Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease

2020 ◽  
pp. 1-7
Author(s):  
Xu Zhao ◽  
Xiaofei Wang ◽  
Minqing Wang ◽  
Qinghu Meng ◽  
Chengwei Wang
Keyword(s):  
Moyamoya Disease ◽  
Intracranial Aneurysms ◽  
Treatment Strategies ◽  
Ruptured Intracranial Aneurysms

Aneurysmal Subarachnoid Hemorrhage: Neurosurgical Frontiers and Nursing Challenges

1991 ◽  
Vol 2 (4) ◽  
pp. 665-674
Author(s):  
Helen A. Cook
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Seizure Activity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Aneurysmal Rupture ◽  
Management Of Complications ◽  
Ruptured Intracranial Aneurysms

Despite increases in survival beyond the initial hemorrhage, the devastating consequences of subarachnoid hemorrhage persist. Ruptured intracranial aneurysms are the most likely cause of subarachnoid hemorrhage, with morbidity and mortality rates approaching 75%. Complications arising from aneurysmal subarachnoid hemorrhage include rebleeding, delayed cerebral ischemia, hydrocephalus, hypothalamic dysfunction, and seizure activity. In order to positively influence outcome after subarachnoid hemorrhage, preservation of an adequate cerebral blood flow and prevention of secondary aneurysmal rupture is essential. This article reviews aneurysmal subarachnoid hemorrhage, relating the management of complications to currently accepted treatment strategies

scholarly journals Ruptured Intracranial Aneurysms Associated With Moyamoya Disease

2011 ◽  
Vol 51 (11) ◽  
pp. 774-776 ◽  
Author(s):  
Yoshikazu ARAI ◽  
Ken MATSUDA ◽  
Makoto ISOZAKI ◽  
Tsuyoshi NAKAJIMA ◽  
Ken-ichiro KIKUTA
Keyword(s):  
Moyamoya Disease ◽  
Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms

scholarly journals Current Treatment Strategies for Intracranial Aneurysms: An Overview

Angiology ◽  
2017 ◽  
Vol 69 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Junjie Zhao ◽  
Hao Lin ◽  
Richard Summers ◽  
Mingmin Yang ◽  
Brian G. Cousins ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
New Technologies ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Clinical Practices ◽  
Treatment Techniques ◽  
Local Experience ◽  
Different Types ◽  
Endovascular Approach ◽  
Ruptured Intracranial Aneurysms

Intracranial aneurysm is a leading cause of stroke. Its treatment has evolved over the past 2 decades. This review summarizes the treatment strategies for intracranial aneurysms from 3 different perspectives: open surgery approach, transluminal treatment approach, and new technologies being used or trialed. We introduce most of the available treatment techniques in detail, including contralateral clipping, wrapping and clipping, double catheters assisting coiling and waffle-cone technique, and so on. Data from major trials such as Analysis of Treatment by Endovascular approach of Non-ruptured Aneurysms (ATENA), Internal Subarachnoid Trial (ISAT), Clinical and Anatomical Results in the Treatment of Ruptured Intracranial Aneurysms (CLARITY), and Barrow Ruptured Aneurysm Trial (BRAT) as well as information from other clinical reports and local experience are reviewed to suggest a clinical pathway for treating different types of intracranial aneurysms. It will be a valuable supplement to the current existing guidelines. We hope it could help assisting real-time decision-making in clinical practices and also encourage advancements in managing the disease.

scholarly journals Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

2021 ◽  
pp. neurintsurg-2021-017641
Author(s):  
Kemal Alpay ◽  
Tero Hinkka ◽  
Antti E Lindgren ◽  
Juha-Matti Isokangas ◽  
Rahul Raj ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Flow Diverter ◽  
Supporting Evidence ◽  
Complication Rates ◽  
Related Complication ◽  
Anterior Circulation ◽  
Clinical And Radiological Results ◽  
Ruptured Intracranial Aneurysms

BackgroundFlow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.MethodsThis is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.Results110 patients (64 females; mean age 55.7 years; range 12–82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0–2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).ConclusionsFD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

scholarly journals Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

2021 ◽  
Vol 10 (7) ◽  
pp. 1348
Author(s):  
Karol Wiśniewski ◽  
Bartłomiej Tomasik ◽  
Zbigniew Tyfa ◽  
Piotr Reorowicz ◽  
Ernest Bobeff ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Porous Media ◽  
Packing Density ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Patient Specific ◽  
Computational Fluid Dynamics Analysis ◽  
Ruptured Intracranial Aneurysms ◽  
Statistical Results

Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.

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