medigraphic.com
Academia Mexicana de Neurología, A.C.

2015, Number 5

Next >>

Rev Mex Neuroci 2015; 16 (5)

Endovascular treatment of ruptured and unruptured intracranial aneurysms: Our experience in a decade

Fernández-Martínez AM, Samper-Wamba JD, Valdivia-Ruiz J, Rosati S, Balboa-Arregui O

Language: Spanish
References: 42
Page: 1-15
PDF size: 644.83 Kb.


ABSTRACT

Introduction: The rupture of an intracranial aneurysm is a vital emergency. Both surgical and endovascular approach are valid therapeutic options in this situation.
Objective: To evaluate the outcomes of endovascular approach of ruptured and unruptured intracranial aneurysms in ten years of experience.
Methods: We analyzed all patients diagnosed and treated intracranial aneurysm using an endovascular approach in our center for ten years, from 2003 to 2012.
Results: A total of 45 unruptured cerebral aneurysms in 38 patients and 106 ruptured aneurysms were embolized; a total of 151 cerebral aneurysms in 144 patients. In all, 89 were women (61.5%) and 55 men (38.5%). The mean age of the patients was 55.5±4.4 years. In patients treated of ruptured aneurysms the time of stay in ICU was significantly higher than in patients treated of unruptured aneurysm (10.4 vs 1.6 days; p‹0.001). Complications occurred in the first 24 hours since the procedure were dominant in the group of patients treated of ruptured aneurysms (2.2% vs 35.8%; p ‹). In all, 97.8% of patients treated of unruptured aneurysm and 72.6% of those treated of ruptured aneurysm were independent for basic activities of daily living one year after the procedure.
Conclusions: Patients with unruptured cerebral aneurysms treated by endovascular approach presented few complications and an early recovery. Patients with ruptured as well as unruptured cerebral aneurysms achieved a high proportion of independence for daily living activities after one year.


REFERENCES

  1. Swietaszczyk C, Maciaczyk J, Tafilklawe M, Kasprzak HA. What is the origin of cerebral aneurysms?. Przegl Lek. 2004; 61: 115-9.

  2. Shojima M, Oshima M, Takagi K, Torii R, Hayakawa M, Katada K, Morita A, Kirino T. Magnitude and role of wall shear stress on cerebral aneurysms: computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke 2004; 35: 2500-05.

  3. Meng H, Wang Z, Hoi Y, Gao L, Metaxa E, Swartz D, Kolega J. Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation. Stroke 2007; 38: 1924-31.

  4. Brisma JL, Song JK, Newell DW. Cerebral aneurysms. N Eng J Med. 2006; 355: 928-39.

  5. Suarez JL, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Eng J Med. 2006; 354: 387-96.

  6. Fontanarosa P. Recognition of subarachnoid hemorrhage. Ann Emerg Med. 1989; 18: 1199-205.

  7. Edlow J. Diagnosis of subarachnoid hemorrhage in the emergency department. Emerg Med Clin North Am. 2003; 21: 73-87.

  8. Krings T, Mandell DM, Kiehl TR, Geibprasert S, Tymianski M, Alvarez H, et al. Intracranial aneurysms: from vessel wall pathology to therapeutic approach. Nat Rev Neurol. 2011; 7: 547-59.

  9. Van Gijn J, Kerr R, Rinkel G. Subarachnoid hemorrhage. Lancet 2007; 369: 306-18.

  10. Lagares A, Gómez P, Alén J, Arikan F, Sarabia R, Horcajadas, et al. A Aneurysmal subarachnoid hemorrhage: group of study of cerebrovascular pathology of the Spanish society of neurosurgery management guideline. Neurocirugia (Astur). 2011; 22: 93-115.

  11. Van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124: 249-78.

  12. Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004; 292: 1823-30.

  13. Tipper G, U-king-Im JM, Price SJ, Trivedi RA, Cross JJ, Higgins NJ, et al. Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography. Clin Radiol. 2005; 60: 565-72.

  14. Fisher C, Kistler J, Davis J. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1-9.

  15. Wiebers D, Whisnant J, Huston J, Meissner I, Brown R, Piepgras D, et al. International Study of Unruptured intracranial Aneurysms Investigators. Subarachnoid Aneurysm Trial. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362: 103-10.

  16. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) collaborative group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet Neurol. 2002; 360: 1267-74.

  17. Molyneux A, Kerr R, Birks J, Ramzi N, Yarnold J, Sneade M, et al.; ISAT Collaborators. Risk of recurrent subarachnoid hemorrhage, death or dependence and standardized mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009; 8: 427-33.

  18. McDougall C, Spetzler R, Zabramski J, Partovi S, Hills N, Nakaji P, et al. The Barrow rupture trial.J Neurosurg. 2012; 116: 135-44.

  19. Rosen DS, Macdonald RL. Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care 2005; 2: 110-8.

  20. Hunt WE, Hess RM. Surgical risk as relates to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28: 14-20.

  21. Rankin J. Cerebral vascular accidents in patients over the age of 60, II: prognosis. Scott Med J. 1957; 2: 200-15.

  22. Cognard C, Pierot L, Anxionnat R, Ricolfi F. CLARITY Study Group. Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC study. Neurosurgery 2011; 69: 837-41.

  23. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40: 994-1025.

  24. Sakai N, Taki W, Yoshimura S, Hyogo T, Ezura M, Matsumoto Y. RESAT Study Group. Retrospective survey of endovascular treatment for ruptured intracranial aneurysm in Japan: Retrospective Endovascular Subarachnoid Aneurysm Treatment (RESAT) study. Neurol Med Chir (Tokyo) 2010; 50: 961-5.

  25. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J. Stent-Assisted Coiling of Intracranial aneurysms: Clinical and Angiographic Results in 216 Consecutive Aneurysms. Stroke 2010; 41: 110-5.

  26. Seibert B, Tummala R, Chow R, Faridar A, Mousavi S, Divani A. Intracranial aneurysms: review of current treatment options and outcomes. Frontiers in Neurology 2011; 2: 45.

  27. Eddleman C, Welch B, Vance A, Rickert K, White J, Pride G, et al. Endovascular Coils: properties, technical complications and salvage techniques. J Neurointervent Surg. 2012; 5: 104-9.

  28. Johnston S, Higashida R, Barrow D, Caplan L, Dion J, Hademenos G, et al. Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the committee on cerebrovascular imaging of the American Heart Association council on cardiovascular radiology. Stroke 2002; 33: 2536-44.

  29. Pierot L, Spelle L, Vitry F; ATENA investigators. Immediate anatomic results after the endovascular treatment of unruptured intracranial aneurysms: analysis of ATENA series. AJNR 2010; 31: 140-4.

  30. Etminan N, Beseoglu K, Barrow D, Bederson J, Brown R, Connolly E, et al. Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an International Research Group. Stroke 2014; 45: 1523-30.

  31. Kallmes D, Ding Y, Dai D, Kadirvel R, Lewis D, Cloft H. A new endoluminal, flow disrupting device for treatment of saccular aneurysms. Stroke 2007; 38: 2346-52.

  32. Van der Schaaf I, Algra A, Wermer M, Molyneux A, Clarke M, Van Gijn J, et al. Endovascular coiling versus neurosurgical clipping for patients with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2005.

  33. Qureshi AI, Janardhan V, Hanel RA, Lanzino G. Comparison of endovascular and surgical treatments for intracranial aneurysms: an evidence-based review. Lancet Neurol. 2007; 6: 816-25.

  34. Darsaut T, Kotowski M, Raymond J. How to choose clipping versus coiling in treating intracranial aneurysms. Neurochirurgie 2012; 58: 61-7.

  35. Kotowski M, Naggara O, Darsaut T, Raymond J. Systematic reviews of the literature on clipping and coiling of unruptured intracranial aneurysms. Neurochirurgie 2012; 58: 125-31.

  36. Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR 2007; 28: 146-51.

  37. Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. Usefulness of the neuroform stent for the treatment of cerebral aneurysms: results and initial (3-6-mo) follow-up. Neurosurgery 2005; 56: 1191-202.

  38. 3Bonneville F, Sourour N, Biondi A. Intracranial aneurysms: an overview. Neuroimaging Clin. N. Am. 2006; 16: 371-82.

  39. Milosevic Medenica S. Endovascular treatment of wide neck, ruptured and unruptured aneurysms without supporting devices. A single center experience. Neuroradiol J. 2013; 26: 97-105.

  40. Gory B, Turjman F. Endovascular treatment of 404 intracranial aneurysms treated with nexus detachable coils: short-term and mid-term results from a prospective, consecutive, European multicenter study. Acta Neurochir (Wien). 2014; 156: 831-7.

  41. Tykocki T, Kostyra K, Czyż M, Kostkiewicz B. Four years trends in the treatment of cerebral aneurysms in Poland in 2009-2012. Acta Neurochir (Wien). 2014; 156: 861-8.

  42. Galal A, Bahrassa F, Dalfino JC, Boulos AS. Stent-assisted treatment of unruptured and ruptured intracranial aneurysms: clinical and angiographic outcome. Br J Neurosurg. 2013; 27: 607-16.




2020     |     www.medigraphic.com