Details of the image Segmental arterial mediolysis with gastroduodenal artery aneurysm Modality: DSA (angiography) (Celiac axis)
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TY - JOUR. T1 - Distal anterior inferior cerebellar artery aneurysms. T2 - Report of four cases. AU - Zager, Eric L.. AU - Shaver, Ellen G.. AU - Hurst, Robert W.. AU - Flamm, Eugene S.. PY - 2002/9. Y1 - 2002/9. N2 - Aneurysms of the distal anterior inferior cerebellar artery (AICA) are rare; fewer than 100 cases have been reported. The authors detail their experience with four cases and present endovascular as well as microsurgical management options. The medical records and neuroimaging studies obtained in four patients who were treated at a single institution were reviewed. Clinical presentations, neuroimaging and intraoperative findings, and clinical outcomes were analyzed. There were three men and one woman; their mean age was 43 years. Two patients presented with acute subarachnoid hemorrhage (SAH), and two presented with ataxia and vertigo (one with tinnitus, the other with hearing loss). Angiographic studies demonstrated aneurysms of the distal segment of the AICA. In one patient with ...
Objectives: To determine under what circumstances repair of unruptured intracranial aneurysms may be beneficial. Methods: A life expectancy analysis of patients with unruptured aneurysms with and without repair based on prospective data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). Results: Life years are lost at all ages by repairing anterior circulation aneurysms under 7 mm in diameter in patients with no history of a subarachnoid haemorrhage from another aneurysm (incidental). For all other aneurysms the number of life years saved by repair is dependent on the patients age at the time when repair is undertaken. Between 2 and 40 years are saved by repairing aneurysms in patients aged 20 years. These benefits fall to 0 when remaining life expectancy falls below 15-35 years, corresponding to the age range of 45-70 years. Conclusions: Repair of unruptured aneurysms benefits patients harbouring them by improving life expectancy except in certain circumstances. The ...
TY - JOUR. T1 - Management of anterior inferior cerebellar artery aneurysms. T2 - Endovascular treatment and clinical outcome. AU - Suh, S. H.. AU - Kim, D. J.. AU - Kim, D. I.. AU - Kim, Byungmoon. AU - Chung, T. S.. AU - Hong, C. K.. AU - Jung, J. Y.. PY - 2011/1/1. Y1 - 2011/1/1. N2 - BACKGROUND AND PURPOSE: AICA aneurysms are rare and a challenge to treat surgically. We present our experience of the angiographic results and the clinical outcomes for 9 AICA aneurysms treated by EVT. MATERIALS AND METHODS: Between 1997 and 2009, EVT was attempted for 9 AICA aneurysms. Six patients presented with SAH, and 3 aneurysms were found incidentally. The location of the aneurysms was the proximal AICA in 7 and the distal AICA in 2. Five aneurysms originated from an AICA-PICA variant. Clinical outcomes and procedural complications were evaluated, and angiography was performed 6, 12, and 24 months after embolization to confirm recanalization of the coiled aneurysm. RESULTS: EVT was technically successful ...
Background To compare the effects of endovascular coiling and neurosurgical clipping in patients with unruptured intracranial aneurysm.
SUZUKI, M.T.M. et al. De novo basilar tip aneurysm: Case report and literature review. Neurocirugía [online]. 2011, vol.22, n.3, pp.251-254. ISSN 1130-1473.. The de novo aneurysms are the formation of new aneurysms in a location previously observed to be normal by a cerebral angiography or direct microsurgical exploration. In this report, we present a review of the theme and describe a case of a ruptured de novo basilar tip aneurysm in a patient previously treated with carotid occlusion for a giant intracavernous aneurysm and microsurgical clipping of contralateral posterior communicating artery aneurysm.. Keywords : Basilar artery; De novo aneurysm; Subarachnoid hemorrhage. ...
Most unruptured cerebral aneurysms can be safely and durably treated using either microsurgical or endovascular techniques. The technical feasibility
Results From December 1996 to August 2012, 281 patients underwent 331 attempted endovascular procedures for treatment of an MCA aneurysm. Of these, 326 procedures were completed (5 attempted and failed). 217 procedures used balloon assistance. 85 were primary coilings. 4 were with the Pipeline device. 25 were with stent assistance. 17 were retreatments. 92 were for ruptured aneurysms. Mean aneurysm size was 6.6 mm.. The rate of intraprocedural aneurysm rupture or vessel perforation was 2.7% (9 of 331). 2 resulted in disabling strokes (mRS,2 at discharge) in patients with unruptured aneurysms, comprising the only patients with new disabling strokes with unruptured aneurysms in the entire cohort (0.6%, 2 of 331).. The rate of intraprocedural thromboembolic events was 13.9% (46 of 331), mostly in patients with acute subarachnoid haemorrhage (SAH, p,0.0001). Of these, 10 were symptomatic (3.0%); 9 of the 10 had SAH. Of the 10, 3 were transient ischaemic attacks (TIA) and 7 were strokes in the ...
To the Editor:. We read with interest the results of a large series of patients with intracranial aneurysms treated with stent-assisted coiling.1 A series of 216 patients with aneurysms (181 unruptured and 35 ruptured) were treated with this technique. Direct procedure-related mortality occurred in 10 of 216 (4.6%) and procedure-related permanent neurological deficit occurred in 16 of 216 (7.4%). In other words, 12% of patients either died or had permanent neurological deficit as a direct consequence of the treatment. This is an alarmingly high rate of serious complications, especially in a population harboring mostly unruptured aneurysms (with benign natural history) located on sites that are easily accessible for surgery. We cannot think of an unruptured aneurysm with a cumulative risk that outweighs this high complication rate. It is difficult to conceive that future patients with incidentally found unruptured aneurysms will consent to a proposed therapy with an almost 1-in-8 chance of death ...
I ve had 2 unruptured aneurysms monitored for about 20 years with CTA s. I m going to have an MRA, but on a 1.5 Tesla rather than the 3T MRI because of the type of aneurysm clip I have. I m concerned that it will not detect the very small aneurysms.
We appreciate the interest of Dr Bergui and colleagues in our article on safe surgery for unruptured intracranial aneurysms in patients without restrictions in postoperative lifestyle.1 Dr Bergui focuses our attention on the exclusion of two patients with surgical complications. We certainly agree with them that clinical symptoms may or may not appear, depending on the extent of the brain damage, the region of the brain damage involved, and the sensitivity of the tests applied. However, we maintain our conclusions for the following reasons.. The cognitive tests we applied can detect general intellectual function, visuospatial construction, and memory function. Although this test battery is not perfect, it can detect cognitive dysfunction if trans-Sylvian surgery affected the frontal and/or temporal lobes of the patient.. I do not agree that even uncomplicated surgery always requires invasive maneuvers in the brain, resulting in unavoidable brain damage. Surgery for unruptured intracranial ...
Objectives: The aim of this study was to compare the pre- and postoperative health-related quality-of-life (QOL) and psychological state of patients with asymptomatic unruptured intracranial aneurysms (ICAs) who underwent elective surgery. Methods: Of 67 patients who underwent neck clipping of ICAs, we assessed the QOL of 61 patients using Short Form-36 (SF-36); their psychological state was rated on the Hospital Anxiety and Depression Scale (HADS) before, 3 months, and 1- and 3 years after treatment. Results: The preoperative mean scores for each of the 8 SF-36 domains except bodily pain were significantly lower in the study- than the reference population. Fourteen patients (20.9%) experienced surgical complications defined as neurological deterioration and/or abnormal CT findings within 30 days of the operation. Despite some complications, the QOL of all operated patients returned to the mean level of the reference population 3 years post-treatment. At 3 months after surgery, the scores for ...
This study showed that coiling is associated with less harm than clipping in terms of disability measured by mRS and GOS, neurological and cardiac complications, but all of the studies included were observational. It is difficult to randomise controlled trials of surgical intervention in terms of such factors; consequently, observational studies may be the best available evidence. This is the first comprehensive systematic review and meta-analysis comparing clipping and coiling in patients with UIA. King et al. [11] and Raaymakers et al. [12] found mortality rates of 1.0% and 2.6% and morbidity rates of 4.1% and 10.9%, respectively, in meta-analyses of the outcome of clipping for UIA. Ontario [13] performed a systematic review on the outcome of clipping for intracranial aneurysms including UIA. These previous studies were systematic reviews of only a single intervention and did not compare interventions with one another. Therefore, the present study is meaningful despite some ...
Deregulation of miRNA-21 expression has been reported to be associated with vascular smooth muscle behavior and cytoskeletal stability. This study is aimed to investigate the density of serum miRNA-21 in patients with different phases of intracranial aneurysms (IAs) and explore its warning function for IA rupture. A total of 16 in 200 IA patients were selected and categorized into 4 groups based on the phase of IA. Microarray study was carried out using serum miRNA and differentially expressed miRNAs were identified. Another 24 samples from a cohort of 360 patients were added and real-time polymerase chain reaction (RT-PCR) was performed on expanded sample size (n = 40) for miRNA-21 validation. Potential gene targets of miRNA-21 were screened out from Gene Ontology (GO) database and literatures. Microarray study identified 77 miRNAs with significantly different expression levels between experimental groups and the control group. RT-PCR assays validated significant downregulation of miRNA-21 in
suggested by others 5, 15, 19 in multiple-aneurysm patients who had only one aneurysm treated. In addition, the percentage of the population suffering a rupture of an intact aneurysm is comparable to that found by Wiebers, et al. , 29 who studied the natural history of unruptured intracranial aneurysms in 65 patients followed for an average of 8.2 years. Eight of their 65 patients (12.3%) suffered a subsequent hemorrhage during the first decade after the initial bleed. The present study has an almost identical follow-up period (8.1 years), during which at least three. ...
Gemayel G, Verdon G, Murith N, Huber C. Rescue of a Failing Endovascular Infrarenal Aortic Repair Using an Off-The-Shelf Branched Endograft. Ann Vasc Surg. 2017 Jul 21. Gemayel G et al. Traitement des anévrismes aortiques à lère endovasculaire. Rev Med Suisse 2017; 13: 519-23. Gemayel G, A Rare Cause of Pulmonary Embolism: Popliteal Vein Aneurysm. Eur J Vasc Endovasc Surg. 2016 Jun;51(6):809. Gemayel G, Mootoosamy P, Murith N, Kalangos A. Embolization of a large rapidly growing aortic pseudo-aneurysm not amenable to open or endovascular repair. Ann Vasc Surg. 2016 May;33:230.e15-8. Myers PO, Gemayel G, Mugnai D, Murith N, Kalangos A. Endovascular exclusion of aortoesophageal fistula after coarctation extraanatomical bypass. Ann Thorac Surg.. 2014 Jul;98(1):314-6. Gemayel G, Murith N, Kalangos A. Off-label use of a reversed flared endurant iliac limb stengraft for the management of a life-threatening internal iliac artery aneurysm rupture. Vascular. 2014 Oct;22(5):381-4. Gariani K, Righini M, ...
The string of beads sign is the description typically given to the appearance of the renal artery in fibromuscular dysplasia (FMD) but may also be used to describe the appearance of splanchnic arteries in segmental arterial mediolysis (SAM). It r...
In this sample of patients treated in the United States from 2001 to 2008, we have found that endovascular coiling of unruptured intracranial aneurysms was associated with significantly less morbidity and mortality than surgical clipping. While we cannot know for any individual case in our study the relative merits of endovascular therapy versus open surgery versus observation, the results from the NIS data base suggest that patients treated in the United States with surgery generally face a significantly higher risk of adverse outcome than patients treated with endovascular therapy. This trend does not necessarily imply that all the patients treated with surgery should have been offered endovascular therapy, because for many of these patients, endovascular therapy may have been an inadequate option. While some have recommended that in treating unruptured cerebral aneurysms, "microsurgical clipping rather than endovascular coiling should be the first treatment choice in low-risk cases,"4 our ...
Endovascular techniques have evolved as an effective treatment for intracranial BBAs and in some studies they were associated with high rates of complete occlusion and good mid- to long-term neurological outcomes.. Due to its characteristics, simple coiling of ruptured BBA is almost impossible and stent-assisted coiling (SAC) is needed; moreover, stent endothelialization can cover the BBA neck. This technique facilitates placement of coils, but is associated with low occlusion rates: 33% initially and around 70% at mid- to long-term follow-up. Furthermore, SAC may be difficult and have potential associated risks, including aneurysm neck disruption or distal coil migration, microcatheter or microwire perforation and the only advantage of coil embolization of BBAs is that antiplatelet therapy is not needed. Some Authors suggest a delayed treatment, because in late stage BBAs may be covered by a thick clot, which improves their stability. In contrast a delayed treatment could be fatal due to the ...
Background and Purpose-The purpose of the present study was to calculate the prevalence and relative risk of unruptured incidental intracranial aneurysms IAs among families with IA cases compared with the general population in one geographically defined area in East Finland and to identify the risk group that could benefit most from screening...
Although treatment of a ruptured aneurysm is accepted as an emergency, indication for treatment of unruptured intracranial aneurysms (IAs) is still being discussed.
Ive been diagnosed with two mirror aneurysms with sacs in opthalmic artery. Have been given advise for clipping or flow diverter. Im looking for others who have or have had treated such aneurysm. Thanks to get In touch!
Objective: To evaluate the outcome and length of hospitalization of Endovascular Coiling and Surgical Clipping methods in the treatment of intracranial aneurysms in patie..
In this study, we assessed the safety and efficacy of an endovascular approach to MCA aneurysms in nonselected patients. All patients were consecutively included, not being selected by any criteria as long as they did not have fusiform or dissecting aneurysms, which minimized the effect of confounders and patient-selection bias. Even though MCA aneurysms are often considered unsuitable for endovascular therapy because of a wide neck and/or branches arising from the neck, these are now accessible because of the development of devices such as balloons and self-expanding stents. During the same time that the present study was conducted, no patients with MCA aneurysms were treated by clipping in our center. Only if the patient had symptomatic large intracerebral hematoma was a surgical evacuation conducted right after coiling. According to our results, endovascular treatment was feasible in all cases regardless of the aneurysm geometry or clinical status.. Complications occurred in 13.7% of patients ...
Disease in human physiology is often related to cardiovascular mechanics. Impressively, strokes are one of the leading causes of death in developed countries, and they might occur as a result of an aneurysm rupture, which is a sudden event in the majority of cases. On the basis of several autopsy and angiography series, it is estimated that 0.4-6 % of the general population harbors one or more intracranial aneurysms, and on average the incidence of an aneurysmal rupture is of 10 per 100,000 population per year, with tendency to increase in patients with multiple aneurysms [14, 20]. ...
Unruptured saccular intracranial aneurysm (sIA) is a relatively common disease (2%-3% prevalence).1 Asymptomatic unruptured sIAs are diagnosed increasingly frequently due to improved availability of magnetic resonance imaging (MRI) scans. Although sIAs may rupture causing devastating hemorrhage with mortality of 30% to 50%,2 most sIAs never rupture.3 The pathobiology of sIA formation and rupture need to be elucidated in…
A leading cosmetic surgery company which carried out a large proportion of PIP implant operations on British women insisted today that its
Jauffrais, T. , Herrenknecht, C. , Séchet, V. , Sibat, V. , Tillmann, U. , Krock, B. , Kilkoyne, J. , Miles, C. O. , McCarron, P. , Amzil, Z. and Hess, P. (2012 ...
TY - JOUR. T1 - Common Data Elements for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage Clinical Research. T2 - A National Institute for Neurological Disorders and Stroke and National Library of Medicine Project. AU - the Unruptured Intracranial Aneurysms and SAH CDE Project Investigators. AU - Suarez, Jose I.. AU - Sheikh, Muniza K.. AU - Macdonald, R. Loch. AU - Amin-Hanjani, Sepideh. AU - Brown, Robert D.. AU - de Oliveira Manoel, Airton Leonardo. AU - Derdeyn, Colin P.. AU - Etminan, Nima. AU - Keller, Emanuela. AU - Leroux, Peter D.. AU - Mayer, Stephan A.. AU - Morita, Akio. AU - Rinkel, Gabriel. AU - Rufennacht, Daniel. AU - Stienen, Martin N.. AU - Torner, James. AU - Vergouwen, Mervyn D.I.. AU - Wong, George K.C.. AU - Mayer, Stephan. AU - Bijlenga, Philippe. AU - Ko, Nerissa. AU - McDougall, Cameron G.. AU - Mocco, J.. AU - Murayama, Yuuichi. AU - Werner, Marieke J.H.. AU - Broderick, Joseph. AU - Dhar, Raj. AU - Jauch, Edward C.. AU - Kirkpatrick, Peter J.. AU - Martin, ...
Clinical presentation A middle-aged patient was referred for treatment of a bilobed saccular aneurysm identified on a CT angiogram performed for a subarachnoid hemorrhage which occurred 20 days prior to presentation. A diagnostic angiogram showed a bilobed wide-necked saccular aneurysm at the AICA origin with the AICA arising from the dome of the aneurysm and also supplying the territory of the posterior inferior cerebellar artery. The therapeutic procedure involved trans-aneurysmal cannulation of the AICA with the microcatheter left in situ. Another microcatheter was maneuvered into the larger dome of the aneurysm. A stent was then deployed in the basilar artery, jailing the previous microcatheter in the aneurysm. Helical Guglielmi detachable coils were deployed in the aneurysm resulting in complete occlusion of the aneurysm with preservation of the AICA.. ...
ISAT 2005": Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; 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 comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005 Sep 3-9;366(9488):809-17 ...
OBJECT: Endovascular treatment of very small aneurysms poses a significant technical challenge for endovascular therapists. The authors review their experience with a series of patients who had intracranial aneurysms smaller than 3 mm in diameter. METHODS: Between 1995 and 2006, 97 very small aneurysms (defined for purposes of this study as | 3 mm in diameter) were diagnosed in 94 patients who were subsequently referred for endovascular treatment. All patients presented after subarachnoid hemorrhage, which was attributed to the very small aneurysms in 85 patients. The authors reviewed the endovascular treatment, the clinical and angiographic results of the embolization, and the complications. RESULTS: Five (5.2%) of the 97 endovascular procedures failed, and these patients underwent craniotomy and clip ligation. Of the 92 aneurysms successfully treated by coil embolization, 64 (69.6%) were completely occluded and 28 (30.4%) showed minor residual filling or neck remnants on the immediate postembolization
We discuss a case with combined vestibulocochlear and facial neuropathy mimicking a less urgent peripheral vestibular pattern of acute vestibular syndrome (AVS). With initial magnetic resonance imaging read as normal, the patient was treated for vestibular neuropathy until headaches worsened and a diagnosis of subarachnoid hemorrhage was made. On conventional angiography, a ruptured distal right-sided aneurysm of the anterior inferior cerebellar artery was diagnosed and coiled. Whereas acute vestibular loss usually points to a benign peripheral cause of AVS, combined neuropathy of the vestibulocochlear and the facial nerve requires immediate neuroimaging focusing on the cerebellopontine angle. Imaging should be assessed jointly by neuroradiologists and the clinicians in charge to take the clinical context into account. ...
TY - JOUR. T1 - External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk. AU - Kammen, Mayte Sánchez van. AU - Greving, Jacoba P. AU - Kuroda, Satoshi. AU - Kashiwazaki, Daina. AU - Morita, Akio. AU - Shiokawa, Yoshiaki. AU - Kimura, Toshikazu. AU - Cognard, Christophe. AU - Januel, Anne C. AU - Lindgren, Antti. AU - Koivisto, Timo. AU - Jääskeläinen, Juha E. AU - Ronkainen, Antti. AU - Pyysalo, Liisa. AU - Öhman, Juha. AU - Rahi, Melissa. AU - Kuhmonen, Johanna. AU - Rinne, Jaakko. AU - Leemans, Eva L. AU - Majoie, Charles B. AU - Vandertop, W Peter. AU - Verbaan, Dagmar. AU - Roos, Yvo B W E M. AU - Berg, René van den. AU - Boogaarts, Hieronymus D. AU - Moudrous, Walid. AU - Wijngaard, Ido R van den. AU - Hove, Laura Ten. AU - Teo, Mario. AU - George, Edward J St. AU - Hackenberg, Katharina A M. AU - Abdulazim, Amr. AU - Etminan, Nima. AU - Rinkel, Gabriël J E. AU - Vergouwen, Mervyn D I. PY - 2019/9/1. Y1 - 2019/9/1. N2 - Background and ...
TY - JOUR. T1 - Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. AU - Mericle, Robert A.. AU - Wakhloo, Ajay K.. AU - Lopes, Demetrius K.. AU - Lanzino, Giuseppe. AU - Guterman, Lee R.. AU - Hopkins, L. Nelson. PY - 1998/7. Y1 - 1998/7. N2 - Guglielmi detachable coil (GDC) treatment for complicated cerebral aneurysms is an attractive option that has become widely accepted in recent years. This technique is usually considered only if the patient harbors an aneurysm that is not a good candidate for surgical clipping. However, the definition of surgical candidate varies among institutions, and many patients worldwide are being treated with GDCs as primary therapy. Although most centers currently perform follow-up angiography at 6 months to 1 year, others do not routinely perform it after an initially good result. The authors present a case that indicates longer follow up may be necessary and illustrates some of the pitfalls of GDC treatment. ...
A prospective study was designed to evaluate clinical outcome in a series of 100 consecutively treated patients who underwent endovascular embolization of 104 intracranial aneurysms using Guglielmi detachable coils (GDCs). Midterm clinical outcome (2-6 years, average 3.5 years) was obtained for 94 p …
In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT mid
Results The aneurysm growth probability was 2.6±0.1% per year. The rate of unexpected aneurysm rupture before treatment was 0.24% per year (95% CI 0.17% to 2.40%). The calculated rate of aneurysm rupture after growth was 6.3% per aneurysm-year (95% CI 1% to 22%). Aneurysms located in the posterior circulation and aneurysms with lobulation were more likely to grow. Females or patients suffering hypertension were more likely to have an aneurysm growing. The probability of aneurysms growth increased with the size of the dome and was proportional to the number of aneurysms diagnosed in a patient. ...
As previously shown, many factors associated with aneurysm rupture, like female sex, smoking, hypertension, larger aneurysm size, posterior circulation location and aneurysm shape, were also associated with aneurysm growth. However, the degree of heterogeneity in the effect estimates was moderate to substantial. The presence of multiple UIAs, which has not been readily identified as a factor associated with aneurysmal rupture, was shown to be significantly associated with aneurysm growth, raising the possibility that patients with multiple aneurysms might have a possibly connective-tissue based predilection towards more rapid growth than patients with single aneurysms, although it is important to note that this signal was also confounded by quite heterogeneous effect estimates. In contrast to their well-established association with aneurysmal rupture, family history of SAH and previous SAH were not significant factors for aneurysmal growth. Interestingly, UIA cohorts from Japan (where rates of ...
Many unruptured cerebral aneurysms can now be identified with CTA or MRA, without the more invasive catheter angiography. However, catheter angiography better diagnoses SAH. Angiography of any type is not perfect and can fail to identify small aneurysms of less than 3 mm.. Cerebral aneurysms may be treated surgically to reduce the risk of rupture, rebleeding, or brain damage from pressure the aneurysm places on brain tissue. Surgery to place a metal clip on the neck of an aneurysm that connects it to a parent vessel has been the standard treatment in the past. This procedure is major brain surgery and requires a craniotomy. A piece of the skull (skull flap) is sawed under general anesthesia and laid back for entry into the brain. This surgery has risks and the surgical risks for small aneurysms considerably exceed the risks of conservative (non-surgical) treatment.. A second surgical option has been the use of detachable coils of various sizes and shapes, which can be inserted without opening ...
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Hemodynamic stress toward the wall of intracranial artery with associated genuine defects of wall remodeling capacity is one of many hypotheses of subarachnoid aneurysm development. In addition, hemodynamic stress toward an aneurysm wall may play a very significant role for the rupture of an aneurysm creating acute Subarachnoid hemorrhage. We think the Wall Shear Stress (WSS) measurement toward an intracranial arterial wall and intracranial aneurysmal wall may provide valuable information for understanding of intracranial aneurysm development as well as predicting future morphological changes of aneurysm and possibly risk of future rupture. This study is significant especially in the management of unruptured subarachnoid arterial aneurysm patients and identifying patients who have higher rupture risks for active treatments such as surgical clipping or coiling to prevent unnecessary but potentially risky procedures.. Gadolinium MR Angiography with NOVA® Software will be used to measure the ...
BACKGROUND AND PURPOSE: Thrombus formation during endovascular embolization of intracranial aneurysms occurs in 2.9%-6% of patients. Use of IIb/IIIA inhibitors such as abciximab or eptifibatide intravenously has been reported in management of this complication. Because the intra-arterial infusion of IIb/IIIA inhibitors may require lower doses to achieve thrombolysis, it may reduce the risk of haemorrhage. Therefore, we retrospectively analyze our database and review the literature. METHODS: This is a retrospective analysis of a prospectively acquired database of patients with ruptured or unruptured aneurysm treated intra-arterially for thrombus formation during endovascular coil embolization between July 2005 and August 2008. Patient demographics, aneurysmal characteristics, procedural, clinical outcome and complications were recorded. RESULTS: From July 2005 to August 2008, out of 184 patients who underwent coil embolization, 19 patients (15 smokers, 14 female, mean age 52) developed intraprocedural
Dear Colleagues, I have a physician who is desperate to read this article ASAP, because his son was just diagnosed with the condition. The full text is not available in our subscribed edition of MD Consult. Wiebers DO. Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am. 2006 Aug;16(3):383-90, vii. PMID: 16935706 [PubMed - in process] Please contact me to avoid duplicates. PDF or fax preferred, but he is so anxious, Im pretty sure he would accept it scribbled on a napkin. Thank you in advance. Valerie ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Valerie G. Rankow, MLS Medical Librarian Brookhaven Memorial Hospital Medical Center Patchogue, NY 11772 Tel. 631-654-7774 Fax 631-447-3723 [log in to unmask] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ -------------------------------------------------------------------- mail2web - Check your email from the web at http://mail2web.com/ ...
When imaging patients for intracranial aneurysm, the goals are: (1) to assess the contour of the intracranial arteries, particularly in he regions of the ACOM (anterior communicating artery), PCOM (posterior communicating artery), ICA (internal carotid artery) bifurcation, MCA (middle cerebral artery) trifurcation, basilar tip, and PICA (posterior inferior cerebellar artery); (2) to assess the anatomy of the Circle of Willis and direction of flow, and; (3) to determine if there is evidence of a recent subarachnoid bleed
Background: Ruptured tiny intracranial aneurysms (TIAs) have been challenging both for endovascular and neurosurgical interventions. Thus, we aimed to evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) device in the treatment of ruptured TIAs (rTIAs). Material and Methods: Among 761 intracranial aneurysms which were treated either surgically or endovascularly, 3...
Subarachnoid haemorrhage (SAH) is a devastating neurological insult, and is increasingly understood as a multi-system condition initiated in the central nervous system. Perioperative investigation of patients presenting for aneurysm surgery often includes a routine electrocardiogram (ECG) which frequently reveals an abnormality. We describe a patient who presented with SAH and who was found to have significant Q waves on the ECG suggestive of a trans-mural myocardial infarction, despite a negative medical history for such an event. We brie-fly highlight the issues faced by the anaesthesiologist when dealing with the patient with SAH and ECG abnormality, and the implications for cardiovascular dysfunction.
For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients (fluid balance over the first 10 days of therapy: 3146.2 ± 296.4 vs 2910.5 ± 450.7 ml, respectively; p = ...
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