A retrospective clinical and angiographic study of the coiling outcome of ruptured intracranial aneurysms

Melake, Mostafa Saleh; Yamamoto, Munetaka; Yoshida, Kensaku; Oishi, Hidenori; Arai, Hajime; Elwan, Mohamed; Okda, Mohamed; El-Sheikh, Wafik M.; Hori, Tomokatsu

doi:10.1016/j.jocn.2009.06.025

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…We acknowledge the use of a unique coding system, whereby IA located in posterior communicating, anterior communicating, internal carotid and middle cerebral arteries were grouped into anterior circulation (n = 271), and those located in the posterior inferior cerebellar, basilar and vertebral arteries grouped into posterior circulation (n = 27). These findings are consistent with some [19,20,21] but not all studies of clinical outcomes in SAH. For example, a hospital-based study in the UK demonstrated that ruptured IA located in the internal carotid artery was associated with an increased risk of delayed ischemic neurological deficit (OR: 1.54; 95% CI: 1.12–2.11) [22], while a Canadian study reported an association between posterior location of ruptured IA and shunt-dependent hydrocephalus (hazard ratio: 1.04) [14].…”

Section: Discussionsupporting

confidence: 92%

Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia

Shiue

Arima²,

Hankey³

et al. 2011

Cerebrovasc Dis

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Background: It is uncertain whether the location and size of a ruptured intracranial aneurysm (IA) independently influences the outcome of subarachnoid hemorrhage (SAH). Objective: To determine the independent relationship of location and size of a ruptured IA with serious clinical outcomes after SAH in an Australasian population-based study. Methods: From 432 first-ever cases of primary SAH registered prospectively over 12 months in 4 Australasian cities between 1995 and 1998, the demographics, clinical features, risk factors and results of investigations were obtained, including the location and size of any ruptured IA as assessed by cerebral angiography, computed tomography and/or magnetic resonance imaging. Location was classified as either anterior (i.e. anterior communicating artery, internal carotid artery and middle cerebral artery) or posterior circulation (i.e. posterior communicating artery, posterior inferior cerebellar artery, basilar artery and vertebral artery), and size was classified as <5, 5–9 and ≧10 mm. Outcomes recorded during hospitalization were rebleeding, delayed ischemia, hydrocephalus, residual neurological impairment and in-hospital death. Logistic regression analysis was used to evaluate the effects of IA location and size on outcome, independent of other potential prognostic factors. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Results: IA location and size were confirmed separately in 299 and 252 patients, respectively. Patients with a posterior circulation IA had a lower rate of rebleeding than those with an anterior circulation IA (adjusted OR: 0.11; 95% CI: 0.02–0.87), but otherwise there was no significant relationship between IA location and outcome. Patients with a larger ruptured IA had higher risks of rebleeding (p = 0.02 for trend) and in-hospital death (p = 0.001) after controlling for age, sex, ethnicity, location of the ruptured IA and neurosurgical intervention. Conclusion: IA location in the posterior circulation was associated with a lower risk of rebleeding than IA in the anterior circulation. A larger IA size was associated with higher risks of rebleeding and in-hospital death.

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Section: Discussionsupporting

confidence: 92%

Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia

Shiue

Arima²,

Hankey³

et al. 2011

Cerebrovasc Dis

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“…long-term stability of the anatomical result is the limit of this therapeutic approach because rehabitation of the sac may lead to rebleeding even after several months or years 25 . A careful clinical and radiological follow-up (MRA and dSA) for at least dural complications found in the literature was between 9% and 14% with a mortality range of 1.4%-2.9% and morbidity of 2.5%-8.6% [3][4][5][11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

et al. 2012

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Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0–1), 8.9% died and the remainder showed moderate-severe disability (mRS2–3). The long-term stability of the anatomical result is a critical issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.

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“…The most common methods for treating intracranial aneurysm are surgical clipping and endovascular embolization with detachable coils. 6,7 The International Subarachnoid Aneurysm Trial (ISAT) compared these techniques in randomized patients who had suffered recent intracranial aneurysm rupture. 8,9 At the one-year followup, death or disability occurred less frequently among those treated with coil embolization.…”

Section: Introductionmentioning

confidence: 99%

The impact of microsurgical clipping and endovascular coiling on the outcome of cerebral aneurysms in patients over 60 years of age

Zhang

et al. 2012

Journal of Clinical Neuroscience

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A retrospective clinical and angiographic study of the coiling outcome of ruptured intracranial aneurysms

Cited by 7 publications

References 23 publications

Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia

Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia

Five to Ten Years Follow-up after Coiling of 241 Patients with Acutely Ruptured Aneurysms

The impact of microsurgical clipping and endovascular coiling on the outcome of cerebral aneurysms in patients over 60 years of age

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