European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

Abstract

Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50–60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

“…Subjects' written informed consent was obtained according to the Declaration of Helsinki. The clinical care of SAH patients conformed to guidelines set forth by the Neurocritical Care Society, the American Heart Association/American Stroke Association and the European Stroke Organization 9, 10, 11. All patients were followed with every‐other‐day transcranial Doppler sonography (DWL Doppler‐Box system; Compumedics, Singen Germany) and received oral or intravenous nimodipine.…”

Decompressive craniotomy in patients with intracranial aneurysmal hemorrhage

“…Помимо операций по выключению аневризм, многим больным устанавливали наружный вентрику-лярный дренаж непосредственно при поступлении или после основной операции. Послеоперационное ведение и медикаментозное лечение в подавляющем большин-стве исследований осуществлялись в соответствии с международными рекомендательными протоколами [24][25][26]. Во многих исследованиях осуществляли до-операционный и/или послеоперационный контроль ВЧД с помощью паренхиматозных или вентрикулярных датчиков, что также входит в стандарт лечения тяжелых больных [26].…”

“…Малое количество и низкая достоверность имеющих-ся в литературе данных по ДТЧ не дают оснований для того, чтобы эта операция была включена в число меро-приятий, рекомендуемых международными протоколами по лечению больных с аневризматическим внутричереп-ным кровоизлиянием [24][25][26].…”

Inflammation in human cerebral aneurysms: pathogenesis, diagnostic imaging, genetics, and therapeutics

“…While having a 3.2% prevalence rate in the general population and 1.1% annual rupture risk, aneurysms remain lethal upon rupture in 40% of cases. [1][2][3] Risk for aneurysmal subarachnoid hemorrhage (SAH) is higher in hypertensive patients, smokers, heavy drinkers, and females. [2,4] The current interventional techniques, surgical clippings and endovascular occlusions, remain invasive despite advancements in technology.…”