Long-term prognosis in patients with clipped unruptured cerebral aneurysms―increased cerebrovascular events in patients with surgically treated unruptured aneurysms

Introduction : Age is an important determinant of outcome in patients with unruptured or ruptured cerebral aneurysms. Advancements in endovascular therapies have significantly impacted patient selection and treatment of patients with cerebral aneurysm. Recent release of the National claims data for 2017–2018 provides the opportunity to explore novel population‐level outcomes following clipping vs endovascular treatment of ruptured and unruptured cerebral aneurysms in different age groups. Methods : Analysis of US National Inpatient Sample of hospitalizations with aneurysmal subarachnoid hemorrhage (aSAH) or unruptured aneurysms treated with clipping or endovascular therapy from January 1, 2017 to December 31, 2018. Pre‐defined age strata included: younger than 50 years; 50–64 years; 65–79 years; and 80 years or older. Primary outcomes included in‐hospital mortality and favorable outcome defined as discharge to home. Results : Overall, 34,955 hospitalizations with unruptured aneurysm treatment, (26,695 endovascular and 8,260 surgical clipping), and 17,525 hospitalizations with aSAH were identified in the study period. In unruptured aneurysm group, endovascular therapy was associated with significantly higher favorable outcome across all age groups, and lower mortality in those 65 years or older (all P<0.001) when compared to clipping. Median hospital length‐of‐stay was 1 day (IQR 1–4) in endovascular vs 4 days (IQR 3–8) in clipping group (P<0.001). In aSAH group, endovascular therapy was associated with higher favorable outcome in 50–80 years age groups when compared to clipping, with no significant differences for in‐hospital mortality outcome (Table). Significantly more favorable outcomes were achieved with coiling vs clipping in those aged 65 or above with unruptured aneurysms. Conclusions : In 2017–2018 in US, unruptured aneurysm patients treated with endovascular therapy had significantly lower morbidity and mortality compared to those treated with surgical clipping, and differences were more pronounced with age. Similar but less strong association was observed in patients with aSAH.

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Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms

American Journal of Neuroradiology ◽

10.3174/ajnr.a6101 ◽

2019 ◽

Vol 40 (7) ◽

pp. 1191-1196 ◽

Cited By ~ 1

Author(s):

T. Murakami ◽

T. Nishida ◽

K. Asai ◽

Y. Kadono ◽

H. Nakamura ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Long Term Results ◽

Unruptured Cerebral Aneurysms

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BNP but Not s-cTnln Is Associated with Cardioembolic Aetiology and Predicts Short and Long Term Prognosis after Cerebrovascular Events

PLoS ONE ◽

10.1371/journal.pone.0102704 ◽

2014 ◽

Vol 9 (7) ◽

pp. e102704 ◽

Cited By ~ 14

Author(s):

Nicole Nigro ◽

Karin Wildi ◽

Christian Mueller ◽

Philipp Schuetz ◽

Beat Mueller ◽

...

Keyword(s):

Cerebrovascular Events ◽

Short And Long Term ◽

Long Term Prognosis

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Advances in endovascular aneurysm management: coiling and adjunctive devices

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000303 ◽

2020 ◽

Vol 5 (1) ◽

pp. 14-21

Author(s):

Jessica K Campos ◽

Brian V Lien ◽

Alice S Wang ◽

Li-Mei Lin

Keyword(s):

Cerebral Aneurysms ◽

Next Generation ◽

Coil Embolisation ◽

Interventional Techniques ◽

Technological Advances ◽

Aneurysm Occlusion ◽

Unruptured Cerebral Aneurysms ◽

Endovascular Coils

Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.

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Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199990050s116 ◽

1999 ◽

Vol 5 (1_suppl) ◽

pp. 89-92 ◽

Cited By ~ 5

Author(s):

Y. Kaku ◽

S. Yoshimura ◽

K. Hayashi ◽

T. Ueda ◽

N. Sakai

Keyword(s):

Lower Incidence ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Neurological Deficits ◽

Safe Treatment ◽

Unruptured Aneurysms ◽

Follow Up Study ◽

Platinum Coil ◽

Unruptured Cerebral Aneurysms

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed. On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization. Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.

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Expanding the use of flow diverters beyond their initial indication: treatment of small unruptured aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013062 ◽

2017 ◽

Vol 10 (3) ◽

pp. 245-248 ◽

Cited By ~ 5

Author(s):

J M Pumar ◽

A Mosqueira ◽

H Cuellar ◽

B Dieguez ◽

L Guimaraens ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Clinical Findings ◽

Anterior Circulation ◽

Unruptured Aneurysms ◽

Patient Demographics ◽

Delayed Hemorrhage ◽

Mean Size ◽

Unruptured Cerebral Aneurysms

BackgroundExperience with the endovascular treatment of unruptured small intracranial aneurysms by flow diverter devices is still limited.ObjectiveTo assess the safety and efficacy of the SILK flow diverter (SFD) in the treatment of small unruptured cerebral aneurysms (<10 mm).MethodsWe performed a retrospective review of a prospectively maintained database of patients treated with a SFD between July 2008 and December 2013 at 4 institutions in Spain to identify all patients with small unruptured aneurysms (<10 mm). Data for patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and at 6- and 12-month follow-ups.ResultsA total of 109 small aneurysms were treated with a SFD in 104 patients (78 women; 26 men; mean, median, and range of age: 55.2, 57.1, and 19–80 years, respectively). A total of 60 patients were asymptomatic (57.7%). All except 7 aneurysms (6.4%) arose from the anterior circulation. The mean size of the aneurysms was 4.7±1.9 mm. At 6 months, the neuromorbidity and neuromortality rates were 2.9% and 0.9%, respectively. Imaging at the 12-month follow-up showed complete occlusion, neck remnants, and residual aneurysm in 88.5% (69/78), 7.7% (6/78), and 3.3% (3/78) of cases, respectively. No delayed hemorrhage occurred.ConclusionsThe findings suggest that the indications for SFD can be safely extended to small intracranial aneurysms.

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Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms

Journal of Neurosurgery ◽

10.3171/jns.2002.96.1.0043 ◽

2002 ◽

Vol 96 (1) ◽

pp. 43-49 ◽

Cited By ~ 139

Author(s):

H. Richard Winn ◽

John A. Jane ◽

James Taylor ◽

Donald Kaiser ◽

Gavin W. Britz

Keyword(s):

Prevalence Rate ◽

Cerebral Aneurysms ◽

Anterior Circulation ◽

Content Type ◽

Unruptured Aneurysms ◽

Incidental Aneurysms ◽

Unruptured Cerebral Aneurysms ◽

The University ◽

Yearly Rate ◽

Fine Print

Object. The prevalence of unruptured cerebral aneurysms is unknown, but is estimated to be as high as 5%. The goal of this study was to determine the prevalence of asymptomatic incidental aneurysms. Methods. The authors studied all cerebral arteriography reports produced at a single institution, the University of Virginia, between April 1969 and January 1980. A review of 3684 arteriograms demonstrated 24 cases of asymptomatic aneurysms, yielding a prevalence rate of 0.65%. The majority (67%) of the 24 patients harboring unruptured aneurysms were women. More than 90% of the unruptured aneurysms were located in the anterior circulation and in locations similar to those found in patients with ruptured aneurysms. Nearly 80% of the aneurysms were smaller than 1 cm in their greatest diameter. The frequency of asymmetrical unruptured aneurysms (0.6–1.5%) was constant throughout all relevant age ranges (35–84 years). Conclusions. While keeping in mind appropriate caveats in extrapolating from these data, the prevalence rate of asymptomatic unruptured aneurysms found in the present study allows an estimation of the yearly rate of rupture of these lesions. The authors suggest that this yearly rate of rupture falls within the range of 1 to 2%.

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Long term prognosis of symptomatic and asymptomatic cerebral aneurysms

Neurosurgical Review ◽

10.1007/bf00313034 ◽

1991 ◽

Vol 14 (2) ◽

pp. 115-118 ◽

Cited By ~ 1

Author(s):

Miroslav Samardzic ◽

Danica Grujicic ◽

Ljiljana Djordjic ◽

Miloje Joksimovic

Keyword(s):

Cerebral Aneurysms ◽

Long Term Prognosis

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