Dual Stenting with New Generation Stents for Aneurysm Embolization in Acute Subarachnoid Hemorrhage

Background and purpose: There are high occurrences of abnormal electrocardio-graphic (ECG) in patients with acute subarachnoid hemorrhage (SAH). Thus, we want to determine whether any specific characteristics in ECG are associated with poor clinical outcomes in patients with SAH inhospital. Methods: A total of 145 patient who selected from 270 cases with non-traumatic SAH was included in this study. A standard surface ECG was assessed for all patients within 72 hours of SAH onset. All patients were stratified into Good or Poor outcome groups according to the in-hospital mortality or neurological worsening (World Federation of Neurological Surgeons, WFNS class) when they discharge from our hospital. Results: These patients in Poor outcome (n = 29) had significantly high heart rate (93.52± 22.23 bpm vs 78.42 ± 18 bpm, P < 0.01), prolonged QTc (458.17 ± 44.88 ms vs 436.89 ± 43.46 ms, P = 0.027) and corrected Tpeak–Tend interval (cTp-e, 106.19 ± 22.22 ms vs 93.14 ± 21.04 ms, P = 0.007) and high occurrence of ECG abnormalities including ST segment (90% vs 44%, P < 0.01) and left ventricular high voltage (28%vs 10%, P = 0.03). Multivariable logistic regression identified independent variables indicating poor outcome in-hospital including abnormal ST (OR = 2.507, 95% CI, 1.051-5.941, P = 0.037) and WFNS class (OR = 2.280, 95% CI, 1.605-3.240, P < 0.001). Conclusions: Abnormal ST segment of ECG is an independent indicator for poor inhospital outcomes regardless the severity of patients with SAH and warrant to further study their mechanism in the future.

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Decreasing incidence of subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014038 ◽

2018 ◽

Vol 11 (3) ◽

pp. 320-322 ◽

Cited By ~ 5

Author(s):

Patrick Nicholson ◽

Alan O’Hare ◽

Sarah Power ◽

Seamus Looby ◽

Mohsen Javadpour ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Population Data ◽

Incidence Rates ◽

Public Hospitals ◽

National Database ◽

Irish Hospital ◽

Acute Subarachnoid Hemorrhage ◽

Adjusted Rate ◽

Using Data ◽

Adjusted Incidence

ObjectiveTo determine the incidence and trends in subarachnoid hemorrhage in Ireland using data from a national database.Materials and methodsWe performed a retrospective nationwide query of the Irish Hospital In-patient Enquiry System (HIPE). This is a national database of all in-patient activity in acute public hospitals in Ireland. Each HIPE entry records one episode of in-patient care. The study period ranged from 1997 to 2015. Population data was obtained from the Irish Central Statistics Office, and the annual prevalence of smoking from the Irish National Tobacco Control Office. We were therefore able to calculate both crude annual acute subarachnoid hemorrhage (SAH) incidence rates, as well as population-standardized rates, and compared them with trends in the annual smoking rates.ResultsThe mean number of SAH cases per year is 549, with 465 cases in 1997 and 517 in 2015 (range: 465–624). The absolute incidence of SAH, therefore, remained relatively stable. Due to population increases over time, the population-adjusted rate of SAH therefore decreased, from 126.9/million people/year in 1997 to 111.5/million people/year in 2015. Nationally, there was a decrease in smoking prevalence, from 31% in 1998 to 19.2% in 2015. There was a statistically significant correlation between decreasing smoking rates and decreasing population-adjusted incidence of SAH (P=<0.0001).ConclusionsOur data suggests that the incidence of non-traumatic subarachnoid hemorrhage in our population appears to be decreasing, a decrease which is correlated with decreasing smoking rates. This provides important data both in terms of the epidemiology of SAH, as well as the possible role of public-health interventions in tackling both smoking and declining rates of SAH.

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Intra-arterial nicardipine successfully relieved post-subarachnoid hemorrhage cerebral vasospasm during aneurysm embolization: a case report

Cerebral Vasospasm - Acta Neurochirurgica Supplementum ◽

10.1007/978-3-211-75718-5_74 ◽

2008 ◽

pp. 357-359

Author(s):

K.- C. Lin ◽

C.-C. Chung ◽

A.- L. Kwan ◽

Y.- L. Kuo ◽

S.- L. Howng ◽

...

Keyword(s):

Case Report ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysm Embolization

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Clinical usefulness 3D-CT Angiography in acute subarachnoid hemorrhage

Japanese Journal of Radiological Technology ◽

10.6009/jjrt.kj00001353851 ◽

1996 ◽

Vol 52 (10) ◽

pp. 1390

Author(s):

H. Yamane ◽

S. Tanaka ◽

T. Yoneda ◽

S. Nishimura ◽

T. Hamamoto

Keyword(s):

Subarachnoid Hemorrhage ◽

Ct Angiography ◽

Clinical Usefulness ◽

3D Ct ◽

3D Ct Angiography ◽

Acute Subarachnoid Hemorrhage

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O-008 Size and location of ruptured intracranial aneurysms in a consecutive series of 588 patients with first-time acute subarachnoid hemorrhage treated endovascularly at a tertiary referral medical center over a 16-year time period

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010455a.8 ◽

2012 ◽

Vol 4 (Suppl 1) ◽

pp. A4.2-A5

Author(s):

J Delgado Almandoz ◽

J Fease ◽

B Crandall ◽

Y Kadkhodayan ◽

J Scholz ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Medical Center ◽

Consecutive Series ◽

Tertiary Referral ◽

Time Period ◽

Acute Subarachnoid Hemorrhage ◽

First Time ◽

Ruptured Intracranial Aneurysms

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Abstract W P307: Novel Application of Reversible Parental Anti-platelets in Patients with Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.46.suppl_1.wp307 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Siddhart Mehta ◽

Mohammed Hussain ◽

Jaskiran Brar ◽

Daniel Korya ◽

Harina Chahal ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Antiplatelet Agents ◽

Endovascular Coiling ◽

International Subarachnoid Aneurysm Trial ◽

Procedural Complications ◽

Acute Subarachnoid Hemorrhage ◽

Comprehensive Stroke Center ◽

Stroke Center

Background and Objective: The International Subarachnoid Aneurysm Trial (ISAT) showed a greater likelihood of survival free 1 year disability in patients undergoing endovascular coiling who were started on antiplatelet agents after SAH compared to ones undergoing neurosurgical clipping. However, data on safety of acute parental antiplatelet agents after aneurysmal coiling is lacking. We report on the safety of IV Eptifibatide (rapidly reversible Glyprotein IIbIIIa inhibitor) on patients presenting with acute subarachnoid hemorrhage undergoing endovascular coiling for aneurysmal embolization. Methods: All the patients from 2009-13 who presented to our university affiliated comprehensive stroke center with aneurysmal subarachnoid hemorrhage and underwent endovascular coiling were included for the study. Patients that received IV Eptifibatide for various reasons including acute need for stent assist coiling after securing the ruptured aneurysm with endovascular coiling were reviewed. Eptifibatide was administered intra-arterially as a 135-μg/kg single-dose bolus, and then continued on intravenous infusion of 0.5-μg/kg/min post-procedurally. Charts were reviewed for all patients to assess for medical/procedural complications including symptomatic and asymptomatic intra- and extra-cranial hemorrhages, groin hematomas, epistaxis and gross hematuria. Results: Of the total of 93 patients treated with coil embolization during this period, 5 patients (mean age 56 years, 20% male [n=1]) received acute intra-procedural Eptifibatide followed by IV infusion for a mean duration of 77 hours (range 20-130 hours). Various reasons for use of Eptifibatide included: stent assist coiling [n=2], multiple stents for flow diversion [n=1], partial coil prolapse [n=1] and vascular lumen flow compromise [n=1]. None of the patients demonstrated symptomatic/asymptomatic hemorrhage, groin hematoma, epistaxis or hematuria. Conclusion: Our results may highlight safety of administering IV Eptifibatide to prevent thrombotic complications after endovascular coil embolization in select patients with aneurysmal subarachnoid hemorrhage. Multicenter prospective trials are warranted to corroborate our findings.

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