Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We dis...Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.展开更多
Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging mo...Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.展开更多
Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence ...Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.展开更多
BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage....BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.展开更多
Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 201...Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 2015.Patients were grouped based on their history of aneurysmal subarachnoid hemorrhage(aSAH)into ruptured and unruptured categories.In the ruptured group,aneurysms were further classified as ruptured MIAs(R-MIAs)and unruptured MIAs(U-MIAs).Patient-and aneurysm-related factors were analyzed using univariate analysis to determine their significance in rupture risk.Receiver operating characteristic(ROC)analysis was employed to calculate the area under the curve(AUC)and identify optimal thresholds for five morphological parameters distinguishing R-MIAs from U-MIAs.Results:Of 368 enrolled patients,327(86 with ruptured aneurysms and 241 unruptured)were included in the analysis.Among the ruptured group,66 patients had R-MIAs and 96 had U-MIAs.Univariate analysis identified statistically significant factors associated with rupture,including BMI,irregular aneurysm shape,size,aspect ratio,size ratio,and bottleneck(P<0.05).Size,size ratio,and bottleneck exhibited high AUC values(AUC>0.7).ROC analysis determined an optimal threshold of 4.6 mm for MIA rupture size.Conclusions:Lower BMI,irregular aneurysm shape,larger size,larger size ratio,and bottleneck are associated with an increased risk of MIA rupture.Notably,MIAs may rupture at smaller sizes compared to single intracranial aneurysms.展开更多
BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneury...BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.展开更多
BACKGROUND In general,venous aneurysm associated with dural arteriovenous fistula(dAVF)is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself.How...BACKGROUND In general,venous aneurysm associated with dural arteriovenous fistula(dAVF)is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself.However,discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein,like cerebral arterial aneurysm,is quite rare and its pathomechanism remains unclear in patients with dAVF.CASE SUMMARY In this report,we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia.In both cases,significant curve or stenosis is observed in draining vein,which is located in just distal portion of the venous aneurysms.These aneurysms were successfully treated with a transarterial embolization.Underlying mechanism of venous aneurysms in these cases is discussed.CONCLUSION Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF,preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms.Considering the significant risk of rupture,a careful review of draining vein features including tortuosity or stenosis is needed,especially in venous aneurysms without evidence of venous hypertension.展开更多
Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatm...Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.展开更多
Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hem...Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.展开更多
The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We ...The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.展开更多
The treatment for intracranial aneurysm (IA) is socially important because of poor outcome posed by subarachnoid hemorrhage after rupture. Further, the incidence of IAs in general public is high and, indeed, in develo...The treatment for intracranial aneurysm (IA) is socially important because of poor outcome posed by subarachnoid hemorrhage after rupture. Further, the incidence of IAs in general public is high and, indeed, in developed countries many IAs are incidentally found through brain check. However, to date, options for treatment of IAs to prevent rupture are quite limited only to surgical procedures such as microsurgical clipping and endovascular coiling. Taking into account unavoidable risks of complication from surgical interventions and numerous aneurysm careers without treatment, less invasive medical therapies should be established. In human IA lesions, the presence of inflammatory responses, such as expressions of pro-inflammatory mediators and infiltration of inflammatory cells, have been reported, which suggests the involvement of inflammatory responses in the pathogenesis of IA. Recent experimental studies using rodent models have revealed the crucial role of inflammatory responses mediated by NF-κB activation in IA formation and progression and supported the notion that IA is an inflammatory disease affected intracranial arteries. To find out a candidate drug for IA treatments, the effect of several drugs with anti-inflammatory and anti-NF-κB actions on IA progression has been examined using rodent models and revealed the excellent inhibitory effect of statins (HMG-CoA reductase inhibitors) on IA progression. Based on these findings, the case-control study was recently carried out enrolling patients with unruptured or ruptured IAs to examine the effect of statin usage on rupture. This study revealed the significant differences in the ratio of statin usage between two groups and notably the remarkable reduction of risk of rupture of pre-existing IAs under statin usage at the adjusted odds ratio of 0.30. Recent laboratory and clinical studies make considerable achievement toward the future development of drugs for IA treatment and especially suggest the potential of statins as a candidate.展开更多
<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy...<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups.<strong> Results:</strong> There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (<em>P</em> > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. <strong>Conclusion:</strong> Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.展开更多
Subaracoid hemorrhage caused by intracranial aneurysms is characterized by high morbidity and mortality.There is no definite conclusion regarding the mechanism of formation,development,and rupture of intracranial aneu...Subaracoid hemorrhage caused by intracranial aneurysms is characterized by high morbidity and mortality.There is no definite conclusion regarding the mechanism of formation,development,and rupture of intracranial aneurysms.It is generally believed to be related to congenital hereditary connective tissue diseases and acquired hemodynamic factors,vascular inflammation,and oral pathogens.In addition,gender,age,hypertension,and psychological status are also important factors.Relevant studies show a significantly lower quality of life in patients with intracranial aneurysms,and psychological factors should be studied in more depth.Neurological complications are considered an important factor in the decrease in quality of life.In conclusion,the formation,development,and rupture of intracranial aneurysms should result from a combination of congenital and acquired factors.展开更多
Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients wit...Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group)and laser-cut stent-assisted coiling(laser-cut stent group)were retrospectively reviewed from January 2014 to December 2017.Propensity score matching was used to adjust for potential differences in age,sex,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results:A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching.The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group(92.7%vs 80.6%;3.7%vs 9.7%,P=0.078).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.495 and P=0.875,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,postoperative early rebleeding,and procedure-related death were 0.7%(1/142),1.4%(2/142),2.8%(4/142),and 2.1%(3/142)in the LVIS stent group,respectively,and 4.3%(4/93),2.2%(2/93),1.1%(1/93),and 3.2%(3/93)in the laser-cut stent group,respectively(P=0.082,0.649,0.651,and 0.683).Nevertheless,the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group(5.6%vs 14.0%,P=0.028;0.7%vs 6.5%,P=0.016).Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedurerelated complications(OR=2.727,P=0.037);a history of diabetes(OR=7.275,P=0.027)and other cerebrovascular diseases(OR=8.083,P=0.022)were independent predictors for ischemic complications,whereas none of the factors were predictors for hemorrhagic complications.Conclusions:Compared with laser-cut stent-assisted coiling,LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.展开更多
Background:The purpose of this analysis is to evaluate the current evidence with regard to the effectiveness and safety between coiling and clipping in patients with ruptured intracranial aneurysms(RIAs).Methods:We pe...Background:The purpose of this analysis is to evaluate the current evidence with regard to the effectiveness and safety between coiling and clipping in patients with ruptured intracranial aneurysms(RIAs).Methods:We performed a meta-analysis that compared clipping with coiling between July 2000 and September 2021.PubMed,EMBASE,and the Cochrane Library were searched for related articles systematically.And the treatment efficacy and postoperative complications were analyzed.Results:We identified three randomized controlled trials and thirty-seven observational studies involving 60,875 patients with ruptured cerebral aneurysms.The summary results showed that coiling was related a better quality of life(mRS0-2;OR=1.327;CI=1.093-1.612;p<0.05),a higher risk of mortality(OR=1.116;CI=1.054-1.180;p<0.05),higher rate of rebleeding(RR=1.410;CI=1.092-1.822;p<0.05),lower incidence of vasospasm(OR=0.787;CI=0.649-0.954;p<0.05),higher risk of hydrocephalous(RR=1.143;CI=1.043-1.252;p<0.05),lower risk of cerebral infarction(RR=0.669;CI=0.596-0.751;p<0.05),lower risk of neuro deficits(RR=0.720;CI=0.582-0.892;p<0.05),and a lower rate of complete occlusion(OR=0.495;CI=0.280-0.876;p<0.05).Conclusion:Coiling was significantly associated with a better life quality(mRS0-2),a lower incidence of postoperative complications,and a higher rate of mortality,rebleeding,hydrocephalous,and a lower rate of complete occlusion than clipping.展开更多
Subarachnoid hemorrhage （SAH） is a subtype of stroke that is most commonly caused by the rupture of intracranial aneurysm. Endovascular occlusion of intracranial aneurysms has emerged as an alternative to the establ...Subarachnoid hemorrhage （SAH） is a subtype of stroke that is most commonly caused by the rupture of intracranial aneurysm. Endovascular occlusion of intracranial aneurysms has emerged as an alternative to the established microsurgical clipping, The decision process when choosing a treatment for ruptured intracranial aneurysm should comprise an algorithm that was based on the characteristics of the aneurysm and patient status, age, and neurological condition, rather than a blanket assumption that one modality is superior to another.展开更多
文摘Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.
基金Supported by Natural Science Foundation Project of Chongqing,No.CSTB2024NSCQ-MSX1265.
文摘Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.
文摘Background: It has been conclusively established that intracranial aneurysms measuring a diameter below 7 mm pose a minimal risk of rupture. Conversely, those exhibiting irregular morphology or featuring the presence of a sac necessitate a more stringent and rigorous management approach. Objective: The primary aim of this study is to delve into the morphological features of ruptured aneurysms situated in distinct regions of the brain. Furthermore, we endeavor to assess the degree of safety and efficacy associated with stent-assisted embolization as a treatment modality for these ruptured aneurysms. Methods: This retrospective study encompassed a cohort of 467 patients who presented with intracranial ruptured aneurysms and were diagnosed through a combination of computed tomography (CT) and digital subtraction angiography (DSA) at Nanfang Hospital of Southern Medical University, spanning from January 2009 to December 2019. The following clinical parameters were meticulously recorded: aneurysm height, width, neck measurements, immediate Raymond grade assessments, and any perioperative complications experienced. Results: Within the study population, the average dimensions of ruptured aneurysms were found to be 4.26 ± 2.10 mm (width), 4.86 ± 2.38 mm (height), and 4.04 ± 1.87 mm (neck). Categorically, the most prevalent types of aneurysms were 170 cases of anterior communicating artery aneurysms (accounting for 36.4%), followed by 161 cases of posterior communicating artery aneurysms (34.5%), 56 cases of middle cerebral artery aneurysms (12.0%), 13 cases of anterior cerebral artery aneurysms (2.8%), 45 cases of paraclinoid aneurysms (9.6%), 6 cases of superior pituitary artery aneurysms (1.3%), 7 cases of anterior choroidal artery aneurysms (1.5%), and 9 cases of vertebrobasilar artery aneurysms (2.0%). Notably, 18 patients (3.9%) presented with ruptured aneurysms coexisting with ascus. Regarding treatment approaches, 228 cases (48.8%) underwent stent-assisted embolization, 234 cases (50.1%) received coils embolization, and 5 cases (1.1%) were treated with the dual-catheter technique. Immediately post-treatment, 422 patients (90.4%) attained a Raymond Class I status, with a procedure-related complication rate of 0.9%. Importantly, no statistically significant differences were observed in the incidence of perioperative complications across the three distinct treatment groups (P = 0.505). Conclusion: The outcomes of this study affirm the safety and efficacy of stent-assisted embolization as a treatment modality for ruptured aneurysms.
文摘BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.
文摘Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 2015.Patients were grouped based on their history of aneurysmal subarachnoid hemorrhage(aSAH)into ruptured and unruptured categories.In the ruptured group,aneurysms were further classified as ruptured MIAs(R-MIAs)and unruptured MIAs(U-MIAs).Patient-and aneurysm-related factors were analyzed using univariate analysis to determine their significance in rupture risk.Receiver operating characteristic(ROC)analysis was employed to calculate the area under the curve(AUC)and identify optimal thresholds for five morphological parameters distinguishing R-MIAs from U-MIAs.Results:Of 368 enrolled patients,327(86 with ruptured aneurysms and 241 unruptured)were included in the analysis.Among the ruptured group,66 patients had R-MIAs and 96 had U-MIAs.Univariate analysis identified statistically significant factors associated with rupture,including BMI,irregular aneurysm shape,size,aspect ratio,size ratio,and bottleneck(P<0.05).Size,size ratio,and bottleneck exhibited high AUC values(AUC>0.7).ROC analysis determined an optimal threshold of 4.6 mm for MIA rupture size.Conclusions:Lower BMI,irregular aneurysm shape,larger size,larger size ratio,and bottleneck are associated with an increased risk of MIA rupture.Notably,MIAs may rupture at smaller sizes compared to single intracranial aneurysms.
文摘BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
文摘BACKGROUND In general,venous aneurysm associated with dural arteriovenous fistula(dAVF)is considered to be developed under long standing venous hypertension and manifested as venous ectasia of draining vein itself.However,discrete saccular shaped venous aneurysm without angiographic evidence of venous hypertension arising from the draining vein,like cerebral arterial aneurysm,is quite rare and its pathomechanism remains unclear in patients with dAVF.CASE SUMMARY In this report,we present two cases of ruptured saccular venous aneurysms associated with dAVF without venous hypertension or venous ectasia.In both cases,significant curve or stenosis is observed in draining vein,which is located in just distal portion of the venous aneurysms.These aneurysms were successfully treated with a transarterial embolization.Underlying mechanism of venous aneurysms in these cases is discussed.CONCLUSION Although there is little doubt that hemodynamic stress has a critical role in the development of venous aneurysms in patients with dAVF,preceding venous hypertension or venous ectasia is not necessary for development and enlargement of venous aneurysms.Considering the significant risk of rupture,a careful review of draining vein features including tortuosity or stenosis is needed,especially in venous aneurysms without evidence of venous hypertension.
文摘Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.
基金supported by Research Project of Third Military Medical University(2016YLC22)
文摘Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.
文摘The spontaneous disappearance of a ruptured intracranial aneurysm is unusual and its mechanism remains incompletely understood. However, several hypotheses are put forward and are mostly found in Virchow’s triad. We report the case of a man who suffered subarachnoid hemorrhage by rupture of a blister aneurysm of the P1 segment of the left posterior cerebral artery. A control arteriography performed one week after the rupture showed a disappearance of the aneurysm and a significant vasospasm of the carrier artery. Angiograms performed at 3 weeks and 3 months confirmed this disappearance of the aneurysm and a return to normal artery size. Clinically the patient was doing well. Therefore his aneurysm was spontaneously declared cured. Several studies are needed to clarify the natural history of spontaneously thrombosed aneurysms and elucidate their occurrence mechanism in order to improve the management of intracranial aneurysmal pathology.
文摘The treatment for intracranial aneurysm (IA) is socially important because of poor outcome posed by subarachnoid hemorrhage after rupture. Further, the incidence of IAs in general public is high and, indeed, in developed countries many IAs are incidentally found through brain check. However, to date, options for treatment of IAs to prevent rupture are quite limited only to surgical procedures such as microsurgical clipping and endovascular coiling. Taking into account unavoidable risks of complication from surgical interventions and numerous aneurysm careers without treatment, less invasive medical therapies should be established. In human IA lesions, the presence of inflammatory responses, such as expressions of pro-inflammatory mediators and infiltration of inflammatory cells, have been reported, which suggests the involvement of inflammatory responses in the pathogenesis of IA. Recent experimental studies using rodent models have revealed the crucial role of inflammatory responses mediated by NF-κB activation in IA formation and progression and supported the notion that IA is an inflammatory disease affected intracranial arteries. To find out a candidate drug for IA treatments, the effect of several drugs with anti-inflammatory and anti-NF-κB actions on IA progression has been examined using rodent models and revealed the excellent inhibitory effect of statins (HMG-CoA reductase inhibitors) on IA progression. Based on these findings, the case-control study was recently carried out enrolling patients with unruptured or ruptured IAs to examine the effect of statin usage on rupture. This study revealed the significant differences in the ratio of statin usage between two groups and notably the remarkable reduction of risk of rupture of pre-existing IAs under statin usage at the adjusted odds ratio of 0.30. Recent laboratory and clinical studies make considerable achievement toward the future development of drugs for IA treatment and especially suggest the potential of statins as a candidate.
文摘<strong>Objective:</strong> To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. <strong>Methods:</strong> Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups.<strong> Results:</strong> There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (<em>P</em> > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. <strong>Conclusion:</strong> Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.
文摘Subaracoid hemorrhage caused by intracranial aneurysms is characterized by high morbidity and mortality.There is no definite conclusion regarding the mechanism of formation,development,and rupture of intracranial aneurysms.It is generally believed to be related to congenital hereditary connective tissue diseases and acquired hemodynamic factors,vascular inflammation,and oral pathogens.In addition,gender,age,hypertension,and psychological status are also important factors.Relevant studies show a significantly lower quality of life in patients with intracranial aneurysms,and psychological factors should be studied in more depth.Neurological complications are considered an important factor in the decrease in quality of life.In conclusion,the formation,development,and rupture of intracranial aneurysms should result from a combination of congenital and acquired factors.
基金This work was supported by the National Key Research and Development Program of China(grant no.: 2016YFC1300703)National Natural Science Foundation of China(grant no.: 81701136, 81571126).
文摘Background:To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods:Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group)and laser-cut stent-assisted coiling(laser-cut stent group)were retrospectively reviewed from January 2014 to December 2017.Propensity score matching was used to adjust for potential differences in age,sex,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results:A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching.The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group(92.7%vs 80.6%;3.7%vs 9.7%,P=0.078).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.495 and P=0.875,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,postoperative early rebleeding,and procedure-related death were 0.7%(1/142),1.4%(2/142),2.8%(4/142),and 2.1%(3/142)in the LVIS stent group,respectively,and 4.3%(4/93),2.2%(2/93),1.1%(1/93),and 3.2%(3/93)in the laser-cut stent group,respectively(P=0.082,0.649,0.651,and 0.683).Nevertheless,the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group(5.6%vs 14.0%,P=0.028;0.7%vs 6.5%,P=0.016).Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedurerelated complications(OR=2.727,P=0.037);a history of diabetes(OR=7.275,P=0.027)and other cerebrovascular diseases(OR=8.083,P=0.022)were independent predictors for ischemic complications,whereas none of the factors were predictors for hemorrhagic complications.Conclusions:Compared with laser-cut stent-assisted coiling,LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.
文摘Background:The purpose of this analysis is to evaluate the current evidence with regard to the effectiveness and safety between coiling and clipping in patients with ruptured intracranial aneurysms(RIAs).Methods:We performed a meta-analysis that compared clipping with coiling between July 2000 and September 2021.PubMed,EMBASE,and the Cochrane Library were searched for related articles systematically.And the treatment efficacy and postoperative complications were analyzed.Results:We identified three randomized controlled trials and thirty-seven observational studies involving 60,875 patients with ruptured cerebral aneurysms.The summary results showed that coiling was related a better quality of life(mRS0-2;OR=1.327;CI=1.093-1.612;p<0.05),a higher risk of mortality(OR=1.116;CI=1.054-1.180;p<0.05),higher rate of rebleeding(RR=1.410;CI=1.092-1.822;p<0.05),lower incidence of vasospasm(OR=0.787;CI=0.649-0.954;p<0.05),higher risk of hydrocephalous(RR=1.143;CI=1.043-1.252;p<0.05),lower risk of cerebral infarction(RR=0.669;CI=0.596-0.751;p<0.05),lower risk of neuro deficits(RR=0.720;CI=0.582-0.892;p<0.05),and a lower rate of complete occlusion(OR=0.495;CI=0.280-0.876;p<0.05).Conclusion:Coiling was significantly associated with a better life quality(mRS0-2),a lower incidence of postoperative complications,and a higher rate of mortality,rebleeding,hydrocephalous,and a lower rate of complete occlusion than clipping.
文摘Subarachnoid hemorrhage （SAH） is a subtype of stroke that is most commonly caused by the rupture of intracranial aneurysm. Endovascular occlusion of intracranial aneurysms has emerged as an alternative to the established microsurgical clipping, The decision process when choosing a treatment for ruptured intracranial aneurysm should comprise an algorithm that was based on the characteristics of the aneurysm and patient status, age, and neurological condition, rather than a blanket assumption that one modality is superior to another.
