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International Subarachnoid Aneurysm Trial

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https://www.readbyqxmd.com/read/28502692/what-factors-determine-treatment-outcome-in-aneurysmal-subarachnoid-haemorrhage-in-the-modern-era-a-post-hoc-stash-analysis
#1
Mario Teo, Mathew R Guilfoyle, Carole Turner, Peter J Kirkpatrick
INTRODUCTION: The management of aneurysmal SAH has changed dramatically in the last few decades with the publication of a few major studies including The International Cooperative Study on the Timing of Aneurysm Surgery Study, International Subarachnoid Aneurysm Trial (ISAT). The aim of this study is to analyse the outcome of patients with aSAH based on a contemporary series, identify the risk factors for poor outcome, and focusing on patients with good grades aSAH (to match the ISAT cohort)...
May 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28377249/trends-in-resident-operative-teaching-opportunities-for-treatment-of-intracranial-aneurysms
#2
Matthew Piazza, Nikhil Nayak, Zarina Ali, Gregory Heuer, Matthew Sanborn, Sherman Stein, James Schuster, M Sean Grady, Neil R Malhotra
OBJECTIVE: The International Subarachnoid Aneurysm Trial heralded a paradigm shift in the treatment of intracranial aneurysms. During this same time frame neurosurgical training programs increased in size and scope. The present study examines the impact of trends in surgical clipping and the endovascular treatment of intracranial aneurysms, over one decade, and the neurosurgical resident complement on the resident teaching environment using the Nationwide Inpatient Sample (NIS). METHODS: The NIS was used to estimate the number of aneurysms treated with either surgical clipping and endovascular methods from 2002 through 2011 at teaching institutions...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28355880/current-treatment-strategies-for-intracranial-aneurysms
#3
Junjie Zhao, Hao Lin, Richard Summers, Mingmin Yang, Brian G Cousins, Janice Tsui
Intracranial aneurysm is a leading cause of stroke. Its treatment has evolved over the past 2 decades. This review summarizes the treatment strategies for intracranial aneurysms from 3 different perspectives: open surgery approach, transluminal treatment approach, and new technologies being used or trialed. We introduce most of the available treatment techniques in detail, including contralateral clipping, wrapping and clipping, double catheters assisting coiling and waffle-cone technique, and so on. Data from major trials such as Analysis of Treatment by Endovascular approach of Non-ruptured Aneurysms (ATENA), Internal Subarachnoid Trial (ISAT), Clinical and Anatomical Results in the Treatment of Ruptured Intracranial Aneurysms (CLARITY), and Barrow Ruptured Aneurysm Trial (BRAT) as well as information from other clinical reports and local experience are reviewed to suggest a clinical pathway for treating different types of intracranial aneurysms...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28298025/outcome-after-hunt-and-hess-grade-v-subarachnoid-hemorrhage-a-comparison-of-pre-coiling-era-1980-1995-versus-post-isat-era-2005-2014
#4
Juergen Konczalla, Volker Seifert, Juergen Beck, Erdem Güresir, Hartmut Vatter, Andreas Raabe, Gerhard Marquardt
OBJECTIVE Outcome analysis of comatose patients (Hunt and Hess Grade V) after subarachnoid hemorrhage (SAH) is still lacking. The aims of this study were to analyze the outcome of Hunt and Hess Grade V SAH and to compare outcomes in the current period with those of the pre-International Subarachnoid Aneurysm Trial (ISAT) era as well as with published data from trials of decompressive craniectomy (DC) for middle cerebral artery (MCA) infarction. METHODS The authors analyzed cases of Hunt and Hess Grade V SAH from 1980-1995 (referred to in this study as the earlier period) and 2005-2014 (current period) and compared the results for the 2 periods...
February 24, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28216398/engaging-in-a-keyhole-concept-for-the-management-of-ruptured-and-unruptured-aneurysms
#5
Daniel D Cavalcanti, Roberto C de Paula, Paula L Alvarenga, Paulo José da Mata Pereira, Paulo Niemeyer Filho
OBJECTIVE: Many new endovascular devices have been used under the guidance of the International Subarachnoid Aneurysm Trial. Clipping still offers higher occlusion rates, and its technique continues to evolve, resulting in smaller exposures and reduced manipulation to brain tissue. We sought to evaluate the routine use of the minisphenoidal approach to manage intracranial aneurysms in a high-volume institution. METHODS: We retrospectively reviewed our database of patients with aneurysm from October 2013 to May 2016...
June 2017: World Neurosurgery
https://www.readbyqxmd.com/read/27621944/cost-effectiveness-analysis-of-endovascular-coiling-versus-neurosurgical-clipping-for-intracranial-aneurysms-in-republic-of-korea
#6
Hyuk Won Chang, Shang Hun Shin, Sang Hyun Suh, Bum-Soo Kim, Myung Ho Rho
PURPOSE: The International Subarachnoid Aneurysm Trial (ISAT) revealed that in ruptured intracranial aneurysms (RA), endovascular coiling (EC) yields better clinical outcomes than neurosurgical clipping (NC) at 1 year. In unruptured aneurysms (UIA), EC is being increasingly used as an alternative to NC due to patients' preference. There is a lot of difference in treatment cost (EC vs. NC) between countries. There is one recently published study dealing with the comparative cost analysis only in UIAs in South Korea...
September 2016: Neurointervention
https://www.readbyqxmd.com/read/27366977/landmark-papers-in-cerebrovascular-neurosurgery-2015
#7
REVIEW
Justin M Moore, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Apar S Patel, Christopher S Ogilvy, Ajith J Thomas
The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al...
September 2016: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/27325362/novel-treatments-in-neuroprotection-for-aneurysmal-subarachnoid-hemorrhage
#8
REVIEW
Robert F James, Daniel R Kramer, Zaid S Aljuboori, Gunjan Parikh, Shawn W Adams, Jessica C Eaton, Hussam Abou Al-Shaar, Neeraj Badjatia, William J Mack, J Marc Simard
New neuroprotective treatments aimed at preventing or minimizing "delayed brain injury" are attractive areas of investigation and hold the potential to have substantial beneficial effects on aneurysmal subarachnoid hemorrhage (aSAH) survivors. The underlying mechanisms for this "delayed brain injury" are multi-factorial and not fully understood. The most ideal treatment strategies would have the potential for a pleotropic effect positively modulating multiple implicated pathophysiological mechanisms at once...
August 2016: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/27160932/delayed-cerebral-ischaemia-prevention-and-treatment-after-aneurysmal-subarachnoid-haemorrhage-a-systematic-review
#9
REVIEW
M Veldeman, A Höllig, H Clusmann, A Stevanovic, R Rossaint, M Coburn
UNLABELLED: : The leading cause of morbidity and mortality after surviving the rupture of an intracranial aneurysm is delayed cerebral ischaemia (DCI). We present an update of recent literature on the current status of prevention and treatment strategies for DCI after aneurysmal subarachnoid haemorrhage. A systematic literature search of three databases (PubMed, ISI Web of Science, and Embase) was performed. Human clinical trials assessing treatment strategies, published in the last 5 yr, were included based on full-text analysis...
July 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27102908/trials-and-tribulations-an-evidence-based-approach-to-aneurysm-treatment
#10
REVIEW
Thomas Sorenson, Giuseppe Lanzino
Since the introduction of embolic coils in the early 1990s, endovascular treatment has gained much traction for use when treating ruptured and unruptured intracranial aneurysms. Three prospective studies have been conducted comparing endovascular coil embolization versus clipping for ruptured intracranial aneurysms. The first study took place in Finland and was the first head-to-head look at treating ruptured aneurysms by either endovascular coiling or surgical clipping. Results from this study suggested better functional outcome after endovascular treatment than surgery at the expenses of higher rates of incomplete aneurysm occlusion...
March 2016: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/27000210/intraoperative-mild-hypothermia-for-postoperative-neurological-deficits-in-people-with-intracranial-aneurysm
#11
REVIEW
Luying Ryan Li, Chao You, Bhuwan Chaudhary
BACKGROUND: Rupture of an intracranial aneurysm causes aneurysmal subarachnoid haemorrhage, which is one of the most devastating clinical conditions. It can be classified into five Grades using the Hunt-Hess or World Federation of Neurological Surgeons (WFNS) scale. Grades 4 and 5 predict poor prognosis and are known as 'poor grade', while grade 1, 2, and 3 are known as 'good grade'. Disturbances of intracranial homeostasis and brain metabolism are known to play certain roles in the sequelae...
March 22, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26985635/prediction-of-60-day-case-fatality-after-aneurysmal-subarachnoid-hemorrhage-external-validation-of-a-prediction-model
#12
Simone A Dijkland, Bob Roozenbeek, Patrick A Brouwer, Hester F Lingsma, Diederik W Dippel, Leonie J Vergouw, Mervyn D Vergouwen, Mathieu van der Jagt
OBJECTIVE: External validation of prognostic models is crucial but rarely done. Our aim was to externally validate a prognostic model to predict 60-day case fatality after aneurysmal subarachnoid hemorrhage developed from the International Subarachnoid Aneurysm Trial in a retrospective unselected cohort of subarachnoid hemorrhage patients. DESIGN: The model's predictors were age, aneurysm size, Fisher grade, and World Federation of Neurological Surgeons grade. Two versions of the model were validated: one with World Federation of Neurological Surgeons grade scored at admission and the other with World Federation of Neurological Surgeons grade at treatment decision...
August 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26733126/-clip-first-policy-in-management-of-intracranial-mca-aneurysms-single-centre-experience-with-a-systematic-review-of-literature
#13
REVIEW
Anna Steklacova, Ondrej Bradac, Frantisek Charvat, Patricia De Lacy, Vladimir Benes
BACKGROUND: The results of microsurgical treatment for middle cerebral artery (MCA) aneurysms (ANs) have been highly satisfying for decades, notoriously posing a challenge for interventional neuroradiologists. Following the International Subarachnoid Aneurysm Trial (ISAT) study results, most centres across Europe and the USA switched to a "coil first" policy. The purpose of this study is to evaluate and critically review the substantiation of this change. METHODS: The authors conducted a single-institution retrospective study of MCA AN treatment between January 2000 and December 2013 maintaining a "clip first" policy...
March 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/26474147/trials-and-tribulations-an-evidence-based-approach-to-aneurysm-treatment
#14
T Sorenson, G Lanzino
Since the introduction of embolic coils in the early 1990s, endovascular treatment has gained much traction for use when treating ruptured and unruptured intracranial aneurysms. Three prospective studies have been conducted comparing endovascular coil embolization versus clipping for ruptured intracranial aneurysms. The first study took place in Finland and was the first head-to-head look at treating ruptured aneurysms by either endovascular coiling or surgical clipping. Results from this study suggested better functional outcome after endovascular treatment than surgery at the expenses of higher rates of incomplete aneurysm occlusion...
October 16, 2015: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/26337329/results-of-surgical-clipping-in-a-neurointerventional-dominant-department
#15
Mario Teo, Sean Martin, Arachchige Ponweera, Alistair Macey, Nigel Suttner, Jennifer Brown, Jerome St George
OBJECTIVES: It has been 10 years since the publication of International Subarachnoid Aneurysm Trial (ISAT) (1-3) and the first-line treatment for cerebral aneurysms in many UK neurosurgical centres is endovascular occlusion. Local audit has shown a significant reduction in surgical clipping cases since 2002, with a fall from over 150 cases per year pre ISAT, to approximately 25 cases per year currently. More so the cases referred for surgical occlusion represent more challenging lesions...
2015: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/26280117/elevated-baseline-c-reactive-protein-as-a-predictor-of-outcome-after-aneurysmal-subarachnoid-hemorrhage-data-from-the-simvastatin-in-aneurysmal-subarachnoid-hemorrhage-stash-trial
#16
MULTICENTER STUDY
Carole L Turner, Karol Budohoski, Christopher Smith, Peter J Hutchinson, Peter J Kirkpatrick, G D Murray
BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome...
November 2015: Neurosurgery
https://www.readbyqxmd.com/read/26256068/management-of-recurrent-aneurysms-following-endovascular-therapy
#17
Kevin S Chen, Thomas J Wilson, William R Stetler, Matthew C Davis, David A Giles, Elyne N Kahn, Neeraj Chaudhary, Joseph J Gemmete, B Gregory Thompson, Aditya S Pandey
The aim of the current study is to describe the complication rates and clinical outcomes in patients who either underwent repeat intervention or conservative management with radiographic surveillance when presenting with aneurysmal recurrence after endovascular treatment. Since publication of the international subarachnoid aneurysm trial (ISAT), an increasing number of patients are treated with endovascular therapy. However, recurrence after endovascular therapy continues to pose a challenge, and there is minimal evidence to guide its management...
December 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/26238743/treatment-of-intracranial-aneurysms-clipping-versus-coiling
#18
REVIEW
Ann Liu, Judy Huang
Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics. The spectrum of presentation of IAs ranges from incidental detection to devastating subarachnoid hemorrhage. Although the gold standard imaging technique is intra-arterial digital subtraction angiography, other modalities such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are being increasingly used for screening and treatment planning...
September 2015: Current Cardiology Reports
https://www.readbyqxmd.com/read/26231628/international-differences-in-the-management-of-intracranial-aneurysms-implications-for-the-education-of-the-next-generation-of-neurosurgeons
#19
Nabeel Alshafai, Olesya Falenchuk, Michael D Cusimano
BACKGROUND: The publication of the International Subarachnoid Aneurysm Trial rapidly changed the management of patients with subarachnoid hemorrhage. The present and perceived future trends of aneurysm management have significant implications for patients and how we educate future cerebrovascular specialists. OBJECTIVE: To determine present perceived competencies of final-year neurosurgical residents who have just finished their residencies and to relate those to what practitioners from a variety of continents expect of these persons...
September 2015: Acta Neurochirurgica
https://www.readbyqxmd.com/read/26170846/aneurismal-subarachnoid-hemorrhage-who-remains-for-surgical-treatment-in-the-post-isat-era
#20
Marta Koźba-Gosztyła, Bogdan Czapiga, Włodzimierz Jarmundowicz
INTRODUCTION: Although there have been a number of studies on changes and trends in the management of aneurismal subarachnoid hemorrhage (aSAH) since publication of the International Subarachnoid Aneurysm Trial (ISAT), no data exist on what category of patients still remains for surgical treatment. Our goal was to investigate the changes that occurred in the characteristics of a population of aSAH patients treated surgically in the post-ISAT period in a single neurosurgical center, with limited availability of endovascular service...
June 19, 2015: Archives of Medical Science: AMS
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