Treatment of ruptured intracranial aneurysms yesterday and now

Hammer, Alexander; Steiner, Anahi; Kerry, Ghassan; Ranaie, Gholamreza; Baer, Ingrid; Hammer, Christian; Kunze, Stefan; Steiner, Hans-Herbert

doi:10.1371/journal.pone.0172837

Cited by 20 publications

(11 citation statements)

References 31 publications

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“…The most common aneurysms were Acom (43%), MCA (16%) and ICA (15%), respectively. This is compatible with most of other studies [7,12,15,17,25,30,36]. The rate of multiple aneurysms have been reported 10-15% in prior literature but the amount of less than 5% to more than 30% have been reported, too [20,31,43].…”

Section: Discussionsupporting

confidence: 91%

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

Gharib-Salehi

Alimohammadi

Bagheri

et al. 2017

IrJNS

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Background and Aim:This study aimed at analyzing the demographic characteristics of the patients with non-traumatic intracranial hemorrhage, their angiographic results and the correlation between computed tomography (CT) scan and angiography findings. Methods and Materials/Patients:In a descriptive study, we retrospectively reviewed the records of the patients with non-traumatic intracranial hemorrhage based on their brain CT or lumbar puncture findings from 2011 to 2017. For all patients, four vessel catheter angiography via the femoral approach was performed in the Medical Imaging Center of Kermanshah University of Medical Sciences, Iran. Results:We investigated 143 cases with non-traumatic intracranial hemorrhage which was indicated in CT findings (91.61%) or lumbar puncture (8.39%). Of 143 patients, 64 (44.8%) were men and 79 (55.2%) women (mean age 53.7±12.1 years old). Moreover, 104(72.7%) patients had Subarachnoid Hemorrhage (SAH), 19(13.3%) of them had Intracranial Hemorrhage (ICH), 8(5.6%) ones had Intraventricular Hemorrhage (IVH) and 12(8.4%) patients had normal brain CT. There were 100 cases of aneurysm (69.93%), 13 cases of Arteriovenous Malformations (AVM) (9.09%), 28 cases with negative angiograms (19.58%), and 2 cases with other pathologies (1.4%). Seven (4.89%) cases of multiple aneurysms were also recorded. Of 13 patients with AVM, 8(61.5%) patients had AVM in parieto-occipital region, 2(15.4%) in temporal, 1(7.7%) in frontal region and 2(15.4%) had deep AVM. Two (1.4%) patients with SAH had dural AVF. Twenty-eight (19.6%) patients had negative angiogram, 22 cases of them had second angiography after one to two weeks. The most common positive finding in the second angiogram was Acom aneurysm (18.18%). Conclusion:Aneurysms and AVMs are the most common causes of non-traumatic intracranial hemorrhage. The most common site of intracranial aneurysms is the circle of Willis. A second angiogram after one to two weeks is necessary in most patients with negative results in first angiography after non-traumatic intracranial hemorrhage.

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Section: Discussionsupporting

confidence: 91%

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

Gharib-Salehi

Alimohammadi

Bagheri

et al. 2017

IrJNS

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“…The study was performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments. Data from the above-mentioned database were used in parts for previous publications [9][10][11] .…”

Section: Methodsmentioning

confidence: 99%

“…Finally, we want to call attention to the fact, that this work is part of a series of investigations which involve comparison of treatment after aneurysmal SAH, outcome and outcome dynamics after SAH and, within this study, LOS in ICU after SAH, where we analysed the same collective in whole or in part [9][10][11] .…”

mentioning

confidence: 99%

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Hammer

Ranaie

Erbguth

et al. 2020

Sci Rep

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In this observational study, we analysed a cohort of 164 subarachnoid haemorrhage survivors (until discharge from intensive care) with the aim to detect factors that influence the length of stay (LOS) in intensive care with multiple linear regression methods. Moreover, binary logistic regression methods were used to examine whether the time in intensive care is a predictor of outcome after 1 year. The clinical 1-year outcome was measured prospectively in a 12-month follow-up by telephone interview and categorised by the modified Rankin Scale (mRS). Patients who died during their stay in intensive care were excluded. Complications like pneumonia (β = 5.11; 95% CI = 1.75-8.46; p = 0.0031), sepsis (β = 9.54; 95% CI = 3.27-15.82; p = 0.0031), hydrocephalus (β = 4.63; 95% CI = 1.82-7.45; p = 0.0014), and delayed cerebral ischemia (DCI) (β = 3.38; 95% CI = 0.19-6.56; p = 0.038) were critical factors depending the LOS in intensive care as well as decompressive craniectomy (β = 5.02; 95% ci = 1.35-8.70; p = 0.0077). All analysed comorbidities such as hypertension, diabetes, hypothyroidism, cholesterinemia, and smoking history had no significant impact on the LOS in intensive care. LOS in intensive care (OR = 1.09; 95% CI = 1.03-1.15; p = 0.0023) as well as WFNS grade (OR = 3.72; 95% ci = 2.23-6.21; p < 0.0001) and age (OR = 1.06; 95% CI = 1.02-1.10; p = 0.0061) were significant factors that had an impact on the outcome after 1 year. Complications in intensive care but not comorbidities are associated with higher LOS in intensive care. LOS in intensive care is a modest but significant predictor of outcomes after subarachnoid haemorrhage. Subarachnoid haemorrhage (SAH) is a devastating disease that challenges all treating disciplines. Aside from direct effects of SAH on the brain parenchyma, and directly associated complications like rebleeding, delayed cerebral ischemia, and hydrocephalus, there is evidence that further medical complications play a crucial role in the outcome after SAH 1,2. It was reported that the proportion of deaths from medical complications is comparable to the proportion of deaths attributed to the direct effects of the initial haemorrhage, rebleeding, and vasospasm 1,2. However, these complications might be preventable or at least controllable. A better outcome might be achievable with improved intensive care management 1. Beside high rates of morbidity and mortality, SAH is associated with prolonged ICU length of stay (LOS) 2-4. Initial poor clinical condition and treatment modality, but especially duration of stay in ICU, are substantial economic factors in SAH. Treatment costs of SAH in the first year easily exceed costs in the first year of ischemic stroke 5,6. Some nosocomial infections in SAH are known to determine prolonged LOS 3,7. Galea et al. reported that patients who had significantly longer LOS after SAH had unfavourable outcomes at discharge 8. However, it is uncertain whether the total LOS in ICU is a direct predictor of outcome.

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“…Data of this study were partially published previously under different aspects by our group 14 , 15 .…”

Section: Methodsmentioning

confidence: 99%

Impact of Comorbidities and Smoking on the Outcome in Aneurysmal Subarachnoid Hemorrhage

Hammer

Steiner

Ranaie

et al. 2018

Sci Rep

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The intention of this observational study is to show the significant impact of comorbidities and smoking on the outcome in aneurysmal subarachnoid hemorrhage (SAH). During this observational study 203 cases of treatment of ruptured intracranial aneurysms were analyzed. We examined and classified prospectively the 12 month outcome according to the modified Rankin Scale (mRS) considering retrospectively a history of smoking and investigated prospectively the occurrence of early and delayed cerebral ischemia between 2012 and 2017. Using logistic regression methods, we revealed smoking (odds ratio 0.21; p = 0.0031) and hypertension (odds ratio 0.18; p = 0.0019) to be predictors for a good clinical outcome (mRS 0–2). Age (odds ratio 1.05; p = 0.0092), WFNS Grade (odds ratio 6.28; p < 0.0001), early cerebral ischemia (ECI) (odds ratio 10.06; p < 0.00032) and delayed cerebral ischemia (DCI) (odds ratio 4.03; p = 0.017) were detected as predictors for a poor clinical outcome. Significant associations of occurrence of death with hypertension (odds ratio 0.12; p < 0.0001), smoking (odds ratio 0.31; p = 0.048), WFNS grade (odds ratio 3.23; p < 0.0001) and age (odds ratio 1.09; p < 0.0001), but not with ECI (p = 0.29) and DCI (p = 0.62) were found. Smoking and hypertension seem to be predictors for a good clinical outcome after aneurysmal SAH.

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Treatment of ruptured intracranial aneurysms yesterday and now

Cited by 20 publications

References 31 publications

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

Impact of Complications and Comorbidities on the Intensive Care Length of Stay after Aneurysmal Subarachnoid Haemorrhage

Impact of Comorbidities and Smoking on the Outcome in Aneurysmal Subarachnoid Hemorrhage

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