Grading and Decision-Making in (Aneurysmal) Subarachnoid Haemorrhage

Mooij, J.J.A.

doi:10.1177/159101990100700402

Cited by 13 publications

(12 citation statements)

References 21 publications

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“…In all patients follow-up outcome from ruptured AA is assessed with Karnovsky Score (KS) 16 and Glasgow Outcome Score (GOS). GOS 1 indicates good recovery without neurological deficit and GOS 5 indicates death 17 In all cases follow-up DSA is expected at three months and 1 year after treatment, with further angiography proposed at 3 and 5 years. Intermediate control angiograms at 6 months are performed in cases of partial occlusion of the AA, recanalisation or regrowth of the lesion was demonstrated.…”

Section: Follow-up -Scoresmentioning

confidence: 99%

5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

Mahadevan

Sachet

et al. 2002

Interv Neuroradiol

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The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid-term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term.

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Section: Follow-up -Scoresmentioning

confidence: 99%

5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

Mahadevan

Sachet

et al. 2002

Interv Neuroradiol

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“…In the remaining patients (poor-grade patients, poor clinical conditions, aneurysms of the posterior circulation, difficult aneurysms of the anterior circulation), the complication rate rises dramatically, and alternative treatments are often employed. The most frequent approach includes medical treatment in intensive care units (ICU) to some hours or days, to allow patients to overcome the hyperacute phase 18,26 . If the patient recovers, the aneurysm is treated.…”

Section: Short-term Results (Protection From Rebleedings)mentioning

confidence: 99%

Endovascular Treatment: Part Two

Bergui

Stura

Bradač

2002

Rivista di Neuroradiologia

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The aim of this study is to consider the results of the aneurysms treated in our unit in the last years. The results of a given treatment are very difficult to evaluate if a series of prior assumptions have not been made, i.e., the goals of treatment, patient selection, and so on. This is particularly true if alternative treatments are available and if, as in the present work, the cases are recruited over a relatively long time with respect to the time of evolution of the technique.Two techniques were used, occlusion of the parent vessel with secondary thrombosis of the aneurysm and selective occlusion of the aneurysm with coils.Il trattamento endovascolare degli aneurismi Parte seconda: i risultati RIASSUNTO -L'obiettivo di questo lavoro è quello di analizzare i risultati del trattamento degli aneurismi nel nostro Istituto durante lo scorso anno.I risultati di un determinato trattamento sono molto difficili da valutare in carenza di alcune premesse, quali ad esempio gli obiettivi del trattamento, la selezione dei pazienti, ecc. Ciò è vero in particolare se sono possibili trattamenti alternativi e se, come in questo lavoro, i casi sono raccolti in un tempo relativamente lungo in proporzione all'evoluzione della tecnica.Vengono usate due tecniche diverse: l'occlusione del vaso afferente, con trombosi secondaria dell'aneurisma e l'occlusione selettiva della sacca con spirali.

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“…The endpoints of the study were the relief of vasospasm as measured by TCD and the numbers of secondarily developed delayed brain infarctions; the latter were compared to the results expected in this subgroup. We included 18 subsequent long-term comatose patients (8 males, 10 females) aged 38-83 years (mean 59 years; SD 13 years; range 32-83 years) post-aSAH (modified Fisher IV [1]) in Hunt-Hess grades IV (without) and V (with) pupil dilatation ( [19][20][21], definitions in "Appendix") who did not recover after cerebrospinal fluid (CSF) drainage and treatment of the aneurysm. Including eight patients with intracerebral and one with subdural hematomas, seven patients presented with ultra-early vasospasm (< 6 h after aSAH, Table 1).…”

Section: Methodsmentioning

confidence: 99%

Nitric Oxide-Based Treatment of Poor-Grade Patients After Severe Aneurysmal Subarachnoid Hemorrhage

et al. 2019

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Background: Patients with aneurysmal subarachnoid hemorrhage (aSAH) require close treatment in neuro intensive care units (NICUs). The treatments available to counteract secondary deterioration and delayed ischemic events remain restricted; moreover, available neuro-monitoring of comatose patients is undependable. In comatose patients, clinical signs are hidden, and timing interventions to prevent the evolution of a perfusion disorder in response to fixed ischemic brain damage remain a challenge for NICU teams. Consequently, comatose patients often suffer secondary brain infarctions. The outcomes for long-term intubated patients w/wo pupil dilatation are the worst, with only 10% surviving. We previously added two nitroxide (NO) donors to the standard treatment: continuous intravenous administration of Molsidomine in patients with mild-to-moderate aSAH and, if required as a supplement, intraventricular boluses of sodium nitroprusside (SNP) in high-risk patients to overcome the so-called NO-sink effect, which leads to vasospasm and perfusion disorders. NO boluses were guided by clinical status and promptly reversed recurrent episodes of delayed ischemic neurological deficit. In this study, we tried to translate this concept, the initiation of intraventricular NO application on top of continuous Molsidomine infusion, from awake to comatose patients who lack neurological-clinical monitoring but are primarily monitored using frequently applied transcranial Doppler (TCD). Methods: In this observational, retrospective, nonrandomized feasibility study, 18 consecutive aSAH comatose/intubated patients (Hunt and Hess IV/V with/without pupil dilatation) whose poor clinical status precluded clinical monitoring received standard neuro-intensive care, frequent TCD monitoring, continuous intravenous Molsidomine plus intraventricular SNP boluses after TCD-confirmed macrospasm during the daytime and on a fixed nighttime schedule. Results: Very likely associated with the application of SNP, which is a matter of further investigation, vasospasmrelated TCD findings promptly and reliably reversed or substantially weakened (p < 0.0001) afterward. Delayed cerebral ischemia (DCI) occurred only during loose, low-dose or interrupted treatment (17% vs. an estimated 65% with secondary infarctions) in 17 responders. However, despite their worse initial condition, 29.4% of the responders survived (expected 10%) and four achieved Glasgow Outcome Scale Extended (GOSE) 8-6, modified Rankin Scale (mRS) 0-1 or National Institutes of Health Stroke Scale (NIHSS) 0-2.

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Grading and Decision-Making in (Aneurysmal) Subarachnoid Haemorrhage

Cited by 13 publications

References 21 publications

5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

Endovascular Treatment: Part Two

Nitric Oxide-Based Treatment of Poor-Grade Patients After Severe Aneurysmal Subarachnoid Hemorrhage

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