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61. Adenosine to facilitate the clipping of cerebral aneurysms: literature review Full Text available with Trip Pro

Adenosine to facilitate the clipping of cerebral aneurysms: literature review Cerebral aneurysms have a high mortality rate when ruptured. Endovascular techniques have improved substantially in treating this pathology. However, surgical clip ligation remains the preferred option for some aneurysms. Various techniques are used intraoperatively to assist the surgeon in dissecting the aneurysmal dome free of surrounding tissue and placing a clip around the neck safely and effectively so

2017 Stroke and vascular neurology

62. Guidelines for the management of patients with unruptured intracranial aneurysms Full Text available with Trip Pro

% to 6.0%, with higher prevalence in women and an increased prevalence with age. A recent cross-sectional study from China of 4813 adults aged 35 to 75 years found a prevalence of 7.0% based on MRA, also with a higher prevalence in women than men. In the population-based Rotterdam Study, in which 2000 patients (mean age 63 years; range, 45.7–96.7 years) underwent protocol-driven high-resolution structural brain MRI, the prevalence of incidental intracranial aneurysms (IAs) was found to be 1.8 (...) . There is also an increased risk of detection if ≥2 members of a family have a history of SAH or UIA. In 1 study of 438 people from 85 families, 38 first-degree relatives (8.7%) had a UIA on screening imaging. In the Familial Intracranial Aneurysm (FIA) Study, first-degree relatives of those affected with brain aneurysm who were >30 years old and had a history of either smoking or hypertension were screened with MRA. Among the first 304 patients screened, 58 (19.1%) had at least 1 IA. In long-term serial MRA

2015 American Academy of Neurology

63. Guidelines for the Management of Patients with Unruptured Intracranial Aneurysms

with unruptured intracranial aneurysms. The guidelines address presentation, natural history , epidemiology , risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. (Stroke. 2015;46:2368-2400. DOI: 10.1161/STR.0000000000000070.) Key Words: AHA Scientific Statements ? cerebral aneurysm ? epidemiology ? imaging ? natural history ? outcome ? risk factors ? treatment Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms A Guideline (...) . †For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. Downloaded from http://ahajournals.org by on March 27, 2019Thompson et al Management of Unruptured Intracranial Aneurysms 2371 underwent protocol-driven high-resolution structural brain MRI, the prevalence of incidental intracranial aneurysms (IAs) was found to be 1.8%, with no change

2015 Congress of Neurological Surgeons

64. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms Full Text available with Trip Pro

-resolution structural brain MRI, the prevalence of incidental intracranial aneurysms (IAs) was found to be 1.8%, with no change in prevalence by age ; however, in another systematic review and meta-analysis of other population-based observational studies of incidental findings on MRI (including the Rotterdam Study), the prevalence of IAs was only 0.35% (95% CI, 0.13%–0.67%), but age data were not complete, and only cross-sectional MRI was available. In the large population-based Norwegian Nord-Trøndelag (...) , higher fasting glucose, family history of polycystic kidney disease, and family history of SAH or aneurysm in ≥2 relatives. There is also an increased risk of detection if ≥2 members of a family have a history of SAH or UIA. In 1 study of 438 people from 85 families, 38 first-degree relatives (8.7%) had a UIA on screening imaging. In the Familial Intracranial Aneurysm (FIA) Study, first-degree relatives of those affected with brain aneurysm who were >30 years old and had a history of either smoking

2015 American Heart Association

65. Assessment of the Most Optimal Control Tissue for Intracranial Aneurysm Gene Expression Studies. (Abstract)

Assessment of the Most Optimal Control Tissue for Intracranial Aneurysm Gene Expression Studies. Background and Purpose- Finding adequate control tissue for intracranial aneurysm (IA) pathophysiological studies, including gene expression studies, can be challenging. We compared gene expression profiles of superficial temporal, cortical, and circle of Willis (CoW) arteries and IA in search of the most optimal control tissue for future experiments. Methods- We compared RNA-sequencing data of IA (...) tissues formed separate groups compared with IA and the 3 control arteries. Conclusions- The cortical arteries and the CoW arteries are better controls for gene expression studies on IA than the superficial temporal artery. This probably relates to differences in anatomy of these tissues, such as the presence of an external elastic lamina in the extracranial vasculature and absence in the intracranial vasculature, because IAs, cortical arteries, and CoW arteries are all intracranial while

2019 Stroke

66. Treatment Scoring of Unruptured Intracranial Aneurysms. (Abstract)

Treatment Scoring of Unruptured Intracranial Aneurysms. Background and Purpose- The purpose was to obtain a reliable treatment score for unruptured intracranial aneurysms (UIAs) from variables known at baseline. Methods- The series included 142 patients with UIAs diagnosed between 1956 and 1978 when UIAs were not treated and were followed up until the first aneurysm rupture, death, or the last contact. Previously published UIA treatment score was recorded, and finally, a new treatment score (...) was constructed. Results- The median follow-up time was 21.0 years (interquartile range, 10.4-31.8 years). A total of 34 patients had an aneurysm rupture during 3064 person-years of follow-up. The UIA treatment score differed slightly between those with and without an aneurysm rupture (9.4±2.8 versus 8.3±3.1, P=0.082). The receiver operating characteristics curve of the UIA treatment score for predicting rupture showed a modest area under the curve (AUC; 0.618, 95% CI, 0.502-0.733; P=0.059). The best new

2019 Stroke

67. Derivo Embolization Device for the Treatment of Intracranial Aneurysms. (Abstract)

Derivo Embolization Device for the Treatment of Intracranial Aneurysms. Background and Purpose- Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods- BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective (...) , interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results- Between December 2016

2019 Stroke

68. Cost-Effectiveness of Computed Tomography Angiography in Management of Tiny Unruptured Intracranial Aneurysms in the United States. (Abstract)

Cost-Effectiveness of Computed Tomography Angiography in Management of Tiny Unruptured Intracranial Aneurysms in the United States. Background and Purpose- Our study aims to evaluate the cost-effectiveness of computed tomography angiography (CTA) for surveillance of tiny unruptured intracranial aneurysms and the impact of CTA radiation-induced brain tumor on the overall effectiveness of CTA. Methods- A Markov decision model was constructed from a societal perspective starting with patients 30 (...) . Results- The base case calculation shows every 5-year CTA follow-up to be the most cost-effective strategy, and the conclusion remains robust in probabilistic sensitivity analysis. It remains the dominant strategy when the annual rupture risk of nongrowing unruptured intracranial aneurysms is smaller than 2.66% or the rupture risk in growing aneurysms is <57.4%. The radiation-induced brain cancer risk is relatively low, and sensitivity analysis shows that the radiation-induced cancer risk does

2019 Stroke

69. Risk Factors for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage in a Prospective Population-Based Study. (Abstract)

Risk Factors for Unruptured Intracranial Aneurysms and Subarachnoid Hemorrhage in a Prospective Population-Based Study. Background and Purpose- We wanted to evaluate potential risk factors for unruptured intracranial aneurysms (UIAs) and aneurysmal subarachnoid hemorrhage (aSAH) in a large, prospective study of the general population with risk factors collected before the detection of UIA or aSAH. Methods- All residents ≥20 years were invited to the HUNT (The Nord-Trøndelag Health Study

2019 Stroke

70. A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2. (Abstract)

A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2. Appropriate management of ruptured intracranial aneurysm (RIA) in patients eligible for surgical clipping but under-represented in or excluded from previous randomized trials remains undetermined.The International Subarachnoid Aneurysm Trial-2 (ISAT-2) is a randomized care trial comparing surgical versus endovascular treatment (EVT) of RIA. All patients considered (...) crossovers in each arm. The main endpoint (1 year mRS>2), available for 76 patients, was reached in 16/42 patients allocated to clipping (38%; 95%CI: 25%-53%), and 10/34 patients allocated to coiling (29%; 17%-46%). One year imaging results were available in 54 patients: complete aneurysm occlusion was found in 23/27 patients allocated to clipping (85%; 67%-94%), and 18/27 patients allocated to coiling (67%; 47%-81%). Hospital stay exceeding 20 days was more frequent in surgery (26/55 [47%; 34%-60

2019 Neuro-Chirurgie Controlled trial quality: predicted high

71. Early interventional embolization in the treatment of cerebral aneurysm rupture. Full Text available with Trip Pro

Early interventional embolization in the treatment of cerebral aneurysm rupture. To analyze the clinical effectiveness and safety of early interventional embolization in the treatment of ruptured cerebral aneurysm.Eighty-eight patients with cerebral aneurysm rupture who were admitted to the hospital between February 2015 and October 2016 were selected as the research subjects and were randomly divided into a control group (N=44) and an observation group (N=44) using random number table (...) significance (P<0.05).Early interventional embolization has satisfactory effect in the treatment of cerebral aneurysm rupture and effectively improve prognosis; hence it is worth promotion in clinical practice.

2019 Pakistan Journal Of Medical Sciences Controlled trial quality: uncertain

72. Obtaining Informed Consent Using Patient Specific 3D Printing Cerebral Aneurysm Model. Full Text available with Trip Pro

Obtaining Informed Consent Using Patient Specific 3D Printing Cerebral Aneurysm Model. Recently, three-dimensional (3D) printed models of the intracranial vascular have served as useful tools in simulation and training for cerebral aneurysm clipping surgery. Precise and realistic 3D printed aneurysm models may improve patients' understanding of the 3D cerebral aneurysm structure. Therefore, we created patient-specific 3D printed aneurysm models as an educational and clinical tool for patients (...) undergoing aneurysm clipping surgery. Herein, we describe how these 3D models can be created and the effects of applying them for patient education purpose.Twenty patients with unruptured intracranial aneurysm were randomly divided into two groups. We explained and received informed consent from patients in whom 3D printed models-(group I) or computed tomography angiography-(group II) was used to explain aneurysm clipping surgery. The 3D printed intracranial aneurysm models were created based on time

2019 Journal of Korean Neurosurgical Society Controlled trial quality: uncertain

73. [Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]. Full Text available with Trip Pro

[Effect of magnesium sulphate and milrinone on cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a randomized study]. Aneurysmal subarachnoid hemorrhage is an important cause of premature death and disability worldwide. Magnesium sulphate is shown to have a neuroprotective effect and it reverses cerebral vasospasm. Milrinone is also used in the treatment of cerebral vasospasm. The aim of the present study was to compare the effect of prophylactic magnesium sulphate and milrinone (...) on the incidence of cerebral vasospasm after subarachnoid hemorrhage.The study included 90 patients with aneurysmal subarachnoid hemorrhage classified randomly (by simple randomization) into two groups: magnesium sulphate was given as an infusion of 500mg.day-1 without loading dose for 21 days. Group B: milrinone was given as an infusion of 0.5μg.kg-1.min-1 without loading dose for 21 days. The cerebral vasospasm was diagnosed by mean cerebral blood flow velocity in the involved cerebral artery (mean flow

2019 Revista brasileira de anestesiologia Controlled trial quality: uncertain

74. Spontaneous recession of a posterior cerebral artery aneurysm concurrent with carotid rete mirabile and moyamoya-pattern collateral vessels: a case report. Full Text available with Trip Pro

Spontaneous recession of a posterior cerebral artery aneurysm concurrent with carotid rete mirabile and moyamoya-pattern collateral vessels: a case report. Carotid rete mirabile (RM) is a meshwork of multiple, freely intercommunicating arterioles that reconstitute the absent or hypoplastic segments of the internal carotid artery (ICA). Carotid RM has been reported to be associated with cerebrovascular diseases. However, it is rarely associated with moyamoya-pattern collateral vessels (...) in the posterior cerebral artery (PCA) region and aneurysm.A 39-year-old woman was admitted complaining of sudden-onset headache, nausea, and vomiting. Further investigation revealed subarachnoid hemorrhage (SAH), carotid RM, a moyamoya collateral pattern in the PCA region, and a pseudoaneurysm in the moyamoya-like vessels. The patient was treated conservatively, recovered well and was discharged 1 week later. Follow-up angiography showed that the aneurysm had disappeared.As shown by the present case, we

2019 BMC Neurology

75. Evaluating the safety and technical effectiveness of a newly developed intravascular 'flow isolator' stent for the treatment of intracranial aneurysms: study protocol for a first-in-human single-arm multiple-site clinical trial in Japan. Full Text available with Trip Pro

Evaluating the safety and technical effectiveness of a newly developed intravascular 'flow isolator' stent for the treatment of intracranial aneurysms: study protocol for a first-in-human single-arm multiple-site clinical trial in Japan. Wide-neck or large intracranial aneurysms are difficult to cure by conventional surgical or endovascular procedures. A flow diverter (FD) is an implantable, stent-like, fine-mesh medical device for the treatment of intracranial aneurysms. Although endovascular (...) of intracranial aneurysms that are difficult to cure by conventional surgical or endovascular procedures. The study is a multicentre, open-label, uncontrolled, exploratory, medical device, investigator-initiated clinical study. The primary safety endpoint of this study is any stroke or death related to the procedure within 180 days, while for efficacy, the endpoint is complete obliteration of the target aneurysm and patency of the target vessel (less than 50% stenosis) confirmed by angiography at 180 days

2019 BMJ open

76. What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. (Abstract)

What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD

2019 Journal of Cerebral Blood Flow and Metabolism

77. Treatment with dimethyl fumarate reduces the formation and rupture of intracranial aneurysms: Role of Nrf2 activation. (Abstract)

Treatment with dimethyl fumarate reduces the formation and rupture of intracranial aneurysms: Role of Nrf2 activation. Oxidative stress and chronic inflammation in arterial walls have been implicated in intracranial aneurysm (IA) formation and rupture. Dimethyl fumarate (DMF) exhibits immunomodulatory properties, partly via activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway which reduces oxidative stress by inducing the antioxidant response element (ARE). This study (...) evaluated the effects of DMF both in vitro, using tumor necrosis factor (TNF)-α-treated vascular smooth muscle cells (VSMC), and in vivo, using a murine elastase model to induce aneurysm formation. The mice were treated with either DMF at 100 mg/kg/day P.O. or vehicle for two weeks. DMF treatment protected VSMCs from TNF-α-induced inflammation as demonstrated by its downregulation of cytokines and upregulation of Nrf2 and smooth muscle cell markers. At higher doses, DMF also inhibited the pro

2019 Journal of Cerebral Blood Flow and Metabolism

78. Delayed cerebral ischaemia in patients with aneurysmal subarachnoid haemorrhage: Functional outcome and long-term mortality. (Abstract)

Delayed cerebral ischaemia in patients with aneurysmal subarachnoid haemorrhage: Functional outcome and long-term mortality. Delayed cerebral ischaemia (DCI) is one of the most frequent complications of aneurysmal subarachnoid haemorrhage (aSAH). The purpose of the present retrospective cohort study of patients with aSAH was to identify the association between DCI, functional outcome and 4-year mortality.Patients admitted to the Neurointensive Care Unit at Rigshospitalet, Copenhagen, with aSAH

2019 Acta Anaesthesiologica Scandinavica

79. The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms. (Abstract)

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms. OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using (...) the National Health Insurance Service-National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses

2019 Journal of Neurosurgery

80. Comparison of Rupture Risk of Intracranial Aneurysms Between Familial and Sporadic Patients. Full Text available with Trip Pro

Comparison of Rupture Risk of Intracranial Aneurysms Between Familial and Sporadic Patients. Background and Purpose A much higher rupture rate for patients with familial intracranial aneurysms (IA) compared with patients with sporadic IA has been reported in a study with highly selected familial aneurysms using sporadic patients from other populations a controls. We aimed to validate these findings in a large independent series of Dutch patients with familial and sporadic IA. Methods We (...) conducted a secondary analysis of our institutional cohort of patients who were screened for IAs between 1994 and 2016. We assessed the incidence of aneurysmal subarachnoid hemorrhage between familial, defined as ≥2 affected first-degree relatives with aneurysmal subarachnoid hemorrhage and unruptured IA (UIA), and sporadic patients with UIA with Cox regression analysis. Results We identified 62 familial IA patients with 91 UIA and 412 sporadic IA patients with 542 UIA. Despite familial aneurysms being

2019 Stroke

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