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

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.

Download Full-text

The Indication for Long-Term Oral Antiplatelet Therapy After Endovascular Embolization of Unruptured Intracranial Aneurysms

Journal of Neurology Research ◽

10.14740/jnr390w ◽

2016 ◽

Vol 6 (4) ◽

pp. 72-80

Author(s):

Kei Harada ◽

Kohsuke Kakumoto ◽

Shogo Oshikata ◽

Kenji Uda ◽

Masahito Kajihara ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Intracranial Aneurysms ◽

Endovascular Embolization ◽

Unruptured Intracranial Aneurysms

Download Full-text

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

Stroke ◽

10.1161/str.46.suppl_1.108 ◽

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.

Download Full-text

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

Stroke ◽

10.1161/str.44.suppl_1.a111 ◽

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.

Download Full-text

Endovascular Management of Intracranial Aneurysms: Current Experience and Future Advances

Neurosurgery ◽

10.1227/01.neu.0000237512.10529.58 ◽

2006 ◽

Vol 59 (suppl_5) ◽

pp. S3-93-S3-102 ◽

Cited By ~ 50

Author(s):

Christopher J. Koebbe ◽

Erol Veznedaroglu ◽

Pascal Jabbour ◽

Robert H. Rosenwasser

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Early Recognition ◽

Treatment Method ◽

Endovascular Embolization ◽

Interventional Treatment ◽

Endovascular Management ◽

The Past

Abstract OBJECTIVE: The past 15 years have seen a revolution in the treatment of intracranial aneurysms. Endovascular technology has evolved rapidly since the Food and Drug Administration approval of Guglielmi detachable coils in 1995, which now allows successful treatment of most aneurysms. The authors provide a review of their 11-year experience at Jefferson Hospital for Neuroscience with endovascular embolization of intracranial aneurysms and discuss clinical trial outcomes and future directions of this treatment method. METHODS: The authors reviewed the clinical and angiographic outcomes for 1307 patients undergoing endovascular treatment of intracranial aneurysms. Their analysis focuses on posterior circulation and middle cerebral artery aneurysms, as well as cases of stent-assisted coil embolization. They review their procedural protocol and patient selection criteria for endovascular management. RESULTS: Several large clinical trials have demonstrated the safety and efficacy of endovascular treatment of intracranial aneurysms. The International Subarachnoid Aneurysm Trial provides Level I evidence demonstrating a significant reduction in disability or death with endovascular treatment compared with surgical clipping. The most common procedural complications include intraprocedural rupture and thromboembolic events; avoidance strategies are also discussed. Vasospasm after subarachnoid hemorrhage causes neurological morbidity and mortality and can be successfully managed by early recognition and interventional treatment with angioplasty, pharmacologic agents, or both. CONCLUSION: Long-term studies evaluating experience with aneurysm coil embolization during the past decade indicate that this is a safe and durable treatment method. The introduction of stent-assist techniques has improved the management of wide-neck aneurysms. Future technology developments will likely improve the durability of endovascular treatment further by delivering bioactive agents that promote aneurysm thrombosis beyond the coil mass alone. It is clear that endovascular therapy of both ruptured and unruptured aneurysms is becoming a mainstay of practice in this patient population. Although not replacing open surgery, the continued improvements have allowed aneurysms that previously were amenable only to open clip ligation to be treated safely with durable long-term outcomes.

Download Full-text

Endovascular Treatment of Unruptured Intracranial Aneurysms With Guglielmi Detachable Coils: Short- and Long-Term Results of a Single-Centre Series

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)79047-7 ◽

2008 ◽

Vol 2008 ◽

pp. 274-275

Author(s):

A.G. Osborn

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Long Term Results ◽

Guglielmi Detachable Coils ◽

Single Centre ◽

Unruptured Intracranial Aneurysms ◽

Detachable Coils ◽

Short And Long Term

Download Full-text

DOES ANGIOGRAPHIC SURVEILLANCE POSE A RISK IN THE MANAGEMENT OF COILED INTRACRANIAL ANEURYSMS? A MULTICENTER STUDY OF 2243 PATIENTS

Neurosurgery ◽

10.1227/01.neu.0000333261.63818.9c ◽

2008 ◽

Vol 63 (5) ◽

pp. 845-849 ◽

Cited By ~ 20

Author(s):

Andrew J. Ringer ◽

Giuseppe Lanzino ◽

Erol Veznedaroglu ◽

Rafael Rodriguez ◽

Robert A. Mericle ◽

...

Keyword(s):

Endovascular Treatment ◽

Scale Score ◽

Intracranial Aneurysms ◽

Accurate Estimate ◽

Endovascular Embolization ◽

Modified Rankin Scale ◽

Major Morbidity ◽

Risk Of Hemorrhage ◽

Aneurysm Coiling

Abstract OBJECTIVE Endovascular treatment of intracranial aneurysms is a less invasive alternative than surgical repair. However, the higher risk of recurrence after coiling necessitates regular angiographic surveillance, which has associated risks. To date, the risk of surveillance angiography has not been quantified in patients with intracranial aneurysms treated by endovascular embolization. METHODS Angiograms performed for the surveillance of coiled intracranial aneurysms in patients treated at 8 institutions were recorded prospectively. Of 3086 patients eligible for surveillance angiography according to each institution's protocol during the study period, 2243 patients (72.7%) underwent this procedure. Data were reviewed retrospectively, including the results of each angiogram, angiographic complications, and morbidity resulting from the procedure. Morbidity was classified as major (modified Rankin Scale score ≥3) or minor (modified Rankin Scale score <3) and as temporary (<30 days) or permanent (≥30 days). RESULTS Of 2814 diagnostic angiograms performed, 12 resulted in complications, including 1 (0.04%) permanent major morbidity, 2 (0.07%) temporary major morbidities, and 9 (0.32%) temporary minor morbidities; 6 of these were access site complications). No mortality or permanent minor morbidity was noted. CONCLUSION In this study, routine angiographic surveillance after endovascular treatment of aneurysms has a very low complication rate (0.43%). Incorporating these initial findings with the rate and risk of recurrent treatment or the risk of hemorrhage after coiling will provide a more accurate estimate of the global long-term risk of aneurysm coiling.

Download Full-text

Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review

Journal of Neurosurgery ◽

10.3171/2011.5.jns101983 ◽

2011 ◽

Vol 115 (4) ◽

pp. 694-699 ◽

Cited By ~ 27

Author(s):

Patrick Schuss ◽

Erdem Güresir ◽

Joachim Berkefeld ◽

Volker Seifert ◽

Hartmut Vatter

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Visual Outcome ◽

Surgical Clipping ◽

Visual Dysfunction ◽

Visual Symptoms ◽

Visual Deficits ◽

Unruptured Intracranial Aneurysms ◽

Number Of Patients

Object Intracranial aneurysms of the anterior circulation might become symptomatic by causing visual deficits. The influence of treatment modality on improvement is still unclear. The objective of this study was to analyze the recovery of visual deficits caused by the mass effect of intracranial aneurysms after surgical clipping or endovascular treatment. Methods Between June 1999 and December 2009, 20 patients with unruptured intracranial aneurysms causing visual dysfunction due to compression of the optical nerve were treated at the authors' institution. Visual deficits were recorded at admission and at follow-up. To evaluate a larger number of patients, MEDLINE was searched for published studies involving visual disturbance caused by an aneurysm. A multivariate analysis was performed to find independent predictors for favorable visual outcome. Results Nine (75%) of 12 patients treated surgically achieved improvement of visual symptoms, compared with 3 (38%) of 8 patients treated endovascularly. A literature review, including the current series, revealed a total of 165 patients with UIAs causing visual dysfunction. Surgical treatment was associated with a significantly higher rate of visual improvement (p = 0.002) compared with endovascular treatment. According to the multivariate analysis, surgical clipping was the only variable significantly associated with improvement of visual outcome (p = 0.02). Conclusions Aneurysm-related visual dysfunction developed from direct mechanical compression may improve after surgical clipping and endovascular coiling. However, based on the present series combined with pooled analysis of data from the literature, the only factor significantly associated with improvement of visual dysfunction was surgical clipping.

Download Full-text

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

Neurosurgery ◽

10.1227/neu.0000000000000450 ◽

2014 ◽

Vol 75 (4) ◽

pp. 380-387 ◽

Cited By ~ 15

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.

Download Full-text

Endovascular Treatment of Intracranial Aneurysms Associated with Moyamoya Disease or Moyamoya Syndrome

Interventional Neuroradiology ◽

10.1177/159101991001600302 ◽

2010 ◽

Vol 16 (3) ◽

pp. 240-248 ◽

Cited By ~ 19

Author(s):

J.-L. Yu ◽

H.-L. Wang ◽

K. Xu ◽

Y. Li ◽

Q. Luo

Keyword(s):

Endovascular Treatment ◽

Moyamoya Disease ◽

Intracranial Aneurysms ◽

Endovascular Embolization ◽

The Other ◽

Moyamoya Syndrome ◽

Surgical Clipping ◽

Treatment Regimens ◽

Selection Of

Direct surgical clipping proves to be difficult and dangerous for intracranial aneurysms associated with moyamoya disease (MMD) or moyamoya syndrome (MMS). This study presents our clinical experience of endovascular embolization of intracranial aneurysms associated with these diseases. A total of 13 cases of intracranial aneurysms associated with MMD or MMS were treated by endovascular embolization between January 2001 and January 2009. Patients were divided into two groups: a saccular aneurysm group (n=10) and a pseudoaneurysm group (n=3). Different endovascular therapeutic strategies were employed for each type of case. Of the 13 cases, 11 received successful endovascular embolization and had an uneventful postoperative course during one to two years of follow-up. However, endovascular embolization failed in the other two cases, of whom one died from rebleeding after the five-month follow-up, while the other was conservatively treated and experienced no rebleeding during the two-year follow-up. A favorable prognosis may be secured through careful selection of endovascular treatment regimens for patients with intracranial aneurysms associated with MMD or MMS according to the site of intracranial aneurysms.

Download Full-text