Posterior circulation perforator aneurysms: a proposed management algorithm
| Autor: | Mary E. Jensen, R. Webster Crowley, Ching-Jen Chen, Kenneth C. Liu, Thomas J. Buell, Harry R. Hixson, Dale Ding, Avery J. Evans, Daniel M.S. Raper |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Subarachnoid hemorrhage Antifibrinolytic medicine.drug_class Aneurysm Ruptured 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale medicine Humans Stroke Aged Retrospective Studies medicine.diagnostic_test business.industry Disease Management Intracranial Aneurysm Retrospective cohort study General Medicine Middle Aged medicine.disease Embolization Therapeutic Occult Cerebral Angiography Surgery Treatment Outcome Female Neurology (clinical) business Algorithms 030217 neurology & neurosurgery Follow-Up Studies Cerebral angiography |
| Zdroj: | Journal of NeuroInterventional Surgery. 10:55-59 |
| ISSN: | 1759-8486 1759-8478 |
| DOI: | 10.1136/neurintsurg-2016-012891 |
| Popis: | IntroductionSubarachnoid hemorrhage (SAH) from posterior circulation perforator aneurysms (PCPAs) is rare and its natural history is unknown. Diagnosis may be difficult, acute management is poorly defined, and long-term recurrent SAH rates and clinical outcome data are lacking.MethodsWe searched our institution's records for cases of PCPA rupture and analyzed patient demographics, Hunt and Hess (HH) grades, diagnostic imaging, management, and clinical outcomes. We conducted telephone interviews to calculate modified Rankin Scale (mRS) scores.ResultsWe identified 9 patients (6 male, 3 female) with a ruptured PCPA who presented to the University of Virginia Health System (Charlottesville, VA, USA) between 2010 and 2016. Median and mean ages were 62 and 63 years, respectively. Median HH grade was 3. Seven of nine (78%) PCPAs were angiographically occult on initial imaging and median time to diagnosis was 5 days. Three conservatively managed patients had a mean mRS score of 0.67 (range 0–1) at mean follow-up of 35.3 months. Antifibrinolytic therapy was administered to all conservatively managed patients without thrombotic complication. Six patients receiving endovascular treatment had a mean mRS score of 2.67 (range 0–6) at mean follow-up of 49.2 months. No cases of recurrent SAH were seen in the study.ConclusionsThe rarity of PCPA has precluded long-term clinical follow-up until now. Our experience suggests low recurrent SAH rates. Until further studies are performed, conservative management, possibly combined with antifibrinolytic therapy, may be a viable treatment with acceptable long-term outcome. |
| Databáze: | OpenAIRE |
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