scholarly journals PND79 REAL-WORLD COMPARISON OF OUTCOMES AMONG PATIENTS WITH UNRUPTURED INTRACRANIAL ANEURYSM (UIA) UNDERGOING ENDOVASCULAR TREATMENT USING THE ENTERPRISE STENT VERSUS NEUROFORM OR LOW-PROFILE VISUALIZED INTRALUMINAL SUPPORT (LVIS) STENT

2020 ◽  
Vol 23 ◽  
pp. S274
Author(s):  
R. De Leacy ◽  
E. Kottenmeier ◽  
S. Lee ◽  
R. Khanna ◽  
A. M Spiotta
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Real World ◽  
Unruptured Intracranial Aneurysm ◽  
Low Profile

Endovascular treatment with the Enterprise stent versus the Neuroform or Low-Profile Visualized Intraluminal Support stent for unruptured aneurysms

2021 ◽  
Vol 10 (4) ◽  
pp. 295-305
Author(s):  
Reade De Leacy ◽  
Emilie Kottenmeier ◽  
Stephanie HY Lee ◽  
Rahul Khanna ◽  
Alejandro M Spiotta
Keyword(s):  
Endovascular Treatment ◽  
Odds Ratio ◽  
Generalized Estimating Equations ◽  
Enterprise Group ◽  
Group Differences ◽  
Stent Group ◽  
Unruptured Intracranial Aneurysm ◽  
Lower Odds ◽  
Unruptured Aneurysms ◽  
Low Profile

Aim: To compare outcomes among patients undergoing endovascular treatment for unruptured intracranial aneurysm (UIA) with the Enterprise stent versus the Neuroform or Low-Profile Visualized Intraluminal Support (LVIS) stent. Patients & methods: Patients undergoing endovascular procedure for UIA were classified into Enterprise stent and Neuroform or LVIS stent group. Groups were propensity-score matched and generalized estimating equations were used for outcomes assessment. Results: There were no significant between-group differences in length of stay or mortality. The Enterprise group had significantly lower odds of UIA-related inpatient readmissions versus the Neuroform/LVIS group (odds ratio: 0.62; 95% CI: 0.42–0.91). Conclusion: Enterprise stent use was associated with significantly lower readmissions versus competitor stent, with no difference in other study outcomes.

scholarly journals P.051 Validation of the unruptured intracranial aneurysm treatment score against “real-world” MDT decisions

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
H Godbout ◽  
J Jarrett ◽  
GE Pickett
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Real World ◽  
Aneurysm Rupture ◽  
Case Control Studies ◽  
Clinical Tool ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment ◽  
Elective Treatment ◽  
Aneurysm Repair

Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT). Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA). Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant. Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.

scholarly journals Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice

2018 ◽  
Vol 129 (1) ◽  
pp. 100-106 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Adam de Havenon ◽  
Timothy C. Gooldy ◽  
Jonathan Scoville ◽  
Jian Guan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Real World ◽  
Roc Curve ◽  
Academic Medical Center ◽  
Treatment Recommendation ◽  
Unruptured Intracranial Aneurysm ◽  
The Real ◽  
Aneurysm Treatment ◽  
Unruptured Intracranial Aneurysms ◽  
Sensitivity Specificity

OBJECTIVEThe purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs).METHODSAll patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision. The authors calculated the percentage of misclassification, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve.RESULTSA total of 221 consecutive patients with UIAs met the inclusion criteria: 69 (31%) patients underwent treatment and 152 (69%) did not. Fifty-nine (27%) patients had a UIATS between −2 and 2, which does not offer a treatment recommendation, leaving 162 (73%) patients with a UIATS treatment recommendation. The UIATS was significantly associated with treatment (p < 0.001); however, the sensitivity, specificity, and percentage of misclassification were 49%, 80%, and 28%, respectively. Notably, 51% of patients for whom treatment would be recommended by the UIATS did not undergo treatment in the real-world cohort and 20% of patients for whom conservative management would be recommended by UIATS had intervention. The area under the ROC curve was 0.646.CONCLUSIONSCompared with the authors’ experience, the UIATS recommended overtreatment of UIAs. Although the UIATS could be used as a screening tool, individualized treatment recommendations based on consultation with a cerebrovascular specialist are necessary. Further validation with longitudinal data on rupture rates of UIAs is needed before widespread use.

scholarly journals Remote ischemic preconditioning for elective endovascular intracranial aneurysm repair: a feasibility study

2019 ◽  
Vol 32 (3) ◽  
pp. 166-172 ◽  
Author(s):  
Seyed Mohammad Seyedsaadat ◽  
Leonardo Rangel Castilla ◽  
Giuseppe Lanzino ◽  
Harry J Cloft ◽  
Daniel J Blezek ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Ischemic Preconditioning ◽  
Brain Lesions ◽  
Remote Ischemic Preconditioning ◽  
Resonance Imaging ◽  
Unruptured Intracranial Aneurysm ◽  
Ischemic Brain ◽  
Weighted Magnetic Resonance Imaging ◽  
Aneurysm Repair

Objectives Remote ischemic preconditioning has been proposed as a possible potential treatment for ischemic stroke. However, neuroprotective benefits of the pre-procedural administration of remote ischemic preconditioning have not been investigated in patients undergoing an elective endovascular intracranial aneurysm repair procedure. This study investigated the safety and feasibility of remote ischemic preconditioning in patients with an unruptured intracranial aneurysm who undergo elective endovascular treatment. Methods In this single-center prospective study, patients with an unruptured intracranial aneurysm undergoing elective endovascular treatment with flow diverters or coiling were recruited. Patients received three intermittent cycles of 5 minutes arm ischemia followed by reperfusion using manual blood cuff inflation/deflation less than 5 hours prior to endovascular treatment. Patients were monitored and followed up for remote ischemic preconditioning-related adverse events and ischemic brain lesions by diffusion -weighted magnetic resonance imaging within 48 hours following endovascular treatment. Results A total of seven patients aged 60 ± 5 years with an unruptured intracranial aneurysm successfully completed a total of 21 sessions of remote ischemic preconditioning and the required procedures. Except for two patients who developed skin petechiae over their arms, no other serious procedure-related adverse events were observed as a result of the remote ischemic preconditioning procedure. On follow-up diffusion -weighted magnetic resonance imaging, a total of 19 ischemic brain lesions with a median (interquartile range) volume of 245 (61–466) mm3 were found in four out of seven patients. Conclusions The application of remote ischemic preconditioning prior to endovascular intracranial aneurysm repair was well tolerated, safe and clinically feasible. Larger sham-controlled clinical trials are required to determine the safety and efficacy of this therapeutic strategy in mitigating ischemic damage following endovascular treatment of intracranial aneurysms.

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

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