors for periprocedural ischemia were IAR during microsurgery, aneurysm diameter, symptomatic aneurysms and smoking in either group. Treatment of UIAs can be conducted with an equivalent low rate of permanent morbidity for clipping and coiling-treatment of symptomatic aneurysms elevates the procedural risk. IAR was less frequent during coiling, but was associated with relevant mortality. IAR and periprocedural ischemia represent significant treatment-associated risks, which should be taken into account in interdisciplinary treatment planning and patient counseling.

  12. Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Schneiders, J J; Marquering, H A; van Ooij, P; van den Berg, R; Nederveen, A J; Verbaan, D; Vandertop, W P; Pourquie, M; Rinkel, G J E; vanBavel, E; Majoie, C B L M

    2015-10-01

    Hemodynamics are thought to play an important role in the rupture of intracranial aneurysms. We tested whether hemodynamics, determined from computational fluid dynamics models, have additional value in discriminating ruptured and unruptured aneurysms. Such discriminative power could provide better prediction models for rupture. A cross-sectional study was performed on patients eligible for endovascular treatment, including 55 ruptured and 62 unruptured aneurysms. Association with rupture status was tested for location, aneurysm type, and 4 geometric and 10 hemodynamic parameters. Patient-specific spatiotemporal velocities measured with phase-contrast MR imaging were used as inflow conditions for computational fluid dynamics. To assess the additional value of hemodynamic parameters, we performed 1 univariate and 2 multivariate analyses: 1 traditional model including only location and geometry and 1 advanced model that included patient-specific hemodynamic parameters. In the univariate analysis, high-risk locations (anterior cerebral arteries, posterior communicating artery, and posterior circulation), daughter sacs, unstable inflow jets, impingements at the aneurysm body, and unstable complex flow patterns were significantly present more often in ruptured aneurysms. In both multivariate analyses, only the high-risk location (OR, 3.92; 95% CI, 1.77-8.68) and the presence of daughter sacs (OR, 2.79; 95% CI, 1.25-6.25) remained as significant independent determinants. In this study population of patients eligible for endovascular treatment, we found no independent additional value of aneurysmal hemodynamics in discriminating rupture status, despite high univariate associations. Only traditional parameters (high-risk location and the presence of daughter sacs) were independently associated with ruptured aneurysms. © 2015 by American Journal of Neuroradiology.

  13. International Subarachnoid Aneurysm Trial 2009 : Endovascular Coiling of Ruptured Intracranial Aneurysms Has No Significant Advantage Over Neurosurgical Clipping

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Mooij, Jan Jakob A.; Van Dijk, J. Marc C.

    In the May 2009 issue of The Lancet Neurology, the 5-year follow-up results of the International Subarachnoid Aneurysm Trial (ISAT) were published. The authors concluded that, although the significant difference between coiling and neurosurgical clipping of ruptured intracranial aneurysms in terms

  14. Pulsatile flow effects on the hemodynamics of intracranial aneurysms.

    Science.gov (United States)

    Le, Trung B; Borazjani, Iman; Sotiropoulos, Fotis

    2010-11-01

    High-resolution numerical simulations are carried out to systematically investigate the effect of the incoming flow waveform on the hemodynamics and wall shear stress patterns of an anatomic sidewall intracranial aneurysm model. Various wave forms are constructed by appropriately scaling a typical human waveform such that the waveform maximum and time-averaged Reynolds numbers, the Womersley number (α), and the pulsatility index (PI) are systematically varied within the human physiologic range. We show that the waveform PI is the key parameter that governs the vortex dynamics across the aneurysm neck and the flow patterns within the dome. At low PI, the flow in the dome is similar to a driven cavity flow and is characterized by a quasi-stationary shear layer that delineates the parent artery flow from the recirculating flow within the dome. At high PI, on the other hand, the flow is dominated by vortex ring formation, transport across the neck, and impingement and breakdown at the distal wall of the aneurysm dome. We further show that the spatial and temporal characteristics of the wall shear stress field on the aneurysm dome are strongly correlated with the vortex dynamics across the neck. We finally argue that the ratio between the characteristic time scale of transport by the mean flow across the neck and the time scale of vortex ring formation can be used to predict for a given sidewall aneurysm model the critical value of the waveform PI for which the hemodynamics will transition from the cavity mode to the vortex ring mode.

  15. Risk Factors Associated With the Presence of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Kang, Hyun Goo; Kim, Bum Joon; Lee, Jisung; Kim, Mi-Jung; Kang, Dong-Wha; Kim, Jong S; Kwon, Sun U

    2015-11-01

    With the increased investigation of cerebral arteries using magnetic resonance angiography in the general population, the detection of unruptured intracranial aneurysms (UIAs) has increased. Understanding the distribution and factors associated with UIAs might be helpful for understanding the pathomechanism. Subjects who underwent magnetic resonance angiography with a health examination at the Health Screening and Promotion Center were enrolled. The incidence and risk factors of UIAs (age, sex, hypertension, diabetes mellitus, smoking, alcohol, and coronary artery disease) were investigated by comparing patients with and without UIAs. These risk factors were also investigated by the UIA location, distal internal carotid artery, anterior cerebral artery and middle cerebral artery (MCA), MCA bifurcation, anterior and posterior communicating artery, and posterior circulation. Among 187 166 subjects who received health examination, 18 954 underwent magnetic resonance angiography. Of them, 367 (1.93%) had UIAs. Age (odds ratio [OR], 1.02; P=0.003), women (OR, 2.00; P<0.001), hypertension (OR, 2.21; P<0.001), smoking (OR, 1.66; P=0.001), and coronary artery disease (OR, 0.23; P<0.001) were independently associated with the presence of UIAs. Hypertension was associated with most UIAs, except for those located at sidewalls (anterior cerebral artery and MCA). MCA aneurysms were associated with old age and smoking. Distal internal carotid artery, posterior communicating artery, and MCA-bifurcation aneurysms were associated with female sex. Anterior communicating artery aneurysms were associated with smoking and alcohol. Posterior circulation UIAs were only associated with hypertension. Coronary artery disease was negatively associated with anterior circulation aneurysms. The risk factors for UIAs differ by their location, compared with the control. Interestingly, the presence of coronary artery disease was protective against the presence of UIAs. © 2015 American Heart

  16. Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Peng; Zhang, Hong-Qi [Capital Medical University, Department of Neurosurgery, Xuanwu Hospital, Beijing (China); Yang, Qi [Capital Medical University, Department of Radiology, Xuanwu Hospital, Beijing (China); Wang, Dan-Dan [Capital Medical University, Department of Clinical Pathology, Xuanwu Hospital, Beijing (China); Guan, Shao-Chen [Capital Medical University, Department of Evidence-Based Medicine, Xuanwu Hospital, Beijing (China)

    2016-10-15

    The aneurysm wall has been reported to play a critical role in the formation, development, and even rupture of an aneurysm. We used high-resolution magnetic resonance imaging (HRMRI) to investigate the aneurysm wall in an effort to identify evidence of inflammation invasion and define its relationship with aneurysm behavior. Patients with intracranial aneurysms who were prospectively evaluated using HRMRI between July 2013 and June 2014 were enrolled in this study. The aneurysm's wall enhancement and evidence of inflammation invasion were determined. In addition, the relationship between aneurysm wall enhancement and aneurysm size and symptoms, including ruptured aneurysms, giant unruptured intracranial aneurysms (UIAs) presenting as mass effect, progressively growing aneurysms, and aneurysms associated with neurological symptoms, was statistically analyzed. Twenty-five patients with 30 aneurysms were available for the current study. Fourteen aneurysms showed wall enhancement, including 6 ruptured and 8 unruptured aneurysms. Evidence of inflammation was identified directly through histological studies and indirectly through intraoperative investigations and clinical courses. The statistical analysis indicated no significant correlation between aneurysm wall enhancement and aneurysm size. However, there was a strong correlation between wall enhancement and aneurysm symptoms, with a kappa value of 0.86 (95 % CI 0.68-1). Aneurysm wall enhancement on HRMRI might be a sign of inflammatory change. Symptomatic aneurysms exhibited wall enhancement on HRMRI. Wall enhancement had a high consistent correlation of symptomatic aneurysms. Therefore, wall enhancement on HRMRI might predict an unsteady state of an intracranial saccular aneurysm. (orig.)

  17. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging

    International Nuclear Information System (INIS)

    Schubiger, O.; Valavanis, A.; Wichmann, W.

    1987-01-01

    In four cases of giant intracranial aneurysm, CT demonstrated a hyperdense open-, or closed-ring structure at the periphery of the aneurysm. Surgery in two of the cases demonstrated that this peripheral hyperdensity represents fresh clot inside the wall of the thrombosed mass. An analogy is established between giant intracranial aneurysms, chronic subdural hematomas and growing encapsulated intracerebral hematomas. The common feature of the three entities is slow growth by recurrent hemorrhages into the lesion. It is proven that growth of chronic subdural hematomas and of growing encapsulated hematomas is related to recurrent hemorrhage from capillaries sprouting within the membrane of the lesion. The highly vascularized membranous wall of a giant intracranial aneurysm seems to behave like the membrane of a chronic subdural hematoma. It is suggested that the giant intracranial aneurysm grows by recurrent hemorrhage into its wall and behaves like growing encapsulated hematomas. (orig.)

  18. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schubiger, O.; Valavanis, A.; Wichmann, W.

    1987-05-01

    In four cases of giant intracranial aneurysm, CT demonstrated a hyperdense open-, or closed-ring structure at the periphery of the aneurysm. Surgery in two of the cases demonstrated that this peripheral hyperdensity represents fresh clot inside the wall of the thrombosed mass. An analogy is established between giant intracranial aneurysms, chronic subdural hematomas and growing encapsulated intracerebral hematomas. The common feature of the three entities is slow growth by recurrent hemorrhages into the lesion. It is proven that growth of chronic subdural hematomas and of growing encapsulated hematomas is related to recurrent hemorrhage from capillaries sprouting within the membrane of the lesion. The highly vascularized membranous wall of a giant intracranial aneurysm seems to behave like the membrane of a chronic subdural hematoma. It is suggested that the giant intracranial aneurysm grows by recurrent hemorrhage into its wall and behaves like growing encapsulated hematomas.

  19. The pathogenesis shared between abdominal aortic aneurysms and intracranial aneurysms: a microarray analysis.

    Science.gov (United States)

    Wang, Wen; Li, Hao; Zhao, Zheng; Wang, Haoyuan; Zhang, Dong; Zhang, Yan; Lan, Qing; Wang, Jiangfei; Cao, Yong; Zhao, Jizong

    2018-04-01

    Abdominal aortic aneurysms (AAAs) and intracranial saccular aneurysms (IAs) are the most common types of aneurysms. This study was to investigate the common pathogenesis shared between these two kinds of aneurysms. We collected 12 IAs samples and 12 control arteries from the Beijing Tiantan Hospital and performed microarray analysis. In addition, we utilized the microarray datasets of IAs and AAAs from the Gene Expression Omnibus (GEO), in combination with our microarray results, to generate messenger RNA expression profiles for both AAAs and IAs in our study. Functional exploration and protein-protein interaction (PPI) analysis were performed. A total of 727 common genes were differentially expressed (404 was upregulated; 323 was downregulated) for both AAAs and IAs. The GO and pathway analyses showed that the common dysregulated genes were mainly enriched in vascular smooth muscle contraction, muscle contraction, immune response, defense response, cell activation, IL-6 signaling and chemokine signaling pathways, etc. The further protein-protein analysis identified 35 hub nodes, including TNF, IL6, MAPK13, and CCL5. These hub node genes were enriched in inflammatory response, positive regulation of IL-6 production, chemokine signaling pathway, and T/B cell receptor signaling pathway. Our study will gain new insight into the molecular mechanisms for the pathogenesis of both types of aneurysms and provide new therapeutic targets for the patients harboring AAAs and IAs.

  20. Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms.

    Science.gov (United States)

    Meyers, Philip M; Schumacher, H Christian; Higashida, Randall T; Derdeyn, Colin P; Nesbit, Gary M; Sacks, David; Wechsler, Lawrence R; Bederson, Joshua B; Lavine, Sean D; Rasmussen, Peter

    2010-12-01

    The goal of this article is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting on the radiological evaluation and endovascular treatment of intracranial, cerebral aneurysms. These criteria can be used to design clinical trials, to provide uniformity of definitions for appropriate selection and stratification of patients, and to allow analysis and meta-analysis of reported data. This article was written under the auspices of the Joint Writing Group of the Technology Assessment Committee, Society of Neurolnterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1991 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data about the assessment and endovascular treatment of cerebral aneurysms useful as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This article offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of cerebral aneurysms. Included in this guidance article are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications. The evaluation and treatment of brain aneurysms often involve multiple medical specialties. Recent reviews by the American Heart Association have surveyed the medical literature to develop guidelines for the clinical

  1. Treatment of ruptured intracranial aneurysms yesterday and now

    Science.gov (United States)

    Hammer, Alexander; Steiner, Anahi; Kerry, Ghassan; Ranaie, Gholamreza; Baer, Ingrid; Hammer, Christian M.; Kunze, Stefan; Steiner, Hans-Herbert

    2017-01-01

    Objective This prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years. Methods We compared 361 treated cases of aneurysm occlusion after subarachnoid hemorrhage from 1997 to 2003 with 281 cases from 2006 to 2014. Specialists of neuroradiology and vascular neurosurgery decided over the modality assignment. We established a prospective data acquisition in both groups to detect significant differences within a follow-up time of one year. With this setting we evaluated the treatment methods over time and compared endovascular with microsurgical treatment. Results When compared to the earlier group, microsurgical treatment was less frequently chosen in the more recent collective because of neck-configuration. Endovascular treatment was chosen more frequently over time (31.9% versus 48.8%). Occurrence of initial symptomatic ischemic stroke was significantly lower in the clipping group compared to the endovascular group and remained stable over time. The number of reinterventions due to refilled treated aneurysms significantly decreased in the endovascular group at one-year follow-up, but the significantly better occlusion- and reintervention-rate of the microsurgical group persisted. The rebleeding rate in the endovascular group at one year follow-up decreased from 6.1% to 2.2% and showed no statistically significant difference to the microsurgical group, anymore (endovascular 2.2% versus microsurgical 0.0%, p = 0.11). Conclusion Microsurgical clipping still has some advantages, however endovascular treatment is improving rapidly. PMID:28257502

  2. The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV

    Directory of Open Access Journals (Sweden)

    Gerrit Blignaut

    2014-04-01

    Objectives: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults. Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 106/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography. Results: Fifteen (65.2% patients had a single aneurysm, of which 12 (80.0% had a saccular appearance. Seven (46.7% of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 106 /L. Eight patients (34.8% had multiple aneurysms, with a total of 26 aneurysms (range 2–6 aneurysms per patient, of which 13 (50.0% had a complex appearance. Twenty-four (92.3% of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 106/L. Conclusion: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes.

  3. A novel intracranial enterprise stent together with colis for the treatment of very small intracranial wide-necked aneurysms

    International Nuclear Information System (INIS)

    Huang Haidong; Zhao Kai; Gu Jianwen; Qu Yan; Yang Tao; Xia Xun; Lin Long; Zhang Hui

    2010-01-01

    Objective: To make a preliminary investigation and summary of the technique and efficacy of the novel intracranial stent, Enterprise, together with hydro-detachable coils for the treatment of very small intracranial wide-necked aneurysms (diameter < 3 mm and body-to-neck ratio < 1.5). Methods: Six cases with very small intracranial wide-necked aneurysms were treated with Enterprise stents and hydrodetachable coils. In 5 cases the Enterprise stent was implanted to cover the neck of the aneurysm, which was followed by the introduction of a microcatheter into the aneurysmal sac through the stent mesh to stuff hydrodetachable coils in order to fill the aneurysmal sac. In the remaining case, the microcatheter was placed into the aneurysmal sac before the Enterprise stent was inserted to embolize the aneurysm. Postoperative follow-up was conducted for 3-6 months. Results: The operation was successfully completed in all 6 patients, with the implanted stents being in right place. The parent arteries remained patency in all patients. No complications occurred. Complete occlusion of aneurysmal cavity was obtained in four cases, and the occlusion degree of the aneurysmal cavity above 95% was seen in 2 cases. After the procedure, all the patients recovered well. Neither rebleeding nor symptoms related to thrombosis occurred during a clinic followup of 3-6 months. Conclusion: Endovascular embolization with Enterprise stent together with hydrodetachable coils is a safe and effective method for the treatment of very small intracranial wide-necked aneurysms.However, its long-term effect needs to be further observed. (authors)

  4. Lipoprotein (a): a potential biological marker for unruptured intracranial aneurysms.

    Science.gov (United States)

    Phillips, J; Roberts, G; Bolger, C; el Baghdady, A; Bouchier-Hayes, D; Farrell, M; Collins, P

    1997-05-01

    The diagnosis and treatment of intracranial aneurysms (IAs) prior to rupture reduces the high morbidity and mortality associated with their occurrence. Elevated serum lipoprotein (a) [Lp(a)] level, an independent risk factor for atherogenesis, has been demonstrated in sporadic IA disease (1). The purpose of this study was to assess the degree of correlation between elevated Lp(a) levels and the occurrence of IAs in asymptomatic first degree relatives of index cases from three families exhibiting a familial tendency towards IA development. 25 family members and 41 healthy controls were screened by random serum Lp(a) sampling. All family members received 4-vessel cerebral angiography. Eleven family members were found on angiography to harbour asymptomatic aneurysms and all were successfully treated by surgery. Of these 11, ten had significantly raised serum Lp(a) levels (> 30 mg%). Fourteen family members had negative angiograms. Eight of this latter group, mean age 43.6 +/- 3.8 years, had serum Lp(a) levels above the normal range. Mean Lp(a) levels were 53.7 +/- 1.2 mg% in subjects with aneurysms compared with 22.1 +/- 1.45 mg% in subjects without demonstrable aneurysms and 10.5 +/- 0.48 mg% in the control population. The prevalence of elevated Lp(a) levels in these families and the high degree of association of raised Lp(a) levels with the presence of IAs in several family members warrants follow up of angiographically negative young subjects. We require a case-control study to establish whether particular polymorphisms at the apoprotein (a) gene level are associated with the occurrence of IAs in these families.

  5. Toward understanding non-coding RNA roles in intracranial aneurysms and subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Huang Fengzhen

    2017-05-01

    Full Text Available Subarachnoid hemorrhage (SAH is a common and frequently life-threatening cerebrovascular disease, which is mostly related with a ruptured intracranial aneurysm. Its complications include rebleeding, early brain injury, cerebral vasospasm, delayed cerebral ischemia, chronic hydrocephalus, and also non neurological problems. Non-coding RNAs (ncRNAs, comprising of microRNAs (miRNAs, small interfering RNAs (siRNAs and long non-coding RNAs (lncRNAs, play an important role in intracranial aneurysms and SAH. Here, we review the non-coding RNAs expression profile and their related mechanisms in intracranial aneurysms and SAH. Moreover, we suggest that these non-coding RNAs function as novel molecular biomarkers to predict intracranial aneurysms and SAH, and may yield new therapies after SAH in the future.

  6. Prevalence of symptomatic intracranial aneurysm and ischaemic stroke in pseudoxanthoma elasticum

    NARCIS (Netherlands)

    van den Berg, J. S.; Hennekam, R. C.; Cruysberg, J. R.; Steijlen, P. M.; Swart, J.; Tijmes, N.; Limburg, M.

    2000-01-01

    BACKGROUND: Pseudoxanthoma elasticum (PXE) is an heritable connective tissue disorder with clinical manifestations of the ocular, dermal, and cardiovascular system. The purpose of this study was to investigate the prevalence of symptomatic intracranial aneurysms (IAs) and ischaemic stroke (IS) in

  7. Familial aggregation of intracranial aneurysms in an Inuit patient population in Kalaallit Nunaat (Greenland)

    DEFF Research Database (Denmark)

    Lindgaard, Lars; Eskesen, Vagn; Gjerris, Flemming

    2003-01-01

    The incidence of subarachnoid hemorrhage (SAH) and intracranial aneurysm (IA) has been reported to be higher in Greenlandic Inuits than in Caucasian Danes, but the rate of familial aggregation in Inuits is unknown....

  8. MR angiography as a screening tool for intracranial aneurysms: feasibility, test characteristics, and interobserver agreement

    NARCIS (Netherlands)

    Raaymakers, T. W.; Buys, P. C.; Verbeeten, B.; Ramos, L. M.; Witkamp, T. D.; Hulsmans, F. J.; Mali, W. P.; Algra, A.; Bonsel, G. J.; Bossuyt, P. M.; Vonk, C. M.; Buskens, E.; Limburg, M.; van Gijn, J.; Gorissen, A.; Greebe, P.; Albrecht, K. W.; Tulleken, C. A.; Rinkel, G. J.

    1999-01-01

    OBJECTIVE: MR angiography may be an appropriate tool to screen for unruptured intracranial aneurysms. Feasibility, test characteristics, and interobserver agreement in evaluation of MR angiograms were assessed by members of the MARS (Magnetic resonance Angiography in Relatives of patients with

  9. Cost-effectiveness of preventive treatment of intracranial aneurysms New data and uncertainties

    NARCIS (Netherlands)

    Greving, Jacoba P.; Rinkel, Gabriel J. E.; Buskens, Erik; Algra, Ale

    2009-01-01

    Background: Previous modeling studies on treatment of unruptured intracranial aneurysms largely disregarded detailed data on treatment risks and omitted several factors that could influence cost-effectiveness. We performed a cost-effectiveness analysis of surgical and endovascular treatment of

  10. The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Park, Seong-Ho; Yim, Man-Bin

    2008-01-01

    Objective The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms. Methods Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed. Results Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2% ; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms. Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months). Conclusion Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option. PMID:19096631

  11. Investigating the influence of haemodynamic stimuli on intracranial aneurysm inception.

    Science.gov (United States)

    Chen, Haoyu; Selimovic, Alisa; Thompson, Harry; Chiarini, Alessandro; Penrose, Justin; Ventikos, Yiannis; Watton, Paul N

    2013-07-01

    We propose a novel method to reconstruct the hypothetical geometry of the healthy vasculature prior to intracranial aneurysm (IA) formation: a Frenet frame is calculated along the skeletonization of the arterial geometry; upstream and downstream boundaries of the aneurysmal segment are expressed in terms of the local Frenet frame basis vectors; the hypothetical healthy geometry is then reconstructed by propagating a closed curve along the skeleton using the local Frenet frames so that the upstream boundary is smoothly morphed into the downstream boundary. This methodology takes into account the tortuosity of the arterial vasculature and requires minimal user subjectivity. The method is applied to 22 clinical cases depicting IAs. Computational fluid dynamic simulations of the vasculature without IA are performed and the haemodynamic stimuli in the location of IA formation are examined. We observe that locally elevated wall shear stress (WSS) and gradient oscillatory number (GON) are highly correlated (20/22 for WSS and 19/22 for GON) with regions susceptible to sidewall IA formation whilst haemodynamic indices associated with the oscillation of the WSS vectors have much lower correlations.

  12. Unruptured Intracranial Aneurysms: Surgery Still Safe as a Treatment Option.

    Science.gov (United States)

    Koźba-Gosztyła, Marta; Czapiga, Bogdan; Jarmundowicz, Włodzimierz; Tomiałowicz, Łukasz

    2016-01-01

    Despite a number of studies on the treatment of unruptured intracranial aneurysms (UIA), the optimal method still remains unclear. The aim of the study was to demonstrate that UIA clipping is a safe procedure and can be a good alternative for patients not qualified for endovascular procedures and who have refused conservative management. Results were gathered from a sample of 104 patients with UIA treated in our facility over a 9-year period starting January 2005. The data from a medical database was collected, followed by a long-term assessment of the functional outcomes using the modified Rankin Scale (mRS) and of quality of life (QoL) using a SF-36 questionnaire and comparing it to a Polish population reference. Overall postoperative morbidity was 5.7% and the mortality rate was 0%. The mean follow-up period was 6.5 years. A favorable outcome (mRS 0-2) was achieved in all the patients. Ninety-eight patients achieved an mRS score of 0, 2 patients an mRS score of 1, and 4 patients an mRS score of 2. All patients lived at home. Sixty-nine point two percent were fully employed, 27.0% were retired because of age, and only 3.8% relied on government help due to postoperative disability. The QoL index was similar to that of the standard Polish population. In unruptured cerebral aneurysms, clipping is a safe procedure that provides good outcomes and an unaffected quality of life. It remains a good option especially for patients with MCA aneurysms that are not appropriate for endovascular management.

  13. Initial experience with 3T 3D-TOF MRA in the diagnosis of intracranial aneurysms

    International Nuclear Information System (INIS)

    Senba, Yoshiki; Takahashi, Shizue; Matsubara, Ichiro; Sadamoto, Kazuhiko; Miki, Hitoshi; Mochizuki, Teruhito

    2006-01-01

    We assessed the value of 3T 3D-time of flight (TOF) MR angiography (MRA) in the diagnosis of intracranial aneurysms compared with 1.5T 3D-TOF MRA. Twenty-one patients with 22 aneurysms underwent MRA at 1.5T and 3T. Images were interpreted by two radiologists. Each of nine aneurysms that had been considered ''definite'' at 1.5T 3D-TOF MRA were considered ''definite'' at 3T 3D-TOF MRA. Seven aneurysms that had been considered ''suspicious'' at 1.5T MRA were considered ''definite'' at 3T. And four aneurysms that had been considered ''suspicious'' at 1.5T were considered ''negative'' at 3T. We concluded that 3T 3D-TOF MRA is superior to 1.5T 3D-TOF MRA in the diagnosis of intracranial aneurysms. (author)

  14. Detection, characterization and endovascular therapy planning of intracranial aneurysms with 16-channel multidetector row CT angiography

    Directory of Open Access Journals (Sweden)

    Amr Badry

    2014-03-01

    Conclusion: Sixteen channel Multidetector CT angiography offers high diagnostic accuracy nearly equivalent to that of DSA in the detection of intracranial aneurysms. However, 16 channel- MDCTA still has limited sensitivity in detecting aneurysms of 3 mm or less, despite its technical advances. MDCT can be used as a reliable alternative imaging technique to DSA in selected cases.

  15. Comparative Ultrastructural and Stereological Analyses of Unruptured and Ruptured Saccular Intracranial Aneurysms

    NARCIS (Netherlands)

    Korkmaz, Emine; Kleinloog, Rachel|info:eu-repo/dai/nl/345480503; Verweij, Bon H.|info:eu-repo/dai/nl/311491774; Allijn, Iris E.; Hekking, Liesbeth H.P.; Regli, Luca; Rinkel, Gabriel J.E.|info:eu-repo/dai/nl/085712000; Ruigrok, Ynte M.|info:eu-repo/dai/nl/303621222; Andries Post, Jan

    2017-01-01

    Insight into processes leading to rupture of intracranial aneurysms (IAs) may identify biomarkers for rupture or lead to management strategies reducing the risk of rupture. We characterized and quantified (ultra)structural differences between unruptured and ruptured aneurysmal walls. Six unruptured

  16. A Theoretical Consideration of the Surgical Treatment of Small Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Chang, Han Soo

    2016-12-01

    Surgical treatment of small, unruptured intracranial aneurysms remains a controversial topic. Recently, some authors have doubted the validity of the low rupture rates of small aneurysms reported in the literature and advocate aggressive surgical treatment of small unruptured aneurysms; however, some theoretical elucidation is necessary to determine whether such aggressive treatment is appropriate. On certain theoretical assumptions, a simulation was performed to examine whether the low rupture rates for small aneurysms could produce a reasonable size distribution of ruptured aneurysms. Second, considering a hypothetical population in which all the unruptured aneurysms over a certain cut-off size are treated, the effect of this policy on reducing the incidence of subarachnoid hemorrhage (SAH) was mathematically analyzed. Then, the contribution of each individual operation to this reduction of SAH incidence was calculated. The low rupture rates reported in the literature produced a reasonable size distribution of ruptured aneurysms (median diameter of 10 mm) in the simulated population. The analysis of the treatment cut-off size showed that, as the cut-off size was progressively lowered to the range of 3-5 mm, further reduction of the incidence of SAH became almost negligible. The contribution of each individual surgery on unruptured aneurysms decreased rapidly as the aneurysm size decreased, and this reduction was proportional to the reduction of the rupture rate of the aneurysm. These results suggest that we should be prudent in providing surgical treatment to small unruptured intracranial aneurysms. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Therapeutic effect of enterprise stent-assisted embolization for very small ruptured intracranial aneurysms.

    Science.gov (United States)

    Qin, Feiyun; Li, Zhenbao; Fang, Xinggen; Zhao, Xintong; Liu, Jiaqiang; Wu, Degang; Lai, Niansheng

    2017-08-01

    Enterprise stent has been widespread used in wide-necked intracranial aneurysms and good efficacy has been achieved, but there are few reports on its applications in very small ruptured intracranial aneurysms in literatures. This study aimed to evaluate the safety and efficacy of Enterprise stent-assisted coiling embolization of very small ruptured intracranial aneurysms.We retrospectively reviewed the clinical and imaging data from 37 patients with very small ruptured intracranial aneurysms who had SAC using Enterprise stents performed from February 2012 to July 2016 in our department. Data collected and analyzed included patient demographics, morphologic features of the aneurysm, treatment results, and follow-up results. Clinical outcomes were evaluated by the Glasgow Outcome Scale (GOS).Enterprise stents were successfully implanted in all 37 patients with very small ruptured intracranial aneurysms. Of the 37 individuals, 28 patients exhibited complete occlusion at Raymond grade I, 5 patients exhibited occlusion at Raymond grade II, and 4 patients at Raymond grade III. Procedure-related complications occurred in 3 of 37 patients (8.1%), including 1 case of intraprocedure aneurysm rupture who died from cerebral herniation caused by severe postoperative cerebral ischemia during the hospital stay, and the other 2 complications were acute in-stent thrombosis, and occlusion of parent artery caused by falling-off internal carotid artery plaque, respectively. A total of 36 patients underwent postoperative clinical follow-up visits for 6 to 24 months of which 31 patients recovered (GOS ≥ 4). One patient had hemiplegic paralysis, and no rehemorrhage was found. A total of 25 patients underwent follow-up digital subtraction angiography (DSA) at 3-21 months postintervention, in whom there were 22 cases with complete occlusion, 2 cases with recurrence of aneurysm neck, and 1 case with in-stent restenosis, but there was no patient with neurologic deficits.The Enterprise

  18. [False traumatic aneurysm of the ulnar artery in a teenager].

    Science.gov (United States)

    Nour, M; Talha, H; El Idrissi, R; Lahraoui, Y; Ouazzani, L; Oubejja, H; Erraji, M; Zerhouni, H; Ettayebi, F

    2014-12-01

    Most aneurysms of hand arteries are traumatic. It is a generally rare unrecognized pathology. Complications are serious (embolism and thromboses of interdigital arteries). Two main causes can be recalled: acute trauma, with development of a false aneurysm; repeated microtrauma (hand hammer syndrome), with occurrence of an arterial dysplasic aneurysm. The diagnosis is based on the presence of a pulsatile mass, with finger dysesthesia, unilateral Raynaud's phenomenon. It is confirmed by duplex Doppler. Arteriography is necessary but can be replaced by an angio-MR. We report a case of false traumatic aneurysm of the ulnar artery in a teenager. This case illustrates this rare condition and opens discussion on therapeutic options. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Tiny intracranial aneurysms: Endovascular treatment by coil embolisation or sole stent deployment

    International Nuclear Information System (INIS)

    Lu Jun; Liu Jiachun; Wang Lijun; Qi Peng; Wang Daming

    2012-01-01

    Purpose: Tiny intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists. The authors report their preliminary results of endovascular treatment of these aneurysms. Methods: Between January 2002 and December 2009, 52 tiny intracranial aneurysms (defined as ≤3 mm in maximum diameter) in 46 patients (22 men; mean age, 57.9 years) were treated by endosaccular coil embolisation or sole stent deployment in the parent artery. Of 52 aneurysms, 29 had ruptured and 23 remained unruptured. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography. Results: One aneurysm coiling procedure failed because of unsuccessful micro-catheterization. Forty-three aneurysms were successfully coil embolized, of which complete occlusion was obtained in 14, subtotal occlusion in 18 and incomplete occlusion in 11. The other 8 aneurysms were treated by sole stent deployment in the parent artery. Procedural complications (2 intraprocedural ruptures and 3 thromboembolic events) occurred in 5 (9.6%) of 52 aneurysms, resulting in permanent morbidity in only 1 (2.2%, 1/46) patient. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Of the 16 coiled aneurysms that receiving repetitive angiography, 6 initially completely and 3 subtotally occluded aneurysms remained unchanged, 4 initially subtotally and 3 incompletely occluded aneurysms progressed to total occlusion. Five sole stent deployed aneurysms received angiographic follow-up (mean duration, 10.0 months), of which 3 remained unchanged, 1 became smaller and 1 progressed to total occlusion. Conclusion: Endovascular treatment of tiny intracranial aneurysms is technical feasible and relatively safe. Coil embolisation seems to be effective in preventing early recanalisation, whereas sole stenting technique needs further investigation to determine its effectiveness.

  20. Comparison of Clinical Outcomes of Intracranial Aneurysms: Procedural Rupture versus Spontaneous Rupture.

    Science.gov (United States)

    Choi, H H; Ha, E J; Lee, J J; Yoo, D H; Cho, W-S; Kim, J E; Cho, Y D; Han, M H; Kang, H-S

    2017-11-01

    Procedural rupture of an intracranial aneurysm is a devastating complication in endovascular treatment. The purpose of this study was to evaluate the clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms compared with those with spontaneously ruptured aneurysms. A retrospective review was performed for 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of unruptured saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms. In this series, procedural rupture developed in 19 patients (1.4% per patient and 1.2% per aneurysm), and the morbidity related to procedural rupture was 26.3% (95% confidence interval, 8.5%-61.4%) with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. Subsequent treatment procedures after hemorrhage (including lumbar drainage, extraventricular drainage, decompressive craniectomy, and permanent shunt) showed no difference between the 2 groups. The hemorrhage volumes were smaller in the procedural-rupture group ( P = .03), and the endovascular vasospasm therapies tended to be more frequently required in the spontaneous aneurysm-rupture group ( P = .08). At postictus 6 months, the proportion of modified Rankin Scale scores of ≥2 were lower in the procedural-rupture group (5.3% versus 26.8%, P = .049). In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome (OR = 14.9; 95% CI, 1.2-193.1; P = .039). This study showed better clinical outcomes in the procedural-rupture group. Even though there is a potential chance of aneurysm rupture during treatment, the clinical outcomes after procedural

  1. A failure of matrix metalloproteinase inhibition in the prevention of rat intracranial aneurysm formation

    International Nuclear Information System (INIS)

    Kaufmann, T.J.; Kallmes, D.F.; Marx, W.F.

    2006-01-01

    We tested the hypothesis that nonspecific matrix metalloproteinase (MMP) inhibition with doxycycline would decrease the incidence of intracranial aneurysm formation in a rat aneurysm model. We performed common carotid artery ligation on 96 Long-Evans rats. A treatment group of 48 animals was chosen at random to receive oral doxycycline (3 mg/kg) in addition to standard rat chow, and the control group of 48 animals received standard rat chow only. The major circle of Willis arteries was dissected at 1 year following carotid ligation, and the proportions of animals with aneurysms were compared between groups using Fisher's exact test. Four animals given oral doxycycline and ten control animals expired before 1 year. Of the examined animals, eight saccular intracranial aneurysms were found in 8 of 45 animals which had received doxycycline (17.8%) and seven saccular intracranial aneurysms were found in 7 of 37 control animals (18.9%). There was no significant difference in aneurysm formation between the doxycycline-treated and control groups (P=0.894). Nonspecific MMP inhibition with doxycycline is not effective in preventing intracranial aneurysm formation in a rat model. (orig.)

  2. Treatment outcomes of unruptured intracranial aneurysm; experience of 1,231 consecutive aneurysms.

    Science.gov (United States)

    Song, Jihye; Kim, Bum-Soo; Shin, Yong Sam

    2015-09-01

    The aim of this study was to review our experience with surgical clipping and endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs), with a special focus on complications. We retrospectively analyzed clinical and radiological data from patients who underwent surgery or EVT. Surgery was performed by one neurosurgeon, and EVT was performed by two neurointerventionists according to one hybrid neurosurgeon's decision. Adverse events included the following: (1) decline of the modified Rankin Scale (mRS) score from 1 to 2 and (2) any unexpected neurological deficit or imaging finding affecting the prognosis and/or requiring additional procedures, medication, or prolonged hospital stay. Of the 1231 UIAs in 1124 patients, 625 (50.7 %) aneurysms were treated with surgery, and 606 (49.3 %) aneurysms were treated with EVT. The overall complication rate of UIA treatment was 3.2 %. The rate of adverse events was 2.4 %, and the rates of morbidity and mortality were 0.6 and 0.2 %, respectively. The rates of adverse events, morbidity, and mortality were not significantly different between surgery and EVT. The rate of hospital use for EVT was stationary over the years of the study. Posterior circulation in surgery, large aneurysms (>15 mm) in EVT, and stent- or balloon-assisted procedures in EVT were associated with the occurrence of complications. Poor clinical outcome (mRS of 3-6) was 0.8 % at hospital discharge. Both UIA treatment modalities decided by one hybrid neurosurgeon showed low complication rates and good clinical outcomes in this study. These results may serve as a point of reference for clinical decision-making for patients with UIA.

  3. Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms.

    Science.gov (United States)

    O'Kelly, C J; Spears, J; Chow, M; Wong, J; Boulton, M; Weill, A; Willinsky, R A; Kelly, M; Marotta, T R

    2013-02-01

    Flow-diverting stents, such as the PED, have emerged as a novel means of treating complex intracranial aneurysms. This retrospective analysis of the initial Canadian experience provides insight into technical challenges, clinical and radiographic outcomes, and complication rates after the use of flow-diverting stents for unruptured aneurysms. Cases were compiled from 7 Canadian centers between July 2008 and December 2010. Each center prospectively tracked their initial experience; these data were retrospectively updated and pooled for analysis. During the defined study period, 97 cases of unruptured aneurysm were treated with the PED, with successful stent deployment in 94 cases. The overall complete or near-complete occlusion rate was 83%, with a median follow-up at 1.25 years (range 0.25-2.5 years). Progressive occlusion was witnessed over time, with complete or near-complete occlusion in 65% of aneurysms followed through 6 months, and 90% of aneurysms followed through 1 year. Multivariate analysis found previous aneurysm treatment and female sex predictive of persistent aneurysm filling. Most patients were stable or improved (88%), with the most favorable outcomes observed in patients with cavernous carotid aneurysms. The overall mortality rate was 6%. Postprocedural aneurysm hemorrhage occurred in 3 patients (3%), while ipsilateral distal territory hemorrhage was observed in 4 patients (3.4%). Flow-diverting stents represent an important tool in the treatment of complex intracranial aneurysms. The relative efficacy and morbidity of this treatment must be considered in the context of available alternate interventions.

  4. Application of dual volume reconstruction technique in embolization of intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xiang-hai ZHANG

    2014-03-01

    Full Text Available Objective To explore the value of dual volume reconstruction technique in Guglielmi detachable coil (GDC embolization of intracranial aneurysms. Methods Three-dimensional imaging data of 20 patients received GDC embolization of intracranial aneurysms from Jun. 2012 to Apr. 2013 were analyzed for dual volume reconstruction. The value of application of dual volume reconstruction was evaluated by the detection rate of coils bolus, degree of aneurysm occlusion, the length of aneurysm sac and aneurysm neck before and after embolization, and the characteristics and clinical value of the reconstructed images. Results  A total of 20 coil boluses were detected by dual volume reconstruction images, and the detection rate was 100%. Among all of 20 patients, no visualization of contrast medium in the aneurysm was found in 13 patients, while contrast agent was found in the aneurysm sac in 3 patients and in the aneurysm neck in 4 patients. The length of aneurysm neck and sac was somewhat changed before and after embolization with no statistically significant difference (P>0.05. The dual volume reconstruction could reveal coil bolus, vessels, cranium and fusion images, and the aneurysms could be shown by different imaging modes according to the clinical requirement. Conclusion Dual volume reconstruction technique can display the location of coil bolus, degree of occlusion and aneurysm size, and evaluate the embolization effect by multifarious imaging modes, providing a great deal of information for the evaluation of GDC embolization of intracranial aneurysm. DOI: 10.11855/j.issn.0577-7402.2014.02.13

  5. DSA volumetric 3D reconstructions of intracranial aneurysms: A pictorial essay

    Science.gov (United States)

    Cieściński, Jakub; Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

    2012-01-01

    Summary A gold standard of cerebral vessel imaging remains the digital subtraction angiography (DSA) performed in three projections. However, in specific clinical cases, many additional projections are required, or a complete visualization of a lesion may even be impossible with 2D angiography. Three-dimensional (3D) reconstructions of rotational angiography were reported to improve the performance of DSA significantly. In this pictorial essay, specific applications of this technique are presented in the management of intracranial aneurysms, including: preoperative aneurysm evaluation, intraoperative imaging, and follow-up. Volumetric reconstructions of 3D DSA are a valuable tool for cerebral vessels imaging. They play a vital role in the assessment of intracranial aneurysms, especially in evaluation of the aneurysm neck and the aneurysm recanalization. PMID:22844309

  6. Non Traumatic Intracranial Infections at the University Teaching ...

    African Journals Online (AJOL)

    Background: Non traumatic intracranial infections are a well recognized disease process encountered in neurosurgery and otolaryngology practices. In this case series study, we analyze the patients that presented with this condition to the neurosurgical unit of the University Teaching Hospital in Lusaka, Zambia. Methods: ...

  7. Sole stenting treatment for small wide-necked saccular intracranial aneurysms:a clinical therapeutic analysis

    International Nuclear Information System (INIS)

    Cheng Jiyong; Hong Bo; Xu Yi; Huang Qinghai; Yang Pengfei; Zhao Wenyuan; Liu Jianmin

    2010-01-01

    Objective: To discuss the feasibility, safety and efficacy of sole stenting technique for the treatment of small wide-necked saccular intracranial aneurysms. Methods: Between February 2001 and November 2009, 36 consecutive patients with small wide-necked saccular intracranial aneurysms (18 males and 18 females, aged 19-75 years,with a mean age of 52.3 years) were treated with stenting technique only. Of 36 patients, the Grade 0 of Hunt and Hess classification was seen in 22,Grade I in 8, Grade II in 5 and Grade III in 1. The aneurysmal diameter ranged from 1.8 mm to 5.0 mm,with a mean diameter of 3.6 mm. The aneurysms were located at the anterior communicating artery (n=1), posterior communicating artery (n=11), intradural paraclinoid internal carotid artery (n=18), basilar artery (n=1), anterior choroidal artery (n=4) or middle cerebral artery (n=1). The clinical manifestations, the angiographic findings and the follow-up observations were analyzed and the results were evaluated by means of the Modified Rankin Scale, magnetic resonance angiography and digital subtraction angiography. Results: Sole stenting treatment was performed in 36 patients with small wide-necked saccular intracranial aneurysms. A total of 37 stents were successfully delivered and deployed at the targeted location. Immediate post-procedural angiography showed that complete occlusion was obtained in one aneurysm, a sluggish intra-aneurysmal vortex motion in 3 aneurysms and a correction of the angle of the parent vessel in two cases, whereas no change was seen in the remaining 30 aneurysms. Angiographic follow-up was carried out in 22 of the 36 patients (61%) during a mean following-up period of 16 months (ranged from 3 to 59 months). The follow-up angiography showed that the complete occlusion was seen in 11 cases, narrowed aneurysmal neck with shrinkage of the aneurysm in 9 cases, narrowed aneurysmal neck only in 1 case, and shrinkage of the aneurysm only in 1 case.All the patients remained

  8. Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms.

    Science.gov (United States)

    Piazza, Matthew; Nayak, Nikhil; Ali, Zarina; Heuer, Gregory; Sanborn, Matthew; Stein, Sherman; Schuster, James; Grady, M Sean; Malhotra, Neil R

    2017-07-01

    The International Subarachnoid Aneurysm Trial heralded a paradigm shift in the treatment of intracranial aneurysms. During this same time frame, neurosurgical training programs increased in size and scope. The present study examines the impact of trends in surgical clipping and the endovascular treatment of intracranial aneurysms, over one decade, and the neurosurgical resident complement on the resident teaching environment using the Nationwide Inpatient Sample (NIS). The NIS was used to estimate the number of aneurysms treated with either surgical clipping and endovascular methods from 2002 through 2011 at teaching institutions. Teaching opportunities per year per resident or chief resident were calculated as the ratio of the number of specified cases to the average number of neurosurgical trainees by year. Annualized trends were assessed. Over the study period, the percent change in odds of occurrence of a clipped ruptured aneurysm was -15.6% per year (P institutions. This corresponded to a decline in teaching opportunities for clipped ruptured aneurysms for both residents and chief residents (P < 0.001). In contrast, teaching opportunities for endovascular treatment of both ruptured and unruptured aneurysms increased dramatically over the study period. There has been a significant decrease in opportunity for operative exposure to craniotomy for ruptured aneurysm clipping over the past decade, whereas the volume of endovascular procedures for aneurysms has dramatically increased, highlighting the need for a shift in training strategy for those neurosurgeons graduating from residency desiring to subspecialize in neurovascular neurosurgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents

    Energy Technology Data Exchange (ETDEWEB)

    Lubicz, Boris [Erasme University Hospital, Department of Neuroradiology, Brussels (Belgium); Hopital Erasme, Service de Radiologie (EA 2691), Brussels (Belgium); Collignon, Laurent; Baleriaux, Danielle [Erasme University Hospital, Department of Neuroradiology, Brussels (Belgium); Lefranc, Florence; Bruneau, Michael; Brotchi, Jacques; Witte, Olivier de [Erasme University Hospital, Department of Neurosurgery, Brussels (Belgium)

    2008-06-15

    We report our experience with endovascular treatment (EVT) of circumferential and fusiform intracranial aneurysms by a reconstructive approach with self-expandable stents. A retrospective review of our prospectively maintained database identified all circumferential and fusiform aneurysms treated by a reconstructive endovascular approach over a 3-year period. Clinical charts, procedural data, and angiographic results were reviewed. From April 2004 to May 2007, 13 patients were identified, of whom 12 were asymptomatic and 1 presented with a subarachnoid hemorrhage. Two patients with an aneurysm {<=}2 mm were treated by stent-within-stent placement without coiling (group 1). In 11 patients with a larger aneurysm, stenting with subsequent coiling was performed (group 2). In this latter approach, a balloon was temporarily inflated within the stent to ensure safe coil delivery. All patients showed an excellent clinical outcome. Asymptomatic procedural complications occurred in three patients, two with cervical internal carotid artery dissection and one with retroperitoneal hematoma. In patients of group 1, the aneurysm had completely disappeared at 6 months. In patients of group 2, aneurysm occlusion was complete in three and incomplete in eight. Follow-up angiography in 12 patients showed four with further thrombosis, six with stable results, and two with minor recanalization. Circumferential and fusiform intracranial aneurysms may be treated by a reconstructive endovascular approach with self-expandable stents. In small aneurysms, a stent-within-stent technique is effective, whereas stenting and subsequent coiling is indicated in larger aneurysms. This therapeutic protocol is associated with good clinical and anatomical results. (orig.)

  10. Circulating neutrophil transcriptome may reveal intracranial aneurysm signature.

    Directory of Open Access Journals (Sweden)

    Vincent M Tutino

    Full Text Available Unruptured intracranial aneurysms (IAs are typically asymptomatic and undetected except for incidental discovery on imaging. Blood-based diagnostic biomarkers could lead to improvements in IA management. This exploratory study examined circulating neutrophils to determine whether they carry RNA expression signatures of IAs.Blood samples were collected from patients receiving cerebral angiography. Eleven samples were collected from patients with IAs and 11 from patients without IAs as controls. Samples from the two groups were paired based on demographics and comorbidities. RNA was extracted from isolated neutrophils and subjected to next-generation RNA sequencing to obtain differential expressions for identification of an IA-associated signature. Bioinformatics analyses, including gene set enrichment analysis and Ingenuity Pathway Analysis, were used to investigate the biological function of all differentially expressed transcripts.Transcriptome profiling identified 258 differentially expressed transcripts in patients with and without IAs. Expression differences were consistent with peripheral neutrophil activation. An IA-associated RNA expression signature was identified in 82 transcripts (p<0.05, fold-change ≥2. This signature was able to separate patients with and without IAs on hierarchical clustering. Furthermore, in an independent, unpaired, replication cohort of patients with IAs (n = 5 and controls (n = 5, the 82 transcripts separated 9 of 10 patients into their respective groups.Preliminary findings show that RNA expression from circulating neutrophils carries an IA-associated signature. These findings highlight a potential to use predictive biomarkers from peripheral blood samples to identify patients with IAs.

  11. Post-thrombolysis hemorrhage risk of unruptured intracranial aneurysms.

    Science.gov (United States)

    Chen, Fujian; Yan, Shenqiang; Jin, Xinchun; Lin, Chen; Cao, Jin

    2015-01-01

    It has been questioned whether patients with unruptured intracranial aneurysms (IAs) are at a greater risk for the development of intracerebral hemorrhage (ICH) following thrombolytic therapy. We thus performed a meta-analysis to better quantify the risk of post-thrombolysis ICH in patients with acute ischemic stroke and incidental IAs. We searched PubMed, Web of Science and EMBASE for studies assessing ICH risk in patients with acute ischemic stroke treated with thrombolysis, in relation to the presence of pretreatment IAs. A fixed-effects model meta-analysis was performed. We identified four studies totaling 707 participants receiving intravenous thrombolysis. The prevalence of unruptured IAs was 6.8%. Pooled analysis demonstrates relative risk (RR) for the presence of unruptured IAs and the development of any ICH to be 1.204 (95% CI 0.709-2.043; p = 0.492; I(2) = 0.0%). The RR for sICH is 1.645 (95% CI 0.453-5.970; p = 0.449; I(2) = 28.1%). Intravenous thrombolysis was safe among patients with acute ischemic stroke and incidental unruptured IAs. Future prospective studies with much larger sample sizes are required to clarify the significance of the association between pre-existing unruptured IAs and the development of post-thrombolysis ICH.

  12. Clinical Application of Insertion Force Sensor System for Coil Embolization of Intracranial Aneurysms.

    Science.gov (United States)

    Matsubara, Noriaki; Miyachi, Shigeru; Izumi, Takashi; Yamada, Hiroyuki; Marui, Naoki; Ota, Keisuke; Tajima, Hayato; Shintai, Kazunori; Ito, Masashi; Imai, Tasuku; Nishihori, Masahiro; Wakabayashi, Toshihiko

    2017-09-01

    In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that force. In this article, coil insertion force was measured in cases of intracranial aneurysm using this sensor, and its actual clinical application was investigated. The sensor consists of a hemostatic valve (Y-connector). A little flexure was intentionally added in the device, and it creates a bend in the delivery wire. The sensor measures the change in the position of the bent wire depending on the insertion force and translates it into a force value. Using this, embolization was performed for 10 unruptured intracranial aneurysms. The sensor adequately recorded the force, and it reflected the operators' usual clinical experience. The presence of the sensor did not affect the procedures. The sensor enabled the operators to objectively note and evaluate the insertion force and better cooperative handling was possible. Additionally, other members of the intervention team shared the information. Force records demonstrated the characteristic patterns according to every stage of coiling (framing, filling, and finishing). The force sensor system adequately measured coil insertion force in intracranial aneurysm coil embolization procedures. The safety of this sensor was demonstrated in clinical application for the limited number of patients. This system is useful adjunct for assisting during coil embolization for an intracranial aneurysm. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. [Effects of Endovascular Treatment on Cranial Nerve Palsy due to Unruptured Intracranial Aneurysms].

    Science.gov (United States)

    Koh, Masaki; Kuwayama, Naoya; Akioka, Naoki; Kashiwazaki, Daina; Kuroda, Satoshi

    2015-10-01

    This study aimed to assess the effects of endovascular treatment on cranial nerve palsy due to unruptured intracranial aneurysms. Endovascular coiling was performed in 203 patients with intracranial aneurysms between April 2002 and March 2012 in our hospital. Of these patients, 8(3.9%)presented with cranial nerve palsy due to unruptured intracranial aneurysms. Cranial nerve palsy involved the oculomotor nerve in 8 patients and the optic nerve in 2 patients. Two patients had both optic nerve and oculomotor nerve dysfunction. Patients with incomplete oculomotor nerve palsy at admission were more likely to have full recovery after coiling. Optic nerve dysfunction did not improve after coiling. Incomplete oculomotor nerve palsy, early treatment(≤15 days), and small aneurysms(≤10 mm)were likely to be associated with complete recovery after coiling. This study indicates that endovascular coiling may resolve cranial nerve palsy due to unruptured intracranial aneurysms in patients who have incomplete oculomotor nerve palsy due to small aneurysms and are treated as early as possible after symptom onset.

  14. The 100 most cited articles in the endovascular management of intracranial aneurysms.

    Science.gov (United States)

    Maingard, Julian; Phan, Kevin; Ren, Yifan; Kok, Hong Kuan; Thijs, Vincent; Hirsch, Joshua A; Lee, Michael J; Chandra, Ronil V; Brooks, Duncan Mark; Asadi, Hamed

    2018-01-19

    Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms. We performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms ('intracranial aneurysm', 'aneurysm', 'aneurysmal subarachnoid', 'endovascular', 'coiling', 'stent-assisted', 'balloon-assisted', 'flow-diversion') yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication. Citations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level-II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA. This study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Traumatic Lumbar Subdural Hematoma in the Absence of Intracranial Disease.

    Science.gov (United States)

    Cooper, Jared; Gillick, John L; LaBagnara, Michael; Das, Kaushik; Hillard, Virany H

    2016-06-01

    Traumatic spinal subdural hematoma is an exceedingly rare condition, with those occurring in the absence of intracranial disease being particularly uncommon. Only 13 such cases have been reported. Although theories exist to describe the pathophysiology of traumatic spinal subdural hematoma, the precise mechanism and guidelines for management remain unclear. This report describes a 37-year-old woman who suffered a traumatic assault who developed progressive low back pain with radicular symptoms 2 days after presentation. Magnetic resonance imaging revealed a lumbar subdural hematoma extending from L1 to L5. No intracranial disease was detected on imaging. Definitive guidelines for management of this condition are uncertain; however, successful use of conservative management, lumbar drainage, and surgical evacuation has been reported. This patient underwent a lumbar laminectomy with evacuation of the hematoma, resulting in immediate pain relief and resolution of symptoms within 1 week of the procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches

    Directory of Open Access Journals (Sweden)

    Hong-guang WANG

    2016-08-01

    Full Text Available Objective To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS.  Results The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique. DOI: 10.3969/j.issn.1672-6731.2016.08.012

  17. Vortex Imprints at the Wall, But Not in the Bulk, Distinguish Ruptured from Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Varble, Nicole; Meng, Hui

    2015-11-01

    Intracranial aneurysms affect 3% of the population. Risk stratification of aneurysms is important, as rupture often leads to death or permanent disability. Image-based CFD analyses of patient-specific aneurysms have identified low and oscillatory wall shear stress to predict rupture. These stresses are sensed biologically at the luminal wall, but the flow dynamics related to aneurysm rupture requires further understanding. We have conducted two studies: one examines vortex dynamics, and the other, high frequency flow fluctuations in patient-specific aneurysms. In the first study, based on Q-criterion vortex identification, we developed two measures to quantify regions within the aneurysm where rotational flow is dominate: the ratio of volume or surface area where Q >0 vs. the total aneurysmal volume or surface area, respectively termed volume vortex fraction (VVF) and surface vortex fraction (SVF). Statistical analysis of 204 aneurysms shows that SVF, but not VVF, distinguishes ruptured from unruptured aneurysms, suggesting that once again, the local flow patterns on the wall is directly relevant to rupture. In the second study, high-resolution CFD (high spatial and temporal resolutions and second-order discretization schemes) on 56 middle cerebral artery aneurysms shows the presence of temporal fluctuations in 8 aneurysms, but such flow instability bears no correlation with rupture. Support for this work was partially provided by NIH grant (R01 NS091075-01) and a grant from Toshiba Medical Systems Corp.

  18. Traumatic rupture of an intracranial dermoid cyst

    Directory of Open Access Journals (Sweden)

    Raksha Ramlakhan, BMedSc, MBBCh

    2015-01-01

    Full Text Available Intracranial dermoid cysts are congenital tumors of ectodermal origin. Rupture of these cysts can occur spontaneously, but rupture in association with trauma is reported infrequently. The diagnosis of rupture is made by the presence of lipid (cholesterol droplets in the subarachnoid spaces and ventricles. Nonenhanced CT of the head demonstrates multiple foci of low attenuation that correspond with hyperintense signal on T1-weighted MRI. We present a case of an adult patient with rupture of an intracranial dermoid cyst, precipitated by minor trauma.

  19. Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization.

    Science.gov (United States)

    Borkon, Matthew J; Hoang, Han; Rockman, Caron; Mussa, Firas; Cayne, Neal S; Riles, Thomas; Jafar, Jafar J; Veith, Frank J; Adelman, Mark A; Maldonado, Thomas S

    2014-01-01

    The incidence of concomitant carotid artery stenosis and unruptured intracranial aneurysms (UIAs) has been reported at between 0.5% and 5%. In these patients, treatment strategies must balance the risk of ischemic stroke with the risk of aneurysmal rupture. Several studies have addressed the natural course of UIAs in the setting of carotid revascularization; however, the final recommendations are not uniform. The purpose of this study was to review our institutional experience with concomitant UIAs and carotid artery stenosis. We performed a retrospective review of all patients with carotid artery stenosis who underwent carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) at our institution between 2003 and 2010. Only patients with preoperative imaging demonstrating intracranial circulation were included. Charts were reviewed for patients' demographic and clinical data, duration of follow-up, and aneurysm size and location. Patients were stratified into 2 groups: carotid artery stenosis with unruptured intracranial aneurysm (CS/UIA) and carotid artery stenosis without intracranial aneurysm (CS). Three hundred five patients met the inclusion criteria and had a total of 316 carotid procedures (CAS or CEA) performed. Eleven patients were found to have UIAs (3.61%) prior to carotid revascularization. Male and female prevalence was 2.59% and 5.26% (P = 0.22), respectively. Patients' demographics did not differ significantly between the 2 groups. The average aneurysm size was 3.25 ± 2.13 mm, and the most common location was the cavernous segment of the internal carotid artery. No patient in the study had aneurysm rupture, and the mean follow-up time was 26.5 months for the CS/UIA group. Concomitant carotid artery stenosis and UIAs is a rare entity. Carotid revascularization does not appear to increase the risk of rupture for small aneurysms (<10 mm) in the midterm. Although not statistically significant, there was a higher incidence of aneurysms found in

  20. Diagnosis and treatment of traumatic intracranial hypotension (cerebrospinal fluid hypovolemia)

    International Nuclear Information System (INIS)

    Shinonaga, Masamichi; Suzuki, Shinichi

    2003-01-01

    Patients who complain headache, neck pain, dizziness or vertigo, tinnitus, blurred vision, loss of concentration, memory disturbance and fatigue for over one year after mild head injury and whiplash injury are diagnosed as post-traumatic syndrome. Mechanism and treatment of post-traumatic syndrome are not well established. We studied radioisotope (RI) cisternography and enhanced brain magnetic resonance imaging (MRI) for the patient of post-traumatic syndrome. Of 175 cases in post-traumatic syndrome 141 cases (120 cases of motor vehicle accident, 21 cases of sports injury) were diagnosed, as intracranial hypotension (cerebrospinal fluid hypovolemia). RI cisternography showed 86% positive findings (early accumulation of RI in bladder and leakage). Prominent findings in MRI were dilatation of subdural space and venous dilatation. In every case epidural blood patch was performed and symptoms were improved in almost 70% of patients. This study revealed cerebrospinal fluid hypovolemia might be one cause of post-traumatic syndrome. (author)

  1. Clinical, radiological, and flow-related risk factors for growth of untreated, unruptured intracranial aneurysms.

    Science.gov (United States)

    Bor, A Stijntje E; Tiel Groenestege, Andreas T; terBrugge, Karel G; Agid, Ronit; Velthuis, Birgitta K; Rinkel, Gabriel J E; Wermer, Marieke J H

    2015-01-01

    Unruptured intracranial aneurysms are frequently followed to monitor aneurysm growth. We studied the yield of follow-up imaging and analyzed risk factors for aneurysm growth. We included patients with untreated, unruptured intracranial aneurysms and ≥6 months of follow-up imaging from 2 large prospectively collected databases. We assessed the proportion of patients with aneurysm growth and performed univariable and multivariable Cox regression analyses to calculate hazard ratios with corresponding 95% confidence intervals (CI) for clinical and radiological risk factors for aneurysm growth. We repeated these analyses for the subset of small ( neck ratio; 2.1 (95% CI, 0.9-4.9) for location in the posterior circulation; and 2.0 (95% CI, 0.8-4.8) for multilobarity. In the subset of aneurysms <7 mm, 37 of 403 (9%) enlarged. In multivariable analysis, hazard ratios for aneurysm growth were 1.1 (95% CI, 0.8-1.5) per each additional mm of initial aneurysm size, 2.2 (95% CI, 1.0-4.8) for smoking, 2.9 (95% CI, 1.0-8.5) for multilobarity, 2.4 (95% CI, 1.0-5.8) for dome/neck ratio, and 2.0 (95% CI, 0.6-7.0) for location in the posterior circulation. Initial aneurysm size, dome/neck ratio, and multilobarity are risk factors for aneurysm growth. Cessation of smoking is pivotal because smoking is a modifiable risk factor for growth of small aneurysms. © 2014 American Heart Association, Inc.

  2. Lumbosacral Subdural Hematoma and Concomitant Acute Lower Extremity Monoparesis After Intracranial Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Choi, Dae Han; Kim, Myeong Jin; Yoo, Chan Jong; Park, Cheol Wan

    2016-11-01

    Spinal subdural hematoma (SDH) secondary to intracranial aneurysmal subarachnoid hemorrhage (SAH) occurs rarely and can cause neurologic deficits. A 52-year-old man was diagnosed with SAH caused by rupture of an anterior communicating artery aneurysm. The aneurysm was treated by coil embolization on the day of admission. After embolization, the patient's left lower extremity strength had decreased and a spinal magnetic resonance imaging showed subarachnoid hematoma and SDH with severe thecal sac compression at L4-S2. On postbleed day 6, L4-S1 laminectomy was performed, and the strength in all muscle of the left leg improved. Rupture of an intracranial aneurysm may cause symptomatic SDH in the lumbosacral spine as well as subarachnoid hematoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. The Effect of Inlet Waveforms on Computational Hemodynamics of Patient-Specific Intracranial Aneurysms

    OpenAIRE

    Xiang, J.; Siddiqui, A.H.; Meng, H.

    2014-01-01

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic qu...

  4. Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

    Directory of Open Access Journals (Sweden)

    Linkai Jing

    Full Text Available The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not.Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured were analyzed from 3D-digital subtraction angiography (DSA images and computational fluid dynamics (CFD. Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC analysis identified area under the curve (AUC and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators.Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity parameters achieved statistical significance (p0.7. By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965.Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

  5. Long-term behavioral and cognitive outcomes following clipping for incidental unruptured intracranial aneurysms.

    Science.gov (United States)

    Pereira-Filho, Arthur A; Pereira, Adriana G; Pereira-Filho, Nelson A; Lima, Leonardo C; Costa, Jaderson Costa da; Kraemer, Jorge L; Portuguez, Mirna W

    2014-01-01

    Recent advances in neuroimaging techniques have resulted in more frequent detection of unruptured intracranial aneurysms. Regardless of the method employed, most interventions to treat lesions have low morbidity and mortality rates. Recently, some studies have suggested that changes in cognitive status are one complication of microsurgical treatments. However, no study to date has performed any behavioral analysis. Moreover, cognitive assessment beyond 12 months after surgical intervention is missing. The current study sought to evaluate the long-term impact of clipping on the behavioral and cognitive functions of patients with unruptured intracranial aneurysms. A within-subjects prospective clinical trial was performed to evaluate 40 patients who underwent microsurgical clipping for incidental unruptured intracranial aneurysms. The participants underwent a full neuropsychological evaluation during the preoperative period, at 3 months after surgery and at 3 years after surgery. Paired Student's t tests and an ANOVA, followed by a Bonferroni post hoc test, were used to examine group differences. The cognitive and behavioral test performance of the patients did not deteriorate during either the short or the long term following intervention. Moreover, the patients' clinical and demographic characteristics did not predict behavioral or cognitive changes, and neither the surgical approach nor the topography, multiplicity, or size of the aneurysms affected the results. In either the short or the long term following clipping for patients with incidental unruptured intracranial aneurysms, behavioral and cognitive functions had no significant change from baseline. The intervention demonstrated high efficacy and was associated with a low morbidity rate.

  6. Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

    Science.gov (United States)

    Jing, Linkai; Fan, Jixing; Wang, Yang; Li, Haiyun; Wang, Shengzhang; Yang, Xinjian; Zhang, Ying

    2015-01-01

    The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not. Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured) were analyzed from 3D-digital subtraction angiography (DSA) images and computational fluid dynamics (CFD). Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC) analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators. Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type) and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity) parameters achieved statistical significance (p0.7). By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965). Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

  7. Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms.

    Science.gov (United States)

    Lukic, Snezana; Jankovic, Slobodan; Popovic, Katarina Surlan; Bankovic, Dragic; Popovic, Peter; Mijailovic, Milan

    2015-12-01

    Endovascular embolization is a treatment of choice for the management of unruptured intracranial aneurysms, but sometimes is complicated with perianeurysmal oedema. The aim of our study was to establish incidence and outcomes of perianeurysmal oedema after endovascular coiling of unruptured intracranial aneurysms, and to reveal possible risk factors for development of this potentially serious complication. In total 119 adult patients with endovascular embolization of unruptured intracranial aneurysm (performed at Department for Interventional Neuroradiology, Clinical Center, Kragujevac, Serbia) were included in our study. The embolizations were made by electrolite-detachable platinum coils: pure platinum, hydrophilic and combination of platinum and hydrophilic coils. Primary outcome variable was perianeurysmal oedema visualized by magnetic resonance imaging (MRI) 7, 30 and 90 days after the embolization. The perianurysmal oedema appeared in 47.6% of patients treated with hydrophilic coils, in 21.6% of patients treated with platinum coils, and in 53.8% of those treated with mixed type of the coils. The multivariate logistic regression showed that variables associated with occurrence of perianeurysmal oedema are volume of the aneurysm, hypertension, diabetes and smoking habit. Hypertension is the most important independent predictor of the perianeurysmal oedema, followed by smoking and diabetes. The results of our study suggest that older patients with larger unruptured intracranial aneurysms, who suffer from diabetes mellitus and hypertension, and have the smoking habit, are under much higher risk of having perianeurysmal oedema after endovascular coiling.

  8. Rapid development of a mycotic aneurysm of the intracranial artery secondary to Scedosporium apiospermum sinusitis

    Directory of Open Access Journals (Sweden)

    Yoshihiko Ogawa

    2016-12-01

    Full Text Available An 85-year-old man complained of a 2-month history of pain on the left side of his face. Brain computed tomography (CT and magnetic resonance imaging/magnetic resonance angiography did not clearly show any intracranial abnormality and only showed fluid effusion in his left sphenoid sinus. Filamentous fungi were detected from the left sphenoid sinus specimen. The isolate was Scedosporium apiospermum. He was empirically treated with voriconazole, to which the isolate was susceptible. His consciousness decreased rapidly. Urgent 3D-CT angiography revealed an intracranial aneurysm near the left sphenoid sinus. Despite urgent coil embolization, the aneurysm ruptured, and he died.

  9. Endovascular treatment of unruptured intracranial aneurysms and circulating endothelial cells.

    Science.gov (United States)

    Vendrell, Jean-François; Cezar, Renaud; Kuster, Nils; Lobotesis, Kyriakos; Costalat, Vincent; Machi, Paolo; Bonafe, Alain; Vendrell, Jean-Pierre

    2013-04-01

    To evaluate the potential implication of circulating endothelial cells (CECs) in complications following endovascular treatment (EVT) of unruptured intracranial aneurysms. CECs characterized as CD146(+)/CD105(+)/CD45(-)/DAPI(+) were considered to originate from an altered endothelial cell layer of the vessel wall. In 15 patients, CECs were characterized and enumerated by the CellTracks(®) System in blood samples from: (1) femoral artery (FA), (2) internal carotid artery (ICA) before (ICA1) and after procedure (ICA2), and (3) a peripheral vein before (PV1) and after EVT (PV2). Ischemic brain events were assessed using diffusion weighted imaging (DWI-MRI) before and 24h after EVT. In ICA1, the median number of single CECs and clusters of 2-5 CECs were higher than in FA, ICA2, PV1 and PV2 samples (P5 cells, sometimes >50μm, were mainly observed in ICA1 and never in PV1, PV2 or PV samples from ten healthy subjects. This distribution of CECs suggested femoral and ICA injury by the devices used, leading to endothelium shearing and desquamation of CECs. All patients discharged on day two (NIHSS score=0), however silent ischemic brain lesions were observed in 9/15 (60%). EVT detaches single and clusters of CECs from wall arteries that may be implicated in silent ischemic brain lesions genesis. Enumeration of CECs associated with DWI-MRI might represent an interesting strategy for monitoring and optimizing endovascular devices, and further limit EVT-related complications. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Traumatic aneurysm of the bifurcation of the abdominal aorta in an infant. A case report.

    Science.gov (United States)

    Boumzebra, D; Ettaoumi, Y; Yaacoubi, M; Haddani, J; Fehri, M; Mehadji, B A

    2005-06-01

    Post-traumatic aneurysms are extremely rare in the infant population. We report a case of delayed abdominal aortic aneurysm that appeared in a 5-year-old female, admitted 5 months previously with contusions to the abdomen.

  11. Multiple intracranial aneurysms following radiation therapy for nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Puneet Gulati

    2014-01-01

    Full Text Available A 30-year-old male presented to the neurosurgical emergency with sudden onset severe headache, nausea, and vomiting. A computed tomography scan showed subarachnoid hemorrhage and a subsequent four vessel angiogram showed six cerebral aneurysms (predominantly fusiform involving both the anterior and posterior circulations, all on the left side. The patient had received 60 Gy external beam radiotherapy for left nasopharyngeal carcinoma 8 years back. The middle cerebral artery aneurysm was clipped, while the internal carotid artery and the two posterior cerebral artery aneurysms were wrapped. The patient was discharged uneventfully and is asymptomatic at follow-up 6 months later. The effects of radiation on cerebral vasculature are well-documented. Radiation-induced vasculopathy generally presents as occlusion/stenosis of cerebral vessels and aneurysms are rare. Only 46 cases of radiation-induced aneurysms have been reported previously. Just seven of these had multiple aneurysms and only one case had as many as six aneurysms.

  12. Intracranial aneurysms: optimized diagnostic tools call for thorough interdisciplinary treatment strategies.

    Science.gov (United States)

    Mueller, Oliver M; Schlamann, Marc; Mueller, Daniela; Sandalcioglu, I Erol; Forsting, Michael; Sure, Ulrich

    2011-09-01

    Intracranial aneurysms (IAs) require deliberately selected treatment strategies as they are incrementally found prior to rupture and deleterious subarachnoid haemorrhage (SAH). Multiple and recurrent aneurysms necessitate both neurointerventionalists and neurosurgeons to optimize aneurysmal occlusion in an interdisciplinary effort. The present study was conducted to condense essential strategies from a single neurovascular centre with regard to the lessons learned. Medical charts of 321 consecutive patients treated for IAs at our centre from September 2008 until December 2010 were retrospectively analysed for clinical presentation of the aneurysms, multiplicity and treatment pathways. In addition, a selective Medline search was performed. A total of 321 patients with 492 aneurysms underwent occlusion of their symptomatic aneurysm: 132 (41.1%) individuals were treated surgically, 189 (58.2%) interventionally; 138 patients presented with a SAH, of these 44.2% were clipped and 55.8% were coiled. Aneurysms of the middle cerebral artery were primarily occluded surgically (88), whereas most of the aneurysms of the internal carotid artery and anterior communicating artery (114) were treated endovascularly. Multiple aneurysms (range 2-5 aneurysms/individual) were diagnosed in 98 patients (30.2%). During the study period 12 patients with recurrent aneurysms were allocated to another treatment modality (previously clip to coil and vice versa). Our data show that successful interdisciplinary occlusion of IAs is based on both neurosurgical and neurointerventional therapy. In particular, multiple and recurrent aneurysms require tailored individual approaches to aneurysmal occlusion. This is achieved by a consequent interdisciplinary pondering of the optimal strategy to occlude IAs in order to prevent SAH.

  13. Intracranial infective aneurysms presenting with haemorrhage: An analysis of angiographic findings, management and outcome

    International Nuclear Information System (INIS)

    Venkatesh, Sudhakar K.; Phadke, Rajendra V.; Kalode, Ravi R.; Kumar, Sunil; Jain, Vijendra K.

    2000-01-01

    AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90.9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms. Venkatesh, S.K. (2000)

  14. Changes of size and shape of small, unruptured intracranial aneurysms in repeated computed tomography angiography studies.

    Science.gov (United States)

    Żyłkowski, Jarosław; Kunert, Przemysław; Jaworski, Maciej; Rosiak, Grzegorz; Marchel, Andrzej; Rowiński, Olgierd

    2015-07-01

    Unruptured intracranial aneurysms (UIAs) are frequently detected in noninvasive imaging studies such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). If small, UIAs are observed in these modalities in order to detect growth or shape change, but there are many questions about proper protocol of the follow-up. To assess changes of small (< 7 mm) UIAs dome size and shape in repeated CTA studies as predictors of growth and rupture. One hundred and ten UIAs (10 posterior circulation) in 70 patients (55 women) were observed, with a cumulative observation time of 333.32 years. Aneurysms' dome and neck perpendicular dimensions were measured in the first and the last CTA study at least twice with the developed application. Confidence intervals (CI) for measurements and dome shape parameters were calculated. For aneurysms ruptured during follow-up intermediate studies were analyzed. Patients' clinical information was recorded. The aneurysm growth detection algorithm integrated CI and spatial resolution of the CT scanner. Twenty-three aneurysms increased in volume, 10 in height and 14 in dome width. Volume increased in 90% of cases of height and 93% of width increase. Posterior circulation aneurysms grew faster than anterior ones (p < 0.003), but calculated time to significant size increase (eT) did not differ between the groups due to higher CI in the posterior circulation. Analysis of eT with Kaplan-Meier curves showed that 75% of growing aneurysms could be detected in the first 3 years of observation. During the follow-up 3 aneurysms bled, and they grew faster than other growing aneurysms. Two of the bleeding aneurysms formed daughter sacs. Dome volume assessment is superior to single dimension assessment in aneurysm growth detection. Confidence intervals assessment helps to avoid overestimation of growth. Seventy-five percent of growing aneurysms could be detected in the first 3 years of observation. Daughter sac formation and fast

  15. Headache outcomes following treatment of unruptured intracranial aneurysms: A prospective analysis

    Science.gov (United States)

    Schwedt, Todd J; Gereau, Robert W; Frey, Karen; Kharasch, Evan D

    2013-01-01

    Objective To analyze headache patterns prior to and following treatment of unruptured intracranial aneurysms and identify factors associated with different headache outcomes. Methods A prospective observational study of patients being treated for unruptured intracranial aneurysms. Headache patterns were established prior to aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated. Results In all patients (n=44), 90-day headache frequency decreased from an average of 31 days prior to aneurysm treatment to 17 days following treatment (p<0.001). In patients with active pretreatment headaches (n=28), 90-day headache frequency decreased from 49 days to 26 days (p=0.002). Headache frequency was reduced in 68% of patients, while 9% of patients had new or worsened headaches following aneurysm treatment. Pretreatment migraine, more severe pretreatment headaches, higher pretreatment trait anxiety, and stent-assisted aneurysm coiling were associated with a lack of headache improvement. Conclusions The majority of patients with headaches at the time of aneurysm treatment had reductions in headache frequency during the 6 months following treatment. Potential risk factors for poor headache outcomes were identified but need to be studied further. PMID:21398420

  16. Flow conditions in intracranial aneurysm lumen associate with inflammation and degenerative changes of the aneurysm wall

    Science.gov (United States)

    Cebral, Juan; Ollikainen, Eliisa; Chung, Bong Jae; Mut, Fernando; Sippola, Visa; Jahromi, Behnam Rezai; Tulamo, Riikka; Hernesniemi, Juha; Niemelä, Mika; Robertson, Anne; Frösen, Juhana

    2016-01-01

    Background and Purpose Saccular intracranial aneurysm (sIA) is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with sIA rupture. We investigated how sIA hemodynamics associates with wall remodeling and inflammation of the sIA wall. Methods Tissue samples resected during sIA surgery (11 unruptured, 9 ruptured sIAs) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT-angiographies. Results More stable and less complex flows were associated with thick, hyperplastic sIA walls while slower flows with more diffuse inflow were associated with degenerated and decellularized sIA walls. Wall degeneration (p=0.041) and rupture was associated with increased inflammation (CD45+, p=0.031). High wall shear stress (WSS, p=0.018), higher vorticity (VO, p=0.046), higher viscous dissipation (VD, p=0.046), and high shear rate (SR, p=0.046) associated with increased inflammation. Inflammation was also associated with lack of intact endothelium (p=0.034), and presence of organized luminal thrombosis (p=0.018), although overall organized thrombosis was associated with low minimum WSS (p=0.034) and not with the flow conditions that associated with inflammation. Conclusions Flow conditions in the sIA associate with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is associated with high flow activity including elevated WSS. Endothelial injury may be a mechanism by which flow induces inflammation in the sIA wall. Hemodynamic simulations might prove to be useful in identifying sIAs at risk of developing inflammation, a potential biomarker for rupture. PMID:27686488

  17. Prevention and management of intraprocedural rupture of intracranial aneurysm with detachable coils during embolization

    Energy Technology Data Exchange (ETDEWEB)

    Li, Ming-Hua; Gao, Bu-Lang; Fang, Chun; Cheng, Ying-Sheng; Li, Yong-Dong; Wang, Jue [Shanghai Jiaotong University School of Medicine, Department of Radiology, Shanghai Sixth Hospital, Shanghai (China); Xu, Guo-Ping [Fudan University Shanghai Medical College, Department of Pathology, Shanghai (China)

    2006-12-15

    Intracranial aneurysm rupture during embolization with detachable coils is reportedly among the gravest of intraprocedural complications. We present here our experiences with this outcome, and a potential intervention for managing this life-threatening complication. From April 1998 to March 2005, 284 patients with cerebral aneurysms were treated with detachable coils. Intraprocedural aneurysm rupture occurred in ten patients with a history of a previously ruptured aneurysm. In the event of intraprocedural hemorrhage, we routinely performed heparin reversal with protamine sulfate. Of the 221 patients with a previously ruptured aneurysm, intraprocedural aneurysm rupture occurred in 10 (4.5%). These ruptures were caused by a microguidewire in one patient, a microcatheter in one, over-packing in two and a coil perforation in three. In the remaining three patients the ruptures were caused by both the microcatheter and the coils. Three patients died because of aneurysm re-rupture, yielding a mortality rate of 30%. One patient presented with a slight disability in the left leg and no neurological deficits were observed in the remaining six patients. Intraprocedural aneurysm rupture during embolization is a rare, but unavoidable and life-threatening event. Proper measures should be taken to reduce and improve the outcome of this tragic occurrence. The majority of patients with an intraprocedural ruptured aneurysm can survive without severe sequelae if managed appropriately. (orig.)

  18. Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

    International Nuclear Information System (INIS)

    Geyik, Serdar; Yavuz, Kivilcim; Ergun, Onur; Koc, Osman; Cekirge, Saruhan; Saatci, Isil

    2008-01-01

    The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with ( 25 mm). The embolization technique was the same with that in standard bare coiling. Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial. (orig.)

  19. Prevention and management of intraprocedural rupture of intracranial aneurysm with detachable coils during embolization

    International Nuclear Information System (INIS)

    Li, Ming-Hua; Gao, Bu-Lang; Fang, Chun; Cheng, Ying-Sheng; Li, Yong-Dong; Wang, Jue; Xu, Guo-Ping

    2006-01-01

    Intracranial aneurysm rupture during embolization with detachable coils is reportedly among the gravest of intraprocedural complications. We present here our experiences with this outcome, and a potential intervention for managing this life-threatening complication. From April 1998 to March 2005, 284 patients with cerebral aneurysms were treated with detachable coils. Intraprocedural aneurysm rupture occurred in ten patients with a history of a previously ruptured aneurysm. In the event of intraprocedural hemorrhage, we routinely performed heparin reversal with protamine sulfate. Of the 221 patients with a previously ruptured aneurysm, intraprocedural aneurysm rupture occurred in 10 (4.5%). These ruptures were caused by a microguidewire in one patient, a microcatheter in one, over-packing in two and a coil perforation in three. In the remaining three patients the ruptures were caused by both the microcatheter and the coils. Three patients died because of aneurysm re-rupture, yielding a mortality rate of 30%. One patient presented with a slight disability in the left leg and no neurological deficits were observed in the remaining six patients. Intraprocedural aneurysm rupture during embolization is a rare, but unavoidable and life-threatening event. Proper measures should be taken to reduce and improve the outcome of this tragic occurrence. The majority of patients with an intraprocedural ruptured aneurysm can survive without severe sequelae if managed appropriately. (orig.)

  20. Is Age a Risk Factor for Poor Outcome of Surgical Treatment of Unruptured Intracranial Aneurysms?

    Science.gov (United States)

    Matsukawa, Hidetoshi; Kamiyama, Hiroyasu; Tsuboi, Toshiyuki; Noda, Kosumo; Ota, Nakao; Miyata, Shiro; Takahashi, Osamu; Tokuda, Sadahisa; Tanikawa, Rokuya

    2016-10-01

    Advanced age is known to be a significant risk factor for the rupture of intracranial aneurysms. The impact of age on outcomes of surgically treated patients with unruptured intracranial aneurysms (UIAs) is less clear. A total of 663 consecutive patients with 823 surgically treated UIAs were evaluated. UIAs, which need bypass surgery including low-flow or high-flow bypass, were defined as complex aneurysms. Aneurysm size was categorized as small (<15 mm), large (15-24 mm), and giant (≥25 mm). In patients without symptoms, a poor outcome is defined as a modified Rankin Scale (mRS) score of 2-6. In those with mRS score higher than 1 as a result of UIA-related symptoms or other comorbidities, a poor outcome is defined as an increase of 1 or more on the mRS. Outcomes were evaluated at the 6-month and 12-month follow-up examinations. The mean age was 62 ± 12 years and 650 UIAs (78%) were observed in women. Previously treated aneurysm (P = 0.009), posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.011), and perforator territory infarction (P < 0.0001) were related to poor outcome at 6 months, and posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.035), and perforator territory infarction (P = 0.013) were related to poor outcome at 12 months. Age was not associated with poor outcome in patients with UIAs who undertook direct surgery. Although risks and benefits of aneurysm treatment in older patients should be carefully considered, surgical treatment of UIAs in the elderly should be considered positively. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Growth rate and rupture rate of unruptured intracranial aneurysms: a population approach

    Science.gov (United States)

    Jou, Liang-Der; Mawad, Michel E

    2009-01-01

    Background Understanding aneurysm growth rate allows us to predict not only the current rupture risk, but also accumulated rupture risk in the future. However, determining growth rate of unruptured intracranial aneurysms often requires follow-up of patients for a long period of time so that significant growth can be observed and measured. We investigate a relationship between growth rate and rupture rate and develop a theoretical model that can predict average behavior of unruptured intracranial aneurysms based on existing clinical data. Methods A mathematical model is developed that links growth rate and rupture rate. This model assumes a stable aneurysm size distribution so the number of aneurysm ruptures is balanced by the growth of aneurysms. Annual growth rates and growth profiles are calculated from a hypothetical size distribution and data from a previous clinical study. Results Our model predicts a growth rate of 0.34–1.63 mm/yr for three different growth models when the rupture rate at 10 mm is 1%. The growth rate is 0.56–0.65 mm/yr if annual rupture rate averaged over all aneurysm sizes is assumed to be 2%. The peak of aneurysm size distribution coincides with a period of slow growth between 5 mm and 8 mm. Conclusion This mathematical model can be used to predict aneurysm growth rate, and the results are consistent with previous clinical studies. Predictions from both hypothetical and clinical cases agree very well. This model explains why some aneurysms may grow into a stable size and remain so without rupture. PMID:19534830

  2. Radiological analysis of subarachnoid hemorrhage from ruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    Lee, Jong Doo; Suh, Jung Ho; Kim, Dong Ik

    1988-01-01

    The CT findings of 98 patients with subarachnoid hemorrhage due to aneurysmal rupture were analyzed and compared with cerebral angiography for the purpose of preangiographic prediction of aneurysmal location as well as evaluation of the CT features corresponding to the vasospasm or ischemic neurologic dysfunctions. The results were as follows: 1.Aneurysms could be identified on initial cerebral angiography in 82 out of 98 patients with subarachnoid hemorrhage and anterior communicating artery aneurysms were most common (42 cases), followed by MCA, posterior communicating artery, ICA, basilar artery in order of frequency. 2.The CT findings of those patients were hemorrhage in subarachnoid space (69%), localized hematoma (47%), ventricular dilatation (31%), enhancing nodule (23%), cisternal enhancement (20%), cerebral infarction (15%), ventricular hemorrhage (14%), and epidural hemorrhage (3%). 3.Localized hematoma was more prevalent in anterior communicating artery aneurysm rupture (54%), and less frequently in MCA, posterior communicating artery and ICA aneurysms. 4.Most of aneurysmal sac could be identified as enhancing nodule on CT when the real size were over 1 cm. 5.The size of ruptured aneurysm could be predicted in many patients with ACA and MCA aneurysm according to the CT features such as hemorrhagic patterns, location of hematomas or enhancing nodules. 6.Localized hematoma or blood clots and cerebral infarction are considered to be the CT features corresponding to the angiographic vasospasm

  3. Radiological analysis of subarachnoid hemorrhage from ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Doo; Suh, Jung Ho; Kim, Dong Ik [Yonsei University, College of Medicine, Seoul (Korea, Republic of)

    1988-02-15

    The CT findings of 98 patients with subarachnoid hemorrhage due to aneurysmal rupture were analyzed and compared with cerebral angiography for the purpose of preangiographic prediction of aneurysmal location as well as evaluation of the CT features corresponding to the vasospasm or ischemic neurologic dysfunctions. The results were as follows: 1.Aneurysms could be identified on initial cerebral angiography in 82 out of 98 patients with subarachnoid hemorrhage and anterior communicating artery aneurysms were most common (42 cases), followed by MCA, posterior communicating artery, ICA, basilar artery in order of frequency. 2.The CT findings of those patients were hemorrhage in subarachnoid space (69%), localized hematoma (47%), ventricular dilatation (31%), enhancing nodule (23%), cisternal enhancement (20%), cerebral infarction (15%), ventricular hemorrhage (14%), and epidural hemorrhage (3%). 3.Localized hematoma was more prevalent in anterior communicating artery aneurysm rupture (54%), and less frequently in MCA, posterior communicating artery and ICA aneurysms. 4.Most of aneurysmal sac could be identified as enhancing nodule on CT when the real size were over 1 cm. 5.The size of ruptured aneurysm could be predicted in many patients with ACA and MCA aneurysm according to the CT features such as hemorrhagic patterns, location of hematomas or enhancing nodules. 6.Localized hematoma or blood clots and cerebral infarction are considered to be the CT features corresponding to the angiographic vasospasm.

  4. Unruptured Intracranial Aneurysms. A Critical Review of the International Study of Unruptured Intracranial Aneurysms (ISUIA) and of Appropriate Methods to Address the Clinical Problem.

    Science.gov (United States)

    Raymond, J; Guillemin, F; Proust, F; Molyneux, A J; Fox, A J; Claiborne, J S; Meder, J F; Rouleau, I

    2008-03-30

    The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blinding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem.

  5. High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms

    NARCIS (Netherlands)

    Kurki, M.I.; Gaal, E.I.; Kettunen, J.; Lappalainen, T.; Menelaou, A.; Anttila, V.; Hof, F.N. van 't; Fraunberg, M. von Und Zu; Helisalmi, S.; Hiltunen, M.; Lehto, H.; Laakso, A.; Kivisaari, R.; Koivisto, T.; Ronkainen, A.; Rinne, J.; Kiemeney, B.; Vermeulen, S.; Kaunisto, M.A.; Eriksson, J.G.; Aromaa, A.; Perola, M.; Lehtimaki, T.; Raitakari, O.T.; Salomaa, V.; Gunel, M.; Dermitzakis, E.T.; Ruigrok, Y.M.; Rinkel, G.J.; Niemela, M.; Hernesniemi, J.; Ripatti, S.; Bakker, P.I. de; Palotie, A.; Jaaskelainen, J.E.

    2014-01-01

    3% of the population develops saccular intracranial aneurysms (sIAs), a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH) is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder

  6. Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Sprengers, Marieke E.; van Rooij, Willem Jan; Sluzewski, Menno; Majoie, Charles B. L. M.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    2009-01-01

    BACKGROUND AND PURPOSE: Coiling is increasingly used as treatment for intracranial aneurysms. Despite its favorable short-term outcome, concerns exist about long-term reopening and inherent risk of recurrent subarachnoid hemorrhage (SAH). We hypothesized a higher risk for recurrent SAH after

  7. Treatment of ruptured intracranial aneurysms: implications of the ISAT on clipping versus coiling

    NARCIS (Netherlands)

    van den Berg, R.; Rinkel, G. J. E.; Vandertop, W. P.

    2003-01-01

    Patients with a ruptured intracranial aneurysm should be treated as soon as possible after the haemorrhage to prevent rebleeding and to allow vigorous treatment of ischemic events in case of vasospasm. The choice of treatment, endovascular or surgical, should be based on the angio-architectural

  8. Long-Term Recurrent Subarachnoid Hemorrhage After Adequate Coiling Versus Clipping of Ruptured Intracranial Aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Sprengers, Marieke E.; van Rooij, Willem Jan; Sluzewski, Menno; Majoie, Charles B. L. M.; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    Background and Purpose-Coiling is increasingly used as treatment for intracranial aneurysms. Despite its favorable short-term outcome, concerns exist about long-term reopening and inherent risk of recurrent subarachnoid hemorrhage (SAH). We hypothesized a higher risk for recurrent SAH after adequate

  9. Relationship between blood viscosity and cerebral ischemia after surgical treatment of ruptured intracranial aneurysms

    NARCIS (Netherlands)

    Schievink, W. I.; Hageman, L. M.; Velis, D. N.; van der Werf, D. J.; Hardeman, M. R.; Goedhart, P. T.

    1987-01-01

    To determine the role of blood viscosity after surgical treatment of ruptured intracranial aneurysms, the relationship between blood viscosity and clinical condition was examined in 17 patients. A total of 213 blood samples were analyzed. An inverse correlation was found between blood viscosity and

  10. Psychosocial impact of screening for intracranial aneurysms in relatives with familial subarachnoid hemorrhage

    NARCIS (Netherlands)

    Wermer, M. J. H.; van der Schaaf, I. C.; van Nunen, P.; Bossuyt, P. M. M.; Anderson, C. S.; Rinkel, G. J. E.

    2005-01-01

    Background and Purpose - In families with >= 2 relatives with intracranial aneurysms (IAs), screening for IAs in asymptomatic first-degree relatives is often recommended. We assessed the long-term psychosocial impact of such screening. Methods - We identified all persons with IA (screen-positives)

  11. Novel ELN mutation in a family with supravalvular aortic stenosis and intracranial aneurysm

    DEFF Research Database (Denmark)

    Jelsig, Anne Marie; Urban, Zsolt; Hucthagowder, Vishwanathan

    2017-01-01

    stenosis, various other arterial stenoses, sudden death, and intracranial aneurysms. A frameshift mutation in exon 12, not described before, was detected in the affected family members. This report emphasises the importance of family history, genetic counselling, and demonstrates the great variability...

  12. Intraprocedural abciximab bolus versus pretreatment oral dual antiplatelet medication for endovascular stenting of unruptured intracranial aneurysms.

    Science.gov (United States)

    Levitt, Michael R; Moon, Karam; Albuquerque, Felipe C; Mulholland, Celene B; Kalani, M Yashar S; McDougall, Cameron G

    2016-09-01

    Standard pretreatment with dual antiplatelet medication (DAPM) was compared with a standalone intraprocedural abciximab bolus for the prevention of thromboembolic and hemorrhagic events during endovascular stenting of unruptured intracranial aneurysms. We treated 94 patients with 99 aneurysms with intracranial stenting (with or without coiling). Patients were either pretreated with DAPM daily for ≥3 days before stenting (pretreatment group) or received an abciximab bolus during or immediately after stent placement followed by postoperative DAPM (abciximab group), at the treating physician's discretion. Twenty patients underwent immediate postoperative MRI. Demographic, clinical, and radiological information and periprocedural complications were recorded. There were 52 procedures in the pretreatment group and 47 in the abciximab group. More flow-diverting stents were placed in the pretreatment group than in the abciximab group (45 vs 23, p0.99 and p=0.12, respectively). There were no intracranial hemorrhages. In patients with postoperative MRI, there was no difference in the presence of diffusion-restricted lesions between groups (p=0.20). Multivariate analysis of a composite of any complication did not show significant associations with aneurysm or patient variables in either group. Standalone intraprocedural abciximab bolus was not associated with an increased rate of complications compared with pretreatment with DAPM for unruptured intracranial aneurysm stenting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Endothelial nitric oxide synthase and superoxide mediate hemodynamic initiation of intracranial aneurysms.

    Directory of Open Access Journals (Sweden)

    Nicholas Liaw

    Full Text Available Hemodynamic insults at arterial bifurcations are believed to play a critical role in initiating intracranial aneurysms. Recent studies in a rabbit model indicate that aneurysmal damage initiates under specific wall shear stress conditions when smooth muscle cells (SMCs become pro-inflammatory and produce matrix metalloproteinases (MMPs. The mechanisms leading to SMC activation and MMP production during hemodynamic aneurysm initiation are unknown. The goal is to determine if nitric oxide and/or superoxide induce SMC changes, MMP production and aneurysmal remodeling following hemodynamic insult.Bilateral common carotid artery ligation was performed on rabbits (n = 19, plus 5 sham operations to induce aneurysmal damage at the basilar terminus. Ligated animals were treated with the nitric oxide synthase (NOS inhibitor LNAME (n = 7 or the superoxide scavenger TEMPOL (n = 5 and compared to untreated animals (n = 7. Aneurysm development was assessed histologically 5 days after ligation. Changes in NOS isoforms, peroxynitrite, reactive oxygen species (ROS, MMP-2, MMP-9, and smooth muscle α-actin were analyzed by immunohistochemistry.LNAME attenuated ligation-induced IEL loss, media thinning and bulge formation. In untreated animals, immunofluorescence showed increased endothelial NOS (eNOS after ligation, but no change in inducible or neuronal NOS. Furthermore, during aneurysm initiation ROS increased in the media, but not the intima, and there was no change in peroxynitrite. In LNAME-treated animals, ROS production did not change. Together, this suggests that eNOS is important for aneurysm initiation but not by producing superoxide. TEMPOL treatment reduced aneurysm development, indicating that the increased medial superoxide is also necessary for aneurysm initiation. LNAME and TEMPOL treatment in ligated animals restored α-actin and decreased MMPs, suggesting that eNOS and superoxide both lead to SMC de-differentiation and MMP production.Aneurysm

  14. Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting.

    Science.gov (United States)

    Štepán-Buksakowska, I L; Accurso, J M; Diehn, F E; Huston, J; Kaufmann, T J; Luetmer, P H; Wood, C P; Yang, X; Blezek, D J; Carter, R; Hagen, C; Hořínek, D; Hejčl, A; Roček, M; Erickson, B J

    2014-10-01

    MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm. © 2014 by American Journal of Neuroradiology.

  15. Risk of aneurysm rupture at intracranial arterial bifurcations.

    NARCIS (Netherlands)

    Kolk, N.M. van der; Algra, A.; Rinkel, G.J.

    2010-01-01

    BACKGROUND: Aneurysms on the posterior circulation, most commonly located at the basilar top, have a higher risk of rupture than aneurysms on the anterior circulation. If hemodynamic shear stress, which has its maximum impact at the distal carina of bifurcations, explains the higher rupture rate of

  16. Clipping and Coiling of Unruptured Intracranial Aneurysms Among Medicare Beneficiaries, 2000 to 2010.

    Science.gov (United States)

    Jalbert, Jessica J; Isaacs, Abby J; Kamel, Hooman; Sedrakyan, Art

    2015-09-01

    Endovascular coiling therapy is increasingly popular for obliteration of unruptured intracranial aneurysms, but older patients face higher procedural risks and shorter periods during which an untreated aneurysm may rupture causing subarachnoid hemorrhage (SAH). We assessed trends in clipping and coiling of unruptured intracranial aneurysms, outcomes after clipping and coiling of unruptured intracranial aneurysms, and in SAH among Medicare beneficiaries. Using 2000 to 2010 Medicare Provider Analysis and Review data, we identified 2 cohorts of patients admitted electively for clipping or coiling of an unruptured aneurysm: (1) utilization cohort (2000-2010): patients ≥65 years enrolled ≥1 month in a given year and (2) outcomes cohort (2001-2010): patients ≥66 years of age enrolled in Medicare for ≥1 year. We calculated rates of clipping, coiling, and SAH per 100 000 Medicare beneficiaries. We tested for trends in the risk of in-hospital mortality and complications, discharge destination, 30-day mortality, 30-day readmissions, and length of hospitalization. Characteristics of patients undergoing clipping (n=4357) or coiling (n=7942) did not change appreciably. Overall, 30-day mortality, in-hospital complications, and 30-day readmissions decreased, generally reaching their lowest levels in 2008 to 2010 (1.6%, 25.0%, and 14.5% for clipping and 1.5%, 13.8%, and 11.0% for coiling, respectively). Procedural treatment rates per 100 000 beneficiaries increased from 1.4 in 2000 to 6.0 in 2010, driven mainly by increased use of coiling but SAH rates did not decrease. Although outcomes tended to improve over time, increased preventative treatment of unruptured intracranial aneurysms among Medicare beneficiaries did not result in a population-level decrease in SAH rates. © 2015 American Heart Association, Inc.

  17. Prevention and management of the complications during embolizing intracranial aneurysm with GDC

    International Nuclear Information System (INIS)

    Zhong Ming; Tan Xianxi; Wang Junlu; Hu Wenhao; Fan Lianghao

    2002-01-01

    Objective: To sum up the experience of embolization of intracranial aneurysm with Guglielmi detachable coil (GDC) and to discuss how to prevent and manage the complications during the endovascular treatment. Methods: 108 patients with intracranial aneurysm were embolized with GDC. 24 accident out of 20 patients during embolization were reviewed. Results: Among the 24 accidents, there were 10 aneurysm rupture, 5 over- embolization 5 coils end protruding to parent artery, and 4 thrombosis. Once the aneurysm ruptures, neutralizing heparin and continuing embolization was administered. Among 10 cases of aneurysm ruptures, 4 were death, 1 was severe deformity, 1 was mild deformity. Thrombolysis, heparinisation and raising blood pressure were used to control over-embolization, coil protrusion, and thrombosis. Among 5 cases of over-embolization, 1 died, 4 recovered. Among 5 cases of coils end protruding, 1 was severe deformity, 1 was mild deformity. Among 4 cases of embolization, 1 died, 1 was led sensory aphasics. The accidents resulted in 5 deaths (4.6%), 4 permanent neurological deficits (3.7%). Conclusion: The correct management of the complications during the treatment, the better understanding of the aneurysm and its parent artery angio-anatomy and the improved skill of embolizing technique are helpful to reduce the accidents and increase the cure rate

  18. Application of a Precision Mobile Platform on an Innovative Intracranial Aneurysm Spherical Stent

    Directory of Open Access Journals (Sweden)

    Bor-Hann Huang

    2014-03-01

    Full Text Available Intracranial aneurysms are the main causes of hemorrhagic stroke. The current intravascular coil embolization has limitations when used to treat intracranial aneurysm. If the aneurysm neck is too large, surgery is problematic and sequelae are more significant. We proposed an innovative design of an aneurysm spherical stent that can be directly placed in the aneurysm, providing more even radial support to the aneurysm and thus reducing the risk of rupture. By using CAD software to sketch and create a finite element computer model, we predicted the clinical behavior and mechanical properties of the spherical stent as a reference index to evaluate whether the material of the spherical stent had the potential to rupture in its manufacturing process or during balloon dilation. Lastly, by using pulse type fiber optic laser with an XY (rotating axes integrated mobile platform, we produced a prototype of the innovative spherical stent with length of 7.5mm, diameter of 2mm and wall thickness of 0.1mm. Then, we successfully combined it with the balloon as a schematic of a finished product.

  19. Comparison of Enterprise with Neuroform stent-assisted coiling of intracranial aneurysms.

    Science.gov (United States)

    Kadkhodayan, Yasha; Rhodes, Nicholas; Blackburn, Spiros; Derdeyn, Colin P; Cross, DeWitte T; Moran, Christopher J

    2013-04-01

    The Enterprise stent is the first closed-cell stent designed to treat wide-necked intracranial aneurysms. Advantages of the design can include improvement in keeping coils within an aneurysm and the ability of the stent to be recaptured. We compared the technical and clinical complications of the Enterprise stent with the open-cell Neuroform stent, its primary alternative. Patients undergoing Enterprise and Neuroform stent-assisted aneurysm coiling were enrolled in prospective registries starting in March 2007 and February 2003, respectively. All consecutive patients through December 2011 were included. Deployment success and difficulty, stent movement and misplacement, and procedural complications were compared. Enterprise deployment success was high (108 of 115 attempts, 93.9%) with 102 aneurysms receiving a stent compared with Neuroform (173 of 214 attempts, 80.8%, p = 0.001) with 163 aneurysms. Enterprise was easier to deploy (1.7% vs 15.9% difficult deployment, p Enterprise stent (8.7% vs 1.4%, p = 0.0021). The Enterprise stent enabled treatment of 10 additional aneurysms that could not be treated with Neuroform and had a higher rate of immediate aneurysm occlusion (87.3% vs 73.0%, p = 0.0058). Enterprise was easier to deploy and enabled treatment of additional aneurysms; however, there were more thromboembolic complications. On the basis of these findings, we prefer to use the Neuroform stent first and rely on the Enterprise stent as an easy-to-deliver backup for stent-assisted coiling.

  20. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography

    International Nuclear Information System (INIS)

    Tipper, G.; U-King-Im, J.M.; Price, S.J.; Trivedi, R.A.; Cross, J.J.; Higgins, N.J.; Farmer, R.; Wat, J.; Kirollos, R.; Kirkpatrick, P.J.; Antoun, N.M.; Gillard, J.H.

    2005-01-01

    AIM: The aim of this study was to assess the usefulness of 16-row multislice CT angiography (CTA) in evaluating intracranial aneurysms, by comparison with conventional digital subtraction angiography (DSA) and intraoperative findings. METHODS: A consecutive series of 57 patients, scheduled for DSA for suspected intracranial aneurysm, was prospectively recruited to have CTA. This was performed with a 16-detector row machine, detector interval 0.75 mm, 0.5 rotation/s, table speed 10 mm/rotation and reconstruction interval 0.40 mm. CTA studies were independently and randomly assessed by two neuroradiologists and a vascular neurosurgeon blinded to the DSA and surgical findings. Review of CTA was performed on workstations with an interactive 3D volume-rendered algorithm. RESULTS: DSA or intraoperative findings or both confirmed 53 aneurysms in 44 patients. For both independent readers, sensitivity and specificity per aneurysm of DSA were 96.2% and 100%, respectively. Sensitivity and specificity of CTA were also 96.2% and 100%, respectively. Mean diameter of aneurysms was 6.3 mm (range 1.9 to 28.1 mm, SD 5.2 mm). For aneurysms of less than 3 mm, CTA had a sensitivity of 91.7% for each reader. Although the neurosurgeon would have been happy to proceed to surgery on the basis of CTA alone in all cases, he judged that DSA might have provided helpful additional anatomical information in 5 patients. CONCLUSION: The diagnostic accuracy of 16-slice CTA is promising and appears equivalent to that of DSA for detection and evaluation of intracranial aneurysms. A strategy of using CTA as the primary imaging method, with DSA reserved for cases of uncertainty, appears to be practical and safe

  1. Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Beuth, Wojciech

    2014-01-01

    The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up.

  2. Flow diverter devices in ruptured intracranial aneurysms: a single-center experience.

    Science.gov (United States)

    Lozupone, Emilio; Piano, Mariangela; Valvassori, Luca; Quilici, Luca; Pero, Guglielmo; Visconti, Emiliano; Boccardi, Edoardo

    2018-04-01

    OBJECTIVE In this single-center series, the authors retrospectively evaluated the effectiveness, safety, and midterm follow-up results of ruptured aneurysms treated by implantation of a flow diverter device (FDD). METHODS The records of 17 patients (12 females, 5 males, average World Federation of Neurosurgical Societies score = 2.9) who presented with subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm treated with an FDD were retrospectively reviewed. Of 17 ruptured aneurysms, 8 were blood blister-like aneurysms and the remaining 9 were dissecting aneurysms. The mean delay between SAH and treatment was 4.2 days. Intraprocedural and periprocedural morbidity and mortality were recorded. Clinical and angiographic follow-up evaluations were conducted between 6 and 12 months after the procedure. RESULTS None of the ruptured aneurysms re-bled after endovascular treatment. The overall mortality rate was 12% (2/17), involving 2 patients who died after a few days because of complications of SAH. The overall morbidity rate was 12%: 1 patient experienced intraparenchymal bleeding during the repositioning of external ventricular drainage, and 1 patient with a posterior inferior cerebellar artery aneurysm developed paraplegia due to a spinal cord infarction after 2 weeks. The angiographic follow-up evaluations showed a complete occlusion of the aneurysm in 12 of 15 surviving patients; of the 3 remaining cases, 1 patient showed a remnant of the aneurysm, 1 patient was retreated due to an enlargement of the aneurysm, and 1 patient was lost at the angiographic follow-up. CONCLUSIONS FDDs can be used in patients with ruptured aneurysms, where conventional neurosurgical or endovascular treatments can be challenging.

  3. Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic-morphological discriminants.

    Science.gov (United States)

    Xiang, Jianping; Yu, Jihnhee; Choi, Hoon; Dolan Fox, Jennifer M; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H; Meng, Hui

    2015-07-01

    We have previously developed three logistic regression models for discriminating intracranial aneurysm rupture status from 119 aneurysms based on hemodynamic-morphological parameters. In this study we exploit their use as a tool for predicting the risk of rupture of aneurysms with a defined Rupture Resemblance Score (RRS). We collected three-dimensional images of 85 consecutive aneurysms, applied the three regression models and compared model performance at predicting rupture status against anecdotal metrics (aneurysm size and aspect ratio). We then reinterpreted the model-predicted probability as RRS, where the higher the score the closer the resemblance to previously known rupture components, and applied the RRS prospectively to four unruptured aneurysms with borderline treatment decisions. All three models yielded excellent sensitivity (0.78-0.83) and specificity (0.78-0.84) at a cutoff score of 50%, whereas aneurysm size and aspect ratio showed poor sensitivities (0.28 and 0.33, respectively). Lowering the cutoff score to 30% improved sensitivity to 0.90. The RRS identified most of the ruptured aneurysms and also some unruptured ones that closely resembled ruptured aneurysms hemodynamically and/or morphologically. The prospective application of the RRS to unruptured aneurysms shows that it could provide additional insights for treatment decisions. Previous regression models based on hemodynamic-morphological parameters are able to discriminate rupture in a new cohort in the same population. A higher probability of rupture is associated with larger size ratio, lower normalized wall shear stress and higher oscillatory shear index. The RRS could potentially stratify rupture risk and assist in treatment decision-making for unruptured aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study.

    Science.gov (United States)

    Vakil, P; Ansari, S A; Cantrell, C G; Eddleman, C S; Dehkordi, F H; Vranic, J; Hurley, M C; Batjer, H H; Bendok, B R; Carroll, T J

    2015-05-01

    Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K(trans), VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K(trans) would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (K(trans), VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K(trans) and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. Interobserver agreement was strong as shown in regression analysis (R(2) > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K(trans) can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. We report the first evidence of dynamic contrast-enhanced MR imaging-modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K(trans) was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms. © 2015 by American Journal of Neuroradiology.

  5. Monitoring of Intracranial Pressure in Patients with Traumatic Brain Injury

    Science.gov (United States)

    Hawthorne, Christopher; Piper, Ian

    2014-01-01

    Since Monro published his observations on the nature of the contents of the intracranial space in 1783, there has been investigation of the unique relationship between the contents of the skull and the intracranial pressure (ICP). This is particularly true following traumatic brain injury (TBI), where it is clear that elevated ICP due to the underlying pathological processes is associated with a poorer clinical outcome. Consequently, there is considerable interest in monitoring and manipulating ICP in patients with TBI. The two techniques most commonly used in clinical practice to monitor ICP are via an intraventricular or intraparenchymal catheter with a microtransducer system. Both of these techniques are invasive and are thus associated with complications such as hemorrhage and infection. For this reason, significant research effort has been directed toward development of a non-invasive method to measure ICP. The principle aims of ICP monitoring in TBI are to allow early detection of secondary hemorrhage and to guide therapies that limit intracranial hypertension (ICH) and optimize cerebral perfusion. However, information from the ICP value and the ICP waveform can also be used to assess the intracranial volume–pressure relationship, estimate cerebrovascular pressure reactivity, and attempt to forecast future episodes of ICH. PMID:25076934

  6. Ruptured intracranial aneurysm in patients with osteogenesis imperfecta: 2 familial cases and a systematic review of the literature.

    Science.gov (United States)

    Gaberel, T; Rochey, A; di Palma, C; Lucas, F; Touze, E; Emery, E

    2016-12-01

    Osteogenesis imperfecta is an inherited connective tissue disorder that causes bone fragility. Vascular complications have been described, but only few cases of ruptured intracranial aneurysm have been reported. We first described 2 familial cases of ruptured intracranial aneurysm and then conducted a systematic review of the literature. A mother and her daughter with a typical history of osteogenesis imperfecta presented with subarachnoid hemorrhage, which was related to a posterior communicating artery aneurysm in both cases. The mother had early rebleeding and died. The aneurysm was excluded by coiling in the daughter. Despite occurrence of hydrocephalus and delayed cerebral ischemia, she had an excellent functional outcome. A systematic review of the literature identified seven additional cases. None of the cases were in fact familial. All patients had a previous medical history of multiple fractures. Seven aneurysms were resolved, three by surgical clipping and four by endovascular procedure. No periprocedural complication was reported. One patient died prematurely and 6 experienced good functional outcome. We report the first familial cases of aneurysmal subarachnoid hemorrhage in osteogenesis imperfecta patients. Intracranial aneurysms are probably linked to a collagen pathology, which is at the origin of osteogenesis imperfecta. In cases of aneurysmal subarachnoid hemorrhage in an osteogenesis imperfecta family, intracranial aneurysm screenings in the relatives showing osteogenesis imperfecta should be considered. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Value of 3D DSA in diagnosis of intracranial aneurysms compared with that of 2D DSA

    International Nuclear Information System (INIS)

    Zhang Xiaolong; Ling Feng; Shen Tianzhen; Huang Xianglong; Wang Daming; Zhang Hongqi; Miao Zhongrong; Song Qingbin

    2001-01-01

    Objective: To compare the value of 3D DSA with 2D DSA in the diagnosis of intracranial aneurysms. Methods: 22 patients suspected to be with intracranial aneurysms were undergone both 3D DSA and 2D DSA. The number of aneurysms, the relationship between aneurysm and parent artery, aneurysm and local vessels branches from the sac were detected with both 3D DSA and 2D DSA with double blind methods. Results: No false positiveness and false negativeness of 3D DSA were found in diagnosis of 30 intracranial aneurysms while 2 false positiveness and 2 false negativeness of 2D DSA were found. 3D DSA could clarify the relationships of all aneurysms with their parent arteries and with the local vessels, and some branches from 2 sacs were identified with 3D DSA. 2D DSA could clarify the relationships of only 8 aneurysms (including 4 PcoAN, 3 AcoAN and 1 CaroOphAN) with their parent arteries and with the local vessels, and 2D DSA could not identify the branches from the sac. Conclusions: 3D DSA was superior to 2D DSA in the diagnosis of intracranial aneurysms

  8. Finite element model of size, shape and blood pressure on rupture of intracranial saccular aneurysms

    Science.gov (United States)

    Rica Nabong, Jennica; David, Guido

    2017-10-01

    Rupture of intracranial saccular aneurysms is a primary concern for neurologists and patients because it leads to stroke and permanent disability. This paper examines the role of blood pressure, in connection with size of and wall thickness, in the rupture of saccular aneurysms. A bulb-shaped geometry of a saccular aneurysm is obtained from angiographic images of a patient and modeled using Finite Elements based on the principle of virtual work under the Fung stress-strain relationship. The numerical model is subjected to varying levels of systolic blood pressure. Rupture is assumed to occur when the wall stress exceeded its mechanical strength. The results show which sizes of this class of aneurysms are at high risk of rupture for varying levels of blood pressure.

  9. Traumatic Spinal Subdural Hematoma with Intracranial Subdural Hematoma.

    Science.gov (United States)

    Kim, Hyun Gon; Kim, Tae Wan; Park, Kwan Ho; Chi, Moon Pyo

    2014-10-01

    Traumatic spinal subdural hematoma associated with intracranial subdural hematoma is a rare condition. Herein, we report the case of a 62-year-old man with lower back pain, radiating pain, and numbness in both lower extremities, without motor weakness, for 2 weeks. Lumbar magnetic resonance imaging (MRI) revealed high signal intensity on T1-weighted image (WI), and low signal intensity on T2-WI from L2 to L5. Two weeks after conservative management, follow-up lumbar MRI did not show the hematoma and his symptoms were relieved and there was no neurological deficit; therefore, he was discharged. However, subsequently, intracranial subdural hematoma increased and upper extremity motor weakness appeared. This was treated surgically. If there is no neurological deficit, conservative treatment may be a good option. Follow-up evaluation for asymptomatic cranial subdural hematoma is necessary.

  10. Detection of intracranial aneurysms with 64 channel multidetector row computed tomography: comparison with digital subtraction angiography.

    Science.gov (United States)

    Pozzi-Mucelli, Fabio; Bruni, Stefano; Doddi, Marco; Calgaro, Antonio; Braini, Massimiliano; Cova, Maria

    2007-10-01

    To compare the contribution of 64 channel multidetector row computed tomography angiography (64MDCT-angiography) with digital subtraction angiography (DSA) in the detection of intracranial aneurysms. Twenty-nine patients (10 males and 19 females, age: 40-84 years; average: 61.9 years) with clinical and imaging findings strongly suggesting the presence of subaracnoid hemorrhage underwent 64MDCT-angiography and DSA with a short interval between the two examinations (less than 12 h-5 days). CT parameters were: 64 mm x 0.5 mm collimation, pitch-0.828 and helical pitch-53. DSA were performed with standard technique (four vessel catheterization) and multiple projections. Axial CT scans as well as maximum intensity projection, volume rendering and multiplanar reformations and angiographic views were independently reviewed by four readers (two for 64MDCT-angiography and two for DSA). Consensus was reached for discordant cases. DSA was considered as the standard of reference. In 29 patients, 28 aneurysms were found (14 patients had 1 aneurysm, 4 patients had 2 aneurysms and 2 patients had 3 aneurysms; in 9 patients no aneurysm were found). 64MDCT-angiography detected 26/28 aneurysms. No false-positive sites were recognized. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 92.8, 100, 100, 99.4 and 99.5%. 64MDCT-angiography is helpful in detecting intracranial aneurysms with results similar to those of DSA but with less discomfort and risks for the patients and can be considered for the first line imaging technique. Conventional angiography is still needed in doubtful cases or negative MDCT-angiography associated with a strong clinical suspect.

  11. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta

    2015-06-01

    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  12. Nursing assistance for spring coil occlusion for the treatment of intracranial giant internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    Ma Yugang; Mao Yanjun; Yuan Yili; Hu Yaqin; Liu Jing; Xi Juan

    2010-01-01

    Objective: To discuss the importance of balloon occlusion test before interventional treatment of the intracranial giant internal carotid artery aneurysms and to sum up the nursing experience in assisting the procedure. Methods: Proper perioperative nursing measures were carried out for 12 patients, who suffered from intracranial giant internal carotid artery aneurysm and underwent spring coil occlusion treatment. Nursing measures included mental care, observation of the vital signs, prevention of the complications, etc. Results: Neither death nor exacerbation of the condition occurred in all the 12 patients. The patients were discharged from the hospital with a mean hospitalization of nine days. During a follow-up period ranged from 4 months to one year, seven patients had no disagreeable feeling, one patient complained of discomfort but no abnormality was found on follow-up DSA, and disappearance of the aneurysm was observed in 4 patients. Conclusion: The monitoring of the vital signs, the prevention of the complications and the standard nursing care are the key points for ensuring a successful operation in treating intracranial giant internal carotid artery aneurysms with spring coil occlusion. (authors)

  13. Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Hong, Seung-Chyul; Kim, Jong-Soo

    2012-01-01

    Objective The lateral supraorbital (LSO) approach is a modified method of the classic pterional approach and it has advantages of short skin incision and small craniotomy compared with the pterional approach. This study was designed to compare the two approaches in the surgical treatment of unruptured intracranial aneurysms. Methods We retrospectively reviewed 122 patients with 137 unruptured intracranial aneurysms treated by clipping, from July 2009 to April 2011. Between August 2010 and April 2011, 61 patients were treated by clipping via the lateral supraorbital approach and the same number of patients treated by clipping via the pterional approach were retrospectively enrolled. We analyzed the two groups and compared demographic, radiologic and clinical variables. Results The mean age of patients in the two groups was 54.6 years (LSO group) and 55.7 years (Pterion group). The mean duration of hospitalization was shorter in the LSO group than in the Pterion group (7.9 days vs. 9.0 days, p=0.125) and the mean operation time was also significantly shorter in the LSO group (117.1 minutes vs. 164.3 minutes, p<0.001). Furthermore, the mean craniotomy area was much smaller in the LSO group (1275.4 mm2 vs. 2858.9 mm2, p<0.001). The two groups showed similar distributions of aneurysm location and postoperative complications. Conclusion The lateral supraorbital approach for the clipping of unruptured intracranial aneurysm could be a good alternative to the classic pterional approach. PMID:22949961

  14. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture?

    Science.gov (United States)

    Mehan, William A; Romero, Javier M; Hirsch, Joshua A; Sabbag, David J; Gonzalez, Ramon G; Heit, Jeremy J; Schaefer, Pamela W

    2014-12-01

    Despite several landmark studies, the natural history of unruptured intracranial aneurysms (UIA) remains uncertain. Our aim was to identify or confirm factors predictive of rupture of UIA being observed conservatively with serial CT angiography (CTA) in a North American patient population. We performed a retrospective review of patients with UIA being followed with serial CTA studies from 1999 to 2010. The following features for each aneurysm were cataloged from the official radiologic reports and CTA images: maximum diameter, growth between follow-up studies, location, multiplicity, wall calcification, intraluminal thrombus and morphology. Univariate logistic regression analysis of the potential independent risk factors for aneurysm rupture was performed. Statistically significant risk factors from the univariate analysis were then entered into a multivariate logistic regression analysis. 152 patients with a total of 180 UIA had at least two CTA studies. Six aneurysms in six different patients ruptured during the CTA follow-up period for an overall rupture rate of 3.3% and an annual rupture rate of 0.97%. All ruptured aneurysms were ≥9 mm. In the univariate analysis, the statistically significant predictors of aneurysm rupture were aneurysm size (p=0.003), aneurysm growth (p<0.0001) and aneurysm multilobulation (p=0.001). The risk factors that remained significant following the multivariate analysis were growth (OR 55.9; 95% CI 4.47 to 700.08; p=0.002) and multilobulation (OR 17.4; 95% CI 1.52 to 198.4; p=0.022). Aneurysm morphology and interval growth are characteristics predictive of a higher risk of subsequent rupture during conservative CTA follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. The effect of inlet waveforms on computational hemodynamics of patient-specific intracranial aneurysms.

    Science.gov (United States)

    Xiang, J; Siddiqui, A H; Meng, H

    2014-12-18

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic quantities that have been shown to predict aneurysm rupture, as well as maximal WSS (MWSS), energy loss (EL) and pressure loss coefficient (PLc). Sixteen pulsatile CFD simulations were carried out on four typical saccular aneurysms using 4 different waveforms and an identical inflow rate as inlet boundary conditions. Our results demonstrated that under the same mean inflow rate, different waveforms produced almost identical WSS distributions and WSS magnitudes, similar OSI distributions but drastically different OSI magnitudes. The OSI magnitude is correlated with the pulsatility index of the waveform. Furthermore, there is a linear relationship between aneurysm-averaged OSI values calculated from one waveform and those calculated from another waveform. In addition, different waveforms produced similar MWSS, EL and PLc in each aneurysm. In conclusion, inlet waveform has minimal effects on WSS, OSI distribution, MWSS, EL and PLc and a strong effect on OSI magnitude, but aneurysm-averaged OSI from different waveforms has a strong linear correlation with each other across different aneurysms, indicating that for the same aneurysm cohort, different waveforms can consistently stratify (rank) OSI of aneurysms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Adenosine-induced cardiac arrest as an alternative to temporary clipping during intracranial aneurysm surgery.

    Science.gov (United States)

    Intarakhao, Patcharin; Thiarawat, Peeraphong; Rezai Jahromi, Behnam; Kozyrev, Danil A; Teo, Mario K; Choque-Velasquez, Joham; Luostarinen, Teemu; Hernesniemi, Juha

    2017-10-27

    OBJECTIVE The purpose of this study was to analyze the impact of adenosine-induced cardiac arrest (AiCA) on temporary clipping (TC) and the postoperative cerebral infarction rate among patients undergoing intracranial aneurysm surgery. METHODS In this retrospective matched-cohort study, 65 patients who received adenosine for decompression of aneurysms during microsurgical clipping were identified (Group A) and randomly matched with 65 selected patients who underwent clipping but did not receive adenosine during surgery (Group B). The matching criteria included age, Fisher grade, aneurysm size, rupture status, and location of aneurysms. The primary outcomes were TC time and the postoperative infarction rate. The secondary outcome was the incidence of intraoperative aneurysm rupture (IAR). RESULTS In Group A, 40 patients underwent clipping with AiCA alone and 25 patients (38%) received AiCA combined with TC, and in Group B, 60 patients (92%) underwent aneurysm clipping under the protection of TC (OR 0.052; 95% CI 0.018-0.147; p AiCA is a useful technique for microneurosurgical treatment of cerebral aneurysms. AiCA can minimize the use of TC and does not increase the risk of IAR and postoperative infarction.

  17. Stent-Assisted Coil Embolization of Intracranial Aneurysms: Complications in Acutely Ruptured versus Unruptured Aneurysms.

    Science.gov (United States)

    Bechan, R S; Sprengers, M E; Majoie, C B; Peluso, J P; Sluzewski, M; van Rooij, W J

    2016-03-01

    The use of stents in the setting of SAH is controversial because of concerns about the efficacy and risk of dual antiplatelet therapy. We compare complications of stent-assisted coil embolization in patients with acutely ruptured aneurysms with complications in patients with unruptured aneurysms. Between February 2007 and March 2015, 45 acutely ruptured aneurysms and 47 unruptured aneurysms were treated with stent-assisted coiling. Patients with ruptured aneurysms were not pretreated with antiplatelet medication but received intravenous aspirin during the procedure. Thromboembolic events and early rebleeds were recorded. In ruptured aneurysms, 9 of 45 patients had thromboembolic complications. Four patients remained asymptomatic, 4 developed infarctions, and 1 patient died. The permanent complication rate in ruptured aneurysms was 11% (95% CI, 4%-24%). Five of 45 patients (11%; 95% CI, 4%-24%) had an early rebleed from the treated aneurysm after 3-45 days, and in 4, this rebleed was fatal. In 46 patients with 47 unruptured aneurysms, thromboembolic complications occurred in 2. One patient remained asymptomatic; the other had a thalamus infarction. The complication rate in unruptured aneurysms was 2.2% (1 of 46; 95% CI, 0.01%-12%). No first-time hemorrhages occurred in 46 patients with 47 aneurysms during 6 months of follow-up. The complication rate of stent-assisted coiling with early adverse events in ruptured aneurysms was 10 times higher than that in unruptured aneurysms. Early rebleed accounted for most mortality. In ruptured aneurysms, stent-assisted coil embolization is associated with increased morbidity and mortality and should only be considered when less risky options have been excluded. © 2016 by American Journal of Neuroradiology.

  18. Management of stent for an emergency situation during coil embolization of intracranial aneurysms

    International Nuclear Information System (INIS)

    Gu Binxian; Li Minghua; Wang Wu

    2011-01-01

    Objective: The purpose of this study is to evaluate the efficacy of stent for endovascular treatment of an emergency situation such as coil migration, coil herniation, prolapsed coil and stretched coil during coil embolization of intracranial aneurysms, and to summarize the possible mechanisms of these emergency situations. Methods: The records of 12 patients, who received coil embolization for intracranial aneurysms and developed emergent complications during the embolization procedures, were retrospectively reviewed. Wide-neck aneurysms were found in 9 and subarachnoid hemorrhages in 10 patients. The maximum diameter of the aneurysms was 3 mm or less in 1, 3-5 mm in 7 and 5-12 mm in 2 patients. All patients were evaluated by angiographic and clinical follow-up for 18 months or more. Results: Coil migration was found in 3, coil herniation in 7 and stretched coil in 2 patients. Eight patients were treated with stenting, and no ischemic stroke occurred. Of the four patients, who were treated without stent, stretched coil was seen in one, which was successfully retrieved, coil herniation was seen in 3, and ischemic stroke occurred in two. No re-bleeding or in-stent stenosis occurred during the follow-up period. Conclusion: Stents can be used as a feasible and effective tool to treat these emergency situations, which occasionally occur during endovascular embolization for intracranial aneurysms. The occurrence of these emergent events is related to the undersized coil and incompatible diameter to that of the aneurysms, which causes the moving of the coil and subsequent coil embolization, and is also related to the excessive embolization and microcatheter-related problems. (authors)

  19. Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon.

    Science.gov (United States)

    Consoli, Arturo; Vignoli, Chiara; Renieri, Leonardo; Rosi, Andrea; Chiarotti, Ivano; Nappini, Sergio; Limbucci, Nicola; Mangiafico, Salvatore

    2016-01-01

    Assisted coiling with stents or balloons enables a higher percentage of complete occlusions of saccular unruptured intracranial aneurysms to be achieved with a reasonable complication rate. The aim of this study was to compare stent-assisted coiling and the balloon remodeling technique in terms of efficacy, stability, and safety for the treatment of comparable unruptured saccular intracranial aneurysms. 268 patients with 286 saccular unruptured wide-necked intracranial aneurysms were treated at our institution with stent- or balloon-assisted coiling and retrospectively reviewed. Statistical analysis was performed to assess significant differences between the two groups. The rate of complete occlusion at the end of the procedure was higher with stent-assisted coiling than with balloon-assisted coiling (86.8% vs 78%) and the same results were also observed after 6 months (92.1% vs 77.6%; p=0.05). About 50% of major recurrences occurred in large to giant aneurysms (p<0.001). The overall complication rate was similar in the stent-assisted and balloon-assisted groups (10.3% vs 9.3%). Independently of the technique, a higher complication rate was observed with bifurcational aneurysms, particularly in the middle cerebral artery (p=0.016). Stent-assisted coiling achieved better results in terms of complete occlusion and stability than balloon-assisted coiling with a lower rate of recurrence without being associated with a higher risk of intraprocedural complications. Bifurcational and large to giant aneurysms were associated with higher complication rates and higher recurrence rates, respectively, and still represent a challenge for both techniques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling

    Science.gov (United States)

    Al-Jehani, Hosam M.; Alwadaani, Hassan A.; Almolani, Fadhel M.

    2016-01-01

    Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature. PMID:26818170

  1. MR susceptibility artefact associated with the use of Barricade coils for treatment of intracranial aneurysms.

    Science.gov (United States)

    Gontu, Vamsi; McConachie, Norman

    2015-04-01

    Magnetic resonance angiography (MRA) is commonly used to follow up patients after endovascular treatment for intracranial aneurysms. Magnetic resonance artefacts from coil constructs may impair image quality and jeopardise the evaluation of the effectiveness of treatment and review of adjacent vasculature. We present here a technical note on the usage of Barricade coils recently introduced at our institution. The MRA artefacts associated with these coils may make it impossible to ascertain aneurysm closure and anatomy. Hence these patients would need to be recalled for digital subtraction angiograms for a complete neuroradiological follow-up. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Does treatment of ruptured intracranial aneurysms within 24 hours improve clinical outcome?

    Science.gov (United States)

    Phillips, Timothy J; Dowling, Richard J; Yan, Bernard; Laidlaw, John D; Mitchell, Peter J

    2011-07-01

    The purpose of this study was to analyze whether treating ruptured intracranial aneurysms within 24 hours of subarachnoid hemorrhage improves clinical outcome. An 11-year database of consecutive ruptured intracranial aneurysms treated with endovascular coiling or craniotomy and clipping was analyzed. Outcome was measured by the modified Rankin Scale at 6 months. Our policy is to treat all cases within 24 hours of subarachnoid hemorrhage. Treatment delays are due to nonclinical logistical factors. Two hundred thirty cases were coiled or clipped within 24 hours of subarachnoid hemorrhage and 229 at >24 hours. No difference in age, gender, smoking, family history of subarachnoid hemorrhage, aneurysm size, or aneurysm location was found between the groups. Poor World Federation of Neurological Surgeons clinical grade patients were overrepresented in the ultra-early group. Increasing age and higher World Federation of Neurological Surgeons clinical grade were predictors of poor outcome. Eight point zero percent (16 of 199) of cases treated within 24 hours of SAH (ultra-early) were dependent or dead at 6 months compared with 14.4% (30 of 209) of those treated at >24 hours post-SAH (delayed; (χ2, P0.044) [corrected]. A total of 3.5% of cases coiled within 24 hours were dependent or dead at 6 months compared with 12.5% of cases coiled at 1 to 3 days, an 82% relative risk reduction and a 10.2% absolute risk reduction (χ2, P=0.040). These groups did not differ in age, World Federation of Neurological Surgeons clinical grade, aneurysm size, or aneurysm location. Treatment of ruptured aneurysms within 24 hours is associated with improved clinical outcomes compared with treatment at >24 hours. The benefit is more pronounced for coiling than clipping.

  3. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2013-01-01

    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  4. Experimental study on blood flow patterns through the phantoms of the intracranial arterial aneurysms using color Doppler imaging

    International Nuclear Information System (INIS)

    Chung, Tae Sub; Jeong, Eun Kee; Rhim, Yoon Chul; Kim, Sung Bin; Lee, Dong Hoon; Kim, Dae In

    1994-01-01

    The occurrence, growth, thrombosis, and rupture of intracranial saccular aneurysms can be directly related to the effect of hemodynamic forces. We developed the phantom flow models and compared with the computer simulation program to analyse the flow pattern and hemodynamics that might be responsible for the intracranial arterial aneurysms. We designed the arterial phantoms of three major sites of intracranial arterial aneurysm ; 1) basilar artery tip, 2) internal carotid artery bifurcation, 3) curved area of internal carotid artery. Flow patterns in the aneurysmal portion of phantoms were evaluated with color Doppler system on the connection with automatic closed type of circulation system. Then, we compared the results with computer simulation. The hemodynamic characteristics of the phantoms were identical with those obtained by computerisation's. Three distinct zones of flow were identified by color Doppler studies on the aneurysm of the curved area of an internal carotid artery : 1) an inflow zone entering the aneurysm at the distal aspect of its orifice, 2) an outflow zone exiting the aneurysm at the proximal aspect of its orifice, 3) a central slow vortex.However, the phantoms of basilar artery tip and artery bifurcation showed a direct inflow stream at the dome of an aneurysm. Flow dynamics in the various phantoms of the aneurysms can be successfully evaluated with color Doppler imaging, and were consistent with those predicted by computer simulations

  5. Identification of vortex structures in a cohort of 204 intracranial aneurysms.

    Science.gov (United States)

    Varble, Nicole; Trylesinski, Gabriel; Xiang, Jianping; Snyder, Kenneth; Meng, Hui

    2017-05-01

    An intracranial aneurysm (IA) is a cerebrovascular pathology that can lead to death or disability if ruptured. Abnormal wall shear stress (WSS) has been associated with IA growth and rupture, but little is known about the underlying flow physics related to rupture-prone IAs. Previous studies, based on analysis of a few aneurysms or partial views of three-dimensional vortex structures, suggest that rupture is associated with complex vortical flow inside IAs. To further elucidate the relevance of vortical flow in aneurysm pathophysiology, we studied 204 patient IAs (56 ruptured and 148 unruptured). Using objective quantities to identify three-dimensional vortex structures, we investigated the characteristics associated with aneurysm rupture and if these features correlate with previously proposed WSS and morphological characteristics indicative of IA rupture. Based on the Q -criterion definition of a vortex, we quantified the degree of the aneurysmal region occupied by vortex structures using the volume vortex fraction ( vVF ) and the surface vortex fraction ( sVF ). Computational fluid dynamics simulations showed that the sVF , but not the vVF , discriminated ruptured from unruptured aneurysms. Furthermore, we found that the near-wall vortex structures co-localized with regions of inflow jet breakdown, and significantly correlated to previously proposed haemodynamic and morphologic characteristics of ruptured IAs. © 2017 The Author(s).

  6. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario.

    Science.gov (United States)

    Longo, Marcello; Granata, Francesca; Racchiusa, Sergio; Mormina, Enricomaria; Grasso, Giovanni; Longo, Giuseppe Maria; Garufi, Giada; Salpietro, Francesco M; Alafaci, Concetta

    2017-09-01

    An understanding of the natural history of unruptured intracranial aneurysms (IAs) has always played a critical role in presurgical or endovascular planning, to avoid possibly fatal events. Size, shape, morphology, and location are known risk factors for rupture of an aneurysm, but morphologic parameters alone may not be sufficient to perform proper rupture risk stratification. We performed a systematic PubMed search and focused on hemodynamics forces that may influence aneurysmal initiation, growth, and rupture. We included 223 studies describing several hemodynamic parameters related to aneurysm natural history. In these studies, different modalities of aneurysm model creation have been used to evaluate flow and to comprehensively analyze the evolution of IAs. Controversy exists about the correlation between these parameters and initiation, growth, rupture risk, or stabilization of the aneurysmal sac. Recent findings have also shown the importance of flow patterns in this process and the relationship between unruptured IA geometry and hemodynamic parameters. The role of hemodynamic forces in evaluation of the natural history of unruptured IAs presents is inherently complex and is still not completely understood. In this complex scenario, although several attempts have been described in the literature, a proper risk rupture stratification and treatment strategy selection based on hemodynamic forces has not yet been created. Further efforts should be made to accomplish this important goal. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Effects of indocyanine green videoangiography and electrophysiological monitoring on surgery for intracranial aneurysms

    International Nuclear Information System (INIS)

    Arai, Yoshikazu; Kitai, Ryuhei; Awara, Kosuke

    2011-01-01

    We analyzed the outcome of 62 consecutive patients with unruptured intracranial aneurysm treated by surgical clipping. Thirty-one cases were operated without intraoperative monitoring, 17 cases with indocyanine green videoangiography (ICGA), and 14 cases with electrophysiological monitoring (EPM) in addition to ICGA. Complete obliteration of the aneurysm was confirmed in all 62 cases. Diffusion-weighted imaging of MRI disclosed no ischemic lesions after surgery in any of the cases. Asymptomatic venous infarction was detected by CT study in 2 cases. Cranial nerve palsy occurred in 4 cases but EPM could not detect it. There was no difference among the group without monitoring, the group with ICGA and the group with ICGA and EPM. The mortality and morbidity of all cases was calculated as 0% and 6.5%, respectively. ICGA appeared to be useful in surgery for aneurysms encasing perforators or for repair of problems such as premature rupture. eicosapentaenoic acid (EPA) seemed effective in surgery for anterior choroidal artery aneurysms or aneurysms requiring trapping before clipping. However, monitoring would not have been effective without extensive dissection of aneurysms, suggesting that basic microsurgical techniques are crucial for successful surgery. (author)

  8. CT during selective arteriography: anatomical assessment of unruptured intracranial aneurysms before endovascular treatment

    International Nuclear Information System (INIS)

    Nomura, M.; Kida, S.; Uchiyama, N.; Yamashima, T.; Yamashita, J.; Sanada, J.; Yoshikawa, J.; Matsui, O.

    2001-01-01

    Our aim was to investigate the usefulness of helical CT during selective angiography (CT arteriography) in pretreatment assessment of unruptured intracranial aneurysms. We studied 47 unruptured aneurysms in 34 prospectively recruited patients for whom endovascular embolisation was initially considered. As pretreatment assessment, we performed rotational digital subtraction angiography (DSA) followed by CT arteriography. The findings on axial source images (axial images) and reconstructed three-dimensional CT angiography (3D-CTA) of CT arteriography were compared to those of rotational DSA, with particular attention to the neck of the aneurysm and arterial branches adjacent to it. Information provided by CT arteriography was more useful than that of rotational DSA as regards the neck in 25 (53 %) of 47 cases and as regards branches in 18 (49 %) of 37 aneurysms. On axial images, small arteries such as the anterior choroidal artery were seen in some cases. CT arteriography can provide valuable additional information about unruptured aneurysms, which cannot be obtained by rotational DSA alone. This technique is useful for obtaining anatomical information about aneurysm anatomy and for deciding the therapeutic strategy. (orig.)

  9. Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms.

    Science.gov (United States)

    Gentric, Jean-Christophe; Biondi, Alessandra; Piotin, Michel; Mounayer, Charbel; Lobotesis, Kyriakos; Bonafé, Alain; Costalat, Vincent

    2015-04-01

    Endovascular treatment of wide-necked and complex aneurysms may require stent-assisted coiling, either as primary stenting or combined with the balloon remodeling technique (BRT). To compare the angiographic results and clinical outcomes of both strategies in the Safety and Efficacy of Neuroform for Treatment of intracranial Aneurysms (SENAT) registry. SENAT was a prospective, multicenter registry that allowed BRT in conjunction with stenting and coiling with bare platinum coils. Clinical and angiographic outcomes of 97 patients with unruptured aneurysms treated with stenting, 51 after BRT (BRT+) and 46 without balloon assistance (BRT-), were retrieved from the SENAT database. Technical, clinical, and angiographic outcomes were compared between the 2 groups. Periprocedural morbimortality and midterm clinical outcomes were not different between groups. Residual aneurysms were observed in 7.8% of BRT+ and in 21.7% of BRT- (P = .08) at the end of the stenting procedure. Four retreatments were performed during the follow-up period (2 BRT+, 2 BRT-). Twelve- to 18-month anatomic results showed a significant difference between groups, with a residual aneurysm being observed in 6.1% of BRT+ as compared to 22.7% of BRT- patients (P = .03). Primary BRT followed by stent-assisted coiling may be associated with fewer residual aneurysms at 12 to 18 months as compared to stent-assisted coiling alone.

  10. Effect of endovascular treatment on headache in elderly patients with unruptured intracranial aneurysms.

    Science.gov (United States)

    Gu, D-Q; Duan, C-Z; Li, X-F; He, X-Y; Lai, L-F; Su, S-X

    2013-01-01

    The incidence of unruptured intracranial aneurysms is increasing in the elderly population as life expectancy increases, and patients often present with headache. The goal of this study was to determine the effect of endovascular treatment on headache and identify factors associated with headache outcome in elderly patients with unruptured intracranial aneurysms. A retrospective study was conducted for elderly patients (≥ 65 years old) being treated for unruptured intracranial aneurysms. Headache assessment was performed by a quantitative 11-point headache scale in all patients before and after endovascular treatment. Factors associated with headache outcome were investigated by univariate analyses. A total of 72 patients (mean age, 70.0 years; age range, 65-80 years; 41 women) fulfilled the inclusion criteria. There were 52 patients (72.2%) who presented with preoperative headache (headache score ≥ 1). Among them, 40 (76.9%) reported that headache score had an improvement according to their self-reported quantitative headache score after endovascular treatment. The average headache score was 5.63 preoperatively vs 2.50 postoperatively (P = .000). Twenty patients (27.8%) had no headache before treatment (headache score = 0), of whom 2 (10.0%) reported new onset of headache postoperatively. Only a preoperative headache score was associated with treatment outcome of headache, and a higher headache score predicted a lack of headache relief after endovascular treatment (P = .003). Endovascular coiling of unruptured intracranial aneurysms resulted in relief of headache in most of the elderly patients. Preoperative headache score was the only statistically significant predictor of headache outcome.

  11. The risk of headache attributed to surgical treatment of intracranial aneurysms: a cohort study.

    Science.gov (United States)

    Magalhães, João E; Azevedo-Filho, Hildo R C; Rocha-Filho, Pedro A S

    2013-01-01

    The aim of this study was to assess the risk of headache in patients undergoing surgical treatment of intracranial aneurysms. The risk of the post-craniotomy headache has never been studied. Patients with intracranial aneurysm, who were consecutively admitted to the Hospital da Restauração, Brazil, from May 2009 to October 2010, were interviewed before they underwent surgical or non-surgical treatment of the aneurysms. The patients were followed for 4 months after intervention. The International Headache Society criteria for post-craniotomy headache were used after surgery and adapted for headache after embolization (maximum intensity of pain on the same side of the aneurysm). We also used the Headache Impact Test, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale. Of 101 patients enrolled, 53 patients underwent craniotomy and 48 patients embolization. The surgery group was younger and had fewer women. The incidence of headache was 28/51 cases (54.9%) after surgery and 12/47 cases (25.5%) after embolization (relative risk = 2.15; 95% confidence interval [CI] 1.24-3.72). The incidence of persistent headache was not different between the 2 groups. The only risk factor for headache after the intervention was craniotomy (odds ratio = 2.6; 95% CI 1.1-6.7) and for persistent headache was anxiety prior to treatment (odds ratio = 8.5; 95% CI 1.7-42.3). The headache after treatment was not associated with the risk of anxiety or depression after the intervention. Patients who underwent craniotomy had an increased risk of headache after treatment of intracranial aneurysms. The incidence of persistent headache after 3 months was higher among patients who had anxiety before the intervention. © 2013 American Headache Society.

  12. Risks associated with preoperative anemia and perioperative blood transfusion in open surgery for intracranial aneurysms.

    Science.gov (United States)

    Seicean, Andreea; Alan, Nima; Seicean, Sinziana; Neuhauser, Duncan; Selman, Warren R; Bambakidis, Nicholas C

    2015-07-01

    Preoperative anemia may be treated with a blood transfusion. Both are associated with adverse outcomes in various surgical procedures, but this has not been clearly elucidated in surgery for cerebral aneurysms. In this study the authors assessed the association of preoperative anemia and perioperative blood transfusion, separately, on 30-day morbidity and mortality in patients undergoing open surgery for ruptured and unruptured intracranial aneurysms. The authors identified 668 cases (including 400 unruptured and 268 unruptured intracranial aneurysms) of open surgery for treatment of intracranial aneurysms in the 2006-2012 National Surgical Quality Improvement Program, a validated and reproducible prospective clinical database. Anemia was defined as a hematocrit level less than 39% in males and less than 36% in females. Perioperative transfusion was defined as at least 1 unit of packed or whole red blood cells given at any point between the start of surgery to 72 hours postoperatively. The authors separately compared surgical outcome between patients with (n = 198) versus without (n = 470) anemia, and those who underwent (n = 78) versus those who did not receive (n = 521) a transfusion, using a 1:1 match on propensity score. In the matched cohorts, all observed covariates were comparable between anemic (n = 147) versus nonanemic (n = 147) and between transfused (n = 67) versus nontransfused patients (n = 67). Anemia was independently associated with prolonged hospital length of stay (LOS; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4-4.5), perioperative complications (OR 1.9, 95% CI 1.1-3.1), and return to the operating room (OR 2.1, 95% CI 1.1-4.5). Transfusion was also independently associated with perioperative complications (OR 2.4, 95% CI 1.1-5.3). Preoperative anemia and transfusion are each independent risk factors for perioperative complications in patients undergoing surgery for cerebral aneurysms. Perioperative anemia is also associated with

  13. Cerebrovascular reactivity after treatment of unruptured intracranial aneurysms--A transcranial Doppler sonography and acetazolamide study.

    Science.gov (United States)

    Bøthun, Marianne Lundervik; Haaland, Øystein Ariansen; Logallo, Nicola; Svendsen, Frode; Thomassen, Lars; Helland, Christian A

    2016-04-15

    Cerebrovascular reactivity (CVR) is defined as the change in cerebral blood flow, or blood velocity, in response to a vasoactive stimulus. There is a possible association between impaired CVR and vasospasm after aneurysmal subarachnoid hemorrhage. Most studies on CVR and vasospasm have used healthy subjects as reference. However, due to potential different vascular features, CVR in persons with intracranial aneurysms may differ from CVR in healthy subjects. Therefore, our aim was to examine CVR in patients with unruptured intracranial aneurysms (UIA). CVR was examined in 37 patients in the first postoperative week after treatment for UIA, using acetazolamide (AZ) test with transcranial Doppler monitoring of blood flow velocities. Mean blood flow velocity in the middle cerebral arteries was 58.5 (SD 12.8) cm/s at baseline, and 94.3 (SD 19.5) cm/s after stimulation with AZ. Mean CVR was 62.6 (SD 16.8) %. There was no significant difference when comparing right and left sides, and treated and untreated sides. A simple regression analysis suggested that CVR increased with 0.7% points for each year a patient aged (p=0.004). However, the significance disappeared in a multiple analysis (increase of 0.6% points per year, p=0.055). Other possible influencing factors (gender, smoking, hypertension, body mass index, aneurysm location and treatment modality) were not significantly associated with CVR. CVR in patients with UIA is not different from normal values reported in healthy subjects, and does not indicate a systemically impaired vascular system in patients with UIA. We suggest that CVR in age and gender matched healthy controls can be used as reference for persons with intracranial aneurysms. Copyright © 2015. Published by Elsevier B.V.

  14. Stent-Assisted Coil Embolization of Intracranial Aneurysms: Complications in Acutely Ruptured versus Unruptured Aneurysms

    NARCIS (Netherlands)

    Bechan, R. S.; Sprengers, M. E.; Majoie, C. B.; Peluso, J. P.; Sluzewski, M.; van Rooij, W. J.

    2016-01-01

    The use of stents in the setting of SAH is controversial because of concerns about the efficacy and risk of dual antiplatelet therapy. We compare complications of stent-assisted coil embolization in patients with acutely ruptured aneurysms with complications in patients with unruptured aneurysms.

  15. Surgical Results of Unruptured Intracranial Aneurysms in the Elderly : Single Center Experience in the Past Ten Years

    Science.gov (United States)

    Jung, Young Jin; Park, Eun Suk; Kwon, Do Hoon; Kwun, Byung Duk; Kim, Chang Jin

    2011-01-01

    Objective As medical advances have increased life expectancy, it has become imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. We therefore analyzed the clinical characteristics and outcomes of the treatment of unruptured intracranial aneurysms in patients older than 70 years. Methods We retrospectively reviewed the medical records and results of neuroimaging modalities on 54 aneurysms of 48 consecutive patients with unruptured intracranial aneurysms. (mean±SD age, 72.11±1.96 years; range, 70-78 years) who underwent surgical clipping over 10 years (May 1999 to June 2010). Results Of the 54 aneurysms, 22 were located in the internal carotid artery, 19 in the middle cerebral artery, 12 in the anterior cerebral artery, and 1 in the superior cerebellar artery. Six patients had multiple aneurysms. Aneurysm size ranged from 3 mm to 17 mm (mean±SD, 6.82±3.07 mm). Fifty of the 54 aneurysms (92.6%) were completely clipped. Three-month outcomes were excellent in 50 (92.6%) aneurysms and good and poor in 2 each (3.7%), with 1 death (2.0%). Procedure-related complications occurred in 7 aneurysms (13.0%), with 2 (3.7%) resulting in permanent neurological deficits, including death. No postoperative subarachnoid hemorrhage occurred during follow-up. The cumulative rates of stroke- or death-free survival at 5 and 10 years were 100% and 78%, respectively. Conclusion Surgical clipping of unruptured intracranial aneurysms in elderly group could get it as a favorable outcome in well selected cases. PMID:21887389

  16. Ultra Low Density Shape Memory Polymer Foams With Tunable Physicochemical Properties for Treatment of intracranial Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Singhal, Pooja [Texas A & M Univ., College Station, TX (United States)

    2013-12-01

    Shape memory polymers (SMPs) are a rapidly emerging class of smart materials that can be stored in a deformed temporary shape, and can actively return to their original shape upon application of an external stimulus such as heat, pH or light. This behavior is particularly advantageous for minimally invasive biomedical applications comprising embolic/regenerative scaffolds, as it enables a transcatheter delivery of the device to the target site. The focus of this work was to exploit this shape memory behavior of polyurethanes, and develop an efficient embolic SMP foam device for the treatment of intracranial aneurysms.In summary, this work reports a novel family of ultra low density polymer foams which can be delivered via a minimally invasive surgery to the aneurysm site, actuated in a controlled manner to efficiently embolize the aneurysm while promoting physiological fluid/blood flow through the reticulated/open porous structure, and eventually biodegrade leading to complete healing of the vasculature.

  17. MRI-validation of SEP monitoring for ischemic events during microsurgical clipping of intracranial aneurysms.

    Science.gov (United States)

    Krayenbühl, Niklaus; Sarnthein, Johannes; Oinas, Minna; Erdem, Eren; Krisht, Ali F

    2011-09-01

    During surgical clipping of intracranial aneurysms, reduction in SEP amplitude is thought to indicate cortical ischemia and subsequent neurological deficits. Since the sensitivity of SEP is questioned, we investigated SEP with respect to post-operative ischemia. In 36 patients with 51 intracranial aneurysms, clinical evaluation and diffusion-weighted MRI (DWI) was performed before and within 24h after surgery. During surgery, time of temporary occlusion was recorded. MRI images were reviewed for signs of ischemia. For 43 clip applications (84%), we observed neither pathologic SEP events nor ischemia in MRI. In two cases where reduction lasted >10 min after clip release, SEP events correlated with ischemia in the MRI. Only one of the ischemic patients was symptomatic and developed a transient hemiparesis. While pathologic SEP events correlated with visible ischemia in MRI only in two cases with late SEP recovery, ischemia in MRI may have been transient or may not have reached detection threshold in the other cases, in agreement with the absence of permanent neurological deficits. In complex aneurysm cases, where prolonged temporary occlusion is expected, SEP should be used to detect ischemia at a reversible stage to improve the safety of aneurysm clipping. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Onyx HD-500 embolization of intracranial aneurysms: modified technique using continuous balloon inflation under conscious sedation.

    Science.gov (United States)

    Rahme, Ralph; Grande, Andrew; Jimenez, Lincoln; Abruzzo, Todd A; Ringer, Andrew J

    2014-08-01

    The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Benefits of Surgical Treatment for Unruptured Intracranial Aneurysms in Elderly Patients

    Science.gov (United States)

    Jang, E-Wook; Jung, Jin-Young; Hong, Chang-Ki

    2011-01-01

    Objective Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. Methods We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). Results Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. Conclusion Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor. PMID:21494358

  20. Outcome of intracranial aneurysm surgery: single center experience

    Directory of Open Access Journals (Sweden)

    Murat Ulutas

    2016-12-01

    Conclusion: Multiple aneurysms, poor grade and intracerebral hematomas are poor prognostic factors. The patients who have subarachnoid hemorrhage should be monitored by an experienced team of neurosurgery and intensive care and should be operated on as soon as possible because of rehemorrhage risk. The surgical clipping as a gold standard is still an affective and successful method. [Cukurova Med J 2016; 41(4.000: 732-743

  1. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

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    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  2. Delayed thromboembolic events more than 30 days after self expandable intracranial stent-assisted embolization of unruptured intracranial aneurysms.

    Science.gov (United States)

    Song, Jihye; Yeon, Je Young; Kim, Jong-Soo; Hong, Seung-Chyul; Kim, Keon-Ha; Jeon, Pyoung

    2015-08-01

    The Enterprise stent is used for endovascular treatment of complex intracranial aneurysms. The purpose of this study was to evaluate delayed thromboembolic events (DTEs) that developed more than 30 days after Enterprise stent-assisted embolization (SAC) and its associated risk factors. There were 125 consecutive patients (90 women and 35 men; mean age, 56.1 years) who received endovascular treatment for 126 complex intracranial aneurysms using the Enterprise stent during December 2008 to May 2011. A DTE was defined as a symptomatic or asymptomatic ischemic stroke with positive findings on brain magnetic resonance imaging in the territory of the treated aneurysm and transient ischemic attack. Asymptomatic in-stent stenosis and occlusion were excluded. During a mean follow-up of 32.4 months, DTEs occurred in 10 patients (7.93%). DTEs occurred on antiplatelet therapy (dual medication, n = 2, 2 months after embolization; single medication, n = 6, 10-20 months after SAC) or after discontinuation of antiplatelet therapy (n = 2, 14 months after embolization). Multivariate analysis showed that current smoking (p = 0.005) and maximum parent artery diameter >4.5mm (p = 0.003) were associated with DTE. SAC with the Enterprise stent poses a considerable risk of DTE. Our results suggest that a longer duration of antiplatelet therapy and clinical follow-up may be warranted for cases with suggested risk factors. The protocol for antiplatelet therapy after SAC should be determined in a large prospective trial. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Unruptured Intracranial Aneurysms with Oculomotor Nerve Palsy : Clinical Outcome between Surgical Clipping and Coil Embolization

    Science.gov (United States)

    Nam, Kyoung Hyup; Lee, Jae Il; Ko, Jun Gyeong; Lee, Tae Hong; Lee, Sang Weon

    2010-01-01

    Objective To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping. Methods A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP. Results Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient's gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping). Conclusion This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy. PMID:20856657

  4. CFD and PIV analysis of hemodynamics in a growing intracranial aneurysm.

    Science.gov (United States)

    Raschi, Marcelo; Mut, Fernando; Byrne, Greg; Putman, Christopher M; Tateshima, Satoshi; Viñuela, Fernando; Tanoue, Tetsuya; Tanishita, Kazuo; Cebral, Juan R

    2012-02-01

    Hemodynamics is thought to be a fundamental factor in the formation, progression, and rupture of cerebral aneurysms. Understanding these mechanisms is important to improve their rupture risk assessment and treatment. In this study, we analyze the blood flow field in a growing cerebral aneurysm using experimental particle image velocimetry (PIV) and computational fluid dynamics (CFD) techniques. Patient-specific models were constructed from longitudinal 3D computed tomography angiography images acquired at 1-y intervals. Physical silicone models were constructed from the computed tomography angiography images using rapid prototyping techniques, and pulsatile flow fields were measured with PIV. Corresponding CFD models were created and run under matching flow conditions. Both flow fields were aligned, interpolated, and compared qualitatively by inspection and quantitatively by defining similarity measures between the PIV and CFD vector fields. Results showed that both flow fields were in good agreement. Specifically, both techniques provided consistent representations of the main intra-aneurysmal flow structures and their change during the geometric evolution of the aneurysm. Despite differences observed mainly in the near wall region, and the inherent limitations of each technique, the information derived is consistent and can be used to study the role of hemodynamics in the natural history of intracranial aneurysms.

  5. Unruptured intracranial aneurysms and the Trial on Endovascular Aneurysm Management (TEAM): The principles behind the protocol.

    Science.gov (United States)

    Raymond, Jean; Roy, Daniel; Weill, Alain; Guilbert, François; Nguyen, Thanh; Molyneux, Andrew J.; Fox, Allan J.; Johnston, S. Claiborne; Collet, Jean-Paul; Rouleau, Isabelle

    2008-01-01

    Background With the widespread availability of non-invasive imaging of the brain in an aging population, we are increasingly confronted with the problem of the incidental discovery of unruptured aneurysms. The management of these patients remains controversial. Endovascular treatment can prevent rupture, but involves immediate risks. Furthermore, successful treatment does not eliminate all risk of rupture. The safety and efficacy of endovascular treatment of unruptured aneurysms remain undetermined. Hence the balance of the risks and benefits is uncertain. A randomized trial is needed to assess the potential benefits of endovascular management of unruptured aneurysms. The Trial: TEAM (Trial on Endovascular Aneurysm Management) is a randomized trial comparing endovascular treatment versus conservative management of unruptured aneurysms. TEAM aims to recruit 2002 patients in 60 centers throughout the world over a 3-year period and to follow all patients for 10 years. The primary outcome is to verify if the clinical outcome (morbidity/mortality (modified Rankin scale > 2) related to the aneurysm or its treatment) can be improved from 8% to 4%. The study is funded by the Canadian Institutes of Health Research. PMID:22518212

  6. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

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    Kwon, B.J.; Kim, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Han, M.H.; Chang, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Institute of Radiation Medicine, Seoul National University Medical Research Centre, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Seoul National University College of Medicine (Korea); Oh, C.W. [Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea)

    2003-08-01

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  7. CFD: computational fluid dynamics or confounding factor dissemination? The role of hemodynamics in intracranial aneurysm rupture risk assessment.

    Science.gov (United States)

    Xiang, J; Tutino, V M; Snyder, K V; Meng, H

    2014-10-01

    Image-based computational fluid dynamics holds a prominent position in the evaluation of intracranial aneurysms, especially as a promising tool to stratify rupture risk. Current computational fluid dynamics findings correlating both high and low wall shear stress with intracranial aneurysm growth and rupture puzzle researchers and clinicians alike. These conflicting findings may stem from inconsistent parameter definitions, small datasets, and intrinsic complexities in intracranial aneurysm growth and rupture. In Part 1 of this 2-part review, we proposed a unifying hypothesis: both high and low wall shear stress drive intracranial aneurysm growth and rupture through mural cell-mediated and inflammatory cell-mediated destructive remodeling pathways, respectively. In the present report, Part 2, we delineate different wall shear stress parameter definitions and survey recent computational fluid dynamics studies, in light of this mechanistic heterogeneity. In the future, we expect that larger datasets, better analyses, and increased understanding of hemodynamic-biologic mechanisms will lead to more accurate predictive models for intracranial aneurysm risk assessment from computational fluid dynamics. © 2014 by American Journal of Neuroradiology.

  8. Size ratio correlates with intracranial aneurysm rupture status: a prospective study.

    Science.gov (United States)

    Rahman, Maryam; Smietana, Janel; Hauck, Erik; Hoh, Brian; Hopkins, Nick; Siddiqui, Adnan; Levy, Elad I; Meng, Hui; Mocco, J

    2010-05-01

    The prediction of intracranial aneurysm (IA) rupture risk has generated significant controversy. The findings of the International Study of Unruptured Intracranial Aneurysms (ISUIA) that small anterior circulation aneurysms (IAs are small. These discrepancies have led to the search for better aneurysm parameters to predict rupture. We previously reported that size ratio (SR), IA size divided by parent vessel diameter, correlated strongly with IA rupture status (ruptured versus unruptured). These data were all collected retrospectively off 3-dimensional angiographic images. Therefore, we performed a blinded prospective collection and evaluation of SR data from 2-dimensional angiographic images for a consecutive series of patients with ruptured and unruptured IAs. We prospectively enrolled 40 consecutive patients presenting to a single institution with either ruptured IA or for first-time evaluation of an incidental IA. Blinded technologists acquired all measurements from 2-dimensional angiographic images. Aneurysm rupture status, location, IA maximum size, and parent vessel diameter were documented. The SR was calculated by dividing the aneurysm size (mm) by the average parent vessel size (mm). A 2-tailed Mann-Whitney test was performed to assess statistical significance between ruptured and unruptured groups. Fisher exact test was used to compare medical comorbidities between the ruptured and unruptured groups. Significant differences between the 2 groups were subsequently tested with logistic regression. SE and probability values are reported. Forty consecutive patients with 24 unruptured and 16 ruptured aneurysms met the inclusion criteria. No significant differences were found in age, gender, smoking status, or medical comorbidities between ruptured and unruptured groups. The average maximum size of the unruptured IAs (6.18 + or - 0.60 mm) was significantly smaller compared with the ruptured IAs (7.91 + or - 0.47 mm; P=0.03), and the unruptured group had

  9. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population; Klinische und radiologische Merkmale des intrakraniellen arteriellen Aneurysmas bei Kindern und Jugendlichen

    Energy Technology Data Exchange (ETDEWEB)

    Abruzzo, Todd A. [Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States). Dept. of Radiology; Aeron, Gunjan; Jones, Blaise V.

    2013-07-15

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  10. Exploring potential association between flow instability and rupture in patients with matched-pairs of ruptured-unruptured intracranial aneurysms.

    Science.gov (United States)

    Xu, Lijian; Gu, Lixu; Liu, Hao

    2016-12-28

    Patients with multiple intracranial aneurysms present a great challenge to the neurosurgeon, particularly when presenting with subarachnoid hemorrhage. Misjudgment may result in disastrous postoperative rebleeding from the untreated but true-ruptured lesion. In this study, computational fluid dynamic simulations of two matched-pairs of ruptured-unruptured cerebral aneurysms were performed to investigate the potential association between flow instability and aneurysm rupture. Two pairs of cerebral aneurysms from two patients were located in the middle cerebral artery and the anterior communicating artery respectively. Our results demonstrated highly disturbed states of the blood flows in the ruptured aneurysms of the two patients with multiple aneurysms, which are characterized by remarked velocity and wall shear stress (WSS) fluctuations at late systole. The ruptured aneurysms exhibit obviously temporal intra-cycle WSS fluctuations rather than the unruptured aneurysms of the same patient. Cycle-to-cycle fluctuations are further observed in the ruptured aneurysms when the flow turns to decelerate. The obvious differences observed between matched-pairs of ruptured-unruptured aneurysms imply that flow instability may be a potential source correlating to aneurysm rupture.

  11. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury.

    NARCIS (Netherlands)

    Biersteker, H.A.; Andriessen, T.M.J.C.; Horn, J.; Franschman, G.; Naalt, J. van der; Hoedemaekers, C.W.E.; Lingsma, H.F.; Haitsma, I.; Vos, P.E.

    2012-01-01

    OBJECTIVE: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  12. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    2012-01-01

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  13. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  14. Traumatic radial artery aneurysm at National Orthopaedic Hospital ...

    African Journals Online (AJOL)

    aneurysms within the period. All the three patients had excision of the aneurysms and reversed cephalic vein interposition graft. The outcomes were satisfactory. Keywords: radial artery aneurysm, vein graft. Nigerian Journal of Plastic Surgery Vol.

  15. Intracranial Aneurysms Involving Circle of Willis in a Child with Human Immunodeficiency Virus Associated Vasculitis- A Rare Case Report.

    Science.gov (United States)

    Lahoti, Amol Madanlal; Taori, Abhijit Kishor; Dhok, Avinash Parashuram; Rawat, Jitesh Subhash; Chandak, Nihar Umakant

    2017-07-01

    Intracranial Arterial Aneurysms (IAAs) are relatively rare in paediatric population and they account for at least 10%-15% of haemorrhagic strokes which occur during the first two decades of life. Here we present a unique and unusual case of Human Immunodeficiency Virus (HIV) infected child who presented with intracranial aneurysms with formation of collaterals and vasculopathy, demonstrating low viral count despite receiving adequate antiretroviral treatment. Intracranial vascular involvement, their complications and its incidence in these patients may become increasingly common as the management of human immunodeficiency virus infection continues to improve and afflicted patients survive for longer periods because of advancement in the antiretroviral treatment. Diagnosing aneurysm of cerebral circulation needs high degree of suspicion and correlation between clinical and radiological findings.

  16. Intracranial traumatic lesion risk factors in elderly patients with minor head injury

    International Nuclear Information System (INIS)

    Kochi, Masato; Hori, Shigeaki

    2011-01-01

    The authors conducted a retrospective analysis of the risk factors of intracranial traumatic lesions in elderly patients with minor head injury. Sixty-nine elderly patients with Glasgow Coma Scale (GCS) scores of 13-15 after head injury who had presented within 24 hours of trauma and admitted to hospital were included in this study. The indications for admission were a GCS score of 13 or 14 on presentation, loss of consciousness, retrograde or posttraumatic amnesia, local neurological deficit, severe headache and vomiting, dangerous mechanism of injury, skull fracture and abnormal CT findings. The relationship between the clinical findings and intracranial traumatic lesions was analized by univariate and multivariate analysis. The relationship between the clinical findings and surgical intervention was also analized by the same methods in those who had intracranial traumatic lesions. The mean and median age of patients were 81.1 and 83 years, respectively. Of 69 patients, 41 had intracranial traumatic lesions present on their CT scan. Of these, 6 needed surgical intervention. Multivariable logistic regression analysis showed that a Glasgow Coma Scale score of 13 and a loss of consciousness at injury were identified as independent risk factors of intracranial traumatic lesions in elderly patients with minor head injury and a dangerous mechanism of injury was identified as an independent risk factor of surgical intervention in those who had traumatic intracranial lesions. Our results offer useful information for evaluating patients with minor head injury in Japan's aging society. (author)

  17. 3D angiography in the evaluation of intracranial aneurysms before and after treatment. Initial experience

    International Nuclear Information System (INIS)

    Lauriola, Walter; Nardella, Michele; Strizzi, Vincenzo; Florio, Francesco; Cali, Alessandro; D'Angelo, Vincenzo

    2005-01-01

    Purpose: The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment. Materials and methods: Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D finding before and after the treatment were compared , and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass. Results: On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of the radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm. Conclusions: In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the

  18. Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury.

    Science.gov (United States)

    Güiza, Fabian; Depreitere, Bart; Piper, Ian; Citerio, Giuseppe; Chambers, Iain; Jones, Patricia A; Lo, Tsz-Yan Milly; Enblad, Per; Nillson, Pelle; Feyen, Bart; Jorens, Philippe; Maas, Andrew; Schuhmann, Martin U; Donald, Rob; Moss, Laura; Van den Berghe, Greet; Meyfroidt, Geert

    2015-06-01

    To assess the impact of the duration and intensity of episodes of increased intracranial pressure on 6-month neurological outcome in adult and paediatric traumatic brain injury. Analysis of prospectively collected minute-by-minute intracranial pressure and mean arterial blood pressure data of 261 adult and 99 paediatric traumatic brain injury patients from multiple European centres. The relationship of episodes of elevated intracranial pressure (defined as a pressure above a certain threshold during a certain time) with 6-month Glasgow Outcome Scale was visualized in a colour-coded plot. The colour-coded plot illustrates the intuitive concept that episodes of higher intracranial pressure can only be tolerated for shorter durations: the curve that delineates the duration and intensity of those intracranial pressure episodes associated with worse outcome is an approximately exponential decay curve. In children, the curve resembles that of adults, but the delineation between episodes associated with worse outcome occurs at lower intracranial pressure thresholds. Intracranial pressures above 20 mmHg lasting longer than 37 min in adults, and longer than 8 min in children, are associated with worse outcomes. In a multivariate model, together with known baseline risk factors for outcome in severe traumatic brain injury, the cumulative intracranial pressure-time burden is independently associated with mortality. When cerebrovascular autoregulation, assessed with the low-frequency autoregulation index, is impaired, the ability to tolerate elevated intracranial pressures is reduced. When the cerebral perfusion pressure is below 50 mmHg, all intracranial pressure insults, regardless of duration, are associated with worse outcome. The intracranial pressure-time burden associated with worse outcome is visualised in a colour-coded plot. In children, secondary injury occurs at lower intracranial pressure thresholds as compared to adults. Impaired cerebrovascular

  19. Mycotic Aneurysm of External Carotid Artery following Traumatic Brain Injury: Case Report and Review of Literature

    OpenAIRE

    Khalili, Hosseinali; Derakhshan, Nima; Malekmohammadi, Zahed; Ghaffarpasand, Fariborz

    2014-01-01

    Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydroceph...

  20. Hemodynamic effect of bypass geometry on intracranial aneurysm: A numerical investigation.

    Science.gov (United States)

    Kurşun, Burak; Uğur, Levent; Keskin, Gökhan

    2018-05-01

    Hemodynamic analyzes are used in the clinical investigation and treatment of cardiovascular diseases. In the present study, the effect of bypass geometry on intracranial aneurysm hemodynamics was investigated numerically. Pressure, wall shear stress (WSS) and velocity distribution causing the aneurysm to grow and rupture were investigated and the best conditions were tried to be determined in case of bypassing between basilar (BA) and left/right posterior arteries (LPCA/RPCA) for different values of parameters. The finite volume method was used for numerical solutions and calculations were performed with the ANSYS-Fluent software. The SIMPLE algorithm was used to solve the discretized conservation equations. Second Order Upwind method was preferred for finding intermediate point values in the computational domain. As the blood flow velocity changes with time, the blood viscosity value also changes. For this reason, the Carreu model was used in determining the viscosity depending on the velocity. Numerical study results showed that when bypassed, pressure and wall shear stresses reduced in the range of 40-70% in the aneurysm. Numerical results obtained are presented in graphs including the variation of pressure, wall shear stress and velocity streamlines in the aneurysm. Considering the numerical results for all parameter values, it is seen that the most important factors affecting the pressure and WSS values in bypassing are the bypass position on the basilar artery (L b ) and the diameter of the bypass vessel (d). Pressure and wall shear stress reduced in the range of 40-70% in the aneurysm in the case of bypass for all parameters. This demonstrates that pressure and WSS values can be greatly reduced in aneurysm treatment by bypassing in cases where clipping or coil embolization methods can not be applied. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Association of intracranial aneurysm rupture with smoking duration, intensity, and cessation.

    Science.gov (United States)

    Can, Anil; Castro, Victor M; Ozdemir, Yildirim H; Dagen, Sarajune; Yu, Sheng; Dligach, Dmitriy; Finan, Sean; Gainer, Vivian; Shadick, Nancy A; Murphy, Shawn; Cai, Tianxi; Savova, Guergana; Dammers, Ruben; Weiss, Scott T; Du, Rose

    2017-09-26

    Although smoking is a known risk factor for intracranial aneurysm (IA) rupture, the exact relationship between IA rupture and smoking intensity and duration, as well as duration of smoking cessation, remains unknown. In this case-control study, we analyzed 4,701 patients with 6,411 IAs diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We divided individuals into patients with ruptured aneurysms and controls with unruptured aneurysms. We performed univariable and multivariable logistic regression analyses to determine the association between smoking status and ruptured IAs at presentation. In a subgroup analysis among former and current smokers, we assessed the association between ruptured aneurysms and number of packs per day, duration of smoking, and duration since smoking cessation. In multivariable analysis, current (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.89-2.59) and former smoking status (OR 1.56, 95% CI 1.31-1.86) were associated with rupture status at presentation compared with never smokers. In a subgroup analysis among current and former smokers, years smoked (OR 1.02, 95% CI 1.01-1.03) and packs per day (OR 1.46, 95% CI 1.25-1.70) were significantly associated with ruptured aneurysms at presentation, whereas duration since cessation among former smokers was not significant (OR 1.00, 95% CI 0.99-1.02). Current cigarette smoking, smoking intensity, and smoking duration are significantly associated with ruptured IAs at presentation. However, the significantly increased risk persists after smoking cessation, and smoking cessation does not confer a reduced risk of aneurysmal subarachnoid hemorrhage beyond that of reducing the cumulative dose. © 2017 American Academy of Neurology.

  2. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models

    Directory of Open Access Journals (Sweden)

    Anderson Chun On Tsang

    2015-04-01

    Full Text Available Purpose: The aim of this study was to validate a computational fluid dynamics (CFD simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. Methods: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

  3. Fluid-Structure Simulations of a Ruptured Intracranial Aneurysm: Constant versus Patient-Specific Wall Thickness

    Directory of Open Access Journals (Sweden)

    S. Voß

    2016-01-01

    Full Text Available Computational Fluid Dynamics is intensively used to deepen the understanding of aneurysm growth and rupture in order to support physicians during therapy planning. However, numerous studies considering only the hemodynamics within the vessel lumen found no satisfactory criteria for rupture risk assessment. To improve available simulation models, the rigid vessel wall assumption has been discarded in this work and patient-specific wall thickness is considered within the simulation. For this purpose, a ruptured intracranial aneurysm was prepared ex vivo, followed by the acquisition of local wall thickness using μCT. The segmented inner and outer vessel surfaces served as solid domain for the fluid-structure interaction (FSI simulation. To compare wall stress distributions within the aneurysm wall and at the rupture site, FSI computations are repeated in a virtual model using a constant wall thickness approach. Although the wall stresses obtained by the two approaches—when averaged over the complete aneurysm sac—are in very good agreement, strong differences occur in their distribution. Accounting for the real wall thickness distribution, the rupture site exhibits much higher stress values compared to the configuration with constant wall thickness. The study reveals the importance of geometry reconstruction and accurate description of wall thickness in FSI simulations.

  4. State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms.

    Science.gov (United States)

    Balik, Vladimir; Yamada, Yasuhiro; Talari, Sandeep; Kei, Yamashiro; Sano, Hirotoshi; Suyama, Daisuke; Kawase, Tukasa; Takagi, Kiyoshi; Takizawa, Katsumi; Kato, Yoko

    2018-01-01

    Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.

  5. [Results of deconstructive endovascular surgery in treatment of large and giant intracranial aneurysms].

    Science.gov (United States)

    Arustamyan, S R; Yakovlev, S B; Shakhnovich, A R; Krasnoperov, I V; Sazonova, O B; Bocharov, A V; Bukharin, E Yu; Belousova, O B; Kaftanov, A N

    To clarify the indications for deconstructive endovascular surgery in patients with large and giant intracranial aneurysms and to evaluate short-term and long-term postoperative outcomes. The study was based on a retrospective analysis of the treatment results in 50 patients with large (15-25 mm) and giant (more than 25 mm) intracranial aneurysms, aged from 18 to 75 years, who were treated at the Burdenko Neurosurgical Institute in 2002-2014. The patients underwent a balloon occlusion test (BOT) in various modifications before stationary occlusion of the carrier artery. For vascular occlusion, we used detachable latex balloon catheters (33 cases) and microcoils (17 cases). The condition of patients in the pre- and postoperative period was assessed by using the modified Rankin Scale. There were no deaths due to occlusion of the internal carotid artery (37 patients). Postoperative complications occurred in 5 patients. On the basis of BOT, revascularization surgery involving placement of an extra-intracranial microanastomosis (EICMA) was performed in 6 cases. In more 4 cases, EICMA was placed in the early postoperative period due to developing signs of ischemia. Two of 7 patients underwent occlusion of both vertebral arteries (VAs) in the vertebrobasilar basin, which led to fatal outcomes. One more patient died of aggravation of brainstem compression after VA occlusion. There was no worsening of neurological symptoms among survivors. There were no deaths and persistent neurological disorders upon occlusion of branches of the main cerebral arteries, starting with the first order arteries (6 patients). Thirty one patients (66%) were followed-up in the period from 1 to 104 months. There were no deaths associated with artery occlusion. Two patients experienced delayed ischemic disorders. Occlusion of the carrier artery should be performed in a carefully selected group of BOT-negative patients. This surgery can be indicated for aneurysms with a complicated configuration

  6. China's growing contribution to global intracranial aneurysm research (1991-2012: a bibliometric study.

    Directory of Open Access Journals (Sweden)

    Ze-jun Jia

    Full Text Available BACKGROUND: We sought to analyze the growing worldwide trends of intracranial aneurysm research, investigate China's recent contribution, and compare the contributions of mainland China, Taiwan, and Hong Kong. METHODS: Global and China intracranial aneurysm-related publications were retrieved from the Web of Science database from 1991 to 2012. Excel 2007, Matlab, and Thomson Data Analyzer (TDA software were used to analyze the search results for number of publications, cited frequency, h-index, and organization contributions. RESULTS: 16468 global papers were identified that were cited 273500 times until 2013-08-15. The United States accounted for 31.497% of the articles, 58.64% of the citations, and the highest h-index (127. Japan and Germany followed in frequency. China's articles ranked eighth (third in 2012 in total number, with most of the contributions occurring since 2002 (91.33%. China was at the early stage of the logic growth curve (exponential growth, with the citation frequency and h-index per year increasing. The quality of the publications was low. The main research centers were located in Beijing, Shanghai, Taiwan, and Hong Kong. The main Asian funding body was the National Natural Science Foundation of China. The number of publications and frequency of citations of papers from mainland China was greater than that of Taiwan or Hong Kong. CONCLUSION: Global intracranial aneurysm research has been developing swiftly since 1991, with the United States making the largest contribution. Research in China started later, in 2002. Since then, China has increased its rate of publication, and became the third largest contributor by 2012.

  7. MR-DWI-positive lesions and symptomatic ischemic complications after coiling of unruptured intracranial aneurysms.

    Science.gov (United States)

    Kang, Dong-Hun; Kim, Byung Moon; Kim, Dong Joon; Suh, Sang Hyun; Kim, Dong Ik; Kim, Yong-Sun; Huh, Seung Kon; Park, Jaechan; Lee, Jae Whan; Kim, Yong Bae

    2013-03-01

    The aims of this study are to evaluate the risk factors for symptomatic ischemic complication (symptomatic ischemic complication [SIC], transient ischemic attack, or stroke) and microembolisms detected as MR diffusion-weighted imaging (MR-DWI)-positive (DWI(+)) lesions, and the relationship between DWI(+) and SIC after coiling of unruptured intracranial aneurysm. Between March 2009 and November 2011, 382 unruptured intracranial aneurysms in 343 patients underwent both coiling and posttreatment MR-DWI. The incidence of and risk factors for SIC and DWI(+), and the relationship between DWI(+) and SIC were retrospectively analyzed. The incidence of SIC was 4.1%. The incidence of DWI(+) was 54.5%. The number of DWI(+) lesions was significantly larger in the SIC group, than in the asymptomatic one (12.1±10.4 versus 5.0±8.7, P<0.00). The cutoff value of DWI(+) for predicting SIC was ≥6 (sensitivity 85.7%, specificity 70.7%). The patients with DWI(+) ≥6 was 28.6%. Of the patients with SIC, the patients with DWI(+) ≥6 was 78.6%. Patients aged≥65 years had a trend for SIC, and it was the only independent risk factor for DWI(+) ≥cutoff (n=6; 95%CI, 1.167-3.083). The number of DWI(+) lesions was significantly larger in the SIC group than in the asymptomatic one after coiling of unruptured intracranial aneurysm. Patients aged≥65 had a trend for SIC, and it was the only independent risk factor for the number of DWI(+) ≥cutoff value (n=6) for predicting SIC.

  8. Endovascular treatment of intracranial aneurysms with the p64 flow diverter stent: mid-term results in 35 patients with 41 intracranial aneurysms.

    Science.gov (United States)

    Morais, Ricardo; Mine, Benjamin; Bruyère, Pierre Julien; Naeije, Gilles; Lubicz, Boris

    2017-03-01

    The p64 flow diverter (FD) device is a fully resheathable and detachable stent dedicated for endovascular treatment (EVT) of intracranial aneurysms (IAs). We report our mid-term experience with this device. Between January 2015 and February 2016, we retrospectively identified, in our prospectively maintained database, all patients treated with p64 FDs in two institutions. Independent clinical follow-up was performed by a vascular neurologist. Imaging follow-up included a digitalized subtraction angiography (DSA) at 3, 6, and 12 months and a magnetic resonance angiography (MRA) at 12 months. Thirty-nine patients (22 women/17 men; median age 54 years) with 48 IAs (median aneurysm size 6.2 mm; mean neck size 3.4 mm) were identified. All IAs were saccular and unruptured. Failure of safe stent delivery occurred in 15% of cases (7/48 IAs) which were excluded. Transient neurological morbidity occurred in 2/35 patients (5.7%) including one delayed thromboembolic complication. No permanent morbidity or mortality was encountered. Complete aneurysmal occlusion at 3, 6, and 12 months was 20/30 (66.6%), 18/27 (66.6%), and 24/28 (85.7%), respectively. Intra-stent stenosis was observed in 9/29 patients (31%) and classified as moderate in 4/29 (13.7%) and mild in 5/29 patients (17.2%). These stenoses gradually improved over time, with only mild stenoses being identified at 6 months and at 12 months. In our small case series, the p64 FD stent appears safe and effective for EVT of IAs. A high occlusion rate and a low morbidity rate were observed.

  9. Patient characteristics support unfavorable psychiatric outcome after treatment of unruptured intracranial aneurysms.

    Science.gov (United States)

    Wenz, H; Wenz, R; Ehrlich, G; Groden, C; Schmieder, K; Fontana, J

    2015-07-01

    Previous studies demonstrated an unfavorable psychological outcome after treatment of unruptured intracranial aneurysms despite an objectively favorable clinical and radiological outcome. The current study was therefore designed to analyze the psychiatric vulnerability of this specific patient collective. Patients treated for a WHO grade I meningioma and incidental intracranial aneurysms in two German neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm after more than 12 months and focal neurological deficits, among others. Seventy-five meningioma patients (M) and 56 incidental aneurysm patients (iA) met the inclusion criteria. The past medical psychiatric history, post-morbid personality characters and coping strategies were determined by questionnaires mailed to the patients in a printed version (Brief COPE, Big Five Personality Test). Fifty-eight M and 45 iA patients returned the questionnaires. Patients with iA demonstrated significantly higher pre-interventional rates of depressive episodes (p = 0.002) and psychological supervision (p = 0.038). These findings were especially aggravated in iA patients who received their cranial imaging for unspecific symptoms such as dizziness, headaches or tinnitus (n = 33, history of depressions: 39.4%; previous psychological supervision: 33.3%). Furthermore, the analysis of the Big Five personality traits revealed remarkably elevated neuroticism scores in the iA collective. The current study demonstrates an increased rate of positive pre-interventional psychiatric histories in the iA collective. Although those patients represent only a small subgroup, they still may play an important role concerning the overall outcome after iA treatment. Early detection and psychological support in this subgroup might help to improve the overall outcome. Further studies are needed to evaluate the influence of this new aspect on

  10. Risk factors for all-cause death after diagnosis of unruptured intracranial aneurysms.

    Science.gov (United States)

    Juvela, Seppo; Lehto, Hanna

    2015-02-03

    We investigated all-cause mortality and risk factors of death of patients with unruptured intracranial aneurysms (UIAs) in a long-term follow-up study. A total of 142 patients with 181 UIAs diagnosed between 1956 and 1978 when UIAs were not treated were included in this study. Patients were followed until death or until 2011 to 2012. Mortality rates and risk factors were studied with Kaplan-Meier survival analysis and the Cox proportional hazards regression models. During 3,530 person-years, 113 (80%) had died, giving an average annual mortality of 3.2%. Of them, 19 (17%) died of aneurysm rupture from the index UIA, 6 (5%) of other aneurysm-related causes, and 2 (2%) of unspecified subarachnoid hemorrhage. The remaining 86 died of causes unrelated to intracranial aneurysms. The cumulative death rate was 20% (95% confidence interval 14%-27%) at 10 years and 60% (52%-68%) at 30 years. Independent risk factors for subsequent death were patient age (adjusted hazard ratio 1.09 per year, 95% confidence interval 1.05-1.12, p < 0.001), male sex (2.81, 1.59-4.96, p < 0.001), heavy alcohol use (4.22, 2.22-8.02, p < 0.001), and cigarette smoking (1.72, 0.97-3.07, p = 0.064). History of hypertension, family history of subarachnoid hemorrhage, and diameter of UIA predicted death only in univariable analysis. In patients of working age with a UIA, alcohol consumption and cigarette smoking are modifiable risk factors for untimely death through several causes and should be taken into account when treatment is considered. © 2015 American Academy of Neurology.

  11. Usefulness of virtual endoscopy for evaluating the relationship between the neck of intracranial aneurysm and surrounding vessels

    International Nuclear Information System (INIS)

    Ikeda, Jota; Horie, Hitoshi; Ishikura, Reiichi; Ando, Kumiko; Morikawa, Tsutomu; Tominaga, Satoru; Nakao, Norio

    2000-01-01

    Application of three-dimensional CT virtual endoscopy for evaluation of the neck and surrounding vessels of intracranial aneurysms. 3D-CT virtual endoscopy (VE) is a reconstructed image using computer processing of 3D-CT images. We evaluated the usefulness of a virtual endoscopy to analyze the relationship between the neck of an intracranial aneurysm and the surrounding vessels. Eight cases with intracranial aneurysms underwent digital subtraction angiography (DSA) and enhanced CT with transarterial infusion of contrast media. 3D-CT angiogram (3D-CTA) and virtual endoscopic images were obtained from the CT image data sets using surface rendering method. The relationship between the neck of an intracranial aneurysm and the surrounding vessels was confirmed by operation or IVR. VE clearly visualized the neck and surrounding vessels in all cases. Operation/IVR findings agreed with the virtual endoscopic findings in all cases, but not with the DSA or 3D-CTA findings in 4 and 2 cases, respectively. 3D-CTA and virtual endoscopy clearly visualizes the relationship between cerebral aneurysms and surrounding vessels, which is useful for determining IVR procedures. (author)

  12. Type A interrupted aortic arch accompanied by intracranial aneurysms causing subarachnoid hemorrhage in an adult man.

    Science.gov (United States)

    Eren, Suat; Kantarci, Mecit; Pirimoglu, Berhan; Cakir, Murteza; Ogul, Hayri

    2014-01-01

    Interrupted aortic arch anomaly (IAA) characterized by complete luminal dissociation between the ascending and descending aorta and accounting for less than 1% of all cases of congenital heart disease. IAA is a rare condition in infants that occurs approximately three times per million births. It is usually diagnosed and repaired during the neonatal period and is extremely rare in adults. We present the case of an adult man who was diagnosed with IAA accompanied by intracranial aneurysms causing subarachnoid hemorrhage and demonstrate the imaging findings with 256-slice computed tomography angiography and digital subtraction angiography. Copyright © 2014. Published by Elsevier Inc.

  13. Shared decision-making in the context of unruptured intracranial aneurysms management

    Directory of Open Access Journals (Sweden)

    Luís Henrique de Castro-Afonso

    2015-09-01

    Full Text Available Shared decision-making practice has been encouraged in several clinical settings. In this model, clinical decisions are defined by doctors and patients based on the principle of patient autonomy. Shared decisions have been argued as an ethical clinical practice during complex and uncertain clinical situations. The best management of unruptured intracranial aneurysms (UIA remains controversial. Despite the fact that shared decisions has probably been practiced, as far as we are aware it has not yet been evaluated, nor has it been standardized for patients presenting UIA. We aim to discuss possible roles, pros and cons of shared decision-making on the management of UIA.

  14. Shared decision-making in the context of unruptured intracranial aneurysms management.

    Science.gov (United States)

    Castro-Afonso, Luís Henrique de; Abud, Daniel Giansante

    2015-09-01

    Shared decision-making practice has been encouraged in several clinical settings. In this model, clinical decisions are defined by doctors and patients based on the principle of patient autonomy. Shared decisions have been argued as an ethical clinical practice during complex and uncertain clinical situations. The best management of unruptured intracranial aneurysms (UIA) remains controversial. Despite the fact that shared decisions has probably been practiced, as far as we are aware it has not yet been evaluated, nor has it been standardized for patients presenting UIA. We aim to discuss possible roles, pros and cons of shared decision-making on the management of UIA.

  15. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report

    OpenAIRE

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2016-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on ...

  16. The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms.

    Science.gov (United States)

    Reynolds, Matthew R; Buckley, Robert T; Indrakanti, Santoshi S; Turkmani, Ali H; Oh, Gerald; Crobeddu, Emanuela; Fargen, Kyle M; El Ahmadieh, Tarek Y; Naidech, Andrew M; Amin-Hanjani, Sepideh; Lanzino, Giuseppe; Hoh, Brian L; Bendok, Bernard R; Zipfel, Gregory J

    2015-10-01

    Vasopressor-induced hypertension (VIH) is an established treatment for patients with aneurysmal subarachnoid hemorrhage (SAH) who develop vasospasm and delayed cerebral ischemia (DCI). However, the safety of VIH in patients with coincident, unruptured, unprotected intracranial aneurysms is uncertain. This retrospective multiinstitutional study identified 1) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who required VIH therapy (VIH group), and 2) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who did not require VIH therapy (non-VIH group). All patients had previously undergone surgical or endovascular treatment for the presumed ruptured aneurysm. Comparisons between the VIH and non-VIH patients were made in terms of the patient characteristics, clinical and radiographic severity of SAH, total number of aneurysms, number of ruptured/unruptured aneurysms, aneurysm location/size, number of unruptured and unprotected aneurysms during VIH, severity of vasospasm, degree of hypervolemia, and degree and duration of VIH therapy. For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients

  17. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

    Science.gov (United States)

    Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

    2016-07-01

    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea.

    Science.gov (United States)

    Kim, Myungsoo; Park, Jaechan; Lee, Joomi

    2015-06-01

    A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments. This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined. When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [mean±standard deviation (SD) : ₩8,280,000±1,490,000] resulted in significantly lower total hospital costs than endovascular treatment (mean±SD : ₩11,700,000±3,050,000, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (₩)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter. In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.

  19. Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping.

    Science.gov (United States)

    Frontera, Jennifer A; Moatti, Joseph; de los Reyes, Kenneth M; McCullough, Stephen; Moyle, Henry; Bederson, Joshua B; Patel, Aman

    2014-01-01

    Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported. A retrospective study was conducted of patients undergoing SAC, coiling or clipping of unruptured intracranial aneurysms between 2003 and 2010. Rates of residual aneurysm, recanalization, complications, cost (adjusted to 2010), length of stay (LOS) and outcome were compared between groups. Of 116 subjects, 47 underwent SAC, 33 coiling and 36 clipping. The groups were similar in age, gender and aneurysm location, although the SAC group had significantly larger aneurysms with wider necks (p=0.001). Patients who underwent SAC had more residual aneurysm after initial treatment than those treated with coiling or clipping (75%, 52% and 19%, respectively, p<0.0001), but this difference was smaller at follow-up angiography (50%, 50% and 17% residual, respectively) and was not significant after adjusting for baseline aneurysm and neck size. SAC was not associated with increased recanalization, requirement for additional treatment, mortality or complications after adjusting for aneurysm and neck size. Patients who underwent SAC and those who underwent coiling were more likely to have a good discharge disposition than patients treated with clipping (100% vs 91%, p=0.042). LOS was significantly shorter for patients who underwent SAC or coiling compared with those treated with clipping (p<0.0001). The overall direct cost was higher for patients who underwent SAC than for those treated with coiling or clipping (median $22 544 vs $12 933 vs $14 656, p=0.001), even after adjusting for aneurysm and neck size, LOS and retreatment. SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.

  20. A Review of the Genetics of Intracranial Berry Aneurysms and Implications for Genetic Counseling.

    Science.gov (United States)

    Hitchcock, Emma; Gibson, William T

    2017-02-01

    Here we review the current understanding of the genetic architecture of intracranial berry aneurysms (IBA) to aid in the genetic counseling of patients at risk for this condition. The familial subtype of IBA, familial intracranial aneurysms (FIA), is associated with increased frequency of IBA, increased risk of rupture, and increased morbidity and mortality after rupture. Family history is the strongest predictor for the development of IBA. However, a genetic test is not yet available to assess risk within a family. Studies using linkage analysis, genome-wide association, and next-generation sequencing have found several candidate loci and genes associated with disease onset, but have not conclusively implicated a single gene. In addition to family history, a separate or concurrent diagnosis of autosomal dominant polycystic kidney disease is a strong genetic risk factor for IBA formation. We also discuss the relative risk for developing IBA in several Mendelian syndromes including vascular Ehlers-Danlos syndrome, Marfan syndrome, Neurofibromatosis Type I, and Loeys-Dietz syndrome.

  1. Paradoxical Increase in Mortality and Rupture of Intracranial Aneurysms in Microsomal Prostaglandin E2 Synthase Type 1-Deficient Mice: Attenuation by Aspirin.

    Science.gov (United States)

    Peña Silva, Ricardo A; Mitchell, Ian J; Kung, David K; Pewe, Lecia L; Granja, Manuel F; Harty, John T; Faraci, Frank M; Heistad, Donald D; Hasan, David M

    2015-10-01

    Inflammation plays an important role in formation and rupture of intracranial aneurysms. Expression of microsomal prostaglandin E2 (PGE2) synthase type 1 (mPGES-1) is increased in the wall of intracranial aneurysms in humans. PGE2, a by-product of mPGES-1, is associated with inflammation and cerebrovascular dysfunction. To test the hypothesis that deletion of mPGES-1 decreases the formation and rupture of intracranial aneurysms in a murine model. Intracranial aneurysms were induced in wild-type and mPGES-1 knockout (mPGES-1 KO) mice by using a combination of deoxycorticosterone acetate-salt-induced hypertension and intracranial injection of elastase in the basal cistern. Prevalence of aneurysms, subarachnoid hemorrhage, and mortality were assessed. We also tested the effects of administration of aspirin (6 mg/kg/d) by gavage and PGE2 (1 mg/kg/d) by subcutaneous infusion. Systolic blood pressure and prevalence of aneurysm were similar in wild-type and mPGES-1 KO mice. However, mortality and the prevalence of subarachnoid hemorrhage were markedly increased in mPGES-1 KO mice (P increase rupture of intracranial aneurysms. Aspirin, but not PGE2, attenuated the increased mortality in mPGES-1 KO mice (P increase in rupture of cerebral aneurysms and mortality, which are attenuated by low-dose aspirin.

  2. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI

    International Nuclear Information System (INIS)

    Isoda, Haruo; Takeda, Hiroyasu; Yamashita, Shuhei; Takehara, Yasuo; Sakahara, Harumi; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Hiramatsu, Hisaya; Namba, Hiroki; Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J.

    2010-01-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall. (orig.)

  3. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI.

    Science.gov (United States)

    Isoda, Haruo; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Takeda, Hiroyasu; Hiramatsu, Hisaya; Yamashita, Shuhei; Takehara, Yasuo; Alley, Marcus T; Bammer, Roland; Pelc, Norbert J; Namba, Hiroki; Sakahara, Harumi

    2010-10-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall.

  4. Complexity of intracranial pressure correlates with outcome after traumatic brain injury

    Science.gov (United States)

    Lu, Cheng-Wei; Czosnyka, Marek; Shieh, Jiann-Shing; Smielewska, Anna; Pickard, John D.

    2012-01-01

    This study applied multiscale entropy analysis to investigate the correlation between the complexity of intracranial pressure waveform and outcome after traumatic brain injury. Intracranial pressure and arterial blood pressure waveforms were low-pass filtered to remove the respiratory and pulse components and then processed using a multiscale entropy algorithm to produce a complexity index. We identified significant differences across groups classified by the Glasgow Outcome Scale in intracranial pressure, pressure-reactivity index and complexity index of intracranial pressure (P intracranial pressure achieved the strongest statistical significance (F = 28.7; P intracranial pressure assessed by multiscale entropy was significantly associated with outcome in patients with brain injury. PMID:22734128

  5. Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography: a prospective comparison of volume-rendered images and digital subtraction angiography.

    Science.gov (United States)

    Yoon, D Y; Lim, K J; Choi, C S; Cho, B M; Oh, S M; Chang, S K

    2007-01-01

    The aim of our study was to compare multidetector row CT angiography (MDCTA) with digital subtraction angiography (DSA) in the detection and characterization of intracranial aneurysms. In our blinded prospective study, 85 patients with suspected intracranial aneurysm (47 women, 38 men; age range, 19-83 years) underwent both 16-channel MDCTA and DSA. The MDCT angiograms were interpreted for the presence, location, size, ratio of the neck to the dome (N/D ratio), and lobularity of the aneurysms and relationship of the aneurysm with the adjacent arterial branches, by using volume-rendering techniques. MDCTA and DSA images (reference standard) were interpreted by 2 independent readers, and the results were compared. A total of 93 aneurysms were detected at DSA in 71 patients, whereas no aneurysms were detected in 14 patients. Compared with DSA, the overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 92.5%, 93.3%, and 92.6%, respectively, for both independent readers. For aneurysms of <3 mm, however, MDCTA had a sensitivity of 74.1% for reader 1 and 77.8% for reader 2. There was excellent agreement between readers in the detection of aneurysms (kappa = 0.822). In addition, MDCTA was also accurate in determining N/D ratio of aneurysms, aneurysm lobularity, and adjacent arterial branches. MDCTA is accurate in the detection and characterization of intracranial aneurysms and can be used as a reliable alternative imaging technique to DSA in selected cases.

  6. Endovascular treatment for intracranial infectious aneurysms Tratamento endovascular de aneurismas infecciosos intracranianos

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2008-12-01

    Full Text Available OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5. Two patients died (GOS 1/5, one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.OBJETIVO: Enfatizar o método endovascular como uma opção de tratamento alternativa e menos agressiva no tratamento de aneurismas infecciosos intracranianos. MÉTODO: Apresentamos uma série de cinco pacientes com endocardite infecciosa e aneurismas infecciosos intra-cranianos (aneurismas micóticos tratados através da via endovascular. RESULTADOS: O tratamento endovascular teve sucesso técnico e sem intercorrências relacionadas ao cateterismo em todos os casos. Três pacientes tiveram desfecho clínico favorável: dois com escala de regeneração de Glasgow 4/5 e um com recuperação neurológica completa (GOS 5/5. Dois pacientes tiveram desfecho desfavorável (GOS 1/5, um devido às conseqüências do sangramento intracraniano inicial e outro devido a complicações cardíacas da endocardite e cirurgia de troca valvar. CONCLUSÃO: As técnicas endovasculares são uma nova opção de tratamento dos aneurismas infecciosos intracranianos. Ela é especialmente

  7. The Siesta Habit is Associated with a Decreased Risk of Rupture of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Huibin Kang

    2017-09-01

    Full Text Available BackgroundPrevious studies have examined an association between the siesta habit and hypertension, as well as coronary heart disease. However, the relationship between a siesta and the risk of rupture of an intracranial aneurysm (IA has not yet been established. We aimed to investigate the effects of a siesta on the risk of rupture of IAs.MethodsWe prospectively enrolled consecutive patients diagnosed with IAs at our hospital between January 2016 and December 2016. Univariate and multivariate logistic regression analysis were performed to identify independent risk factors associated with IA rupture.ResultsWe studied 581 consecutive patients with 514 unruptured and 120 ruptured aneurysms. Univariate analysis demonstrated that hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, location, size, as well as shape and aspect ratio were associated with the risk of rupture of IAs. Multivariate analysis identified hypertension [odds ratio (OR 1.68, 95% confidence interval (CI 1.03–2.73], hyperlipidemia (OR 0.25, 95% CI 0.08–0.72, current cigarette smoking ≥20 cigarettes/day (d (OR 3.48, 95% CI 1.63–7.47, siesta (siesta time <1 h, OR 0.49, 95% CI 0.24–0.98 and siesta time ≥1 h, OR 0.32, 95% CI 0.19–0.57, location of largest aneurysm on the anterior communicating and internal carotid-posterior communicating artery (PCOM (anterior communicating artery OR 16.27, 95% CI 7.40–35.79 and PCOM OR 11.21, 95% CI 5.15–24.43, and size of aneurysm ≥7 mm (OR 2.19, 95% CI 1.21–3.97 as independent strong risk factors associated with risk of aneurysm rupture.ConclusionIn the present study, we found that a habitual siesta is a new predictive factor to assess the risk of rupture of an IA. We found the siesta habit may reduce the risk of aneurysm rupture. We also found that hypertension, hyperlipidemia, cigarette smoking, location, and size of aneurysm were associated with the risk of rupture of IAs.

  8. Detection of unruptured familial intracranial aneurysms by intravenous digital subtraction angiography

    International Nuclear Information System (INIS)

    Berg, H.W.M. ter; Regional Hospital Almelo; Overtoom, T.M.D.; Ludwig, J.W.; Bijlsma, J.B.; Tulleken, C.A.F.; Willemse, J.

    1987-01-01

    The authors discuss the detection of intracranial aneurysms (IA) by means of intravenous digital angiography (ivDSA) in (a)symptomatic first degree relatives of families in which more than two or more individuals have IA. ivDSA is an almost noninvasive and low-risk diagnostic procedure. Screening, by means of ivDSA, of two affected families is described. In family I which includes 7 members with proven IA, ivDSA has been carried out in 36 asymptomatic individuals: in one, a 6x15 mm aneurysm was found at the left posterior communicating artery (PCoA). In family II, including one member with a proven IA and another with a subarachnoidal hemorrhage, ivDSA has been carried out in 4 members: one aneurysm with a diameter of 6 mm was found at the left PCoA. Conventional cerebral angiography (CCA) confirmed both IA's. Neurosurgical treatment followed. The advantages and disadvantages of ivDSA vs. CCA as elective screening procedure in such cases are discussed. Screening of asymptomatic first degree relatives of cases with familial IA by means of ivDSA is strongly advocated. (orig.)

  9. Results of Endovascular Coil Embolization Treatment for Small (≤ 5 mm) Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Lee, Siwoo; Gong, Tae-Sik; Lee, Yong-Woo; Kim, Hyo-Joon; Kweon, Chang-Young

    2016-09-01

    Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs.

  10. Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling

    NARCIS (Netherlands)

    Westerlaan, H. E.; Gravendeel, J.; Fiore, D.; Metzemaekers, J. D. M.; Groen, R. J. M.; Mooij, J. J. A.; Oudkerk, M.

    2007-01-01

    Introduction We sought to establish whether CT angiography (CTA) can be applied to the planning and performance of clipping or coiling in ruptured intracranial aneurysms without recourse to intraarterial digital subtraction angiography (IA-DSA). Methods Over the period April 2003 to January 2006 in

  11. Intracranial Aneurysm-Associated Single-Nucleotide Polymorphisms Alter Regulatory DNA in the Human Circle of Willis

    NARCIS (Netherlands)

    Laarman, Melanie D; Vermunt, Marit W; Kleinloog, Rachel; de Boer-Bergsma, Jelkje J; Huitinga, I.; Rinkel, Gabriël J E; Creyghton, Menno P; Mokry, Michal; Bakkers, Jeroen; Ruigrok, Ynte M

    BACKGROUND AND PURPOSE: Genome-wide association studies significantly link intracranial aneurysm (IA) to single-nucleotide polymorphisms (SNPs) in 6 genomic loci. To gain insight into the relevance of these IA-associated SNPs, we aimed to identify regulatory regions and analyze overall gene

  12. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes.

    Science.gov (United States)

    Mahaney, Kelly B; Todd, Michael M; Bayman, Emine O; Torner, James C

    2012-06-01

    Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, even among patients who reach medical attention in good neurological condition. Many patients have neurological decline in the perioperative period, which contributes to long-term outcomes. The focus of this study is to characterize the incidence of, characteristics predictive of, and outcomes associated with acute postoperative neurological deterioration in patients undergoing surgery for ruptured intracranial aneurysm. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) was a multicenter randomized clinical trial that enrolled 1001 patients and assesssed the efficacy of hypothermia as neuroprotection during surgery to secure a ruptured intracranial aneurysm. All patients had a radiographically confirmed SAH, were classified as World Federation of Neurosurgical Societies (WFNS) Grade I-III immediately prior to surgery, and underwent surgery to secure the ruptured aneurysm within 14 days of SAH. Neurological assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed preoperatively, at 24 and 72 hours postoperatively, and at time of discharge. The primary outcome variable was a dichotomized scoring based on an IHAST version of the Glasgow Outcome Scale (GOS) in which a score of 1 represents a good outcome and a score > 1 a poor outcome, as assessed at 90-days' follow-up. Data from IHAST were analyzed for occurrence of a postoperative neurological deterioration. Preoperative and intraoperative variables were assessed for associations with occurrence of postoperative neurological deterioration. Differences in baseline, intraoperative, and postoperative variables and in outcomes between patients with and without postoperative neurological deterioration were compared with Fisher exact tests. The Wilcoxon rank-sum test was used to compare variables reported as means. Multiple logistic regression was used to adjust for covariates associated with occurrence

  13. The Preinterventional Psychiatric History as a Major Predictor for a Reduced Quality of Life After Treatment of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Fontana, Johann; Wenz, Ralf; Groden, Christoph; Schmieder, Kirsten; Wenz, Holger

    2015-11-01

    A significantly increased rate of positive preinterventional psychiatric histories in the unruptured aneurysm collective was demonstrated previously. The current study was designed to analyze the influence of the preinterventional psychiatric status on the outcome after treatment of unruptured intracranial aneurysms. Patients treated due to meningioma World Health Organization °I and unruptured intracranial aneurysms in 2 German neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm, and neurologic deficits among others. The preinterventional psychiatric histories and the rates of postinterventional headaches, sleeping disorders, symptoms of chronic fatigue syndrome, and quality of life (QOL) were determined by questionnaires that were mailed to the patients in a printed version. A total of 58 M patients and 45 iA patients who met the inclusion criteria returned the questionnaires; 10 M (17.2%) and 17 iA patients (37.8%) had a positive psychiatric history. The overall Incidental aneurysm collective demonstrated significantly lower overall QOL scores (P = 0.003) and significant greater rates of chronic fatigue syndrome (P = 0.009) compared with the M collective. After we excluded all patients with positive pre-interventional psychiatric histories, those differences were no longer reproducible. Subjectively, the patients did not realize any significant changes in their QOL after successful aneurysm treatment. The results of the current study demonstrate the importance of taking the preinterventional psychiatric history into considerations when evaluating the outcome after unruptured aneurysm treatment. The unfavorable outcome of the aneurysm group seems to be caused by factors that are not related the aneurysm diagnosis or treatment itself. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Use of a Polytetrafluoroethylene-Coated Vascular Plug for Focal Intracranial Parent Vessel Sacrifice for Fusiform Aneurysm Treatment.

    Science.gov (United States)

    Carlson, Andrew P; Abbas, Mohammad; Hall, Patricia; Taylor, Christopher

    2017-10-01

    Fusiform intracranial aneurysms are challenging due to the circumferential nature of the disease. Endovascular parent vessel sacrifice with coils may be a treatment option, but typically requires a long vessel segment to induce complete cessation of flow.   We evaluate early clinical experience with the intracranial use of the microvascular plug (MVP; Medtronic, Dublin, Ireland) device and to compare to previous coil-only techniques for vertebral artery sacrifice for fusiform vertebral aneurysm. We reviewed patients treated with the MVP for intracranial aneurysms at our institution. As a case-control study, we located 6 control patients who underwent coiling alone for vertebral artery sacrifice. The number of implants, fluoroscopy time, and procedural charges were compared using unpaired t -tests. Twelve patients underwent vessel sacrifices with MVP. Eight were for vertebral artery dissecting aneurysms. Comparing only vertebral aneurysms, the mean implants was 7 in the MVP group (n = 8) and 19.5 in the coiling group (n = 6; P = .0015). Mean fluoroscopy time was 17.62 min in the MVP group compared to 24.2 min in the coiling group ( P = .07). Procedural costs were less in the MVP group ($19 667.38) compared to coiling ($44 909.50, P = .05). There were no technical failures and no cases with persistent flow in the parent vessel at the end of the procedure. The MVP is a cost-effective device for focal intracranial vessel occlusion in select patients. This is an important tool for cerebrovascular surgeons, particularly in cases of ruptured dissecting vertebral aneurysms. Copyright © 2017 by the Congress of Neurological Surgeons

  15. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms

    International Nuclear Information System (INIS)

    Lubicz, Boris; Bandeira, Alexandra; Baleriaux, Danielle; Bruneau, Michael; Witte, Olivier de; Dewindt, Aloys

    2009-01-01

    Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC. A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed. Thirty-two patients with 34 IA were identified including 25 asymptomatic patients, four with cranial nerve palsies, two with a subarachnoid hemorrhage, and one with transient ischemic attacks. Mean aneurysm size was 10.2 mm (range 3.5 to 26 mm). Embolization was successful in all patients and no procedure-related neurological morbidity or mortality was observed. Immediate anatomical results included nine complete occlusions (26.5%), two neck remnants (6%), and 23 incomplete occlusions (67.5%). Mean imaging follow-up of 20 months showed 18 further thrombosis (53%) and 16 stable results (47%). Finally, 27 aneurysms were completely occluded (79%), three had a neck remnant (9%), and four were incompletely occluded (12%). Asymptomatic and nonsignificant in-stent stenosis occurred in seven patients (22%). SAC is safe and effective for the treatment of wide-necked IA. Despite unsatisfying immediate aneurysm occlusion, the adjunctive effect of the stent is stabilizing or significantly improving long-term anatomical results. (orig.)

  16. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    Science.gov (United States)

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.

    Science.gov (United States)

    Dixon, Rebecca R; Nocera, Maryalice; Zolotor, Adam J; Keenan, Heather T

    2016-11-01

    To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. Prospective, observational cohort study. Twelve PICUs in North Carolina. All children 24 months old or younger with traumatic brain injury, admitted to an included PICU. None. The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5-9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old

  18. Primitive experience of three dimensional multi-slice spiral CT angiography for the follow-up of intracranial aneurysm clipping

    International Nuclear Information System (INIS)

    Yang Yunjun; Chen Weijian; Hu Zhangyong; Wu Enfu; Wang Meihao; Zhuge Qichuan; Zhongming; Cheng Jingliang; Ren Cuiping; Zhang Yong

    2008-01-01

    Objective To evaluate multi-slice three-dimensional CT angiography (MS 3D-CTA) for the follow-up of intracranial aneurysm clipping. Methods: MS 3D-CTA of 16 patients with intracranial aneurysm clipping were retrospectively analyzed. The patients were scanned on a 16-slice spiral CT (GE Lightspeed pro). Volume rendering(VR), thin maximum intensity projection(thin MIP) and multi-planar reconstruction (MPR) were employed in image postprocessing in all cases. Results: There were 17 clips in the 16 patients with aneurysm clipping. Six clips were located at the posterior communicating artery, 5 at the anterior communicating artery, 4 at the middle cerebral artery, and the remaining 2 clips were located at the pericallosal artery, in 1 patient. There were no abnormalities found in the aneurysm clipping region in 7 cases by MS 3D- CTA. There were residual aneurysm in 2 cases, parent artery stenosis in 4 cases, and artery spasm in 3 eases. There was no parent artery occlusion and clip displacement in all cases. VR showed excellent 3D spacial relations between the clip and parent artery in 12 cases, and showed good relations in 3 cases. The 1 case with 2 clips in the pericallosal artery showed heavy beam-hardening artifacts. The size and shape of aneurysm clips were clearly depicted by MPR and thin MIP, while 3D spacial relation of aneurysm clip and parent artery were poorly showed. Conclusion: MS 3D-CTA is a safe and efficient method for the follow-up of intracranialaneurysm clipping. Combined VR with MPR or thin MIP can well reveal postoperative changes after aneurysm clipping. (authors)

  19. Relationship between endothelial nitric oxide synthase (eNOS) and natural history of intracranial aneurysms: meta-analysis.

    Science.gov (United States)

    Paschoal, Eric Homero Albuquerque; Yamaki, Vitor Nagai; Teixeira, Renan Kleber Costa; Paschoal Junior, Fernando Mendes; Jong-A-Liem, Glaucia Suzanna; Teixeira, Manoel Jacobsen; Yamada, Elizabeth Sumi; Ribeiro-Dos-Santos, Ândrea; Bor-Seng-Shu, Edson

    2018-01-01

    The aneurysmal subarachnoid hemorrhage is a major public health problem described as a sudden drastic event with no warning symptoms and high morbidity and mortality rates. The role of the endothelial isoform of nitric oxide synthase gene polymorphism in intracranial aneurysms (IAs) is still a matter of controversy with divergent findings among European, American, and Asian populations. Our study purposed to test the association between intracranial aneurysms formation and nitric oxide gene polymorphisms through a systematic review and meta-analysis. Systematic search on Medline, Lilacs, and EMBASE was performed. The primary search resulted in 139 papers, out of which 9 met our inclusion criteria after a full text analysis. The dominant T786C model found a significant association with IA (OR 1.22, 95 % CI 1.04-1.44, p = 0.01), so did studies of the recessive T786C model (OR 0.37, 95 % CI 0.30-0.45, p < 0.0001) but with opposite effect. Our findings support the presence of the T786C polymorphism as a predictor for the development of intracranial aneurysm in the cerebral vascular system. More studies are necessary in order to elucidate the pathways of the endothelial nitric oxide synthase (eNOS) in cerebrovascular diseases and in defining how different allelic combinations of the eNOS gene single-nucleotide polymorphism (SNP) could favor this pathological process.

  20. Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review

    Directory of Open Access Journals (Sweden)

    Hwang Jin

    2012-09-01

    Full Text Available Abstract Background To compare the effects of endovascular coiling and neurosurgical clipping in patients with unruptured intracranial aneurysm. Methods Sixteen electronic databases were searched for articles published between 1950 and July 2010 to compare clinical outcomes of clipping and coiling. Researchers reviewed all searched articles and extracted data independently. The quality of studies and evidence were evaluated using MINORS and GRADEprofiler, respectively. The odds ratio (OR was calculated using the inverse variance meta-analysis method for each study outcome. To assess heterogeneity of ORs across cohorts, Cochran’s Q statistic and I2 were used. Results Of 4160 studies, 24 were identified (n  =  31865. Clipping resulted in significantly higher disability using the Glasgow Outcome Scale (OR, 2.38; 95% CI, 1.33–4.26 and Modified Rankin Scale (OR, 2.83; 95% CI, 1.42–5.63 when compared with coiling. ORs for complications were also higher with clipping (ORs for neurological and cardiac complications were 1.94 with a 95% confidence interval [CI] of 1.09–3.47 and 2.51 with a 95% CI of 1.15–5.50. Clipping resulted in significantly greater disability in the short term (≤6 m(OR on the Glasgow Outcome Scale, 2.72; 95% CI, 1.16–6.34, but not in the long term (>6 m(OR for Glasgow Outcome Scale, 2.12; 95% CI, 0.93–4.84. Conclusions Coiling was a better procedure for treatment of unruptured intracranial aneurysm in terms of disability, complications, especially in the short term. Because of the limitations of the reviewed studies, further studies are required to support the present results.

  1. Cost Comparison of Surgical and Endovascular Treatment of Unruptured Giant Intracranial Aneurysms.

    Science.gov (United States)

    Familiari, Pietro; Maldaner, Nicolai; Kursumovic, Adisa; Rath, Stefan A; Vajkoczy, Peter; Raco, Antonino; Dengler, Julius

    2015-11-01

    Giant intracranial aneurysms (GIAs), which are defined as intracranial aneurysms (IAs) with a diameter of ≥25 mm, are most likely associated with the highest treatment costs of all IAs. However, the treatment costs of unruptured GIAs have so far not been reported. To examine direct costs of endovascular and surgical treatment of unruptured GIAs. We retrospectively examined 55 patients with unruptured GIAs treated surgically (37 patients) or endovascularly (18 patients) between April 2004 and March 2014. We analyzed the costs of all hospital stays, interventions, and imaging with a median follow-up of 46 months. There was no difference in the costs of hospital stay between surgical and endovascular treatment groups ($10,565 vs. $14,992; P = .37). Imaging costs were significantly higher in the surgical group than in the endovascular treatment group ($2890 vs. $1612; P < .01), as were the costs of the intervention room and personnel involved in the intervention ($5566 vs. $1520; P < .01). Implants used per patient were more expensive in the endovascular group than in the surgical treatment group ($20,885 vs. $167). The total direct treatment costs were higher in the endovascular group ($52,325) than in the surgical treatment group ($20,619; P < .01). Treatment costs were associated with the type of treatment and GIA location but not with patient age, sex, or GIA size. Endovascular GIA treatment produced higher direct costs than surgical GIA treatment mainly due to higher implant costs. Reducing endovascular implant costs may be the most effective tool to decrease direct costs of GIA treatment.

  2. Y-stent-assisted coil embolisation of wide-necked aneurysms using a new fully retrievable and detachable intracranial stent: report of two cases.

    Science.gov (United States)

    Muda, Ahmad Sobri; Ralib, Ahmad Razali Md; Yaacob, Yazmin; Zakaria, Rozman; Bakar, Azizi Abu

    2011-10-01

    Endovascular treatment of wide-necked aneurysms poses a challenge for the endovascular therapist. The Y-stent-assisted technique has been used for stent-assisted coil embolisation for wide-necked bifurcation aneurysms. This technique has been described for basilar tip aneurysms and middle cerebral artery bifurcation aneurysms using Neuroform and Enterprise stents. We report 2 cases of wide-necked bifurcation aneurysms that were treated with Y-stent-assisted coil embolisation using a new, fully retrievable and detachable intracranial stent (Solitaire AB™). We describe the advantages of a fully retrievable and detachable stent and its feasibility of forming a Y configuration.

  3. Silk Device for the Treatment of Intracranial Aneurysms. Part 1: Peri-Procedural Results, Technical Aspects and Learning Curve.

    Science.gov (United States)

    Gurkas, Erdem; Kaya, Tunca; Daglioglu, Ergun; Akmangit, Ilkay; Belen, Deniz; Peker, Ahmet; Dede, Dogan; Arat, Anil

    2016-01-01

    We evaluated the procedural outcomes of intracranial aneurysm treatment with the Silk device and its relation with operator experience. We also detailed some technical points we learned throughout our experience. One hundred and six consecutive patients with intracranial aneurysms treated using Silk (BaltExtrusion, Montmorency, France) stent between October 2010 and November 2013 were included. Patients were evaluated in terms of age, sex, aneurysm size, location, technical success, and adverse events. There were 106 patients (71 female) undergoing 116 procedures with a mean age of 49.8 (range: 3-78 years). Mean aneurysm size was 10.7±8.0 (range, 2-40 mm). Technical success of the procedures was 96.5%. Adverse event rate was 11.2%. Among adverse events, there were 4 adverse events without complications, 2 mild complications, 7 severe complications, 4 of which resulted with death. The adverse event rate was significantly higher during the first half of the operator's experience. The rate of adverse events seemed to stabilize after around 50 patients. Adverse events, regardless of the presence or absence of a clinical complication, were more frequent in aneurysms larger than 18.5 mm. Safety of flow-diverter (FD) placement for intracranial aneurysms increases with operator experience. Training programs in endovascular management of cerebrovascular diseases and relevant fellowship curricula must be adapted to include sufficient flow diverter experience. The learning curve needs to be kept in mind when studies comparing different FD devices or those comparing other treatments to FDS are planned.

  4. Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    MAO Zhi-qi

    2012-02-01

    Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

  5. Relationship between aneurysm wall enhancement and conventional risk factors in patients with unruptured intracranial aneurysms: A black-blood MRI study.

    Science.gov (United States)

    Liu, Peng; Qi, Haikun; Liu, Aihua; Lv, Xianli; Jiang, Yuhua; Zhao, Xihai; Li, Rui; Lu, Bing; Lv, Ming; Chen, Huijun; Li, Youxiang

    2016-10-01

    Aneurysmal wall enhancement (AWE) has emerged as a new possible biomarker for depicting inflammation of the intracranial aneurysm (IA). However, the relationships of AWE with other risk factors are still unclear for unruptured IA. The purpose of this study was to investigate the association between AWE and other risk metrics. Forty-eight patients with unruptured saccular IAs diagnosed by digital subtraction angiography were recruited to undergo magnetic resonance (MR) black-blood imaging. AWE was evaluated using the pre- and post-contrast black-blood MR images. Univariate and multivariate logistic regression analysis was performed to investigate the association of AWE with other risk factors, including size, maximal neck width, parent vessel diameter, location, multiplicity, daughter sacs and other clinical factors. The prevalence of AWE in each ISUIA grade was reported and compared by Wilcoxon rank sum test. In total, 61 aneurysms were detected in 48 patients. Aneurysm size was found to be an independent risk factor associated with AWE (OR 2.46 per mm increase, 95% CI 1.34-4.51; p = 0.004). Patient age was independently and inversely associated with AWE (OR 0.898 per year increase, 95% CI 0.812-0.994; p = 0.037). Higher prevalence of AWE was observed in larger aneurysms (12%, 71.4%, 100%, and 100% of ISUIA grade 1-4 IAs have AWE, respectively). Notably, 12% of small IAs (size <7 mm) exhibited AWE. The IAs with AWE had significant higher ISUIA grade than the IAs without (p < 0.001, Wilcoxon rank sum test). The wall enhancement in contrast-enhanced black-blood MR images was independently associated with aneurysm size in unruptured IAs. However, some small unruptured aneurysms did exhibit wall enhancement, suggesting that AWE may provide additional aneurysm instability information to improve current size-based rupture risk evaluation metrics. © The Author(s) 2016.

  6. Influence of hemodynamic factors on rupture of intracranial aneurysms: patient-specific 3D mirror aneurysms model computational fluid dynamics simulation.

    Science.gov (United States)

    Lu, G; Huang, L; Zhang, X L; Wang, S Z; Hong, Y; Hu, Z; Geng, D Y

    2011-08-01

    Hemodynamics factors play an important role in the rupture of cerebral aneurysms. The purpose of this study was to evaluate the impact of hemodynamic factors on the rupture of the MANs with 3D reconstruction model CFD simulation. RDSA was performed in 9 pairs of intracranial MANs. Each pair was divided into ruptured and unruptured groups. The hemodynamic factors of the aneurysms and their parent arteries were compared. There was a significant difference in the WSS at peak systole between the regions of the aneurysms and their parent arteries in the ruptured group (ie, 6.49 ± 3.48 Pa versus 8.78 ± 3.57 Pa, P =.015) but not in the unruptured group (ie, 9.80 ± 4.12 Pa versus 10.17 ± 7.48 Pa, P =.678). The proportion of the low WSS area to the whole area of the aneurysms was 12.20 ± 18.08% in the ruptured group and 3.96 ± 6.91% in the unruptured group; the difference between the 2 groups was statistically significant (P =.015). The OSI was 0.0879 ± 0.0764 in the ruptured group, which was significantly higher than that of the unruptured group (ie, 0.0183 ± 0.0191, P =.008). MANs may be a useful disease model to investigate possible causes linked to ruptured aneurysms. The ruptured aneurysms manifested lower WSS compared with their parent arteries, a higher proportion of the low WSS area to the whole area of aneurysm, and higher OSI compared with the unruptured aneurysms.

  7. PIV Measurement of Wall Shear Stress and Flow Structures within an Intracranial Aneurysm Model

    Science.gov (United States)

    Chow, Ricky; Sparrow, Eph; Campbell, Gary; Divani, Afshin; Sheng, Jian

    2012-11-01

    The formation and rupture of an intracranial aneurysm (IA) is a debilitating and often lethal event. Geometric features of the aneurysm bulb and upstream artery, such as bulb size, bulb shape, and curvature of the artery, are two groups of factors that define the flow and stresses within an IA. Abnormal flow stresses are related to rupture. This presentation discusses the development of a quasi-3D PIV technique and its application in various glass models at Re = 275 and 550 to experimentally assess at a preliminary level the impact of geometry and flow rate. Some conclusions are to be drawn linking geometry of the flow domain to rupture risk. The extracted results also serve as the baseline case and as a precursor to a companion presentation by the authors discussing the impact of flow diverters, a new class of medical devices. The PIV experiments were performed in a fully index-matched flow facility, allowing for unobstructed observations over complex geometry. A reconstruction and analysis method was devised to obtain 3D mean wall stress distributions and flow fields. The quasi 3D measurements were reconstructed from orthogonal planes encompassing the entire glass model, spaced 0.4mm apart. Wall shear stresses were evaluated from the near-wall flow viscous stresses.

  8. Clinical Risk Factors Affecting Procedure-Related Major Neurological Complications in Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Jang, E-Wook; Kim, Yong Bae; Chung, Joonho; Suh, Sang Hyun; Hong, Chang-Ki; Joo, Jin-Yang

    2015-07-01

    The operative risk and natural history rupture risk for the treatment of unruptured intracranial aneurysms (UIAs) should be evaluated. The purpose of this study was to report our experience with treating UIAs and to outline clinical risk factors associated with procedure-related major neurological complications. We treated 1158 UIAs in 998 patients over the last 14 years. All patients underwent operation performed by a single microvascular surgeon and two interventionists at a single institution. Patient factors, aneurysm factors, and clinical outcomes were analyzed in relation to procedure-related complications. The total complication rate was 22 (2.2%) out of 998 patients. Among them, complications developed in 14 (2.3%) out of 612 patients who underwent microsurgery and in 8 (2.1%) out of 386 patients who underwent endovascular procedures. One patient died due to intraoperative rupture during an endovascular procedure. The procedure-related complication was highly correlated with age (p=0.004), hypertension (p=0.002), and history of ischemic stroke (p<0.001) in univariate analysis. The multivariate analysis revealed previous history of ischemic stroke (p=0.001) to be strongly correlated with procedure-related complications. A history of ischemic stroke was strongly correlated with procedure-related major neurological complications when treating UIAs. Accordingly, patients with UIAs who have a previous history of ischemic stroke might be at risk of procedure-related major neurological complications.

  9. Outcome after endovascular therapy of ruptured intracranial aneurysms: morbidity and impact of rebleeding

    International Nuclear Information System (INIS)

    Kremer, C.; Groden, C.; Zeumer, H.; Lammers, G.; Weineck, G.; Hansen, H.C.

    2002-01-01

    We evaluated midterm functional outcome after endovascular occlusion of aneurysms in patients with subarachnoid haemorrhage (SAH) and determined the incidence of late rebleeding as an additional prognostic parameter. We treated 79 consecutive patients with SAH from an intracranial aneurysm admitted from a neurological intensive care unit by the endovascular route between 1993 and 1997 and 52 survivors were followed up in 1999-2000. The mean interval between SAH and follow-up was 41 months (range 13-74 months). Outcome was determined by the Glasgow outcome (GOS) and Rankin (RS) scales and by questions concerning neuropsychological disorders. The patients were analysed according to Hunt and Hess (H and H) grades I-III or IV-V on admission. We observed two episodes of rebleeding (3%) with impact on outcome at 907 and 2010 days after SAH, respectively. A complete recovery (GOS 5) was achieved in 53% of H and H grade I-III and 17% of grade IV-V patients; with death rates 19% and 50%, and morbidity according to the RS (5-2) 18% and 29%, respectively. Midterm morbidity after endovascular therapy is thus low. Rebleeding with an impact on outcome can be observed up to 2010 days after SAH, suggesting that long-term angiographic follow-up is indispensable. (orig.)

  10. Glycemia in conditions of hypothermia in patients with intracranial aneurysmal hemorrhage

    Directory of Open Access Journals (Sweden)

    Світлана Олександрівна Дудукіна

    2015-04-01

    Full Text Available Despite the proven effectiveness of hypothermia as a method of neuroprotection, the presence of significant side effects requires further development of detailed protocols of usage, especially glucose.Aim: Improving treatment outcomes of patients with subarachnoid aneurysmal hemorrhage by preventing the development of hyperglycemia during systemic hypothermia.Materials and Methods: The study involved 48 patients with spontaneous subarachnoid hemorrhage of aneurysmal origin. All patients were conducted intracranial surgery - clipping aneurysms of cerebral vessels during regression of arterial vascular spasm (AVS in the systemic hypothermia prevention. Therapeutic hypothermia was performed in 29 patients with complicated disease course for 48 hours. It is evaluated the effectiveness of its own method of prevention and correction of hyperglycemia - permanent short-acting insulin before the warm saline at a dose of 2 units/hour during hypothermiaResults: During the prevention of hypothermia using methods of hyperglycemia episodes of above 10 mmol / L did not observe the rejection of a group of patients using the conventional method of correction of glycemia. Episodes of hypoglycemia do not observed in both groups of the study. Up to 48 hours of therapeutic hypothermia glucose levels remained stable, after 48 hours of hypothermia it is observed a significant increase in blood glucose that was cool termination criterion.Conclusions: Holding insulin infusion at short-acting dose of 2 units/hour during prophylactic hypothermia prevents episodes of hyperglycemia and consequently helps to maintain homeostasis. Carrying insulin infusion at short-acting dose of 2 units/hour during therapeutic hypothermia promotes stable blood glucose levels to 48 hours. After 48 hours of hypothermia in 51.72% of patients experienced a significant increase in blood glucose, which is one of the criteria for termination of cooling

  11. Detection and characterization of unruptured intracranial aneurysms: Comparison of 3T MRA and DSA.

    Science.gov (United States)

    Mine, Benjamin; Pezzullo, Martina; Roque, Gonçalo; David, Philippe; Metens, Thierry; Lubicz, Boris

    2015-06-01

    To compare magnetic resonance angiography (MRA) at 3 Tesla (3T) and digital subtraction angiography (DSA) for the detection and characterization of unruptured intracranial aneurysms (UIA). This study has been approved by our local ethical committee. From February to August 2010, 40 consecutive patients with UIA contemporarily underwent MRA at 3T including time-of-flight (TOF-MRA) and contrast enhanced (CE-MRA) techniques and DSA. MR images were independently reviewed by 3 radiologists and DSA images were reviewed by 2 radiologists together. Interobserver and intertechnique agreements were assessed for aneurysm detection and characterization including maximal diameter, neck width and the presence of a bleb or a branch arising from the sac. DS angiography revealed 56 aneurysms. Mean sensitivity and positive predictive value of MRA were 91.4% and 93.4% respectively. For UIA < 3 mm and those ≥ 3 mm, MRA had a mean sensitivity of 74.1% and 100% respectively. Intertechnique and interobserver agreements were substantial for the measurement of UIA maximal diameter (mean κ, 0.607 and 0.601 respectively) and were moderate and fair for neck width measurement respectively (mean κ, 0.456 and 0.285 respectively). For bleb detection, intertechnique and interobserver agreements were fair and slight respectively (mean κ, 0.312 and 0.116 respectively) whereas both were slight for detection of branches arising from the sac (mean κ, 0.151 and 0.070 respectively). MR angiography at 3T has a high sensitivity for the detection of UIA. However, it remains significantly inferior to DSA for morphological characterization of UIA. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients.

    Science.gov (United States)

    Oishi, Hidenori; Yamamoto, Munetaka; Nonaka, Senshu; Shimizu, Takashi; Yoshida, Kensaku; Mitsuhashi, Takashi; Arai, Hajime

    2015-09-01

    We report the results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms (UIAs) in elderly patients (≥65 years). There were 375 elderly patients with 400 asymptomatic UIAs. Patients were divided into two groups: group A included patients aged 65-74 years and group B patients aged ≥75 years. Endovascular procedures were completed in 97.8% of patients. Immediate anatomical outcomes showed complete occlusion in 53.7%, residual neck in 18.9%, and residual aneurysm in 27.4%. Anatomical follow-ups (mean 36.3±28.1 months) were unchanged in 55.7%, improved in 22.6%, minor recurrence in 11.5%, and major recurrence in 10.2%. Procedure related complications occurred in 31 patients (8.3%). 15 patients had ischemic and 10 hemorrhagic complications. Retreatments were performed in 16 patients (4.3%). Among 366 patients technically completed, 363 (99.2%) showed a favorable clinical outcome (modified Rankin Scale (mRS) score 0 at 30 days. The latest clinical follow-up outcomes showed: mRS score 0 in 362 patients; mRS score 1 in one; mRS score 3 in one; mRS score 4 in one; and mRS score 5 in one patient. Permanent morbidity and mortality rates were 1.1% and 0%, respectively. There were no statistically significant differences in gender, comorbidities, aneurysm size, neck width, dome-to-neck ratio, immediate anatomical outcomes, anatomical follow-up outcomes, or procedure related complications between the groups. Endosaccular coil embolization is safe and feasible for elderly patients with asymptomatic UIAs. Old age itself should not be a contraindication. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Intracranial Aneurysms in Sickle-Cell Disease Are Associated With the Hemoglobin SS Genotype But Not With Moyamoya Syndrome

    DEFF Research Database (Denmark)

    Birkeland, Peter; Gardner, Kate; Kesse-Adu, Rachel

    2016-01-01

    BACKGROUND AND PURPOSE: Intracranial aneurysms and aneurysmal subarachnoid hemorrhage may occur more frequently in sickle-cell disease (SCD), and this could be related to the sickle genotype and moyamoya syndrome seen in SCD. METHODS: Records from a total of 1002 patients with SCD attending 2...... had imaging data; the prevalence was significantly higher in patients with HbSS genotype compared with other sickle genotypes with the highest prevalence (15%) observed in women in the age group 30 to 39 years. Fifty-one HbSS patients had a moyamoya vasculopathy, but only 3 of these had concomitant...

  14. Giant intracranial aneurysm with fistula to the paranasal sinuses - a case report; Aneurisma gigante intracraniano com fistula para os seios paranasais - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Luciano Gusmao; Monteiro, Soraya Silveira; Rossi, Luiz Antonio; Araujo, Marcelo Antonio Nobrega; Iagarachi, Celso Kendy; Oliveira, Luiz Antonio Nunes de [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Serv. de Radiologia

    1998-09-01

    The authors present a case of giant aneurysm of internal carotid artery with extensive bone erosion, which led to a fistula to the paranasal sinuses. The clinical aspects, radiological findings and differential diagnosis of giant intracranial aneurysms are discussed. (author) 9 refs., 5 figs.

  15. Intracranial aneurysm segmentation in 3D CT angiography: Method and quantitative validation with and without prior noise filtering

    International Nuclear Information System (INIS)

    Firouzian, Azadeh; Manniesing, Rashindra; Flach, Zwenneke H.; Risselada, Roelof; Kooten, Fop van; Sturkenboom, Miriam C.J.M.; Lugt, Aad van der; Niessen, Wiro J.

    2011-01-01

    Intracranial aneurysm volume and shape are important factors for predicting rupture risk, for pre-surgical planning and for follow-up studies. To obtain these parameters, manual segmentation can be employed; however, this is a tedious procedure, which is prone to inter- and intra-observer variability. Therefore there is a need for an automated method, which is accurate, reproducible and reliable. This study aims to develop and validate an automated method for segmenting intracranial aneurysms in Computed Tomography Angiography (CTA) data. Also, it is investigated whether prior smoothing improves segmentation robustness and accuracy. The proposed segmentation method is implemented in the level set framework, more specifically Geodesic Active Surfaces, in which a surface is evolved to capture the aneurysmal wall via an energy minimization approach. The energy term is composed of three different image features, namely; intensity, gradient magnitude and intensity variance. The method requires minimal user interaction, i.e. a single seed point inside the aneurysm needs to be placed, based on which image intensity statistics of the aneurysm are derived and used in defining the energy term. The method has been evaluated on 15 aneurysms in 11 CTA data sets by comparing the results to manual segmentations performed by two expert radiologists. Evaluation measures were Similarity Index, Average Surface Distance and Volume Difference. The results show that the automated aneurysm segmentation method is reproducible, and performs in the range of inter-observer variability in terms of accuracy. Smoothing by nonlinear diffusion with appropriate parameter settings prior to segmentation, slightly improves segmentation accuracy.

  16. Traumatic arteriovenous fistulas and aneurysms at the Tikur ...

    African Journals Online (AJOL)

    was 32 years (range 17-49). Nine were men. The aneurysms were located in the lower extremities in eight patients, and in the upper extremities in two. Eight of the injuries leading to aneurysms involved military personnel and there were two civilians. The mean time of operation after injury was 48.9 months (range.

  17. The Course of Intracranial Pressure in Traumatic Brain Injury : Relation with Outcome and CT-characteristics

    NARCIS (Netherlands)

    Bremmer, Rosette; de Jong, Bauke M.; Wagemakers, Michiel; Regtien, Joost G.; van der Naalt, Joukje

    One of the predictive factors of outcome in traumatic brain injury is high intracranial pressure (ICP). Recently, the time course of ICP has been described but few data are available on the relation of these ICP profiles and outcome. The aim of this study is to investigate the relation of the time

  18. Usefulness of {sup 99m}Tc-HMPAO SPECT in Patients with Subarachnoid Hemorrhage due to Ruptured Intracranial Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, C. W.; Lee, K. H.; Kim, J. H.; Kwark, C. E.; Lee, D. S.; Chung, J. K.; Lee, M. C.; Han, D. H.; Koh, C. S. [Seoul National University Hospital, Seoul (Korea, Republic of)

    1993-07-15

    We evaluated the usefulness of {sup 99m}Tc-HMPAO SPECT in 21 Patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm and in 3 patients with unruptured intracranial aneurysm. SPECT study could detect the bilaterally hypoperfused cases in 10 patients(48%), but CT/MRI showed the bilateral abnormalities in only 3 patients(14%). The number of abnormal lesions were 56 in SPECT and 25 in CT/MRI. The lesions found in SPECT were well correlated with the neurological signs of the patients such as aphasia or hemiplegia. SPECT study during Matas test was helpful in evaluating the risk for carotid artery occlusion therapy. We thought that {sup 99m}Tc-HMPAO brain SPECT is helpful in evaluating the functional changes in patients with subarachnoid hemorrhage.

  19. Mycotic Aneurysm of External Carotid Artery following Traumatic Brain Injury: Case Report and Review of Literature.

    Science.gov (United States)

    Khalili, Hosseinali; Derakhshan, Nima; Malekmohammadi, Zahed; Ghaffarpasand, Fariborz

    2014-04-01

    Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy.

  20. Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    2016-06-01

    Full Text Available ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH. In total, 35 patients (71% were grade 4, and 14 (29% were grade 5. A total of 42 (85% patients had one aneurysm, 6 (12% had two aneurysms, and 1 (3% had three aneurysms. Out of 49 patients, one technical (2% and one clinical (2% complication occurred at surgery. Twenty-one (43% patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29% patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

  1. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury

    DEFF Research Database (Denmark)

    Cnossen, Maryse C; Huijben, Jilske A; van der Jagt, Mathieu

    2017-01-01

    BACKGROUND: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management...... strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. METHODS: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion...... the others were considered more conservative (n = 34, 52%). CONCLUSIONS: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide...

  2. Effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory: a prospective cohort study.

    Science.gov (United States)

    Chung, Joonho; Seok, Jeong-Ho; Kwon, Min A; Kim, Yong Bae; Joo, Jin-Yang; Hong, Chang-Ki

    2016-01-01

    We prospectively evaluated the effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory. Between March 2012 and June 2013, 56 patients were recruited for this study. Fifty-one patients met the inclusion criteria and were enrolled. Inclusion criteria were as follows: (1) age ≤65 years and (2) planned microsurgery or endovascular surgery for unruptured intracranial aneurysm. Exclusion criteria were as follows: (1) preoperative intelligence quotient color test (WCT) and verbal learning test (VLT) were performed before and after (6 months) preventive surgery. ACCPT (attention), WCT (executive function) and VLT (learning and memory) scores did not change significantly between the pre- and postoperative evaluations. The ACCPT, WCT, total VLT scores (verbal learning) and delayed VLT scores (memory) did not differ significantly between patients undergoing microsurgery and those undergoing endovascular surgery. However, ACCPT, WCT and delayed VLT scores decreased postoperatively in patients with leukoaraiosis on preoperative FLAIR images (OR 9.899, p = 0.041; OR 11.421, p = 0.006; OR 2.952, p = 0.024, respectively). Preventive surgery for unruptured intracranial aneurysms did not affect attention, executive function, learning or memory. However, patients with leukoaraiosis on FLAIR images might be prone to deficits in attention, executive function and memory postoperatively, whereas learning might not be affected.

  3. Unruptured intracranial aneurysm presenting with epiletic seizure Epilepsia secundária a aneurisma cerebral não roto

    Directory of Open Access Journals (Sweden)

    José C. Sena

    2003-09-01

    Full Text Available Intracranial aneurysms are frequently present with subarachnoid hemorrhage.Less often they produce suggestive symptoms of cranial nerve dysfunction or intracranial tumor when very large. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. When the patient presents with epileptiforme attacks the presence of an intracranial aneurysm is rarely considered. In this paper we report the case of a 45-years-old patient with an unruptured aneurysm of the middle cerebral artery with a 10 years history of epileptic seizure.Aneurismas intracranianos freqüentemente se apresentam com hemorragia subaracnóidea quando rotos, porém quando gigantes sangram com menor freqüência e se comportam como verdadeiros tumores, comprimindo estruturas cerebrais adjacentes, apresentando sintomatologia peculiar. Relatamos o caso de um paciente de 45 anos que apresentava crises convulsivas generalizadas com evolução de 10 anos. A investigação radiológica revelou presença de aneurisma gigante da artéria cerebral média, não roto. É realizada revisão da literatura correlacionando a presença de aneurismas não rotos e epilepsia, pois esta associação é pouco freqüente na literatura.

  4. Visualization of novel microstents in patients with unruptured intracranial aneurysms with contrast-enhanced flat panel detector CT.

    Science.gov (United States)

    Poncyljusz, Wojciech; Zwarzany, Łukasz; Safranow, Krzysztof

    2015-07-01

    The aim of our study was to evaluate the feasibility of contrast-enhanced flat panel detector CT (FPDCT) for visualizing the novel microstents implanted in patients with unruptured wide-necked intracranial aneurysms. Forty-four cases of patients who underwent stent assisted coiling at our department were retrospectively analyzed. In each case, FPDCT images were performed after stent and coils deployment and then assessed in the terms of stent struts and all radiopaque markers and tantalum strands visibility separately using a 3-grade scale (1 - inadequate, 2 - good, 3 - excellent). Stent struts visibility was assessed to be inadequate for evaluation in all cases. All radiopaque markers and tantalum strands visibility was excellent in 61.4% and good in 38.6% of cases. We observed 4 (9.09%) cases of incomplete stent opening. Treated aneurysm size <10mm was an independent predictor of excellent stent all radiopaque markers and tantalum strands visibility (ρ=0.014). Contrast-enhanced FPDCT is feasible for visualizing stents implanted in patients with intracranial aneurysms as it gives precise visualization of the relationships between the stent tantalum strands and the vessel wall. Stents used in the treatment of aneurysms ≥10 mm in size are worse visualized because of the coil streaking artifacts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass.

    Science.gov (United States)

    Zhu, Wei; Tian, Yan-Long; Zhou, Liang-Fu; Song, Dong-Lei; Xu, Bin; Mao, Ying

    2011-01-01

    Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. During a 7-year period, 49 patients with complex ICA aneurysms underwent direct ICA sacrifice, or ICA sacrifice combined with EC-IC bypass. The appropriate type of bypass was determined by the results of balloon occlusion test and computed tomographic perfusion. The technique of ICA sacrifice used was selected based on the evaluation of retrograde filling of the aneurysm during balloon occlusion test. Ten patients underwent direct ICA sacrifice and no ischemia-related complications were evident during the 5-12 months of follow-up. A total of 39 patients were treated by ICA sacrifice combined with EC-IC bypass, including 21 cases of superficial temporal artery-radial artery-middle cerebral artery and 18 cases of external carotid artery-radial artery-middle cerebral artery. ICA sacrifice was achieved in 38 patients by using prolonged occlusion (25 cases) or acute occlusion (13 cases). Five patients presented with minor ischemia after surgery, but four patients recovered completely. Two patients developed brain swelling postoperatively and one developed intracranial hemorrhage, which required evacuation of the hematoma. Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jeong Jin [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeon, Jin Pyeong [Dept. of Neurosurgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2015-10-15

    The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months). The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations.

  7. Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

    International Nuclear Information System (INIS)

    Lubicz, Boris; Neugroschl, Carine; Collignon, Laurent; Francois, Olivier; Baleriaux, Danielle

    2008-01-01

    Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up. From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n=9) or without (n=58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images. Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%. CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up. (orig.)

  8. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: A single center experience

    International Nuclear Information System (INIS)

    Cho, Young Dae; Rhim, Jong Kook; Kang, Hyun Seung; Kim, Jeong Eun; Cho, Won Sang; Han, Moon Hee; Park, Jeong Jin; Jeon, Jin Pyeong

    2015-01-01

    The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 ± 22.7 months). The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations

  9. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data.

    Science.gov (United States)

    Lall, Rohan R; Eddleman, Christopher S; Bendok, Bernard R; Batjer, H Hunt

    2009-05-01

    Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a meta-analysis is nearly impossible to perform. This review will instead focus on the various anatomical and morphological characteristics of aneurysms reported in the literature with an attempt to draw broad inferences and serve to highlight pressing questions for the future in our continued effort to improve clinical management of unruptured intracranial aneurysms.

  10. Distribution of ABO blood groups in the patients with intracranial aneurysm and association of different risk factors with particular blood type.

    Science.gov (United States)

    Bir, Shyamal Chandra; Bollam, Papireddy; Nanda, Anil

    2015-01-01

    The association between ABO blood groups and intracranial aneurysms is not well-known. Many co-morbid factors are associated with intracranial aneurysms. Our objective was to assess the prevalence of different blood group in patients with intracranial aneurysm and to look for associations between risk factors and these groups. This retrospective study includes 1,491 cases who underwent surgical operations for intracranial aneurysms from 1993-2014. We have evaluated the information related to clinical history, ABO blood groups and associated risk factors in the patients both ruptured and unruptured intracranial aneurysms by chart review of the cases. In our study, out of 1,491 cases, the most common ABO blood groups were group O (668 cases, 44.80%) and Group A (603 cases, 40.44%), and Rh(+) in 1,319 (88.4%) and Rh(-) in 147 (11.6%). Blood Group A (43% vs. 36%) and Group B (16.2% vs. 8.6%) were significantly higher in Caucasian and African Americans respectively. However, in general population, there was no significant difference in blood groups between Caucasians and African Americans. Rh(-) factor was significantly higher in Caucasians compared to African Americans. Incidence of smoking was significantly higher in aneurysm patients with O group compared to others. In addition, incidence of hypercholesterolemia was significantly higher in aneurysm patients with A group compared to others. The racial disparity in the distribution of blood groups, and risk factor association with blood groups in the development of intracranial aneurysm needs to be considered. The findings from our study may be useful in identifying patients at increased risk. Further study may be required to establish the risks from multiple centers studies around the world.

  11. Pulsatile Intracranial Pressure and Cerebral Autoregulation After Traumatic Brain Injury

    NARCIS (Netherlands)

    Radolovich, D. K.; Aries, M.J.H.; Castellani, G.; Corona, A.; Lavinio, A.; Smielewski, P.; Pickard, J. D.; Czosnyka, M.

    2011-01-01

    Strong correlation between mean intracranial pressure (ICP) and its pulse wave amplitude (AMP) has been demonstrated in different clinical scenarios. We investigated the relationship between invasive mean arterial blood pressure (ABP) and AMP to explore its potential role as a descriptor of

  12. Treatment of Unruptured Intracranial Aneurysms and Cognitive Performance: Preliminary Results of a Prospective Clinical Trial.

    Science.gov (United States)

    Bründl, Elisabeth; Böhm, Christina; Lürding, Ralf; Schödel, Petra; Bele, Sylvia; Hochreiter, Andreas; Scheitzach, Judith; Zeman, Florian; Brawanski, Alexander; Schebesch, Karl-Michael

    2016-10-01

    Few studies have addressed the effect of treatment of unruptured intracranial aneurysm (UIA) on cognitive function. Neuropsychological assessment after UIA treatment is underreported, and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective controlled study to evaluate the differences in cognitive processing caused by the treatment of anterior circulation UIAs. Thirty patients were enrolled until September 2015. Ten patients received endovascular aneurysm occlusion (EV), 10 patients were treated microsurgically (MS), and 10 patients with surgically treated degenerative lumbar spine disease (LD) served as control. All patients underwent extended standardized neuropsychological assessment before (t 1 ) and 6 weeks after treatment (t 2 ). Tests included verbal, visual, and visuospatial memory, psychomotor functioning, executive functioning, and its subdomains verbal fluency and cognitive flexibility. We statistically evaluated intragroup and intergroup changes. Intragroup comparisons and group-rate analysis showed no significant impairment in overall neuropsychological performance, either postinterventionally or postoperatively. However, the postoperative performance in cognitive processing speed, cognitive flexibility, and executive functioning was significantly worse in the MS group than in the EV (P = 0.038) and LD group (P = 0.02). Compared with the EV group, patients with MS showed significant postoperative impairment in a subtest for auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. EV P = 0.011). The MS group trended toward posttreatment impairment in subtests for verbal fluency and semantic memory (Regensburg Word Fluency Test; MS vs. EV P = 0.083) and in auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. LD P = 0.06). Our preliminary data showed no effect of anterior circulation UIA treatment on overall neuropsychological function but impaired

  13. Greater Rupture Risk for Familial as Compared to Sporadic Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Broderick, Joseph P.; Brown, Robert D.; Sauerbeck, Laura; Hornung, Richard; Huston, John; Woo, Daniel; Anderson, Craig; Rouleau, Guy; Kleindorfer, Dawn; Flaherty, Matthew L.; Meissner, Irene; Foroud, Tatiana; Moomaw, E. Charles J.; Connolly, E. Sander

    2009-01-01

    Background The risk of intracranial aneurysm (IA) rupture in asymptomatic members of families who have multiple affected individuals is not known. Methods First-degree unaffected relatives of those with a familial history of IA who had a history of smoking or hypertension but no known IA were offered cerebral magnetic resonance angiography (MRA) and followed yearly as part of an NINDS-funded study of familial IA (FIA Study). Results 2874 subjects from 542 FIA families were enrolled. After study enrollment, MRAs were performed in 548 FIA family members with no known history of IA. Of these 548 subjects, 113 subjects (20.6%) had 148 IAs by MRA of whom 5 subjects had IA >= 7 mm. Two subjects with an unruptured IA by MRA/CTA (3 mm and 4mm ACOM) subsequently had rupture of their IA. This represents an annual rate of 1.2 ruptures per 100 subjects (1.2% per year, 95% CI of 0.14% to 4.3% per year). None of the 435 subjects with a negative MRA have had a ruptured IA. Survival curves between the MRA positive and negative cohorts were significantly different (p = 0.004). This rupture rate of unruptured IA in the FIA cohort of 1.2% per year is approximately 17 times higher than the rupture rate for subjects with an unruptured IA in the International Study of Unruptured Aneurysm Study with a matched distribution of IA size and location - 0.069% per year. Conclusions Small unruptured IAs in patients from FIA families may have a higher risk of rupture than sporadic unruptured IAs of similar size, which should be considered in the management of these patients. PMID:19228834

  14. Incidence and Characteristics of Remote Intracerebral Hemorrhage After Endovascular Treatment of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Sim, Sook Young; Song, Jihye; Oh, Se-Yang; Kim, Myeong Jin; Lim, Yong Cheol; Park, Sang Kyu; Shin, Yong Sam; Chung, Joonho

    2016-11-01

    The purpose of this study was to investigate the incidence and characteristics of remote intracerebral hemorrhage (ICH) after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). Between March 2007 and September 2015, 11 patients with remote ICH from a series of 2258 consecutive patients with 2597 UIAs treated via EVT were identified. Baseline demographic characteristics, medical history, radiologic imaging data, characteristics of remote ICH, and clinical outcomes were retrospectively reviewed. The characteristics of patients with remote ICH were compared with those of patients without remote ICH. All hematomas were single lesions located in the subcortical white matter as lobar-type in 9 patients (81.8%) and in the basal ganglia in 2 patients (18.2%). Events occurred mostly within 1 week and up to 3 weeks after EVT. Hematoma was located on the ipsilateral side in 8 patients (72.7%) and in the contralateral side in 3 patients (27.3%). Compared with patients without remote ICH, there were more aneurysms located on the internal carotid artery (ICA) (P = 0.041), more patients treated with stents (P < 0.001), more patients with hypertension (P = 0.026), and poorer clinical outcomes at discharge (P < 0.001) for patients with remote ICH. The incidence of remote ICH after EVT of UIAs was 0.46%. This event occurred mostly in patients with stents, hypertension, and UIAs on the ICA. It presented mostly as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Results of re-exploration because of compromised distal blood flow after clipping unruptured intracranial aneurysms.

    Science.gov (United States)

    Park, Wonhyoung; Ahn, Jae Sung; Lee, Sung Ho; Park, Jung Cheol; Kwun, Byung Duk

    2015-06-01

    One of the major causes for performing unplanned re-exploration of a craniotomy after microsurgery for unruptured intracranial aneurysms (UIAs) is compromised distal blood flow after clipping. Therefore, it is important to identify the causes of compromised distal blood flow after clipping and the factors that influence the prognosis for re-exploration in order to decrease ischemic complications related to clipping UIAs. Between January 2007 and December 2013, 1954 patients underwent microsurgery for UIAs. In this cohort, 20 patients (1.0%) required unplanned re-exploration of the craniotomy for several reasons, and 11 patients (0.6%) underwent unplanned re-exploration with clip repositioning or changing of the previous clip because of compromised distal blood flow after clipping. Patient characteristics, aneurysm properties, intraoperative findings, annual incidence and prognosis were analyzed in these 11 patients. The annual incidence of re-exploration has gradually decreased since the introduction of several intraoperative monitoring techniques. In total, 3.0% of UIAs in the M1 trunk, 0.8% of UIAs at the origin of the anterior choroidal artery (AchA) and 0.5% of UIAs at the bifurcation of the middle cerebral artery (MCA) required re-exploration. Here, all 11 UIAs had broad necks, and atherosclerosis was identified around 10 UIAs. Six patients with compromised MCA flow demonstrated relatively better outcomes following re-exploration than five patients with a compromised lenticulostriate artery (LSA) or AchA flow. Four patients with delayed ischemic symptoms demonstrated relatively better outcomes than the seven patients who developed ischemic symptoms immediately postoperatively. Clinicians need to be more careful not to compromise distal blood flow when clipping UIAs at the MCA and AchA origin. Various intraoperative monitoring techniques can help reduce the incidence of compromised distal blood flow after clipping.

  16. Efficacy of Arachnoid-Plasty on Chronic Subdural Hematoma Following Surgical Clipping of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Kim, Jae-Hyun; Kim, Chang-Hyun; Lee, Chang-Young

    2017-08-01

    We aimed to elucidate the effects of arachnoid plasty (ARP) on chronic subdural hematoma (CSDH) occurrence following clipping surgery. In total 217 patients (ARP, n = 97; non-ARP, n = 120) who had undergone unruptured intracranial aneurysm (UIA) surgical clipping via the pterional approach were retrospectively assessed. Predisposing factors for CSDH development following the surgery were investigated. Thickness and volume of the subdural fluid collection (SDFC) were measured to determine whether ARP affects postoperative SDFC. The occurrence of postoperative CSDH was higher in patients without ARP compared to those with ARP (12.5 vs. 3.1%; P = 0.01). In multivariate analyses, having an SDFC volume ≥15 mL on postoperative day (POD) 8, (odds ratio [OR] = 15.113; range = 3.159-72.290), and male sex (OR = 4.274; range = 1.291-14.148) were identified as independent predictive factors. Having had ARP (OR = 0.228; range = 0.056-0.927) was, as an independent variable, negatively correlated with the occurrence of CSDH (P < 0.05). Moreover, SDFC volume ≥15 ml on POD 8 was significantly less common in the ARP group compared with the non-ARP group (P = 0.03). Patients who underwent ARPs developed fewer CSDHs following UIA clipping surgery. The factors that predicted the development of CSDH included male sex, SDFC volume on POD 8, and ARP. In addition, the ARP patients had lower SDFC volumes (<15 mL). These findings suggested that ARP reduced the incidence of CSDHs after surgical clippings in patients with unruptured aneurysms. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Delayed massive epistaxis from traumatic cavernous carotid false aneurysms: A report of two unusual cases.

    Science.gov (United States)

    Mankahla, Ncedile; LeFeuvre, David; Taylor, Allan

    2017-08-01

    Introduction Blunt head trauma can injure the cavernous segment of the internal carotid artery (ICA). This may result in a carotid cavernous fistula (CCF). Rarely, a traumatic aneurysm may bleed medially causing massive epistaxis. Case presentation We present two cases of traumatic intracavernous carotid pseudoaneurysms with delayed massive epistaxis. The patients were managed with endovascular treatment involving coil embolization with parent vessel sparing and detachable balloon occlusion with carotid sacrifice. Early clinical outcome was good in both patients. Wherever possible, the CARE 1 guidelines were followed in the reporting. Conclusion These cases illustrate the delayed nature of traumatic aneurysms and the need for a high index of suspicion in the presence of skull base fractures. The use of endovascular detachable balloon occlusion and coil embolization treatment with parent vessel preservation is shown.

  18. Predicting Intracranial Pressure and Brain Tissue Oxygen Crises in Patients With Severe Traumatic Brain Injury.

    Science.gov (United States)

    Myers, Risa B; Lazaridis, Christos; Jermaine, Christopher M; Robertson, Claudia S; Rusin, Craig G

    2016-09-01

    To develop computer algorithms that can recognize physiologic patterns in traumatic brain injury patients that occur in advance of intracranial pressure and partial brain tissue oxygenation crises. The automated early detection of crisis precursors can provide clinicians with time to intervene in order to prevent or mitigate secondary brain injury. A retrospective study was conducted from prospectively collected physiologic data. intracranial pressure, and partial brain tissue oxygenation crisis events were defined as intracranial pressure of greater than or equal to 20 mm Hg lasting at least 15 minutes and partial brain tissue oxygenation value of less than 10 mm Hg for at least 10 minutes, respectively. The physiologic data preceding each crisis event were used to identify precursors associated with crisis onset. Multivariate classification models were applied to recorded data in 30-minute epochs of time to predict crises between 15 and 360 minutes in the future. The neurosurgical unit of Ben Taub Hospital (Houston, TX). Our cohort consisted of 817 subjects with severe traumatic brain injury. Our algorithm can predict the onset of intracranial pressure crises with 30-minute advance warning with an area under the receiver operating characteristic curve of 0.86 using only intracranial pressure measurements and time since last crisis. An analogous algorithm can predict the start of partial brain tissue oxygenation crises with 30-minute advanced warning with an area under the receiver operating characteristic curve of 0.91. Our algorithms provide accurate and timely predictions of intracranial hypertension and tissue hypoxia crises in patients with severe traumatic brain injury. Almost all of the information needed to predict the onset of these events is contained within the signal of interest and the time since last crisis.

  19. Rare Coding Variants in ANGPTL6 Are Associated with Familial Forms of Intracranial Aneurysm.

    Science.gov (United States)

    Bourcier, Romain; Le Scouarnec, Solena; Bonnaud, Stéphanie; Karakachoff, Matilde; Bourcereau, Emmanuelle; Heurtebise-Chrétien, Sandrine; Menguy, Céline; Dina, Christian; Simonet, Floriane; Moles, Alexis; Lenoble, Cédric; Lindenbaum, Pierre; Chatel, Stéphanie; Isidor, Bertrand; Génin, Emmanuelle; Deleuze, Jean-François; Schott, Jean-Jacques; Le Marec, Hervé; Loirand, Gervaise; Desal, Hubert; Redon, Richard

    2018-01-04

    Intracranial aneurysms (IAs) are acquired cerebrovascular abnormalities characterized by localized dilation and wall thinning in intracranial arteries, possibly leading to subarachnoid hemorrhage and severe outcome in case of rupture. Here, we identified one rare nonsense variant (c.1378A>T) in the last exon of ANGPTL6 (Angiopoietin-Like 6)-which encodes a circulating pro-angiogenic factor mainly secreted from the liver-shared by the four tested affected members of a large pedigree with multiple IA-affected case subjects. We showed a 50% reduction of ANGPTL6 serum concentration in individuals heterozygous for the c.1378A>T allele (p.Lys460Ter) compared to relatives homozygous for the normal allele, probably due to the non-secretion of the truncated protein produced by the c.1378A>T transcripts. Sequencing ANGPTL6 in a series of 94 additional index case subjects with familial IA identified three other rare coding variants in five case subjects. Overall, we detected a significant enrichment (p = 0.023) in rare coding variants within this gene among the 95 index case subjects with familial IA, compared to a reference population of 404 individuals with French ancestry. Among the 6 recruited families, 12 out of 13 (92%) individuals carrying IA also carry such variants in ANGPTL6, versus 15 out of 41 (37%) unaffected ones. We observed a higher rate of individuals with a history of high blood pressure among affected versus healthy individuals carrying ANGPTL6 variants, suggesting that ANGPTL6 could trigger cerebrovascular lesions when combined with other risk factors such as hypertension. Altogether, our results indicate that rare coding variants in ANGPTL6 are causally related to familial forms of IA. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  20. Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms.

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    Goyal, Nitin; Tsivgoulis, Georgios; Zand, Ramin; Sharma, Vijay K; Barlinn, Kristian; Male, Shailesh; Katsanos, Aristeidis H; Bodechtel, Ulf; Iftikhar, Sulaiman; Arthur, Adam; Elijovich, Lucas; Alexandrov, Anne W; Alexandrov, Andrei V

    2015-10-27

    We sought to determine the safety of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients harboring unruptured intracranial aneurysm (UIA) in a multicenter study and a comprehensive meta-analysis of available case series. We analyzed prospectively collected data from consecutive AIS patients treated with IVT during a 4-year period at 4 tertiary-care stroke centers. All patients routinely underwent CT or magnetic resonance angiography during hospitalization. The presence of UIA was documented on the basis of neuroradiology reports. Symptomatic intracranial hemorrhage (sICH) was defined as imaging evidence of ICH combined with an increase in NIH Stroke Scale score of ≥4 points. A systematic meta-analysis of case series reporting safety of IVT in AIS with concomitant UIA was conducted according to PRISMA recommendations. Among 1,398 AIS patients treated with IVT, we identified 42 cases (3.0%) harboring a total of 48 UIAs. The rates of symptomatic and asymptomatic ICH were 2.4% (95% confidence interval [CI] by adjusted Wald method: 0%-12.6%) and 7.1% (95% CI: 1.8%-19.7%), respectively. A total of 5 case series met our inclusion criteria for meta-analysis, and the pooled rate of sICH among 120 IVT-treated AIS patients harboring UIA was 6.7% (95% CI: 3.1%-13.7%). In the overall analysis of 5 case-series studies, the risk ratio of sICH did not differ between AIS patients with and without UIA (risk ratio = 1.60; 95% CI: 0.54-4.77; p = 0.40) with no evidence of heterogeneity across included studies (I(2) = 22% and p = 0.27 for Cochran Q test). Our prospectively collected multicenter data, coupled with the findings of the meta-analysis, indicate the potential safety of IVT in AIS patients with UIA. © 2015 American Academy of Neurology.

  1. Mind the gap: impact of computational fluid dynamics solution strategy on prediction of intracranial aneurysm hemodynamics and rupture status indicators.

    Science.gov (United States)

    Valen-Sendstad, K; Steinman, D A

    2014-03-01

    Computational fluid dynamics has become a popular tool for studying intracranial aneurysm hemodynamics, demonstrating success for retrospectively discriminating rupture status; however, recent highly refined simulations suggest potential deficiencies in solution strategies normally used in the aneurysm computational fluid dynamics literature. The purpose of the present study was to determine the impact of this gap. Pulsatile flow in 12 realistic MCA aneurysms was simulated by using both high-resolution and normal-resolution strategies. Velocity fields were compared at selected instants via domain-averaged error. We also compared wall shear stress fields and various reduced hemodynamic indices: cycle-averaged mean and maximum wall shear stress, oscillatory shear index, low shear area, viscous dissipation ratio, and kinetic energy ratio. Instantaneous differences in flow and wall shear stress patterns were appreciable, especially for bifurcation aneurysms. Linear regressions revealed strong correlations (R(2) > 0.9) between high-resolution and normal-resolution solutions for all indices except kinetic energy ratio (R(2) = 0.25) and oscillatory shear index (R(2) = 0.23); however, for most indices, the slopes were significantly computational fluid dynamics solution strategies may ultimately be adequate for augmenting rupture risk assessment on the basis of certain highly reduced indices; however, they cannot be relied on for predicting the magnitude and character of the complex biomechanical stimuli to which the aneurysm wall may be exposed. This impact of the computational fluid dynamics solution strategy is likely greater than that for other modeling assumptions or uncertainties.

  2. Comparison of computational fluid dynamics findings with intraoperative microscopy findings in unruptured intracranial aneurysms- An initial analysis.

    Science.gov (United States)

    Talari, Sandeep; Kato, Yoko; Shang, Hanbing; Yamada, Yasuhiro; Yamashiro, Kei; Suyama, Daisuke; Kawase, Tsukasa; Balik, Vladimir; Rile, Wu

    2016-01-01

    The increase in the detection of unruptured cerebral aneurysms has led to management dilemma. Prediction of risk based on the size of the aneurysm is not always accurate. There is no objective way of predicting rupture of aneurysm so far. Computational fluid dynamics (CFDs) was proposed as a tool to identify the rupture risk. To know the correlation of CFD findings with intraoperative microscopic findings and to know the relevance of CFD in the prediction of rupture risk and in the management of unruptured intracranial aneurysms. A prospective study involving nine cases over a period of 6 months as an initial analysis. Both males and females were included in the study. Preoperative analysis was performed using computed tomography angiogram, magnetic resonance imaging in all cases and digital substraction angiogram in some cases. Intraoperatively microscopic examination of the aneurysm wall was carried out and images recorded. The correlation was done between microscopic and CFD images. Seven cases were found intraoperatively to have a higher risk of rupture based on the thinning of the wall. Two cases had an atherosclerotic wall. All cases had low wall shear stress (WSS).Only two cases with atherosclerotic wall had a correlation with low WSS. While the pressure measured with CFD technique is a good predictor of rupture risk, the WSS component is controversial. Multicentric trials involving a larger subset of population are needed before drawing any definite conclusions. On-going development in the CFD analysis may help to predict the rupture chances accurately in future.

  3. Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

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    Ying Song

    Full Text Available The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs after stent assisted coiling (SAC has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years. The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months. Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be

  4. Thinner regions of intracranial aneurysm wall correlate with regions of higher wall shear stress: a 7.0 tesla MRI

    Science.gov (United States)

    Blankena, Roos; Kleinloog, Rachel; Verweij, Bon H.; van Ooij, Pim; ten Haken, Bennie; Luijten, Peter R.; Rinkel, Gabriel J.E.; Zwanenburg, Jaco J.M.

    2016-01-01

    Purpose To develop a method for semi-quantitative wall thickness assessment on in vivo 7.0 tesla (7T) MRI images of intracranial aneurysms for studying the relation between apparent aneurysm wall thickness and wall shear stress. Materials and Methods Wall thickness was analyzed in 11 unruptured aneurysms in 9 patients, who underwent 7T MRI with a TSE based vessel wall sequence (0.8 mm isotropic resolution). A custom analysis program determined the in vivo aneurysm wall intensities, which were normalized to signal of nearby brain tissue and were used as measure for apparent wall thickness (AWT). Spatial wall thickness variation was determined as the interquartile range in AWT (the middle 50% of the AWT range). Wall shear stress was determined using phase contrast MRI (0.5 mm isotropic resolution). We performed visual and statistical comparisons (Pearson’s correlation) to study the relation between wall thickness and wall shear stress. Results 3D colored AWT maps of the aneurysms showed spatial AWT variation, which ranged from 0.07 to 0.53, with a mean variation of 0.22 (a variation of 1.0 roughly means a wall thickness variation of one voxel (0.8mm)). In all aneurysms, AWT was inversely related to WSS (mean correlation coefficient −0.35, P<0.05). Conclusions A method was developed to measure the wall thickness semi-quantitatively, using 7T MRI. An inverse correlation between wall shear stress and AWT was determined. In future studies, this non-invasive method can be used to assess spatial wall thickness variation in relation to pathophysiologic processes such as aneurysm growth and –rupture. PMID:26892986

  5. Detection of unruptured intracranial aneurysms on noninvasive imaging. Is there still a role for digital subtraction angiography?

    Science.gov (United States)

    Rustemi, Oriela; Alaraj, Ali; Shakur, Sophia F; Orning, Jennifer L; Du, Xinjian; Aletich, Victor A; Amin-Hanjani, Sepideh; Charbel, Fady T

    2015-01-01

    To determine the utility of digital subtraction angiography (DSA) in patients with unruptured intracranial aneurysms (UIA) detected on noninvasive imaging, such as magnetic resonance angiography (MRA) and computed tomography angiography (CTA). The follow-up of patients with untreated UIAs involves serial imaging; however, this diagnosis may be based on false positive (FP) results. We examined the incidence of FPs in our institutional series. DSAs performed at our institution from January 2011 to June 2014 were retrospectively reviewed and patients referred with UIA detected on noninvasive imaging were selected. Clinical presentation as well as aneurysm location, size, and number reported on DSA and noninvasive imaging were assessed. Two hundred and eighty six patients (mean age 56.8 years, female 74.8%) with a total of 355 UIA were included. Thirty-one patients had a symptomatic presentation. Analysis per patient showed the pooled FP rate of noninvasive imaging was 15%. MRA FP was 13% (22/171) and CTA FP was 18% (22/120). FP increased significantly with aneurysm size < 3.5 mm on MRA (P < 0.001) and <4.0 mm on CTA (P = 0.01). Mean aneurysm size among symptomatic patients was significantly larger (P < 0.001) as compared to the incidental group (17.8 vs. 7.7 mm). No location was significantly susceptible to false detection of aneurysms. DSA detection of FP UIA diagnosed on noninvasive imaging is significantly higher for aneurysms <4.0 mm. Accurate diagnosis with DSA may eliminate the need for further follow-up and its associated negative psychological and economic effects. Within the limitations of this retrospective study, we conclude that DSA has a diagnostic role in small aneurysms detected on noninvasive imaging.

  6. Effects of Reynolds and Womersley Numbers on the Hemodynamics of Intracranial Aneurysms

    Science.gov (United States)

    Asgharzadeh, Hafez

    2016-01-01

    The effects of Reynolds and Womersley numbers on the hemodynamics of two simplified intracranial aneurysms (IAs), that is, sidewall and bifurcation IAs, and a patient-specific IA are investigated using computational fluid dynamics. For this purpose, we carried out three numerical experiments for each IA with various Reynolds (Re = 145.45 to 378.79) and Womersley (Wo = 7.4 to 9.96) numbers. Although the dominant flow feature, which is the vortex ring formation, is similar for all test cases here, the propagation of the vortex ring is controlled by both Re and Wo in both simplified IAs (bifurcation and sidewall) and the patient-specific IA. The location of the vortex ring in all tested IAs is shown to be proportional to Re/Wo2 which is in agreement with empirical formulations for the location of a vortex ring in a tank. In sidewall IAs, the oscillatory shear index is shown to increase with Wo and 1/Re because the vortex reached the distal wall later in the cycle (higher resident time). However, this trend was not observed in the bifurcation IA because the stresses were dominated by particle trapping structures, which were absent at low Re = 151.51 in contrast to higher Re = 378.79. PMID:27847544

  7. Hypertrophic remodeling and increased arterial stiffness in patients with intracranial aneurysms.

    Science.gov (United States)

    Maltete, David; Bellien, Jeremy; Cabrejo, Lucie; Iacob, Michele; Proust, François; Mihout, Bruno; Thuillez, Christian; Guegan-Massardier, Evelyne; Joannides, Robinson

    2010-08-01

    Because an underlying arteriopathy might contribute to the development of intracranial aneurysms (IAs), we assessed the elastic properties of proximal conduit arteries in patients with IA. In 27 patients with previous ruptured IA and 27 control subjects matched for age, gender and BMI, we determined arterial pressure, internal diameter, intima-media thickness (IMT), circumferential wall stress (CWS) and elastic modulus (wall stiffness) in common carotid arteries using applanation tonometry and echotracking. Moreover, carotid augmentation index (AIx, arterial wave reflections) and carotid-to-femoral pulse wave velocity (PWV, aortic stiffness) were assessed. Compared with controls, patients with IA exhibited higher brachial and carotid systolic and diastolic blood pressures, with similar brachial but higher carotid artery pulse pressure (35 + or - 6mm Hg vs. 41 + or - 8mm Hg, P=0.014). Moreover, patients have higher PWV (7.8 + or - 1.2ms(-1) vs. 8.3 + or - 1.1ms(-1), P=0.048) and AIx (15.8 + or - 10.8% vs. 21.1 + or - 8.5%, PIA display a particular carotid artery phenotype with an exaggerated hypertrophic remodeling and altered elastic properties. Thus, a systemic arteriopathy might contribute, together with the arterial wall fatiguing effect of the increased pulsatile stress, to the pathogenesis of IA. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Association between NFKB1 -94 insertion/deletion ATTG polymorphism and risk of intracranial aneurysm.

    Science.gov (United States)

    Sima, Xiutian; Xu, Jianguo; Li, Jin; You, Chao

    2013-08-01

    Growing evidence indicates that vascular inflammation is a common phenomenon in the pathogenesis of intracranial aneurysms (IAs). Nuclear factor kappa B is a key molecule that is involved in the vascular inflammation of IA. We hypothesized that an insertion/deletion (ins/del) ATTG polymorphism located between two putative key promoter regulatory elements in the NFKB1 gene may be related to the risk of IA. We performed a case-control study, including 164 patients with IA and 525 healthy controls in a Chinese population using a polymerase chain reaction-polyacrylamide gel electrophoresis assay. A significantly decreased risk of IA was observed in the ATTG1/ATTG2 and ATTG2/ATTG2 genotypes compared with the ATTG1/ATTG1 genotype (ATTG1/ATTG2 vs. ATTG1/ATTG1: odds ratio [OR]=0.58, 95% confidence interval [95% CI]=0.39-0.87, p=0.007; ATTG2/ATTG2 vs. ATTG1/ATTG1: OR=0.12, 95% CI=0.06-0.23, p41, 95% CI=0.32-0.54, pIA.

  9. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Directory of Open Access Journals (Sweden)

    Pankaj K. Singh

    2009-01-01

    Full Text Available Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs is widely accepted. Computational fluid dynamics (CFD is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4 which was 63% (range 0–100% of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  10. Blood Pressure and Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease

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    Mariusz Niemczyk

    2014-12-01

    Full Text Available Background/Aims: Autosomal dominant polycystic kidney disease (ADPKD is correlated with an increased frequency of both intracranial aneurysms (ICANs, and arterial hypertension (AH. The aim of our study was to search for the association between blood pressure (BP and ICANs in ADPKD patients. Methods: Sixty-eight adult, pre-dialysis phase ADPKD patients underwent both screening for ICANs with magnetic resonance angiography of the brain, and ambulatory blood pressure monitoring (ABPM. Results: ICANs were diagnosed in 10 patients (ICAN(+ group, while in 58 were not (ICAN(- group. The nighttime maximum diastolic blood pressure (DBP, maximum increase in DBP from measurement to measurement (positive delta of DBP at night, and the standard deviation of the daytime mean arterial pressure were significantly higher in ICAN(+ compared to ICAN(- patients. Additionally, in a subgroup of patients after 45 years-of-age, ICAN(+ patients had significantly higher maximum 24-hour and daytime systolic blood pressure, maximum 24-hour, daytime, nighttime DBP, maximum daytime and nighttime positive delta of DBP compared to ICAN(- cases. Conclusions: Development of ICANs in hypertensive ADPKD patients is accompanied with higher values of some BP parameters measured by ABPM. Hypertensive ADPKD patients with substantial fluctuations in BP assessed by ABPM, especially those after 45 years-of-age, should become candidates for screening for ICANs.

  11. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Science.gov (United States)

    Singh, Pankaj K.; Marzo, Alberto; Coley, Stuart C.; Berti, Guntram; Bijlenga, Philippe; Lawford, Patricia V.; Villa-Uriol, Mari-Cruz; Rufenacht, Daniel A.; McCormack, Keith M.; Frangi, Alejandro; Patel, Umang J.; Hose, D. Rodney

    2009-01-01

    Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs) is widely accepted. Computational fluid dynamics (CFD) is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT) Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4) which was 63% (range 0–100%) of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject. PMID:19696903

  12. The role of computational fluid dynamics in the management of unruptured intracranial aneurysms: a clinicians' view.

    Science.gov (United States)

    Singh, Pankaj K; Marzo, Alberto; Coley, Stuart C; Berti, Guntram; Bijlenga, Philippe; Lawford, Patricia V; Villa-Uriol, Mari-Cruz; Rufenacht, Daniel A; McCormack, Keith M; Frangi, Alejandro; Patel, Umang J; Hose, D Rodney

    2009-01-01

    The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs) is widely accepted. Computational fluid dynamics (CFD) is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT) Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0-4) which was 63% (range 0-100%) of an expert user. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  13. Late-onset Pompe disease with complicated intracranial aneurysm: a Chinese case report

    Directory of Open Access Journals (Sweden)

    Zhang B

    2016-03-01

    Full Text Available Bin Zhang,1,2,* Yuying Zhao,1,3,* Junling Liu,1,4 Ling Li,1 Jingli Shan,1 Dandan Zhao,1 Chuanzhu Yan1,3 1Laboratory of Neuromuscular Disorders and Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, 2Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong, 3Department of Neurology, Qilu Hospital of Shandong University, Key Laboratory for Experimental Teratology of the Ministry of Education, Brain Science Research Institute, Shandong University, Jinan, Shandong, 4Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, People’s Republic of China *These authors contributed equally to this work Abstract: Pompe disease is a rare autosomal recessive hereditary disease caused by genetic defects of acid maltase. This disease could be divided into two forms: infantile and late-onset, which mainly affect cardiac, respiratory, and skeletal muscle systems. Late-onset patients mainly show symptoms of skeletal muscle involvement, but recent reports have found that the central nervous system was also affected in some patients. Herein, we report a case of a female, adolescent-onset Pompe patient, who was diagnosed with complicated intracranial aneurysm in adulthood. Keywords: Pompe disease, glycogen storage disease II, acid maltase, acid alpha-glucosidase, cerebrovascular disorders

  14. Impact of age on 30-day postoperative outcome of surgery for ruptured and unruptured intracranial aneurysms.

    Science.gov (United States)

    Alan, Nima; Seicean, Andreea; Seicean, Sinziana; Selman, Warren R; Bambakidis, Nicholas C

    2015-06-01

    To assess in a retrospective analysis of a prospectively collected database, the impact of increased age on 30-day postoperative outcomes of surgery for intracranial aneurysms (ICAs). 721 adult patients who underwent surgery for ICA were identified in the 2006-2012 American College of Surgeons' National Surgical Quality Improvement Program. Baseline characteristics and 30-day outcomes were stratified by age: 60 years (n=266). Patients 60 years. Logistic regression was used to examine the relationship between increased age and surgical outcome. In unadjusted analyses, age 60 years. Patients aged between 50 and 60 years were less likely to have complications (OR=0.6, 95% CI 0.4 to 0.8) in unadjusted analyses. Upon propensity score matching, covariate balance was achieved for all age strata. In adjusted analyses, patients 60. Age >60 is independently associated with 30-day postoperative morbidity in patients undergoing surgery for ICA. The results of this study suggest age >60 should be considered an a priori risk factor in surgical management of ICA, regardless of associated comorbidities often associated with increased age. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm.

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A; Tutino, Vincent M; Dou, Zhongwang; Siddiqui, Adnan H; Meng, Hui

    2017-12-01

    Computational fluid dynamics (CFD) is a promising tool to aid in clinical diagnoses of cardiovascular diseases. However, it uses assumptions that simplify the complexities of the real cardiovascular flow. Due to high-stakes in the clinical setting, it is critical to calculate the effect of these assumptions in the CFD simulation results. However, existing CFD validation approaches do not quantify error in the simulation results due to the CFD solver's modeling assumptions. Instead, they directly compare CFD simulation results against validation data. Thus, to quantify the accuracy of a CFD solver, we developed a validation methodology that calculates the CFD model error (arising from modeling assumptions). Our methodology identifies independent error sources in CFD and validation experiments, and calculates the model error by parsing out other sources of error inherent in simulation and experiments. To demonstrate the method, we simulated the flow field of a patient-specific intracranial aneurysm (IA) in the commercial CFD software star-ccm+. Particle image velocimetry (PIV) provided validation datasets for the flow field on two orthogonal planes. The average model error in the star-ccm+ solver was 5.63 ± 5.49% along the intersecting validation line of the orthogonal planes. Furthermore, we demonstrated that our validation method is superior to existing validation approaches by applying three representative existing validation techniques to our CFD and experimental dataset, and comparing the validation results. Our validation methodology offers a streamlined workflow to extract the "true" accuracy of a CFD solver.

  16. Large Eddy Simulation of "turbulent-like" flow in intracranial aneurysms

    Science.gov (United States)

    Khan, Muhammad Owais; Chnafa, Christophe; Steinman, David A.; Mendez, Simon; Nicoud, Franck

    2016-11-01

    Hemodynamic forces are thought to contribute to pathogenesis and rupture of intracranial aneurysms (IA). Recent high-resolution patient-specific computational fluid dynamics (CFD) simulations have highlighted the presence of "turbulent-like" flow features, characterized by transient high-frequency flow instabilities. In-vitro studies have shown that such "turbulent-like" flows can lead to lack of endothelial cell orientation and cell depletion, and thus, may also have relevance to IA rupture risk assessment. From a modelling perspective, previous studies have relied on DNS to resolve the small-scale structures in these flows. While accurate, DNS is clinically infeasible due to high computational cost and long simulation times. In this study, we present the applicability of LES for IAs using a LES/blood flow dedicated solver (YALES2BIO) and compare against respective DNS. As a qualitative analysis, we compute time-averaged WSS and OSI maps, as well as, novel frequency-based WSS indices. As a quantitative analysis, we show the differences in POD eigenspectra for LES vs. DNS and wavelet analysis of intra-saccular velocity traces. Differences in two SGS models (i.e. Dynamic Smagorinsky vs. Sigma) are also compared against DNS, and computational gains of LES are discussed.

  17. Bare platinum coils vs. HydroCoil in the treatment of unruptured intracranial aneurysms-A single center randomized controlled study.

    Science.gov (United States)

    Poncyljusz, Wojciech; Zarzycki, Artur; Zwarzany, Łukasz; Burke, Thomas H

    2015-02-01

    The HydroCoil Embolic System (HES) was developed to improve aneurysm filling to provide superior occlusion efficacy, reduce retreatment rates and enhance long-term durability. We performed a randomized clinical trial to compare the effectiveness of bare platinum coils (BPC) vs. HES for unruptured intracranial aneurysms. Ninety-six patients underwent endovascular coiling of unruptured intracranial aneurysms. The aneurysms were randomized equally to receive BPC or HES. Immediate angiographic results, number of coils used and complications were evaluated and all cases had 12-month follow-up angiography. Immediate angiographic results demonstrated that 84.0% of aneurysms treated with HES were completely occluded compared to 76.1% of aneurysms treated with BPC (p=0.3310). The mean number of coils utilized to fill the aneurysm was significantly lower in the HES arm (5.04 vs. 6.93). Additional adjunctive techniques were performed in 51.1% of all cases. There were seven patients (7.3%) with postoperative complications during the study period. The coil type used during the treatment did not demonstrate any significant differences on the overall recurrence rate (HES - 18.0%, BPC - 17.4%, p=0.9712). There was a statistically significant difference in the aneurysm size and the neck width between completely occluded aneurysms and aneurysms with residual flow in both immediate angiographic and mid-term follow-up. Overall, aneurysm size and neck width are the main risk factors associated with aneurysm recurrence. HES compared to BPC required less total number of coils to provide a denser aneurysm filling. However, there were equivocal results with both devices, at the mid-term angiographic follow-up. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. A comparison of 4D flow MRI-derived wall shear stress with computational fluid dynamics methods for intracranial aneurysms and carotid bifurcations - A review.

    Science.gov (United States)

    Szajer, Jeremy; Ho-Shon, Kevin

    2018-05-01

    4D flow MRI is a relatively quick method for obtaining wall shear stress (WSS) in vivo, a hemodynamic parameter which has shown promise in risk stratification for rupture of cerebrovascular diseases such as intracranial aneurysms and atherosclerotic plaques. The accuracy of such measurements is still largely unknown. To quantify the accuracy of 4D flow MRI-derived wall shear stress values for intracranial aneurysms and carotid bifurcations. We performed a review of all original research articles which compared the magnitudes of WSS derived from 4D flow MRI with corresponding values derived from computational fluid dynamics (CFD) within both intracranial aneurysms and carotid bifurcations. For intracranial aneurysms and carotid bifurcations, 4D flow MRI-derived WSS estimations are generally lower in magnitude compared to WSS derived by CFD methods. These differences are more pronounced in regions of higher WSS. However, the relative distributions of WSS derived from both methods are reasonably similar. Pooled analysis suggests that WSS magnitudes obtained by 4D flow MRI are underestimated, while the relative distribution is reasonably accurate, the latter being an important factor for determining the natural history of intracranial aneurysms and other cerebrovascular diseases. 4D flow MRI shows enormous potential in providing new risk stratification parameters which could have significant impact on individualized treatment decisions and improved patient outcomes. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  19. Methods and time schedule for follow-up of intracranial aneurysms treated with endovascular embolization: a systematic review.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

    2011-01-01

    To review the diagnostic value of angiographic methods and the optimal timetable for follow-up imaging of patients after endovascular treatment of intracranial aneurysms. A comprehensive computer-aided search for relevant primary papers was performed using the MEDLINE, PubMed, Embase, and Cochrane Collaboration database from January 1991 to March 2011. Original papers were included that reported either diagnostic value of angiographic modalities for follow-up vs. digital subtracted angiography (DSA) or comparison of aneurysm occlusion rate in delayed vs. early follow-up. The systematic review identified 35 relevant studies: 3 on the diagnostic value of three-dimensional (3D) DSA, 30 on the performance of magnetic resonance angiography (MRA), and 3 on time schedules for follow-up. 3D DSA had sensitivity of 100%, and specificity of 58.3-94.7%. Magnetic resonance angiography had sensitivity of 28.4-100%, and specificity of 50.0-100%. The proportion of aneurysms that recanalized between the early follow-up examination at 6 months and the delayed imaging at 1.5-6.0 years was 0-2.5%. Magnetic resonance angiography seems to be the best imaging method for the follow-up. In selected cases, when invasive angiography is necessary, 3D DSA should be considered to improve the diagnostic accuracy. Most patients who present with stable and adequate aneurysm occlusion at 6 months after coiling may not require further follow-up. Key words: intracranial aneurysm, embolization, coils, digital subtracted angiography, magnetic resonance, computed tomography.

  20. Delayed traumatic intracranial hematoma. In view of serial CT examinations

    Energy Technology Data Exchange (ETDEWEB)

    Tomita, Hiroki (Tokyo Medical and Dental Univ. (Japan). School of Medicine)

    1984-03-01

    CT was performed serially within 24 hours after head injury in 64 patients having Glasgow Coma Scale of 14 or less or cranial fracture shown on roentgenogram. Delayed traumatic extradural hematoma was observed within 7-12 hours after head injury in 6 cases (9.4%). This was prominent in the frontal and occipital regions (67%). Good recovery was seen in 83.3%. Delayed traumatic intracerebral hematoma was observed within 6-24 hours after head injury in 17 cases (26.6%). This higher incidence was related to contre coup injury. Conservative treatment was possible in 14 of the 17 patients (82.4%), showing good recovery in 70%.

  1. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

    NARCIS (Netherlands)

    M.C. Cnossen (Maryse); Huijben, J.A. (Jilske A.); van der Jagt, M. (Mathieu); Volovici, V. (Victor); van Essen, T. (Thomas); S. Polinder (Suzanne); D. Nelson (David); Ercole, A. (Ari); Stocchetti, N. (Nino); Citerio, G. (Giuseppe); W.C. Peul (Wilco); A.I.R. Maas (Andrew I.R.); D.K. Menon (David ); E.W. Steyerberg (Ewout W.); Lingsma, H.F. (Hester F.); Adams, H. (Hadie); Alessandro, M. (Masala); J.E. Allanson (Judith); Amrein, K. (Krisztina); Andaluz, N. (Norberto); N. Andelic (Nada); Andrea, N. (Nanni); L. Andreassen (Lasse); Anke, A. (Audny); Antoni, A. (Anna); Ardon, H. (Hilko); Audibert, G. (Gérard); Auslands, K. (Kaspars); Azouvi, P. (Philippe); Baciu, C. (Camelia); Bacon, A. (Andrew); Badenes, R. (Rafael); Baglin, T. (Trevor); R.H.M.A. Bartels (Ronald); P. Barzo (P.); Bauerfeind, U. (Ursula); R. Beer (Ronny); Belda, F.J. (Francisco Javier); B.-M. Bellander (Bo-Michael); A. Belli (Antonio); Bellier, R. (Rémy); H. Benali (Habib); Benard, T. (Thierry); M. Berardino (Maurizio); L. Beretta (Luigi); Beynon, C. (Christopher); Bilotta, F. (Federico); H. Binder (Harald); Biqiri, E. (Erta); Blaabjerg, M. (Morten); Lund, S.B. (Stine Borgen); Bouzat, P. (Pierre); Bragge, P. (Peter); Brazinova, A. (Alexandra); F. Brehar (Felix); Brorsson, C. (Camilla); Buki, A. (Andras); M. Bullinger (Monika); Bucková, V. (Veronika); Calappi, E. (Emiliana); P. Cameron (Peter); Carbayo, L.G. (Lozano Guillermo); Carise, E. (Elsa); K.L.H. Carpenter (Keri L.H.); Castaño-León, A.M. (Ana M.); Causin, F. (Francesco); Chevallard, G. (Giorgio); A. Chieregato (Arturo); G. Citerio (Giuseppe); Cnossen, M. (Maryse); M. Coburn (Mark); J.P. Coles (Jonathan P.); Cooper, J.D. (Jamie D.); Correia, M. (Marta); A. Covic (Amra); N. Curry (Nicola); E. Czeiter (Endre); M. Czosnyka (Marek); Dahyot-Fizelier, C. (Claire); F. Damas (François); P. Damas (Pierre); H. Dawes (Helen); De Keyser, V. (Véronique); F.D. Corte (Francesco); B. Depreitere (Bart); Ding, S. (Shenghao); D.W.J. Dippel (Diederik); K. Dizdarevic (Kemal); Dulière, G.-L. (Guy-Loup); Dzeko, A. (Adelaida); G. Eapen (George); Engemann, H. (Heiko); A. Ercole (Ari); P. Esser (Patrick); Ezer, E. (Erzsébet); M. Fabricius (Martin); V.L. Feigin (V.); Feng, J. (Junfeng); Foks, K. (Kelly); F. Fossi (Francesca); Francony, G. (Gilles); J. Frantzén (Janek); Freo, U. (Ulderico); S.K. Frisvold (Shirin Kordasti); Furmanov, A. (Alex); Gagliardo, P. (Pablo); D. Galanaud (Damien); G. Gao (Guoyi); K. Geleijns (Karin); A. Ghuysen (Alexandre); Giraud, B. (Benoit); Glocker, B. (Ben); Gomez, P.A. (Pedro A.); Grossi, F. (Francesca); R.L. Gruen (Russell); Gupta, D. (Deepak); J.A. Haagsma (Juanita); E. Hadzic (Ermin); I. Haitsma (Iain); J.A. Hartings (Jed); R. Helbok (Raimund); E. Helseth (Eirik); Hertle, D. (Daniel); S. Hill (Sean); Hoedemaekers, A. (Astrid); S. Hoefer (Stefan); P.J. Hutchinson (Peter J.); Håberg, K.A. (Kristine Asta); B.C. Jacobs (Bart); Janciak, I. (Ivan); K. Janssens (Koen); Jiang, J.-Y. (Ji-Yao); Jones, K. (Kelly); Kalala, J.-P. (Jean-Pierre); Kamnitsas, K. (Konstantinos); Karan, M. (Mladen); Karau, J. (Jana); A. Katila (Ari); M. Kaukonen (Maija); Keeling, D. (David); Kerforne, T. (Thomas); N. Ketharanathan (Naomi); Kettunen, J. (Johannes); Kivisaari, R. (Riku); A.G. Kolias (Angelos G.); Kolumbán, B. (Bálint); E.J.O. Kompanje (Erwin); D. Kondziella (Daniel); L.-O. Koskinen (Lars-Owe); Kovács, N. (Noémi); F. Kalovits (Ferenc); A. Lagares (Alfonso); L. Lanyon (Linda); S. Laureys (Steven); Lauritzen, M. (Martin); F.E. Lecky (Fiona); C. Ledig (Christian); R. Lefering; V. Legrand (Valerie); Lei, J. (Jin); L. Levi (Leon); R. Lightfoot (Roger); H.F. Lingsma (Hester); D. Loeckx (Dirk); Lozano, A. (Angels); Luddington, R. (Roger); Luijten-Arts, C. (Chantal); Maas, A.I.R. (Andrew I.R.); MacDonald, S. (Stephen); MacFayden, C. (Charles); M. Maegele; M. Majdan (Marek); Major, S. (Sebastian); A. Manara (Alex); Manhes, P. (Pauline); G. Manley (Geoffrey); Martin, D. (Didier); C. Martino (Costanza); Maruenda, A. (Armando); H. Maréchal (Hugues); Mastelova, D. (Dagmara); Mattern, J. (Julia); McMahon, C. (Catherine); Melegh, B. (Béla); Menon, D. (David); T. Menovsky (Tomas); Morganti-Kossmann, C. (Cristina); Mulazzi, D. (Davide); Mutschler, M. (Manuel); H. Mühlan (Holger); Negru, A. (Ancuta); Nelson, D. (David); E. Neugebauer (Eddy); V.F. Newcombe (Virginia F.); Noirhomme, Q. (Quentin); Nyirádi, J. (József); M. Oddo (Mauro); A.W. Oldenbeuving; M. Oresic (Matej); Ortolano, F. (Fabrizio); A. Palotie (Aarno); P.M. Parizel; Patruno, A. (Adriana); J.-F. Payen (Jean-François); Perera, N. (Natascha); V. Perlbarg (Vincent); Persona, P. (Paolo); Peul, W. (Wilco); N. Pichon (Nicolas); Piilgaard, H. (Henning); A. Piippo (Anna); S.P. Floury (Sébastien Pili); M. Pirinen (Matti); H. Ples (Horia); Polinder, S. (Suzanne); Pomposo, I. (Inigo); M. Psota (Marek); P. Pullens (Pim); L. Puybasset (Louis); A. Ragauskas (Arminas); R. Raj (Rahul); Rambadagalla, M. (Malinka); Rehorcíková, V. (Veronika); J.K.J. Rhodes (Jonathan K.J.); S. Richardson (Sylvia); S. Ripatti (Samuli); S. Rocka (Saulius); Rodier, N. (Nicolas); Roe, C. (Cecilie); Roise, O. (Olav); C.M.A.A. Roks (Gerwin); Romegoux, P. (Pauline); J. Rosand (Jonathan); Rosenfeld, J. (Jeffrey); C. Rosenlund (Christina); G. Rosenthal (Guy); R. Rossaint (Rolf); S. Rossi (Sandra); Rostalski, T. (Tim); D. Rueckert (Daniel); de Ruiz, A.F. (Arcaute Felix); M. Rusnák (Martin); Sacchi, M. (Marco); Sahakian, B. (Barbara); J. Sahuquillo (Juan); O. Sakowitz (Oliver); Sala, F. (Francesca); Sanchez-Pena, P. (Paola); Sanchez-Porras, R. (Renan); Sandor, J. (Janos); Santos, E. (Edgar); N. Sasse (Nadine); Sasu, L. (Luminita); Savo, D. (Davide); I.B. Schipper (Inger); Schlößer, B. (Barbara); S. Schmidt (Silke); Schneider, A. (Annette); H. Schoechl (Herbert); G.G. Schoonman; Rico, F.S. (Frederik Schou); E. Schwendenwein (Elisabeth); Schöll, M. (Michael); Sir, O. (özcan); T. Skandsen (Toril); Smakman, L. (Lidwien); D. Smeets (Dominique); Smielewski, P. (Peter); Sorinola, A. (Abayomi); E. Stamatakis (Emmanuel); S. Stanworth (Simon); Stegemann, K. (Katrin); Steinbüchel, N. (Nicole); R. Stevens (Robert); W. Stewart (William); E.W. Steyerberg (Ewout); N. Stocchetti (Nino); Sundström, N. (Nina); Synnot, A. (Anneliese); J. Szabó (József); J. Söderberg (Jeannette); F.S. Taccone (Fabio); Tamás, V. (Viktória); Tanskanen, P. (Päivi); A. Tascu (Alexandru); Taylor, M.S. (Mark Steven); Te, A.B. (Ao Braden); O. Tenovuo (Olli); Teodorani, G. (Guido); A. Theadom (Alice); Thomas, M. (Matt); D. Tibboel (Dick); C.M. Tolias (Christos M.); Tshibanda, J.-F.L. (Jean-Flory Luaba); Tudora, C.M. (Cristina Maria); P. Vajkoczy (Peter); Valeinis, E. (Egils); Hecke, W.V. (Wim Van); Praag, D.V. (Dominique Van); Dirk, V.R. (Van Roost); Vlierberghe, E.V. (Eline Van); Vyvere, T.V. (Thijs vande); Vanhaudenhuyse, A. (Audrey); A. Vargiolu (Alessia); E. Vega (Emmanuel); J. Verheyden (Jan); Vespa, P.M. (Paul M.); A. Vik (Anne); R. Vilcinis (Rimantas); Vizzino, G. (Giacinta); C.L.A.M. Vleggeert-Lankamp (Carmen); V. Volovici (Victor); P. Vulekovic (Peter); Vámos, Z. (Zoltán); Wade, D. (Derick); Wang, K.K.W. (Kevin K.W.); Wang, L. (Lei); E.D. Wildschut (Enno); G. Williams (Guy); Willumsen, L. (Lisette); Wilson, A. (Adam); Wilson, L. (Lindsay); Winkler, M.K.L. (Maren K.L.); P. Ylén (Peter); Younsi, A. (Alexander); M. Zaaroor (Menashe); Zhang, Z. (Zhiqun); Zheng, Z. (Zelong); Zumbo, F. (Fabrizio); de Lange, S. (Stefanie); G.C.W. De Ruiter (Godard C.W.); den Boogert, H. (Hugo); van Dijck, J. (Jeroen); T.A. van Essen (T.); C.M. van Heugten (Caroline M.); M. van der Jagt (Mathieu); J. van der Naalt (Joukje)

    2017-01-01

    textabstractBackground: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP)

  2. Lessons learned from whole exome sequencing in multiplex families affected by a complex genetic disorder, intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Janice L Farlow

    Full Text Available Genetic risk factors for intracranial aneurysm (IA are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES in seven densely-affected families (45 individuals recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B was differentially expressed in aneurysmal samples (n=44 as compared to control samples (n=16 (false discovery rate adjusted p-value=0.023. We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.

  3. Management of raised intracranial pressure in children with traumatic brain injury

    Science.gov (United States)

    Kukreti, Vinay; Mohseni-Bod, Hadi; Drake, James

    2014-01-01

    Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI). The current guidelines and management strategies are aimed at maintaining adequate cerebral perfusion pressure and treating elevated ICP. Despite controversies, ICP monitoring is important particularly after severe TBI to guide treatment and in developed countries is accepted as a standard of care. We provide a narrative review of the recent evidence for the use of ICP monitoring and management of ICP in pediatric TBI. PMID:25624921

  4. Patterns of Traumatic Intracranial Bleeds at Kenyatta National ...

    African Journals Online (AJOL)

    Valued eMachines Customer

    In China, the Incidence of traumatic brain injury was reported to be 56 per 100,000 populations in 19824, while in New South Wales Australia, the .... unemployment and crime levels. In the Bronx study, road traffic accidents ... Brain Injury due to head trauma in urban areas of the. People's Republic of China. Arch Neurol ...

  5. Differential effects of chromosome 9p21 variation on subphenotypes of intracranial aneurysm: site distribution.

    Science.gov (United States)

    Nakaoka, Hirofumi; Takahashi, Tomoko; Akiyama, Koichi; Cui, Tailin; Tajima, Atsushi; Krischek, Boris; Kasuya, Hidetoshi; Hata, Akira; Inoue, Ituro

    2010-08-01

    Recently, a genome-wide association study identified associations between single nucleotide polymorphisms on chromosome 9p21 and risk of harboring intracranial aneurysm (IA). Aneurysm characteristics or subphenotypes of IAs, such as history of subarachnoid hemorrhage, presence of multiple IAs and location of IAs, are clinically important. We investigated whether the association between 9p21 variation and risk of IA varied among these subphenotypes. We conducted a case-control study of 981 cases and 699 controls in Japanese. Four single nucleotide polymorphisms tagging the 9p21 risk locus were genotyped. The OR and 95% CI were estimated using logistic regression analyses. Among the 4 single nucleotide polymorphisms, rs1333040 showed the strongest evidence of association with IA (P=1.5x10(-6); per allele OR, 1.43; 95% CI, 1.24-1.66). None of the patient characteristics (gender, age, smoking, and hypertension) was a significant confounder or effect modifier of the association. Subgroup analyses of IA subphenotypes showed that among the most common sites of IAs, the association was strongest for IAs of the posterior communicating artery (OR, 1.69; 95% CI, 1.26-2.26) and not significant for IAs in the anterior communicating artery (OR, 1.22; 95% CI, 0.96-1.57). When dichotomizing IA sites, the association was stronger for IAs of the posterior circulation-posterior communicating artery group (OR, 1.73; 95% CI, 1.32-2.26) vs the anterior circulation group (OR, 1.28; 95% CI, 1.07-1.53). Heterogeneity in these ORs was significant (P=0.032). The associations did not vary when stratifying by history of subarachnoid hemorrhage (OR, 1.42; 95% CI, 1.18-1.71 for ruptured IA; OR, 1.27; 95% CI, 1.00-1.62 for unruptured IA) or by multiplicity of IA (OR, 1.57; 95% CI, 1.21-2.03 for multiple IAs; OR, 1.36; 95% CI, 1.15-1.61 for single IA). Our results suggest that genetic influence on formation may vary between IA subphenotypes.

  6. Aneurysm in the brain

    Science.gov (United States)

    ... gov/ency/article/001414.htm Aneurysm in the brain To use the sharing features on this page, ... aneurysm occurs in a blood vessel of the brain, it is called a cerebral, or intracranial, aneurysm. ...

  7. Anosmia after endovascular and open surgical treatment of intracranial aneurysms Clinical article

    NARCIS (Netherlands)

    Moman, Maaike R.; Verweij, Bon H.; Buwalda, Joeri; Rinkel, Gabriel J. E.

    Object. Patients treated for aneurysmal subarachnoid hemorrhage (SAH) often report a loss of smell. To discriminate between the effects of aneurysmal rupture and treatment, the authors assessed the occurrence of anosmia after clipping and coiling of unruptured aneurysms as well as after the coiling

  8. The Computational Fluid Dynamics Rupture Challenge 2013—Phase I: prediction of rupture status in intracranial aneurysms.

    Science.gov (United States)

    Janiga, G; Berg, P; Sugiyama, S; Kono, K; Steinman, D A

    2015-03-01

    Rupture risk assessment for intracranial aneurysms remains challenging, and risk factors, including wall shear stress, are discussed controversially. The primary purpose of the presented challenge was to determine how consistently aneurysm rupture status and rupture site could be identified on the basis of computational fluid dynamics. Two geometrically similar MCA aneurysms were selected, 1 ruptured, 1 unruptured. Participating computational fluid dynamics groups were blinded as to which case was ruptured. Participants were provided with digitally segmented lumen geometries and, for this phase of the challenge, were free to choose their own flow rates, blood rheologies, and so forth. Participants were asked to report which case had ruptured and the likely site of rupture. In parallel, lumen geometries were provided to a group of neurosurgeons for their predictions of rupture status and site. Of 26 participating computational fluid dynamics groups, 21 (81%) correctly identified the ruptured case. Although the known rupture site was associated with low and oscillatory wall shear stress, most groups identified other sites, some of which also experienced low and oscillatory shear. Of the 43 participating neurosurgeons, 39 (91%) identified the ruptured case. None correctly identified the rupture site. Geometric or hemodynamic considerations favor identification of rupture status; however, retrospective identification of the rupture site remains a challenge for both engineers and clinicians. A more precise understanding of the hemodynamic factors involved in aneurysm wall pathology is likely required for computational fluid dynamics to add value to current clinical decision-making regarding rupture risk. © 2015 by American Journal of Neuroradiology.

  9. Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up

    Directory of Open Access Journals (Sweden)

    Anna-Katharina Breu

    2016-01-01

    Full Text Available Flow diverters (FDs are designed for the endovascular treatment of complex intracranial aneurysm configurations. From February 2009 to March 2013 28 patients (22 females, 6 males were treated with FD; mean age was 57 years. Data, including aneurysm features, clinical presentation, history of previous bleeding, treatment, and follow-up results, are presented. Early postinterventional neurological deficits (transient: n=3/enduring: n=1 appeared in 4/28 patients (14%, and early improvement of neurological symptoms was observed in 7 patients with previous restriction of cranial nerve function. The overall occlusion rate was 20/26 (77%; 59% after 3 months. 77% achieved best results according to O’Kelly-Marotta score grade D with no contrast material filling (70% of those after 3 months. In 4/6 patients who did not achieve grade D, proximal and/or distal stent overlapping ≥5 mm was not guaranteed sufficiently. During follow-up we did not detect any aneurysm recurrence or haemorrhage. In-stent stenosis emerged as the most frequent complication (4/27; 15% followed by 2 cases of vascular obliteration (AICA/VA. In conclusion endovascular reconstruction using a FD represents a modern and effective treatment in those aneurysms that are not suitable for conventional interventional or surgical treatment. The appearance of severe complications was rare.

  10. Core curriculum case illustration: blunt traumatic thoracic aortic pseudo aneurysm.

    Science.gov (United States)

    Ramzan, Muhammad Mubashir; Fadl, Shaimaa Abdelhassib; Robinson, Jeffrey D

    2017-06-19

    Core Curriculum Illustration: [blunt thoracic aortic pseudo aneurysm]. This is the [40th] installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.html.

  11. Clinical and Angiographical Delayed Cerebral Vasospasms After Uncomplicated Surgical Clipping of Unruptured Intracranial Aneurysms: Illustrated Review and Two Case Reports.

    Science.gov (United States)

    Yang, Kuhyun; Ahn, Jae Sung; Park, Jung Cheol; Kwon, Do Hoon; Kwun, Byung Duk

    2015-01-01

    From January 2007 to April 2012, we performed 2427 surgical clippings for unruptured intracranial aneurysms (UIAs). Among these patients, two cases showed symptomatic and angiographic cerebral vasospasm in the delayed post-operative period without a complicated event. Additionally, we reviewed four cases of delayed cerebral vasospasms following uncomplicated operations that were consistent with our inclusion criteria in the previous literature. The pathogenesis and characteristics of these rare occurrences are reviewed from our two cases and previous literature. For clipping of UIAs, it should be kept mind that neurological symptoms are caused by delayed cerebral vasospasm, and careful observation with proper conservative treatment are necessary to ensure favorable outcomes.

  12. Screening for Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Survey of 420 Nephrologists.

    Directory of Open Access Journals (Sweden)

    Adrien Flahault

    Full Text Available Despite a high prevalence of intracranial aneurysm (ICA in autosomal dominant polycystic kidney disease (ADPKD, rupture events are rare. The current recommendations for ICA screening are based on expert opinions and studies with low levels of evidence.The aim of our study was to describe the attitudes of practicing nephrologists in Europe towards screening for ICA using magnetic resonance angiography (MRA.We conducted a web-based survey among 1315 European French-speaking nephrologists and nephrology residents. An anonymous, electronic questionnaire including 24 independent questions related to ICA screening modalities, indications and participant profiles was sent by email between September and December 2014. Four hundred and twenty nephrologists (mostly from France participated, including 31 nephrology residents; the response rate was 32%.Systematic screening for ICA was advocated by 28% of the nephrologists. A family history of ICA rupture, sudden death, stroke and migraine were consensual indications for screening (> 90% of the panel. In other clinical situations largely not covered by the recommendations (pregnancy, nephrectomy, kidney transplantation, cardiac or hepatic surgery, uncontrolled hypertension, lack of familial ADPKD history, at-risk activity, tobacco use, the attitudes towards screening were highly divergent. ICA screening was influenced by nephrologists experience with ADPKD and by their practice setting. The majority of participants (57% would not repeat a normal ICA screening. Only a few participants (22% knew that non-contrast MRA was the reference diagnostic tool for ICA screening, whereas most participants thought that contrast enhancement was necessary to screen for ICA. The results from the nephrology residents were analyzed separately and yielded similar results.This practice survey revealed that most nephrologists follow the current recommendations for the initial screening of ICAs. However, more than a quarter of the

  13. Relationship between intracranial aneurysms and the severity of autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Yoshida, Hiroki; Higashihara, Eiji; Maruyama, Keisuke; Nutahara, Kikuo; Nitatori, Toshiaki; Miyazaki, Isao; Shiokawa, Yoshiaki

    2017-12-01

    Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease characterized by the progressive enlargement of innumerable renal cysts. Although the association of intracranial aneurysms (ICANs) with ADPKD is well known, the relationship between the ICAN and the disease severity including total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) is poorly understood. We screened 265 patients with ADPKD (mean age, 48.8 years; range, 14.9-88.3 years) with MR angiography. The patients with a past history related to ICANs were excluded from the study. The incidence and characteristics of ICAN in patients with ADPKD were evaluated. TKV was measured by volumetric analyses of MR imaging. We detected 65 ICANs in 49 patients (37 women and 12 men, mean age, 52.7 years; range, 20.4-86 years). The incidence of ICANs was 18.5% and female patients had was higher incidence (23.1%) than male patients (11.4%) (p = 0.02). An age of those with ICANs was significantly higher than those without (p = 0.006), and the cumulative risk of diagnosis of ICANs increased with age. TKV was significantly larger in those with ICANs than those without (p = 0.001), but eGFR was not different between two groups (p = 0.07). By multivariate analyses, only TKV was significantly related to the development of ICANs (p = 0.02). The incidence of ICANs increased with age, was higher in females, and correlated with kidney enlargement in patients with ADPKD. Necessity of screening ICANs would be particularly high in elderly women with large kidneys.

  14. Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve.

    Science.gov (United States)

    Egbe, Alexander C; Padang, Ratnasari; Brown, Robert D; Khan, Arooj R; Luis, Sushil A; Huston, John; Akintoye, Emmanuel; Connolly, Heidi M

    2017-10-01

    To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV). Retrospective review of patients with BAV who underwent brain MR angiography at the Mayo Clinic from 1994 to 2013. There were 678 patients included in this study-mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients.There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (pIA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age ≤40 years versus 41-60 years (HR 1.19, p=0.34), and age 41-60 years versus 61-80 years (HR 1.06, p=0.56).Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up. BAV is associated with a higher prevalence of IA compared to the general population, and this risk is higher in patients with COA, right-left cusp fusion and female gender. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Search for intracranial aneurysm susceptibility gene(s using Finnish families

    Directory of Open Access Journals (Sweden)

    Ryynänen Markku

    2002-08-01

    Full Text Available Abstract Background Cerebrovascular disease is the third leading cause of death in the United States, and about one-fourth of cerebrovascular deaths are attributed to ruptured intracranial aneurysms (IA. Epidemiological evidence suggests that IAs cluster in families, and are therefore probably genetic. Identification of individuals at risk for developing IAs by genetic tests will allow concentration of diagnostic imaging on high-risk individuals. We used model-free linkage analysis based on allele sharing with a two-stage design for a genome-wide scan to identify chromosomal regions that may harbor IA loci. Methods We previously estimated sibling relative risk in the Finnish population at between 9 and 16, and proceeded with a genome-wide scan for loci predisposing to IA. In 85 Finnish families with two or more affected members, 48 affected sibling pairs (ASPs were available for our genetic study. Power calculations indicated that 48 ASPs were adequate to identify chromosomal regions likely to harbor predisposing genes and that a liberal stage I lod score threshold of 0.8 provided a reasonable balance between detection of false positive regions and failure to detect real loci with moderate effect. Results Seven chromosomal regions exceeded the stage I lod score threshold of 0.8 and five exceeded 1.0. The most significant region, on chromosome 19q, had a maximum multipoint lod score (MLS of 2.6. Conclusions Our study provides evidence for the locations of genes predisposing to IA. Further studies are necessary to elucidate the genes and their role in the pathophysiology of IA, and to design genetic tests.

  16. RNF213 Is Associated with Intracranial Aneurysms in the French-Canadian Population.

    Science.gov (United States)

    Zhou, Sirui; Ambalavanan, Amirthagowri; Rochefort, Daniel; Xie, Pingxing; Bourassa, Cynthia V; Hince, Pascale; Dionne-Laporte, Alexandre; Spiegelman, Dan; Gan-Or, Ziv; Mirarchi, Cathy; Zaharieva, Vessela; Dupré, Nicolas; Kobayashi, Hatasu; Hitomi, Toshiaki; Harada, Kouji; Koizumi, Akio; Xiong, Lan; Dion, Patrick A; Rouleau, Guy A

    2016-11-03

    Intracranial aneurysms (IAs) are the result of focal weakness in the artery wall and have a complex genetic makeup. To date, genome-wide association and sequencing studies have had limited success in identifying IA risk factors. Distinct populations, such as the French-Canadian (FC) population, have increased IA prevalence. In our study, we used exome sequencing to prioritize risk variants in a discovery cohort of six FC families affected by IA, and the analysis revealed an increased variation burden for ring finger protein 213 (RNF213). We resequenced RNF213 in a larger FC validation cohort, and association tests on further identified variants supported our findings (SKAT-O, p = 0.006). RNF213 belongs to the AAA+ protein family, and two variants (p.Arg2438Cys and p.Ala2826Thr) unique to affected FC individuals were found to have increased ATPase activity, which could lead to increased risk of IA by elevating angiogenic activities. Common SNPs in RNF213 were also extracted from the NeuroX SNP-chip genotype data, comprising 257 FC IA-affected and 1,988 control individuals. We discovered that the non-ancestral allele of rs6565666 was significantly associated with the affected individuals (p = 0.03), and it appeared as though the frequency of the risk allele had changed through genetic drift. Although RNF213 is a risk factor for moyamoya disease in East Asians, we demonstrated that it might also be a risk factor for IA in the FC population. It therefore appears that the function of RNF213 can be differently altered to predispose distinct populations to dissimilar neurovascular conditions, highlighting the importance of a population's background in genetic studies of heterogeneous disease. Copyright © 2016. Published by Elsevier Inc.

  17. Preoperative simulation for the planning of microsurgical clipping of intracranial aneurysms.

    Science.gov (United States)

    Marinho, Paulo; Vermandel, Maximilien; Bourgeois, Philippe; Lejeune, Jean-Paul; Mordon, Serge; Thines, Laurent

    2014-12-01

    The safety and success of intracranial aneurysm (IA) surgery could be improved through the dedicated application of simulation covering the procedure from the 3-dimensional (3D) description of the surgical scene to the visual representation of the clip application. We aimed in this study to validate the technical feasibility and clinical relevance of such a protocol. All patients preoperatively underwent 3D magnetic resonance imaging and 3D computed tomography angiography to build 3D reconstructions of the brain, cerebral arteries, and surrounding cranial bone. These 3D models were segmented and merged using Osirix, a DICOM image processing application. This provided the surgical scene that was subsequently imported into Blender, a modeling platform for 3D animation. Digitized clips and appliers could then be manipulated in the virtual operative environment, allowing the visual simulation of clipping. This simulation protocol was assessed in a series of 10 IAs by 2 neurosurgeons. The protocol was feasible in all patients. The visual similarity between the surgical scene and the operative view was excellent in 100% of the cases, and the identification of the vascular structures was accurate in 90% of the cases. The neurosurgeons found the simulation helpful for planning the surgical approach (ie, the bone flap, cisternal opening, and arterial tree exposure) in 100% of the cases. The correct number of final clip(s) needed was predicted from the simulation in 90% of the cases. The preoperatively expected characteristics of the optimal clip(s) (ie, their number, shape, size, and orientation) were validated during surgery in 80% of the cases. This study confirmed that visual simulation of IA clipping based on the processing of high-resolution 3D imaging can be effective. This is a new and important step toward the development of a more sophisticated integrated simulation platform dedicated to cerebrovascular surgery.

  18. Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis.

    Science.gov (United States)

    Ferreira, Cesar Biselli; Bassi, Estevão; Lucena, Lucas; Carreta, Hernandez; Miranda, Leandro Costa; Tierno, Paulo Fernando Guimarães Mazorcchi; Amorim, Robson Luis; Zampieri, Fernando Godinho; Malbouisson, Luis Marcelo Sá

    2015-01-01

    To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients. Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm). Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups. Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.

  19. The New Low-Profile WEB 17 System for Treatment of Intracranial Aneurysms: First Clinical Experiences.

    Science.gov (United States)

    van Rooij, S B T; Peluso, J P; Sluzewski, M; Kortman, H G; van Rooij, W J

    2018-03-22

    The Woven EndoBridge (WEB) is an intrasaccular flow diverter intended to treat wide-neck aneurysms. The latest generation WEBs needed a 0.021-inch microcatheter in the small sizes. Recently, a lower profile range of WEBs compliant with a 0.017-inch microcatheter (WEB 17) has been introduced. We present the first clinical results of treatment of both ruptured and unruptured aneurysms with the WEB 17. Between December 2016 and September 2017, forty-six aneurysms in 40 patients were treated with the WEB 17. No supporting stents or balloons were used. Twenty-five aneurysms were ruptured (54%). There were 6 men and 34 women (mean age, 62 years; median, 63 years; range, 46-87 years). The mean aneurysm size was 4.9 mm (median, 5 mm; range, 2-7 mm). There were 2 thromboembolic procedural complications without clinical sequelae and no ruptures. The overall permanent procedural complication rate was 0% (0 of 40; 97.5% CI, 0%-10.4%). Imaging follow-up at 3 months was available in 33 patients with 39 aneurysms (97.5% of 40 eligible aneurysms). In 1 aneurysm, the detached WEB was undersized and the remnant was additionally treated with coils after 1 week. This same aneurysm reopened at 3 months and was again treated with a second WEB. One other aneurysm showed persistent WEB filling at 3 months. Complete occlusion was achieved in 28 of 39 aneurysms (72%), and 9 aneurysms (23%) showed a neck remnant. The WEB 17 is safe and effective for both ruptured and unruptured aneurysms. The WEB 17 is a valuable addition to the existing WEB size range, especially for very small aneurysms. © 2018 by American Journal of Neuroradiology.

  20. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro, Angelo; Byrne, James V. [ohn Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, Oxford (United Kingdom); Rane, Neil; Kueker, Wilhelm; Cellerini, Martino; Corkill, Rufus [John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2014-01-15

    This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow diverter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent; six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR; in one case, failure was attributed to suboptimal position of the stent; in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded; none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause. (orig.)

  1. Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study.

    Directory of Open Access Journals (Sweden)

    James V Byrne

    Full Text Available INTRODUCTION: Flow diversion is a new approach to the endovascular treatment of intracranial aneurysms which uses a high density mesh stent to induce sac thrombosis. These devices have been designed for the treatment of complex shaped and large size aneurysms. So far published safety and efficacy data on this approach is sparse. MATERIAL AND METHODS: Over 8 months, standardized clinical and angiographic data were collected on 70 patients treated with a flow diverter device (SILK flow diverter (SFD in 18 centres worldwide. Treatment and early follow up details were audited centrally. SFDs were deployed alone in 57 (81% or with endosaccular coils in 10 (14% aneurysms, which included: 44 (63% saccular, 26 (37% fusiform shapes and 18 (26% small, 37 (53% large, 15 (21% giant sizes. Treatment outcome data up to 30 days were reported for all patients, with clinical (50 patients and imaging (49 patients follow up (median 119 days data available. RESULTS: Difficulties in SFD deployment were reported in 15 (21% and parent artery thrombosis in 8 (11% procedures. Procedural complications caused stroke in 1 and serious extracranial bleeding in 3 patients; 2 of whom developed fatal pneumonias. Delayed worsening of symptoms occurred in 5 patients (3 transient, 1 permanent neurological deficit, and 1 death and fatal aneurysm bleeding in 1 patient. Overall permanent morbidity rates were 2 (4% and mortality 4 (8%. Statistical analysis revealed no significant association between complications and variables related to treated aneurysm morphology or rupture status. CONCLUSION: This series is the largest reporting outcome of the new treatment approach and provides data for future study design. Procedural difficulties in SFD deployment were frequent and anti-thrombosis prophylaxis appears to reduce the resulting clinical sequelae, but at the cost of morbidity due to extracranial bleeding. Delayed morbidity appears to be a consequence of the new approach and warrants

  2. Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

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    Serafin, Zbigniew; Strzesniewski, Piotr; Lasek, Wladyslaw [Nicolaus Copernicus University, Department of Radiology and Diagnostic Imaging, Collegium Medicum, Bydgoszcz (Poland); Beuth, Wojciech [University of Humanities and Economics in Wloclawek, Faculty of Health Sciences, Wloclawek (Poland)

    2012-12-15

    The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA). Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T. There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 {+-} 19.0 mm{sup 3} in TOF-MRA to 30.5 {+-} 44.6 mm{sup 3} in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA. TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization. (orig.)

  3. Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

    International Nuclear Information System (INIS)

    Serafin, Zbigniew; Strzesniewski, Piotr; Lasek, Wladyslaw; Beuth, Wojciech

    2012-01-01

    The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA). Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T. There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 ± 19.0 mm 3 in TOF-MRA to 30.5 ± 44.6 mm 3 in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA. TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization. (orig.)

  4. Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

    2012-12-01

    The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA). Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T. There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 ± 19.0 mm(3) in TOF-MRA to 30.5 ± 44.6 mm(3) in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA. TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization.

  5. MR derived volumetric flow rate waveforms of internal carotid artery in patients treated for unruptured intracranial aneurysms by flow diversion technique.

    Science.gov (United States)

    Eker, Omer F; Boudjeltia, Karim Zouaoui; Jerez, Ricardo A Corredor; Le Bars, Emmanuelle; Sanchez, Mathieu; Bonafé, Alain; Costalat, Vincent; Courbebaisse, Guy

    2015-12-01

    Little is known about the hemodynamic disturbances induced by the cerebral aneurysms in the parent artery and the effect of flow diverter stents (FDS) on these latter. A better understanding of the aneurysm-parent vessel complex relationship may aid our understanding of this disease and to optimize its treatment. The ability of volumetric flow rate (VFR) waveform to reflect the arterial compliance modifications is well known. By analyzing the VFR waveform and the pulsatility in the parent vessel, this study aimed to test the hypotheses that (1) intracranial aneurysms might disrupt the blood flow of the parent vessel and (2) the treatment by FDS might have measurable corrective effect on these changes. Ten patients followed for unruptured intracranial aneurysms treated by FDS and ten healthy volunteers as control group were included in this study. Two-dimensional quantitative phase-contrast magnetic resonance imaging (MRI) was performed on each patient on the ICA artery upstream and downstream to the aneurysm, and on each volunteer at similar locations. The aneurysms altered significantly the parent vessel pulsatility and this effect was correlated to their volume. The aneurysms treatment by FDS allowed for the restoration of a normally modulated flow and pulsatility correction in the parent vessel.

  6. Experimental and CFD flow studies in an intracranial aneurysm model with Newtonian and non-Newtonian fluids.

    Science.gov (United States)

    Frolov, S V; Sindeev, S V; Liepsch, D; Balasso, A

    2016-05-18

    According to the clinical data, flow conditions play a major role in the genesis of intracranial aneurysms. The disorder of the flow structure is the cause of damage of the inner layer of the vessel wall, which leads to the development of cerebral aneurysms. Knowledge of the alteration of the flow field in the aneurysm region is important for treatment. The aim is to study quantitatively the flow structure in an patient-specific aneurysm model of the internal carotid artery using both experimental and computational fluid dynamics (CFD) methods with Newtonian and non-Newtonian fluids. A patient-specific geometry of aneurysm of the internal carotid artery was used. Patient data was segmented and smoothed to obtain geometrical model. An elastic true-to-scale silicone model was created with stereolithography. For initial investigation of the blood flow, the flow was visualized by adding particles into the silicone model. The precise flow velocity measurements were done using 1D Laser Doppler Anemometer with a spatial resolution of 50 μ m and a temporal resolution of 1 ms. The local velocity measurements were done at a distance of 4 mm to each other. A fluid with non-Newtonian properties was used in the experiment. The CFD simulations for unsteady-state problem were done using constructed hexahedral mesh for Newtonian and non-Newtonian fluids. Using 1D laser Doppler Anemometer the minimum velocity magnitude at the end of systole -0.01 m/s was obtained in the aneurysm dome while the maximum velocity 1 m/s was at the center of the outlet segment. On central cross section of the aneurysm the maximum velocity value is only 20% of the average inlet velocity. The average velocity on the cross-section is only 11% of the inlet axial velocity. Using the CFD simulation the wall shear stresses for Newtonian and non-Newtonian fluid at the end of systolic phase (t= 0.25 s) were computed. The wall shear stress varies from 3.52 mPa (minimum value) to 10.21 Pa (maximum value) for the

  7. Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics

    International Nuclear Information System (INIS)

    Isoda, Haruo; Sakahara, Harumi; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J.; Namba, Hiroki

    2010-01-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to compare hemodynamics of intracranial aneurysms of MR fluid dynamics (MRFD) using 3D cine PC MR imaging (4D-Flow) at 1.5 T and MR-based computational fluid dynamics (CFD). 4D-Flow was performed for five intracranial aneurysms by a 1.5 T MR scanner. 3D TOF MR angiography was performed for geometric information. The blood flow in the aneurysms was modeled using CFD simulation based on the finite element method. We used MR angiographic data as the vascular models and MR flow information as boundary conditions in CFD. 3D velocity vector fields, 3D streamlines, shearing velocity maps, wall shear stress (WSS) distribution maps and oscillatory shear index (OSI) distribution maps were obtained by MRFD and CFD and were compared. There was a moderate to high degree of correlation in 3D velocity vector fields and a low to moderate degree of correlation in WSS of aneurysms between MRFD and CFD using regression analysis. The patterns of 3D streamlines were similar between MRFD and CFD. The small and rotating shearing velocities and higher OSI were observed at the top of the spiral flow in the aneurysms. The pattern and location of shearing velocity in MRFD and CFD were similar. The location of high oscillatory shear index obtained by MRFD was near to that obtained by CFD. MRFD and CFD of intracranial aneurysms correlated fairly well. (orig.)

  8. Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study.

    Science.gov (United States)

    Picetti, Edoardo; Caspani, Maria Luisa; Iaccarino, Corrado; Pastorello, Giulia; Salsi, Pierpaolo; Viaroli, Edoardo; Servadei, Franco

    2017-04-01

    Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation. Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC. A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%). Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

  9. The prognostic reliability of intracranial pressure monitoring and MRI data in severe traumatic brain injury.

    Science.gov (United States)

    Woischneck, Dieter; Kapapa, Thomas

    2017-02-01

    The predictive quality of intracranial pressure (ICP) monitoring has for many years been a matter of debate. We correlate ICP data comparing MRI data with the outcome after severe traumatic brain injury to evaluate their prognostic potency. This study compares the results of ICP monitoring, MRI, coma duration and outcome according to Glasgow Outcome Scale obtained in 32 patients having suffered severe TBI. Level of significance was set to p≤0.05 in statistical tests. The MRI results were closely correlated with coma duration and Glasgow Outcome Scale, but the ICP measurements were not. With the exception of severe, bipontine lesions, there is no other region of the brain in which increased evidence of traumatogenic lesions emerges as the intracranial pressure rises. Just bipontine lesions that proof to be infaust correlate with elevated ICP values. ICP monitoring does not allow individual prognostic conclusions to be made. Implantation of an intracranial pressure sensor alone for making a prognostic estimate is not advisable. The use of intracranial pressure measurements in the retrospective appraisal of disease progress is highly problematic. However, MRI diagnostic in patients with severe TBI improves prognostic potency of clinical parameters. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Association between polymorphism of SMAD3 gene and risk of sporadic intracranial arterial aneurysms in the Chinese Han population.

    Science.gov (United States)

    Liao, Mao-Fan; Gong, Qiu-Wen; Liu, Liang; Xiong, Xiao-Yi; Zhang, Qin; Gong, Chang-Xiong; Yang, Qing-Wu

    2018-01-01

    Intracranial arterial aneurysms (IAAs) are locally abnormal dilations of the cerebral arteries and often result in subarachnoid hemorrhages (SAH). Genetic, molecular and cellular mechanisms of sporadic IAAs forms are poorly understood. In this study, we investigate the association between mothers against decapentaplegic homolog 3 (SMAD3) genotypes and the risk of sporadic intracranial arterial aneurysms among the Chinese Han population. A case-control study was conducted examining 330 IAA patients and 313 controls. There were eight single nucleotide polymorphisms of SMAD3 selected and genotyped using the polymerase chain reaction-ligase detection reaction (PCR-LDR) method. Our results indicated that SMAD3 rs1065080 polymorphism was associated with a risk of IAAs in a codominant model (GA vs GG, OR=1.433; 95% CI 1.030-1.994; P=0.032). In summary, we observed that SMAD3 rs1065080 single nucleotide gene polymorphisms were significantly associated with patient susceptibility to IAAs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Quantifying unruptured giant intracranial aneurysms by measuring diameter and volume--a comparative analysis of 69 cases.

    Science.gov (United States)

    Dengler, Julius; Maldaner, Nicolai; Bijlenga, Philippe; Burkhardt, Jan-Karl; Graewe, Alexander; Guhl, Susanne; Nakamura, Makoto; Hohaus, Christian; Kursumovic, Adisa; Schmidt, Nils Ole; Schebesch, Karl-Michael; Wostrack, Maria; Vajkoczy, Peter; Mielke, Dorothee

    2015-03-01

    Intracranial aneurysms (IA) are usually quantified according to their largest diameter. However, volumetry has recently been increasingly conducted as well, especially in giant intracranial aneurysms (GIAs). Since so far the true value of GIA volumetry is unknown, we designed a trial to examine correlations between GIA diameter and volume with special focus on clinical implications. Magnetic resonance imaging of 69 unruptured GIAs in 66 patients was retrospectively evaluated. The largest diameter and volume were measured. Also, potential associations to the patients' clinical conditions were examined. Comparing GIA sizes of our patient cohort produced different results depending on whether GIA diameter or volume was measured. Measuring the diameter identified posterior circulation GIAs as the largest ones (39.2 mm, IQR 37.3-48.3), while measuring the volume found GIAs of the MCA to be the largest ones (12.3 cm(3), IQR 7.2-27.8). A correlation of GIA diameter and volume was only found in anterior circulation GIAs, which were predominantly saccular in shape, but not in those of the posterior circulation, of which most were fusiform. Neither GIA diameter nor GIA volume but only GIA location was associated with neurological deficits. Diameter and volume measurements are not interchangeable modes of GIA quantification. Our data suggest that the idea of distinguishing different sizes of GIA may be clinically less relevant than examining their location, shape or mass effect.

  12. 3D Printing of Intracranial Aneurysms Using Fused Deposition Modeling Offers Highly Accurate Replications.

    Science.gov (United States)

    Frölich, A M J; Spallek, J; Brehmer, L; Buhk, J-H; Krause, D; Fiehler, J; Kemmling, A

    2016-01-01

    As part of a multicenter cooperation (Aneurysm-Like Synthetic bodies for Testing Endovascular devices in 3D Reality) with focus on implementation of additive manufacturing in neuroradiologic practice, we systematically assessed the technical feasibility and accuracy of several additive manufacturing techniques. We evaluated the method of fused deposition modeling for the production of aneurysm models replicating patient-specific anatomy. 3D rotational angiographic data from 10 aneurysms were processed to obtain volumetric models suitable for fused deposition modeling. A hollow aneurysm model with connectors for silicone tubes was fabricated by using acrylonitrile butadiene styrene. Support material was dissolved, and surfaces were finished by using NanoSeal. The resulting models were filled with iodinated contrast media. 3D rotational angiography of the models was acquired, and aneurysm geometry was compared with the original patient data. Reproduction of hollow aneurysm models was technically feasible in 8 of 10 cases, with aneurysm sizes ranging from 41 to 2928 mm(3) (aneurysm diameter, 3-19 mm). A high level of anatomic accuracy was observed, with a mean Dice index of 93.6% ± 2.4%. Obstructions were encountered in vessel segments of modeling is a promising technique, which allows rapid and precise replication of cerebral aneurysms. The porosity of the models can be overcome by surface finishing. Models produced with fused deposition modeling may serve as educational and research tools and could be used to individualize treatment planning. © 2016 by American Journal of Neuroradiology.

  13. Endovascular treatment of unruptured wide-necked intracranial aneurysms: comparison of dual microcatheter technique and stent-assisted coil embolization.

    Science.gov (United States)

    Starke, Robert M; Durst, Christopher R; Evans, Avery; Ding, Dale; Raper, Daniel M S; Jensen, Mary E; Crowley, Richard W; Liu, Kenneth C

    2015-04-01

    Endovascular treatment of wide-necked aneurysms is challenging. Stent-assisted coiling (SAC) is associated with increased complications and requires dual antiplatelet therapy. To compare treatment of unruptured, wide-necked aneurysms with a dual-microcatheter technique (DMT) versus SAC. Between 2006 and 2011, 100 patients with unruptured wide-necked intracranial aneurysms were treated with DMT and 160 with SAC. Over time there was a significant decrease in the use of SAC and a corresponding increase in DMT. The investigators matched 60 patients treated with DMT blinded to outcome in a 1:2 fashion based on maximal aneurysm dome diameter with 120 patients treated with SAC. Outcomes were determined with conditional (matched) multivariate analysis. There were no significant differences in patient or aneurysm characteristics between cohorts, including aneurysm diameter, neck width, or volume. Overall packing density and coil volume achieved was not significantly different between cohorts. There were higher rates of overall complications in those receiving SAC (19.2%) compared with DMT (5.0%; p=0.012), but no significant difference in major complications (8.3% vs 1.7%, respectively; p=0.103). At a mean follow-up of 27.0 ± 18.9 months, rates of retreatment did not differ between DMT (15.1%) and SAC (17.7%). Delayed in-stent stenosis occurred in five patients and in-stent thrombosis in four patients treated with SAC. There was no difference in favorable functional outcome (modified Rankin score 0-2) between those treated with DMT (90.6%) compared with SAC (91.2%). DMT and SAC are effective endovascular approaches for unruptured, wide-necked aneurysms; however, DMT may result in less morbidity. Further long-term studies are necessary to determine the optimal indications for these treatment options. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage.

    Science.gov (United States)

    Vaiman, Michael; Sigal, Tal; Kimiagar, Itzhak; Bekerman, Inessa

    2016-12-01

    The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6±0.8mm (cut-off value >5.5mm; pintracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Early Craniectomy Improves Intracranial and Cerebral Perfusion Pressure after Severe Traumatic Brain Injury.

    Science.gov (United States)

    Allen, Casey J; Baldor, Daniel J; Hanna, Mena M; Namias, Nicholas; Bullock, M Ross; Jagid, Jonathan R; Proctor, Kenneth G

    2018-03-01

    After traumatic brain injury, decompressive craniectomy (DC) is a second-tier, late therapy for refractory intracranial hypertension. We hypothesize that early DC, based on CT evidence of intracranial hypertension, improves intracranial pressure (ICP) and cerebral perfusion pressure (CPP). From September 2008 to January 2015, 286 traumatic brain injury patients requiring invasive ICP monitoring at a single Level I trauma center were reviewed. DC and non-DC patients were propensity score matched 1:1, based on demographics, hemodynamics, injury severity score (ISS), Glasgow Coma Scale (GCS), transfusion requirements, and need for vasopressor therapy. Data are presented as M ± SD or median (IQR) and compared at P ≤ 0.05. The study population was 42 ± 17 years, 84 per cent male, ISS = 29 ± 11, GCS = 6(5), length of stay (LOS) = 32(40) days, and 28 per cent mortality. There were 116/286 (41%) DC, of which 105/116 (91%) were performed at the time of ICP placement. For 50 DC propensity matched to 50 non-DC patients, the midline shift was 7(11) versus 0(5) mm (P 20 mm Hg) was 1(10) versus 8(16) (P = 0.017), abnormal CPP (hours < 60 mm Hg) was 0(6) versus 4(9) (P = 0.008), daily minimum CPP (mm Hg) was 67(13) versus 62(17) (P = 0.010), and daily maximum ICP (mm Hg) was 18(9) versus 22(11) (P < 0.001). However, LOS [33(37) versus 25(34) days], mortality (24 versus 30%), and Glasgow Outcome Score Extended [3.0(3.0) versus 3.0(4.0)] did not improve significantly. Early DC for CT evidence of intracranial hypertension decreased abnormal ICP and CPP time and improved ICP and CPP thresholds, but had no obvious effect on the outcome.

  16. Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety

    International Nuclear Information System (INIS)

    Ferns, Sandra P.; Nieuwkerk, Pythia T.; Majoie, Charles B.L.M.; Rooij, Willem Jan J. van; Rinkel, Gabriel J.E.

    2011-01-01

    Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms. Of 162 patients participating in a long-term (>4.5 years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age. Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38 56%) at baseline and 42 of 100 patients (42%; 95%CI32 52%) at 3 months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9 67%) and 27% (95%CI4 50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH. Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3 months. (orig.)

  17. Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety

    Energy Technology Data Exchange (ETDEWEB)

    Ferns, Sandra P.; Nieuwkerk, Pythia T.; Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Rooij, Willem Jan J. van [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Rinkel, Gabriel J.E. [University Medical Center, Department of Neurology, Rudolf Magnus Institute of Neuroscience, Utrecht (Netherlands)

    2011-05-15

    Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms. Of 162 patients participating in a long-term (>4.5 years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age. Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38<->56%) at baseline and 42 of 100 patients (42%; 95%CI32<->52%) at 3 months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9<->67%) and 27% (95%CI4<->50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH. Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3 months. (orig.)

  18. Safety and efficiency of flow diverters for treating small intracranial aneurysms: A systematic review and meta-analysis.

    Science.gov (United States)

    Yao, Xiyang; Ma, Junwei; Li, Haiying; Shen, Haitao; Lu, Xiaojun; Chen, Gang

    2017-02-01

    Background We evaluated the safety and efficiency of flow diverters (FDs) in treating small intracranial aneurysms (IAs). Materials and Methods We reviewed the literature published in PubMed and EMBASE. R for Project software was used to calculate the complete aneurysm occlusion rates, procedure-related neurologic mortality, procedure-related neurologic morbidity and procedure-related permanent morbidity. Results Ten observational studies were included in this analysis. The complete aneurysm occlusion rate was 84.23% (80.34%-87.76%), the procedure-related neurologic mortality was 0.87% (0.29%-1.74%), the procedure-related neurologic morbidity rate was 5.22% (3.62%-7.1%), the intracerebral haemorrhage rate was 1.42% (0.64%-2.49%), the ischemic rate was 2.35% (1.31%-3.68%), the subarachnoid haemorrhage rate was 0.03% (0%-0.32%) and the procedure-related permanent morbidity was 2.41% (0.81%-4.83%). Conclusions Treatment of small IAs with FDs may be correlated with high complete occlusion rates and low complication rates. Future long-term follow-up randomized trials will determine the optimal treatment for small IAs.

  19. Optimal Guiding Catheter Length for Endovascular Coiling of Intracranial Aneurysms in Anterior Circulation in Era of Flourishing Distal Access System.

    Science.gov (United States)

    Jia, Zhen Yu; Lee, Sang Hun; Kim, Young Eun; Choi, Joon Ho; Hwang, Sun Moon; Lee, Ga Young; Youn, Jin Ho; Lee, Deok Hee

    2017-09-01

    To determine the minimum required guiding catheter length for embolization of various intracranial aneurysms in anterior circulation and to analyze the effect of various patient factors on the required catheter length and potential interaction with its stability. From December 2016 to March 2017, 90 patients with 93 anterior circulation aneurysms were enrolled. Three types of guiding catheters (Envoy, Envoy DA, and Envoy DA XB; Codman Neurovascular, Raynham, MA, USA) were used. We measured the in-the-body length of the catheter and checked the catheter tip location in the carotid artery. We analyzed factors affecting the in-the-body length and stability of the guiding catheter system. The average (±standard deviation) in-the-body length of the catheter was 84.2±5.9 cm. The length was significantly longer in men (89.1±5.6 vs. 82.1±4.6 cm, Pguiding catheter was 84 cm on average for elective anterior-circulation aneurysm embolization. The length increased in men older than 65 years with a more tortuous arch. We could reach a higher position with distal access catheters with little difference in the stability once we reached the target location.

  20. Cost-Effectiveness of Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography to Follow-Up Patients With Coiled Intracranial Aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriel J. E.

    Background and Purpose-To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  1. Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriël J.E.

    Background and Purpose-: To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  2. GDC 360 for the endovascular treatment of intracranial aneurysms: a matched-pair study analysing angiographic outcomes with GDC 3D coils in 38 patients

    International Nuclear Information System (INIS)

    Taschner, Christian A.; Thines, Laurent; Lejeune, Jean-Paul; El-Mahdy, Mohamed; Rachdi, Henda; Gauvrit, Jean-Yves; Pruvo, Jean-Pierre; Leclerc, Xavier

    2009-01-01

    The purpose of this study was to determine whether coil embolisation with a new complex-shaped Guglielmi Detachable Coil (GDC 360 ; Boston Scientific Neurovascular, Fremont, CA, USA) has any effect on the stability of aneurysm occlusion. Fifty-one consecutive patients with intracranial aneurysms treated with GDC 360 were included. Angiographic results and adverse neurological events during the follow-up period were recorded. For 38 patients treated with GDC 360 with available follow-up data, a corresponding patient treated with GDC 3D was identified from our database. Matches were sought for rupture status, location, aneurysmal size, and neck size. The angiographic outcome of these matched controls at 6 months was compared to aneurysms treated with GDC 360 . Initial angiographic controls for 38 patients treated with GDC 360 showed complete occlusion in 32 aneurysms, and a neck remnant in six. At 6-month follow-up, complete occlusion was found in 29, a neck remnant in eight, and a residual aneurysm in one. One patient treated with GDC 360 needed retreatment for a major recanalisation. In 38 matched patients treated with GDC 3D, initial angiographic controls found complete aneurysmal occlusion in 30 aneurysms and a residual neck in 8. At 6-month follow-up, 24 aneurysms were completely occluded, ten showed a neck remnant, and residual aneurysms were seen in four. Four patients, treated with GDC 3D, were retreated for major aneurysm recanalisations. Our data suggests that endovascular coil embolisation with GDC 360 might improve long-term stability of coiled aneurysms when compared to GDC 3D. (orig.)

  3. Stent-assisted coiling versus coiling alone in unruptured intracranial aneurysms in the matrix and platinum science trial: safety, efficacy, and mid-term outcomes.

    Science.gov (United States)

    Hetts, S W; Turk, A; English, J D; Dowd, C F; Mocco, J; Prestigiacomo, C; Nesbit, G; Ge, S G; Jin, J N; Carroll, K; Murayama, Y; Gholkar, A; Barnwell, S; Lopes, D; Johnston, S C; McDougall, C

    2014-04-01

    Stent-assisted coiling may result in less aneurysm recanalization but more complications than coiling alone. We evaluated outcomes of coiling with and without stents in the multicenter Matrix and Platinum Science Trial. All patients in the Matrix and Platinum Science Trial with unruptured intracranial aneurysms treated per protocol were included. Baseline patient and aneurysm characteristics, procedural details, neurologic outcomes, angiographic outcomes, and safety data were analyzed. Overall, 137 of 361 (38%) patients were treated with a stent. Stent-coiled aneurysms had wider necks (≥4 mm in 62% with stents versus 33% without, P < .0001) and lower dome-to-neck ratios (1.3 versus 1.8, P < .0001). Periprocedural serious adverse events occurred infrequently in those treated with and without stents (6.6% versus 4.5%, P = .39). At 1 year, total significant adverse events, mortality, and worsening of mRS were similar in treatment groups, but ischemic strokes were more common in stent-coiled patients than in coiled patients (8.8% versus 2.2%, P = .005). However, multivariate analysis confirmed that at 2 years after treatment, prior cerebrovascular accident (OR, 4.7; P = .0089) and aneurysm neck width ≥4 mm (OR, 4.5; P = .02) were the only independent predictors of ischemic stroke. Stent use was not an independent predictor of ischemic stroke at 2 years (OR, 1.1; P = .94). Stent use did not predict target aneurysm recurrence at 2 years, but aneurysm dome size ≥10 mm (OR, 9.94; P < .0001) did predict target aneurysm recurrence. Stent-coiling had similar outcomes as coiling despite stented aneurysms having more difficult morphology than coiled aneurysms. Increased ischemic events in stent-coiled aneurysms were attributable to baseline risk factors and aneurysm morphology.

  4. High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms.

    Directory of Open Access Journals (Sweden)

    Mitja I Kurki

    2014-01-01

    Full Text Available 3% of the population develops saccular intracranial aneurysms (sIAs, a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder population and bottleneck events. As the sIA-SAH incidence in Finland is >2× increased, such variants may associate with sIA in the Finnish population. We tested 9.4 million variants for association in 760 Finnish sIA patients (enriched for familial sIA, and in 2,513 matched controls with case-control status and with the number of sIAs. The most promising loci (p<5E-6 were replicated in 858 Finnish sIA patients and 4,048 controls. The frequencies and effect sizes of the replicated variants were compared to a continental European population using 717 Dutch cases and 3,004 controls. We discovered four new high-risk loci with low frequency lead variants. Three were associated with the case-control status: 2q23.3 (MAF 2.1%, OR 1.89, p 1.42×10-9; 5q31.3 (MAF 2.7%, OR 1.66, p 3.17×10-8; 6q24.2 (MAF 2.6%, OR 1.87, p 1.87×10-11 and one with the number of sIAs: 7p22.1 (MAF 3.3%, RR 1.59, p 6.08×-9. Two of the associations (5q31.3, 6q24.2 replicated in the Dutch sample. The 7p22.1 locus was strongly differentiated; the lead variant was more frequent in Finland (4.6% than in the Netherlands (0.3%. Additionally, we replicated a previously inconclusive locus on 2q33.1 in all samples tested (OR 1.27, p 1.87×10-12. The five loci explain 2.1% of the sIA heritability in Finland, and may relate to, but not explain, the increased incidence of sIA-SAH in Finland. This study illustrates the utility of population isolates, familial enrichment, dense genotype imputation and alternate phenotyping in search for variants associated with complex diseases.

  5. Preoperative coiling of coexisting intracranial aneurysm and subsequent brain tumor surgery

    Energy Technology Data Exchange (ETDEWEB)

    Park, Keun Young; Kim, Byung Moon; Kim, Dong Joon [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-11-15

    Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery. A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated. Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2-120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0-2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery. Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

  6. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report.

    Science.gov (United States)

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2017-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on computed tomography. The trapping and bypass was planned. However, sudden epistaxis occurred, we performed trapping to stop the bleeding and save his life. After the operation, no right ICA or aneurysm was detected. However, severe epistaxis recurred two months after the operation. In the second operation, a ligation of the common -/- external carotid artery and a severance of an ICA portion between the ophthalmic artery and the aneurysm were insufficient to stop the bleeding. This case indicates ICA trapping, even if a trapping portion is below an ophthalmic artery, is insufficient to treat an ICA aneurysm. ICA aneurysms should be suspected when a patient present with recurrent -/- massive epistaxis, who has a head injury history, even if it is far past.

  7. A New Imaging Tool for Realtime Measurement of Flow Velocity in Intracranial Aneurysms

    Science.gov (United States)

    Petridis, Athanasios K.; Kaschner, Marius; Cornelius, Jan F.; Kamp, Marcel A.; Tortora, Angelo; Steiger, Hans-Jakob; Turowski, Bernd

    2017-01-01

    With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.). It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way. PMID:28839527

  8. A new imaging tool for realtime measurement of flow velocity in intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Athanasios K. Petridis

    2017-08-01

    Full Text Available With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.. It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way.

  9. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent

    DEFF Research Database (Denmark)

    Wagner, Aase; Cortsen, Marie; Hauerberg, John

    2011-01-01

    INTRODUCTION: Since the flow diverters (FDs) have been introduced it is possible to treat aneurysms that are considered difficult or impossible to treat with usual endovascular or surgical methods. It is still uncertain which aneurysms are suitable for this new treatment. We present the periproce...

  10. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  11. Novel device and technique for minimally invasive intracerebral hematoma evacuation in the same setting of a ruptured intracranial aneurysm: combined treatment in the neurointerventional angiography suite.

    Science.gov (United States)

    Turner, Raymond D; Vargas, Jan; Turk, Aquilla S; Chaudry, M Imran; Spiotta, Alejandro M

    2015-03-01

    The presence of intracerebral hematoma from aneurysm rupture is an indication for craniotomy for clot evacuation and aneurysm clipping. Some centers have begun securing aneurysms with coil embolization followed by clot evacuation in the operating room. This approach requires transporting a patient from the angiography suite to the operating room, which can take valuable time and resources. To report our experience with 3 cases in which a novel technique for minimally invasive evacuation of intracerebral hematomas after endovascular treatment of ruptured intracranial aneurysms was used. The Penumbra Apollo system can be used in the angiography suite in conjunction with neuroendovascular techniques to simultaneously address a symptomatic hematoma associated with a ruptured aneurysm. Standard preoperative computed tomography angiography was performed on arrival to the emergency department. The patients underwent diagnostic cerebral angiography followed by balloon-assisted coil embolization and then remained in the neurointerventional suite for intracerebral hematoma evacuation with the Apollo system. All patients tolerated coil embolization and hematoma evacuation well. The combined procedures lasted hematoma evacuation, particularly when coupled with endovascular embolization of ruptured intracranial aneurysms. Future work will address which patient population is most likely to benefit from this promising technique.

  12. Time-resolved imaging of contrast kinetics does not improve performance of follow-up MRA of embolized intracranial aneurysms.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

    2012-07-01

    The use of contrast media and the time-resolved imaging of contrast kinetics (TRICKS) technique have some theoretical advantages over time-of-flight magnetic resonance angiography (TOF-MRA) in the follow-up of intracranial aneurysms after endovascular treatment. We prospectively compared the diagnostic performance of TRICKS and TOF-MRA with digital subtracted angiography (DSA) in the assessment of occlusion of embolized aneurysms. Seventy-two consecutive patients with 72 aneurysms were examined 3 months after embolization. Test characteristics of TOF-MRA and TRICKS were calculated for the detection of residual flow. The results of quantification of flow were compared with weighted kappa. Intraobserver and interobserver reproducibility was determined. The sensitivity of TOF-MRA was 85% (95% CI, 65-96%) and of TRICKS, 89% (95% CI, 70-97%). The specificity of both methods was 91% (95% CI, 79-98%). The accuracy of the flow quantification ranged from 0.76 (TOF-MRA) to 0.83 (TRICKS). There was no significant difference between the methods in the area under the ROC curve regarding both the detection and the quantification of flow. Intraobserver reproducibility was very good with both techniques (kappa, 0.86-0.89). The interobserver reproducibility was moderate for TOF-MRA and very good for TRICKS (kappa, 0.74-0.80). In this study, TOF-MRA and TRICKS presented similar diagnostic performance; therefore, the use of time-resolved contrast-enhanced MRA is not justified in the follow-up of embolized aneurysms.

  13. The Computational Fluid Dynamics Rupture Challenge 2013--Phase II: Variability of Hemodynamic Simulations in Two Intracranial Aneurysms.

    Science.gov (United States)

    Berg, Philipp; Roloff, Christoph; Beuing, Oliver; Voss, Samuel; Sugiyama, Shin-Ichiro; Aristokleous, Nicolas; Anayiotos, Andreas S; Ashton, Neil; Revell, Alistair; Bressloff, Neil W; Brown, Alistair G; Chung, Bong Jae; Cebral, Juan R; Copelli, Gabriele; Fu, Wenyu; Qiao, Aike; Geers, Arjan J; Hodis, Simona; Dragomir-Daescu, Dan; Nordahl, Emily; Bora Suzen, Yildirim; Owais Khan, Muhammad; Valen-Sendstad, Kristian; Kono, Kenichi; Menon, Prahlad G; Albal, Priti G; Mierka, Otto; Münster, Raphael; Morales, Hernán G; Bonnefous, Odile; Osman, Jan; Goubergrits, Leonid; Pallares, Jordi; Cito, Salvatore; Passalacqua, Alberto; Piskin, Senol; Pekkan, Kerem; Ramalho, Susana; Marques, Nelson; Sanchi, Stéphane; Schumacher, Kristopher R; Sturgeon, Jess; Švihlová, Helena; Hron, Jaroslav; Usera, Gabriel; Mendina, Mariana; Xiang, Jianping; Meng, Hui; Steinman, David A; Janiga, Gábor

    2015-12-01

    With the increased availability of computational resources, the past decade has seen a rise in the use of computational fluid dynamics (CFD) for medical applications. There has been an increase in the application of CFD to attempt to predict the rupture of intracranial aneurysms, however, while many hemodynamic parameters can be obtained from these computations, to date, no consistent methodology for the prediction of the rupture has been identified. One particular challenge to CFD is that many factors contribute to its accuracy; the mesh resolution and spatial/temporal discretization can alone contribute to a variation in accuracy. This failure to identify the importance of these factors and identify a methodology for the prediction of ruptures has limited the acceptance of CFD among physicians for rupture prediction. The International CFD Rupture Challenge 2013 seeks to comment on the sensitivity of these various CFD assumptions to predict the rupture by undertaking a comparison of the rupture and blood-flow predictions from a wide range of independent participants utilizing a range of CFD approaches. Twenty-six groups from 15 countries took part in the challenge. Participants were provided with surface models of two intracranial aneurysms and asked to carry out the corresponding hemodynamics simulations, free to choose their own mesh, solver, and temporal discretization. They were requested to submit velocity and pressure predictions along the centerline and on specified planes. The first phase of the challenge, described in a separate paper, was aimed at predicting which of the two aneurysms had previously ruptured and where the rupture site was located. The second phase, described in this paper, aims to assess the variability of the solutions and the sensitivity to the modeling assumptions. Participants were free to choose boundary conditions in the first phase, whereas they were prescribed in the second phase but all other CFD modeling parameters were not

  14. Time-of-flight MR angiography at 3 T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils

    Energy Technology Data Exchange (ETDEWEB)

    Ferre, Jean-Christophe [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France)], E-mail: jean-christophe.ferre@chu-rennes.fr; Carsin-Nicol, Beatrice [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Morandi, Xavier [Department of Neurosurgery, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Carsin, Michel [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Kersaint-Gilly, Axel de [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France); Gauvrit, Jean-Yves [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Desal, Hubert-Armand [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France)

    2009-12-15

    Objective: To compare 3D time-of-flight MR angiography (TOF-MRA) at 3 Tesla (3 T) with digital subtraction angiography (DSA) for the evaluation of intracranial aneurysm occlusion after endovascular coiling. Methods: In a prospective study, 51 consecutive patients (25 females, 26 males; median age, 51 years) with 51 saccular aneurysms treated with endovascular coiling underwent simultaneous DSA and 3 T TOF-MRA at follow-up. DSA and TOF-MRA images were analyzed independently by two senior neuroradiologists. Findings were assigned to 1 of 3 categories in the Raymond classification: complete obliteration, residual neck or residual aneurysm. Agreement between observers and techniques was evaluated using {kappa} statistics. Results: DSA images were not interpretable for one patient. Interobserver agreement was determined as excellent for DSA ({kappa} = 0.86) and TOF-MRA ({kappa} = 0.80). After reaching a consensus, DSA follow-up showed 26 (51%) complete obliterations, 20 (39%) residual necks and 4 (8%) residual aneurysms. TOF-MRA showed 23 (45%) complete obliterations, 22 (43%) residual necks and 6 (12%) residual aneurysms. Comparison between TOF-MRA and DSA showed excellent agreement between the techniques ({kappa} = 0.86). In the four cases that were misclassified, TOF-MRA findings were assigned to a higher class than for DSA. Conclusion: TOF-MRA at 3 T is at least as efficient as DSA for the evaluation of intracranial aneurysm occlusion after endovascular treatment with detachable coils. We suggest that TOF-MRA at 3 T might be used as the primary method for imaging follow-up of coiled intracranial aneurysms.

  15. Endovascular treatment of unruptured intracranial aneurysms with Guglielmi detachable coils: short- and long-term results of a single-centre series.

    Science.gov (United States)

    Standhardt, Harald; Boecher-Schwarz, Hans; Gruber, Andreas; Benesch, Thomas; Knosp, Engelbert; Bavinzski, Gerhard

    2008-03-01

    Purpose of the present study is to evaluate the clinical outcome of endovascular treatment of unruptured intracranial aneurysms and to address the question of long-term stability and protection against future subarachnoid hemorrhage. Retrospective analysis of all patients treated in a 12-year period (173 patients: age 26 to 76 yr, mean 52.2+/-10.8/202 aneurysms: size 3 to 50 mm, mean 10.0+/-8.3). The mortality was 0.5%; the overall morbidity was 3.5%. The most frequent complications were thromboembolic events (10.9%). Of these, 3.0% of patients suffered a stroke, leading to severe disability in 1 patient (0.5%). In 1 patient, the aneurysm ruptured during treatment, resulting in relevant neurological disability. Another patient suffered a fatal aneurysm rupture hours after treatment. The occlusion rate depended on aneurysm and neck size. Follow-up angiography revealed a decrease of the occlusion rate over time. This trend was obvious in all size categories and was most pronounced in giant aneurysms. In 3 patients (1.5%) with partially thrombosed giant aneurysms of the posterior circulation, embolization could not prevent later aneurysm rupture. There were no ruptures of any other aneurysms in the follow-up period (3.7+/-3.4 yr). Endovascular treatment is a highly safe procedure with low intervention-related morbidity and mortality. Long-term data for nongiant aneurysms showed good protection against rupture in the observation period. In contrast, the risk of rupture for giant aneurysms of the posterior circulation was as high as expected in observational studies.

  16. The hemodynamics in intracranial aneurysm ruptured region with active contrast leakage during computed tomography angiography

    Science.gov (United States)

    Li, Ming-Lung; Wang, Yi-Chou; Liou, Tong-Miin; Lin, Chao-An

    2014-10-01

    Precise locations of rupture region under contrast agent leakage of five ruptured cerebral artery aneurysms during computed tomography angiography, which is to our knowledge for the first time, were successfully identified among 101 patients. These, together with numerical simulations based on the reconstructed aneurysmal models, were used to analyze hemodynamic parameters of aneurysms under different cardiac cyclic flow rates. For side wall type aneurysms, different inlet flow rates have mild influences on the shear stresses distributions. On the other hand, for branch type aneurysms, the predicted wall shear stress (WSS) correlates strongly with the increase of inlet vessel velocity. The mean and time averaged WSSes at rupture regions are found to be lower than those over the surface of the aneurysms. Also, the levels of the oscillatory shear index (OSI) are higher than the reported threshold value, supporting the assertion that high OSI correlates with rupture of the aneurysm. However, the present results also indicate that OSI level at the rupture region is relatively lower.

  17. Low plasma arginine:asymmetric dimethyl arginine ratios predict mortality after intracranial aneurysm rupture

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Bergström, Anita; Edsen, Troels

    2013-01-01

    Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthases, predicts mortality in cardiovascular disease and has been linked to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In this prospective study, we assessed whether circulating ADMA, arginine...

  18. The influence of hyperthermia on intracranial pressure, cerebral oximetry and cerebral metabolism in traumatic brain injury

    Science.gov (United States)

    Nyholm, Lena; Howells, Tim; Lewén, Anders; Hillered, Lars; Enblad, Per

    2017-01-01

    Background Hyperthermia is a common secondary insult in traumatic brain injury (TBI). The aim was to evaluate the relationship between hyperthermia and intracranial pressure (ICP), and if intracranial compliance and cerebral blood flow (CBF) pressure autoregulation affected that relationship. The relationships between hyperthermia and cerebral oximetry (BtipO2) and cerebral metabolism were also studied. Methods A computerized multimodality monitoring system was used for data collection at the neurointensive care unit. Demographic and monitoring data (temperature, ICP, blood pressure, microdialysis, BtipO2) were analyzed from 87 consecutive TBI patients. ICP amplitude was used as measure of compliance, and CBF pressure autoregulation status was calculated using collected blood pressure and ICP values. Mixed models and comparison between groups were used. Results The influence of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and BtipO2) was small, but individual differences were seen. Linear mixed models showed that hyperthermia raises ICP slightly more when temperature increases in the groups with low compliance and impaired CBF pressure autoregulation. There was also a tendency (not statistically significant) for increased BtipO2, and for increased pyruvate and lactate, with higher temperature, while the lactate/pyruvate ratio and glucose were stable. Conclusions The major finding was that the effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and BtipO2) were not extensive in general, but there were exceptional cases. Hyperthermia treatment has many side effects, so it is desirable to identify cases in which hyperthermia is dangerous. Information from multimodality monitoring may be used to guide treatment in individual patients. PMID:28463046

  19. Multiparametric MRI of intracranial aneurysms treated with the Woven EndoBridge (WEB): a case of Faraday's cage?

    Science.gov (United States)

    Nawka, Marie Teresa; Sedlacik, Jan; Frölich, Andreas; Bester, Maxim; Fiehler, Jens; Buhk, Jan-Hendrik

    2018-02-10

    To evaluate multiparametric MRI including non-contrast and contrast-enhanced morphological and angiographic techniques for intracranial aneurysms treated with the single-layer Woven EndoBridge (WEB) embolization system applying simultaneous digital subtraction angiography (DSA) as the reference of standard. We retrospectively identified all patients with incidental and acute ruptured intracranial aneurysms treated with a WEB device (WEB SL and WEB SLS) between March 2014 and June 2016 in our neurovascular center with early (within 7 days) postinterventional multiparametric MRI as well as mid-term (5-8 months) follow-up MRI and DSA available. Occlusion rates were recorded both in DSA and MR angiography (MRA). In MRI, signal intensities within the WEB as well as in the occluded dome distal to the WEB, if present, were measured by region-of-interest (ROI) analysis. Twenty-five patients fulfilled the inclusion criteria. Rates of complete/adequate occlusion at mid-term follow-up were 84% with both MRA and DSA. A strong signal loss within the WEB was observed in all MR sequences at initial and follow-up examinations. ROI analysis did not reveal significant differences in non-contrast (P=0.946) and contrast-enhanced imaging (P=0.377). A T1-hyperintense thrombus in the non-WEB-carrying dome was a frequent observation. Signal intensity measurements in multiparametric MRI suggest that neither contrast-enhanced MRA nor morphological sequences are capable of revealing reliable information on the WEB lumen, presumably due to radio frequency shielding. MRI is therefore not suitable for confirming complete thrombus formation within the WEB. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

    Directory of Open Access Journals (Sweden)

    Chao-liang Tang

    2018-01-01

    Full Text Available Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 μg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 μg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spontaneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100β and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/ (registration number: ChiCTR-IPR-16008113.

  1. The possibility and the countermeasure of the re-rupture within procedure in the embolization of intracranial aneurysms with Guglielmi detachable coils

    International Nuclear Information System (INIS)

    Li Minghua; Gu Binxian; Cheng Yingsheng; Fang Chun; Wang Wu; Xu Tao; Xu Shiding

    2004-01-01

    Objective: To study the possibility and the way to deal with the re-rupture within procedure for rupture aneurysms with Guglielmi detachable coil (GDC) embolization. Methods: When 159 cases with intracranial aneurysms were treated with GDC embolization, the rupture during procedure occurred in 7 cases. Of them, the re-rupture was related to microguidewire in one cases, related to coils in 3 cases, related to microcatheter in 2 cases, and related to over-packing with coils in one case. Results: A continuous packing with GDC with or without microcatheter adjustment, till a total occlusion of aneurysm, was performed in 3 cases with re-rupture related to coils and in 2 cases with re-rupture related to microcatheter. Of them, a complete recovery was acquired in 4 and a monoplegia remained in one case; Both the case with re-rupture related to microguidewire and the case with re-rupture related to over-packing with coils died due to intracerebral over-bleeding. Conclusion: It is unavoidable that the re-rupture occurred during the procedure of GDC embolization of intracranial aneurysms. Its occurrence is in inverse proportion with operator's experience. The proper choice of coils may reduce the occurrence of re-rupture related to procedure. A continuous packing with coils is possible to get a total occlusion without any sequels in re-ruptured aneurysms

  2. Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Wrede, Karsten H.; Chen, Bixia [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Matsushige, Toshinori [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Hiroshima University, Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima (Japan); Goericke, Sophia L.; Umutlu, Lale; Forsting, Michael [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Quick, Harald H. [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, High Field and Hybrid MR Imaging, Essen (Germany); Ladd, Mark E. [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology (E020), Heidelberg (Germany); Johst, Soeren [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); Sure, Ulrich [University Hospital Essen, Department of Neurosurgery, Essen (Germany); Schlamann, Marc [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); University Hospital Giessen, Department of Neuroradiology, Giessen (Germany)

    2017-01-15

    To prospectively evaluate non-contrast-enhanced 7-Tesla (T) MRA for delineation of unruptured intracranial aneurysms (UIAs) in comparison with DSA. Forty patients with single or multiple UIAs were enrolled in this IRB-approved trial. Sequences acquired at 7 T were TOF MRA and non-contrast-enhanced MPRAGE. All patients additionally underwent 3D rotational DSA. Two neuroradiologists individually analysed the following aneurysm and image features on a five-point scale in 2D and 3D image reconstructions: delineation of parent vessel, dome and neck; overall image quality; presence of artefacts. Interobserver accordance was assessed by the kappa coefficient. A total of 64 UIAs were detected in DSA and in all 2D and 3D MRA image reconstructions. Ratings showed comparable results for DSA and 7-T MRA when considering all image reconstructions. Highest ratings for individual image reconstructions were given for 2D MPRAGE and 3D TOF MRA. Interobserver accordance was almost perfect for the majority of ratings. This study demonstrates excellent delineation of UIAs using 7-T MRA within a clinical setting comparable to the gold standard, DSA. The combination of 7-T non-enhanced MPRAGE and TOF MRA for assessment of untreated UIAs is a promising clinical application of ultra-high-field MRA. (orig.)

  3. Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

    Science.gov (United States)

    Fenz, Wolfgang; Dirnberger, Johannes

    2015-03-01

    Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

  4. Narrowing the Expertise Gap for Predicting Intracranial Aneurysm Hemodynamics: Impact of Solver Numerics versus Mesh and Time-Step Resolution.

    Science.gov (United States)

    Khan, M O; Valen-Sendstad, K; Steinman, D A

    2015-07-01

    Recent high-resolution computational fluid dynamics studies have uncovered the presence of laminar flow instabilities and possible transitional or turbulent flow in some intracranial aneurysms. The purpose of this study was to elucidate requirements for computational fluid dynamics to detect these complex flows, and, in particular, to discriminate the impact of solver numerics versus mesh and time-step resolution. We focused on 3 MCA aneurysms, exemplifying highly unstable, mildly unstable, or stable flow phenotypes, respectively. For each, the number of mesh elements was varied by 320× and the number of time-steps by 25×. Computational fluid dynamics simulations were performed by using an optimized second-order, minimally dissipative solver, and a more typical first-order, stabilized solver. With the optimized solver and settings, qualitative differences in flow and wall shear stress patterns were negligible for models down to ∼800,000 tetrahedra and ∼5000 time-steps per cardiac cycle and could be solved within clinically acceptable timeframes. At the same model resolutions, however, the stabilized solver had poorer accuracy and completely suppressed flow instabilities for the 2 unstable flow cases. These findings were verified by using the popular commercial computational fluid dynamics solver, Fluent. Solver numerics must be considered at least as important as mesh and time-step resolution in determining the quality of aneurysm computational fluid dynamics simulations. Proper computational fluid dynamics verification studies, and not just superficial grid refinements, are therefore required to avoid overlooking potentially clinically and biologically relevant flow features. © 2015 by American Journal of Neuroradiology.

  5. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis.

    Science.gov (United States)

    HaiFeng, Liu; YongSheng, Xu; YangQin, Xun; Yu, Dou; ShuaiWen, Wang; XingRu, Lu; JunQiang, Lei

    2017-11-01

    This meta-analysis is to comprehensively evaluate the diagnostic performance of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) for detecting intracranial aneurysm (IA). PubMed, Embase, Web of Science, and the Cochrane library were systematically searched for retrieving eligible studies. Study inclusion, data extraction, and risk of bias assessment were performed by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were carried out. In total, 18 studies comprising 3463 patients were selected. The results of 3D-TOF-MRA for diagnosing IA were SEN 0.89 (95% CI 0.82-0.94), SPE 0.94 (0.86-0.97), PLR 13.79 (5.92-32.12), NLR 0.11 (0.07-0.19), DOR 121.90 (38.81-382.94), and AUC 0.96 (0.94-0.98), respectively. In the subgroup analysis, studies without subarachnoid hemorrhage (SAH) tend to perform statistical significantly better (P 3D-TOF-MRA had better SEN in aneurysms > 3 mm than the aneurysms ≤ 3 mm in diameter: 0.89 (0.87-0.92) vs. 0.78 (0.71-0.84) with P 3D-TOF-MRA has an excellent diagnostic performance for the overall assessment of IA and may serve as an alternative for further patient management with IA.

  6. Extended Follow-Up of Unruptured Intracranial Aneurysms Detected by Presymptomatic Screening in Patients with Autosomal Dominant Polycystic Kidney Disease

    Science.gov (United States)

    Irazabal, Maria V.; Huston, John; Kubly, Vickie; Rossetti, Sandro; Sundsbak, Jamie L.; Hogan, Marie C.; Harris, Peter C.; Brown, Robert D.

    2011-01-01

    Summary Background and objectives Autosomal dominant polycystic kidney disease (ADPKD) patients have an increased risk for intracranial aneurysms (IAs). The importance of screening for unruptured IAs (UIAs) depends on their risks for growth and rupture. Design, setting, participants, & measurements ADPKD patients with UIAs found by presymptomatic screening with magnetic resonance angiography (MRA) during 1989 to 2009 were followed initially at 6 months and annually, and less frequently after demonstration of stability. Results Forty-five saccular aneurysms were detected in 38 patients from 36 families. Most were small (median diameter 3.5 mm) and in the anterior circulation (84%). Median age at diagnosis was 49 years. During cumulative imaging follow-up of 243 years, one de novo UIA was detected and increased in size from 2 to 4.4 mm over 144 months and two UIAs grew from 4.5 to 5.9 mm and 4.7 to 6.2 mm after 69 and 184 months, respectively. Seven patients did not have imaging follow-up. No change was detected in the remaining 28 patients. During cumulative clinical follow-up of 316 years, no aneurysm ruptured. Five patients died from unrelated causes and two were lost to follow-up after 8 and 120 months. Three patients underwent surgical clipping. Conclusions Most UIAs detected by presymptomatic screening in ADPKD patients are small and in the anterior circulation. Growth and rupture risks are not higher than those of UIAs in the general population. These data support very selective screening for UIAs in ADPKD patients, and widespread screening is not indicated. PMID:21551026

  7. Prospective Evaluation of Noninvasive HeadSense Intracranial Pressure Monitor in Traumatic Brain Injury Patients Undergoing Invasive Intracranial Pressure Monitoring.

    Science.gov (United States)

    Herklots, Martin W; Moudrous, Walid; Oldenbeuving, Annemarie; Roks, Gerwin; Mourtzoukos, Stylianos; Schoonman, Guus G; Ganslandt, Oliver

    2017-10-01

    Currently, intracranial pressure (ICP) is measured by invasive methods with a significant risk of infectious and hemorrhagic complications. Because of these high risks, there is a need for a noninvasive ICP (nICP) monitor with an accuracy similar to that of an invasive ICP (iICP) monitor. We sought to assess prospectively the accuracy and precision of an nICP monitor compared with iICP measurement in severe traumatic brain injury (TBI) patients. Participants were ICP-monitored patients who had sustained TBI. In parallel with the standard invasive ICP measurements, nICP was measured by the HeadSense HS-1000, which is based on sound propagation. The device generated an acoustic signal using a small transmitter, placed in the patient's ear, and picked up by an acoustic sensor placed in the other ear. The signal is then analyzed using proprietary algorithms, and the ICP value is calculated in millimeter of mercury (mm Hg). Analysis of 2911 paired iICP and nICP measurements from 14 severe TBI patients showed a good accuracy of the nICP monitor indicated by a mean difference of 0.5 mm Hg. The precision was also good with a standard deviation of 3.9 mm Hg. The Pearson r correlation was 0.604 (P < 0.001). The HeadSense HS-1000 nICP monitor seems sufficiently accurate to measure the ICP in severe TBI patients, is patient friendly, and has minimal risk of complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. A trial of intracranial-pressure monitoring in traumatic brain injury.

    Science.gov (United States)

    Chesnut, Randall M; Temkin, Nancy; Carney, Nancy; Dikmen, Sureyya; Rondina, Carlos; Videtta, Walter; Petroni, Gustavo; Lujan, Silvia; Pridgeon, Jim; Barber, Jason; Machamer, Joan; Chaddock, Kelley; Celix, Juanita M; Cherner, Marianna; Hendrix, Terence

    2012-12-27

    Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a multicenter, controlled trial in which 324 patients 13 years of age or older who had severe traumatic brain injury and were being treated in intensive care units (ICUs) in Bolivia or Ecuador were randomly assigned to one of two specific protocols: guidelines-based management in which a protocol for monitoring intraparenchymal intracranial pressure was used (pressure-monitoring group) or a protocol in which treatment was based on imaging and clinical examination (imaging-clinical examination group). The primary outcome was a composite of survival time, impaired consciousness, and functional status at 3 months and 6 months and neuropsychological status at 6 months; neuropsychological status was assessed by an examiner who was unaware of protocol assignment. This composite measure was based on performance across 21 measures of functional and cognitive status and calculated as a percentile (with 0 indicating the worst performance, and 100 the best performance). There was no significant between-group difference in the primary outcome, a composite measure based on percentile performance across 21 measures of functional and cognitive status (score, 56 in the pressure-monitoring group vs. 53 in the imaging-clinical examination group; P=0.49). Six-month mortality was 39% in the pressure-monitoring group and 41% in the imaging-clinical examination group (P=0.60). The median length of stay in the ICU was similar in the two groups (12 days in the pressure-monitoring group and 9 days in the imaging-clinical examination group; P=0.25), although the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was higher in the imaging-clinical examination group

  9. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Takamasa Nanba

    2016-01-01

    Full Text Available Although posterior reversible encephalopathy syndrome (PRES is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

  10. Three-dimensional printing of anatomically accurate, patient specific intracranial aneurysm models.

    Science.gov (United States)

    Anderson, Jeff R; Thompson, Walker L; Alkattan, Abdulaziz K; Diaz, Orlando; Klucznik, Richard; Zhang, Yi J; Britz, Gavin W; Grossman, Robert G; Karmonik, Christof

    2016-05-01

    To develop and validate a method for creating realistic, patient specific replicas of cerebral aneurysms by means of fused deposition modeling. The luminal boundaries of 10 cerebral aneurysms, together with adjacent proximal and distal sections of the parent artery, were segmented based on DSA images, and corresponding virtual three-dimensional (3D) surface reconstructions were created. From these, polylactic acid and MakerBot Flexible Filament replicas of each aneurysm were created by means of fused deposition modeling. The accuracy of the replicas was assessed by quantifying statistical significance in the variations of their inner dimensions relative to 3D DSA images. Feasibility for using these replicas as flow phantoms in combination with phase contrast MRI was demonstrated. 3D printed aneurysm models were created for all 10 subjects. Good agreement was seen between the models and the source anatomy. Aneurysm diameter measurements of the printed models and source images correlated well (r=0.999; pmodels, respectively. 3D printed models could be imaged with flow via MRI. The 3D printed aneurysm models presented were accurate and were able to be produced inhouse. These models can be used for previously cited applications, but their anatomical accuracy also enables their use as MRI flow phantoms for comparison with ongoing studies of computational fluid dynamics. Proof of principle imaging experiments confirm MRI flow phantom utility. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent

    DEFF Research Database (Denmark)

    Wagner, Aase; Cortsen, Marie; Hauerberg, John

    2011-01-01

    the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and clinical follow-up at 2-23 months. METHODS: Twenty-two patients with 26 wide-necked or blister-like aneurysms had 23 treatments with implantation of a Silk stent. Eleven patients had re...... (86%) were occluded. CONCLUSION: The effect of the Silk FD in terms of occlusion of the aneurysms seems to occur mainly during the first 6 months after placement but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation medication...

  12. Computed tomographic evaluation due to ruptured intracranial aneurysms in the posterior fossa

    Energy Technology Data Exchange (ETDEWEB)

    Sugawara, Takayuki; Kayama, Takamasa; Sakurai, Yoshiharu; Ogawa, Akira; Onuma, Takehide; Yoshimoto, Takashi; Suzuki, Jiro.

    1988-12-01

    From April, 1978 through December, 1984, computed tomographic (CT) findings were carefully examined in 34 cases of initial subarachnoid bleeding due to a single ruptured aneurysm in the posterior fossa. All of the patients were hospitalized within 3 days of the onset of symptoms. High-density areas, which indicate the presence of subarachnoid clots, were evaluated in the interhemispheric and Sylvian fissures and the interpeduncular, prepontine, ambient, and quadrigeminal cisterns. The CT data suggest that hematomas in the four cisterns are thicker than those in the supratentorial subarachnoid spaces. Only one patient had an intracerebral hematoma. Hydrocephalus accompanied aneurysms of the posterior fossa more frequently than those of the anterior circulation.

  13. Analysis of Associated Spinal Fractures in Cases of Traumatic Intracranial Hemorrhage or Skull Fracture

    Directory of Open Access Journals (Sweden)

    Yunoki M

    2016-03-01

    Full Text Available Introduction: Patients with traumatic intracranial hemorrhage (ICH or skull fracture are typically admitted to the Department of Neurosurgery for fear of delayed neurological deterioration. Neurosurgeons, therefore, must be careful not to overlook a spinal fracture in these patients. In this study, we investigated the occurrence and risk factor of spinal fracture in patients with traumatic ICH or skull fracture. Patients and methods: We retrospectively analyzed the hospital records of 134 patients admitted to the Department of Neurosurgery at Kagawa Rosai Hospital for traumatic ICH or skull fracture. The etiology of trauma, level of consciousness, presence or absence of ICH, skull fracture, craniotomy and spinal surgery were investigated. Furthermore, in cases of spinal fracture, its type, neurological symptoms, treatment were investigated. Results: In an analysis of 134 patients, Ground level fall and traffic accident were the most frequent etiologies of trauma (47.0% and 23.9% respectively. Glasgow coma scale on admission was 15-13 for 106 patients (79.1%. Spinal fracture was identified in 10 of 134 patients (7.5%. Two patients had cervical, 8 had thoracolumbar fractures. In the analysis of risk factors, an accidental fall and skull fracture was observed significantly more in the spinal fracture cases. Conclusion: The majority of traumatic ICH or skull fracture cases treated in the Department of Neurosurgery were caused by minor head impacts. When treating these patients, it is necessary to investigate not only the cervical, but also the thoracolumbar spine, especially when the cause of injury is an accidental fall and a skull fracture is identified.

  14. A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms

    Directory of Open Access Journals (Sweden)

    Kishi S

    2012-04-01

    Full Text Available Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma

  15. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Thompson, B Gregory; Brown, Robert D; Amin-Hanjani, Sepideh; Broderick, Joseph P; Cockroft, Kevin M; Connolly, E Sander; Duckwiler, Gary R; Harris, Catherine C; Howard, Virginia J; Johnston, S Claiborne Clay; Meyers, Philip M; Molyneux, Andrew; Ogilvy, Christopher S; Ringer, Andrew J; Torner, James

    2015-08-01

    The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. © 2015 American Heart Association, Inc.

  16. Advances in endovascular aneurysm treatment: are we making a difference?

    International Nuclear Information System (INIS)

    Katz, Jeffrey M.; Ougorets, Igor; Tsiouris, Apostolos J.; Biondi, Alessandra; Salvaggio, Kimberly A.; Gobin, Y. Pierre; Stieg, Philip E.; Riina, Howard A.

    2005-01-01

    Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

  17. Characteristics of Intracranial Aneurysms in the Else Kröner-Fresenius Registry of Autosomal Dominant Polycystic Kidney Disease

    Science.gov (United States)

    Neumann, Hartmut P.H.; Malinoc, Angelica; Bacher, Janina; Nabulsi, Zinaida; Ivanovas, Vera; Bruechle, Nadine Ortiz; Mader, Irina; Hoffmann, Michael M.; Riegler, Peter; Kraemer-Guth, Annette; Burchardi, Christian; Schaeffner, Elke; Martin, Rodolfo S.; Azurmendi, Pablo J.; Zerres, Klaus; Jilg, Cordula; Eng, Charis; Gläsker, Sven

    2012-01-01

    Background Patients who harbor intracranial aneurysms (IAs) run a risk for aneurysm rupture and subsequent subarachnoid hemorrhage which frequently results in permanent deficits or death. Prophylactic treatment of unruptured aneurysms is possible and recommended depending on the size and location of the aneurysm as well as patient age and condition. IAs are major manifestations of autosomal dominant polycystic kidney disease (ADPKD). Current guidelines do not suggest surveillance of IAs in ADPKD except in the setting of family history if IA was known in any relative with ADPKD. Management of IAs in ADPKD is problematic because limited data exist from large studies. Methods We established the Else Kröner-Fresenius Registry for ADPKD in Germany. Clinical data were assessed for age at diagnosis of IAs, stage of renal insufficiency, and number, location and size of IAs as well as family history of cerebral events. Patients with symptomatic or asymptomatic IAs were included. All patients with ADPKD-related IAs were offered mutation scanning of the susceptibility genes for ADPKD, the PKD1 and PKD2 genes. Results Of 463 eligible ADPKD patients from the population base of Germany, 32 (7%) were found to have IAs, diagnosed at the age of 2–71 years, 19 females and 13 males. Twenty (63%) of these 32 patients were symptomatic, whereas IAs were detected in an asymptomatic stage in 12 patients. IAs were multifocal in 12 and unifocal in 20 patients. In 26 patients (81%), IAs were diagnosed before end-stage renal failure. Twenty-five out of 27 unrelated index cases (93%) had no IAs or cerebral events documented in their relatives with ADPKD. In 16 unrelated index patients and 3 relatives, we detected germline mutations. The mutations were randomly distributed across the PKD1 gene in 14 and the PKD2 gene in 2 index cases. Questionnaires answered for 320/441 ADPKD patients without IAs revealed that only 45/320 (14%) had MR angiography. Conclusion In ADPKD, rupture of IAs occurs

  18. Characteristics of Intracranial Aneurysms in the Else Kröner-Fresenius Registry of Autosomal Dominant Polycystic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Hartmut P.H. Neumann

    2012-10-01

    Full Text Available Background: Patients who harbor intracranial aneurysms (IAs run a risk for aneurysm rupture and subsequent subarachnoid hemorrhage which frequently results in permanent deficits or death. Prophylactic treatment of unruptured aneurysms is possible and recommended depending on the size and location of the aneurysm as well as patient age and condition. IAs are major manifestations of autosomal dominant polycystic kidney disease (ADPKD. Current guidelines do not suggest surveillance of IAs in ADPKD except in the setting of family history if IA was known in any relative with ADPKD. Management of IAs in ADPKD is problematic because limited data exist from large studies. Methods: We established the Else Kröner-Fresenius Registry for ADPKD in Germany. Clinical data were assessed for age at diagnosis of IAs, stage of renal insufficiency, and number, location and size of IAs as well as family history of cerebral events. Patients with symptomatic or asymptomatic IAs were included. All patients with ADPKD-related IAs were offered mutation scanning of the susceptibility genes for ADPKD, the PKD1 and PKD2 genes. Results: Of 463 eligible ADPKD patients from the population base of Germany, 32 (7% were found to have IAs, diagnosed at the age of 2–71 years, 19 females and 13 males. Twenty (63% of these 32 patients were symptomatic, whereas IAs were detected in an asymptomatic stage in 12 patients. IAs were multifocal in 12 and unifocal in 20 patients. In 26 patients (81%, IAs were diagnosed before end-stage renal failure. Twenty-five out of 27 unrelated index cases (93% had no IAs or cerebral events documented in their relatives with ADPKD. In 16 unrelated index patients and 3 relatives, we detected germline mutations. The mutations were randomly distributed across the PKD1 gene in 14 and the PKD2 gene in 2 index cases. Questionnaires answered for 320/441 ADPKD patients without IAs revealed that only 45/320 (14% had MR angiography. Conclusion: In ADPKD

  19. Repeat neuroimaging of mild traumatic brain-injured patients with acute traumatic intracranial hemorrhage: clinical outcomes and radiographic features.

    Science.gov (United States)

    Kreitzer, Natalie; Lyons, Michael S; Hart, Kim; Lindsell, Cristopher J; Chung, Sora; Yick, Andrew; Bonomo, Jordan

    2014-10-01

    Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center's standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging. This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS 24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs). Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED

  20. A novel approach using Neuron 6F guiding catheter for the embolization of intracranial aneurysm with coiling of the parent internal carotid artery.

    Science.gov (United States)

    Wang, Donghai; Wang, Ying; Su, Wandong; Wang, Yunyan; Li, Gang; Li, Xingang

    2015-01-01

    To describe our initial experience and early outcomes with distal placement of the Neuron 6F guiding catheter through coiled ICA for aneurysmal EVT. We examined the utility of the Neuronf 70 6F guiding catheter for the embolization procedure in such cases, fourteen cases of aneurysm with coiling of the parent ICA are presented via traditional guiding catheters. With the support of 8F ENVOY guiding catheter as a shuttle sheath, the Neuron(TM) 70 6F guiding catheter was successfully placed through coiled extracranial ICA, so the mirocatheter could be delivered to a more strategic position for embolization of the aneurysm. Coiling of extracranial ICA was found as parent artery on angiogram in all patients with ruptured aneurysms. Even where there were two curvatures of more than 360° in the coiled segment of the ICA, Neuron(TM) 70 6F guiding catheter could be placed through the coiling to a distal position and enabled EVT of intracranial aneurysms with no related neurological complications. Neuron guiding catheter is a useful device for embolization of aneurysm where there is coiling of parent ICA, easily placed through the coiling of the ICA and provided robust anatomical support via enhanced catheter-to-vessel wall engagement.

  1. EVIDENCE trial: design of a phase 2, randomized, controlled, multicenter study comparing flow diversion and traditional endovascular strategy in unruptured saccular wide-necked intracranial aneurysms.

    Science.gov (United States)

    Turjman, Francis; Levrier, Olivier; Combaz, Xavier; Bonafé, Alain; Biondi, Alessandra; Desal, Hubert; Bracard, Serge; Mounayer, Charbel; Riva, Roberto; Chapuis, Francois; Huot, Laure; Armoiry, Xavier; Gory, Benjamin

    2015-01-01

    Endovascular treatment of large, wide-necked intracranial aneurysms with coils is associated with low rates of initial angiographic occlusion and high rates of recurrence. The Pipeline™ Embolization Device has shown high rates of complete occlusion in uncontrolled clinical series. The study is a prospective, controlled, randomized, multicenter, phase 2 open-label trial. Intention-to-treat population includes age ≥18, unruptured saccular aneurysm located in the intra-dural area, neck diameter ≥4 and ≤10 mm, sac diameter ≥7 mm and ≤20 mm, "dome/neck" ratio is ≥1, diameter of the parent artery ≥2 mm and ≤5 mm, and no prior treatment of the aneurysm. Site can only participate if five patients have been previously treated with the Pipeline device. The primary end point of the study is complete occlusion of the aneurysm on angiogram performed 12 months after the endovascular procedure. Complete aneurysm occlusion is defined as the absence of visible blood flow, grade 1 according to the Raymond scale for the standard procedure group and grade 4 according to the grading scale of Kamran for the flow diverter group. The trial is currently enrolling and results of the data are pending the completion of enrollment and follow-up. This paper details the trial design of the French EVIDENCE phase 2 trial, a blinded, controlled randomized trial of wide-neck intra-dural aneurysms amenable to either traditional endovascular strategy or flow diversion with Pipeline device.

  2. Functional Capacity Scale as a new tool for early functional assessment in patients after surgical treatment of intracranial aneurysms: A prospective study involving 128 patients

    OpenAIRE

    ?lusarz, Robert; Beuth, Wojciech; ?niegocki, Maciej

    2012-01-01

    Summary Background Functional assessment of a patient focuses on the assessment of independence in activities of daily living. The aim of the study was to verify the usefulness of a new tool (Functional Capacity Scale ? FCS) for early functional assessment of patients after surgical treatment of an intracranial aneurysm. Material/Methods The study was conducted in the Neurosurgical Department and Clinic, CM in Bydgoszcz, NCU, within a group of 128 patients after surgical treatment of an intra...

  3. The incidence of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by microsurgical clipping versus endovascular coiling: a systematic review

    OpenAIRE

    Qing-guo LIU; Zhi-bin SONG; Jian-wei GAO; Xu-guang LI; Yun-li WU; Long WANG; Bing GUO

    2016-01-01

    Objective To systematically review the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by microsurgical clipping versus endovascular coiling.  Methods A comprehensive literature search from January 1990 to September 2015 was conducted in electronic databases, such as PubMed, EMBASE/SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and Wanfang data, for randomized controlled trials (R...

  4. A Less Invasive Approach for Ruptured Aneurysm with Intracranial Hematoma: Coil Embolization Followed by Clot Evacuation

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Je Hoon; Koh, Jun Seok; Kim, Eui Jong [Kyung-Hee University, College of Medicine, Seoul (Korea, Republic of)

    2007-02-15

    The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation. Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation. Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures. The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.

  5. Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model--a report on the Virtual Intracranial Stenting Challenge 2007.

    Science.gov (United States)

    Radaelli, A G; Augsburger, L; Cebral, J R; Ohta, M; Rüfenacht, D A; Balossino, R; Benndorf, G; Hose, D R; Marzo, A; Metcalfe, R; Mortier, P; Mut, F; Reymond, P; Socci, L; Verhegghe, B; Frangi, A F

    2008-07-19

    This paper presents the results of the Virtual Intracranial Stenting Challenge (VISC) 2007, an international initiative whose aim was to establish the reproducibility of state-of-the-art haemodynamical simulation techniques in subject-specific stented models of intracranial aneurysms (IAs). IAs are pathological dilatations of the cerebral artery walls, which are associated with high mortality and morbidity rates due to subarachnoid haemorrhage following rupture. The deployment of a stent as flow diverter has recently been indicated as a promising treatment option, which has the potential to protect the aneurysm by reducing the action of haemodynamical forces and facilitating aneurysm thrombosis. The direct assessment of changes in aneurysm haemodynamics after stent deployment is hampered by limitations in existing imaging techniques and currently requires resorting to numerical simulations. Numerical simulations also have the potential to assist in the personalized selection of an optimal stent design prior to intervention. However, from the current literature it is difficult to assess the level of technological advancement and the reproducibility of haemodynamical predictions in stented patient-specific models. The VISC 2007 initiative engaged in the development of a multicentre-controlled benchmark to analyse differences induced by diverse grid generation and computational fluid dynamics (CFD) technologies. The challenge also represented an opportunity to provide a survey of available technologies currently adopted by international teams from both academic and industrial institutions for constructing computational models of stented aneurysms. The results demonstrate the ability of current strategies in consistently quantifying the performance of three commercial intracranial stents, and contribute to reinforce the confidence in haemodynamical simulation, thus taking a step forward towards the introduction of simulation tools to support diagnostics and

  6. Endovascular management for intracranial ruptured aneurysms in elderly patients: outcome and technical aspects

    International Nuclear Information System (INIS)

    Mont'alverne, F.; Musacchio, M.; Tolentino, V.; Riquelme, C.; Tournade, A.

    2005-01-01

    The definition of an elderly person is debateable; however, age is a recognised negative prognostic factor for outcome after subarachnoid haemmorrhage, and the age cut-off of 60 years is accepted to define a high risk population. The goal of this article is to access the outcome in this precise population of patients that underwent endovascular treatment (EVT) after aneurysm rupture. Forty-two patients (mean age = 70.24) had 40 aneurysms located at the anterior circulation and nine at the posterior circulation. Thirty-seven (87.9%) patients had Fisher III or IV. Forty-six (93.8%) aneurysms were smaller than 15 mm. Twenty-eight (66.7%) patients were in good neurological state on admission (Hunt and Hess I-III) and 14 (33.3%) in poor state. Satisfactory occlusion rate (total occlusion or neck flow) was achieved in 75% of patients. Follow-up was available in 19 (43.18%) out of the 44 aneurysms treated. Aneurysm recanalization was disclosed in three cases. Satisfactory outcome was achieved on: 60.7% of good grades, 21.4% of poor grades, 43.7% of patients with and 57.6% of patents without comorbidites. Fisher grade (P=0.0346), comorbidities (P=0.525) and risk factors (P=0.515) were not associated with clinical outcome. No age cut-off (65,70 and 75) for favourable outcome could be established, P-values were 0.723, 0.741 and 0.738, respectively. Advancing of age was not associated with an increase number of unfavourable outcome (P=0.125). Poor neurological status on admission was the only variable associated with unfavourable outcome (P=0.02). Mortality and morbidity rate related to the procedure were 4.8% and 9.5% respectively. Age should not be taken alone for precluding treatment in ruptured aneurysms, EVT can be considered as a first therapeutic option for elderly persons, since an overall favourable outcome could be achieved in most cases, mainly in non-comatose patients. (orig.)

  7. The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil.

    Science.gov (United States)

    Ishida, Wataru; Sato, Masayuki; Amano, Tatsuo; Matsumaru, Yuji

    2016-09-01

    OBJECTIVE The importance of a framing coil (FC)-the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil-is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better

  8. Epidemiology of Mild Traumatic Brain Injury with Intracranial Hemorrhage: Focusing Predictive Models for Neurosurgical Intervention.

    Science.gov (United States)

    Orlando, Alessandro; Levy, A Stewart; Carrick, Matthew M; Tanner, Allen; Mains, Charles W; Bar-Or, David

    2017-11-01

    To outline differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries and help identify which ICH types are most likely to benefit from creation of predictive models for NI. A multicenter retrospective study of adult patients spanning 3 years at 4 U.S. trauma centers was performed. Patients were included if they presented with mild traumatic brain injury (Glasgow Coma Scale score 13-15) with head CT scan positive for ICH. Patients were excluded for skull fractures, "unspecified hemorrhage," or coagulopathy. Primary outcome was NI. Stepwise multivariable logistic regression models were built to analyze the independent association between ICH variables and outcome measures. The study comprised 1876 patients. NI rate was 6.7%. There was a significant difference in rate of NI by ICH type. Subdural hematomas had the highest rate of NI (15.5%) and accounted for 78% of all NIs. Isolated subarachnoid hemorrhages had the lowest, nonzero, NI rate (0.19%). Logistic regression models identified ICH type as the most influential independent variable when examining NI. A model predicting NI for isolated subarachnoid hemorrhages would require 26,928 patients, but a model predicting NI for isolated subdural hematomas would require only 328 patients. This study highlighted disparate NI rates among ICH types in patients with mild traumatic brain injury and identified mild, isolated subdural hematomas as most appropriate for construction of predictive NI models. Increased health care efficiency will be driven by accurate understanding of risk, which can come only from accurate predictive models. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. GFAP out-performs S100β in detecting traumatic intracranial lesions on computed tomography in trauma patients with mild traumatic brain injury and those with extracranial lesions.

    Science.gov (United States)

    Papa, Linda; Silvestri, Salvatore; Brophy, Gretchen M; Giordano, Philip; Falk, Jay L; Braga, Carolina F; Tan, Ciara N; Ameli, Neema J; Demery, Jason A; Dixit, Neha K; Mendes, Matthew E; Hayes, Ronald L; Wang, Kevin K W; Robertson, Claudia S

    2014-11-15

    Both glial fibrillary acidic protein (GFAP) and S100β are found in glial cells and are released into serum following a traumatic brain injury (TBI), however, the clinical utility of S100β as a biomarker has been questioned because of its release from bone. This study examined the ability of GFAP and S100β to detect intracranial lesions on computed tomography (CT) in trauma patients and also assessed biomarker performance in patients with fractures and extracranial injuries on head CT. This prospective cohort study enrolled a convenience sample of adult trauma patients at a Level I trauma center with and without mild or moderate traumatic brain injury (MMTBI). Serum samples were obtained within 4 h of injury. The primary outcome was the presence of traumatic intracranial lesions on CT scan. There were 397 general trauma patients enrolled: 209 (53%) had a MMTBI and 188 (47%) had trauma without MMTBI. Of the 262 patients with a head CT, 20 (8%) had intracranial lesions. There were 137 (35%) trauma patients who sustained extracranial fractures below the head to the torso and extremities. Levels of S100β were significantly higher in patients with fractures, compared with those without fractures (p0.05). The area under the receiver operating characteristics curve (AUC) for predicting intracranial lesions on CT for GFAP was 0.84 (0.73-0.95) and for S100β was 0.78 (0.67-0.89). However, in the presence of extracranial fractures, the AUC for GFAP increased to 0.93 (0.86-1.00) and for S100β decreased to 0.75 (0.61-0.88). In a general trauma population, GFAP out-performed S100β in detecting intracranial CT lesions, particularly in the setting of extracranial fractures.

  10. A Systematic Review and Meta-Analysis on Economic Comparison Between Endovascular Coiling Versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms.

    Science.gov (United States)

    Zhang, Xiaoxi; Li, Li; Hong, Bo; Xu, Yi; Liu, Yuan; Huang, Qinghai; Liu, Jianmin

    2018-05-01

    Healthcare expenditures and cost reduction have been under critical surveillance in all countries and are critical for policymakers. This review aims at qualitatively and quantitatively analyzing the difference of hospital costs and length of stay between endovascular coiling versus neurosurgical clipping in ruptured intracranial aneurysms (RAs). MEDLINE, the Cochrane database, Embase, and the Web of Science database were searched and evaluated independently by 2 authors according to the Newcastle-Ottawa Scale for cohort studies describing economic hospital cost or length of stay in patients with RAs. A total of 8 studies were included, describing 24,219 RAs treated with neurosurgical clipping and 24,962 RAs with endovascular coiling. Meta-analysis revealed that the total hospital costs (THCs) were similar between coiling versus clipping in RAs (standard mean difference [SMD], -0.05; 95% confidence interval [CI], -0.12 to 0.22; I 2  = 99%; P = 0.50). Subgroup analysis showed that THCs of clipping and coiling were similar in ruptured aneurysms in the United States. However, in South Korea, the THCs of coiling were significantly higher than clipping. In the long run, 1-year medical costs of endovascular treatment were significantly lower than that of clipping in RAs (SMD, 0.15; 95% CI, 0.05-0.25; I 2  = 66%; P = 0.005). In addition, the length of stay of coiled patients was significantly shorter than clipped patients (SMD, 0.29; 95% CI, 0.13-0.45; I 2  = 96%; P China, coiling was more expensive. The length of stay was much shorter in coiled patients in all countries. Copyright © 2018. Published by Elsevier Inc.

  11. Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: Is it a predisposing factor for rupture risk?

    Science.gov (United States)

    Dusak, Abdurrahim; Kamasak, Kaan; Goya, Cemil; Adin, Mehmet E.; Elbey, Mehmet A.; Bilici, Aslan

    2013-01-01

    Background A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture. Material/Methods The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant. Results General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs. Conclusions Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space. PMID:23974299

  12. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Liu, HaiFeng; Xu, YongSheng [First Hospital of LanZhou University, Department of Radiology, Lanzhou, Gansu (China); First Clinical Medical College of LanZhou University, Lanzhou, Gansu (China); Xun, YangQin [Lanzhou University, Evidence-based Medicine Center, Lanzhou (China); Dou, Yu; Wang, ShuaiWen; Lu, XingRu; Lei, JunQiang [First Hospital of LanZhou University, Department of Radiology, Lanzhou, Gansu (China)

    2017-11-15

    This meta-analysis is to comprehensively evaluate the diagnostic performance of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) for detecting intracranial aneurysm (IA). PubMed, Embase, Web of Science, and the Cochrane library were systematically searched for retrieving eligible studies. Study inclusion, data extraction, and risk of bias assessment were performed by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were carried out. In total, 18 studies comprising 3463 patients were selected. The results of 3D-TOF-MRA for diagnosing IA were SEN 0.89 (95% CI 0.82-0.94), SPE 0.94 (0.86-0.97), PLR 13.79 (5.92-32.12), NLR 0.11 (0.07-0.19), DOR 121.90 (38.81-382.94), and AUC 0.96 (0.94-0.98), respectively. In the subgroup analysis, studies without subarachnoid hemorrhage (SAH) tend to perform statistical significantly better (P < 0.05) in detecting IAs than studies with SAH 0.99 (0.98-1.00) vs. 0.89 (0.86-0.91). The diagnostic value of studies with a two-image reconstruction method was higher than studies with only one image reconstruction method: 0.99 (0.98-1.00) vs. 0.91 (0.89-0.94) with P < 0.05. The 3D-TOF-MRA had better SEN in aneurysms > 3 mm than the aneurysms ≤ 3 mm in diameter: 0.89 (0.87-0.92) vs. 0.78 (0.71-0.84) with P < 0.05. This study demonstrated that 3D-TOF-MRA has an excellent diagnostic performance for the overall assessment of IA and may serve as an alternative for further patient management with IA. (orig.)

  13. Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods

    OpenAIRE

    Cardim, Danilo; Robba, Chiara; Donnelly, Joseph; Bohdanowicz, Michal; Schmidt, Bernhard; Damian, Maxwell; Varsos, Georgios V.; Liu, Xiuyun; Cabeleira, Manuel; Frigieri, Gustavo; Cabella, Brenno; Smielewski, Peter;