Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study

Hostettler, Isabel C.; Alg, Varinder S; Shahi, Nichole; Jichi, Fatima; Bonner, Stephen; Walsh, Daniel; Bulters, Diederik; Kitchen, Neil; Brown, Martin M.; Houlden, Henry; Grieve, Joan; Werring, David J.; investigators, Observational Subarachnoid Haemorrhage Study

doi:10.1093/neuros/nyx365

Cited by 38 publications

(37 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With respect to the above-mentioned preceding investigations, our patient sample is in line with the main epidemiological SAH characteristics and, therefore, representative. A total of 78.5% of our patients suffered from bleeding as a result of an aneurysm located at the anterior cerebral circulation with a mean aneurysm size of 5.9 ± 3.2 mm, which is in line with other studies [2,19,28,69]. The SAH severity distribution of the study population differed significantly from other surveys which generally give account of lower percentages of patients grouped into neurologically favorable low SAH grades [2,39].…”

Section: Discussionsupporting

confidence: 86%

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

et al. 2020

View full text Add to dashboard Cite

Background Aneurysmal subarachnoid hemorrhage (SAH) as a serious type of stroke is frequently accompanied by a so-called initial thunderclap headache. However, the occurrence of burdensome long-term headache following SAH has never been studied in detail so far. The aim of this study was to determine the prevalence and characteristics of long-term burdensome headache in good-grade SAH patients as well as its relation to health-related quality of life (HR-QOL). Methods All SAH cases treated between January 2014 and December 2016 with preserved consciousness at hospital discharge were prospectively interviewed regarding burdensome headache in 2018. Study participants were subsequently scrutinized by means of a standardized postal survey comprising validated pain and HR-QOL questionnaires. A retrospective chart review provided data on the initial treatment. Results A total of 93 out of 145 eligible SAH patients participated in the study (62 females). A total of 41% (38/93) of subjects indicated burdensome headache at follow-up (mean 32.6 ± 9.3 months). Comparison between patients with (HA+) and without long-term headache (HA-) revealed significantly younger mean age (47.9 ± 11.8 vs. 55.6 ± 10.3 years; p < .01) as well as more favorable neurological conditions (WFNS I/II: 95% vs. 75%; p = .03) in HA+ cases. The mean average headache of the HA+ group was 3.7 ± 2.3 (10-point numeric rating scale), and the mean maximum headache intensity was 5.7 ± 2.9. Pain and HR-QOL scores demonstrated profound alterations in HA+ compared to HA-patients. Conclusions Our results suggest that a considerable proportion of SAH patients suffers from burdensome headache even years after the hemorrhage. Moreover, long-term headache is associated with reduced HR-QOL in these cases. Keywords Headache. Intracranial aneurysm. Quality of life. Subarachnoid hemorrhage This article is part of the Topical Collection on Vascular Neurosurgery-Aneurysm Previous presentation Parts of this study have been presented as an oral contribution at the 70th annual meeting of the German Society of Neurosurgery. The meeting was held in Würzburg (Germany) from May 12 to 15, 2019.

show abstract

Section: Discussionsupporting

confidence: 86%

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Finally, evidence on dyslipidemia and aneurysm growth/rupture is controversial. Our multivariate analysis found that hypercholesterolemia was not associated with aneurysm rupture, which contradicts data from Hostettler et al, 18 in which hyperlipidemia was inversely related to rupture. Other studies have shown that a statin is associated with an increased risk of rupture, 39 while a recent meta-analysis showed no effect of statins on rupture status.…”

Section: Study Limitationscontrasting

confidence: 99%

“…Another study of 192 patients harboring 234 unruptured IAs 35 showed that aspirin was protective for aneurysm growth (OR 0.72), but the findings did not reach statistical significance, potentially due to the small size of the cohort. On the other hand, in their multivariate analysis of 2334 patients, Hostettler et al 18 demonstrated that aspirin use was inversely associated with rupture (OR 0.65). In our study, ruptured aneurysms were secured within 24 hours from ictus and, hence, we did not find any case of early rebleeding.…”

Section: Zanaty Et Almentioning

confidence: 98%

Aspirin associated with decreased rate of intracranial aneurysm growth

Zanaty¹,

Roa²,

Nakagawa

et al. 2020

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEAspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors’ goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm.METHODSThe authors performed a retrospective review of a prospectively maintained database covering the period July 2009 through January 2019. Patients’ data were included if the following criteria were met: 1) the patient harbored multiple IAs; 2) designated primary aneurysms were treated by surgical/endovascular means; 3) the remaining aneurysms were observed for growth; and 4) a follow-up period of at least 5 years after the initial treatment was available. Demographics, earlier medical history, the rupture status of designated primary aneurysms, aneurysms’ angiographic features, and treatment modalities were gathered.RESULTSThe authors identified 146 patients harboring a total of 375 IAs. At the initial encounter, 146 aneurysms were treated and the remaining 229 aneurysms (2–5 mm) were observed. During the follow-up period, 24 (10.48%) of 229 aneurysms grew. All aneurysms observed to grow later underwent treatment. None of the observed aneurysms ruptured. Multivariate analysis showed that aspirin was significantly associated with a decreased rate of growth (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05–0.63). Variables associated with an increased rate of growth included hypertension (OR 14.38, 95% CI 3.83–53.94), drug abuse (OR 11.26, 95% CI 1.21–104.65), history of polycystic kidney disease (OR 9.48, 95% CI 1.51–59.35), and subarachnoid hemorrhage at presentation (OR 5.91, 95% CI 1.83–19.09).CONCLUSIONSIn patients with multiple IAs, aspirin significantly decreased the rate of aneurysm growth over time. Additional prospective interventional studies are needed to validate these findings.

show abstract

“…The estimated prevalence of UIAs in the general population is 3% [23]. Our observations demonstrate that UIAs are more commonly located in the ICA and MCA [24]. UIAs were found to have no impact on autoregulation of cerebral circulation [25].…”

Section: Discussionmentioning

confidence: 56%

Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Karwacki

Niewiadomski²,

Witkowska³

et al. 2018

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Background: The estimated prevalence of unruptured intracranial aneurysms is 3%. Standard monitoring does not enable one to assess the influence of anaesthetics on the factors determining intracranial homeostasis. Thanks to transcranial Doppler ultrasonography, middle cerebral artery flow velocity (V MCA), reflecting cerebral blood flow, can be measured. The aim of the study was to assess the effects of propofol on intracranial homeostasis in patients with unruptured intracranial aneurysms during the induction of anaesthesia based on V MCA changes. Methods: The study encompassed 21 patients (group II) anaesthetised for elective craniotomy due to unruptured intracranial aneurysms. The control group (group I) included 21 patients who underwent discoidectomy. V MCA , as well as HR, MAP, etCO 2 , and SpO 2 were monitored at the following time points: T 0 -onset of study; T 1 -after 1 minute; T 2 -onset of preoxygenation; T 3 -after 1 minute of preoxygenation; T 4 -administration of fentanyl; T 5 -1 minute after fentanyl; T 6 -administration of propofol; T 7 -1 minute after propofol; T 8 -intubation; T 9 -1 minute after intubation; T 10 -2 minutes after intubation. results: In both groups, no changes in mean HR, etCO 2 and SpO 2 were observed at the successive time points of observation. In groups I and II, an MAP decrease between T 6 and T 7 and an MAP increase between T 7 and T 9 were noted. There were no intergroup differences in mean values of MAP at the times of observation. In both groups and bilaterally, a V MCA decrease was recorded between T 6 and T 7 and an increase between T 7 and T 8 . There were no intergroup differences in mean values of V MCA at the times of observation. In both groups, a weak correlation between V MCA and MAP changes was found bilaterally. Conclusions: Propofol depresses the cerebral circulation during the induction of anaesthesia. The presence of an unruptured aneurysm does not affect the reactivity of the cerebral vessels during the induction of anaesthesia with propofol.

show abstract

Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study

Cited by 38 publications

References 56 publications

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

Aspirin associated with decreased rate of intracranial aneurysm growth

Wpływ propofolu na prędkość przepływu krwi w tętnicy środkowej mózgu (VMCA) u chorych z niepękniętym tętniakiem wewnątrzczaszkowym podczas indukcji znieczulenia ogólnego

Contact Info

Product

Resources

About