scholarly journals Definitions of intracranial aneurysm size and morphology: A call for standardization

2021 ◽  
Vol 12 ◽  
pp. 506
Author(s):  
William C. Merritt ◽  
Holly F. Berns ◽  
Andrew F. Ducruet ◽  
Timothy Andrew Becker
Keyword(s):  
Quantitative Measurement ◽  
Treatment Options ◽  
Publication Date ◽  
Rupture Risk ◽  
Scholarly Journals ◽  
Aneurysm Morphology ◽  
Size And Morphology ◽  
Neck Diameter ◽  
Wide Neck ◽  
Small Aneurysms

Background: Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods: We queried the MEDLINE (EBSCO) database using the terms “unruptured IA” and (“small” or “medium” or “large”) and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results: A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion: It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.

Larger size ratio associated with the rupture of very small (≤3 mm) anterior communicating artery aneurysms

2016 ◽  
Vol 9 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Ting Xu ◽  
Boli Lin ◽  
Shuailiang Liu ◽  
Xiaotong Shao ◽  
Nengzhi Xia ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Univariate Analysis ◽  
Maximum Size ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Aneurysm Size ◽  
Aneurysm Morphology ◽  
Small Aneurysms

BackgroundAnterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.MethodsWe conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.ResultsOf the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.ConclusionsAbout one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.

Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications

2020 ◽  
Vol 133 (1) ◽  
pp. 159-165 ◽  
Author(s):  
Benjamin K. Hendricks ◽  
James S. Yoon ◽  
Kurt Yaeger ◽  
Christopher P. Kellner ◽  
J Mocco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Imaging Modality ◽  
Cerebral Aneurysms ◽  
Neck Size ◽  
Common Definition ◽  
Aneurysm Morphology ◽  
Microsurgical Techniques ◽  
Definition Of ◽  
Neck Diameter ◽  
Wide Neck

OBJECTIVEWide-necked aneurysms (WNAs) are a variably defined subset of cerebral aneurysms that require more advanced endovascular and microsurgical techniques than those required for narrow-necked aneurysms. The neurosurgical literature includes many definitions of WNAs, and a systematic review has not been performed to identify the most commonly used or optimal definition. The purpose of this systematic review was to highlight the most commonly used definition of WNAs.METHODSThe authors searched PubMed for the years 1998–2017, using the terms “wide neck aneurysm” and “broad neck aneurysm” to identify relevant articles. All results were screened for having a minimum of 30 patients and for clearly stating a definition of WNA. Reference lists for all articles meeting the inclusion criteria were also screened for eligibility.RESULTSThe search of the neurosurgical literature identified 809 records, of which 686 were excluded (626 with < 30 patients; 60 for lack of a WNA definition), leaving 123 articles for analysis. Twenty-seven unique definitions were identified and condensed into 14 definitions. The most common definition was neck size ≥ 4 mm or dome-to-neck ratio < 2, which was used in 49 articles (39.8%). The second most commonly used definition was neck size ≥ 4 mm, which was used in 26 articles (21.1%). The rest of the definitions included similar parameters with variable thresholds. There was inconsistent reporting of the precise dome measurements used to determine the dome-to-neck ratio. Digital subtraction angiography was the only imaging modality used to study the aneurysm morphology in 87 of 122 articles (71.3%).CONCLUSIONSThe literature has great variability regarding the definition of a WNA. The most prevalent definition is a neck diameter of ≥ 4 mm or a dome-to-neck ratio of < 2. Whether this is the most appropriate and clinically useful definition is an area for future study.

scholarly journals Systematic review of transdermal treatment options in attention-deficit/hyperactivity disorder: implications for use in adult patients

CNS Spectrums ◽  
2021 ◽  
pp. 1-13
Author(s):  
Christoph U. Correll ◽  
Brittney R. Starling ◽  
Michael Huss
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
English Language ◽  
Treatment Options ◽  
Adult Patients ◽  
Publication Date ◽  
Potential Cost ◽  
Hyperactivity Disorder ◽  
Related Quality ◽  
Treatment Safety

Abstract Background Adults with attention-deficit/hyperactivity disorder (ADHD) often face delays in diagnosis and remain untreated, despite significant negative impacts. To evaluate the safety and efficacy of transdermal treatment options in children, adolescents, and adults, a systematic literature review was conducted, with a focus on the implications of transdermal therapies for ADHD in adults. Methods A MEDLINE/Embase/BIOSIS/SCOPUS database search was conducted December 4, 2019, for English-language articles of interventional clinical trials using transdermal formulations for the treatment of ADHD without publication date limit. Assessed outcomes included efficacy, safety, adherence, abuse potential, cost efficacy, and health-related quality of life. Results Of 23 eligible publications, 18 were in children or adolescents (n = 1699; range 23-305), and 5 in adults (n = 274; range 14-90); all included methylphenidate transdermal system (MTS). All seven pediatric publications reporting change in ADHD symptomology from baseline reported a significant improvement with MTS treatment. Similarly, in three adult publications, ADHD symptoms improved significantly with MTS treatment. Safety findings in pediatric and adult studies were comparable; the most frequently reported treatment-emergent adverse events (TEAEs), namely, headache, decreased appetite, and insomnia, were reported in 13/16 (81%) of publications reporting specific TEAEs. MTS-related dermal reactions were mostly mild and transient. Discontinuation due to dermal reactions was reported in 10 studies (range 0%-7.1% [1 of 14 patients]). MTS compliance was high when assessed (97%-99%). Conclusions Transdermal therapies provide a useful treatment formulation for ADHD. Studies of MTS and other transdermal formulations, such as amphetamine, in adult patients are needed in this underserved population.

Intracranial Aneurysm Morphology and Flow Dynamics to Assess Rupture Risk

2009 ◽  
Author(s):  
Jianping Xiang ◽  
Markus Tremmel ◽  
Ding Ma ◽  
J. Mocco ◽  
Adnan Siddiqui ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Flow Dynamics ◽  
Rupture Risk ◽  
Parent Vessel ◽  
Aneurysm Morphology

The effectiveness of Intracranial Aneurysm (IA) size as a predictor for rupture has been debated. The confusing trends observed *unicefwhile stratifying IA rupture risk according to IA size may have arisen from overlooking its morphology and size relative to its parent vessel.

scholarly journals Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)

2018 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Reade A De Leacy ◽  
Kyle M Fargen ◽  
Justin R Mascitelli ◽  
Johanna Fifi ◽  
Lena Turkheimer ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Techniques ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Procedural Information ◽  
Morbidity Data ◽  
Aneurysm Morphology ◽  
Wide Neck

Background and purposeBRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.Materials and methodsConsecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.Results115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).ConclusionEndovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.

Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics

2010 ◽  
Author(s):  
Haithem Babiker ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
Arius Elvikis ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Treatment Option ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
The Past ◽  
Alternative Treatment Option ◽  
Wide Neck

Treatment options for cerebral aneurysms have drastically evolved in the last decade. In the past, surgical clipping through craniotomy was the predominant treatment option for cerebral aneurysms. Presently, endovascular coiling, a minimally invasive technique, has superseded clipping in many centers [1]. However, the coiling of wide-neck aneurysms is still a challenge [2]. Complete aneurysmal occlusion is often impossible [3]. Recently, stand-alone stents have been explored as an alternative treatment option for wide-neck aneurysms [4].

scholarly journals Background and Proposed Design for a Metformin Abdominal Aortic Aneurysm Suppression Trial

2020 ◽  
Vol 3 ◽  
Author(s):  
Ronald L Dalman ◽  
Ying Lu ◽  
Kenneth W Mahaffey ◽  
Amanda J Chase ◽  
Jordan R Stern ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Controlled Clinical Trial ◽  
Rupture Risk ◽  
Double Blind ◽  
Abdominal Aortic ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Toxic Potential ◽  
Small Aneurysms

Abdominal aortic aneurysm (AAA) may lead to rupture and death if left untreated. While endovascular or surgical repair is generally recommended for AAA greater than 5–5.5 cm, the vast majority of aneurysms detected by screening modalities are smaller than this threshold. Once discovered, there would be a significant potential benefit in suppressing the growth of these small aneurysms in order to obviate the need for repair and mitigate rupture risk. Patients with diabetes, in particular those taking the oral hypoglycaemic medication metformin, have been shown to have lower incidence, growth rate, and rupture risk of AAA. Metformin therefore represents a widely available, non-toxic, potential inhibitor of AAA growth, but thus far no prospective clinical studies have evaluated this. Here, we present the background, rationale, and design for a randomised, double-blind, placebo-controlled clinical trial of metformin for growth suppression in patients with small AAA.

Designing Relevant Preclinical Rodent Models for Studying Links Between Nutrition, Obesity, Metabolism, and Cancer

2021 ◽  
Vol 41 (1) ◽  
Author(s):  
Elaine M. Glenny ◽  
Michael F. Coleman ◽  
Erin D. Giles ◽  
Elizabeth A. Wellberg ◽  
Stephen D. Hursting
Keyword(s):  
Treatment Options ◽  
Annual Review ◽  
Publication Date ◽  
Rodent Models ◽  
Cancer Model ◽  
Preclinical Models ◽  
Cancer Models ◽  
The Impact ◽  
The Relationship ◽  
Insight Into

Diet and nutrition are intricately related to cancer prevention, growth, and treatment response. Preclinical rodent models are a cornerstone to biomedical research and remain instrumental in our understanding of the relationship between cancer and diet and in the development of effective therapeutics. However, the success rate of translating promising findings from the bench to the bedside is suboptimal. Well-designed rodent models will be crucial to improving the impact basic science has on clinical treatment options. This review discusses essential experimental factors to consider when designing a preclinical cancer model with an emphasis on incorporating these models into studies interrogating diet, nutrition, and metabolism. The aims of this review are to ( a) provide insight into relevant considerations when designing cancer models for obesity, nutrition, and metabolism research; ( b) identify common pitfalls when selecting a rodent model; and ( c) discuss strengths and limitations of available preclinical models. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. E865-E875 ◽  
Author(s):  
Ronie L. Piske ◽  
Luis H. Kanashiro ◽  
Eric Paschoal ◽  
Celso Agner ◽  
Sergio S. Lima ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
High Rate ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion ◽  
Wide Neck ◽  
Small Aneurysms ◽  
Platinum Coils

Abstract OBJECTIVE We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck &gt;4 mm and/or dome-to-neck ratio &lt;1.5). Fifty aneurysms were small (&lt;12 mm), 30 were large (12 to &lt;25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

scholarly journals Aneurysm characteristics, coil packing, and post-coiling hemodynamics affect long-term treatment outcome

2019 ◽  
Vol 12 (7) ◽  
pp. 706-713 ◽  
Author(s):  
Robert J Damiano ◽  
Vincent M Tutino ◽  
Nikhil Paliwal ◽  
Tatsat R Patel ◽  
Muhammad Waqas ◽  
...  
Keyword(s):  
Kinetic Energy ◽  
Multivariable Analysis ◽  
Post Treatment ◽  
Endovascular Coiling ◽  
Parent Artery ◽  
Univariable Analysis ◽  
Maximum Dimension ◽  
Long Term Treatment ◽  
Aneurysm Morphology ◽  
Neck Diameter

BackgroundRecurrence of intracranial aneurysms after endovascular coiling is a serious clinical concern.ObjectiveWe hypothesized that recurrence is associated with aneurysm morphology and flow, as well as the coil intervention and the induced flow modifications.MethodsWe collected 52 primary-coiling aneurysm cases that were either occluded (n=34) or recurrent (n=18) at >1 year follow-up. We created aneurysm models from pre-coiling digital subtraction angiographic images, calculated aneurysm morphology, simulated pre-coiling hemodynamics, modeled coil deployment, and obtained post-coiling hemodynamics for each case. We performed univariable analysis on 26 morphologic, treatment-specific, and hemodynamic parameters to distinguish between recurrent and occluded groups, and multivariable analysis to identify independently significant parameters associated with recurrence. Univariable analysis was also performed on ruptured and unruptured aneurysm subcohorts separately to investigate if they shared specific significant parameters.ResultsRecurrence was associated with pre-coiling aneurysm morphologic and flow parameters including larger size (maximum dimension and volume), larger neck (diameter, area, and neck-to-parent-artery ratio), and higher flow momentum and kinetic energy. Recurrence was also associated with lower coil packing (packing density and uncoiled volume), higher post-treatment flow (velocity, momentum, and kinetic energy), lower post-treatment washout time, and higher post-treatment impingement force at the neck. Multivariable analysis identified two aneurysmal characteristics (neck diameter and pre-coiling flow kinetic energy), one coil packing parameter (uncoiled volume), and one post-treatment hemodynamic parameter (flow momentum) that were independently associated with recurrence. In ruptured aneurysms, recurrence was associated with larger neck (diameter and area), whereas in unruptured aneurysms, recurrence was associated with larger size (maximum dimension and volume). In both subcohorts, recurrence was associated with higher post-coiling flow momentum and kinetic energy.ConclusionRecurrence at >1 year after coil treatment is associated with intrinsic aneurysm characteristics, coiling itself, and flow changes induced by coiling. Larger aneurysm size and neck, less coil packing, and higher intra-aneurysmal flow before and after coiling predict recurrence.

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