ruptured aneurysm
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Author(s):  
Radek Frič ◽  
Bård Nedregaard ◽  
Ketil Riddevold Heimdal ◽  
Clemens Weber ◽  
Bernt Johan Due-Tønnessen

AbstractWe report the case of a 3-week-old neonate who presented with massive subarachnoid and intraventricular hemorrhage from a ruptured aneurysm of the anterior communicating artery (ACommA). An attempt on endovascular treatment ended up with therapeutic closure of the parent artery. However, since further investigation revealed a disastrous supratentorial cerebral infarction as a result of the hemorrhage, active treatment was terminated and the neonate died a few days after the initial stroke. To the best of our knowledge and after reviewing available literature, this is one of only five cases of ACommA aneurysm in newborns reported to date. Bleeding from an ACommA aneurysm in a neonate thus represents an extreme clinical rarity. There are no available data comparing the efficacy and safety of microsurgical versus endovascular treatment in neonates and small infants, but the latter option may at least reduce the risk associated with open surgery and further blood loss in this age group.


2021 ◽  
Author(s):  
Paolo Missori ◽  
Angela Ambrosone ◽  
Antonio Currà ◽  
Sergio Paolini ◽  
Giorgio Incarbone ◽  
...  

Abstract The relationship between nicotine levels in smokers and brain aneurysm has never been determined. To assess the levels of cotinine in smoker patients with ruptured and unruptured brain aneurysm and the risk of aneurysm rupture we quantified cotinine levels in smoker patients with ruptured or unruptured brain aneurysms. We identified a control group of smokers and nonsmokers without brain aneurysm. Out of 182 participants cerebral aneurysms were statistically significantly associated with smoking (P<0.001) and female sex (P=0.006). Cotinine levels were significantly correlated with both the presence (P=0.009) and the rupture (P=0.002) of brain aneurysms. Compared with nonsmokers, smokers had a 5-fold higher risk of having a brain aneurysm (OR, 5.72; 95% CI, 2.96–11.07; P<0.001). The risk of rupture of brain aneurysms increased by 50% with each cotinine unit and was 4-fold higher with cotinine levels between 4 and 6 (OR, 3.75; 95% CI, 1.48–9.53; P=0.005). With increasing age, the cotinine level decreased (P <0.001, rho= –0.28), declining by 2% with each year of age. In the whole population, the probability of a ruptured aneurysm in patients with cotinine levels between 4 and 6 was higher than in those with levels between 0 and 3 (OR, 5.55; 95% CI, 1.08–28.5; P=0.040). Our results suggest that high cotinine levels in smokers with brain aneurysm, rather than size, are significantly associated with high rupture risk. Cotinine levels decrease with age, possibly reducing the risk of formation and rupture of a brain aneurysm.


2021 ◽  
Author(s):  
Thomas METAYER ◽  
Arthur Leclerc ◽  
Alin Borha ◽  
Stephane Derrey ◽  
Olivier Langlois ◽  
...  

Abstract Objective Middle cerebral artery aneurysms (MCAas) with rupture and unruptured IAs are considered good candidates for microsurgery. The objective of the present study was to evaluate the risk of complications and the risk factors for microsurgical treatment of MCAas to better define the indications for microsurgery. Methods We conducted a retrospective cohort study based on data provided from three French tertiary neurosurgical units from January 1, 2013 to May 31, 2020. We first collected data on all the patients who required microsurgical treatment for MCAas. We evaluated the frequency of complications and finally searched for the risk factors for complications after microsurgery. Complications were defined as a composite criterion with the presence of one of the following: procedural-related death, symptomatic cerebral ischemia, impossible exclusion, incomplete exclusion, or (re)bleeding of the treated aneurysm and symptomatic surgical site hematoma. We then compared patients with and without complications using univariate and multivariate analyses. Results Between January 2013 and May 2020, 292 MCAas in 284 patients were treated. A total of 29 (9.9%) MCAas had a complication. The complications were as follows: symptomatic cerebral ischemia: 4.8%, aneurysm rebleeding: 0.3%, surgical site hematoma: 1.0%, impossible exclusion: 0.3%, and incomplete exclusion: 4.1%. However, severe complications, defined as death or a modified Rankin score (mRs) score ≥4 at 3 months, were infrequent and occurred in 7/292 patients (2.4%). In the multivariate analysis, independent risk factors for complications were the following: a ruptured aneurysm, a larger maximum IA size, a larger neck size, and arterial branches passing less than <1 mm from the IA neck or dome. Conclusions MCAa surgery is a safe procedure with a low rate of serious procedure-related complications and an excellent rate of occlusion. The risk factors for complications are a ruptured aneurysm, a larger IA, a larger neck size, and the presence of an “en passage” arterial branch less than 1 mm from the IA. In these cases, at least for factors that do not present a significant difficulty for EVT, such as the presence of an “en passage” artery or ruptured IA, EVT has to be more thoroughly discussed.


2021 ◽  
pp. 1-8
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Kavelin Rumalla ◽  
...  

OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial that compared endovascular coiling to microsurgical clipping in patients treated for aneurysmal subarachnoid hemorrhage (aSAH). However, because patients in the BRAT were treated more than 15 years ago, and because there have been advances since then—particularly in endovascular techniques—the relevance of the BRAT today remains controversial. Some hypothesize that these technical advances may reduce retreatment rates for endovascular intervention. In this study, the authors analyzed data for the post-BRAT (PBRAT) era to compare microsurgical clipping with endovascular embolization (coiling and flow diverters) in the two time periods and to examine how the results of the original BRAT have influenced the practice of neurosurgeons at the study institution. METHODS In this retrospective cohort study, the authors evaluated patients with saccular aSAHs who were treated at a single quaternary center from August 1, 2007, to July 31, 2019. The saccular aSAH diagnoses were confirmed by cerebrovascular experts. Patients were separated into two cohorts for comparison on the basis of having undergone microsurgery or endovascular intervention. The primary outcome analyzed for comparison was poor neurological outcome, defined as a modified Rankin Scale (mRS) score > 2. The secondary outcomes that were compared included retreatment rates for both therapies. RESULTS Of the 1014 patients with aSAH during the study period, 798 (79%) were confirmed to have saccular aneurysms. Neurological outcomes at ≥ 1-year follow-up did not differ between patients treated with microsurgery (n = 451) and those who received endovascular (n = 347) treatment (p = 0.51). The number of retreatments was significantly higher among patients treated endovascularly (32/347, 9%) than among patients treated microsurgically (6/451, 1%) (p < 0.001). The retreatment rate after endovascular treatment was lower in the PBRAT era (9%) than in the BRAT (18%). CONCLUSIONS Similar to results from the BRAT, results from the PBRAT era showed equivalent neurological outcomes and increased rates of retreatment among patients undergoing endovascular embolization compared with those undergoing microsurgery. However, the rate of retreatment after endovascular intervention was much lower in the PBRAT era than in the BRAT.


Author(s):  
Alejandro M Spiotta ◽  
B. Keith Woodward ◽  
Min S Park ◽  
Richard J Bellon ◽  
Osama O Zaidat

Introduction : The purpose of this study was to assess the 1‐year clinical outcomes of wide‐necked ruptured aneurysms treated with coiling. Methods : Data on patients with a wide‐necked ruptured aneurysm were extracted from a prospective multicenter registry (SMART) that enrolled patients with intracranial aneurysm or other neurovascular abnormality who underwent coiling. A wide neck was defined as a neck width of at least 4 mm or as a dome‐to‐neck ratio (largest diameter / neck width) of less than 2. Enrollment was not limited by Hunt and Hess grade. The primary safety outcome was device‐related serious adverse events within 24 hours, and the primary effectiveness outcome was retreatment through follow‐up. Results : Of the 995 adults enrolled in the SMART registry, 144 had a wide‐necked ruptured aneurysm (Table). Average patient age was 59.3 years (SD 14.3), and 74.3% were female. Lesion locations were internal carotid artery, 31.3%; anterior communicating artery, 31.9%; middle communicating artery, 10.4%; and posterior circulation, 26.4%. Aneurysm sizes were small, 27.1%; medium, 54.2%; large, 18.1%; and giant, 0.7%. The most common aneurysm type was saccular (88.8%, 127/143). Coiling was stent assisted in 10.4% of patients and balloon assisted in 36.1% of patients. The rate of device‐related serious adverse events within 24 hours was 3.5%. The rate of retreatment through follow‐up was 20.6% (20/97). At 1 year, 82.6% (76/92) of patients had a Raymond–Roy Occlusion Classification of I or II, 32.6% (30/92) had progressive occlusion, and 46.7% (43/92) had stable occlusion. The 1‐year all‐cause mortality rate was 12.5%. At 1‐year follow‐up, 58.3% (42/72) of patients had a modified Rankin Scale score of 0 to 2. Conclusions : Treatment of wide‐necked ruptured aneurysms with coiling has acceptable occlusion and retreatment rates at 1‐year follow‐up.


2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Shingo Nishihiro ◽  
Tomotsugu Ichikawa ◽  
Yu Takahashi ◽  
Yuichi Hirata ◽  
Nobuhiko Kawai ◽  
...  

BACKGROUND Normal posterior inferior cerebellar artery (PICA) anatomy is highly variable, but bihemispheric PICA crossing the midline to supply the vascular territory of bilateral cerebellar hemisphere is rare. Herein, the authors reported a rare case of ruptured aneurysm that was associated with bihemispheric PICA and successfully treated endovascularly. OBSERVATIONS A 46-year-old woman presented with sudden headache and loss of consciousness because of an intraventricular hemorrhage due to a ruptured aneurysm that was associated with the bihemispheric PICA. Angiography revealed that the aneurysm was located at the bifurcation between the bihemispheric PICA and the bilateral distal PICA. The ruptured aneurysm was successfully occluded using coil embolization, which preserved the parent artery with no procedural-related complication. LESSONS To the best of the authors’ knowledge, this was the first report of a ruptured aneurysm associated with bihemispheric PICA being successfully treated endovascularly. Aneurysm formation may be accelerated by hemodynamic stress and vascular fragility. For neurosurgeons and neurointerventionalists, it is important to understand the anatomical variation of PICA, especially bihemispheric PICA, which is a potential risk factor for a fatal stroke.


Medicine ◽  
2021 ◽  
Vol 100 (32) ◽  
pp. e26904
Author(s):  
Sen He ◽  
Ming-Li Wei ◽  
Fei Xie ◽  
Seidu A. Richard

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