Browsing by Subject "Subarachnoid hemorrhage"
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Item Acute and Delayed Cerebrovascular Injury From Gunshot to the Head in a 12-Year-Old Child During the COVID-19 Pandemic(Elsevier, 2022) Golomb, Meredith R.; Tejada, Juan G.; Ducis, Katrina A.; Martinez, Mesha L.; Neurology, School of MedicineItem Comparison of Blister Aneurysm Treatment Techniques: A Systematic Review and Meta-Analysis(Elsevier, 2021-10) Sanchez, Victoria E.; Haider, Ali S.; Rowe, Scott E.; Wahood, Waseem; Sagoo, Navraj S.; Ozair, Ahmad; El Ahmadieh, Tarek Y.; Kan, Peter; Johnson, Jeremiah N.; Neurological Surgery, School of MedicineObjective Blood blister aneurysms are small, thin-walled, rapidly growing side-wall aneurysms that have proven particularly difficult to treat, and evidence-based guidance for treatment strategies is lacking. A systematic review and meta-analysis was performed to aggregate the available data and compare the three primary treatment modalities. Methods We performed a comprehensive literature search according to PRISMA guidelines followed by an indirect meta-analysis that compares the safety and efficacy of surgical, flow-diverting stents (FDS), and other endovascular approaches for the treatment of ruptured blood blister aneurysms. Results A total of 102 studies were included for quantitative synthesis with sample sizes of 687 treated surgically, 704 treated endovascularly without FDS, and 125 treated via flow-diversion. Comparatively, FDS achieved significantly reduced rates of perioperative retreatment compared to both surgical (P=0.025) and non-FDS endovascular (P<0.001). The FDS subgroup also achieved a significantly lower incidence of perioperative rebleed (P<0.001), perioperative hydrocephalus (P=0.012), postoperative infarction (P=0.002), postoperative hydrocephalus (P<0.001), and postoperative vasospasm (P=0.002) when compared to those patients in the open surgical subgroup. While no significant differences were found between groups on the basis of functional outcomes, angiographic outcomes detailed by rates of radiographic complete occlusion were highest for surgical (90.7%, 262/289) and FDS (89.1%, 98/110) subgroups versus the non-FDS endovascular subgroup at (82.7%, 268/324). Conclusion Flow-diversion appears to be an effective treatment strategy for ruptured BBAs with lower rates of perioperative complications when compared to surgical and other endovascular techniques but studies investigating long-term outcomes following flow-diversion warrant further study.Item Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis(MDPI, 2022-08-30) Morel, Sandrine; Hostettler, Isabel C.; Spinner, Georg R.; Bourcier, Romain; Pera, Joanna; Meling, Torstein R.; Alg, Varinder S.; Houlden, Henry; Bakker, Mark K.; van’t Hof, Femke; Rinkel, Gabriel J.E.; Foroud, Tatiana; Lai, Dongbing; Moomaw, Charles J.; Worrall, Bradford B.; Caroff, Jildaz; Constant-dits-Beaufils, Pacôme; Karakachoff, Matilde; Rimbert, Antoine; Rouchaud, Aymeric; Gaal-Paavola, Emilia I.; Kaukovalta, Hanna; Kivisaari, Riku; Laakso, Aki; Jahromi, Behnam Rezai; Tulamo, Riikka; Friedrich, Christoph M.; Dauvillier, Jerome; Hirsch, Sven; Isidor, Nathalie; Kulcsàr, Zolt; Lövblad, Karl O.; Martin, Olivier; Machi, Paolo; Pereira, Vitor Mendes; Rüfenacht, Daniel; Schaller, Karl; Schilling, Sabine; Slowik, Agnieszka; Jaaskelainen, Juha E.; von und zu Fraunberg, Mikael; Jiménez-Conde, Jordi; Cuadrado-Godia, Elisa; Soriano-Tárraga, Carolina; Millwood, Iona Y.; Walters, Robin G.; The @neurIST project; The ICAN Study Group; Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study Investigators; International Stroke Genetics Consortium (ISGC); Kim, Helen; Redon, Richard; Ko, Nerissa U.; Rouleau, Guy A.; Lindgren, Antti; Niemelä, Mika; Desal, Hubert; Woo, Daniel; Broderick, Joseph P.; Werring, David J.; Ruigrok, Ynte M.; Bijlenga, Philippe; Medical and Molecular Genetics, School of MedicineIntracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.Item Safety and Feasibility of Intra-Arterial Nicardipine for the Treatment of Subarachnoid Hemorrhage-Associated Vasospasm: Initial Clinical Experience with High-Dose Infusions(American Society of Neuroradiology, 2007-05) Tejada, J.G.; Taylor, R.A.; Ugurel, M.S.; Hayakawa, M.; Lee, S.K.; Chaloupka, J.C.; Radiology and Imaging Sciences, School of MedicineBackground and purpose: Delayed cerebral ischemia from vasospasm is a major complication after aneurysmal subarachnoid hemorrhage (SAH), but complications and/or low efficacy are associated with current therapy. We report our initial experience with intra-arterial use of a calcium channel blocker, nicardipine. Materials and methods: A retrospective review of a consecutive series of patients with clinical and angiographic vasospasm treated with intra-arterial nicardipine was performed. Standard criteria for definition of significant, intractable vasospasm after aneurysmal SAH were used. After catheter angiographic confirmation of vasospasm, arteries showing severe narrowing were targeted for superselective catheterization. Nicardipine was infused at a high dose rate (0.415-0.81 mg/min). Contrast injections were performed at 2-5-mg intervals to assess effective response (a 60% increase in arterial diameter of the most severely decreased in caliber vessel compared with the very first angiographic run). Results: Eleven consecutive patients underwent a total of 20 procedures; most had SAH with high Hunt and Hess grades (III or IV). All had depressed level of consciousness; others had paresis (7/20, 35%), aphasia (1/20, 5%), and facial nerve palsy (1/20, 5%). Between 10 and 40 mg of nicardipine was used. A 60% increase in diameter of the main affected artery compared with the initial diameter measured in the initial angiographic run was achieved in all procedures. Clinical improvement (resolved focal symptoms or increased Glasgow Coma Score) occurred in 10 of 11 patients (91%). One patient died from complications of the initial hemorrhage. No complications occurred after 16 of 20 procedures (80%); minor complications without sequelae occurred after the remaining procedures. Follow-up of at least 2 months in 10 survivors revealed minor or no deficits in most patients with a Glasgow Outcome Score of 1 or 2 in 9 of 10 patients (90%). Conclusion: In this small series, high-dose intra-arterial nicardipine infusion to treat SAH-associated vasospasm seems to be safe and effective.Item The Use of a Pipeline Embolization Device for Treatment of a Ruptured Dissecting Middle Cerebral Artery M3/M4 Aneurysm: Challenges and Technical Considerations(Korean Society of Interventional Neuroradiology, 2022) Berwanger, Robert P.; Hoover, Madeline C.; Scott, John A.; DeNardo, Andrew J.; Amuluru, Krishna; Payner, Troy D.; Kulwin, Charles G.; Sahlein, Daniel H.; Neurological Surgery, School of MedicinePrompt, effective treatment is necessary following aneurysmal subarachnoid hemorrhage to prevent recurrent rupture, which is thought to double mortality. Atypical ruptured aneurysms, such as blister or dissecting pseudoaneurysms, or those that are unusually distal in the middle cerebral artery (MCA) are challenging to treat with either open or endovascular options, though the pipeline embolization device (PED) has shown promise in multiple case series. We present a case of a ruptured dissecting pseudoaneurysm in the distal MCA (distal M3/proximal M4) prefrontal division in an healthy young patient (<60 years) successfully treated with a PED. The PED was chosen both as the only vessel sparing option in the young patient as well as for its potential as a vessel sacrifice tool if the pseudoaneurysm was felt to be incompletely treated, which in this case was not necessary-though would have leveraged the thrombogenicity of the device as a therapeutic advantage.Item Treatment of Acute Intracranial Vertebrobasilar Dissection with Angioplasty and Stent Placement: Report of Two Cases(American Society of Neuroradiology, 2003-05) Willing, Steven J.; Skidmore, Frank; Donaldson, Jill; Nobo, Ulises Lisandro; Chernukha, Konstantin; Radiology and Imaging Sciences, School of MedicineAcute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection.Item Trends Over Time in Stroke Incidence by Race in the Greater Cincinnati Northern Kentucky Stroke Study(Wolters Kluwer, 2024) Madsen, Tracy E.; Ding, Lili; Khoury, Jane C.; Haverbusch, Mary; Woo, Daniel; Ferioli, Simona; De Los Rios La Rosa, Felipe; Martini, Sharyl R.; Adeoye, Opeolu; Khatri, Pooja; Flaherty, Matthew L.; Mackey, Jason; Mistry, Eva A.; Demel, Stacie; Coleman, Elisheva; Jasne, Adam; Slavin, Sabreena; Walsh, Kyle B.; Star, Michael; Broderick, Joseph P.; Kissela, Brett; Kleindorfer, Dawn O.; Neurology, School of MedicineBackground and objectives: Understanding the current status of and temporal trends of stroke epidemiology by age, race, and stroke subtype is critical to evaluate past prevention efforts and to plan future interventions to eliminate existing inequities. We investigated trends in stroke incidence and case fatality over a 22-year time period. Methods: In this population-based stroke surveillance study, all cases of stroke in acute care hospitals within a 5-county population of southern Ohio/northern Kentucky in adults aged ≥20 years were ascertained during a full year every 5 years from 1993 to 2015. Temporal trends in stroke epidemiology were evaluated by age, race (Black or White), and subtype (ischemic stroke [IS], intracranial hemorrhage [ICH], or subarachnoid hemorrhage [SAH]). Stroke incidence rates per 100,000 individuals from 1993 to 2015 were calculated using US Census data and age-standardized, race-standardized, and sex-standardized as appropriate. Thirty-day case fatality rates were also reported. Results: Incidence rates for stroke of any type and IS decreased in the combined population and among White individuals (any type, per 100,000, 215 [95% CI 204-226] in 1993/4 to 170 [95% CI 161-179] in 2015, p = 0.015). Among Black individuals, incidence rates for stroke of any type decreased over the study period (per 100,000, 349 [95% CI 311-386] in 1993/4 to 311 [95% CI 282-340] in 2015, p = 0.015). Incidence of ICH was stable over time in the combined population and in race-specific subgroups, and SAH decreased in the combined groups and in White adults. Incidence rates among Black adults were higher than those of White adults in all time periods, and Black:White risk ratios were highest in adults in young and middle age groups. Case fatality rates were similar by race and by time period with the exception of SAH in which 30-day case fatality rates decreased in the combined population and White adults over time. Discussion: Stroke incidence is decreasing over time in both Black and White adults, an encouraging trend in the burden of cerebrovascular disease in the US population. Unfortunately, however, Black:White disparities have not decreased over a 22-year period, especially among younger and middle-aged adults, suggesting the need for more effective interventions to eliminate inequities by race.