Small Aneurysms Account for the Majority and Increasing Percentage of Aneurysmal Subarachnoid Hemorrhage: A 25-Year, Single Institution Study

Bender, Matthew T.; Wendt, Haley; Monarch, Thomas; Beaty, Narlin; Lin, Li; Huang, Judy; Coon, Alexander L.; Tamargo, Rafael J.; Colby, Geoffrey P.

doi:10.1093/neuros/nyx484

Cited by 67 publications

(44 citation statements)

References 44 publications

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“…The rupture risk of IAs has been known to increase with increasing aneurysm size. However, some authors have found that the incidence of SAH caused by small aneurysms was increased [4][5][6][7], and have clearly demonstrated that approximately 13-50% of ruptured IAs (RIAs) were small (< 5 mm) [8,9]. As with large aneurysms, the most widely used scales for grading the disease severity of SAH in small (< 5 mm) intracranial aneurysms (SIAs) are the Hunt and Hess (H&H) and the Fisher grades (FG).…”

Section: Introductionmentioning

confidence: 99%

“…Junli Tai et al, Factors associated with severity of SAH For small aneurysms (< 5 mm) that are often considered to be at a low risk of rupture, conservative treatment is generally recommended clinically [8,9,12], so small aneurysms are the most likely type of aneurysm to receive conservative observations and protective treatments such as taking aspirin. Therefore, it is important to investigate the risk factors affecting the severity of SAH caused by small aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)

Tai¹,

Liu²,

Lv³

et al. 2019

Neurol Neurochir Pol.

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Aim. To identify the risk factors for clinical and radiographic grades of subarachnoid haemorrhage (SAH) in small (< 5 mm) intracranial aneurysms (SIAs). Material and methods. We retrospectively analysed patients with SIAs treated in our centre between February 2009 and June 2018. The clinical status was graded using the Hunt and Hess (H&H) score and the radiological severity of SAH was graded by Fisher grades (FG). The risk factors were determined using multivariate logistic regression analysis. results. A total of 160 patients with ruptured SIAs (< 5 mm) were included. In univariate analysis, smoking (P = 0.007), alcohol use (P = 0.048), aspirin use (P = 0.001), and higher size ratio (SR) (P = 0.001) were significantly associated with a higher H&H grade (3-5) in SIAs; and smoking (P = 0.019), aspirin use (P = 0.031), inflow angle < 90 degrees (P = 0.011), and aneurysm size (P = 0.039) were significantly associated with a higher FG score (3-4). In the adjusted multivariate analysis, previous SAH (

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)

Tai¹,

Liu²,

Lv³

et al. 2019

Neurol Neurochir Pol.

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“…Aneurysmal subarachnoid hemorrhage (aSAH) is a fateful neurological disorder which affects millions of people and aSAH always results in high mortality and disability, as well as high medical expenses . It was estimated that the annual incidence of aSAH worldwide was about 9/100 000 person/year and as many as 29% of aSAH patients died in the first 3 month . What's more, more than 1/3 of aSAH patients suffered cognitive impairment and experienced a decline of quality of life .…”

Section: Introductionmentioning

confidence: 99%

Increased concentration of serum periostin is associated with poor outcome of patients with aneurysmal subarachnoid hemorrhage

Luo

Wang

2018

Clinical Laboratory Analysis

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“…In the past 10 years of cerebral aneurysm research, the proportion of small ruptured aneurysms has increased to nearly 50% (26)(27)(28). Kim et al believed that a sidewall aneurysm found with multiple aneurysms or an AcomA aneurysm found from a patient with hypertension may be prone to rupture at smaller sizes.…”

Section: Discussionmentioning

confidence: 99%

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

2020

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Background: Small ruptured cerebral aneurysms (≤5 mm) account for the majority of aneurysmal subarachnoid hemorrhages, and its clinical management remains a challenge. The aim of this study was to identify the effect of age-related complications on the outcome of patients with small ruptured aneurysm. Methods: A retrospective review was performed in patients with small ruptured aneurysms who underwent microsurgical clipping or endovascular coiling from September 2012 to December 2018. According to their ages, the patients were divided into the elderly group and the non-elderly group. Baseline characteristics, clinical complications, and outcome of patients were analyzed between the two groups. A multivariate logistic regression analysis was used to determine the risk factors associated with the poor outcome of the elderly patients. Results: In the elderly group, 83 patients were treated with clipping and 50 were treated with coiling. In the non-elderly group, 188 patients were treated with clipping and 117 were treated with coiling. The incidence of neurological complications with neurologic deficit in the elderly group was significantly higher compared with that in the non-elderly group (P = 0.006). The elderly patients had a longer hospital stay (P = 0.032) and a poorer outcome (P = 0.001) compared with the non-elderly patients. A multivariate analysis showed that irregular aneurysms (P = 0.045) and ischemic events (P < 0.001) were independent risk factors associated with poor outcome in the elderly. Conclusions: Neurological complications with neurologic deficit, especially ischemic complications, were clearly more common in the elderly patients. Irregular small aneurysms or postoperative ischemic events should be paid attention as the higher risk of poor outcome in the elderly.

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Small Aneurysms Account for the Majority and Increasing Percentage of Aneurysmal Subarachnoid Hemorrhage: A 25-Year, Single Institution Study

Abstract: Ruptured small and very small aneurysms represent a majority and increasing share of aSAH. Identification and prophylactic treatment of these aneurysms remains an important clinical role for cerebrovascular neurosurgery.

Cited by 67 publications

References 44 publications

Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)

Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)

Increased concentration of serum periostin is associated with poor outcome of patients with aneurysmal subarachnoid hemorrhage

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

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