Confidence of treatment decision and perceived risk of procedure-related neurological complications in the management of unruptured intracranial aneurysms

2018 ◽  
Vol 11 (5) ◽  
pp. 479-484
Author(s):  
Marielle Ernst ◽  
Levente Kriston ◽  
Uta Hanning ◽  
Andreas M Frölich ◽  
Jens Fiehler ◽  
...  
Keyword(s):  
Risk Score ◽  
Perceived Risk ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Treatment Recommendation ◽  
Management Approach ◽  
Neck Width ◽  
Unruptured Intracranial Aneurysms ◽  
Random Guess ◽  
Better Than

Background and purposeTo evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score.Materials and methodsTwenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications. Knowledge and experience in interventional neuroradiology (INR) of each participant were assessed.ResultsReliability was moderate regarding any treatment recommendation (ICC=0.49) and low regarding the estimation of risk of complications (ICC=0.38). The recommendation of clipping was less likely with more experience in INR (OR=0.6) and more likely with increasing knowledge (OR=1.7). Odds of recommending WEB device were lower with more experience in INR (OR=0.6), higher in patients with multiple aneurysms (OR=3.6) and increasing neck width (OR=2.7). The recommendation of stent-assisted coiling was more likely with increasing neck width (OR=2.4) and when cerebral ischemic comorbidities were present (OR=2.9). The participants were significantly worse than the risk score (mean area under the curve of 0.53) and not better than random guess in predicting complications. Neither knowledge nor experience in INR was significantly associated with the participants’ ability to predict neurological complications.ConclusionsOur study shows a moderate interrater reliability of treatment recommendations of UIAs. Confidence in treatment recommendation varied significantly according to recommended treatments. Overall performance in predicting neurological complications was worse than the risk score and not better than random guess.

scholarly journals Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms

Stroke ◽  
2016 ◽  
Vol 47 (4) ◽  
pp. 971-978 ◽  
Author(s):  
Wenjun Ji ◽  
Aihua Liu ◽  
Xianli Lv ◽  
Huibin Kang ◽  
Liqian Sun ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Risk Score ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Unruptured Intracranial Aneurysms

ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms

Neurology ◽  
2017 ◽  
Vol 88 (17) ◽  
pp. 1600-1606 ◽  
Author(s):  
Daan Backes ◽  
Gabriel J.E. Rinkel ◽  
Jacoba P. Greving ◽  
Birgitta K. Velthuis ◽  
Yuichi Murayama ◽  
...  
Keyword(s):  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Risk Score ◽  
Intracranial Aneurysms ◽  
Cox Regression Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth ◽  
Risk Factor Status

Objective:To develop a risk score that estimates 3-year and 5-year absolute risks for aneurysm growth.Methods:From 10 cohorts of patients with unruptured intracranial aneurysms and follow-up imaging, we pooled individual data on sex, population, age, hypertension, history of subarachnoid hemorrhage, and aneurysm location, size, aspect ratio, and shape but not on smoking during follow-up and family history of intracranial aneurysms in 1,507 patients with 1,909 unruptured intracranial aneurysms and used aneurysm growth as outcome. With aneurysm-based multivariable Cox regression analysis, we determined predictors for aneurysm growth, which were presented as a risk score to calculate 3-year and 5-year risks for aneurysm growth by risk factor status.Results:Aneurysm growth occurred in 257 patients (17%) and 267 aneurysms (14%) during 5,782 patient-years of follow-up. Predictors for aneurysm growth were earlier subarachnoid hemorrhage, location of the aneurysm, age >60 years, population, size of the aneurysm, and shape of the aneurysm (ELAPSS). The 3-year growth risk ranged from <5% to >42% and the 5-year growth risk from <9% to >60%, depending on the risk factor status.Conclusions:The ELAPSS score consists of 6 easily retrievable predictors and can help physicians in decision making on the need for and timing of follow-up imaging in patients with unruptured intracranial aneurysms.

scholarly journals Scoring of Growth of Unruptured Intracranial Aneurysms

2020 ◽  
Vol 9 (10) ◽  
pp. 3339
Author(s):  
Seppo Juvela
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Receiver Operating Curve ◽  
Female Sex ◽  
Unruptured Intracranial Aneurysms ◽  
Long Term Follow Up ◽  
Better Than

The purpose was to obtain a reliable scoring for growth of unruptured intracranial aneurysms (UIAs) in a long-term follow-up study from variables known at baseline and to compare it with the ELAPSS (Earlier subarachnoid hemorrhage, Location of the aneurysm, Age > 60 years, Population, Size of the aneurysm, and Shape of the aneurysm) score obtained from an individual-based meta-analysis. The series consists of 87 patients with 111 UIAs and 1669 person-years of follow-up between aneurysm size measurements (median follow-up time per patient 21.7, range 1.2 to 51.0 years). These were initially diagnosed between 1956 and 1978, when UIAs were not treated in our country. ELAPSS scores at baseline did not differ between those with and those without aneurysm growth. The area under the curve (AUC) for the receiver operating curve (ROC) of the ELAPSS score for predicting long-term growth was fail (0.474, 95% CI 0.345–0.603), and the optimal cut-off point was obtained at ≥7 vs. <7 points for sensitivity (0.829) and specificity (0.217). In the present series UIA growth was best predicted by female sex (4 points), smoking at baseline (3 points), and age <40 years (2 points). The AUC for the ROC of the new scoring was fair (0.662, 95% CI 0.546–0.779), which was significantly better than that of ELAPSS score (p < 0.05). The optimal cut-off point was obtained at ≥4 vs. <4 points for sensitivity (0.971) and specificity (0.304). A new simple scoring consisting of only female sex, cigarette smoking and age <40 years predicted growth of an intracranial aneurysm in long-term follow-up, significantly better than the ELAPSS score.

Aspect ratio is associated with recanalization after coiling of unruptured intracranial aneurysms

2021 ◽  
Author(s):  
Takeshi Hara ◽  
Tetsu Satow ◽  
Eika Hamano ◽  
Naoki Hashimura ◽  
Masatake Sumi ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Neck Width ◽  
Tof Mra ◽  
Unruptured Intracranial Aneurysms ◽  
The Mean

Abstract Background The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3-49%. Aim of this study is to investigated the factors that influence the recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) in our institution. Methods We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent used cases were excluded. Cerebral angiography and 3D TOF MRA were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. Results The mean follow-up period ranged from 6 to 172 months (mean: 79.0±39.8 months). Recanalization was noted in 87 (28.3%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p = 0.002), AR (p = 0.003), and VER (p = 0.027) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. Conclusions In our study, AR and VER were significant predictors of recanalization after coil embolization for UIAs.

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

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

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