Factors responsible for poor outcome after intraprocedural rerupture of ruptured intracranial aneurysms: Identification of risk factors, prevention and management on 18 cases

2012 ◽  
Vol 81 (1) ◽  
pp. e77-e85 ◽  
Author(s):  
Xin Zhang ◽  
Xiao-Ao Long ◽  
Bin Luo ◽  
Tamrakar Karuna ◽  
Chuan-Zhi Duan
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Poor Outcome ◽  
Ruptured Intracranial Aneurysms

RISK OF SHUNT-DEPENDENT HYDROCEPHALUS AFTER OCCLUSION OF RUPTURED INTRACRANIAL ANEURYSMS BY SURGICAL CLIPPING OR ENDOVASCULAR COILING

Neurosurgery ◽  
2007 ◽  
Vol 61 (5) ◽  
pp. 924-934 ◽  
Author(s):  
Jean G. de Oliveira ◽  
Jürgen Beck ◽  
Matthias Setzer ◽  
Rüdiger Gerlach ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intraventricular Hemorrhage ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Long Term Outcome ◽  
Acute Hydrocephalus ◽  
Angiographic Vasospasm ◽  
Fisher Grade ◽  
Shunt Dependency ◽  
Ruptured Intracranial Aneurysms

Abstract OBJECTIVE To compare the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by clipping versus coiling. METHODS We analyzed 596 patients prospectively added to our database from July of 1999 to November of 2005 concerning the risk of shunt dependency after clipping versus coiling. Factors analyzed included age; sex; Hunt and Hess grade; Fisher grade; acute hydrocephalus; intraventricular hemorrhage; angiographic vasospasm; and number, size, and location of aneurysms. In addition, a meta-analysis of available data from the literature was performed identifying four studies with quantitative data on the frequency of clip, coil, and shunt dependency. RESULTS The institutional series revealed Hunt and Hess grade, Fisher grade, acute hydrocephalus, intraventricular hemorrhage, and angiographic vasospasm as significant (P < 0.05) risk factors for shunt dependency after a univariate analysis. In a multivariate logistic regression analysis, we isolated intraventricular hemorrhage, acute hydrocephalus, and angiographic vasospasm as independent, significant risk factors for shunt dependency. The meta-analysis, including the current data, revealed a significantly higher risk for shunt dependency after coiling than after clipping (P = 0.01). CONCLUSION Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.

TREATMENT OF RUPTURED INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1157-1167 ◽  
Author(s):  
Justin F. Fraser ◽  
Howard Riina ◽  
Nandita Mitra ◽  
Y. Pierre Gobin ◽  
Arlene Stolper Simon ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
National Registry ◽  
The Other ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Surgical Clipping ◽  
Poor Outcome ◽  
Procedural Complication ◽  
International Subarachnoid Aneurysm Trial ◽  
Ruptured Intracranial Aneurysms

Abstract OBJECTIVE The outcomes reported in the International Subarachnoid Aneurysm Trial (ISAT), a multicenter, prospective, randomized trial to directly compare surgical clipping with endovascular coiling as treatments for ruptured intracranial aneurysms, have been misinterpreted by many to indicate the superiority of coiling to surgical clipping in all instances. To better understand the results of ISAT and their implications for practice patterns, we compared the ISAT results with the results of other published studies regarding the treatment of ruptured intracranial aneurysms. METHODS Data from 19 published studies were compared with each other and with ISAT results. Outcomes examined were overall rates of mortality, rebleeding, poor outcome (disability and death), procedural complication rates, and rates of reoperation and nontotal occlusion. RESULTS In the 19 published studies, mean procedural complication rates were similar (surgical clipping, 11%; endovascular coiling, 9%); ISAT did not report procedural complications. ISAT rates were within the range of the other studies for overall mortality, total rebleeding, and poor outcome. Reoperation rates in the other studies were similar to those of ISAT (endovascular coiling, 12.5%; surgical clipping, 3.4%). The ISAT rate for less than 100% occlusion for endovascular coiling (6%) was below the range in the other studies (8.3–70.4%). CONCLUSION Discrepancies with the results of other published studies, procedural limitations in study design, and lack of some data endpoints and subgroup analysis raise concerns regarding extracting generalizations from the conclusions of ISAT. We think that the creation of a national registry would further the study of treatment of ruptured intracranial aneurysms.

Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system

1996 ◽  
Vol 84 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Rohit K. Khanna ◽  
Ghaus M. Malik ◽  
Nuzhat Qureshi
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Poor Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Predicting Outcome ◽  
Fine Print

✓ Surgical treatment of unruptured aneurysms is gaining increased support owing to the recently defined poor long-term natural history of these aneurysms. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk of surgery. To identify those patients at a higher risk from surgery, the authors reviewed the management of 172 patients with unruptured intracranial aneurysms treated at their institution. The size of the aneurysms ranged from 3 to 45 mm (mean 13.7 mm). Twenty-two patients (12.8%) had aneurysms in the posterior circulation, and 32 (18.6%) of these were giant aneurysms. Major morbidity occurred in 12 patients (6.9%) and five patients (2.9%) died. Multivariate logistic analysis of several risk factors revealed that aneurysm size and location had an independent correlation with surgical outcome and that patient age approached statistical significance. Patients presenting with ischemic cerebrovascular disease, in particular, did not have a higher risk of a poor outcome. A simple classification for predicting patients at high risk from surgical morbidity and mortality is proposed. Preoperative grading is based on the size and location of the aneurysm and patient's age. The lowest grade is given to young patients with small anterior circulation aneurysms, and the highest grade includes elderly patients with complex giant posterior circulation aneurysms. A retrospective analysis of this classification demonstrated a strong correlation with postoperative outcome. The incidence of poor outcome progressively increased with a higher grade, ranging from 0% in Grade 0 to 66.6% in Grade VI. An analysis of this classification on 50 consecutive surgically treated patients with unruptured aneurysms not included in the analysis also validated the predictive value of this system. Along with predicting outcome, this classification should provide a standardized format for comparison of results from different clinical centers as well as different therapeutic techniques (surgical vs. endovascular) without omission of significant risk factors found to influence outcome.

scholarly journals Incidence and Risk Factors for Rebleeding during Cerebral Angiography for Ruptured Intracranial Aneurysms

2015 ◽  
Vol 56 (2) ◽  
pp. 403 ◽  
Author(s):  
Yong Cheol Lim ◽  
Chang-Hyun Kim ◽  
Yong Bae Kim ◽  
Jin-Yang Joo ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms

scholarly journals Risk factors for ruptured intracranial aneurysms

2018 ◽  
Vol 147 (1) ◽  
pp. 51 ◽  
Author(s):  
Wen Li ◽  
Guang-Xian Wang ◽  
Dong Zhang ◽  
Zhi-Ping Wang ◽  
Liu-Qing Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms
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