Comment to “Endovascular treatment of ruptured intracranial aneurysms during pregnancy: report of three cases”

Marshman, Laurence A.G.; Manjit, S.; Aspoas, A. Robert

doi:10.1007/s00404-004-0707-x

Cited by 20 publications

(15 citation statements)

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“…Late trials state the 2 year complete obliteration rate as 80-84% [73,74], compared to 14-90% using combined SRS and Endovascular approaches [75]. 90% of AVM obliterations occur between 24 and 58 months period [68], for these reasons (mainly for safety), we didn't recommend stereotactic management at all in our cases.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to stereotactic radiosurgery, the radiation used in endovascular embolization falls mostly short of teratogenicity [63]. First, Marshman et al [68] report a 30-45 minute radiation exposure of 0.17 to 2.8 mGy [69], well below the teratogenic threshold (estimated to be 100 mGy at 0-8 embryonic days, 120 mGy at 8-15 weeks, 250 mGy at 16-25 weeks and 500 mGy at 2-8 weeks & 25th week onwards). In addition, Onyx and DMSO materials -being inert molecules-have not yet proved to be teratogenic [70,71].…”

Section: Discussionmentioning

confidence: 99%

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Untitled

2016

JNSK

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Submit Manuscript | http://medcraveonline.com IntroductionBrain Arteriovenous malformations (AVM) are abnormal communication between parts of cranial arterial and venous systems with the lack of a true nutritive and absorptive capillary bed [1]. The universal prevalence of AVM is relatively uncommon, with a prevalence ranging from 0.01-0.5%, 10/100000 to 140-500/100000 specifically [2][3][4][5][6][7] clustering between 3 rd and 5 th decade i.e. presenting usually before 40 years old of age [4,8,9]. AVM commonly presents with hemorrhage in more than one half of the cases even during pregnancy [4,8,[10][11][12][13][14][15][16][17] AbstractBackground: Cerebral arteriovenous malformations (AVMs) are relatively uncommon lesions in general population and rare among pregnant females, meanwhile they carry a relatively higher morbidity and mortality. In view of limited data for optimal management, we try to address dilemmas commonly encountered in pregnant females with cranial AVM and propose multidisciplinary algorithms for safe management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

2016

JNSK

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“…16) An experiment using a standard body phantom was conducted in a digital subtraction angiography suite. 25) The scattered``uterine'' dose was 11 mGy/min, whereas the direct``uterine'' dose was 4.6 mGy/min. Assuming that the radiation exposure for the groin and for the head is 30 seconds and 45 minutes, respectively, in a general endovascular procedure, the absorbed fetal dose was measured to be 2.8 mGy.…”

Section: Maternal and Fetal Radiation Exposurementioning

confidence: 99%

“…As described earlier, the impact of ionizing radiation on the fetus is considered to be negligible in routine endovascular procedures such as coil embolization for aneurysms. 25) Antiplatelet and anticoagulation drugs are mostly non-teratogenic. However, heparin, routinely used in endovascular procedures, should be stopped before cesarean section to avoid hemorrhagic risk.…”

Section: Subarachnoid Hemorrhage (Sah)mentioning

confidence: 99%

“…With optimal shielding, a routine endovascular procedure such as coiling does not cause radiation exposure over the threshold that leads to consideration of abortion. 25) It is recommended that antiplatelet drugs be administered for a certain period after the endovascular procedure, particularly after coiling for unruptured aneurysm. 10) However, these medicines may increase hemorrhagic risks during delivery.…”

Section: Unruptured Cerebral Aneurysmmentioning

confidence: 99%

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Endovascular Treatment in Pregnancy

Ishii

Miyamoto

2013

Neurol. Med. Chir.(Tokyo)

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There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient.

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