1
|
Yang M, Li Y, Li J, An X, Li H, Wang B, Zhao Y, Zhu X, Hou C, Huan L, Yang X, Yu J. The safety and clinical outcomes of endovascular treatment versus microsurgical clipping of ruptured anterior communicating artery aneurysms: a 2-year follow-up, multicenter, observational study. Front Neurol 2024; 15:1389950. [PMID: 38846042 PMCID: PMC11153848 DOI: 10.3389/fneur.2024.1389950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
Background and objective Current data on the optimal treatment modality for ruptured anterior communicating artery (AComA) aneurysms are limited. We conducted this multicenter retrospective study to evaluate the safety and clinical outcomes of endovascular treatment (EVT) and microsurgical clipping (MC) for the treatment of ruptured AComA patients. Methods Patients with ruptured AComA aneurysms were screened from the Chinese Multicenter Cerebral Aneurysm Database. Propensity score matching (PSM) was used to adjust for baseline characteristic imbalances between the EVT and MC groups. The safety outcomes included total procedural complications, procedure-related morbidity/death and remedial procedure for complication. The primary clinical outcome was 2-year functional independence measured by the modified Rankin scale (mRS) score. Results The analysis included 893 patients with ruptured AComA aneurysms (EVT: 549; MC: 346). PSM yielded 275 pairs of patients in the EVT and MC cohorts for comparison. Decompressive craniectomy being more prevalent in the MC group (19.3% vs. 1.5%, p < 0.001). Safety data revealed a lower rate of total procedural complications (odds ratio [OR] = 0.62, 95% CI 0.39-0.99; p = 0.044) in the EVT group and similar rates of procedure-related morbidity/death (OR = 0.91, 95% CI 0.48-1.73; p = 0.880) and remedial procedure for complication (OR = 1.35, 95% CI 0.51-3.69, p = 0.657) between the groups. Compared with that of MC patients, EVT patients had a greater likelihood of functional independence (mRS score 0-2) at discharge (OR = 1.68, 95% CI 1.14-2.50; p = 0.008) and at 2 years (OR = 1.89, 95% CI 1.20-3.00; p = 0.005), a lower incidence of 2-year all-cause mortality (OR = 0.54, 95% CI 0.31-0.93; p = 0.023) and a similar rate of retreatment (OR = 1.00, 95% CI 0.23-4.40; p = 1.000). Conclusion Clinical outcomes after treatment for ruptured AComA aneurysms appear to be superior to those after treatment with MC, with fewer overall procedure-related complications and no increase in the retreatment rate. Additional studies in other countries are needed to verify these findings.
Collapse
Affiliation(s)
- Minghao Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Cerebrovascular Disease, The Second Affiliated Hospital of Guilin Medical University, Guangxi Zhuang, China
| | - Yang Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurosurgery, Baoding No.1 Central Hospital, Hebei, China
| | - Xiuhu An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongwen Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangyue Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaowei Zhu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Changkai Hou
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Linchun Huan
- Department of Neurosurgery, Linyi People’s Hospital, Shandong, China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianjun Yu
- Department of Neurosurgery, Linyi People’s Hospital, Shandong, China
| |
Collapse
|
2
|
Young M, Muram S, Shutran M, Ogilvy CS. Clipping of a Ruptured Small Anterior Communicating Artery Aneurysm: Technical Video. World Neurosurg 2024; 187:66. [PMID: 38608815 DOI: 10.1016/j.wneu.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
In recent years there has been a significant shift in the management of intracranial aneurysms, as most, both ruptured and unruptured, are being treated through an endovascular approach.1-3 However, there are still instances in which open surgical clipping is the best option for definitive management. Both patient factors, such as age and comorbidities, and aneurysm characteristics, such as size, morphology, and location, must be taken into consideration when treating aneurysms. This is especially true for anterior1 communicating artery aneurysms, as these have been treated successfully using multiple different techniques.4,5 There are no absolute guidelines indicating how a particular aneurysm should be treated and, therefore, one must be able to determine how to best manage a patient based on their own skill set, knowledge, and experience. We present a case of a 61-year-old woman who presented with a ruptured anterior communicating artery aneurysm. Initially she was brought to the angiography suite to undergo possible endovascular treatment of the aneurysm, but after reviewing the morphology and size of the aneurysm, we believed that this aneurysm could not be treated safely through an endovascular approach and surgical clipping was the better option. The patient consented to the procedure. In this operative video, we describe the technical aspects of the surgical procedure and the benefits of our approach (Video 1).
Collapse
Affiliation(s)
- Michael Young
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandeep Muram
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Max Shutran
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
3
|
Carvalho V, Vilarinho A, Polónia P, Silva ML, Vaz R, Alberto Silva P. The impact of selection bias in the treatment for ruptured anterior communicating artery aneurysms: different results or different patients? World Neurosurg X 2024; 21:100255. [PMID: 38169854 PMCID: PMC10758962 DOI: 10.1016/j.wnsx.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/15/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Anterior communicating artery is one of the most frequent locations for the development of intracranial aneurysm. The availability and advances of different treatments modalities allows for case-specific selection, but potentially impacts our ability to assess equipoise among them. Objective Investigate and compare clinical and morphological variables among surgical and endovascular treatment groups with ruptured anterior communicating artery aneurysms. Methods Data from patients from a single university hospital treated for ruptured anterior communicating aneurysms after multidisciplinary discussion in a period from January 2009 to January 2020 were retrospectively reviewed. Demographics, clinical status, aneurysm morphologic features and in-hospital complications were registered for each treatment (endovascular coiling vs. microsurgical clipping). Clinical assessment was made from outpatient evaluation at 1-year follow-up. Results A total of 119 patients was obtained adding surgical (n = 80) and endovascular (n = 39) treatment groups. No significant changes between groups were detected regarding gender, age of treatment or other risk factors. Global complication rate (p = 0.335, p = 0.225, p = 0.428) and clinical outcome (p = 0.802) was similar among both groups. Univariate and multivariate analysis revealed statistically significant differences between endovascular and surgical treatment groups regarding dome orientation (p = 0.011), aneurysm height (p < 0.001) and maximum diameter (p < 0.001), aspect-ratio (p < 0.001), dome-to-neck ratio (p < 0.001) and dome diameter (p = 0.014). Conclusions Despite similar clinical outcomes and rate of complications, morphological differences highlight the presence of a selection bias and high heterogeneity, which hampers inferential analysis when comparing both techniques.
Collapse
Affiliation(s)
- Vasco Carvalho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - António Vilarinho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Patrícia Polónia
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Maria Luís Silva
- Neuroradiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Pedro Alberto Silva
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
4
|
Saghebdoust S, Barani AR, Mehrizi MAA, Ekrami M, Lajimi AV, Termechi G. Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country. Asian J Neurosurg 2023; 18:522-527. [PMID: 38152542 PMCID: PMC10749845 DOI: 10.1055/s-0043-1771316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond-Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0-2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.
Collapse
Affiliation(s)
- Sajjad Saghebdoust
- Department of Neurosurgery, Section of Neurovascular Intervention, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
| | - Amir Reza Barani
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehran Ekrami
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Valinezhad Lajimi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | |
Collapse
|
5
|
Yarahmadi P, Kabiri A, Bavandipour A, Jabbour P, Yousefi O. Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3157-3170. [PMID: 36029421 DOI: 10.1007/s10143-022-01853-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/30/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
In recent years, intracranial aneurysms have been widely treated with endovascular methods. The anterior communicating artery (Acom) is the most common site of intracranial aneurysms. Despite its effectiveness, endovascular interventions can be associated with various intra-procedural and post-procedural complications. A systematic review of the literature was performed through PubMed, Embase, Scopus, and Web of Sciences databases up to March 18, 2022. The pooled rates of intra-procedural complications, mortality, procedure-related morbidities, the immediate and late aneurysm occlusion, and also the necessity for retreatment were calculated by applying random-effects models. A total of 41 articles with 4583 patients were included in the meta-analysis. The pooled rate of overall intra-procedural complications was 9.6% (95% CI: 7.7 to 11.8%). The initial rupture status and also type of EVT procedure did not affect the overall complication rate. The pooled rate of intra-procedural thrombosis, aneurysm rupture, coil prolapse, and early aneurysm rebleeding were 6.1% (95% CI: 4.5 to 8.2%); 4.2% (95% CI: 3.4 to 5.2%), 4.7% (95% CI: 3.2 to 6.7%), and 2.2% (95% CI: 1.5 to 3.2%), respectively. Our analysis showed that intra-procedural mortality occurred in 1.7% (95% CI: 1.1 to 2.5%) and procedure-related permanent morbidities in 3.3% (95% CI: 2.3 to 4.7%) of patients. Endovascular methods achieved complete and near to complete aneurysm occlusion (Raymond-Roy occlusion classification 1 and 2) in 89.2% (95% CI: 86.4 to 92.5%) of cases post-procedure, and 9.5% (95% CI: 7.3 to 12.4%) of patients needed retreatment due to recanalization in follow-ups. Endovascular treatment can serve as an acceptable method for Acom aneurysms. However, improved endovascular treatment equipment and new techniques provide more satisfactory outcomes for complicated cases.
Collapse
Affiliation(s)
- Pourya Yarahmadi
- Faculty of Medicine, Tehran University of Medical Sciences, Medicine, Tehran, Iran
| | - Ali Kabiri
- Faculty of Medicine, Iran University of Medical Sciences, Medicine, Tehran, Iran
| | | | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Omid Yousefi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
6
|
Catapano JS, Karahalios K, Rumalla K, Srinivasan VM, Rutledge C, Baranoski JF, Cole TS, Jadhav AP, Ducruet AF, Albuquerque FC. Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization. J Neurointerv Surg 2021; 14:1018-1021. [PMID: 34615688 DOI: 10.1136/neurintsurg-2021-017695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ruptured anterior communicating artery (ACoA) aneurysms can be challenging to treat via an endovascular procedure. This study analyzed retreatment rates and neurological outcomes associated with ruptured ACoA aneurysms treated via endovascular coiling. METHODS All patients with a ruptured ACoA aneurysm treated with endovascular coiling from 2003 to 2019 were retrospectively analyzed at a single center. Two comparisons were performed: no retreatment versus retreatment and coil embolization versus balloon-assisted coil embolization. Outcomes included retreatment and neurological outcome assessed via modified Rankin Scale (mRS). RESULTS During the study period, 186 patients with ruptured ACoA aneurysms underwent coil embolization. Treatment included standard coil embolization (68.3%, n=127), balloon-assisted coiling (28.5%, n=53), and stent-assisted embolization (2.7%, n=5). Angiographic outcomes were as follows: class I, 65.1% (n=121); class II, 28.5% (n=53); and class III, 6.5% (n=12). There were no aneurysm reruptures after the index procedure. The mean (SD) mRS score was 2.7 (2.0) at last follow-up (mortality, 19 (10%)). Retreatment occurred in 9.7% (n=18). Patients with retreatment were younger with lower-grade subarachnoid hemorrhage and more favorable functional status at discharge. Patients with aneurysms >7 mm (n=36) were significantly more likely to have recurrence (22.2% vs 6.7%, P=0.005). CONCLUSIONS Endovascular treatment of ruptured ACoA aneurysms is safe and is associated with low mortality and retreatment rates. Younger patients with favorable functional status and larger aneurysm size are more likely to be retreated. Ruptured aneurysms <4 mm, although prevalent in the study (29%), never required retreatment.
Collapse
Affiliation(s)
| | | | - Kavelin Rumalla
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Caleb Rutledge
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Tyler S Cole
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Andrew F Ducruet
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | |
Collapse
|
7
|
Shang W, Chang X, Wang X, Li J, Xu Y. Risk factors for intraprocedural rupture during emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Interv Neuroradiol 2021; 28:426-432. [PMID: 34515559 PMCID: PMC9326866 DOI: 10.1177/15910199211039689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anterior communicating artery aneurysms are the second most common type of intracranial aneurysm and have a high incidence of rupture. Intraprocedural rupture can lead to a high mortality and morbidity rate, representing a major challenge in emergency endovascular treatment of ruptured anterior communicating artery aneurysms. METHODS We performed a retrospective review of 344 consecutive patients with emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Patients were grouped into intraprocedural rupture and non-intraprocedural rupture groups according to whether intraprocedural rupture occurred. Demographic and clinical factors, vessel-related factors and therapy-related factors were compared between the two groups. RESULTS Intraprocedural rupture occurred in 11 patients (3.2%). Univariate analysis showed that hypertension, the occurrence of vasospasm, aneurysm size, aneurysm angle and a high aspect ratio value were significantly associated with intraprocedural rupture (P < 0.05). Multivariate analysis showed that hypertension odds ratio (OR, 9.799; P = 0.007), the occurrence of vasospasm (OR, 10.121; P = 0.002) and a high aspect ratio value (OR, 10.571; P = 0.006) were independent risk factors for intraprocedural rupture. CONCLUSIONS A history of hypertension, the occurrence of vasospasm and a high aspect ratio value are independent risk factors for intraprocedural rupture among patients with ruptured anterior communicating artery aneurysms.
Collapse
Affiliation(s)
- Wei Shang
- 36674Dalian Medical University, China.,Department of Neurosurgery, 74710The First Affiliated Hospital of Dalian Medical University, China
| | - Xiaoting Chang
- Department of Neurology, 540418the Second Affiliated Hospital of Dalian Medical University, China
| | - Xiaotong Wang
- 36674Dalian Medical University, China.,Department of Neurosurgery, 74710The First Affiliated Hospital of Dalian Medical University, China
| | - Jun Li
- 36674Dalian Medical University, China
| | | |
Collapse
|
8
|
Xue G, Liu P, Xu F, Fang Y, Li Q, Hong B, Xu Y, Liu J, Huang Q. Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device. Front Neurol 2021; 11:611875. [PMID: 33584512 PMCID: PMC7876256 DOI: 10.3389/fneur.2020.611875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms. Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed. Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes. Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.
Collapse
Affiliation(s)
- Gaici Xue
- Department of Neurosurgery, General Hospital of Southern Theatre Command of People's Liberation Army of China, Guangzhou, China
| | - Peng Liu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Fengfeng Xu
- Department of Neurosurgery, Naval Medical Center of People's Liberation Army of China, Navy Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Medical University, Shanghai, China
| |
Collapse
|
9
|
Beighley A, Glynn R, Scullen T, Mathkour M, Werner C, Berry JF, Carr C, Abou-Al-Shaar H, Aysenne A, Nerva JD, Dumont AS. Aneurysmal subarachnoid hemorrhage during pregnancy: a comprehensive and systematic review of the literature. Neurosurg Rev 2021; 44:2511-2522. [PMID: 33409763 DOI: 10.1007/s10143-020-01457-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent condition requiring rapid intervention and prolonged monitoring. There are few recommendations regarding the management of aSAH in pregnancy. We identified all available literature and compiled management decisions as well as reported outcomes through a systematic literature review without meta-analysis to provide recommendations for management of aSAH during pregnancy. We included a total of 23 articles containing 54 cases of pregnancy-related aSAH in our review. From these reports and other literature, we evaluated information on aSAH pathophysiology, diagnosis, and management with respect to pregnancy. Early transfer to an appropriate facility with neurocritical care, a high-risk obstetric service, and a neurosurgery team available is crucial for the management of aSAH in pregnancy. Intensive monitoring and a multidisciplinary approach remain fundamental to ensure maternal and fetal health.
Collapse
Affiliation(s)
- Adam Beighley
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Ryan Glynn
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Tyler Scullen
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA. .,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA. .,Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Cassidy Werner
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - John F Berry
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aimee Aysenne
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA.,Department of Neurocritical Care, Tulane Medical Center, New Orleans, LA, USA
| | - John D Nerva
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA. .,Department of Neurological Surgery, Ochsner Medical Center, New Orleans, LA, USA.
| |
Collapse
|
10
|
Darkwah Oppong M, Deuschl C, Pierscianek D, Rauschenbach L, Chihi M, Radbruch A, Dammann P, Wrede KH, Özkan N, Müller O, Forsting M, Sure U, Jabbarli R. Treatment allocation of ruptured anterior communicating artery aneurysms: The influence of aneurysm morphology. Clin Neurol Neurosurg 2019; 186:105506. [PMID: 31494460 DOI: 10.1016/j.clineuro.2019.105506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Since publication of the ISAT study, the majority of neurovascular centers adhere to "coil first" policy for patients with subarachnoid hemorrhage (SAH). However, final allocation in favor of coiling or clipping is based on anatomic features of ruptured intracranial aneurysms with respect to clinical characteristics of SAH. In this study, we analyzed the parameters relevant for treatment allocation of ruptured anterior communicating artery aneurysms (AComAA). PATIENTS AND METHODS From our institutional SAH database, all cases with ruptured AComAA, which underwent diagnostic subtraction angiography (DSA) with subsequent treatment allocation, were included. The radiographic features of AComAA were collected from pre-treatment DSA. In addition, demographic, clinical and radiographic parameters of SAH were recorded. The variables selected through univariate analyses were subsequently evaluated using multivariate regression analysis. RESULTS Of 300 SAH patients in the final analysis, the majority of the cases underwent endovascular coiling (n = 221, 73.7%). The following aneurysm features were associated with treatment modality in the univariate analysis: maximal sack size (p = 0.034), perpendicular height (p = 0.007), aspect ratio (p < 0.001) and sack/neck-ratio (p = 0.001). Accordingly, the following cutoffs for these variables were defined upon the receiver operating characteristics curves: 5 mm for sack size, 6 mm for perpendicular height, 1.6 for aspect ratio and sack/neck-ratio. In the multivariate analysis, aspect ratio of 1.6 was the only independent predictor of treatment allocation (p = 0.005; aOR = 2.57; 95% CI 1.33-4.96), which remained significant (p = 0.003; aOR = 2.77; 95% CI 1.41-5.45) after adjusting for patients' age, WFNS & Fisher grades, as well as intracerebral hematoma volume. CONCLUSION Although not-routinely assessed during initial allocation treatment, our retrospective analysis proved that aspect ratio is a reliable predictor of treatment allocation of ruptured AComAA. Except for large space-occupying ICH commonly obligating the microsurgical treatment, other clinical and radiographic characteristics of SAH do not seem to be of clinical relevance for the selection of treatment modality.
Collapse
Affiliation(s)
- Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany.
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Alexander Radbruch
- Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|