Does the presence of a subarachnoid haemorrhage (SAH) influence analgesic requirements after treatment with surgery or endovascular coiling in patients with intracranial aneurysms?

The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests an endovascular procedure would be the gold standard of treatment for ruptured multiple intracranial aneurysms.

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Does the presence of subarachnoid haemorrhage influence analgesic requirements after treatment with surgical clipping or endovascular coiling of intracranial aneurysms?

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03019954 ◽

2007 ◽

Vol 54 (S1) ◽

pp. 44471-44471

Author(s):

Dhuleep Wijayatilake ◽

Suwimon Tangwiwat ◽

Karolinah Lukitti ◽

H. El-Beheiry ◽

P. Manninen

Keyword(s):

Subarachnoid Haemorrhage ◽

Intracranial Aneurysms ◽

Endovascular Coiling ◽

Surgical Clipping

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Faculty Opinions recommendation of International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14584.472091 ◽

2006 ◽

Author(s):

Luciana Mascia

Keyword(s):

Intracranial Aneurysms ◽

Endovascular Coiling ◽

International Subarachnoid Aneurysm Trial ◽

Aneurysm Occlusion ◽

Ruptured Intracranial Aneurysms

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EXPRESS: A meta-analysis of aspirin and subarachnoid haemorrhage in patients with intracranial aneurysms yields different results to the general population

International Journal of Stroke ◽

10.1177/17474930211004888 ◽

2021 ◽

pp. 174749302110048

Author(s):

Frederick Ewbank ◽

Jacqueline Birks ◽

Diederik Bulters

Keyword(s):

General Population ◽

Subarachnoid Haemorrhage ◽

Confidence Intervals ◽

Random Effects ◽

Intracranial Aneurysms ◽

Meta Analysis ◽

Risk Of Bias ◽

Random Effects Models ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms

Abstract Background Some studies have shown a protective association between aspirin use and subarachnoid haemorrhage (SAH). Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of SAH. Aims Our aim was to establish 1) if there is an association between aspirin and SAH, 2) how this differs between the general population and those with intracranial aneurysms. Summary of review Studies reporting aspirin use and the occurrence of SAH were included and grouped based on population (general population vs aneurysm population). Odds ratios, hazard ratios and confidence intervals were combined in random-effects models. 11 studies were included. Overall, there was an association between aspirin and SAH (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high (p<0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population there was no difference in aspirin use between individuals with and without SAH (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without SAH (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias. Conclusions There is an association between aspirin use and SAH in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomised studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.

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DEFINING THE RISK OF RETREATMENT FOR ANEURYSM RECURRENCE OR RESIDUAL AFTER INITIAL TREATMENT BY ENDOVASCULAR COILING

Neurosurgery ◽

10.1227/01.neu.0000349922.05350.96 ◽

2009 ◽

Vol 65 (2) ◽

pp. 311-315 ◽

Cited By ~ 56

Author(s):

Andrew J. Ringer ◽

Rafael Rodriguez-Mercado ◽

Erol Veznedaroglu ◽

Elad I. Levy ◽

Ricardo A. Hanel ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Surgical Repair ◽

The United States ◽

Patient Treatment ◽

Endovascular Coiling ◽

Total Risk ◽

Clinical Recurrence ◽

Choice Of Treatment ◽

Procedural Complications

Abstract OBJECTIVE Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. METHODS Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). RESULTS Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. CONCLUSION Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

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