Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

Cho, Won Sang; Kim, Jeong Eun; Park, Sukh Que; Ko, Jun Kyeung; Kim, Dae‐Won; Park, Jung Cheol; Yeon, Je Young; Chung, Seung Young; Chung, Joonho; Joo, Sung‐Pil; Hwang, Gyojun; Kim, Deog Young; Chang, Won Hyuk; Choi, Kyu-Sun; Lee, Sung Ho; Sheen, Seung Hun; Kang, Hyun-Seung; Kim, Byung Moon; Bae, Hee‐Joon; Oh, Chang Wan; Park, Hyeon Seon

doi:10.3340/jkns.2017.0404.005

Cited by 58 publications

(57 citation statements)

References 355 publications

(437 reference statements)

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“…To gain a more complete understanding of aSAH management, we recommend reading this paper in conjunction with guidelines statements, that discuss the evidence or lack thereof upon which aSAH management is based [ 2 , 56 , 58 , 115 , 116 , 117 ].…”

Section: Discussionmentioning

confidence: 99%

Lessons from the CONSCIOUS-1 Study

Schüpper

Eagles

Neifert

et al. 2020

JCM

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After years of research on treatment of aneurysmal subarachnoid hemorrhage (aSAH), including randomized clinical trials, few treatments have been shown to be efficacious. Nevertheless, reductions in morbidity and mortality have occurred over the last decades. Reasons for the improved outcomes remain unclear. One randomized clinical trial that has been examined in detail with these questions in mind is Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1). This was a phase-2 trial testing the effect of clazosentan on angiographic vasospasm (aVSP) in patients with aSAH. Clazosentan decreased moderate to severe aVSP. There was no statistically significant effect on the extended Glasgow outcome score (GOS), although the study was not powered for this endpoint. Data from the approximately 400 patients in the study were detailed, rigorously collected and documented and were generously made available to one investigator. Post-hoc analyses were conducted which have expanded our knowledge of the management of aSAH. We review those analyses here.

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Section: Discussionmentioning

confidence: 99%

Lessons from the CONSCIOUS-1 Study

Schüpper

Eagles

Neifert

et al. 2020

JCM

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“…In the 2015 American Heart Association (AHA)/ American Stroke Association (ASA) Guidelines for the Management of Spontaneous ICH 19) , GCS is considered not beneficial (Class III, level of evidence [LOE] A), but IPC should be used just after admission (Class I, LOE A). AHA/ASA Guidelines for the Management of Aneurysmal SAH do not describe the use IPC or GCS 11) , but European Stroke Organization (ESO) Guidelines for the Management of Intracranial Aneurysms and SAH 40) in 2012 and Korean Clinical Practice Guidelines for Aneurysmal SAH 7) in 2018 recommended applying IPC, GCS, or both to prevent DVT.…”

Section: Prophylaxis and Treatment Graduated Compression Stockings (Gcsmentioning

confidence: 99%

“…However, their conclusion does not seem to be clear. AHA/ASA Guidelines for the Management of Aneurysmal SAH and Korean Clinical Practice Guidelines for Aneurysmal SAH also indicate a lack of sufficient evidence for heparin use in SAH patients 7,11) . However, the AHA/ASA Guidelines for the Management of Spontaneous ICH recommend low-dose LMWH or UFH for immobile ICH patients 1-4 days from onset until after bleeding stops (Class IIb, LOE B) 19) .…”

Section: Unfractionated Heparin (Ufh) / Low-molecular-weight Heparin mentioning

confidence: 99%

Deep Vein Thrombosis and Pulmonary Embolism following Hemorrhagic Stroke

Lee

Jeong

Choi

et al. 2018

J Neurointensive Care

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Venous thromboembolism (VTE) after stroke is an infrequent but potentially fatal medical complication. The incidence of VTE was shown to be higher in hemorrhagic stroke than in ischemic stroke by several studies; however, no strategy for VTE screening and prophylaxis has been established. Lower extremity ultrasonography (US) is the diagnostic method of choice, but routine application for stroke patients is still debated. For prevention, graduated compression stockings (GCS) have little effect on VTE, and thigh-high GCS should be selected. Early use of intermittent pneumatic compression (IPC) has strong evidence for preventing VTE and is recommended in several clinical guidelines for managing intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Prophylactic heparin products are still debated for preventing VTE despite the risk of rebleeding or hematoma enlargement. To date, administering low-dose, low-molecular-weight heparin (LMWH) seems the best method to prevent VTE with less risk of hemorrhagic complications. However, the optimal product, dose, and timing are unclear.

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“…Endovascular treatment of intracranial aneurysms using coils has become an accepted alternative to aneurysm neck clipping 3,4,8) . Technological advancements have led to increased coil stability, improved microwire stability and flexibility, and development of smaller microcatheters, which have rendered the process safer and simpler.…”

Section: Introductionmentioning

confidence: 99%

Clinical Safety and Effectiveness of Stent-Assisted Coil Embolization with Neuroform Atlas Stent in Intracranial Aneurysm

Kim

Sung

et al. 2020

J Korean Neurosurg Soc

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Stent-assisted coil embolization (SAC) is commonly used for treating wide-neck intracranial aneurysms. In this study, we aimed to assess the clinical safety and efficacy of the NeuroForm Atlas Stent during SAC of intracranial aneurysms. Methods : We retrospectively analyzed data from patients with ruptured and unruptured cerebral aneurysms, who underwent SAC using the NeuroForm Atlas between February 2018 and July 2018. Favorable clinical outcomes and degree of aneurysm occlusion were defined as a modified Rankin scale score of ≤2 and a Raymond-Roy occlusion classification (RROC) class I/II during the immediate postoperative period and at the 6-month follow-up, respectively. Results : Thirty-one consecutive patients with 33 cases, including 11 ruptured and 22 unruptured cases were treated via NeuroForm Atlas SAC. Among the 22 unruptured cases with 24 unruptured aneurysms had favorable clinical outcome. Complete occlusion (RROC I) was achieved in 16 aneurysms (66.7%), while neck remnants (RROC II) were observed in six aneurysms (25%). Among the 11 patients with ruptured aneurysms, two died due to re-bleeding and diabetic ketoacidosis. In ruptured cases, RROC I was observed in eight (72.7%) and RROC II was observed in three cases (27.3%). At the 6-month follow-up, no clinical events were observed in the 22 unruptured cases. In the ruptured nine cases, five patients recovered without neurologic deficits, while four experienced unfavorable outcomes at 6 months. Of the 29 aneurysms examined via angiography at the 6-month follow-up, 19 (65.5%) were RROC I, eight (27.6%) were RROC II and two (6.9%) were RROC III. There were no procedure-related hemorrhagic complications. Conclusion : In this study, we found that stent-assisted coil embolization with NeuroForm Atlas stent may be safe and effective in the treatment of wide-neck intracranial aneurysms. NeuroForm Atlas SAC is feasible for the treatment of both ruptured and unruptured wide-neck aneurysms.

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Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

Cited by 58 publications

References 355 publications

Lessons from the CONSCIOUS-1 Study

Lessons from the CONSCIOUS-1 Study

Deep Vein Thrombosis and Pulmonary Embolism following Hemorrhagic Stroke

Clinical Safety and Effectiveness of Stent-Assisted Coil Embolization with Neuroform Atlas Stent in Intracranial Aneurysm

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