One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

scholarly journals C.03 Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomized trial

2017 ◽  
Vol 44 (S2) ◽  
pp. S12-S13
Author(s):  
TE Darsaut ◽  
Keyword(s):  
Randomized Trial ◽  
Intracranial Aneurysms ◽  
Primary Outcome ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Background: Unruptured intracranial aneurysms (UIAs) are treated using endovascular treatment or microsurgical clipping. The safety and efficacy of treatments have not been compared in a randomized trial. Methods: We randomly allocated clipping or coiling to patients with 3-25mm UIAs judged treatable both ways. The primary outcome was treatment failure, defined as: initial failure of aneurysm treatment, intracranial hemorrhage or residual aneurysm on one year imaging. Secondary outcomes included neurological deficits following treatment, hospitalization >5 days, overall morbidity and mortality and angiographic results at one year. Results: 136 patients were enrolled from 2010 through 2016 and 134 patients were treated. The one-year primary outcome, available for 104 patients, was reached in 5/48 (10.4% (4.5%-22.2%)) patients allocated surgical clipping, and 10/56 (17.9% (10.0%-29.8%)) patients allocated endovascular coiling (OR: 0.54 (0.13, 1.90), P=0.40). Morbidity and mortality (mRS>2) at one year occurred in 2/48 (4.2% (1.2%-14.0%)) and 2/56 (3.6% (1.0%-12.1%)) patients allocated clipping and coiling respectively. New neurological deficits (15/65 vs 6/69; OR: 3.12 (1.05, 10.57), P=0.031), and hospitalizations beyond 5 days (30/65 vs 6/69; OR: 8.85 (3.22,28.59), P=0.0001) were more frequent after clipping. Conclusions: Surgical clipping led to greater initial treatment-related morbidity than endovascular coiling. At one year, the superior efficacy of clipping remains unproven and in need of randomized evidence.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

scholarly journals Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms

2021 ◽  
pp. 159101992110549
Author(s):  
Shuo-Chi Chien ◽  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Alvin Yi-Chou Wang ◽  
Po-Chuan Hsieh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Systemic Review ◽  
Bleeding Tendency ◽  
Unruptured Intracranial Aneurysms ◽  
Low Dose Aspirin ◽  
Hemorrhagic Events ◽  
One Year

Background Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. Methods A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. Results Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. Conclusion Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

scholarly journals Unruptured intracranial aneurysms and life insurance underwriting

2017 ◽  
Vol 7 (3) ◽  
pp. 274-277 ◽  
Author(s):  
Eugene Scharf ◽  
Sean Pelkowski ◽  
Bogachan Sahin
Keyword(s):  
Intracranial Aneurysm ◽  
Life Insurance ◽  
Intracranial Aneurysms ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
Negative Effect ◽  
Considerable Morbidity

AbstractUnruptured intracranial aneurysms are common. Rupture is rare, but associated with considerable morbidity and mortality. Screening for unruptured intracranial aneurysms is indicated in certain patient populations, but many patients request screening outside of established guidelines. In addition, intracranial aneurysms may be discovered incidentally. The presence of an intracranial aneurysm has a negative effect for the patient seeking life insurance. This commentary provides a perspective on insurance underwriting in individuals with unruptured intracranial aneurysms and offers points for clinicians to consider when counseling patients seeking screening.

Age-related differences in unruptured intracranial aneurysms: 1-year outcomes

2014 ◽  
Vol 121 (5) ◽  
pp. 1024-1038 ◽  
Author(s):  
Kelly B. Mahaney ◽  
Robert D. Brown ◽  
Irene Meissner ◽  
David G. Piepgras ◽  
John Huston ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Neurological Outcome ◽  
Intracranial Aneurysms ◽  
Morbidity And Mortality ◽  
Age Related ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Poor Neurological Outcome ◽  
Hospital Morbidity ◽  
Surgical Group

Object The aim of this study was to determine age-related differences in short-term (1-year) outcomes in patients with unruptured intracranial aneurysms (UIAs). Methods Four thousand fifty-nine patients prospectively enrolled in the International Study of Unruptured Intracranial Aneurysms were categorized into 3 groups by age at enrollment: < 50, 50–65, and > 65 years old. Outcomes assessed at 1 year included aneurysm rupture rates, combined morbidity and mortality from aneurysm procedure or hemorrhage, and all-cause mortality. Periprocedural morbidity, in-hospital morbidity, and poor neurological outcome on discharge (Rankin scale score of 3 or greater) were assessed in surgically and endovascularly treated groups. Univariate and multivariate associations of each outcome with age were tested. Results The risk of aneurysmal hemorrhage did not increase significantly with age. Procedural and in-hospital morbidity and mortality increased with age in patients treated with surgery, but remained relatively constant with increasing age with endovascular treatment. Poor neurological outcome from aneurysm- or procedure-related morbidity and mortality did not differ between management groups for patients 65 years old and younger, but was significantly higher in the surgical group for patients older than 65 years: 19.0% (95% confidence interval [CI] 13.9%–24.4%), compared with 8.0% (95% CI 2.3%–13.6%) in the endovascular group and 4.2% (95% CI 2.3%–6.2%) in the observation group. All-cause mortality increased steadily with increasing age, but differed between treatment groups only in patients < 50 years of age, with the surgical group showing a survival advantage at 1 year. Conclusions Surgical treatment of UIAs appears to be safe, prevents 1-year hemorrhage, and may confer a survival benefit in patients < 50 years of age. However, surgery poses a significant risk of morbidity and death in patients > 65 years of age. Risk of endovascular treatment does not appear to increase with age. Risks and benefits of treatment in older patients should be carefully considered, and if treatment is deemed necessary for patients older than 65 years, endovascular treatment may be the best option.

An Immersed Porous Boundary Method for Computational Fluid Dynamics of Blood Flow in Aneurysms With Flow Diverters

2012 ◽  
Author(s):  
Viorel Mihalef ◽  
Puneet Sharma ◽  
Ali Kamen ◽  
Thomas Redel
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Flow Diverters

Intracranial aneurysms are pathological dilatations of a cerebral artery that may suffer rupture and lead to subarachnoid hemorrhage. Such a condition presents high morbidity and mortality rates for the patients concerned.

Total Morbidity and Mortality Rates of Patients with Surgically Treated Intracranial Aneurysms

Neurosurgery ◽  
1979 ◽  
Vol 4 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Steven L. Giannotta ◽  
Glenn W. Kindt
Keyword(s):  
Intracranial Aneurysms ◽  
Total Mortality ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Recent Experience ◽  
Monitoring And Control ◽  
Perioperative Morbidity ◽  
And Control ◽  
Circulatory Dynamics ◽  
Early Surgical Intervention

Abstract The authors report their recent experience in treating 80 patients with intracranial aneurysms. A total of 83 surgical procedures were performed with a surgical mortality of 4.8%. Fifty-six patients had suffered a subarachnoid hemorrhage. Total mortality for this group was 14.2% regardless of clinical grade. Early surgical intervention, meticulous preoperative monitoring, and control of circulatory dynamics were used to improve the perioperative morbidity and mortality rates. We believe that any major improvements in the outcome of patients with aneurysms will come from advances in perioperative management.

scholarly journals Predictors of clinical outcomes for the treatment of complex intracranial aneurysms in the anterior circulation: a prospective randomised study; SCAT

2020 ◽  
Vol 24 (4) ◽  
pp. 92
Author(s):  
R. S. Kiselev ◽  
A. V. Dubovoy ◽  
D. S. Kislitsin ◽  
A. V. Gorbatykh ◽  
K. S. Ovsyannikov ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Conflict Of Interest ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Complication Rates ◽  
Aneurysm Size ◽  
Temporary Occlusion

<p><strong>Background.</strong> Large and giant aneurysms (&gt; 10 mm and &gt;25 mm, respectively), wide-necked (dome / neck ratio &gt; 1.5) and fusiform examples are challenging for both endovascular and microsurgical intervention. Currently, there is a lack of a universal approach in treating complex anterior circulatory aneurysms. Due to high morbidity and mortality rates and the absence of a common strategy, predictor analysis may have diagnostic relevance.</p><p><strong>Aim.</strong> We sought to identify predictors of unfavourable neurological outcomes for the treatment of complex intracranial aneurysms.</p><p><strong>Methods.</strong> The investigation of complex intracranial aneurysms (SCAT, NCT03269942) is a prospective randomised multicentre study. Unifactorial and multifactorial analyses of clinical outcomes were performed to identify predictors. According to our study protocol, we included 110 patients admitted to Meshalkin National Medical Research Center and the Federal Neurosurgical Center (Novosibirsk, Russian Federation) from March 2015 to June 2018, who met eligibility criteria (age &gt; 75 years, neck size &gt; 4 mm and dome/neck ratio &lt;1.5). Depending on the procedure, patients were divided into two groups using sealed envelope randomisation: 1) endovascular flow diversion (55 patients) and 2) microsurgical revascularisation (55 patients). Unfavourable outcomes were thought to be neurological deterioration with two or more mRS (modified Rankin scale) scores or ≥ mRS 4 decline.</p><p><strong>Results.</strong> Data analysis revealed significatly favourable outcomes in 94.5 % of the endovascular group, and 76.4 % of the microsurgical group at 12 months follow-up (p = 0.001). Morbidity and mortality rates were 5.5 and 1.8 % for the endovascular group, and 25.4 and 3.6 % for the microsurgical group, respectively. Log-rank criteria did not reveal any differences in mortality (p = 0.32). The overall complication rates were 29.1 % for the endovascular group, and 5.4 % for the microsurgical group (p = 0.001). We identified a significant difference in the frequency of ischaemic complications (p = 0.004), but haemorrhagic complication rates were similar (p = 0.297). Unifactorial analysis revealed predictors of unfavourable clinical outcomes: gender (male, ОR = 2.475, 95% CI: 1.005–6.094, p = 0.049), microsurgical intervention (OR = 5.618, 95% CI: 1.635–19.302, p = 0.006), giant aneurysm size (OR = 3.1, 95% CI: 1.22–7.88, p = 0,017), and temporary occlusion for &gt; 40 min (OR = 3.016, 95% CI: 1.13–8.04, p = 0.028). Giant aneurysm size is 6.1 times more increase the probability of unfavorable outcomes according multifactorial analysis.</p><p><strong>Conclusion.</strong> In spite of a high complete occlusion rate after microsurgical treatment with revascularisation, endovascular flow diversion demonstrated better clinical outcomes at short-term follow-up (12 months). Giant aneurysm size was a predictor of both ischaemic and haemorrhagic complications, with an approximate six-fold rise in unfavourable clinical outcomes. Other predictors included the microsurgical intervention itself, especially with increased temporary occlusion for &gt; 40 min, and the male gender.</p><p>Received 12 May 2020. Revised 11 November 2020. Accepted 12 November 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: K.Yu. Orlov, A.V. Dubovoy<br />Data collection and analysis: R.S. Kiselev<br />Statistical analysis: R.S. Kiselev<br />Drafting the article: R.S. Kiselev<br />Critical revision of the article: D.S. Kislitsin, A.V. Gorbatykh, A.V. Dubovoy, K.Yu. Orlov, V.V. Berestov, K.S. Ovsyannikov<br />Final approval of the version to be published: R.S. Kiselev, A.V. Dubovoy, D.S. Kislitsin, A.V. Gorbatykh, K.S. Ovsyannikov, V.V. Berestov, K.Yu. Orlov</p>

scholarly journals Cognitive function in neurosurgical clipping of patients with unruptured intracranial aneurysms

2018 ◽  
Vol 19 (3) ◽  
pp. 15-19
Author(s):  
Arthur A. Pereira Filho ◽  
Matthew M. Kang ◽  
Tibor Becske ◽  
Peter K. Nelson ◽  
Jafar J. Jafar
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Intracranial Aneurysms ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
Postoperative Cognitive Impairment

There is a consensus that most unruptured intracranial aneurysms can be treated with acceptably low morbidity and mortality. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributableto neurosurgical clipping. The goal of this report is to review and discuss aspects referring to cognitive function and neurosurgical repair in patients with unruptured intracranial aneurysms.

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