State of Practice: Endovascular Treatment of Acute Aneurysmal SAH in Germany

Janssen, Hendrik; Berlis, Ansgar; Lutz, Juergen; Thon, Niklas; Brückmann, H.

doi:10.3174/ajnr.a5260

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…This proportion is higher than the 66% from a recent survey in Germany. 30 This indicates that the avoidance of the use of stents by introduction of the WEB was probably not counterweighted by increased referral to surgery.…”

Section: Discussionmentioning

confidence: 99%

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

Rooij

Rooij²,

Peluso³

et al. 2017

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

Rooij

Rooij²,

Peluso³

et al. 2017

AJNR Am J Neuroradiol

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“…The proper treatment of intracranial aneurysms is still controversial. Only 66% of all unruptured aneurysms in Germany were treated by endovascular techniques, 5 despite the results of the ISAT study 2002 and its recommendation of endovascular treatment. One point of criticism of endovascular aneurysm treatment is the higher reintervention rate compared with clipping.…”

Section: Comparison Between Surgical Clipping and Endovascular Techniquementioning

confidence: 99%

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Hagen

Maurer

Berlis

2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms. MATERIALS AND METHODS: Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1-3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB (n ϭ 38) and coiling with (n ϭ 45) or without stent assistance (n ϭ 67). RESULTS: The procedure-associated good clinical outcome (mRS Ϲ 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0-2 (91.3%) and 13 had an mRS of 3-6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement (P Ͻ .05). CONCLUSIONS: Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.

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“…As a result, resources for the diagnosis and treatment of aSAH are available round-the-clock in many neurovascular centers. Nevertheless, a survey among German hospitals involved in treatment of aSAH showed that the majority of hospitals (98%) does not provide immediate aneurysm closure at night, be it by either endovascular or neurosurgical treatment [10]. Moreover, most hospitals do not start treatment later than 20:00.…”

Section: Discussionmentioning

confidence: 99%

“…Both human and situational factors may cause decreased quality of care during nighttime, and indeed task performance on manual monitoring tasks has been found worse at night [11,12]. It is therefore surmised that aneurysm repair during out of office hours increases the risk of treatmentrelated complications, based upon translation of results from nightly treatment of other diseases, although so far this has not been studied explicitly for endovascular closure of ruptured cerebral aneurysms [10,13,14].…”

Section: Discussionmentioning

confidence: 99%

Endovascular aneurysm closure during out of office hours is not related to complications or outcome

et al. 2020

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Purpose A possible disadvantage of endovascular occlusion outside work hours is that complex procedures might expose patients to additional risk when performed in a suboptimal setting. In this prospective cohort study, we evaluated whether treatment during out of office hours is a risk factor for per-procedural complications and clinical outcome. Methods We included 471 endovascular-treated, consecutive aneurysmal subarachnoid hemorrhage patients (56.6 ± 13.1, 69% female), from two prospective observational databases which were retrospectively analyzed. Primary outcome was the occurrence of per-procedural complications. Secondary outcomes were good clinical outcome (modified ranking scale ≤ 2) and death at 6-month follow-up. We determined odds ratios (OR) with 95% confidence intervals (CI) by ordered polytomous logistic regression analysis and adjusted odds ratios (aOR) for age, World Federation of Neurosurgical Societies grade, and time to treatment. Results Most patients were treated during office hours (363/471; 77.1%). Treatment during out of office hours did not result in an increased risk of per-procedural complications (OR 0.85 (95% CI 0.53–1.37; p = 0.51). Patients treated during out of office hours displayed similar odds of good clinical outcome and death after 6 months (OR 1.14, 95% CI 0.68–1.97 and 1.16 95% CI 0.56–2.29, respectively) compared to patients treated during office hours. Conclusion In our study, endovascular coil embolization during out of office hours did not expose patients to an increased risk of procedural complications or affect functional outcome after 6 months.

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State of Practice: Endovascular Treatment of Acute Aneurysmal SAH in Germany

Abstract: Our survey gives a detailed summary of the current practice of endovascular treatment and related topics in acute aneurysmal SAH in Germany and also reveals considerable changes in practice in comparison with older data.

Cited by 10 publications

References 25 publications

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

WEB Treatment of Ruptured Intracranial Aneurysms: A Single-Center Cohort of 100 Patients

Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up

Endovascular aneurysm closure during out of office hours is not related to complications or outcome

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