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Cerebral aneurysm randomized

Marielle Ernst, Levente Kriston, Uta Hanning, Andreas M Frölich, Jens Fiehler, Jan Hendrik Buhk
BACKGROUND AND PURPOSE: To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score. MATERIALS AND METHODS: Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications...
December 4, 2018: Journal of Neurointerventional Surgery
Jie Song, Yue-Qin Xue, Yan-Ju Wang, Peng Xu, De-Ke Sun, Wei Chen
AIMS: The present meta-analysis was conducted to provide an update on the efficacy and safety profile of clazosentan with different doses in aSAH. METHODS: We performed a comprehensive and electronic search of the following databases updated to September, 2018: the Cochrane library, Embase and PubMed, to identify relevant clinical trials. Trials of the effectiveness of clazosentan in treating cerebral vasospasm after aSAH were studied, of which the main outcomes included new cerebral infarction (NCI), delayed ischemic neurological deficit (DIND), vasospasm associated with morbidity/mortality (M/M), angiographic vasospasm, rescue therapy and adverse events...
November 26, 2018: World Neurosurgery
Ofer Sadan, Owen Samuels, William H Asbury, John J Hanfelt, Kai Singbartl
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition that results from a ruptured cerebral vessel. Cerebral edema and vasospasm are common complications and frequently require treatment with hypertonic solutions, in particular hypertonic sodium chloride (NaCl). We have previously shown that hyperchloremia in patients with aSAH given hypertonic NaCl is associated with the development of acute kidney injury (AKI), which leads to higher morbidity and mortality...
November 14, 2018: Trials
Rabie Soliman, Gomaa Zohry
BACKGROUND: Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone on the incidence of cerebral vasospasm after subarachnoid hemorrhage. METHODS: The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg...
November 5, 2018: Revista Brasileira de Anestesiologia
Jie Sun, Yuchun Liu, Junjun Zhang, Xiaosheng Chen, Zhiqing Lin, Sheng Nie, Manhua Shi, Xiang Gao, Yi Huang
Cerebral vasospasm is the major cause of a poor outcome after aneurysmal subarachnoid hemorrhage (aSAH), and effective treatments for vasospasm are limited. The purpose of this study was to research the impact of electroacupuncture (EA) on cerebral vasospasm and the outcomes of patients with aSAH. A total of 60 age- and sex-matched aSAH patients were collected from Ningbo First Hospital between December 2015 and June 2017. All patients were given a basic treatment of nimodipine and randomized into two groups...
2018: Frontiers in Neuroscience
Kazutaka Sugimoto, Sadahiro Nomura, Satoshi Shirao, Takao Inoue, Hideyuki Ishihara, Reo Kawano, Akiko Kawano, Fumiaki Oka, Eiichi Suehiro, Hirokazu Sadahiro, Mizuya Shinoyama, Takayuki Oku, Yuichi Maruta, Yuya Hirayama, Koichiro Hiyoshi, Miwa Kiyohira, Hiroshi Yoneda, Koki Okazaki, Jens P Dreier, Michiyasu Suzuki
OBJECTIVE: Traditionally, angiographic vasospasm (aVS) has been thought to cause delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, successful treatment of aVS alone does not result in improved neurological outcome. Therefore, there may be other potential causes of poor neurological outcome, including spreading depolarization (SD). A recent study showed beneficial effects of cilostazol on DCI and neurological outcome. The present prospective clinical trial and experimental study focused on effects of cilostazol on SDs...
October 20, 2018: Annals of Neurology
Jonathan Rychen, Davide Croci, Michel Roethlisberger, Erez Nossek, Matthew B Potts, Ivan Radovanovic, Howard A Riina, Luigi Mariani, Raphael Guzman, Daniel W Zumofen
OBJECTIVE: To clarify the reported experience with keyhole approaches for the treatment of intracranial aneurysms. METHODS: The PubMed and Embase databases were searched up to December 2017 for full-text publications that report the treatment of aneurysms with the eyebrow variant of the supraorbital craniotomy (SOC), the minipterional craniotomy, or the eyelid variant of the SOC. The anatomical distribution of aneurysms, the postoperative aneurysm occlusion rate, and the type and rate of complications were examined using univariate analysis...
October 12, 2018: Neurological Research
Giuseppe Esposito, Martina Sebök, Sepideh Amin-Hanjani, Luca Regli
BACKGROUND AND AIMS: Cerebral bypasses are categorized according to function (flow augmentation or flow preservation) and to characteristics: direct, indirect or combined bypass, extra-to-intracranial or intra-to-intracranial bypass, and high-, moderate- or low-capacity bypass. We critically summarize the current state of evidence and grades of recommendation for cerebral bypass surgery. METHODS: The current indications for cerebral bypass are discussed depending on the function of the bypass (flow preservation or augmentation) and analyzed according to level of evidence criteria...
2018: Acta Neurochirurgica. Supplement
Hamidreza Saber, Aaron Desai, Mohan Palla, Wazim Mohamed, Navid Seraji-Bozorgzad, Muhammed Ibrahim
OBJECTIVES: Cilostazol, a selective inhibitor of phosphodiesterase 3, may reduce symptomatic vasospasm and improve outcome in patients with aneurysmal subarachnoid hemorrhage considering its anti-platelet and vasodilatory effects. We aimed to analyze the effects of cilostazol on symptomatic vasospasm and clinical outcome among patients with aneurysmal subarachnoid hemorrhage (aSAH). PATIENTS AND METHODS: We searched PubMed and Embase databases to identify 1) prospective randomized trials, and 2) retrospective trials, between May 2009 and May 2017, that investigated the effect of cilostazol in patients with aneurysmal aSAH...
August 6, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jean-Mathieu Mastantuono, Christophe Combescure, Nadia Elia, Martin R Tramèr, Christopher Lysakowski
OBJECTIVES: To evaluate the performance of transcranial Doppler and transcranial color-coded duplex Doppler in patients with cerebral vasospasm due to aneurysm rupture. Angiography was considered as the gold standard comparator. DATA SOURCES: Search in MEDLINE, Embase, and Central from January 2001 to October 2017, without language restriction. Bibliographies of retrieved articles were screened for additional studies. STUDY SELECTION: Randomized studies comparing transcranial Doppler or transcranial color-coded duplex Doppler with angiography in adults...
October 2018: Critical Care Medicine
Jong Wha Lee, Jae Hee Woo, Hee Jung Baik, Dong Yeon Kim, Ji Seon Chae, Na Rae Yang, Eui Kyo Seo
Cerebral vasospasm is the most important cause of morbidity after an aneurysm clipping in the early postoperative period. The aim of this retrospective study was to evaluate whether the incidence of vasospasms differs when using propofol or desflurane for an emergent aneurysm clipping.The data from 102 patients (50 in the propofol group, 52 in the desflurane group) were analyzed. The occurrence of vasospasm based on daily transcranial Doppler, angiography, and cerebral infarction during 14 days after surgery were compared by anesthetic agents...
August 2018: Medicine (Baltimore)
Xinrui Wang, Chengcheng Zhu, Jing Li, Andrew J Degnan, Tao Jiang, Jianping Lu
The aim of this study was to compare image quality of low tube voltage cerebral computed tomography angiography (CTA) reconstructed with knowledge-based iterative model reconstruction (IMR), filtered back projection (FBP), and hybrid iterative reconstruction (HIR).A total of 101 patients with suspected cerebrovascular diseases were enrolled and randomized into 2 groups, 100 kVp tube voltage (n = 53) and reduced tube voltage (80 kVp) (n = 48). Computed tomography data were reconstructed with IMR, FBP, and HIR algorithms...
July 2018: Medicine (Baltimore)
Hidenori Suzuki, Yoshinari Nakatsuka, Ryuta Yasuda, Masato Shiba, Yoichi Miura, Mio Terashima, Yume Suzuki, Koichi Hakozaki, Fuki Goto, Naoki Toma
Cilostazol is a selective inhibitor of phosphodiesterase type III that downregulates tenascin-C (TNC), a matricellular protein, which may cause delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (SAH). The authors increased the dosage and evaluated the dose-dependent effects of cilostazol on delayed cerebral infarction and outcomes in SAH patients. This was a retrospective cohort study in a single center. One hundred fifty-six consecutive SAH patients including 67 patients of admission World Federation of Neurological Surgeons grades IV-V who underwent aneurysmal obliteration within 48 h post-SAH from 2007 to 2017 were analyzed...
July 23, 2018: Translational Stroke Research
Connor Howe, Saswat Mishra, Yun-Soung Kim, Yanfei Chen, Sang-Ho Ye, William R Wagner, Jae-Woong Jeong, Hun-Soo Byun, Jong-Hoon Kim, Youngjae Chun, Woon-Hong Yeo
Random weakening of an intracranial blood vessel results in abnormal blood flow into an aneurysmal sac. Recent advancements show that an implantable flow diverter, integrated with a medical stent, enables a highly effective treatment of cerebral aneurysms by guiding blood flow into the normal vessel path. None of such treatment systems, however, offers post-treatment monitoring to assess the progress of sac occlusion. Therefore, physicians rely heavily on either angiography or magnetic resonance imaging. Both methods require a dedicated facility with sophisticated equipment settings and time-consuming, cumbersome procedures...
August 28, 2018: ACS Nano
Daniel Hänggi, Nima Etminan, Stephan A Mayer, E Francois Aldrich, Michael N Diringer, Erich Schmutzhard, Herbert J Faleck, David Ng, Benjamin R Saville, R Loch Macdonald
BACKGROUND: Nimodipine is the only drug approved in the treatment of aneurysmal subarachnoid hemorrhage (aSAH) in many countries. EG-1962, a product developed using the Precisa™ platform, is an extended-release microparticle formulation of nimodipine that can be administered intraventricularly or intracisternally. It was developed to test the hypothesis that delivering higher concentrations of extended-release nimodipine directly to the cerebrospinal fluid would provide superior efficacy compared to systemic administration...
July 16, 2018: Neurocritical Care
Tim E Darsaut, Robert Fahed, R Loch Macdonald, Adam S Arthur, M Yashar S Kalani, Fuat Arikan, Daniel Roy, Alain Weill, Alain Bilocq, Jeremy L Rempel, Michael M Chow, Robert A Ashforth, J Max Findlay, Luis H Castro-Afonso, Miguel Chagnon, Guylaine Gevry, Jean Raymond
OBJECTIVE Ruptured intracranial aneurysms (RIAs) can be managed surgically or endovascularly. In this study, the authors aimed to measure the interobserver agreement in selecting the best management option for various patients with an RIA. METHODS The authors constructed an electronic portfolio of 42 cases of RIA in which an angiographic image along with a brief clinical vignette for each patient were displayed. Undisclosed to the responders was that the RIAs had been categorized as International Subarachnoid Aneurysm Trial (ISAT) (small, anterior-circulation, non-middle cerebral artery location, n = 18) and non-ISAT (n = 22) aneurysms; the non-ISAT group also included 2 basilar apex aneurysms for which a high number of endovascular choices was expected...
July 13, 2018: Journal of Neurosurgery
Gyanendra Kumar, Oana M Dumitrascu, Chia-Chun Chiang, Cumara B O'Carroll, Andrei V Alexandrov
OBJECT: Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD. METHODS: We searched PUBMED, the Cochrane database, and clinicaltrials...
July 11, 2018: Neurocritical Care
Xiya Chen, Ting Lei
The aim of the present study is to investigate whether glycerol fructose combined with vitamin B6 is beneficial to the postoperative recovery of patients with cerebral aneurysm (CA). A total of 134 patients receiving embolization of CA in the Central Hospital of Wuhan between February, 2013 and June, 2015 and were divided into observation and control groups according to the random number table method, with 67 cases in each group. The control was given vitamin B6 routine treatment, while the observation group received glycerol fructose on the basis of treatment in the control group...
July 2018: Experimental and Therapeutic Medicine
Christopher R Andersen, Emily Fitzgerald, Anthony Delaney, Simon Finfer
Consensus on appropriate outcome measures to use in aneurysmal subarachnoid hemorrhage (aSAH) research has not been established, although the transition toward a core outcome set (COS) would provide significant benefits. To inform COS development, we conducted a systematic review to identify outcome measures included in reports of randomized clinical trials (RCTs) of interventions in patients with aSAH. Ovid Medline, EMBASE, CINAHL, and CENTRAL were searched. RCTs investigating aSAH published between January 1996 and May 2015 were included...
June 27, 2018: Neurocritical Care
A I Khripun, A D Priamikov, A B Mironkov, L D Gulina
Presented herein is the world experience of surgical treatment and various tactical approaches in a combined lesion of the extracranial and intracranial portions of the internal carotid artery (ICA): a combination of its stenosis or occlusion with vascular malformation of the brain (a cerebral aneurysm, pathological anastomoses, arteriovenous malformations). Also pointed out is the prevalence of the pathology involved, followed by describing various types of surgical policy in this condition: staged and simultaneous interventions, endovascular and standard operative auxiliary techniques...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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