Erratum to “Spontaneous thrombosis of cerebral aneurysms presenting with ischemic stroke”

Background and Purpose: Unruptured cerebral aneurysms are currently considered a contraindication to intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke. This is due to a theoretical increase in the risk of hemorrhage from aneurysm rupture, although it is unknown whether this risk is significant. We sought to determine the safety of IV tPA administration in a cohort of patients with pre-existing aneurysms. Methods: We reviewed the medical records of patients treated for acute ischemic stroke with IV tPA during an 11-year period at two academic medical centers. We identified a subset of patients with unruptured cerebral aneurysms present on pre-thrombolysis vascular imaging. Our outcomes of interest were any intracranial hemorrhage (ICH), symptomatic ICH, and subarachnoid hemorrhage (SAH). Fisher’s exact test was used to compare the rates of hemorrhage among patients with and without aneurysms. Results: We identified 236 eligible patients, of whom 22 had unruptured cerebral aneurysms. The rate of ICH among patients with aneurysms (14%, 95% CI 3-35%) did not significantly differ from the rate among patients without aneurysms (19%, 95% CI 14-25%). None of the patients with aneurysms developed symptomatic ICH (0%, 95% CI 0-15%), compared with 10 of 214 patients without aneurysms (5%, 95% CI 2-8%). Similar proportions of patients developed SAH (5%, 95% CI 0-23% versus 6%, 95% CI 3-10%). Conclusion: Our findings suggest that IV tPA for acute ischemic stroke is safe to administer in patients with pre-existing cerebral aneurysms as the risk of aneurysm rupture and symptomatic ICH is low.

Download Full-text

Abstract WP94: Clinical Outcomes of Unruptured Cerebral Aneurysms Treated With Clipping or Coiling in Japan: The J-aspect Study

Stroke ◽

10.1161/str.47.suppl_1.wp94 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Ataru Nishimura ◽

Kunihiro Nishimura ◽

Akiko Kada ◽

Satoru Kamitani ◽

Ryota Kurogi ◽

...

Keyword(s):

Ischemic Stroke ◽

Postoperative Complications ◽

Clinical Outcomes ◽

Brain Infarction ◽

Cerebral Aneurysms ◽

Nationwide Survey ◽

Mortality Rates ◽

Lower Number ◽

Patient Safety Indicators ◽

Unruptured Cerebral Aneurysms

Background: Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC). Methods and Results: Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P < 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients. Conclusions: Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.

Download Full-text

Detection and Significance of Incidental Unruptured Cerebral Aneurysms in Patients Undergoing Intravenous Thrombolysis for Acute Ischemic Stroke

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2010.00560.x ◽

2010 ◽

Vol 22 (2) ◽

pp. 197-200 ◽

Cited By ~ 18

Author(s):

Joon-Tae Kim ◽

Man-Seok Park ◽

Woong Yoon ◽

Ki-Hyun Cho

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Aneurysms ◽

Intravenous Thrombolysis ◽

Unruptured Cerebral Aneurysms

Download Full-text

Cardiac Myxoma Embolization Causing Ischemic Stroke and Multiple Partially Thrombosed Cerebral Aneurysms

Stroke ◽

10.1161/strokeaha.120.031679 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Praveen Kesav ◽

Seby John ◽

Priti Joshi ◽

Waqar Haider Gaba ◽

Syed Irteza Hussain

Keyword(s):

Ischemic Stroke ◽

Cardiac Myxoma ◽

Cerebral Aneurysms

Download Full-text

Delayed ischemic stroke following spontaneous thrombosis of an arteriovenous malformation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2013-010817.rep ◽

2013 ◽

Vol 6 (8) ◽

pp. e40-e40 ◽

Cited By ~ 2

Author(s):

Ashish Harish Shah ◽

Diogo C Haussen ◽

Brian M Snelling ◽

Roberto C Heros ◽

Dileep R Yavagal

Keyword(s):

Ischemic Stroke ◽

Arteriovenous Malformation ◽

Spontaneous Thrombosis

Download Full-text

Tissue plasminogen activator for acute ischemic stroke in patients with unruptured cerebral aneurysms

Journal of Stroke and Cerebrovascular Diseases ◽

10.1053/jscd.2000.7213 ◽

2000 ◽

Vol 9 (4) ◽

pp. 181-184 ◽

Cited By ~ 8

Author(s):

Luis D'Olhaberriague ◽

Nishit Joshi ◽

Seement Chaturvedi ◽

Panayiotis Mitsias ◽

William Coplin ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Cerebral Aneurysms ◽

Tissue Plasminogen ◽

Unruptured Cerebral Aneurysms

Download Full-text

Carotid artery web and ischemic stroke

Neurology ◽

10.1212/wnl.0000000000003464 ◽

2016 ◽

Vol 88 (1) ◽

pp. 65-69 ◽

Cited By ~ 53

Author(s):

Jonathan M. Coutinho ◽

Sheldon Derkatch ◽

Alphonse R.J. Potvin ◽

George Tomlinson ◽

Leanne K. Casaubon ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Confidence Interval ◽

Atherosclerotic Plaque ◽

Odds Ratio ◽

Conditional Logistic Regression ◽

Cerebral Aneurysms ◽

Anterior Circulation ◽

Stroke Treatment ◽

Significant Difference

Objective:To determine whether there is an association between carotid artery web and ischemic stroke.Methods:This was a single-center, age- and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age <60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness ≥3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval.Results:Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio = 8.0, 95% confidence interval = 1.2–67, p = 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen κ for interobserver agreement was 0.93.Conclusions:There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke.

Download Full-text