MicroRNAs as Biomarkers for Predicting Complications following Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is a high mortality hemorrhagic stroke that affects nearly 30,000 patients annually in the United States. Approximately 30% of aSAH patients die during initial hospitalization and those who survive often carry poor prognosis with one in five having permanent physical and/or cognitive disabilities. The poor outcome of aSAH can be the result of the initial catastrophic event or due to the many acute or delayed neurological complications, such as cerebral ischemia, hydrocephalus, and re-bleeding. Unfortunately, no effective biomarker exists to predict or diagnose these complications at a clinically relevant time point when neurologic injury can be effectively treated and managed. Recently, a number of studies have demonstrated that microRNAs (miRNAs) in extracellular biofluids are highly associated with aSAH and complications. Here we provide an overview of the current research on relevant human studies examining the correlation between miRNAs and aSAH complications and discuss the potential application of using miRNAs as biomarkers in aSAH management.

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Palliative Care Involvement in Patients Hospitalized in the United States with Aneurysmal Subarachnoid Hemorrhage

Journal of Palliative Medicine ◽

10.1089/jpm.2021.0116 ◽

2021 ◽

Author(s):

Ambereen Kurwa Mehta ◽

Scott Mitchell Wright ◽

David Shih Wu ◽

Ché Matthew Harris

Keyword(s):

United States ◽

Palliative Care ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States

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Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000200010 ◽

2004 ◽

Vol 62 (2a) ◽

pp. 245-249 ◽

Cited By ~ 2

Author(s):

Leodante Batista da Costa Jr ◽

Josaphat Vilela de Morais ◽

Agustinho de Andrade ◽

Marcelo Duarte Vilela ◽

Renato P. Campolina Pontes ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Treatment ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Anterior Circulation ◽

Common Location ◽

Belo Horizonte ◽

Spontaneous Subarachnoid Hemorrhage ◽

Anterior Circulation Aneurysms

Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.

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Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2016.9.jns161593 ◽

2018 ◽

Vol 128 (1) ◽

pp. 86-93 ◽

Cited By ~ 6

Author(s):

Christoph J. Griessenauer ◽

R. Shane Tubbs ◽

Paul M. Foreman ◽

Michelle H. Chua ◽

Nilesh A. Vyas ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Aneurysm ◽

Genetic Polymorphisms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Renin Angiotensin System ◽

The United States ◽

Dominant Effect ◽

Potential Implication ◽

Angiotensin System ◽

Renin Angiotensin

OBJECTIVERenin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin-Angiotensin System (CARAS) study prospectively evaluated common RAS polymorphisms and their relation to aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe CARAS study prospectively enrolled aSAH patients and controls at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin-converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5′ exonuclease (TaqMan) genotyping assays and restriction fragment length polymorphism analysis.RESULTSTwo hundred forty-eight patients were screened, and 149 aSAH patients and 50 controls were available for analysis. There was a recessive effect of the C allele of the angiotensinogen (AGT) C/T single-nucleotide polymorphism (SNP) (OR 1.94, 95% CI 0.912–4.12, p = 0.0853) and a dominant effect of the G allele of the angiotensin II receptor Type 2 (AT2) G/A SNP (OR 2.11, 95% CI 0.972–4.57, p = 0.0590) on aSAH that did not reach statistical significance after adjustment for potential confounders. The ACE level was significantly lower in aSAH patients with the II genotype (17.6 ± 8.0 U/L) as compared with the ID (22.5 ± 12.1 U/L) and DD genotypes (26.6 ± 14.2 U/L) (p = 0.0195).CONCLUSIONSThe AGT C/T and AT2 G/A polymorphisms were not significantly associated with aSAH after controlling for potential confounders. However, a strong trend was identified for a dominant effect of the G allele of the AT2 G/A SNP. Downregulation of the local RAS may contribute to the formation of cerebral aneurysms and subsequent presentation with aSAH. Further studies are required to elucidate the relevant pathophysiology and its potential implication in treatment of patients with aSAH.

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Healthcare Economics of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage in the United States

Translational Stroke Research ◽

10.1007/s12975-019-00697-9 ◽

2019 ◽

Vol 10 (6) ◽

pp. 650-663 ◽

Cited By ~ 6

Author(s):

Syed M. Adil ◽

Beiyu Liu ◽

Lefko T. Charalambous ◽

Musa Kiyani ◽

Robert Gramer ◽

...

Keyword(s):

United States ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Healthcare Economics

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Unresolved Issues in the Management of Aneurysmal Subarachnoid Hemorrhage

AACN Advanced Critical Care ◽

10.4037/nci.0b013e31824ebcfa ◽

2012 ◽

Vol 23 (2) ◽

pp. 175-185

Author(s):

Cynthia Bautista

Keyword(s):

Subarachnoid Hemorrhage ◽

Patient Outcomes ◽

Arterial Wall ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Management Strategies ◽

The United States ◽

Critical Care Nurses ◽

Evidence Based ◽

Complex Care ◽

Prevention And Treatment

A cerebral aneurysm is an outpouching of a weakened arterial wall, usually at a bifurcation of one of the larger vessels of the Circle of Willis. When the outpouching ruptures, arterial pressure forces blood into the subarachnoid space. The annual incidence of aneurysmal subarachnoid hemorrhage is 8 to 10 per 100 000 in the United States. The outcome varies for this patient population. New management strategies have emerged; some practices are evidence based, whereas others are based on anecdotal experiences. This variation has resulted in a number of unresolved issues in caring for patients with an aneurysmal subarachnoid hemorrhage. This article discusses some of these unresolved issues, including the use of medications such as nimodipine, antifibrinolytics, statins, and magnesium; coiling or clipping for aneurysm securement; and the prevention and treatment of potential complications. Critical care nurses must conduct detailed assessments and provide complex care to optimize patient outcomes.

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Abstract P100: Hemorrhagic Stroke in the Setting of COVID-19 is Associated With Anticoagulation Use

Stroke ◽

10.1161/str.52.suppl_1.p100 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alexandra Kvernland ◽

Arooshi Kumar ◽

Shadi Yaghi ◽

Eytan Raz ◽

Jennifer Frontera ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Characteristics ◽

Hemorrhagic Stroke ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Sensitivity Analyses ◽

Hospital System ◽

Therapeutic Anticoagulation ◽

Thrombotic Complications ◽

Parametric Testing ◽

Historical Controls

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

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Abstract TP423: Trends of Hospitalization Cost of Aneurysmal Subarachnoid Hemorrhage in the United States

Stroke ◽

10.1161/str.48.suppl_1.tp423 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sumul Modi ◽

Kavit Shah ◽

Muhammad Affan ◽

Rizwan Tahir ◽

Panayiotis Varelas ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Respiratory Failure ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Male Gender ◽

Cost Of Care ◽

Hospitalization Cost ◽

The Cost

Background: Recent large scale studies describing the trends of hospitalization cost secondary to aneurysmal subarachnoid hemorrhage (aSAH) in the United States are lacking. We performed this study to discover these trends and the factors affecting the cost of hospitalization. Methods: The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project from year 2002 to 2013 was searched for patients with a primary diagnosis of subarachnoid hemorrhage International Classification of Diseases - Ninth Revision (ICD-9) code 430) who underwent either clipping or coiling of an aneurysm. Patients with traumatic intracranial hemorrhage, arteriovenous malformation, arteriovenous fistula, cost of care ≤ 0, discharge to another hospital, and any missing variables were excluded. The cost of hospitalization was calculated using total charge and cost-to-charge ratio provided by HCUP, and then was adjusted for inflation (for the year 2016) utilizing the Consumer Price Index inflation calculator. Univariate and multivariable linear regression analysis was performed on selected variables to identify the factors associated with a higher cost of care. The multivariable model was adjusted for calendar year, medical comorbidities (using the Charlson Comorbidity Index), hospital location (urban or rural) and hospital teaching status (teaching or non-teaching). Results: We identified 20,905 patients with aSAH over the course of the 12 years. The mean and the median costs of hospitalization were $80,859 and $66,274, respectively. The median cost increased from $53,697 in 2002 to $73,901 in 2013 (p<0.001). Cost was also noted to increase by $2690 with the male gender, $18,877 with the presence of an acute ischemic stroke, $33,942 with the presence of respiratory failure and $18,464 with the requirement of ventriculostomy (all p<0.001). Every decade increase in age was associated with $3022 reduction in the cost (P<0.001). Conclusion: Among the factors we studied, higher hospitalization cost was independently associated with the male gender and the presence of ischemic stroke, respiratory failure and the requirement of ventriculostomy. Older age was associated with a lower hospitalization cost.

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Abstract P39: Outcomes Across the Course of Recovery From Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p39 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sean Neifert ◽

Alexander Schupper ◽

William Shuman ◽

Michael Martini ◽

Emily Chapman ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Secondary Analysis ◽

Small Samples ◽

Individual Data ◽

Chi Square ◽

Entire Cohort ◽

One Year ◽

Time Frames ◽

Time Point

Introduction: Data on progression of recovery after aneurysmal subarachnoid hemorrhage (aSAH) is rare and limited to small samples. We sought to characterize recovery after SAH in a secondary analysis of six SAH trials. Methods: Individual data on 3,717 patients from CONSCIOUS-1, ISAT, IHAST, trials of erythropoietin and statins, NEWTON-1, and NEWTON-2 was included. Outcome was described with the Glasgow Outcomes Scale (GOS). Proportions of GOS scores between the first and second time-point were compared using chi-square tests. Rates of improvement (final GOS > initial GOS), no change (final GOS = initial GOS), and worsening (final GOS < initial GOS) and the differences between initial and final GOS scores were calculated. Results: There were improvements in outcomes across the entire cohort (p<0.001) and from 30 days to three months (p<0.001), discharge to three months (p<0.001), six weeks to three months (p<0.001), and two months to one year (p<0.001). 907 (26%) of patients improved their outcome, while 2,228 (64%) had no change and 336 (9.7%) worsened. Of the 907 who improved, 773 (85%) improved by one GOS point, 128 (14%) improved by two points, and six (0.7%) improved by three points. Of patients with initial GOS scores of 2, 62 (38%) remained unchanged, while 91 (55%) improved and 11 (6.7%) died. Patient cohorts with initial WFNS grades of 1 (p<0.001), 2 (p<0.001), 3 (p=0.004), and 4 (p<0.001) improved their GOS scores. Conclusions: Across most time-frames, many SAH patients can be expected to recover, while a few will regress. Furthermore, even patients with the poorest initial neurological grades and outcomes showed improvement.

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Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data

Neurosurgical FOCUS ◽

10.3171/2009.2.focus0921 ◽

2009 ◽

Vol 26 (5) ◽

pp. E2 ◽

Cited By ~ 79

Author(s):

Rohan R. Lall ◽

Christopher S. Eddleman ◽

Bernard R. Bendok ◽

H. Hunt Batjer

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Morphological Characteristics ◽

Preventive Treatment ◽

Rupture Risk ◽

Catastrophic Event ◽

Aneurysmal Rupture ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms

Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a metaanalysis is nearly impossible to perform. This review will instead focus on the various anatomical and morphological characteristics of aneurysms reported in the literature with an attempt to draw broad inferences and serve to highlight pressing questions for the future in our continued effort to improve clinical management of unruptured intracranial aneurysms.

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