Treatment of Ruptured Intracranial Aneurysms

Fraser, Justin F.; Riina, Howard A.; Mitra, Nandita; Gobin, Y. Pierre; Simon, Arlene Stolper; Stieg, Philip E.

doi:10.1227/01.neu.0000245623.70344.f7

Cited by 38 publications

(3 citation statements)

References 39 publications

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“…Besides, some authors suggest that small aneurysms are associated with more extensive SAH. [45] Taylor et al [46] reported that aneurysms <5 mm tend to a more significant association with a higher score on the Fisher scale, although there was no difference in the incidence of vasospasm or overall outcomes.…”

Section: Discussionmentioning

confidence: 99%

Small aneurysms should be clipped?

et al. 2019

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Background: Cerebral aneurysm prevalence may vary from 0.4% to 10%. The decision to treat or not incidental aneurysms remains controversial, especially when the lesions are small (<5 mm). Many recent publications are demonstrating that these lesions often bleed. Methods: We reviewed admitted patients with angiographic studies submitted to intracranial aneurysm surgical treatment from April 2012 to July 2013 in the Neurosurgery Department of São Paulo Medical School University (15 months), to define the rate and risk of bleeding. In addition, we proceeded literature review with collected 357 papers (past 5 years) which were selected 50 that were focused on our research. Clinical patients’ status at the time of discharge was evaluated with the modified Rankin scale. Results: A series of 118 cases of surgically clipped aneurysms was analyzed: 73.7% woman; Ruptured (61 cases, 51%); middle cerebral artery (51 cases, 43%) was the more common aneurysm. Small size (<5 mm) was 25 cases (21%); that 2 died (16%), 3 (25%) with severe disability,restricted to bed and dependent on nursing care; blood pressure was the main risk factors (56%); and an aneurysm <2 mm (100%) was ruptured. Conclusion: The number of small aneurysms in our series was significant (25 cases, 21%), and its rate of bleeding was high (25 cases, 48%), resulting in death and disability in a significant number of cases. Our tendency is for surgical treatment when it is associated with risk factors.

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Section: Discussionmentioning

confidence: 99%

Small aneurysms should be clipped?

et al. 2019

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“…Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery 3)7)9). For successful treatment, the proper selection of devices is important as well as the operator's experience.…”

Section: Introductionmentioning

confidence: 99%

The Benefits of Navien™ Intracranial Support Catheter for Endovascular Treatment

Lee

Gong

Lee

et al. 2016

J Cerebrovasc Endovasc Neurosurg

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ObjectiveEndovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navien™ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter.Materials and MethodsWe reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels.ResultsThe Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications.ConclusionThe Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.

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“…A neurysmal subarachnoid hemorrhage (aSAH) affects more than 500 000 individuals annually and is associated with significant morbidity and mortality. [1][2][3][4] Historically, aSAH was primarily treated with microsurgical clipping. After the advent of modern endovascular techniques, many centers shifted to an endovascular approach as the primary treatment 1,5 because it is minimally invasive and has proven efficiency and efficacy in randomized controlled trials.…”

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confidence: 99%

Cost Comparison of Microsurgery vs Endovascular Treatment for Ruptured Intracranial Aneurysms: A Propensity-Adjusted Analysis

et al. 2022

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BACKGROUND:In specialized neurosurgical centers, open microsurgery is routinely performed for aneurysmal subarachnoid hemorrhage (aSAH).OBJECTIVE:To compare the cost of endovascular vs microsurgical treatment for aSAH at a single quaternary center.METHODS:All patients undergoing aSAH treatment from July 1, 2014, to July 31, 2019, were retrospectively reviewed. Patients were grouped based on primary treatment (microsurgery vs endovascular treatment). The primary outcome was the difference in total cost (including hospital, discharge facility, and all follow-up) using a propensity-adjusted analysis.RESULTS:Of 384 patients treated for an aSAH, 234 (61%) were microsurgically treated and 150 (39%) were endovascularly treated. The mean cost of index hospitalization for these patients was marginally higher ($9504) for endovascularly treated patients ($103 980) than for microsurgically treated patients ($94 476) (P = .047). For the subset of patients with follow-up data available, the mean total cost was $45 040 higher for endovascularly treated patients ($159 406, n = 59) than that for microsurgically treated patients ($114 366, n = 105) (P < .001). After propensity scoring (adjusted for age, sex, comorbidities, Glasgow Coma Scale score, Hunt and Hess grade, Fisher grade, aneurysms, and type/size/location), linear regression analysis of patients with follow-up data available revealed that microsurgery was independently associated with healthcare costs that were $37 244 less than endovascular treatment costs (P < .001). An itemized cost analysis suggested that this discrepancy was due to differences in the rates of aneurysm retreatment and long-term surveillance.CONCLUSION:Microsurgical treatment for aSAH is associated with lower total healthcare costs than endovascular therapy. Aneurysm surveillance after endovascular treatments, retreatment, and device costs warrants attention in future studies.

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Treatment of Ruptured Intracranial Aneurysms

Cited by 38 publications

References 39 publications

Small aneurysms should be clipped?

Small aneurysms should be clipped?

The Benefits of Navien™ Intracranial Support Catheter for Endovascular Treatment

Cost Comparison of Microsurgery vs Endovascular Treatment for Ruptured Intracranial Aneurysms: A Propensity-Adjusted Analysis

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