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Cerebral Aneurysm

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5401. Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms. (Abstract)

Therapeutic trial of intravenous nimodipine in patients with established cerebral vasospasm after rupture of intracranial aneurysms. The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both

1988 Neurosurgery Controlled trial quality: predicted high

5402. [Intravenous nimodipine in the treatment of cerebral vasospasm following subarachnoid hemorrhage caused by aneurysm rupture: a comparative multicenter study]. (Abstract)

[Intravenous nimodipine in the treatment of cerebral vasospasm following subarachnoid hemorrhage caused by aneurysm rupture: a comparative multicenter study]. The efficacy of intravenous Nimodipine (used at the rate of 2 mg.h-1) was investigated in the treatment of delayed ischemic deterioration or angiographic vasospasm after subarachnoid haemorrhage caused by a ruptured aneurysm in a randomized, double-blind, placebo-controlled multicenter study. A total of 127 case reports was validated: 73 (...) in group Nimodipine. The results of this study demonstrate the efficacy of intravenous Nimodipine in the treatment of consequences of cerebral vasospasm after a subarachnoid haemorrhage caused by a ruptured aneurysm.

1989 Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression Controlled trial quality: uncertain

5403. Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery. (Abstract)

Long-term effects of nimodipine on cerebral infarcts and outcome after aneurysmal subarachnoid hemorrhage and surgery. A total of 213 patients with verified aneurysmal subarachnoid hemorrhage (SAH) of Grades I to III (Hunt and Hess classification) were enrolled in a double-blind placebo-controlled trial to determine the effect of intravenous nimodipine on delayed ischemic deterioration and computerized tomography (CT)-visualized infarcts after SAH and surgery. The administration of the drug (...) or matching placebo was started immediately after the radiological diagnosis of a ruptured aneurysm had been made. Of the 213 patients enrolled in the study, 58 were operated on early (within 72 hours after the bleed: Days 0 to 3), 69 were operated on subacutely (between Days 4 and 7), and 74 had late surgery (on Day 8 or later). Eleven patients died before surgery was undertaken and one was not operated on. A follow-up examination with CT scanning, performed 1 to 3 years after the SAH (mean 1.4 years

1991 Journal of neurosurgery Controlled trial quality: predicted high

5404. Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. Full Text available with Trip Pro

Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. With the cooperation of 60 neurosurgical centers in Japan, a prospective randomized placebo-controlled double-blind trial of a new calcium antagonist AT877 (hexahydro-1-(5-isoquinolinesulfonyl)-1H-1,4-diazepine hydrochloride, or fasudil hydrochloride) was undertaken to determine the drug's effect on delayed cerebral vasospasm in patients with a ruptured (...) cerebral aneurysm. A total of 276 patients, who underwent surgery within 3 days after subarachnoid hemorrhage (SAH) of Hunt and Hess Grades I to IV, were entered into the study. Nine patients were excluded because of protocol violation. The remaining 267 patients received either 30 mg AT877 or a placebo (saline) by intravenous injection over 30 minutes, three times a day for 14 days following surgery. Demographic and clinical data were well matched between the two groups. It was found that AT877

1992 Journal of neurosurgery Controlled trial quality: predicted high

5405. Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. (Abstract)

Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. The angle of arteries at bifurcations, as well as the blood flow, are factors of hemodynamic stress on the apical region, where aneurysms often develop. Using images obtained with three-dimensional computed tomographic angiography, we sought to determine the angles between the A1 and A2 segments (...) of the anterior cerebral artery of the anterior communicating artery (ACoA) complex associated with aneurysms. These angles cannot be detected by conventional cerebral angiography.The course of the anterior cerebral artery was studied using three-dimensional computed tomographic angiography in 42 consecutive patients with ACoA aneurysms. Twenty-one other subjects, randomly chosen from patients without aneurysms, served as controls. Bilateral A1-A2 angles of the contrast-opacified anterior cerebral artery were

1999 Neurosurgery Controlled trial quality: uncertain

5406. Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Full Text available with Trip Pro

Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Transluminal angioplasty has become a widely used adjunct therapy to medical management of symptomatic cerebral vasospasm following subarachnoid hemorrhage (SAH). Despite anecdotal reports of universal, angiographically confirmed reversal of vasospasm and high rates of clinical improvement, no rigorous examination of the efficacy of this procedure has been (...) conducted. In this study the authors assess the efficacy of the aforementioned procedure.Thirty-eight patients enrolled as part of the North American trial of tirilazad in aneurysmal SAH underwent transluminal angioplasty for symptomatic cerebral vasospasm. Fifty-three percent of these patients showed good recovery or moderate disability based on their 3-month Glasgow Outcome Scale score. Among the 38 patients who underwent angioplasty, the severity and type of vasospasm, use of papaverine in addition

2000 Journal of neurosurgery Controlled trial quality: uncertain

5407. A phase II clinical trial of recombinant human tissue-type plasminogen activator against cerebral vasospasm after aneurysmal subarachnoid hemorrhage. (Abstract)

A phase II clinical trial of recombinant human tissue-type plasminogen activator against cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The results of a Phase II clinical trial of intrathecal recombinant tissue-type plasminogen activator for the prevention of vasospasm were reported. The subjects were 53 patients with aneurysmal subarachnoid hemorrhage (SAH), Groups 2 to 4 in Fisher's preoperative computed tomography classification and Grades II to IV in the Hunt-Kosnik

1994 Neurosurgery Controlled trial quality: uncertain

5408. Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage. (Abstract)

Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage. A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim (...) enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. Paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades

2003 American Journal of Tropical Medicine & Hygiene

5409. Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. Full Text available with Trip Pro

Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. The goal of this study was to examine the impact of hospital characteristics on outcome after the treatment of ruptured and unruptured cerebral aneurysms.We identified all discharges in New York State from 1995 through 2000 with a principal diagnosis of subarachnoid hemorrhage (SAH) or unruptured cerebral aneurysm (UCA) in patients who were treated by aneurysm clipping, wrapping, or endovascular coiling (...) after aneurysm clipping than after endovascular therapy.Hospital procedural volume and the propensity of a hospital to use endovascular therapy are both independently associated with better outcome. Improvement in outcome could be achieved by a program of regionalization and selective referral for the treatment of cerebral aneurysms.

2003 Stroke

5410. In vitro measurement of fluid-induced wall shear stress in unruptured cerebral aneurysms harboring blebs. (Abstract)

In vitro measurement of fluid-induced wall shear stress in unruptured cerebral aneurysms harboring blebs. Little attention has been focused on the role of fluid-induced wall shear stress in fully developed cerebral aneurysms. The purpose of this study is to evaluate the alternation and distribution of wall shear stress over 1 cardiac cycle in patients' aneurysms.A middle cerebral artery aneurysm and a basilar tip aneurysm with localized outpouching (blebs) in their domes were selected (...) to conduct a more realistic evaluation of wall shear stress in the aneurysms harboring blebs. These results provide us with further indications of the correlation of wall shear stress with the natural history of cerebral aneurysms.

2003 Stroke

5411. Role of a decreased expression of the local renin-angiotensin system in the etiology of cerebral aneurysms. Full Text available with Trip Pro

Role of a decreased expression of the local renin-angiotensin system in the etiology of cerebral aneurysms. Local renin-angiotensin systems (RAS) have been implicated as playing an important role in vascular remodeling. The relationship of this system to the etiology of cerebral aneurysm was investigated.The aneurysmal wall from patients with a ruptured or unruptured cerebral aneurysm and the cortical cerebral artery in control patients with head trauma or a glioma were taken during surgery (...) for study. Local RAS were evaluated by reverse transcription-polymerase chain reaction (RT-PCR) and/or immunohistochemistry. RT-PCR analysis revealed a significantly decreased expression of angiotensin-converting enzyme (ACE), angiotensin type 1 (AT1) receptor, basic fibroblast growth factor, platelet-derived growth factor-AA, and tissue inhibitor of matrix metalloproteinases-1 mRNA in the aneurysmal wall as compared with the control cortical arterial wall. Immunohistochemistry also revealed a decreased

2003 Circulation

5412. Intracranial heme metabolism and cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Full Text available with Trip Pro

Intracranial heme metabolism and cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The goal of this prospective study was to clarify the potential role of an inducible heme-metabolizing enzyme, heme oxygenase (HO)-1, and an inducible iron-detoxifying protein, ferritin, in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH).The authors measured the levels of bilirubin and iron, which are by-products of HO-1, and the ferritin levels in the cerebrospinal fluid in 39 (...) consecutive patients with aneurysmal SAH of Fisher computed tomography group III, and determined the relationship between these by-products of HO-1 or ferritin and vasospasm.Fourteen of 39 patients (35.9%) developed asymptomatic vasospasm, while 6 patients (15.4%) developed symptomatic vasospasm. The levels of ferritin, bilirubin, and iron were all significantly elevated after SAH. The levels of ferritin and bilirubin were significantly higher in patients with no vasospasm than in patients

2003 Stroke

5413. Disruption of gene for inducible nitric oxide synthase reduces progression of cerebral aneurysms. Full Text available with Trip Pro

Disruption of gene for inducible nitric oxide synthase reduces progression of cerebral aneurysms. The rupture of a cerebral aneurysm is a major cause of subarachnoid hemorrhage, but the mechanism of its development remains unclear. Inducible nitric oxide synthase (iNOS) is expressed in human and rat cerebral aneurysms, and aminoguanidine, a relatively selective inhibitor of iNOS, can decrease the number of the aneurysms in rats. In this study we applied our new mouse model of cerebral aneurysms (...) to the iNOS gene knockout mice and observed experimental cerebral aneurysms in these animals to elucidate the role of iNOS in the process of cerebral aneurysm formation.Eight C57/Bl6 mice and 16 iNOS knockout mice received a cerebral aneurysm induction procedure. Four months after the operation, the mice were killed, their cerebral arteries were dissected, and the region of the bifurcation of the anterior cerebral artery/olfactory artery was examined histologically and immunohistochemically.No significant

2003 Stroke

5414. The Feasibility of Three-Dimensional Guglielmi Detachable Coil for Embolisation of Wide Neck Cerebral Aneurysms Full Text available with Trip Pro

The Feasibility of Three-Dimensional Guglielmi Detachable Coil for Embolisation of Wide Neck Cerebral Aneurysms The three-dimensional Guglielmi detachable coil is a modification of the conventional Guglielmi coil. It has a unique complex structure, with alternating small and large loops at 90 degrees angle to each other during deployment. The enhanced coil complexity optimizes coil purchase on the aneurysm wall, promoting coil stability within the aneurysm sac. It may be the solution (...) of the single catheter technique in the embolisation of wide neck aneurysms.We report our early experience in the embolisation of wide neck aneurysms using these complex coils.

2001 Interventional Neuroradiology

5415. Iatrogenic Rupture of a Cerebral Aneurysm on the Feeding Artery of an Arteriovenous Malformation Full Text available with Trip Pro

Iatrogenic Rupture of a Cerebral Aneurysm on the Feeding Artery of an Arteriovenous Malformation We present the case of a patient with acute onset of headache who showed a flow-related acutely ruptured aneurysm on the feeding artery of an AVM in the angiogram. Rerupture of the aneurysm occurred during angiography after endovascular treatment with a Guglielmi detachable coil. The possible mechanisms leading to rupture of the aneurysm are discussed.

2001 Interventional Neuroradiology

5416. Significance of Volume Embolization Ratio as a Predictor of Recanalization on Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils Full Text available with Trip Pro

Significance of Volume Embolization Ratio as a Predictor of Recanalization on Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils The purposes of this study are, firstly, to define the relationship between volume embolization ratio (VER) and degree of angiographical occlusion in endovascular treatment with Guglielmi detachable coils, and secondly, to examine influences of neck and dome sizes of aneurysms on the VER and the angiographical treatment result, and thirdly (...) , to determine the relationship between the VER and the recanalization of coiled aneurysms. Fifty-two aneurysms in 46 patients were examined. VER ranged 8.1-31.9% (mean 18.5%). The mean VERs of each categories based on angiographical treatment results were 23.1% in complete occlusion, 16.1% in neck remnant and 12.2% in incomplete occlusion, respectively. The VER correlated significantly with both neck and dome size, while the angiographical treatment result was only affected by neck size. Five aneurysms

2001 Interventional Neuroradiology

5417. An Early Experience of Endovascular Treatment for Cerebral Aneurysms Harboring Blebs Full Text available with Trip Pro

An Early Experience of Endovascular Treatment for Cerebral Aneurysms Harboring Blebs Re-rupture of cerebral aneurysms often occurs at their blebs, and the treatment of cerebral aneurysms harboring blebs has been considered difficult. To prevent rupture during embolization, the authors have tried to deliver coils only into aneurysm domes, without inserting coils, a microcatheter, or a microguidewire into the blebs. Here, to prove such a treatment strategy, the authors report early experience (...) in 3 cases with cerebral aneurysms harboring blebs.

2001 Interventional Neuroradiology

5418. Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass: A Technical Case Report Full Text available with Trip Pro

Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass: A Technical Case Report A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted. During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate

2001 Interventional Neuroradiology

5419. Time of Flight 3D Magnetic Resonance Angiography in the Follow-up of Coiled Cerebral Aneurysms Full Text available with Trip Pro

Time of Flight 3D Magnetic Resonance Angiography in the Follow-up of Coiled Cerebral Aneurysms The use of Guglielmi Detachable Coil (GDC) for the en do vascular treatment of intracerebral aneurysms is increasing, particularly in those aneurysms for which there is a high surgical morbidity and mortality. However, the long-term efficacy of GDC is not known. Until the natural history of GDC treatment is established longterm follow-up in this cohort of patients is required, of necessity involving (...) be obtained by performing plain films of the skull to demonstrate change in coil ball configuration. MRA has the potential to replace IA DSA in the follow- up of GDC treated cerebral aneurysms.

2001 Interventional Neuroradiology

5420. Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping Full Text available with Trip Pro

Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth (...) of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping. As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month

2001 Interventional Neuroradiology

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