Aneurysmal subarachnoid hemorrhage in patients under 35-years-old: A single-center experience

Chalouhi, Nohra; Teufack, Sonia; Chandela, Sid; Dalyai, Richard; Tjoumakaris, Stavropoula; Hasan, David; Dumont, Aaron S.; Gonzalez, L. Fernando; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1016/j.clineuro.2012.07.016

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…While other studies have reported mortality rates between 0% and 34% following treatment [8,10], our surgical clipping patients showed total mortality and morbidity rates of 11.2% and 22%, respectively.…”

Section: Discussioncontrasting

confidence: 80%

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Management of aneurysmal subarachnoid hemorrhage with surgical clipping: A single center perspective

Küçükyıldız¹,

Özüm²

2022

Journal of Surgery and Medicine

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Background/Aim: There is no consensus on the optimal treatment for intracranial aneurysm rupture due to subarachnoid hemorrhage (SAH). In this study, we analyzed a series of ruptured intracranial aneurysms treated with the clipping method at our center. Methods: In this retrospective cohort study; we searched our patient database for patients who developed SAH due to ruptured intracranial aneurysm treated at the Neurosurgery Clinic of Sivas Cumhuriyet University. A total of 304 patients who underwent the clipping operation due to aneurysmal SAH between 2010 and 2020 were included in the study. Cases with aneurysmal SAH who underwent endovascular coiling which is consisted of 22 patients were excluded. Results: A significant inverse correlation was found between age and Glasgow coma scores (GCS) (r=−0.137, P=0.017). Hunt-Hess and Fisher grades increased significantly with increasing age (r=0.187, P<0.001 and r=0.185, P<0.001). The mean age of men was significantly lower than that of women (P=0.005). Aneurysms located in the anterior communicating artery were significantly more frequent in men than in women (P<0.001). There was no significant difference in the distribution of other aneurysm locations by gender (P>0.05). No significant differences were observed in GCS scores and Hunt-Hess and Fisher grades between genders (P>0.05). There were no significant effects of aneurysm locations on mortality (P>0.05). Conversely, GCS scores were significantly lower and Hunt-Hess and Fisher grades were significantly higher in the surviving group than in the deceased group (P<0.001). Conclusion:Our study presented the outcomes of patients treated in our clinic with surgical clipping. Based on our findings, we believe that surgical clipping is still a safe and valid treatment method.

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Section: Discussioncontrasting

confidence: 80%

“…In a study of 248 poor grade SAH patients evaluated by Patrick et al [8], the mean aneurysm size was 8.5 mm. A study of SAH patients under 35 years of age by Chalouhi et al [10] found that more than half of the patients had an aneurysm size below 7 mm.…”

Section: Discussionmentioning

confidence: 99%

Management of aneurysmal subarachnoid hemorrhage with surgical clipping: A single center perspective

Küçükyıldız¹,

Özüm²

2022

Journal of Surgery and Medicine

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“…These results are in agreement with the findings of a previously published study where we investigated the effects of aspirin on the expression of inflammatory molecules in human CAs. 21 Decreased expression of cyclooxygenase-2 (Cox-2) (not Cox-1) and macrophages among other mediators were found in patients treated with aspirin compared with controls. This suggested that aspirin may exert its protective effects through the Cox-2 pathway.…”

Section: Discussionmentioning

confidence: 99%

Differential Sex Response to Aspirin in Decreasing Aneurysm Rupture in Humans and Mice

et al. 2016

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We previously found that aspirin decreases the risk of cerebral aneurysm rupture in humans. We aim to assess whether a sex differential exists in the response of human cerebral aneurysms to aspirin and confirm these observations in a mouse model of cerebral aneurysm. A nested case-control analysis from the International Study of Unruptured Intracranial Aneurysms was performed to assess whether a sex differential exists in the response of human cerebral aneurysms to aspirin. A series of experiments were subsequently performed in a mouse model of cerebral aneurysms. Aneurysms were induced with hypertension and elastase injection into mice basal cisterns. We found that aspirin decreased the risk of aneurysm rupture in men significantly more than women in the International Study of Unruptured Intracranial Aneurysms. In mice, aspirin and cyclooxygenase-2 inhibitor did not affect cerebral aneurysm formation but significantly decreased the incidence of rupture. The incidence of rupture was significantly lower in male vs. female mice on aspirin. Gene expression analysis from cerebral arteries showed higher 15-hydroxyprostaglandin dehydrogenase levels in male mice. The rate of cerebral aneurysm rupture was similar in male mice receiving aspirin and 15-hydroxyprostaglandin dehydrogenase inhibitor compared to females receiving aspirin and 15-hydroxyprostaglandin dehydrogenase agonist signaling a reversal of the sex-differential response to aspirin. Aspirin decreases aneurysm rupture in human and mice, in part through cyclooxygenase-2 pathways. Evidence from animal and human studies suggests a consistent differential effect by sex. 15-hydroxyprostaglandin dehydrogenase activation in females reduces the incidence of rupture and eliminates the sex-differential response to aspirin.

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“…Fourteen endovascular treatments were performed (82.4%), which resulted in eight complete obliterations with no contrast filling of the aneurysmal sac (57.1%), six small residual neck (42.9%) with no residual delayed contrast stagnation argues that this difference stems from an embryological process in which the ICA develops before the ACA and MCA; therefore, hemodynamic stress causes a defect in a congenitally fragile ICA earlier than in the ACA 2) . Thus, a fragile and congenital portion of the ICA may develop into an aneurysm owing to hemodynamic stress, and the development of an ACA aneurysm may take longer than the growth of an ICA lesion 7) .…”

Section: Endovascular Resultsmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage in Young Adult Patients: Single Center Reports

Ji,

Hwang

2023

Nerve

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Objective: The mechanisms underlying the formation and rupture of intracranial aneurysms in young adults remain a matter of debate. This study aimed to evaluate the clinical characteristics of young adult patients with aneurysmal subarachnoid hemorrhage (SAH) treated with endovascular or clipping techniques at a single center.Methods: Seventeen young adult patients (age, 18–40 years; 7 men and 10 women; mean age, 35.7 years) with aneurysmal SAH were treated at our hospital using an endovascular or clip ligation approach between February 2018 and March 2023. The clinical outcomes, complications, and patient characteristics were evaluated. The mean follow-up duration was 13 months (range, 0–44 months).Results: The male-to-female ratio was 0.7 (7 vs. 10 patients), and the most common location of aneurysm was the internal carotid artery (7 patients, 41.2%). Two patients (11.8%) presented with a history of hypertension, and six (35.3%) with smoking. The overall favorable outcome rate was 64.7% (Glasgow Outcome Scale [GOS] 4 and 5), while unfavorable outcomes occurred in 35.3% of patients (GOS 1, 2, and 3). None of the patients rebounded after clipping or endovascular treatment. Two (14.3%) patients treated with coil embolization (14 patients) showed an interval change in the residual neck (recanalization).Conclusion: Our results suggest that young adults with ruptured intracranial aneurysms exhibit different characteristics. However, well-controlled investigations using larger prospective studies are warranted to further clarify the clinical characteristics of these patients, including the mechanisms of aneurysm formation and rupture.

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Aneurysmal subarachnoid hemorrhage in patients under 35-years-old: A single-center experience

Cited by 11 publications

References 18 publications

Management of aneurysmal subarachnoid hemorrhage with surgical clipping: A single center perspective

Management of aneurysmal subarachnoid hemorrhage with surgical clipping: A single center perspective

Differential Sex Response to Aspirin in Decreasing Aneurysm Rupture in Humans and Mice

Aneurysmal Subarachnoid Hemorrhage in Young Adult Patients: Single Center Reports

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