Magnesium and Intracranial Aneurysms: Not Only Acute Subarachnoid Hemorrhage

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012247
Author(s):  
Joanna Pera ◽  
Christopher D. Anderson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Acute Subarachnoid Hemorrhage

Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms

2020 ◽  
Vol 133 (3) ◽  
pp. 814-820 ◽  
Author(s):  
Haewon Roh ◽  
Junwon Kim ◽  
Heejin Bae ◽  
Kyuha Chong ◽  
Jong Hyun Kim ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Viable Option ◽  
Safety And Efficacy ◽  
Ruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Acute Subarachnoid Hemorrhage ◽  
Ruptured Intracranial Aneurysms

OBJECTIVEThe safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm.METHODSA total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes.RESULTSThere were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78–83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.CONCLUSIONSRuptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

Hemorrhagic Complications Related to the Stent-Remodeled Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Dong Joon Kim ◽  
Sang Hyun Suh ◽  
Byung Moon Kim ◽  
Dong Ik Kim ◽  
Seung Kon Huh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Brain Infarction ◽  
Hemorrhagic Complication ◽  
Intraparenchymal Hemorrhage ◽  
Antiplatelet Medication ◽  
Hemorrhagic Complications ◽  
Acute Subarachnoid Hemorrhage

Abstract OBJECTIVE To evaluate the postprocedural hemorrhagic complications associated with stent-remodeled coil embolization of intracranial aneurysms. METHODS From the database of 163 cases of stent-remodeled therapy for wide-neck intracranial aneurysms, patients who showed intracranial hemorrhagic complications on follow-up brain imaging were selected. The initial presentation, antithrombotic medication, hemorrhagic type, location, amount, association with ventriculostomy, symptomatic involvement, and outcome were assessed. RESULTS Ten patients (6.1%) developed intracranial hemorrhagic complications (range; 0–422 days; mean; 56 days). The hemorrhagic complication rate was higher in patients with acute subarachnoid hemorrhage (20%, 6 of 30 patients) than in patients with unruptured aneurysms (3%, 4 of 133 patients). Nine of the 10 patients were on dual-antiplatelet therapy at the time of hemorrhage development. Seven of the hemorrhages developed in patients with ventriculostomies (intraparenchymal, n = 4; subdural hematoma, n = 3). Three patients who did not receive a ventriculostomy also developed intracranial hemorrhage (n = 1) or intraparenchymal hemorrhage (n = 2). Hemorrhagic transformation in the recently infarcted brain tissue seemed to be the cause of nonventriculostomy related intraparenchymal hemorrhage. The hemorrhages were accompanied by symptomatic aggravation in 6 of 10 cases, with 5 cases resulting in moribund clinical outcome. CONCLUSION Postprocedural intracranial hemorrhage may be a risk of stent-remodeled therapy while the patient is on dual-antiplatelet medication. Extra caution is warranted especially in patients with acute subarachnoid hemorrhage requiring ventriculostomy or with underlying recent brain infarction.

scholarly journals Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

2021 ◽  
Author(s):  
David Evans ◽  
Richard Flood ◽  
Owain Davies ◽  
James Wareham ◽  
Alex Mortimer
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Perceived Risk ◽  
Odds Ratio ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Minimal Impact ◽  
Beneficial Effects ◽  
Acute Subarachnoid Hemorrhage ◽  
Elevated Rate ◽  
Ruptured Intracranial Aneurysms

Purpose: Aspirin has beneficial effects on coiling, even in acute subarachnoid hemorrhage, but there is also a perceived risk of increased bleeding and, importantly, a concern regarding ventriculostomy-associated hemorrhage (VAH) in those with complicating hydrocephalus. We aimed to assess the rate and extent of VAH in patients specifically treated with procedural intravenous aspirin during endovascular coiling of ruptured intracranial aneurysms.Materials and Methods: This was a single neurovascular center retrospective observational study of consecutive patients treated over a three-year period. The rate of VAH assessed using computed tomography and clinical outcomes were compared in patients receiving intraprocedural intravenous aspirin loading (n=90) versus those that did not receive the drug (n=40).Results: There was a significantly elevated rate of VAH in patients receiving intravenous aspirin (30% vs. 2.5%, odds ratio 16.7 [95% confidence interval: 2.2–128.0], P<0.0001). The majority of VAH was <10 mm in size (70%) with the largest bleed measuring 20 mm. No hematoma required surgical evacuation. No difference in favorable outcome at discharge was demonstrated. There was no difference in mortality between the 2 groups.Conclusion: Loading with intravenous aspirin during endovascular treatment of ruptured intracranial aneurysms significantly increases the risk of VAH, but most are small with minimal impact on clinical outcome at discharge. Intravenous aspirin should probably be reserved for selected cases but should not be withheld based on risk of VAH.

Murphey’s teat: history and insight into an enigmatic cerebrovascular eponym

2020 ◽  
Vol 133 (2) ◽  
pp. 369-373
Author(s):  
Daniel M. Heiferman ◽  
Daphne Li ◽  
Joseph C. Serrone ◽  
Matthew R. Reynolds ◽  
Anand V. Germanwala ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Important Work ◽  
Multiple Intracranial Aneurysms ◽  
Angiographic Evidence ◽  
Insight Into

Dr. Francis Murphey of the Semmes-Murphey Clinic in Memphis recognized that a focal sacculation on the dome of an aneurysm may be angiographic evidence of a culpable aneurysm in the setting of subarachnoid hemorrhage with multiple intracranial aneurysms present. This has been referred to as a Murphey’s “teat,” “tit,” or “excrescence.” With variability in terminology, misspellings in the literature, and the fact that Dr. Murphey did not formally publish this important work, the authors sought to clarify the meaning and investigate the origins of this enigmatic cerebrovascular eponym.

Infusion therapy as hemodynamic adjustment in patients with acute subarachnoid hemorrhage

2019 ◽  
Vol 17 (6 (part 1)) ◽  
pp. 31-34
Author(s):  
R. Ya. Shpaner ◽  
◽  
A. Zh. Bayalieva ◽  
◽  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Infusion Therapy ◽  
Acute Subarachnoid Hemorrhage
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