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1.
No Shinkei Geka ; 49(2): 220-228, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762441

RESUMO

Intracranial aneurysms or arterial dissections are major causes of subarachnoid hemorrhage(SAH). Early surgical or endovascular repair of the bleeding source is crucial because rebleeding mostly occurs within a few days after the initial attack. Radiological examination is an initial step for the appropriate diagnosis of ruptured intracranial aneurysms and arterial dissections. However, misdiagnosis may occur, especially in patients with minor bleeding or multiple aneurysms. In addition to computed tomography, magnetic resonance imaging, including FLAIR and SWI, and T2*WI are useful for detecting minor SAH. Vessel-wall imaging has recently been applied to diagnosing the site of rupture in patients with multiple cerebral aneurysms or microaneurysms, but not to assessing the instability of unruptured cerebral aneurysms or intracranial arterial dissections. In this article, we discuss the current radiological modalities and their usefulness for diagnosing SAH.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(2): 200-206, 2021 Feb 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33678659

RESUMO

In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Digital , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia
3.
Rozhl Chir ; 100(1): 32-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33691421

RESUMO

INTRODUCTION: Arterial aneurysms of the pancreaticoduodenal arcade (PDA) represent approximately 2% of all aneurysms of visceral arteries. Despite a low incidence, this group of aneurysms is clinically significant due to its high risk of rupture. CASE REPORT: A 45 years old patient presented with a pancreaticoduodenal arcade aneurysm rupture along with a tight stenosis at the origin of the coeliac trunk. Retrograde blood flow from the superior mesenteric artery (SMA) to the hepatic artery (HA) via PDA limited our therapeutic options due to the necessity to maintain liver perfusion. The patient was indicated for an interventional radiology procedure, which consisted of percutaneous transluminal angioplasty (PTA) with stent placement at the origin of the coeliac trunk and subsequent transarterial embolisation (TAE) - trapping of the aneurysm using coils. Due to clinical signs of the intra-abdominal compartment syndrome, within 24 hours of the radiological treatment, the patient was indicated for surgical revision (laparotomy). During the surgery, no signs of active bleeding were found; coagula were evacuated from the abdominal cavity (800 ml) and laparostomy was performed with a temporary closure using a grid. Final closure of the abdominal cavity was performed on postoperative day 20 from the initial procedure. Follow-up abdominal CT performed 22 months after TAE showed no recurrence of the aneurysm. CONCLUSION: Aneurysm rupture represents a serious case of acute abdomen which requires urgent treatment. The preferred method of treatment for ruptured PDA aneurysms is the endovascular intervention using TAE, which is associated with lower morbidity and mortality than the surgical intervention. Concurrent coeliac trunk stenosis requires consideration given the need to maintain sufficient liver perfusion after TAE of the PDA aneurysm, acting up to this point as a collateral circulation of the liver. The choice of the therapeutic approach should be individualised taking into account the above mentioned recommendations.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Artéria Celíaca , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Artéria Mesentérica Superior , Pessoa de Meia-Idade , Pâncreas , Resultado do Tratamento
4.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526539

RESUMO

Haemodynamic flow-related stress at the vessel curvatures is an important risk factor for intracranial aneurysmal growth and rupture. The rete middle cerebral artery (MCA) is a rare entity causing hyperdynamic blood flow into the ipsilateral anterior cerebral artery (ACA), especially when the contralateral A1-segment is non-dominant. Ruling out the clinicoradiological mimics like vasculitis, moyamoya and chronic occlusive disease with vessel wall imaging and detailed investigations helps manage the clinical entity effectively. We present a successfully managed case of ruptured ACA aneurysm at the acute curvature of the A1-A2 junction associated with ipsilateral rete MCA. Pre-emptive diagnosis of the rete MCA can aid preventive strategies to manage rupture and regrowth of the aneurysm at the points of flow-related stress.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/anormalidades , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/complicações , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/terapia , Imagem por Ressonância Magnética , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Tomografia Computadorizada por Raios X
5.
Medicina (B Aires) ; 81(1): 96-98, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33611250

RESUMO

True splenic aneurysms are saccular dilations of all the layers of the splenic artery, more common in women, pregnancy and portal hypertension. They are usually asymptomatic and diagnosed incidentally during the study of other abdominal diseases. Up to 10% may present with rupture, which implies a high morbidity and mortality. Treatment of splenic aneurysms is still a subject of controversy and there is a great variety of therapeutic modalities. We present two cases of patients with splenic aneurysms: one who presented with rupture and the other one incidentally diagnosed. Both were treated with endovascular embolization achieving optimal results. Although the utility of this therapy has not been assessed for giant or ruptured aneurysms, it allowed us to solve these scenarios in a secure and effective way, with minimum morbidity and mortality.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Feminino , Humanos , Gravidez , Artéria Esplênica/diagnóstico por imagem , Resultado do Tratamento
7.
Yonsei Med J ; 62(1): 91-94, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381939

RESUMO

We report the 3-year follow-up result of Wingspan intracranial stenting for symptomatic severe in-stent stenosis after stent-assisted coiling (SAC) for a ruptured left distal internal carotid artery (ICA) aneurysm. A middle-aged male patient visited our hospital for in-stent stenosis of a stent that was placed to treat a ruptured ICA aneurysm. Routine follow-up cerebral angiography, 1 year after SAC, showed in-stent stenosis around the distal markers of the inserted stent at the left M1 proximal segment. Six months later, he developed right dysesthesia. We performed intracranial stenting with Wingspan stent for the in-stent stenosis. Follow-up digital subtraction angiography performed 1 year after the Wingspan stenting showed good patency of the ICA and middle cerebral artery flow without evidence of restenosis. At 3-year follow-up, magnetic resonance angiography showed sufficient middle cerebral artery flow although the stenting segment could not be visualized clearly. Wingspan stenting might be a feasible option in patients with iatrogenic intracranial stenosis resulting from in-stent stenosis who experience the progression of intracranial stenosis with manifestation of neurological symptoms despite dual anti-platelet therapy.


Assuntos
Aneurisma Roto/terapia , Aneurisma Intracraniano/terapia , Stents , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Angiografia Digital , Angiografia Cerebral , Constrição Patológica/complicações , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Vasc Endovascular Surg ; 55(1): 81-85, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32873222

RESUMO

Treating carotid blowout syndrome following rupture of giant pseudoaneurysms is difficult because the destroyed parent artery precludes conventional treatment. We present a patient with a ruptured giant pseudoaneurysm that we occluded using a modified internal trapping technique with low-concentration N-butyl-2-cyanoacrylate (NBCA) and a minimum number of coils. An 80-year-old man with a history of chemoradiation therapy for oropharyngeal cancer presented with several episodes of active bleeding from the subsequent tracheostomy site. Radiological examination revealed a giant right common carotid artery (CCA) pseudoaneurysm. Endovascular internal trapping was performed using both NBCA and coils under proximal flow control. We slowly injected 9 ml of low-concentration NBCA, which subsequently filled the entire pseudoaneurysm. We then injected an additional 2 ml of NBCA into the proximal CCA to achieve complete obliteration. No re-bleeding was observed during the 6-month follow-up. Endovascular internal trapping using low-concentration NBCA was feasible to treat a giant CCA pseudoaneurysm. The injected low-concentration NBCA filled the entire pseudoaneurysm without the risk of catheter entrapment.


Assuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Primitiva , Embolização Terapêutica , Embucrilato/administração & dosagem , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Resultado do Tratamento
9.
Brain Nerve ; 73(1): 89-93, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33361516

RESUMO

Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.


Assuntos
Aneurisma Roto , Doença Cerebrovascular dos Gânglios da Base , Febre Familiar do Mediterrâneo , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragias Intracranianas , Pessoa de Meia-Idade
10.
Clin Neurol Neurosurg ; 201: 106425, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33340837

RESUMO

BACKGROUND/OBJECTIVES: The present study aimed at evaluating the impact on the early outcome of patients with ruptured intracranial aneurysms. METHODS: Our study prospectively included 26 consecutive patients with ruptured intracranial aneurysm managed at our institution in context of COVID-19 pandemic between March 1st, 2020 and April, 26th, 2020 (2020 group). A group control included other 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group). On admission, poor neurological status was defined as WFNS score >3. Severe radiological status was defined by the presence of intracerebral hematoma, or/and acute hydrocephalus requiring further EVD or/and the presence of vasospasm on presentation. Statistical analysis was performed to compare the 2 distinct groups. RESULTS: Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher in the 2020 group (p = 0.01 and p = 0.02, respectively). The delayed hospital admission was 2.7 days in 2020 group and 0.75 days in 2019 group (p = 0.005). Therefore, vasospasm's rate on presentation was also higher in the 2020 group (p = 0.04). CONCLUSION: To our knowledge, this is one of the first studies demonstrating influence of the COVID-19 pandemic on patients with urgent and severe intracranial aneurysmal disease. In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/epidemiologia , /epidemiologia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos
11.
No Shinkei Geka ; 48(12): 1139-1145, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353876

RESUMO

The posterior inferior cerebellar artery(PICA)communicating artery is a fine tortuous artery that interconnects the bilateral vermian branches of the distal PICAs. Aneurysms of this anastomotic vessel have been reported in only seven cases(including ours)in the available literature. The PICA communicating artery supplied collateral blood flow to the contralateral vermian territory in all seven cases. A 51-year-old man presented with a rare PICA communicating artery aneurysm(which manifested as a hematoma in the fourth ventricle)and mild subarachnoid hemorrhage at the cerebellomedullary fissure. Angiography revealed a hypoplastic right PICA and a PICA communicating artery from the left PICA that supplied the right vermian territory; the ruptured aneurysm originated from this vessel. Aneurysm trapping is associated with the risk of cerebral infarction of the right vermian territory. We concluded that the distal part of the telovelotonsillar segment could be sacrificed because the right anterior inferior cerebellar artery and the superior cerebellar artery would supply collateral blood flow; therefore, we attempted trapping in this case. A bilateral midline suboccipital approach was used, and we detected a reddish fusiform aneurysm at the top of a hairpin curve of the PICA communicating artery in the uvula of the cerebellar vermis. The aneurysm was trapped and removed without complications. Histopathological evaluation confirmed findings of a true aneurysm. Congenital vulnerability of the arterial wall and hemodynamic stress are considered contributors to PICA communicating artery aneurysms. Preservation of the affected vessel is difficult in patients in whom aneurysmal clipping is challenging. Other vessels tend to establish collateral blood flow to the contralateral vermian territory in such cases. Trapping is a simple and effective therapeutic strategy for these aneurysms.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cerebelo/diagnóstico por imagem , Cerebelo/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Artéria Vertebral
12.
No Shinkei Geka ; 48(11): 1073-1078, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199666

RESUMO

Kissing aneurysms are defined as two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. Mirror aneurysms are defined as intracranial aneurysms located in similar positions bilaterally on the parent arteries. Both kissing and mirror aneurysms at the anterior communicating artery(AcomA)are rare. We report a case of subarachnoid hemorrhage(SAH)due to ruptured kissing mirror aneurysms of the AcomA. An 80-year-old woman was admitted to our hospital with a sudden headache and vomiting. CT revealed diffuse SAH. Digital subtraction arteriography(DSA)revealed an aneurysm at the right A1-A2 junction of the AcomA. Hence, coil embolization was performed. On day 14 following embolization, rebleeding occurred. DSA revealed complete occlusion of the aneurysm at the right A1-A2 junction. However, left carotid angiography revealed an aneurysm at the left A1-A2 junction. We did not understand the anatomical construction of the aneurysms;therefore, we selected microsurgical treatment to clip the AcomA aneurysm using an interhemispheric approach. The left A1-A2 junctional aneurysm was anterior to the right A1-A2 junctional aneurysm, which was coil embolized. We detected the left A1-A2 junctional aneurysm as a ruptured aneurysm. The two aneurysms were adhered to each other. After dissection to expose the aneurysmal neck, the left A1-A2 junctional aneurysm was clipped. Kissing mirror aneurysms are difficult to diagnose before treatment. Knowledge and suspicion of the occurrence of kissing mirror aneurysms in the AcomA are important.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
13.
No Shinkei Geka ; 48(10): 949-955, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071232

RESUMO

Cerebral aneurysms and arachnoid cysts are relatively common cerebral malformations and the use of recent modalities has increased their detection rates. However, cerebral aneurysms associated with arachnoid cysts are unusual. We describe two cases of ruptured cerebral aneurysms associated with arachnoid cysts. According to previous reports, clinical presentation may sometimes be unusual, as cysts can prevent subarachnoid hemorrhage. Moreover, in some cases, CT may reveal typical arachnoid cysts without subarachnoid hemorrhage, without intracystic hematoma, or with subdural hematoma alone. These clinical presentations and radiologic findings can lead to delayed diagnosis of subarachnoid hemorrhage. Therefore, we should consider the coexistence of arachnoid cyst in case of a warning sign of aneurysm rupture.


Assuntos
Aneurisma Roto , Cistos Aracnóideos , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Hematoma Subdural , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
14.
J Stroke Cerebrovasc Dis ; 29(11): 105224, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066904

RESUMO

A 66-year-old man presented with a 6-day history of progressive posterior cervical pain that included lower back pain and fever. Neurological examinations revealed neck stiffness. Computed tomography demonstrated convexity subarachnoid hemorrhage. A spinal T2-weighted image revealed a hypointense signal lesion with contrast enhancement of the intradural extramedullary space at Th12-L1. Digital subtraction angiography showed a fusiform aneurysm with a 10 mm diameter in the artery of Adamkiewicz. We diagnosed the patient's condition as a ruptured aneurysm of the artery of Adamkiewicz. By day 41 the aneurysm had disappeared following conservative treatment. Aneurysms arising from the artery of Adamkiewicz are extremely rare and can cause both convexity and spinal subarachnoid hemorrhages. Clinicians should therefore look for spinal lesions if patients with convexity subarachnoid hemorrhage of an unknown origin have lower back pain as their initial symptom.


Assuntos
Aneurisma Roto/complicações , Coluna Vertebral/irrigação sanguínea , Hemorragia Subaracnóidea/etiologia , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Tratamento Conservador , Humanos , Dor Lombar/etiologia , Masculino , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
15.
Stroke ; 51(10): 3045-3054, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32878566

RESUMO

BACKGROUND AND PURPOSE: The role of aspirin in unruptured intracranial aneurysm (UIA) growth remains largely unknown. We aim to identify whether aspirin is associated with a lower rate of UIA growth in patients with UIA <7 mm. METHODS: This prospective cohort study consecutively enrolled patients with UIAs <7 mm with ischemic cerebrovascular disease between January 2016 and December 2019. Baseline and follow-up patient information, including the use of aspirin and blood pressure level, were recorded. Patients were considered aspirin users if they took aspirin, including standard- and low-dose aspirin, ≥3× per week. The primary end point was aneurysm growth in any direction or an indisputable change in aneurysm shape. RESULTS: Among the 315 enrolled patients, 272 patients (86.3%) underwent imaging examinations during follow-up (mean follow-up time, 19.6±12.7 months). A total of 113 patients were continuously treated with aspirin. UIA growth occurred in 31 (11.4%) patients. In the multivariate Cox analysis, specific aneurysm locations (anterior communicating artery, posterior communicating artery, or middle cerebral artery; hazard ratio, 2.89 [95% CI, 1.22-6.88]; P=0.016) and a UIA size of 5 to <7 mm (hazard ratio, 7.61 [95% CI, 3.02-19.22]; P<0.001) were associated with a high risk of UIA growth, whereas aspirin and well-controlled blood pressure were associated with a low risk of UIA growth (hazard ratio, 0.29 [95% CI, 0.11-0.77]; P=0.013 and hazard ratio, 0.25 [95% CI, 0.10-0.66]; P=0.005, respectively). The cumulative annual growth rates were as high as 40.0 and 53.3 per 100 person-years in the high-risk patients (>1 risk factor) with and without aspirin, respectively. CONCLUSIONS: Aspirin therapy and well-controlled blood pressure are associated with a low risk of UIA growth; the incidence of UIA growth in high-risk patients in the first year is high, warranting intensive surveillance in this patient group. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02846259.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Pressão Sanguínea/fisiologia , Aneurisma Intracraniano/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/epidemiologia , Aneurisma Roto/prevenção & controle , Angiografia Digital , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/prevenção & controle , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Risco
16.
J Stroke Cerebrovasc Dis ; 29(10): 105124, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912535

RESUMO

OBJECTIVE: This study investigates the effect of aneurysm circulation on mortality and patient outcomes after aneurysmal subarachnoid hemorrhage (SAH) within the United States. METHODS: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS), a part of the Healthcare Cost and Utilization Project (HCUP), with ICD-10 codes for non-traumatic SAH between 2015-2016. Aneurysms were stratified as either anterior or posterior circulation. Multivariate logistic regression was used to find the impact of selected variables on the odds of mortality. RESULTS: The NIS reported 1,892 cases of non-traumatic SAH within the study period that were predominantly anterior circulation (82.6%), female (68.6%), white (57.7%), with mean age of 59.07 years, and in-hospital mortality of 21.4%. Anterior circulation aneurysms were associated with lower severity of initial illness (p = 0.014) but higher likelihood of vasospasm (p = 0.0006) than those of the posterior circulation. In a multivariate logistic regression analysis, mortality was associated with posterior circulation aneurysms (OR: 1.42; CI 95% 1.005-20.10, p = 0.047), increasing age (OR: 1.035; 95% CI 1.022-1.049; p < 0.0001), and shorter hospital stays (OR: 0.7838; 95% CI 0.758-0.811; p < 0.0001). Smoking history (OR: 0.825; 95% CI 0.573-1.187, p > 0.05) and vasospasm (OR: 1.005; 95% CI 0.648-1.558; p > 0.05) were not significantly associated with higher odds of mortality. CONCLUSIONS: Mortality following aneurysmal SAH is associated with posterior circulation aneurysms, and increasing age, but not smoking history or vasospasm. These findings may be useful for prognostication and counseling patients and families.


Assuntos
Aneurisma Roto/mortalidade , Circulação Cerebrovascular , Mortalidade Hospitalar , Aneurisma Intracraniano/mortalidade , Hemorragia Subaracnóidea/mortalidade , Adulto , Fatores Etários , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/fisiopatologia , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Estados Unidos/epidemiologia
17.
J Stroke Cerebrovasc Dis ; 29(9): 105039, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807451

RESUMO

BACKGROUND: Data comparing the effect of age on outcomes of patients who underwent either endovascular coiling (EVC) or neurosurgical clipping (NSC) for ruptured intracranial aneurysms remains limited. OBJECTIVE: To better elucidate the preferred intervention for ruptured aneurysm management by presenting the results of our systematic review of the literature that evaluated the potential advantages of the two interventions between different age groups. METHODS: Systematic review of PubMed and Embase was performed (2002 - June 10, 2019) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2013 guidelines. Median ages of EVC and NSC cohorts were 54 and 56, respectively. Ages below the median were used in our "younger" cohort; ages above the median were used in our "older" cohort. RESULTS: We reviewed 13 studies on 7,137 patients. In the younger cohort, there were 2840 (EVC: 1412, NSC: 1428) patients. In the older cohort, there were 4297 (EVC: 2552, NSC: 1745) patients. Overall, there was a significant difference in functionality between EVC (77.70%) and NSC (69.23%) (OR=1.69; 95% C.I.: 1.10-2.60, p = 0.0212). In our younger cohort, functionality was significantly different between EVC (77%) and NSC (69%) (OR=1.54; 95% C.I.: 1.29-1.84, p < 0.001). For the older cohort, there was no significant difference in functionality, complications, or efficacy. CONCLUSIONS: We have highlighted the importance of considering age prior to deciding which intervention is most appropriate for ruptured aneurysms, with higher morbidity and mortality with NSC versus EVC in the younger population.


Assuntos
Aneurisma Roto/terapia , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Procedimentos Neurocirúrgicos , Fatores Etários , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/mortalidade , Aneurisma Roto/fisiopatologia , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/mortalidade , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Resultado do Tratamento
18.
Stroke ; 51(9): e246-e249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811385

RESUMO

BACKGROUND AND PURPOSE: We investigated white matter abnormalities in patients with spontaneous subarachnoid hemorrhage following aneurysmal rupture, by using tract-based spatial statistics. METHODS: Sixteen patients with spontaneous subarachnoid hemorrhage due to aneurysmal rupture and 18 age- and sex-matched healthy control subjects were recruited. Voxel-wise statistical analysis of fractional anisotropy data was performed by using tract-based spatial statistics as implemented in the Functional Magnetic Resonance Imaging of the Brain Software Library. We calculated mean fractional anisotropy values across the tract skeleton and within 48 regions of interest based on the intersections between the fractional anisotropy skeleton and the probabilistic Johns Hopkins University white matter atlases. RESULTS: Comparing the patient and control groups, the fractional anisotropy values of 44 regions of interest among the 48 regions of interest showed significant differences (P<0.05). However, significant differences were not observed in the remaining 4 regions of interest (both retrolenticular parts of the internal capsule, the right superior longitudinal fasciculus, and the right superior corona radiata; P>0.05). CONCLUSIONS: By undertaking tract-based spatial statistics analysis, we detected wide-ranging white matter abnormalities in patients with spontaneous subarachnoid hemorrhage. Registration: URL: http://www.e-irb.com/index.jsp. Unique identifier: 2019-06-032.


Assuntos
Hemorragia Subaracnóidea/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Idoso , Aneurisma Roto/diagnóstico por imagem , Anisotropia , Imagem de Tensor de Difusão , Feminino , Humanos , Leucoaraiose/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
19.
Stroke Vasc Neurol ; 5(3): 291-301, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792460

RESUMO

BACKGROUND: The management of bilateral intracranial vertebral artery dissecting aneurysms (IVADAs) is controversial, and requires the development of endovascular treatment modalities and principles. We aim to investigate the endovascular treatment strategy and outcomes of bilateral IVADAs. METHODS: We identified all bilateral IVADAs at a high-volume neurointerventional centre over a 10-year period (from January 2009 to December 2018). Radiographic and clinical data were recorded, and a treatment algorithm was derived. RESULTS: Twenty-seven patients with bilateral IVADAs (54 IVADAs in total, 51 unruptured, 3 ruptured) were diagnosed. Four patients (14.8%) received single-stage endovascular treatment, 12 patients (44.4%) with staged endovascular treatment and 11 patients (40.8%) with unilateral endovascular treatment of bilateral IVADAs. Thirty-six IVADAs (85.7%) have complete obliteration at the follow-up angiography. Two of three ruptured IVADAs with stent-assisted coiling recanalised, and had further recoiling. Three patients (11.1%) have intraprocedural or postprocedural complications (two in single-stage and one in staged). Twenty-five patients (92.6%) had a favourable clinical outcome, and two patients (7.4%, all in single-stage) showed an unfavourable clinical outcome at follow-up. For the patients with unilateral reconstructive endovascular treatment, the contralateral untreated IVADAs were stable and had no growth or ruptured during follow-up period. None of all IVADAs had rebleeding during the clinical follow-up. CONCLUSIONS: Endovascular treatment can be performed in bilateral IVADAs with high technical success, high complete obliteration rates and acceptable morbidity/mortality. Contralateral IVADAs had low rates of aneurysm growth and haemorrhage when treated in a staged/delayed fashion.


Assuntos
Algoritmos , Aneurisma Roto/terapia , Técnicas de Apoio para a Decisão , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Dissecação da Artéria Vertebral/terapia , Artéria Vertebral , Aneurisma Roto/diagnóstico por imagem , Tomada de Decisão Clínica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/diagnóstico por imagem
20.
Acta Neurochir (Wien) ; 162(11): 2725-2729, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720013

RESUMO

The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Roto/etiologia , Hemorragia Cerebral/etiologia , Infecções por Coronavirus/complicações , Artéria Cerebral Média , Pneumonia Viral/complicações , Adolescente , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Digital , Ascite/etiologia , Betacoronavirus , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Coronavirus , Infecções por Coronavirus/diagnóstico , Craniotomia , Progressão da Doença , Feminino , Hepatomegalia/etiologia , Humanos , Nefropatias/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X
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