Endovascular Treatment of Unruptured Intracranial Aneurysms: Occurrence of Thromboembolic Events

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 612-618 ◽  
Author(s):  
Iris Quasar Grunwald ◽  
Panagiotis Papanagiotou ◽  
Maria Politi ◽  
Tobias Struffert ◽  
Christian Roth ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Intracranial Aneurysms ◽  
Thrombus Formation ◽  
High Rate ◽  
Thromboembolic Events ◽  
Patient Age ◽  
Diffusion Weighted ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms

Abstract OBJECTIVE: The purpose of this study was to evaluate the frequency and causes of thromboembolic events associated with endovascular embolization of asymptomatic aneurysms. Correlations between radiological findings (aneurysm size, localization, embolization time, number of coils used, as well as patient age) were evaluated with the occurrence of thromboembolic events and clinical findings. METHODS: Sixty-eight patients treated for unruptured intracranial aneurysms (mean age, 49 yr) were evaluated. Hyperintense lesions on diffusion weighted imaging were analyzed in 50 patients. Aneurysm size was 3 to 15 mm. RESULTS: Complete occlusion of the aneurysms was achieved in 55 of 68 (82%). One patient had a transient paresis. There was one infarction and one aneurysm rupture during the procedure with no consecutive neurological symptoms. We found new hyperintense lesions in 21 of 50 (42%) diffusion weighted imaging studies. In 43% of these, there was only one lesion smaller than 2 mm. In 33%, there was more than one lesion less than 2 mm; in 19%, we found a lesion of 2 to 10 mm in size. In one case, a lesion greater than 10 mm occurred. There was no correlation between aneurysm location and the occurrence of lesions or among the number of coils used, the size of the aneurysm, patient age, or embolization time. Mortality rate was 0%, morbidity 4.0%. If the 18 aneurysms where no diffusion weighted imaging was obtained are included, morbidity is 2.9%. CONCLUSION: The high rate of thromboembolic events suggests that heparin is not sufficient to prevent ischemic lesions. An antiplatelet therapy, started before or during intervention, might diminish thrombus formation.

scholarly journals Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography

2016 ◽  
Vol 22 (3) ◽  
pp. 293-298 ◽  
Author(s):  
Osman Kizilkilic ◽  
Eldeniz Huseynov ◽  
Sedat G Kandemirli ◽  
Naci Kocer ◽  
Civan Islak
Keyword(s):  
Computed Tomography ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Flat Detector ◽  
Patient Age ◽  
Flat Detector Computed Tomography ◽  
Aneurysm Size ◽  
Aneurysm Wall ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms

Object Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients’ risk factors for microclipping. Methods A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ2 test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. Results None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size ( P < 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. Conclusion In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered.

Functional outcome after repair of unruptured intracranial aneurysms

2001 ◽  
Vol 94 (3) ◽  
pp. 417-421 ◽  
Author(s):  
Douglas Chyatte ◽  
Rebecca Porterfield
Keyword(s):  
Functional Outcome ◽  
Intracranial Aneurysms ◽  
Patient Age ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Fine Print

Object. Repair of unruptured aneurysms is a reasonable course of action if their expected natural history is worse than the predicted risks of treatment. The purpose of this study was to examine the presenting symptoms of unruptured aneurysms and to test the hypothesis that unruptured intracranial aneurysms can be repaired without significant functional worsening. A second hypothesis was also examined—that is, that the experience of the surgeon, the aneurysm size, and the patient age can be used to predict functional outcome. Methods. Consecutive patients who underwent repair of an unruptured intracranial aneurysm at a single institution between 1980 and 1998 were studied. Clinical and radiographic data were collected in all patients. Their modified Rankin Scale (mRS) score was determined before treatment (baseline), at 6 weeks, and at 6 months. The primary endpoint for analysis was the mRS score. Four hundred forty-nine aneurysms were repaired in 366 patients by 10 surgeons. The mean size of the primary lesion repaired was 14.6 + 10.4 mm and 27% were judged to be symptomatic. Aneurysm treatment involved either microsurgical clipping (78%), wrapping (4%), trapping with or without bypass (5%), hunterian ligation with or without bypass (9%), or other methods (4%). The mRS scores at 6 weeks were worse than at baseline (p < 0.0001), but there was no significant difference between the baseline and 6-month mRS score. At 6 months, 94% of patients showed no significant functional worsening as a result of treatment. The number of aneurysms treated by a specific surgeon was a strong predictor of better functional outcome (r = 0.99, p = 0.05). Increasing patient age (r = 0.16, p = 0.003) and increasing aneurysm size (r = 0.15, p = 0.004) were predictors of worsened functional outcome. Conclusions. Many unruptured aneurysms produce symptoms. Unruptured intracranial aneurysms can be treated without significant permanent functional worsening. The surgeon's experience, aneurysm size, and patient age are predictors of functional outcome.

Abstract 126: Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Robert M Starke ◽  
L Fernando Gonzalez ◽  
Ciro Randazzo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Multivariable Analysis ◽  
Flow Diversion ◽  
Similar Proportion ◽  
Anterior Communicating Artery ◽  
Patient Age ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Complete Obliteration ◽  
Saccular Aneurysms

Background and purpose: Flow diversion has emerged as an important tool for management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥ 10 mm). Methods: Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There were no differences between the 2 groups in terms of patient age, gender, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5% p=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared to coiled aneurysms (41%, p<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%, p<0.001). A similar proportion of patients attained a favorable outcome (mRS 0-2) in the PED group (92%) and the coil group (94%, p=0.8). Conclusion: The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED is a preferred treatment option for large unruptured saccular aneurysms.

scholarly journals Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

2020 ◽  
pp. 159101992095953
Author(s):  
Dylan Noblett ◽  
Lotfi Hacein-Bey ◽  
Ben Waldau ◽  
Jordan Ziegler ◽  
Brian Dahlin ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Methamphetamine Use ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

scholarly journals Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Hua Chen ◽  
Guo Yao Chen ◽  
Hong Zheng ◽  
Quan He Chen ◽  
Fa Yuan Fu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
High Rate ◽  
Atrial Pacing ◽  
Patient Age ◽  
Cox Regression Analysis ◽  
Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P &lt; 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

Silent ischemic events after Pipeline embolization device: a prospective evaluation with MR diffusion-weighted imaging

2016 ◽  
Vol 8 (11) ◽  
pp. 1136-1139 ◽  
Author(s):  
Leonardo B C Brasiliense ◽  
Morgan A Stanley ◽  
Sanjeet S Grewal ◽  
Harry J Cloft ◽  
Eric Sauvageau ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Older Patients ◽  
Demographic Data ◽  
Thromboembolic Events ◽  
Pipeline Embolization Device ◽  
High Metal Content ◽  
Endovascular Interventions ◽  
Diffusion Weighted ◽  
Increased Risk ◽  
Ischemic Events

BackgroundThe development of ischemic events is relatively common after endovascular interventions, and flow diverters may pose a particular threat owing to their increased technical complexity and high metal content.ObjectiveTo investigate the incidence and potential risk factors for thromboembolic lesions after treatment with a Pipeline embolization device (PED).MethodsThis prospective study included a total of 59 patients electively treated with a PED over 12 months. Postprocedural diffusion-weighted imaging sequences of the brain were obtained 24 h after interventions to detect ischemic lesions. Demographic data, aneurysm characteristics, antiplatelet management, and perioperative data were correlated with the rate of ischemic events.ResultsThe incidence of silent ischemic events after use of a PED was 62.7% (37 patients) and neurological symptoms occurred in 8.1% of affected patients. Development of ischemic events was significantly associated with older patients (≥60 years; p=0.038). Routine use of platelet function assays and newer P2Y12 receptor inhibitors (ticagrelor) were not associated with fewer thromboembolic events.ConclusionsThromboembolic events are relatively common after treatment with a PED with an incidence comparable to stent-assisted and conventional coiling but the risk of neurological morbidity from ischemic burden is low. Older patients are at particularly increased risk of thromboembolic events.

Factors influencing management of unruptured intracranial aneurysms: an analysis of 424 consecutive patients

2017 ◽  
Vol 127 (1) ◽  
pp. 96-101 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
William T. Couldwell ◽  
Richard H. Schmidt ◽  
Philipp Taussky ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Intracranial Aneurysms ◽  
Medical Center ◽  
Aneurysm Rupture ◽  
Patient Treatment ◽  
Patient Specific ◽  
Multiple Aneurysms ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
Comorbidity Index

OBJECTIVEThe choice between treating and observing unruptured intracranial aneurysms is often difficult, with little guidance on which variables should influence decision making on a patient-by-patient basis. Here, the authors compared demographic variables, aneurysm-related variables, and comorbidities in patients who received microsurgical or endovascular treatment and those who were conservatively managed to determine which factors push the surgeon toward recommending treatment.METHODSA retrospective chart review was conducted of all patients diagnosed with an unruptured intracranial aneurysm at their institution between January 1, 2013, and January 1, 2016. These patients were dichotomized based on whether their aneurysm was treated. Demographic, geographic, socioeconomic, comorbidity, and aneurysm-related information was analyzed to assess which factors were associated with the decision to treat.RESULTSA total of 424 patients were identified, 163 who were treated surgically or endovascularly and 261 who were managed conservatively. In a multivariable model, an age < 65 years (OR 2.913, 95% CI 1.298–6.541, p = 0.010), a lower Charlson Comorbidity Index (OR 1.536, 95% CI 1.274–1.855, p < 0.001), a larger aneurysm size (OR 1.176, 95% CI 1.100–1.257, p < 0.001), multiple aneurysms (OR 2.093, 95% CI 1.121–3.907, p = 0.020), a white race (OR 2.288, 95% CI 1.245–4.204, p = 0.008), and living further from the medical center (OR 2.125, 95% CI 1.281–3.522, p = 0.003) were all associated with the decision to treat rather than observe.CONCLUSIONSWhereas several factors were expected to be considered in the decision to treat unruptured intracranial aneurysms, including age, Charlson Comorbidity Index, aneurysm size, and multiple aneurysms, other factors such as race and proximity to the medical center were unanticipated. Further studies are needed to identify such biases in patient treatment and improve treatment delineation based on patient-specific aneurysm rupture risk.

Cognitive Outcome and Clinically Silent Thromboembolic Events After Coiling of Asymptomatic Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 638-645 ◽  
Author(s):  
Dong-Hun Kang ◽  
Yang-Ha Hwang ◽  
Yong-Sun Kim ◽  
Geum Ye Bae ◽  
Seung Jae Lee
Keyword(s):  
Cognitive Deficits ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cognitive Outcome ◽  
Cognitively Impaired ◽  
Thromboembolic Events ◽  
Cognitive Changes ◽  
Focal Neurological Deficit ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

Abstract BACKGROUND: Thromboembolic events are the most common complication after coiling of unruptured intracranial aneurysms (UIAs). However, it remains unclear whether these clinically silent ischemic lesions (CSILs) have any clinical significance. OBJECTIVE: To evaluate cognitive outcome after coil embolization of asymptomatic UIAs and its relationship with CSILs after the procedure. METHODS: We prospectively enrolled 40 UIA patients who showed no new focal neurological deficit after coil embolization. CSILs were assessed with diffusion-weighted imaging (DWI) within 1 day after the procedure. A battery of neuropsychological tests was performed 3 times: preoperatively and postoperatively at 1 and 4 weeks after coil embolization. RESULTS: The incidence of cognitive impairment after coiling in patients with UIAs was 44% (17 of 39) at 1 week and 19% (7 of 37) at 4 weeks after coil embolization. DWI within 1 day after coil embolization revealed that 60% of patients (24 of 40) showed CSILs. However, no significant difference was found in any mean cognitive scores or in the number of cognitively impaired variables between patients with and without CSILs at weeks 1 and 4. Additional correlation analysis revealed no correlations between the number of CSILs on DWI and the cognitive sum z score at both 1 and 4 weeks. CONCLUSION: Exhaustive neuropsychological evaluation of UIA patients who underwent coil embolization demonstrated recovery or improvements from baseline cognitive function after 4 weeks, although some patients still showed cognitive deficits at 4 weeks after the procedure. However, we found no statistically significant relationship between the presence and number of CSILs on DWI and cognitive changes after the procedure.

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