Abstract 108: Long-Term Outcome of Giant Unruptured Intracranial Aneurysms

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
James C Torner ◽  
David Piepgras ◽  
John Huston ◽  
Irene Meissner ◽  
Robert Brown
Keyword(s):  
High Risk ◽  
Endovascular Treatment ◽  
Prospective Cohort ◽  
Intracranial Aneurysms ◽  
Smoking History ◽  
Maximum Diameter ◽  
Giant Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Introduction: Giant intracranial aneurysms are uncommon, have a high risk for rupture and are difficult to treat. The International Study of Unruptured Intracranial Aneurysms (ISUIA) prospective cohort included 187 patients with maximal diameter of 25 mm or greater. This analysis was to determine the long-term prognosis of these aneurysms both treated and untreated. Methods: Patients were enrolled into ISUIA at 61 centers from 1991-1998. A prospective cohort included the managed with observation, surgery or endovascular treatment. Patients were followed for a median of 9.2 years. Aneurysms were measured using a central reading of bi-planar cerebral angiography. Outcomes were determined prospectively and with central review. Results: 187 patients with a maximum diameter of 25 mm were followed. The mean size was 30.3 mm, ranging from 25 to 63 mm. 39% of the aneurysms were surgically treated at baseline, 27% were endovascularly treated, and 32% were managed conservatively;3% had subsequent endovascular treatment and 5% surgical treatment. Patients with giant aneurysms were predominantly women (83%), had a baseline Rankin Score of in 93%, were located predominantly in the anterior circulation (internal carotid 44%, cavernous ICA 28%, middle cerebral 12%). 80% of the patients were symptomatic with cranial nerve deficit in 47% (III and VI nerves), mass effect in 16%, headaches in 44%, orbital pain in 21%, and vision loss in 25%. Smoking history was present in 67%, hypertension in 44%, vascular headaches in 29% and family history in 10%. 70 patients (39%) died during follow-up however 59% were still Rankin 1 or 2. Both surgical and endovascular treated patients had 60-64% good outcome and 34-36% mortality. Untreated patients had a 57% mortality. Subarachnoid hemorrhage occurred in 11 untreated patients and 12 treated patients with most occurring in the first year. Conclusions: Giant intracranial aneurysms are typically symptomatic, and have a high risk of rupture early after diagnosis. Outcome was similar with surgical and endovascular treatment but post-procedure hemorrhage did occur.

scholarly journals Long-term outcomes of coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (6) ◽  
pp. 1492-1498 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Akira Ishii ◽  
Hirotoshi Imamura ◽  
Tetsu Satow ◽  
Kazumichi Yoshida ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Long Term Follow Up ◽  
Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

scholarly journals Both Surgical Clipping and Endovascular Embolization of Unruptured Intracranial Aneurysms Are Associated With Long-term Improvement in Self-Reported Quantitative Headache Scores

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 128-134 ◽  
Author(s):  
Ankeet A Choxi ◽  
Alia K Durrani ◽  
Robert A Mericle
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Pain Scale ◽  
Endovascular Embolization ◽  
Senior Author ◽  
Dramatic Improvement ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Before And After

Abstract BACKGROUND: The most common presenting symptom for unruptured intracranial aneurysms (UIAs) is headache (HA). However, most experts believe that UIAs associated with HAs are unrelated and incidental. OBJECTIVE: To analyze the incidence and characterization of HAs in patients with UIAs before and after treatment with either surgical clipping or endovascular embolization. METHOD: We prospectively determined the presence, sidedness, and severity of HAs preoperatively in patients who presented to the senior author with a UIA. A validated, quantitative 11-point HA pain scale was used in all patients. The same HA assessments were performed again on these patients an average of 32.4 months postoperatively. RESULTS: In this study, 92.45% (n = 53) of patents for whom we were able to obtain both a preoperative and postoperative pain score had an improvement in their HAs. The average quantitative HA score was 5.87 preoperatively vs 1.39 postoperatively (P < .001). There was no relationship found between the following: (1) HA severity vs aneurysm size, (2) sidedness of aneurysm vs sidedness of HA, and (3) HA improvement after surgical vs endovascular treatment. CONCLUSION: This study suggests that surgical and endovascular treatment of a UIA is associated with dramatic improvement in self-reported HA score an average of 32.4 months postoperatively.

scholarly journals EXPRESS: Preventive screening for intracranial aneurysms

2021 ◽  
pp. 174749302110245
Author(s):  
Gabriel Rinkel ◽  
Ynte Ruigrok
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Preventive Treatment ◽  
Preventive Screening ◽  
Advantages And Disadvantages ◽  
Poor Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Background: Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage, ASAH) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after ASAH, prevention of ASAH has the highest potential to prevent poor outcome from ASAH. Aim: In this review, we describe the groups at high risk of ASAH who may benefit from preventive screening for unruptured intracranial aneurysms (UIA) followed by preventive treatment of UIAs found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening. Summary of review: Modelling studies show that persons with two or more affected first-degree relatives with ASAH and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for UIAs. One modelling study also suggest that persons with only one affected first-degree relative with ASAH are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of ASAH of up to 7%, but the prevalence of UIAs in such persons, and thus the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening –such as risk of incidental findings, very small UIAs that require regular follow-up, preventive treatment with inherent risk of complications and anxiety- should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged. Conclusions: Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all ASAH patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of UIA become available, the groups of persons who may benefit from screening could increase considerably.

scholarly journals Detection rates and sites of unruptured intracranial aneurysms according to sex and age: an analysis of MR angiography–based brain examinations of 4070 healthy Japanese adults

2019 ◽  
Vol 130 (2) ◽  
pp. 573-578 ◽  
Author(s):  
Yohichi Imaizumi ◽  
Tohru Mizutani ◽  
Katsuyoshi Shimizu ◽  
Yosuke Sato ◽  
Junichi Taguchi
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Mr Angiography ◽  
Detection Rate ◽  
Smoking History ◽  
Maximum Diameter ◽  
Detection Rates ◽  
Female Sex ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Detection

OBJECTIVEThe purpose of this study was to evaluate the detection rate and occurrence site according to patient sex and age of unruptured intracranial aneurysms detected through MRI and MR angiography (MRA).METHODSA total of 4070 healthy adults 22 years or older (mean age [± SD] 50.6 ± 11.0 years; 41.9% women) who underwent a brain examination known as “Brain Dock” in the central Tokyo area between April 2014 and March 2015 were checked for unruptured saccular aneurysm using 3-T MRI/MRA. The following types of cases were excluded: 1) protrusions with a maximum diameter < 2 mm at locations other than arterial bifurcations, 2) conical protrusions at arterial bifurcations with a diameter < 3 mm, and 3) cases of suspected aneurysms with unclear imaging of the involved artery. When an aneurysm was definitively diagnosed, the case was included in the aneurysm group. The authors also investigated the relationship between aneurysm occurrence and risk factors (age, sex, smoking history, hypertension, diabetes, and hyperlipidemia).RESULTSOne hundred eighty-eight aneurysms were identified in 176 individuals (detection rate 4.32%), with the detection rate for women being significantly higher (6.2% vs 3.0%, p < 0.001). The average age in the aneurysm group was significantly higher than in the patients in whom aneurysms were not detected (53.0 ± 11.1 vs 50.5 ± 11.0 years). The detection rate tended to increase with age. The detection rates were 3.6% for people in their 30s, 3.5% for those in their 40s, 4.1% for those in their 50s, 6.9% for those in their 60s, and 6.8% for those in their 70s. Excluding persons in their 20s and 80s—age groups in which no aneurysms were discovered—the detection rate in women was higher in all age ranges. Of the individuals with aneurysms, 12 (6.81%) had multiple cerebral aneurysms; no sex difference was observed with respect to the prevalence of multiple aneurysms. Regarding aneurysm size, 2.0–2.9 mm was the most common size range, with 87 occurrences (46.3%), followed by 3.0–3.9 mm (67 [35.6%]) and 4.0–4.9 mm (20 [10.6%]). The largest aneurysm was 13 mm. Regarding location, the internal carotid artery (ICA) was the most common aneurysm site, with 148 (78.7%) occurrences. Within the ICA, C1 was the site of 46 aneurysms (24.5%); C2, 57 (30.3%); and C3, 29 (15.4%). The aneurysm detection rates for C2, C3, and C4 were 2.23%, 1.23%, and 0.64%, respectively, for women and 0.68%, 0.34%, and 0.21%, respectively, for men; ICA aneurysms were significantly more common in women than in men (5.27% vs 2.20%, p < 0.001). Multivariate logistic regression analysis revealed that age (p < 0.001, OR 1.03, 95% CI 1.01–1.04), female sex (p < 0.001, OR 2.28, 95% CI 1.64–3.16), and smoking history (p = 0.011, OR 1.52, 95% CI 1.10–2.11) were significant risk factors for aneurysm occurrenceCONCLUSIONSIn this study, both female sex and older age were independently associated with an increased aneurysm detection rate. Aneurysms were most common in the ICA, and the frequency of aneurysms in ICA sites was markedly higher in women.

Abstract 111: Comparison of Long-term Outcomes Associated with Endovascular Treatment Versus Surgical Treatment Among Medicare Beneficiaries with Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Saqib A Chaudhry ◽  
Wondwossen G Tekle ◽  
M Fareed K Suri
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Objective: To determine the 5 year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. Methods: The study included a representative sample of fee-for-service Medicare beneficiaries aged 65 years or older who underwent endovascular or surgical treatment for unruptured intracranial aneurysms between 1999 through 2010. The Medicare Provider Analysis and Review files were linked to the Center for Medicaid and Medicare Services denominator files for 2000-2010 to ascertain any new admission or mortality. Cox proportional hazards and Kaplan Meir survival analyses were used to assess the relative risk of all-cause mortality, new intracranial hemorrhage, or second procedure for patients treated with endovascular treatment compared with those treated with surgical treatment after adjusting for potential confounders. Results: A total of 1005 patients with unruptured intracranial aneurysms were treated with either endovascular (n=569) or surgical treatment (n=436) with post-procedure follow-up available for 4.64 (±2.98) years. The rate of immediate post-procedural neurological complications (8.7% vs. 3.2%, p<0.0001) and requirement for intraventricular catheter (2.8% vs. 0.7%, p=0.019) was higher among patients treated with surgery compared with those treated with endovascular treatment. The estimated 5 year survival was 93.6% and 95.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for age, gender, and race/ethnicity, relative risks of all-cause mortality (RR 0.5, 95% CI 0.3-0.9) and new intracranial hemorrhage (RR 0.4, 95% CI 0.2-0.8) were significantly lower with endovascular treatment. Conclusions: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events, long-term all-cause mortality and new intracranial hemorrhages.

Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 380-387 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Saqib A. Chaudhry ◽  
Wondwossen G. Tekle ◽  
M. Fareed K. Suri
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Medicare Beneficiaries ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality ◽  
Second Procedure

Abstract BACKGROUND: Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date. OBJECTIVE: To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment. METHODS: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with postprocedure follow-up of 4.7 (±3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier survival methods. RESULTS: A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n = 398) or surgical treatment (n = 290). The rate of immediate postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were lower with endovascular treatment. CONCLUSION: In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.

scholarly journals A data-driven model to identify high-risk aneurysms and guide management decisions: the Rupture Resemblance Score

2020 ◽  
pp. 1-8
Author(s):  
Hamidreza Rajabzadeh-Oghaz ◽  
Muhammad Waqas ◽  
Sricharan S. Veeturi ◽  
Kunal Vakharia ◽  
Michael K. Tso ◽  
...  
Keyword(s):  
High Risk ◽  
Intracranial Aneurysms ◽  
Clinical Utility ◽  
Treatment Decision ◽  
Dynamics Simulation ◽  
Data Driven ◽  
Computer Assisted ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Hemodynamic Characteristics

OBJECTIVEPrevious studies have found that ruptured intracranial aneurysms (RIAs) have distinct morphological and hemodynamic characteristics, including higher size ratio and oscillatory shear index and lower wall shear stress. Unruptured intracranial aneurysms (UIAs) that possess similar characteristics to RIAs may be at a higher risk of rupture than those UIAs that do not. The authors previously developed the Rupture Resemblance Score (RRS), a data-driven computer model that can objectively gauge the similarity of UIAs to RIAs in terms of morphology and hemodynamics. The authors aimed to explore the clinical utility of RRS in guiding the management of UIAs, especially for challenging cases such as small UIAs.METHODSBetween September 2018 and June 2019, the authors retrospectively collected consecutive challenging cases of incidentally identified UIAs that were discussed during their weekly multidisciplinary neurovascular conference. From patient 3D digital subtraction angiography, they reconstructed the aneurysm geometry and performed computer-assisted 3D morphology analysis and computational fluid dynamics simulation. They calculated RRS for every UIA case and compared it against the treatment decision made at the neurovascular conference as well as the recommendation based on the unruptured intracranial aneurysm treatment score (UIATS).RESULTSForty-seven patients with 79 UIAs, 90% of which were < 7 mm in size, were included in this study. The mean RRS (range 0.0–1.0) was 0.24 ± 0.31. At the conferences, treatment was endorsed for 45 of the UIAs (57%). These cases had significantly higher RRSs than the 34 cases suggested for observation (0.33 ± 0.34 vs 0.11 ± 0.19, p < 0.001). The UIATS-based recommendations were “observation” for 24 UIAs (30%), “treatment” for 21 UIAs (27%), and “not definitive” for 34 UIAs (43%). These “not definitive” cases were stratified by RRS based on similarity to RIAs.CONCLUSIONSAlthough not a rupture predictor, RRS is a data-driven model that gauges the similarity of UIAs to RIAs in terms of morphology and hemodynamics. In cases in which the UIATS-based recommendation is not definitive, RRS provides additional stratification to assist the identification of high-risk UIAs. The current study highlights the clinical utility of RRS in a real-world setting as an adjunctive tool for the management of UIAs.

Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience

2013 ◽  
Vol 118 (2) ◽  
pp. 408-416 ◽  
Author(s):  
Mariangela Piano ◽  
Luca Valvassori ◽  
Luca Quilici ◽  
Guglielmo Pero ◽  
Edoardo Boccardi
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Long Term Results ◽  
Maximum Diameter ◽  
Consecutive Series ◽  
Flow Diverter Devices

Object The introduction of flow diverter devices is revolutionizing the endovascular approach to cerebral aneurysms. Midterm and long-term results of angiographic, cross-sectional imaging and clinical follow-up are still lacking. The authors report their experience with endovascular treatment of intracranial aneurysms using both the Pipeline embolization device and Silk stents. Methods From October 2008 to July 2011 a consecutive series of 104 intracranial aneurysms in 101 patients (79 female, 22 male; average age 53 years) were treated. Three of the 104 aneurysms were ruptured and 101 were unruptured. Silk stents were implanted in 47 of the aneurysms and Pipeline stents in the remaining 57. In 14 cases a combination of flow diverter devices and coils were used to treat larger aneurysms (maximum diameter > 15 mm). Patients underwent angiographic follow-up examination at 6 months after treatment, with or without CT or MRI, and at 1 year using CT or MRI, with or without conventional angiography. Results In all cases placement of flow diverter stents was technically successful. The mortality and morbidity rates were both 3%. Adverse events without lasting clinical sequelae occurred in 20% of cases. Angiography performed at 6 months after treatment showed complete aneurysm occlusion in 78 of 91 cases (86% of evaluated aneurysms) and subocclusion in 11 (12%); only in 2 cases were the aneurysms unchanged. Fifty-three aneurysms were evaluated at 1 year after treatment. None of these aneurysms showed recanalization, and 1 aneurysm, which was incompletely occluded at the 6-month follow-up examination, was finally occluded. Aneurysmal sac shrinkage was observed in 61% of assessable aneurysms. Conclusions Parent artery reconstruction using flow diverter devices is a feasible, safe, and successful technique for the treatment of endovascular treatment of cerebral aneurysms.

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