Predictive value of radiomics for intracranial aneurysm rupture: a systematic review and meta-analysis.

Objective: To systematically review the literature on radiomics for predicting intracranial aneurysm rupture and conduct a meta-analysis to obtain evidence confirming the value of radiomics in this prediction. Methods: A systematic literature search was conducted in PubMed, Web of Science, Embase, and The Cochrane Library databases up to March 2024. The QUADAS-2 tool was used to assess study quality. Stata 15.0 and Review Manager 5.4.1 were used for statistical analysis. Outcomes included combined sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and their 95% confidence intervals (CI), as well as pre-test and post-test probabilities. The SROC curve was plotted, and the area under the curve (AUC) was calculated. Publication bias and small-study effects were assessed using the Deeks' funnel plot. Results: The 9 included studies reported 4,284 patients, with 1,411 patients with intracranial aneurysm rupture (prevalence 32.9%). The overall performance of radiomics for predicting intracranial aneurysm rupture showed a combined Sen of 0.78 (95% CI: 0.74-0.82), Spe of 0.74 (95% CI: 0.70-0.78), +LR of 3.0 (95% CI: 2.7-3.4), -LR of 0.29 (95% CI: 0.25-0.35), DOR of 10 (95% CI: 9-12), and AUC of 0.83 (95% CI: 0.79-0.86). Significant heterogeneity was observed in both Sen (I2 = 90.93, 95% CI: 89.00-92.87%) and Spe (I2 = 94.28, 95% CI: 93.21-95.34%). Conclusion: Radiomics can improve the diagnostic efficacy of intracranial aneurysm rupture. More large-sample, prospective, multicenter clinical studies are needed to further evaluate its predictive value. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/.

Ruptured aortic aneurysm with previous endovascular aneurysm repair in a patient with high-grade angiosarcoma.

Ruptured aortic aneurysms after endovascular repair is rare, particularly in the absence of type I or type III endoleaks. In such cases, a thorough investigation into the causes is imperative, including the consideration of an underlying malignancy. We report a case involving a 78-year-old woman who experienced abdominal aortic aneurysm rupture 4 years after aortic endograft treatment. We explanted the endograft and performed aortobi-iliac bypass. Initial aortic thrombus pathological analysis revealed atherosclerosis. However, the patient returned 4 months later with multiple lesions suggestive of metastases, and a reevaluation of the pathology slides uncovered a diagnosis of angiosarcoma.

[Immediate and long-term results after microsurgical clipping of ruptured aneurysms in acute period of hemorrhage]. / Blizhaishie i otdalennye rezul'taty posle mikrokhirurgicheskogo klipirovaniya razorvavshikhsya anevrizm v ostrom periode krovoizliyaniya.

Cerebral aneurysms are diagnosed in 1-5% of people and cause 80-85% of subarachnoid hemorrhages (SAH). Aneurysmal hemorrhages are more common in people aged 30-50 years causing high socio-economic significance of this disease. Therefore, the outcomes of microsurgical clipping are an urgent problem in these patients. OBJECTIVE: To evaluate the immediate and long-term results after microsurgical treatment of cerebral aneurysms in acute period of hemorrhage; to analyze functional results and long-term outcomes, including higher mental functions and return to previous work. MATERIAL AND METHODS: The study included 517 patients in acute period of subarachnoid hemorrhage between 2019 and 2022. Severity of hemorrhage was assessed using the Hunt-Hess scale while the Fisher scale was valuable to estimate dimensions of hemorrhage and predictions for vasospasm. All patients underwent microsurgical clipping of aneurysms. We assessed clinical status and outcomes immediately after microsurgical clipping, within 2 weeks, 1, 3, 6 and 12 months after surgery. The Modified Glasgow Outcome Scale, Modified Rankin Scale (mRS), EQ-5D-3L Quality of Life Questionnaire, Mini-Mental State Examination MMSE and Hamilton Anxiety Rating Scale were used. RESULTS: After 1 month, mRS score 0 was observed in 22% of patients, score 1 - 17%, score 2 - 19.4%, score 3 - 6.2%, score 4 - 2.6%, score 5 - 1% of patients. Mortality rate was 6.4%. After 12 months, mRS score 0, 1, 2, 3 and 4 was observed in 67%, 15%, 8%, 3% and 0.4% of patients, respectively. After 12 months, 39 (8.3%) patients did not return to previous work. Among 427 (91.7%) patients who returned to previous work, 20% returned to work after 3 months, 65% after 6 months and 15% after 9 months. CONCLUSION: Short-term and long-term functional outcomes vary significantly. There were significantly better mRS scores in long-term period compared to early period. Analysis of immediate and long-term results after hemorrhage will allow us to determine the most important predictors of adverse functional outcomes, assess the prevalence, characteristics, modifiable risk factors and consequences of hemorrhage.

Risk analysis of intracranial aneurysm rupture based on the arterial segment of origin.

Background and objective: The rupture risk of intracranial aneurysms (IAs) is related to their arterial origin, but whether the different segments of the artery have different risks and act as independent risk factors is still unknown. Our study aimed to investigate the rupture risk of IAs in different arterial segments in a large Chinese cohort. Methods: Imaging and clinical data of consecutive patients with IAs diagnosed by Computed Tomography angiography (CTA) from January 2013 to December 2022 were collected. Two neuroradiologists independently identified ruptured and unruptured IAs based on imaging and medical records. The internal carotid artery (ICA), middle cerebral artery (MCA), anterior cerebral artery (ACA), vertebral artery (VA), and posterior cerebral artery (PCA) were segmented according to the Bouthillier and Fischer segmentation methods. Stenoses of the proximal parent vessel were evaluated and documented. The Institutional Review Board (IRB) at Beijing Tiantan Hospital approved this retrospective study. Results: A total of 3,837 aneurysms {median size 3.5 mm [interquartile range (IQR) 2.6-5.1 mm]; 532 ruptured} were included in this study from 2,968 patients [mean age: 57 years (IQR 50-64); male patients: 1,153]. Ruptured aneurysms were most commonly located in the posterior inferior cerebellar artery (PICA) (52.9%), anterior communicating artery (ACoA) (33.8%), other locations (33.3%), ACA (22.4%), and basilar artery (BA) (21.4%). The locations with the highest likelihood of rupture were the C7 ICA (21.3%), M2 MCA (24.0%), distal MCA (25.0%), and A2 ACA (28.1%). IAs originating from the C7 (p < 0.001), dM1 (p = 0.022), and dA1 (p = 0.021) segments were independent risk factors for rupture. IAs without stenosis of the proximal parent vessel were associated with a higher risk of rupture (p = 0.023). Conclusion: There are unique associations between the origins of aneurysms from various arterial segments. Aneurysms originating from the anterior communicating artery (ACoA), BA, PICA, A2, dA, C7, and M2 indicate a higher risk of rupture. Aneurysms originating from C4, C5, and C6 indicate a lower risk of rupture. C7 IAs, ACoA IAs, and PICA IAs seem to be independent risk factors.

Characteristics of a Pure Acute Subdural Hematoma Caused by Intracranial Aneurysm Rupture: A Case Report and Review of Literature.

Pure acute subdural hematomas (ASDHs) due to ruptured aneurysms without subarachnoid or intracerebral hemorrhage are rare. We report the case of a 26-year-old female who presented with a pure ASDH caused by a ruptured distal anterior cerebral artery (ACA). The patient complained of sudden headache and vomiting and was transferred to our hospital. On the ambulance journey to the hospital, her consciousness level decreased suddenly just after experiencing additional pain in the head. At admission, the consciousness level was 4 points on the Glasgow coma scale with bilateral pupil dilatation. Computed tomography (CT) and CT angiography showed a left ASDH without subarachnoid hemorrhage (SAH) and a distal ACA aneurysm. Emergent hematoma evacuation was performed, but SAH and the bleeding point were not observed. Therefore, coil embolization for the distal ACA aneurysm was performed after an emergent operation. During embolization, intraoperative rupture was observed. The contrast media was seen up to the convexity subdural space along the falx. Extravasation ceased after intraaneurysmal coil embolization. Consequently, the rupture of the distal ACA aneurysm was diagnosed as the cause of the pure ASDH. The patient received additional coil embolization due to recanalization of the aneurysm without rebleeding 44 days after admission and was transferred to a rehabilitation hospital 55 days after admission to our hospital with a score of 4 on the modified ranking scale. From the reviews of 56 patients from 32 studies, including our case, we determine that an ACA aneurysm could show the distant hematomas located far from the site of a ruptured aneurysm compared with a ruptured aneurysm located in the internal carotid and middle cerebral arteries. Distant hematoma location could also lead to delayed diagnosis of aneurysms and lead to rebleeding and poor outcomes. Aneurysm rupture diagnoses should receive special attention, especially for ACA aneurysms, as the hematoma may be located far from the rupture site.

Cardiac tamponade caused by a ruptured coronary aneurysm treated with open-chest hemostasis after esophageal cancer surgery: a case report.

Cardiac tamponade is a rare postoperative complication of esophagectomy, with no previous reports of association with coronary artery aneurysm rupture. We present a case of cardiac tamponade caused by coronary aneurysm rupture following esophageal cancer surgery. A 68-year-old man with no history of heart disease underwent robotic subtotal esophagectomy for esophageal squamous cell carcinoma. He experienced intermittent chest pain on postoperative day (POD) 17. Echocardiography revealed increasing pericardial fluid, and pericardiocentesis on POD 34 revealed bloody pericardial fluid. Contrast-enhanced computed tomography and coronary angiography revealed a ruptured coronary aneurysm causing cardiac tamponade. Emergency surgery with a median sternotomy achieved hemostasis, and the patient recovered successfully. Cardiac tamponade after esophageal surgery, particularly from coronary aneurysm rupture, is rare. Prompt diagnosis and treatment are crucial for patient survival. Despite its risks, median sternotomy was effective in achieving rapid hemostasis and patient recovery in this case.

Unveiling the devastations of Streptococcus sanguinis infective endocarditis masquerading as iron deficiency anaemia: a case report.

Background: Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis. Case summary: A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle haematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days. Discussion: This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasizes the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.

Rupture of a Splenic Artery Aneurysm With Gastric Perforation After Pancreaticoduodenectomy: A Case Report.

Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm and can lead to severe outcomes if ruptured. This report presents the case of a 71-year-old female who experienced a sudden and severe gastrointestinal hemorrhage 19 years after undergoing pancreaticoduodenectomy for pancreatic head cancer. The patient arrived at the hospital with signs of shock, and imaging revealed an SAA rupture with associated gastric perforation. Emergency treatment involved endovascular techniques, which stabilized the patient and controlled the bleeding. This case highlights the importance of rapid diagnosis and the effectiveness of endovascular therapy in managing SAA rupture, particularly in patients with complex surgical histories.

Management of renal artery aneurysms: A retrospective study.

BACKGROUND: Although renal artery aneurysms (RAAs) are rare and often asymptomatic with slow growth, their natural progression and optimal management are not well understood. Treatment recommendations for RAAs do exist; however, they are supported by limited data. METHODS: A retrospective cohort study was conducted to explore the management of patients diagnosed with an RAA at our institution from January 1st, 2013, to December 31st, 2020. Patients were identified through a search of our radiological database, followed by a comprehensive chart review for further assessment. Data collection encompassed patient and aneurysm characteristics, the rationale for initial imaging, treatment, surveillance, and all-cause mortality. RESULTS: One hundred eighty-five patients were diagnosed with or treated for RAAs at our center during this timeframe, with most aneurysms having been discovered incidentally. Average aneurysm size was 1.40 cm (±0.05). Of those treated, the mean size was 2.38 cm (±0.24). Among aneurysms larger than 3 cm in size, comprising 3.24% of the total cases, 83.3% underwent treatment procedures. Only 20% of women of childbearing age received treatment for their aneurysms. There was one instance of aneurysm rupture, with no associated mortality or significant morbidity. CONCLUSIONS: Our institution's management of RAAs over the period of the study generally aligned with guidelines. One potential area of improvement is more proactive intervention for women of childbearing age.

On the Importance of Including Cohesive Zone Models in Modelling Mixed-Mode Aneurysm Rupture.

INTRODUCTION: The precise mechanism of rupture in abdominal aortic aneurysms (AAAs) has not yet been uncovered. The phenomenological failure criterion of the coefficient of proportionality between von Mises stress and tissue strength does not account for any mechanistic foundation of tissue fracture. Experimental studies have shown that arterial failure is a stepwise process of fibrous delamination (mode II) and kinking (mode I) between layers. Such a mechanism has not previously been considered for AAA rupture. METHODS: In the current study we consider both von Mises stress in the wall, in addition to interlayer tractions and delamination using cohesive zone models. Firstly, we present a parametric investigation of the influence of a range of AAA anatomical features on the likelihood of elevated interlayer traction and delamination. RESULTS: We observe in several cases that the location of peak von Mises stress and tangential traction coincide. Our simulations also reveal however, that peak von Mises and intramural tractions are not coincident for aneurysms with Length/Radius less than 2 (short high-curvature aneurysms) and for aneurysms with symmetric intraluminal thrombus (ILT). For an aneurysm with (L/R = 2.0), the peak σ vm moves slightly towards the origin while the peak T t is near the peak bulge with a separation distance of ~ 17 mm. Additionally, we present three patient-specific AAA models derived directly from CT scans, which also illustrate that the location of von Mises stress does not correlate with the point of interlayer delamination. CONCLUSION: This study suggests that incorporating cohesive zone models into clinical based FE analyses may capture a greater proportion of ruptures in-silico.

Intermediate catheter use is associated with intraprocedural rupture during coil embolization of ruptured intracranial aneurysms: a retrospective propensity score-matched study.

Introduction: An intermediate catheter (IMC) may pose a risk of intraprocedural rupture (IPR) during coil embolization of ruptured intracranial aneurysms (RIAs), because the pressure on the microcatheter and coil might be more direct. To verify this hypothesis, this study explored whether use of an IMC might correlate with an increased rate of IPR during coil embolization for RIAs. Methods: We retrospectively reviewed 195 consecutive aneurysms in 192 patients who underwent initial coil embolization for saccular RIAs at our institution between January 2007 and December 2023. Patients were divided into two groups with aneurysms treated either with an IMC (IMC group) or without an IMC (non-IMC group). To investigate whether IMC use increased the rate of IPR, a propensity score-matched analysis was employed to control for age, sex, maximal aneurysm size, neck size, bleb formation, aneurysm location, proximal vessel tortuosity, balloon-assisted coiling, type of microcatheter, and type of framing coil. Results: Ultimately, 43 (22%) coil embolization used IMC. In univariate analysis, the incidence of IPR was significantly higher in the IMC group compared with the non-IMC group (14.0 vs. 3.3%, p = 0.016). Propensity score matching was successful for pairs of 26 aneurysms in the IMC group and 52 aneurysms in the non-IMC group. The incidence of IPR was still significantly higher in the IMC group than in the non-IMC group (23.1 vs. 3.8%, p = 0.015). No significant differences in the incidences of ischemic complications and IMC-related parent artery dissection were observed between the two groups. Discussion: When using IMC for coil embolization of RIAs, the surgeons should be more careful and delicate in manipulating the microcatheter and inserting the coils to avoid IPR.

Presumed renal arterial aneurysm in a cat.

A 3-year-old cat was presented for an abdominal ultrasound examination with apathy and anemia. The US revealed the enlargement of the left kidney with a hypoechoic subcapsular thickening. An abnormal, tortuous vessel was visible in the medulla with arterial flow on pulsed-wave Doppler examination. The CT examination confirmed the ultrasound findings and a presumptive diagnosis of the intraparenchymal renal aneurysm was made. Four days later, the cat presented again with a worsening of its condition. The US features were suggestive for that of an aneurysm rupture.

Aneurysm sac shrinkage at 1 year after fenestrated-branched endovascular aortic repair of complex aortic aneurysms offers mid-term survival advantage.

OBJECTIVES: To investigate the impact of 1-year changes in aneurysm sac diameter on patient survival after fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal aortic aneurysms or thoracoabdominal aortic aneurysms. METHODS: We reviewed the clinical data of patients enrolled in a prospective nonrandomized study investigating FB-EVAR (2013-2022). Patients with sequential follow up computed tomography scans at baseline and 6 to 18 months after FB-EVAR were included in the analysis. Aneurysm sac diameter change was defined as the difference in maximum aortic diameter from baseline measurements obtained in centerline of flow. Patients were classified as those with sac shrinkage (≥5 mm) or failure to regress (<5 mm or expansion) according to sac diameter change. The primary end point was all-cause mortality. Secondary end points were aortic-related mortality (ARM), aortic aneurysm rupture (AAR), and aorta-related secondary intervention. RESULTS: There were 549 patients treated by FB-EVAR. Of these, 463 patients (71% male, mean age, 74 ± 8 years) with sequential computed tomography imaging were investigated. Aneurysm extent was thoracoabdominal aortic aneurysms in 328 patients (71%) and abdominal aortic aneurysms in 135 (29%). Sac shrinkage occurred in 270 patients (58%) and failure to regress in 193 patients (42%), including 19 patients (4%) with sac expansion at 1 year. Patients from both groups had similar cardiovascular risk factors, except for younger age among patients with sac shrinkage (73 ± 8 years vs 75 ± 8 years; P < .001). The median follow-up was 38 months (interquartile range, 18-51 months). The 5-year survival estimate was 69% ± 4.1% for the sac shrinkage group and 46% ± 6.2% for the failure to regress group. Survival estimates adjusted for confounders (age, chronic pulmonary obstructive disease, chronic kidney disease, congestive heart failure, and aneurysm extent) revealed a higher hazard of late mortality in patients with failure to regress (adjusted hazard ratio, 1.72; 95% confidence interval, 1.18-2.52; P = .005). The 5-year cumulative incidences of ARM (1.1% vs 3.1%; P = .30), AAR (0.6% vs 2.6%; P = .20), and aorta-related secondary intervention (17.0% ± 2.8% vs 19.0% ± 3.8%) were both comparable between the groups. CONCLUSIONS: Aneurysm sac shrinkage at 1 year is common after FB-EVAR and is associated with improved patient survival, whereas sac enlargement affects only a minority of patients. The low incidences of ARM and AAR indicate that failure to regress may serve as a surrogate marker for nonaortic-related death.

Giant Thoracic Aortic Aneurysm Rupture in a Patient with Extensive Atherosclerotic Disease.

Aneurysmal dilatations can affect any aortic segment and represent the result of various causes, atherosclerotic disease being the most common and frequently involved. We hereby illustrate a case of a patient with thoracic aortic aneurysm rupture due to extensive atherosclerotic disease, with multiple complex penetrating ulcerated atherosclerotic plaques located in the descending aorta. CT angiography evaluation included a comprehensive description of imaging features and extent of the thoracic aortic aneurysm, the presence of thrombus, relationship to adjacent structures and branches, associated complications. Teaching Point: Thoracic aortic aneurysm rupture due to extensive atherosclerotic disease with multiple penetrating ulcers.

Identifying hemodynamic factors associated with the rupture of anterior communicating artery aneurysms based on global modeling of blood flow in the cerebral artery network.

Anterior communicating artery (ACoA) aneurysms are more prone to rupture compared to aneurysms present in other cerebral arteries. We hypothesize that systemic blood flow in the cerebral artery network plays an important role in shaping intra-aneurysmal hemodynamic environment thereby affecting the rupture risk of ACoA aneurysms. The majority of existing numerical studies in this field employed local modeling methods where the physical boundaries of a model are confined to the aneurysm region, which, though having the benefit of reducing computational cost, may compromise the physiological fidelity of numerical results due to insufficient account of systemic cerebral arterial hemodynamics. In the present study, we firstly carried out numerical experiments to address the difference between the outcomes of local and global modeling methods, demonstrating that local modeling confined to the aneurysm region results in inaccurate predictions of hemodynamic parameters compared with global modeling of the ACoA aneurysm as part of the cerebral artery network. Motivated by this finding, we built global hemodynamic models for 40 ACoA aneurysms (including 20 ruptured and 20 unruptured ones) based on medical image data. Statistical analysis of the computed hemodynamic data revealed that maximum wall shear stress (WSS), minimum WSS divergence, and maximum WSS gradient differed significantly between the ruptured and unruptured ACoA aneurysms. Optimal threshold values of high/low WSS metrics were determined through a series of statistical tests. In the meantime, some morphological parameters of aneurysms, such as large nonsphericity index, aspect ratio, and bottleneck factor, were found to be associated closely with aneurysm rupture. Furthermore, multivariate logistic regression analyses were performed to derive models combining hemodynamic and morphological parameters for discriminating the rupture status of aneurysms. The capability of the models in rupture status discrimination was high, with the area under the receiver operating characteristic curve reaching up to 0.9. The findings of the study suggest that global modeling of the cerebral artery network is essential for reliable quantification of hemodynamics in ACoA aneurysms, disturbed WSS and irregular aneurysm morphology are associated closely with aneurysm rupture, and multivariate models integrating hemodynamic and morphological parameters have high potential for assessing the rupture risk of ACoA aneurysms.

Ruptured external iliac artery aneurysm: A case report.

INTRODUCTION: Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair. PRESENTATION OF CASE: An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it. DISCUSSION: In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions. CONCLUSION: EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm.

A Comparison of Perioperative Complications and Outcomes in Patients Undergoing Cerebral Aneurysm Clipping Performed Ultra-Early (≤ 24 hours) versus Late (> 24 hours): A 7-Year Retrospective Study of 302 Patients.

Objectives The intracerebral aneurysm with subarachnoid hemorrhage (SAH) has a high morbidity and mortality rate. This study aimed to compare the incidences of perioperative complications in ultra-early surgery (within 24 hours) with those in late surgery (> 24 hours). Methods Retrospective data were reviewed for 302 patients who underwent craniotomies with aneurysm clipping between January 2014 and December 2020. Perioperative data were obtained from the medical records and reviewed by the investigators. The complications were compared between ultra-early and late operations. We were interested in major complications such as delayed ischemic neurologic deficit (DIND), intraoperative aneurysm rupture (IAR), and anesthesia-related complications. The short-term (in hospital) and long-term (1 year) outcomes in patients with or without DIND and IAR were compared. The collected data was statistically analyzed. Results Three hundred and two patients were analyzed, and 264 patients had completed follow-up. The ultra-early cases (150 patients) had a higher American Society of Anesthesiologists physical status, a lower Glasgow Coma Scale, and higher Hunt and Hess scales. The surgeons operated on more cases of the anterior cerebral artery as ultra-early operations. The incidence rates of DIND, IAR, severe hemodynamic instability, and cardiac arrest were 5.6, 8.3, 6.3, and 0.3%, respectively, which were not different between groups. However, the reintubation rate was higher in the ultra-early surgery cases (0 vs. 3.3%, p = 0.023). The DIND and IAR patients had poorer short-term (in hospital) outcomes. Conclusions There were no differences in major complications between ultra-early and late craniotomy with aneurysm clipping. However, the reintubation rate was strikingly higher in the ultra-early group. Patients with major complications had early, unfavorable outcomes.

Intracranial mycotic aneurysm rupture following cupping therapy.

Background: Cupping therapy is an alternative treatment that uses a small glass cup to suck the skin with a needle and has been used to manage skin problems and pain. However, serious complications have been reported. Herein, we describe a case of intracranial mycotic aneurysm rupture after cupping therapy. Case Description: A 25-year-old male patient presented with a headache and fever after cupping therapy for atopic dermatitis. He was diagnosed with infective endocarditis, and antibiotic therapy was initiated. After that, he suddenly lost consciousness, and head imaging revealed a cerebral hemorrhage due to a ruptured intracranial mycotic aneurysm. He underwent craniotomy, which was successful, and he was transferred to a rehabilitation center with a modified Rankin scale score of 2 at three months post-stroke. Conclusion: This case serves as a reminder of life-threatening infectious complication risks after cupping therapy. A patient who has a compromised skin barrier may experience serious adverse effects, especially when cupping is performed without implementing suitable infection prevention measures.

Traumatic Aneurysm Involving the Posterior Communicating Artery.

Traumatic intracranial aneurysms (TICAs) are rare, accounting for less than 1% of all intracranial aneurysms. However, they are associated with a mortality rate of over 50%. The case presented herein focuses on a posterior communicating artery TICA caused by violent aggression. A 41-year-old man with massive subarachnoid hemorrhage (SAH), on admission to hospital, had a CT angiography that showed a ruptured left posterior communicating artery aneurysm with continuous blood loss and underwent neurosurgical cooling. The CT scan also showed fractures of the mandible, mastoid and left styloid process, as well as brain contusions caused by blows and kicks. Despite medical treatment and surgery, after four days, he died. The assault dynamics were recorded by a camera in the bar. The damage was caused by kicks to the neck and head. The forensic neuropathological examination showed the primary injury (SAH, subdural hemorrhage, cerebral contusions, head-neck fractures), as well as secondary damage following the attack (cerebral infarcts, edema, supratentorial hernia, midbrain hemorrhage). The coil was intact and well positioned. In this case, circumstantial information, medical records, and the type of injury could shed light on the mechanism of the production of a TICA. In addition, the CT angiography and histological investigations helped to distinguish a recent and traumatic aneurysm from a pre-existing one. Following precise steps, the study of aneurysms can be helpful in clarifying their traumatic origin even when the victim was taking drugs. The aim of this study is also to share the diagnostic process that we used in the forensic field for the assessment of suspected traumatic aneurysms.

Dietary Iron Restriction Protects against Aneurysm Rupture in a Mouse Model of Intracranial Aneurysm.

INTRODUCTION: Iron accumulation in vessel walls induces oxidative stress and inflammation, which can cause cerebrovascular damage, vascular wall degeneration, and intracranial aneurysmal formation, growth, and rupture. Subarachnoid hemorrhage from intracranial aneurysm rupture results in significant morbidity and mortality. This study used a mouse model of intracranial aneurysm to evaluate the effect of dietary iron restriction on aneurysm formation and rupture. METHODS: Intracranial aneurysms were induced using deoxycorticosterone acetate-salt-induced hypertension and a single injection of elastase into the cerebrospinal fluid of the basal cistern. Mice were fed an iron-restricted diet (n = 23) or a normal diet (n = 25). Aneurysm rupture was detected by neurological symptoms, while the presence of intracranial aneurysm with subarachnoid hemorrhage was confirmed by post-mortem examination. RESULTS: The aneurysmal rupture rate was significantly lower in iron-restricted diet mice (37%) compared with normal diet mice (76%; p < 0.05). Serum oxidative stress, iron accumulation, macrophage infiltration, and 8-hydroxy-2'-deoxyguanosine in the vascular wall were lower in iron-restricted diet mice (p < 0.01). The areas of iron positivity were similar to the areas of CD68 positivity and 8-hydroxy-2'-deoxyguanosine in both normal diet and iron-restricted diet mouse aneurysms. CONCLUSIONS: These findings suggest that iron is involved in intracranial aneurysm rupture via vascular inflammation and oxidative stress. Dietary iron restriction may have a promising role in preventing intracranial aneurysm rupture.