The aspect ratio (dome/neck) of ruptured and unruptured aneurysms

Object. In this retrospective study the authors examined the aspect ratio (AR; the maximum dimension of the dome/width of the neck of an aneurysm) and compared the distribution of this ratio in a group of ruptured and unruptured aneurysms. A similar comparison was performed in relation to the maximum dimension of the aneurysm alone. The authors sought to evaluate the utility of these measures for differentiating ruptured and unruptured aneurysms. Methods. Measurements were made of 774 aneurysms in 532 patients at three medical centers. One hundred twenty-seven patients harbored only unruptured lesions, 290 only ruptured lesions, and 115 both ruptured and unruptured lesions. Cases were included if angiograms were available for measurement and the status of the individual patient's aneurysm(s) was known. The odds of a lesion falling in the ruptured aneurysm group increased with both the lesion's maximum size and the AR. The odds ratio for rupture rose progressively only for the AR. The distribution curves showed that ruptured aneurysms were larger and had greater ARs. The mean size of unruptured aneurysms was 7 mm and that of ruptured ones was 8 mm; the corresponding mean ARs were 1.8 and 3.4, respectively. The odds of rupture were 20-fold greater when the AR was larger than 3.47 compared with an AR less than or equal to 1.38. Only 7% of ruptured aneurysms had an AR less than 1.38 compared with 45% of unruptured lesions. Conclusions. The AR is probably a useful index to calculate. A high AR might reasonably influence the decision to treat actively an unruptured aneurysm independent of its maximum size. Prospective studies are warranted.

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Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients

Journal of Neurosurgery ◽

10.3171/jns.2002.96.1.0064 ◽

2002 ◽

Vol 96 (1) ◽

pp. 64-70 ◽

Cited By ~ 162

Author(s):

Bryce Weir ◽

Lew Disney ◽

Theodore Karrison

Keyword(s):

Cerebral Artery ◽

Patient Age ◽

Content Type ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Patient Âgé ◽

Risk Of Rupture ◽

Mean Size ◽

The Mean ◽

Fine Print

Object. The authors explore the risk of rupture in aneurysms categorized by size. Methods. A computerized database of 945 patients with aneurysms treated between 1967 and 1987 was retrospectively established. All available clinical and radiological studies were abstracted. Because of the recent interest in the size of intracranial aneurysms in relation to their likelihood of rupture, the database was searched with respect to this parameter. In 390 patients representing 41% of all cases, aneurysms were measured by neuroradiologists at the time of diagnosis. In 78% of the 945 patients there was only one aneurysm, and of the 507 aneurysms that were measured, 60% were solitary. Of all patients, 86% had ruptured aneurysms. The average age of all patients was 47 years, and for those with ruptured aneurysms it was 46 years. Of the ruptured aneurysms, 77% were 10 mm or smaller, compared with 85% of the unruptured aneurysms. It was found that 40.3% of the ruptured aneurysms were on the anterior cerebral artery or anterior communicating artery, compared with 13% of the unruptured aneurysms. None of the cavernous internal carotid artery (ICA) aneurysms were ruptured and 65% of the ophthalmic artery (OphA) aneurysms were. Of the unruptured aneurysms, 15% were located in the cavernous ICA or the OphA. Of the ruptured aneurysms, 29% were on the middle cerebral artery, compared with 36% of the unruptured aneurysms. The mean size of ruptured and unruptured aneurysms showed no statistically significant increase with patient age, although the difference in size between the ruptured and unruptured aneurysms decreased with increasing age. The mean size of all ruptured aneurysms (10.8 mm) was significantly larger than the mean size of all unruptured aneurysms (7.8 mm, p < 0.001); the median sizes were 10 mm and 5 mm, respectively. The size of ruptured aneurysms in patients who died in the hospital was significantly larger than those in the patients who survived (12 mm compared with 9.9 mm, p = 0.004). Symptomatic unruptured aneurysms were significantly larger than incidental unruptured aneurysms (14.6 mm compared with 6.9 mm, p = 0.032), which were, in turn, larger than aneurysms that were unruptured and part of a multiple aneurysm constellation. Both ruptured and unruptured aneurysms were larger in male than in female patients, but not significantly. Conclusions. Site and patient age, as well as lesion size, may affect the chance of rupture.

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Role of apoptosis in intracranial aneurysm rupture

Journal of Neurosurgery ◽

10.3171/jns.2004.101.6.1018 ◽

2004 ◽

Vol 101 (6) ◽

pp. 1018-1025 ◽

Cited By ~ 51

Author(s):

Luigi Pentimalli ◽

Andrea Modesti ◽

Andrea Vignati ◽

Enrico Marchese ◽

Alessio Albanese ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Superficial Temporal Artery ◽

Aneurysm Rupture ◽

Terminal Deoxynucleotidyl Transferase ◽

Content Type ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Aneurysm Wall ◽

Unruptured Intracranial Aneurysms ◽

Fine Print

Object. Mechanisms involved in the rupture of intracranial aneurysms remain unclear, and the literature on apoptosis in these lesions is extremely limited. The hypothesis that apoptosis may reduce aneurysm wall resistance, thus contributing to its rupture, warrants investigation. The authors in this study focused on the comparative evaluation of apoptosis in ruptured and unruptured intracranial aneurysms. Peripheral arteries in patients harboring the aneurysms and in a group of controls were also analyzed. Methods. Between September 1999 and February 2002, specimens from 27 intracranial aneurysms were studied. In 13 of these patients apoptosis was also evaluated in specimens of the middle meningeal artery (MMA) and the superficial temporal artery (STA). The terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling technique was used to study apoptosis via optical microscopy; electron microscopy evaluation was performed as well. Apoptotic cell levels were related to patient age and sex, aneurysm volume and shape, and surgical timing. Significant differences in apoptosis were observed when comparing ruptured and unruptured aneurysms. High levels of apoptosis were found in 88% of ruptured aneurysms and in only 10% of unruptured lesions (p < 0.001). Elevated apoptosis levels were also detected in all MMA and STA specimens obtained in patients harboring ruptured aneurysms, whereas absent or very low apoptosis levels were observed in MMA and STA specimens from patients with unruptured aneurysms. A significant correlation between aneurysm shape and apoptosis was found. Conclusions. In this series, aneurysm rupture appeared to be more related to elevated apoptosis levels than to the volume of the aneurysm sac. Data in this study could open the field to investigations clarifying the causes of aneurysm enlargement and rupture.

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Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial

Journal of Neurosurgery ◽

10.3171/jns.1998.89.1.0081 ◽

1998 ◽

Vol 89 (1) ◽

pp. 81-86 ◽

Cited By ~ 186

Author(s):

Joseph M. Eskridge ◽

Joon K. Song ◽

_ _

Keyword(s):

Clinical Trial ◽

Drug Administration ◽

Guglielmi Detachable Coils ◽

Content Type ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Platinum Coil ◽

Detachable Coils ◽

Fine Print

Object. To assess the safety and efficacy of aneurysm embolization performed using Guglielmi detachable coils (GDCs), the authors reviewed the results of a cohort of 150 patients with either ruptured (83 patients) or unruptured (67 patients) basilar tip aneurysms treated with these detachable platinum coil devices in the early part of the United States multicenter GDC clinical trial that led to Food and Drug Administration approval for the device. Methods. The most common presentation in this cohort of patients was headache (53%). All patients were entered into the trial after neurosurgical assessment excluded them as candidates for surgical clipping of their aneurysms. Greater than 90% coil packing was achieved in 75% of the patients. For those patients in whom follow-up information was available, the mean angiographic and clinical evaluation follow-up time for 61 patients with ruptured aneurysms was 13.7 months (range 0–43 months) and that for the 49 patients with unruptured aneurysms was 9.8 (range 0–40 months). Conservative mortality rates included up to 23% for the ruptured aneurysm group and up to 12% for the unruptured aneurysm group; the rebleeding rate for treated ruptured aneurysms was up to 3.3% and the bleeding rate for unruptured aneurysms up to 4.1%. Permanent deficits due to stroke in patients with ruptured or unruptured aneurysms occurred in up to 5% and 9%, respectively. Vasospasm occurred in 8% of the patients; it was associated with two deaths. Periprocedural mortality was 2.7% (four patients with ruptured aneurysms). Conclusions. Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management. The role of this procedure in unruptured basilar tip aneurysms is unclear with less supportive results. More long-term follow-up evaluation is necessary and results are expected to improve.

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Conspicuous consumption of luxury experiences: an experimental investigation of status perceptions on social media

Journal of Product & Brand Management ◽

10.1108/jpbm-08-2020-3047 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Carolin Siepmann ◽

Lisa Carola Holthoff ◽

Pascal Kowalczuk

Keyword(s):

Social Media ◽

Personal Characteristics ◽

Conspicuous Consumption ◽

Individual Characteristics ◽

Luxury Goods ◽

Content Type ◽

The Status ◽

Self Actualization ◽

The Individual ◽

High Level

Purpose As luxury goods are losing their importance for demonstrating status, wealth or power to others, individuals are searching for alternative status symbols. Recently, individuals have increasingly used conspicuous consumption and displays of experiences on social media to obtain affirmation. This study aims to analyze the effects of luxury and nonluxury experiences, as well as traditional luxury goods on status- and nonstatus-related dimensions. Design/methodology/approach After presenting the theoretical foundation, the authors conduct a study with 599 participants to compare status perceptions elicited by the conspicuous consumption of luxury goods, luxury experiences and nonluxury experiences. The authors investigate whether experiences that are visibly consumed on Instagram are replacing traditional luxury goods as the most important status symbols. Furthermore, the authors examine the effects of the content shown on nonstatus-related dimensions and analyze whether status perceptions differ between female and male social media communicators. Finally, the authors analyze how personal characteristics (self-esteem, self-actualization and materialism) influence the status perceptions of others on social media. Findings The results show that luxury goods are still the most important means of displaying status. However, especially for women, luxury experiences are also associated with a high level of social status. Thus, the results imply important gender differences in the perceptions of status- and nonstatus-related dimensions. Furthermore, the findings indicate that, in particular, the individual characteristics of self-actualization and materialism affect status perceptions depending on the posted content. Originality/value While the research has already considered some alternative forms of conspicuous consumption, little attention has been given to experiences as status symbols. However, with their growing importance as substitutes for luxury goods and the rise of social media, the desire to conspicuously consume experiences is increasing. The authors address this gap in the literature by focusing on the conspicuous display of luxury and nonluxury experiences on social media.

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Ruptured aneurysms of the proximal middle cerebral artery

Journal of Neurosurgery ◽

10.3171/jns.1973.39.4.0498 ◽

1973 ◽

Vol 39 (4) ◽

pp. 498-502 ◽

Cited By ~ 12

Author(s):

Matej Lipovšek

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bed Rest ◽

Content Type ◽

Ruptured Aneurysms ◽

Carotid Ligation ◽

Angiographic Evidence ◽

Proximal Middle Cerebral Artery ◽

Middle Cerebral Artery Aneurysms ◽

Fine Print

✓ In 57 patients with proximal middle cerebral artery aneurysms, two forms of treatment are reviewed, namely, bed rest and common carotid ligation. Patients who had no angiographic evidence of spasm or accompanying hematoma did better with carotid ligation than with bed rest if they were treated within the first week of the onset of subarachnoid hemorrhage.

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Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.2000.92.6.0995 ◽

2000 ◽

Vol 92 (6) ◽

pp. 995-1001 ◽

Cited By ~ 50

Author(s):

Manfred Westphal ◽

Ulrich Grzyska

Keyword(s):

Arteriovenous Malformations ◽

Endovascular Techniques ◽

Treatment Procedure ◽

Major Hemorrhage ◽

Content Type ◽

Ruptured Aneurysms ◽

Aggressive Management ◽

Feeding Vessels ◽

Fine Print ◽

Feeding Vessel

Object. The diminishing threshold for the application of neuroimaging leads to an increasingly frequent diagnosis of previously asymptomatic arteriovenous malformations (AVMs). In such a context, it is warranted to define the criteria that make a lesion potentially hazardous so that neurosurgeons and patients reach a decision concerning how to manage the AVM. In addition to the proposed grading system for AVMs, which assesses the risk of an actual treatment procedure, several studies have been concerned with the evaluation of angioarchitectural features. The goal of the present study is to demonstrate the significance of feeding vessel pedicle aneurysms, especially those found in infratentorial AVMs.Methods. To determine the incidence of associated aneurysms, the authors reviewed an unselected cohort of 242 consecutive patients with AVMs managed between 1989 and 1999. Within this group were 240 patients who were treated by surgery, endovascular techniques, or a combination of both. Of these patients, 216 harbored a supratentorial and 24 an infratentorial AVM. Two additional patients with supratentorial AVMs underwent treatment of ruptured aneurysms without treatment of the AVMs. In six of the patients with supratentorial AVMs, proximal flow-related aneurysms were found on major feeding arteries, only one of which had caused hemorrhage. In only one patient were there additional distal feeding vessel pedicle aneurysms near the AVM, one of which had caused a major hemorrhage. In contrast, four of 24 patients with infratentorial AVMs had distal feeding artery pedicle aneurysms. Three of these aneurysms had caused hemorrhage.Conclusions. Pedicle aneurysms on feeding vessels are frequently associated with hemorrhage (four of five cases in this series). In our cohort of 242 treated patients (240 treated for AVM and two for an aneurysm), feeding vessel pedicle aneurysms appear to occur more frequently in conjunction with infratentorial AVMs, which justifies aggressive management to prevent incidences of morbidity associated with rupture of the aneurysm.

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Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1971.35.3.0291 ◽

1971 ◽

Vol 35 (3) ◽

pp. 291-295 ◽

Cited By ~ 71

Author(s):

Peter D. Moyes

Keyword(s):

Surgical Treatment ◽

Intracranial Hemorrhage ◽

Content Type ◽

Unruptured Aneurysms ◽

Multiple Aneurysms ◽

Spontaneous Intracranial Hemorrhage ◽

Fine Print

✓ Review of a series of 460 patients with spontaneous intracranial hemorrhage showed that 241 had demonstrable aneurysms and 38 had multiple aneurysms. The importance of demonstrating the entire circulation following ligation of one aneurysm is emphasized. Treatment of the 38 patients with multiple aneurysms is described. Ligation of unruptured aneurysms that are incidentally discovered is advocated in patients who are Grade 1 on the Botterell scale and who are well informed as to the risks.

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Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors

Journal of Neurosurgery ◽

10.3171/jns.1995.83.5.0812 ◽

1995 ◽

Vol 83 (5) ◽

pp. 812-819 ◽

Cited By ~ 124

Author(s):

Christopher L. Taylor ◽

Zhong Yuan ◽

Warren R. Selman ◽

Robert A. Ratcheson ◽

Alfred A. Rimm

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Cerebral Aneurysm ◽

Primary Diagnosis ◽

Content Type ◽

Unruptured Aneurysms ◽

Aneurysm Formation ◽

Unruptured Cerebral Aneurysm ◽

Significant Protective Effect ◽

Fine Print

✓ Cerebral arterial aneurysms are common in the general population and their rupture is a catastrophic event. Considerable uncertainty remains concerning the conditions that predispose individuals to aneurysm formation or rupture. The role of systemic hypertension in aneurysm formation and rupture has been especially controversial. Demographic variables have rarely been addressed because of the small sample sizes in previous studies. The authors describe the demographics and prevalence of hypertension in 20,767 Medicare patients with an unruptured aneurysm and compare these to a random sample of the hospitalized Medicare population. The prevalence of hypertension in patients with unruptured aneurysms was 43.2% compared with 34.4% in the random sample. Patients who survived their initial hospitalization were separated into two groups: those with an unruptured cerebral aneurysm as the primary diagnosis and those with an unruptured cerebral aneurysm as a secondary diagnosis. Follow-up data for 18,119 patients were examined to determine the risk of subarachnoid hemorrhage (SAH) associated with age, gender, race, hypertension, insulin-dependent diabetes mellitus, and surgical treatment. For patients with an unruptured cerebral aneurysm as the primary diagnosis, hypertension was found to be a significant risk factor for future SAH (risk ratio: 1.46, 95% confidence interval (CI): 1.01–2.11), whereas surgical treatment (risk ratio: 0.29, 95% CI: 0.09–0.97) had a significant protective effect. Advancing age had a small but significant protective effect in both groups. Elderly patients identified with unruptured aneurysms are more likely to have coexisting hypertension than the general hospitalized population. In elderly patients hospitalized with an unruptured cerebral aneurysm as their primary diagnosis, hypertension is a risk factor for subsequent SAH, whereas surgical treatment is a protective factor against SAH.

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A rapid noninvasive method to visualize ruptured aneurysms in the emergency room: three-dimensional power Doppler imaging

Journal of Neurosurgery ◽

10.3171/jns.2004.100.4.0619 ◽

2004 ◽

Vol 100 (4) ◽

pp. 619-622 ◽

Cited By ~ 5

Author(s):

Fabienne Perren ◽

Peter Horn ◽

Rolf Kern ◽

Eva Bueltmann ◽

Michael Hennerici ◽

...

Keyword(s):

Emergency Room ◽

Power Doppler ◽

Three Dimensional ◽

Doppler Imaging ◽

Power Doppler Ultrasonography ◽

Content Type ◽

Ruptured Aneurysms ◽

3D Power Doppler ◽

Power Doppler Imaging ◽

Fine Print

Object. Three-dimensional (3D) power Doppler ultrasonography imaging provides a rapid, noninvasive visualization of ruptured intracranial aneurysms, including their relationship to other vascular structures. Methods. The authors used transcranial 3D power Doppler imaging in the emergency room to examine patients with acute subarachnoid hemorrhage. In all patients, the ruptured aneurysm was rapidly located with 3D power Doppler imaging. Conventional x-ray angiography confirmed both the ultrasonography-based diagnosis and the location of aneurysmal bleeding. Conclusions. These preliminary results indicate that 3D power Doppler imaging is a rapid, noninvasive screening method for the visualization of ruptured aneurysms.

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