Epidemiology, Therapy and Functional Outcome of Aneurysmal Subarachnoid Hemorrhage in Sapporo Between 2003 and 2007: An Area-specific, Group-based Study by Hokkaido University Hospital Group

敏, 黒田; 達哉, 石川; 正昭, 穂刈; 若樹, 中山; 宏, 安田; 哲之, 吉本; 聡, 牛越; 研, 数又; 孝治, 板本; 剛, 浅野; 毅, 青樹; 徹, 小林; 修吾, 瀧川; 好正, 新谷; 明弘, 高橋; 俊介, 寺坂; 敏光, 会田; 正二, 馬渕; 三起夫, 野村; 久壽, 斉藤; 貞男, 金子; 喜信, 岩崎

doi:10.2335/scs.37.109

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…The results of a prospective registration study involving 836 patients with SAH during a period of 5 years in Hokkaido University and 7 major affiliated institutions were previously published. 9) The rate of severe-status patients was high, similar to that in this study. Concerning treatment methods, clipping was performed in 548 patients (79.5%) and coil embolization was performed in 121 (17.6%); there was a deviation.…”

Section: Discussionsupporting

confidence: 89%

“…In addition, the prevention and treatment of cerebral vasospasm and hydrocephalus differed among the institutions. In comparison with other articles, the definitions of cerebral vasospasm and hydrocephalus vary, 14) and the timing of evaluation differs 9) ; therefore, these factors may have influenced the results. In studies involving a large-scale database or volunteer registration, there may be omissions, making the calculation of incidences inaccurate through a sampling bias.…”

Section: Discussionmentioning

confidence: 88%

“…These are considered important complications. Kuroda et al 9) also reported cerebral vasospasm and hydrocephalus as factors for a poor outcome.…”

Section: Discussionmentioning

confidence: 95%

“…3 . 9 , 10 , 12 , 13 , 15 – 20) The definition of hydrocephalus also varies: symptomatic, imaging findings, and hydrocephalus requiring surgery. Its incidence ranges from approximately 10 to 40%, but hydrocephalus after coil embolization is less frequent than after clipping.…”

Section: Discussionmentioning

confidence: 99%

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Vasospasm and Hydrocephalus Following Subarachnoid Hemorrhage Are Less Frequent in Coil Embolization than in Clipping

Hayashi

Ogawa

Fujimoto

et al. 2021

NOUSHINKEI KEKKANNAI TIRYOU

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Objective The effects of treatment methods for ruptured aneurysms on the incidence of vasospasm and normal pressure hydrocephalus (NPH) following subarachnoid hemorrhage (SAH) are controversial. We retrospectively examined the Nagasaki SAH registry data, and the complication rates of symptomatic vasospasm and NPH were analyzed based on the treatment methods. Methods Between January 2015 and December 2017, 800 SAH patients were registered from 18 hospitals, and their age, sex, World Federation of Neurological Societies (WFNS) grade, Fisher group, size and location of cerebral aneurysms, treatment methods, incidence of symptomatic vasospasm and shunt-dependent hydrocephalus, and prognosis (discharge or 3 months later) were retrospectively analyzed. The effects of treatment methods for the ruptured aneurysm on the incidence of symptomatic vasospasm and shunt-dependent hydrocephalus were then statistically analyzed. Results The mean age was 66.2 years old. There were 245 (30.6%) male patients and 555 (69.3%) female patients. Cerebral aneurysms were identified in 708 patients (87.5%) and surgical treatments were performed for 620. Neck clipping was employed in 416 patients (67.1%) and coil embolization was employed in 180 (29.0%). Symptomatic vasospasm developed in 118 (28.4%) in the clipping group and 30 (16.7%) in the coiling group (P = 0.0024). NPH developed in 148 (35.6%) in the clipping group and 42 (23.3%) in the coiling group (P = 0.0032). Vasospasm was listed as a major factor for an unfavorable outcome in 23 patients (8.9%) and as a minor factor in 33 (13.3%). NPH was listed as a major factor for an unfavorable outcome in 19 patients (3.5%) and as a minor factor in 46 (18.5%). Conclusions The multicenter registry study demonstrated lower incidences of both symptomatic vasospasms and NPH in the coiling group than in the clipping group. This superiority may result in better outcomes in the coiling group.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 88%

“…These are considered important complications. Kuroda et al 9) also reported cerebral vasospasm and hydrocephalus as factors for a poor outcome.…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Vasospasm and Hydrocephalus Following Subarachnoid Hemorrhage Are Less Frequent in Coil Embolization than in Clipping

Hayashi

Ogawa

Fujimoto

et al. 2021

NOUSHINKEI KEKKANNAI TIRYOU

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“…The epidemiological, demographic, and therapeutic features of aneurysmal SAH in Sapporo City have been reported before. 14 In this study, the clinical and radiological information of patients with aneurysmal SAH was precisely collected. Patient age and sex and the location of aneurysm were recorded.…”

Section: Methodsmentioning

confidence: 99%

Size Ratio Can Highly Predict Rupture Risk in Intracranial Small (<5 mm) Aneurysms

Kashiwazaki

Kuroda

2013

Stroke

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120

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Background and Purpose-Management strategies for unruptured intracranial aneurysms (UIAs) are controversial. This study aimed to identify surrogate parameters that highly predict the rupture risk of small (<5 mm) UIAs. Methods-Radiological data were collected from 854 patients with aneurysmal subarachnoid hemorrhages who were enrolled in the Sapporo SAH Study. They had a total of 854 ruptured intracranial aneurysms and 180 UIAs. The size, aneurysm-to-vessel size ratio, and distribution were precisely compared between ruptured intracranial aneurysms and UIAs. Results-For all aneurysms, the size was significantly larger in ruptured intracranial aneurysms (7.0±1.3 mm) than in the UIAs (3.7±1.2 mm; P<0.001). Size ratio was also significantly higher in ruptured intracranial aneurysms (4.3±1.9) than in the UIAs (2.2±1.6; P<0.001). Multivariate logistic analysis showed that size and size ratio were correlated with aneurysm rupture. However, in small aneurysms, multivariate logistic regression revealed that only size ratio was associated with ruptured aneurysms (P=0.008; odds ratio, 9.1). There were no significant differences in size or aneurysm location. A receiver operating characteristic analysis was performed for size ratio in small aneurysms, and the threshold separating ruptured and unruptured groups was 3.12 and the area under the curve was 0.801. Conclusions-This study revealed that the size ratio, and not the absolute size, may highly predict the risk of rupture in small UIAs. Size ratio measurements are very simple and provide useful information for determining treatment and follow-up strategies for patients with small UIAs. (Stroke. 2013;44:2169-2173.)

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Pathological findings of saccular cerebral aneurysms—impact of subintimal fibrin deposition on aneurysm rupture

et al. 2015

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Although several studies have suggested that aneurysmal wall inflammation and laminar thrombus are associated with the rupture of saccular aneurysms, the mechanisms leading to the rupture remain obscure. We performed full exposure of aneurysms before clip application and attempted to keep the fibrin cap on the rupture point. Using these specimens in a nearly original state before surgery, we conducted a pathological analysis and studied the differences between ruptured and unruptured aneurysms to clarify the mechanism of aneurysmal wall degeneration. This study included ruptured (n=28) and unruptured (n=12) saccular aneurysms resected after clipping. All of the ruptured aneurysms were obtained within 24 hours of onset. Immunostainings for markers of inflammatory cells (CD68) and classical histological staining techniques were performed. Clinical variables and pathological findings from ruptured and unruptured aneurysms were compared.Patients with ruptured or unruptured aneurysms did not differ by age, gender, size, location, and risk factors, such as hypertension, smoking, and hyperlipidemia. The absence or fragmentation of the internal elastica lamina, the myointimal hyperplasia, and the thinning of the aneurysmal wall were generally observed in both aneurysms. The existence of subintimal fibrin deposition, organized laminar thrombus, intramural hemorrhage, neovascularization and monocyte infiltration are more frequently observed in ruptured aneurysms. Multivariate logistic regression analysis showed that ruptured aneurysm was associated with presence of subintimal fibrin deposition and monocyte infiltration. These findings suggest that subintimal fibrin deposition and chronic inflammation have a strong impact on degeneration of the aneurysmal wall leading to their rupture, and this finding may be caused by endothelial dysfunction.

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Epidemiology, Therapy and Functional Outcome of Aneurysmal Subarachnoid Hemorrhage in Sapporo Between 2003 and 2007: An Area-specific, Group-based Study by Hokkaido University Hospital Group

Cited by 5 publications

References 19 publications

Vasospasm and Hydrocephalus Following Subarachnoid Hemorrhage Are Less Frequent in Coil Embolization than in Clipping

Vasospasm and Hydrocephalus Following Subarachnoid Hemorrhage Are Less Frequent in Coil Embolization than in Clipping

Size Ratio Can Highly Predict Rupture Risk in Intracranial Small (<5 mm) Aneurysms

Pathological findings of saccular cerebral aneurysms—impact of subintimal fibrin deposition on aneurysm rupture

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