scholarly journals Influencing Factors for Complication with Aneurysm Rupture of the Fetal Posterior Communicating Artery After Clipping Through the Lateral Supraorbital Approach and Prognosis

2021 ◽  
Author(s):  
Yunxiang Chen ◽  
Yurong Cai ◽  
Huahui Chen ◽  
Xiafeng Lin ◽  
Gezhi Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influencing Factors ◽  
Poor Prognosis ◽  
Aneurysm Rupture ◽  
Posterior Communicating Artery ◽  
Goodness Of Fit Test ◽  
Fisher Grade ◽  
History Of ◽  
Independent Risk Factors

Abstract Background To explore the influencing factors for complication with aneurysm rupture of the fetal posterior communicating artery after clipping through the lateral supraorbital (LSO) approach and prognosis. Methods A total of 119 patients with posterior communicating artery aneurysm (PCoAA) accompanied by fetal posterior cerebral artery (fPCA), who underwent clipping through the LSO approach from January 2014 to December 2019, were selected. They were aged 50–70 years old, (60.5 ± 13.7) on average. The treatment outcome, incidence of complications and follow-up results were analyzed. Based on the follow-up results, univariate comparative analysis was conducted for the clinical data of patients with good or poor prognosis. The statistically significant factors were incorporated into multivariate Cox regression analysis, and the nomogram prediction model for prognosis was established. The accuracy of the model was assessed using the Hosmer–Lemeshow goodness-of-fit test. Results Clipping through the LSO approach was successful in all cases. Perioperative complications occurred in 41 patients. According to the follow-up results, 89 patients had good prognosis, while 30 had poor prognosis. Age of > 65 years old, history of hypertension, high Hunt–Hess grade and high modified Fisher grade were independent risk factors for the poor prognosis of patients with PCoAA accompanied by fPCA after clipping through the LSO approach. The results obtained by the established model were consistent with the actual ones. Conclusion Age, history of hypertension, Hunt–Hess grade and modified Fisher grade are independent risk factors for the prognosis of patients with PCoAA accompanied by fPCA after clipping through the LSO approach.

scholarly journals Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Ischaemic Attack ◽  
Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture

2008 ◽  
Vol 108 (5) ◽  
pp. 1052-1060 ◽  
Author(s):  
Seppo Juvela ◽  
Matti Porras ◽  
Kristiina Poussa
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Smoking Status ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Aneurysm Rupture ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Object The authors conducted a study to investigate the long-term natural history of unruptured intracranial aneurysms and the predictive risk factors determining subsequent rupture in a patient population in which surgical selection of cases was not performed. Methods One hundred forty-two patients with 181 unruptured aneurysms were followed from the 1950s until death or the occurrence of subarachnoid hemorrhage or until the years 1997 to 1998. The annual and cumulative incidence of aneurysm rupture as well as several potential risk factors predictive of rupture were studied using life-table analyses and Cox's proportional hazards regression models including time-dependent covariates. The median follow-up time was 19.7 years (range 0.8–38.9 years). During 2575 person-years of follow up, there were 33 first-time episodes of hemorrhage from previously unruptured aneurysms, for an average annual incidence of 1.3%. In 17 patients, hemorrhage led to death. The cumulative rate of bleeding was 10.5% at 10 years, 23% at 20 years, and 30.3% at 30 years after diagnosis. The diameter of the unruptured aneurysm (relative risk [RR] 1.11 per mm in diameter, 95% confidence interval [CI] 1–1.23, p = 0.05) and patient age at diagnosis inversely (RR 0.97 per year, 95% CI 0.93–1, p = 0.05) were significant independent predictors for a subsequent aneurysm rupture after adjustment for sex, hypertension, and aneurysm group. Active smoking status at the time of diagnosis was a significant risk factor for aneurysm rupture (RR 1.46, 95% CI 1.04–2.06, p = 0.033) after adjustment for size of the aneurysm, patient age, sex, presence of hypertension, and aneurysm group. Active smoking status as a time-dependent covariate was an even more significant risk factor for aneurysm rupture (adjusted RR 3.04, 95% CI 1.21–7.66, p = 0.02). Conclusions Cigarette smoking, size of the unruptured intracranial aneurysm, and age, inversely, are important factors determining risk for subsequent aneurysm rupture. The authors conclude that such unruptured aneurysms should be surgically treated regardless of their size and of a patient's smoking status, especially in young and middle-aged adults, if this is technically possible and if the patient's concurrent diseases are not contraindications. Cessation of smoking may also be a good alternative to surgery in older patients with small-sized aneurysms.

Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1047-1053 ◽  
Author(s):  
Nobuhiko Miyazawa ◽  
Iwao Akiyama ◽  
Zentaro Yamagata
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Unruptured Aneurysms ◽  
Logistic Analysis ◽  
Aneurysm Size ◽  
History Of ◽  
Aneurysm Growth ◽  
Independent Risk Factors

Abstract OBJECTIVE: The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5–T serial magnetic resonance angiography with stereoscopic images. METHODS: Age, sex, site of aneurysm, size of aneurysm, multiplicity of aneurysms, type of circle of Willis, length of follow-up period, cerebrovascular event, hypertension, diabetes, hyperlipidemia, smoking habit, and family history of subarachnoid hemorrhage were investigated using multiple logistic analysis. RESULTS: Fourteen patients (16 aneurysms) among the 130 patients (159 aneurysms) showed aneurysm growth (10.8%) during follow-up of 10 to 69 months (mean 29.3 ± 10.5 mo). Multiple logistic analysis disclosed that location on the middle cerebral artery (odds ratio [OR] 0.08, P &lt; 0.01), multiplicity of aneurysms (OR 68.5, P &lt; 0.01), aneurysm size of 5 mm or larger (OR 1.17, P = 0.05), and family history of subarachnoid hemorrhage (OR 10.9, P &lt; 0.01) were independent risk factors. CONCLUSION: Location on the middle cerebral artery, multiplicity, aneurysm size of 5 mm or larger, and family history of subarachnoid hemorrhage are independent risk factors for aneurysm growth. These results may help to determine the treatment choice for unruptured aneurysms.

Risk factors for a first thrombotic event in antiphospholipid antibody carriers. A multicentre, retrospective follow-up study

2008 ◽  
Vol 68 (3) ◽  
pp. 397-399 ◽  
Author(s):  
A Ruffatti ◽  
T Del Ross ◽  
M Ciprian ◽  
M Nuzzo ◽  
M Rampudda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Anticardiolipin Antibody ◽  
Primary Prophylaxis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Independent Risk Factors

Objectives:To asses risk factors for a first thrombotic event in antiphospholipid antibody (aPL) positive carriers and evaluate the efficacy of prophylactic treatments.Methods:Recruitment criteria were age 18–65 years, no history of thrombosis, positivity for lupus anticoagulant and/or IgG/IgM anticardiolipin antibody (aCL) on ⩾2 occasions at least 6 weeks apart. Demographic, laboratory and clinical parameters were collected at enrolment and at the time of the thrombotic event.Results:370 patients/subjects (mean (SD) age 34 (9.9) years) were analysed retrospectively for a mean (SD) follow-up of 59.3 (45.5) months. Thirty patients (8.1%) developed a first thrombotic event during follow-up. Hypertension and medium/high levels of IgG aCL were identified by multivariate logistic regression analysis as independent risk factors for thrombosis. Thromboprophylaxis during high-risk and long-term periods was significantly protective.Conclusions:Hypertension or medium/high titres of IgG aCL are risk factors for a first thrombotic event in asymptomatic aPL carriers and primary prophylaxis is protective.

Abstract 14539: Incidence, Risk Factors, Natural History, and Outcomes of Atrial Fibrillation in Patients With Graves’ Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jwan A Naser ◽  
Sorin Pislaru ◽  
Marius N Stan ◽  
Grace Lin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Major Cardiovascular Events ◽  
Multivariate Risk ◽  
Incidence Risk ◽  
History Of ◽  
Independent Risk Factors ◽  
Artery Disease ◽  
Overt Hyperthyroidism

Background: Hyperthyroidism is associated with atrial fibrillation (AF) with a reported prevalence of 16-60%. However, risk factors for onset of AF with hyperthyroidism are not well defined. We sought to identify patients with hyperthyroidism most likely to develop AF. Methods: We reviewed the medical records of 1371 consecutive patients with GD evaluated at our clinic between 2009 and 2019. GD-related AF was defined as AF diagnosed up to 30 days before or at any time after Grave’s disease (GD). Spontaneous recovery was defined as sinus rhythm after attainment of euthyroidism without the need for pharmacologic or electrical cardioversion. Outcomes of major cardiovascular events, all-cause mortality, and cardiac hospitalizations were compared between cases and controls (GD without AF) matched 1:1 for age, gender, and history of coronary artery disease. Results: AF occurred in 140 patients with an incidence of 10.2%. Older age (RR 1.63 per 10 years, p <0.001), male gender (RR 2.06, p < 0.001), overt hyperthyroidism (RR 2.48, p = 0.002), COPD (RR 2.14, p =0.006), and higher BMI (RR 1.03 per unit, p=0.023) were independent risk factors for AF. Spontaneous AF recovery occurred in 44 of 128 (34.6%) patients with adequate follow up. The multivariate risk factor for failed recovery was the presence of heart failure (HF) (OR =3.52, p= 0.004). GD patients with AF had higher rates of cardiac hospitalizations (Figure) that persisted even after adjusting to HF presence (27.9% vs 2.9%, p < 0.001). Conclusion: Risk factors for AF in GD are similar to those in the general population, although overt hyperthyroidism conferred the highest risk. These data argue for careful monitoring of GD patients with multimorbidity who may be at high risk of developing AF.

scholarly journals Risk factors of recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism: from the COMMAND VTE Registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Yamashita ◽  
H Amano ◽  
T Morimoto ◽  
T Kimura ◽  
Keyword(s):  
Risk Factors ◽  
Major Bleeding ◽  
Independent Risk Factor ◽  
Anticoagulation Therapy ◽  
Intermediate Risk ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Recurrent Vte

Abstract Background/Introduction Patients with venous thromboembolism (VTE), including pulmonary embolism (PE), have a long-term risk of recurrence, and anticoagulation therapy is recommended for the prevention of recurrence. The latest 2019 European Society of Cardiology (ESC) guideline classified the risks of recurrence into low- (&lt;3%/year), intermediate- (3–8%/year), and high- (&gt;8%/year) risk, and recommended the extended anticoagulation therapy of indefinite duration for high-risk patients as well as intermediate-risk patients. However, extended anticoagulation therapy of indefinite duration for all of intermediate-risk patients have been a matter of active debate. Thus, additional risk assessment of recurrence in intermediate-risk patients might be clinically relevant in defining the optimal duration of anticoagulation therapy. Furthermore, bleeding risk during anticoagulation therapy should also be taken into consideration for optimal duration of anticoagulation therapy. However, there are limited data assessing the risk of recurrence as well as bleeding in patients with intermediate-risk for recurrence based on the classification in the latest 2019 ESC guideline. Purpose The current study aimed to identify the risk factors of recurrence as well as major bleeding in patients with intermediate-risk for recurrence, using a large observational database of VTE patients in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. Results In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37). Conclusions Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

scholarly journals Factors Affecting the Outcome of Multiple Intracranial Aneurysm Surgery

2018 ◽  
Vol 07 (02) ◽  
pp. 116-121 ◽  
Author(s):  
Anas Abdallah ◽  
Murad Asiltürk ◽  
Erhan Emel ◽  
Betül Güler Abdallah
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Core Sample ◽  
Morbidity Rate ◽  
Factors Affecting ◽  
Unruptured Aneurysms ◽  
History Of ◽  
Independent Risk Factors

Abstract Objectives Multiple intracranial aneurysms (MIAs) are fairly common entities. Unless MIAs are incidentally diagnosed, they remain asymptomatic until they rupture. In this study, the authors investigated factors affecting the surgical outcomes in patients with MIA by evaluating the surgical outcomes of 90 consecutive cases. Material and Methods Medical records were retrospectively reviewed for 409 consecutive cerebral aneurysm cases that underwent surgery in the hospital from 2011 to 2013. The patients’ data were prospectively collected. All MIA patients (n = 90) constituted the core sample for this study. Results The authors detected 221 aneurysms in 90 patients (49 females and 41 males; mean age: 50.8 ± 11.9 years; range: 25–82 years). Of the patients, 67 presented with subarachnoid hemorrhage, whereas 23 were incidentally diagnosed with unruptured aneurysms. The mortality rate was 13.3% (n = 12). The morbidity rate was 18.8% (n = 17). Of the patients, 67.8% (n = 61) had returned to their jobs and normal daily activities by their last follow-up (average: 52.3 months). History of coronary artery diseases (CADs) and low neurologic grade at presentation (Hunt-Hess grade 4/5) are independent risk factors for increasing morbidity and mortality in patients with MIA (odds ratio [OR]: 18.46; p = 0.007); (OR: 30.0; p = 0.002) and (OR: 0.06; p = 0.0001); (OR: 0.07; p = 0.002), respectively. Conclusion History of CADs and high Hunt-Hess grade are independent risk factors for poor surgical outcomes of patients with MIA.

scholarly journals Therapeutic Effects of Microsurgical Clipping at Different Time Points on Intracranial Aneurysm and Prognostic Factors

2021 ◽  
Author(s):  
Ge Huang ◽  
Yang Sun ◽  
Jinhong Li ◽  
Zhengyuan Xie ◽  
Xiaoguang Tong
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Postoperative Complications ◽  
Poor Prognosis ◽  
Therapeutic Effects ◽  
Time Points ◽  
Microsurgical Clipping ◽  
History Of ◽  
Prognosis Group ◽  
Independent Risk Factors

Abstract Background Microsurgical clipping is effective for treating early rupture hemorrhage in intracranial aneurysm (IA) patients. We aimed to evaluate the therapeutic effects of microsurgical clipping at different time points on IA and to explore prognostic factors. Methods A total of 102 eligible patients were divided into good prognosis group (n = 87) and poor prognosis group (n = 15) according to Glasgow Outcome Scale (GOS) scores at discharge. The effects of microsurgical clipping at different time points (within 24 h, 48 h and 72 h) were compared. The incidence rates of postoperative complications in patients with different Hunt–Hess grades were compared. Prognostic factors were determined by multivariate logistic regression analysis. The nomogram prediction model was established based on independent risk factors and validated. Results The good recovery and success rates of complete aneurysm clipping were significantly higher in patients undergoing surgery within 24 h after rupture. The incidence rate of complications was significantly higher in patients with Hunt–Hess grade IV. Good and poor prognosis groups had significantly different age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and National Institute of Health Stroke Scale (NIHSS) score, as independent risk factors for prognosis. The nomogram model predicted that poor prognosis rate was 14.71%. Conclusion Timing (within 24 h after rupture) microsurgical clipping benefits the prognosis of IA patients. Age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and NIHSS score are independent risk factors for poor prognosis.

Suicide in recently released prisoners: a case-control study

2009 ◽  
Vol 40 (5) ◽  
pp. 827-835 ◽  
Author(s):  
D. Pratt ◽  
L. Appleby ◽  
M. Piper ◽  
R. Webb ◽  
J. Shaw
Keyword(s):  
Risk Factors ◽  
Community Mental Health Services ◽  
England And Wales ◽  
White Ethnicity ◽  
History Of ◽  
Self Harm ◽  
Independent Risk Factors ◽  
Risk Factors For Suicide ◽  
Release From Prison

BackgroundRecently released prisoners are at markedly higher risk of suicide than the general population. The aim of this study was to identify key risk factors for suicide by offenders released from prisons in England and Wales.MethodAll suicides committed by offenders within 12 months of their release from prison in England and Wales, between 2000 and 2002, were identified. One control matched on gender and date of release from prison was recruited for each case. Univariate and multivariate logistic regression modelling identified key independent risk factors for suicide.ResultsOf 256 920 released prisoners, 384 suicides occurred within a year of release. Factors significantly associated with post-release suicide were increasing age over 25 years, released from a local prison, a history of alcohol misuse or self-harm, a psychiatric diagnosis, and requiring Community Mental Health Services (CMHS) follow-up after release from prison. Non-white ethnicity and a history of previous imprisonment were protective factors.ConclusionsThere is a need to improve the continuity of care for people who are released from prison and for community health, offender and social care agencies to coordinate care for these vulnerable individuals.

scholarly journals Growth and rupture of unruptured intracranial aneurysms

2019 ◽  
Vol 131 (3) ◽  
pp. 843-851 ◽  
Author(s):  
Seppo Juvela
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cigarette Smoking ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Growth ◽  
Independent Risk Factors

OBJECTIVERisk factors for growth of unruptured intracranial aneurysms (UIAs) during a lifelong follow-up in relation to subsequent rupture are unknown. The author’s aim in this study was to investigate whether risk factors for UIA growth are different for those that lead to rupture than for those that do not.METHODSThe series consists of 87 patients with 111 UIAs diagnosed before 1979, when UIAs were not treated. A total follow-up time of the patients was 2648 person-years for all-cause death and 2182 years when patients were monitored until the first rupture, death due to unrelated causes, or the last contact (annual incidence of aneurysm rupture, 1.2%). The follow-up time between aneurysm measurements was 1669 person-years. Risk factors for UIA growth were analyzed in relation to subsequent rupture.RESULTSThe median follow-up time between aneurysm measurements was 21.7 years (range 1.2–51.0 years). In 40 of the 87 patients (46%), the UIAs increased in size ≥ 1 mm, and in 31 patients (36%) ≥ 3 mm. All ruptured aneurysms in 27 patients grew during the follow-up of 324 person-years (mean growth rates 6.1 mm, 0.92 mm/year, and 37%/year), while growth without rupture occurred in 13 patients during 302 follow-up years (3.9 mm, 0.18 mm/year, and 4%/year) and no growth occurred in 47 patients during 1043 follow-up years. None of the 60 patients without aneurysm rupture experienced one during the subsequent 639 follow-up years after the last aneurysm measurement. Independent risk factors for UIA growth (≥ 1 mm) in all patients were female sex (adjusted OR 3.08, 95% CI 1.04–9.13) and smoking throughout the follow-up time (adjusted OR 3.16, 95% CI 1.10–9.10), while only smoking (adjusted OR 4.36, 95% CI 1.27–14.99) was associated with growth resulting in aneurysm rupture. Smoking was the only independent risk factor for UIA growth ≥ 3 mm resulting in aneurysm rupture (adjusted OR 4.03, 95% CI 1.08–15.07). Cigarette smoking at baseline predicted subsequent UIA growth, while smoking at the end of the follow-up was associated with growth resulting in aneurysm rupture.CONCLUSIONSCigarette smoking is an important risk factor for UIA growth, particularly for growth resulting in rupture. Cessation of smoking may reduce the risk of devastating aneurysm growth.

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