scholarly journals Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms

2015 ◽  
Vol 123 (2) ◽  
pp. 453-459 ◽  
Author(s):  
Andrew Kelly Johnson ◽  
Stephan A. Munich ◽  
Lee A. Tan ◽  
Daniel Mark Heiferman ◽  
Kiffon Marie Keigher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Aneurysm ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Neurological Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Aneurysm Size ◽  
Aneurysm Treatment ◽  
Independent Risk Factors

OBJECT Stent-assisted embolization (SAE) has broadened the scope of endovascular cerebral aneurysm treatment. The risks associated with stent selection and configuration are poorly defined. In this study, the authors aimed to characterize the risk factors that contribute to complications in SAE of intracranial aneurysms. METHODS Over a 10-year period, a single surgeon treated 486 aneurysms with SAE in which open-cell Neuroform or closed-cell Enterprise stents were used. Single stents were used in 386 cases, overlapping stents were deployed in 80 cases, and Y-configuration stents were used in the remaining 20 cases. All neurological complications, which included transient deficits, were analyzed; disabling strokes and death were considered major complications. The chi-square test and multivariate logistic regression were used to evaluate the influence of aneurysm size and morphology, aneurysm location, stent selection, and stent configuration on complication rates. RESULTS There were 7 deaths (1.4%), 9 major strokes (1.9%), and 18 minor neurological complications (3.7%). For all complications, multivariate analysis revealed that large aneurysm size (10–25 mm; p = 0.01), giant aneurysm size (> 25 mm; p = 0.04), fusiform aneurysm morphology (p = 0.03), and using a Y-configuration stent (p = 0.048) were independent risk factors. For the major complications, independent risk factors included an aneurysm in the posterior circulation (p = 0.02), using an overlapping stent configuration (p = 0.03), and using a Y-configuration stent (p < 0.01). CONCLUSIONS In this series, SAE for cerebral aneurysm treatment carried an acceptable complication rate. With continued innovations in techniques and devices and with increased experience, the complication rates associated with SAE may be even lower in the future.

scholarly journals Aneurysm characteristics and risk of rebleeding after subarachnoid haemorrhage

2018 ◽  
Vol 4 (2) ◽  
pp. 153-159
Author(s):  
Inez Koopman ◽  
Jacoba P Greving ◽  
Irene C van der Schaaf ◽  
Albert van der Zwan ◽  
Gabriel JE Rinkel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aspect Ratio ◽  
Subarachnoid Haemorrhage ◽  
Independent Risk Factor ◽  
Irregular Shape ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Size ◽  
Aneurysm Treatment ◽  
Independent Risk Factors

Introduction Knowledge of risk factors for rebleeding after aneurysmal subarachnoid haemorrhage can help tailoring ultra-early aneurysm treatment. Previous studies have identified aneurysm size and various patient-related risk factors for early (≤24 h) rebleeding, but it remains unknown if aneurysm configuration is also a risk factor. We investigated whether irregular shape, aspect- and bottleneck ratio of the aneurysm are independent risk factors for early rebleeding after aneurysmal subarachnoid haemorrhage. Patients and methods From a prospectively collected institutional database, we investigated data from consecutive aneurysmal subarachnoid haemorrhage patients who were admitted ≤24 h after onset between December 2009 and January 2015. The admission computed tomographic angiogram was used to assess aneurysm size and configuration. With Cox regression, we calculated stepwise-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for irregular shape, aspect ratio ≥1.6 mm and bottleneck ratio ≥1.6 mm. Results Of 409 included patients, 34 (8%) patients had in-hospital rebleeding ≤24 h after ictus. Irregular shape was an independent risk factor for rebleeding (HR: 3.9, 95% CI: 1.3–11.3) after adjustment for age, sex, PAASH score, aneurysm location, aneurysm size and aspect- and bottleneck ratio. Aspect ratio ≥1.6 mm (HR: 2.3, 95% CI: 0.8–6.5) and bottleneck ratio ≥1.6 mm (HR: 1.7, 95% CI: 0.8–3.6) were associated with an increased risk of rebleeding, but were not independent risk factors after multivariable adjustment. Conclusions Irregular shape is an independent risk factor for early rebleeding. However, since the majority of subarachnoid haemorrhage patients have an irregular aneurysm, additional risk factors have to be found for aneurysm treatment prioritisation.

scholarly journals Predictors of clinical outcomes for the treatment of complex intracranial aneurysms in the anterior circulation: a prospective randomised study; SCAT

2020 ◽  
Vol 24 (4) ◽  
pp. 92
Author(s):  
R. S. Kiselev ◽  
A. V. Dubovoy ◽  
D. S. Kislitsin ◽  
A. V. Gorbatykh ◽  
K. S. Ovsyannikov ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Conflict Of Interest ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Complication Rates ◽  
Aneurysm Size ◽  
Temporary Occlusion

<p><strong>Background.</strong> Large and giant aneurysms (&gt; 10 mm and &gt;25 mm, respectively), wide-necked (dome / neck ratio &gt; 1.5) and fusiform examples are challenging for both endovascular and microsurgical intervention. Currently, there is a lack of a universal approach in treating complex anterior circulatory aneurysms. Due to high morbidity and mortality rates and the absence of a common strategy, predictor analysis may have diagnostic relevance.</p><p><strong>Aim.</strong> We sought to identify predictors of unfavourable neurological outcomes for the treatment of complex intracranial aneurysms.</p><p><strong>Methods.</strong> The investigation of complex intracranial aneurysms (SCAT, NCT03269942) is a prospective randomised multicentre study. Unifactorial and multifactorial analyses of clinical outcomes were performed to identify predictors. According to our study protocol, we included 110 patients admitted to Meshalkin National Medical Research Center and the Federal Neurosurgical Center (Novosibirsk, Russian Federation) from March 2015 to June 2018, who met eligibility criteria (age &gt; 75 years, neck size &gt; 4 mm and dome/neck ratio &lt;1.5). Depending on the procedure, patients were divided into two groups using sealed envelope randomisation: 1) endovascular flow diversion (55 patients) and 2) microsurgical revascularisation (55 patients). Unfavourable outcomes were thought to be neurological deterioration with two or more mRS (modified Rankin scale) scores or ≥ mRS 4 decline.</p><p><strong>Results.</strong> Data analysis revealed significatly favourable outcomes in 94.5 % of the endovascular group, and 76.4 % of the microsurgical group at 12 months follow-up (p = 0.001). Morbidity and mortality rates were 5.5 and 1.8 % for the endovascular group, and 25.4 and 3.6 % for the microsurgical group, respectively. Log-rank criteria did not reveal any differences in mortality (p = 0.32). The overall complication rates were 29.1 % for the endovascular group, and 5.4 % for the microsurgical group (p = 0.001). We identified a significant difference in the frequency of ischaemic complications (p = 0.004), but haemorrhagic complication rates were similar (p = 0.297). Unifactorial analysis revealed predictors of unfavourable clinical outcomes: gender (male, ОR = 2.475, 95% CI: 1.005–6.094, p = 0.049), microsurgical intervention (OR = 5.618, 95% CI: 1.635–19.302, p = 0.006), giant aneurysm size (OR = 3.1, 95% CI: 1.22–7.88, p = 0,017), and temporary occlusion for &gt; 40 min (OR = 3.016, 95% CI: 1.13–8.04, p = 0.028). Giant aneurysm size is 6.1 times more increase the probability of unfavorable outcomes according multifactorial analysis.</p><p><strong>Conclusion.</strong> In spite of a high complete occlusion rate after microsurgical treatment with revascularisation, endovascular flow diversion demonstrated better clinical outcomes at short-term follow-up (12 months). Giant aneurysm size was a predictor of both ischaemic and haemorrhagic complications, with an approximate six-fold rise in unfavourable clinical outcomes. Other predictors included the microsurgical intervention itself, especially with increased temporary occlusion for &gt; 40 min, and the male gender.</p><p>Received 12 May 2020. Revised 11 November 2020. Accepted 12 November 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: K.Yu. Orlov, A.V. Dubovoy<br />Data collection and analysis: R.S. Kiselev<br />Statistical analysis: R.S. Kiselev<br />Drafting the article: R.S. Kiselev<br />Critical revision of the article: D.S. Kislitsin, A.V. Gorbatykh, A.V. Dubovoy, K.Yu. Orlov, V.V. Berestov, K.S. Ovsyannikov<br />Final approval of the version to be published: R.S. Kiselev, A.V. Dubovoy, D.S. Kislitsin, A.V. Gorbatykh, K.S. Ovsyannikov, V.V. Berestov, K.Yu. Orlov</p>

Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3)

2020 ◽  
Vol 133 (1) ◽  
pp. 166-173 ◽  
Author(s):  
Masafumi Hiramatsu ◽  
Kenji Sugiu ◽  
Tomohito Hishikawa ◽  
Shingo Nishihiro ◽  
Naoya Kidani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Data Extraction ◽  
Transarterial Embolization ◽  
Complication Rates ◽  
Multicenter Observational Study ◽  
Arteriovenous Fistulas ◽  
Emergency Procedures ◽  
Dural Arteriovenous Fistulas ◽  
Nature Frequency ◽  
Independent Risk Factors

OBJECTIVEEmbolization is the most common treatment for dural arteriovenous fistulas (dAVFs). A retrospective, multicenter observational study was conducted in Japan to clarify the nature, frequency, and risk factors for complications of dAVF embolization.METHODSPatient data were derived from the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET3). A total of 40,169 procedures were registered in JR-NET3, including 2121 procedures (5.28%) in which dAVFs were treated with embolization. After data extraction, the authors analyzed complication details and risk factors in 1940 procedures performed in 1458 patients with cranial dAVFs treated with successful or attempted embolization.RESULTSTransarterial embolization (TAE) alone was performed in 858 cases (44%), and transvenous embolization (TVE) alone was performed in 910 cases (47%). Both TAE and TVE were performed in one session in 172 cases (9%). Complications occurred in 149 cases (7.7%). Thirty-day morbidity and mortality occurred in 55 cases (2.8%) and 16 cases (0.8%), respectively. Non–sinus-type locations, radical embolization as the strategy, procedure done at a hospital that performed dAVF embolization in fewer than 10 cases during the study period, and emergency procedures were independent risk factors for overall complications.CONCLUSIONSComplication rates of dAVF embolization in Japan were acceptable. For better results, the risk factors identified in this study should be considered in treatment decisions.

scholarly journals Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

2021 ◽  
Author(s):  
Miao He ◽  
Qinghong Fan ◽  
Yuhang Zhu ◽  
Dexing Liu ◽  
Xingxing Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Assessment ◽  
Femoral Fractures ◽  
Prognostic Nutritional Index ◽  
Adverse Outcomes ◽  
Major Influence ◽  
Binary Logistic Regression Analysis ◽  
Complication Rates ◽  
Nutritional Index ◽  
Independent Risk Factors

Abstract Background: Surgery is usually the best treatment for patients with femoral fractures. However, the incidence of perioperative adverse outcomes in such cases is quite high. Nutrition has a major influence on fracture healing, and malnutrition is associated with higher complication rates, higher mortality rates, and longer hospitalisation periods. In this study, we aimed to identify independent risk factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods: This retrospective observational study included 343 patients who underwent surgery for a single femur fracture at the Affiliated Hospital of Zunyi Medical University in 2018. Binary logistic regression analysis was applied to identify significant independent risk factors. The discriminatory ability of independent predictors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results: In total, 159 patients (46.4%) had perioperative adverse outcomes. PNI (OR: 0.819, 95% CI: 0.754–0.889, P < 0.001), age (OR: 1.042, 95% CI: 1.020–1.066, P < 0.001), time to admission (OR: 1.404, 95% CI: 1.117–1.765, P = 0.004), hypertension (OR: 1.912, 95% CI: 1.049–3.488, P = 0.034), combined injures (OR: 2.739, 95% CI: 1.338–5.607, P = 0.006), and operation types (OR: 3.696, 95% CI: 1.913–7.138, P < 0.001) were independent factors for perioperative adverse outcomes. Based on the AUC (PNI: 0.772, 95% CI: 0.723–0.821, P < 0.001; age: 0.678, 95% CI: 0.622–0.734, P < 0.001; time to admission: 0.585, 95% CI: 0.525–0.646, P = 0.006), the PNI had the optimal discrimination ability, indicating its superiority over other independent predictors (age vs. PNI, P = 0.002; time to admission vs. PNI, P < 0.001). Conclusions: This study showed that the PNI was a better and effective independent predictor of perioperative adverse outcomes in patients with femoral fractures. Our findings suggest that nutritional assessment at admission and appropriate intervention strategies are necessary for patients with femoral fractures.

Neurosurgical versus endovascular treatment of craniocervical junction arteriovenous fistulas: a multicenter cohort study of 97 patients

2021 ◽  
pp. 1-8
Keyword(s):  
Risk Factors ◽  
Endovascular Treatment ◽  
Craniocervical Junction ◽  
Complication Rates ◽  
Multicenter Cohort Study ◽  
Arteriovenous Fistulas ◽  
Multicenter Cohort ◽  
Ischemic Complication ◽  
Independent Risk Factors ◽  
Poor Outcomes

OBJECTIVE Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are treated using neurosurgical or endovascular options; however, there is still no consensus on the safest and most effective treatment. The present study compared the treatment results of neurosurgical and endovascular procedures for CCJ AVFs, specifically regarding retreatment, complications, and outcomes. METHODS This was a multicenter cohort study authorized by the Neurospinal Society of Japan. Data on consecutive patients with CCJ AVFs who underwent neurosurgical or endovascular treatment between 2009 and 2019 at 29 centers were analyzed. The primary endpoint was the retreatment rate by procedure. Secondary endpoints were the overall complication rate, the ischemic complication rate, the mortality rate, posttreatment changes in the neurological status, independent risk factors for retreatment, and poor outcomes. RESULTS Ninety-seven patients underwent neurosurgical (78 patients) or endovascular (19 patients) treatment. Retreatment rates were 2.6% (2/78 patients) in the neurosurgery group and 63% (12/19 patients) in the endovascular group (p < 0.001). Overall complication rates were 22% and 42% in the neurosurgery and endovascular groups, respectively (p = 0.084). Ischemic complication rates were 7.7% and 26% in the neurosurgery and endovascular groups, respectively (p = 0.037). Ischemic complications included 8 spinal infarctions, 2 brainstem infarctions, and 1 cerebellar infarction, which resulted in permanent neurological deficits. Mortality rates were 2.6% and 0% in the neurosurgery and endovascular groups, respectively (p > 0.99). Two patients died of systemic complications. The percentages of patients with improved modified Rankin Scale (mRS) scores were 60% and 37% in the neurosurgery and endovascular groups, respectively, with a median follow-up of 23 months (p = 0.043). Multivariate analysis identified endovascular treatment as an independent risk factor associated with retreatment (OR 54, 95% CI 9.9–300; p < 0.001). Independent risk factors associated with poor outcomes (a postoperative mRS score of 3 or greater) were a pretreatment mRS score of 3 or greater (OR 13, 95% CI 2.7–62; p = 0.001) and complications (OR 5.8; 95% CI 1.3–26; p = 0.020). CONCLUSIONS Neurosurgical treatment was more effective and safer than endovascular treatment for patients with CCJ AVFs because of lower retreatment and ischemic complication rates and better outcomes.

scholarly journals Severe neurological outcomes after very early bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kathrin Burgmaier ◽  
◽  
Gema Ariceta ◽  
Martin Bald ◽  
Anja Katrin Buescher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Autosomal Recessive ◽  
Neurological Complications ◽  
Control Group ◽  
Polycystic Kidney ◽  
Neurological Outcomes ◽  
Additional Control ◽  
Independent Risk Factors

Abstract To test the association between bilateral nephrectomies in patients with autosomal recessive polycystic kidney disease (ARPKD) and long-term clinical outcome and to identify risk factors for severe outcomes, a dataset comprising 504 patients from the international registry study ARegPKD was analyzed for characteristics and complications of patients with very early (≤ 3 months; VEBNE) and early (4–15 months; EBNE) bilateral nephrectomies. Patients with very early dialysis (VED, onset ≤ 3 months) without bilateral nephrectomies and patients with total kidney volumes (TKV) comparable to VEBNE infants served as additional control groups. We identified 19 children with VEBNE, 9 with EBNE, 12 with VED and 11 in the TKV control group. VEBNE patients suffered more frequently from severe neurological complications in comparison to all control patients. Very early bilateral nephrectomies and documentation of severe hypotensive episodes were independent risk factors for severe neurological complications. Bilateral nephrectomies within the first 3 months of life are associated with a risk of severe neurological complications later in life. Our data support a very cautious indication of very early bilateral nephrectomies in ARPKD, especially in patients with residual kidney function, and emphasize the importance of avoiding severe hypotensive episodes in this at-risk cohort.

scholarly journals Headache outcomes following treatment of unruptured intracranial aneurysms: A prospective analysis

Cephalalgia ◽  
2011 ◽  
Vol 31 (10) ◽  
pp. 1082-1089 ◽  
Author(s):  
Todd J Schwedt ◽  
Robert W Gereau ◽  
Karen Frey ◽  
Evan D Kharasch
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Prospective Observational Study ◽  
Prospective Analysis ◽  
Headache Frequency ◽  
Factors Associated ◽  
Aneurysm Treatment ◽  
Unruptured Intracranial Aneurysms ◽  
Potential Risk Factors ◽  
Aneurysm Coiling

Objective: To analyze headache patterns prior to and following treatment of unruptured intracranial aneurysms and identify factors associated with different headache outcomes. Methods: A prospective observational study of patients being treated for unruptured intracranial aneurysms. Headache patterns were established prior to aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated. Results: In all patients ( n = 44), 90-day headache frequency decreased from an average of 31 days prior to aneurysm treatment to 17 days following treatment ( p < 0.001). In patients with active pretreatment headaches ( n = 28), 90-day headache frequency decreased from 49 days to 26 days ( p = 0.002). Headache frequency was reduced in 68% of patients, while 9% of patients had new or worsened headaches following aneurysm treatment. Pretreatment migraine, more severe pretreatment headaches, higher pretreatment trait anxiety, and stent-assisted aneurysm coiling were associated with a lack of headache improvement. Conclusions: The majority of patients with headaches at the time of aneurysm treatment had reductions in headache frequency during the 6 months following treatment. Potential risk factors for poor headache outcomes were identified but need to be studied further.

Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1047-1053 ◽  
Author(s):  
Nobuhiko Miyazawa ◽  
Iwao Akiyama ◽  
Zentaro Yamagata
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Unruptured Aneurysms ◽  
Logistic Analysis ◽  
Aneurysm Size ◽  
History Of ◽  
Aneurysm Growth ◽  
Independent Risk Factors

Abstract OBJECTIVE: The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5–T serial magnetic resonance angiography with stereoscopic images. METHODS: Age, sex, site of aneurysm, size of aneurysm, multiplicity of aneurysms, type of circle of Willis, length of follow-up period, cerebrovascular event, hypertension, diabetes, hyperlipidemia, smoking habit, and family history of subarachnoid hemorrhage were investigated using multiple logistic analysis. RESULTS: Fourteen patients (16 aneurysms) among the 130 patients (159 aneurysms) showed aneurysm growth (10.8%) during follow-up of 10 to 69 months (mean 29.3 ± 10.5 mo). Multiple logistic analysis disclosed that location on the middle cerebral artery (odds ratio [OR] 0.08, P &lt; 0.01), multiplicity of aneurysms (OR 68.5, P &lt; 0.01), aneurysm size of 5 mm or larger (OR 1.17, P = 0.05), and family history of subarachnoid hemorrhage (OR 10.9, P &lt; 0.01) were independent risk factors. CONCLUSION: Location on the middle cerebral artery, multiplicity, aneurysm size of 5 mm or larger, and family history of subarachnoid hemorrhage are independent risk factors for aneurysm growth. These results may help to determine the treatment choice for unruptured aneurysms.

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