Giant intracranial aneurysms: Natural history and 1-year case fatality after endovascular or surgical treatment

Autor: Dengler, Julius, Rüfenacht, Daniel, Meyer, Bernhard, Rohde, Veit, Endres, Matthias, Lenga, Pavlina, Uttinger, Konstantin, Rücker, Viktoria, Kursumovic, Adisa, Hong, Bujung, Mielke, Dorothee, Schmidt, Nils Ole, Burkhardt, Jan-Karl, Bijlenga, Philippe, Boccardi, Edoardo, Cognard, Christophe, Heuschmann, Peter U., Vajkoczy, Peter, Bauknecht, H.C., Bohner, G., Liebig, T., Wiener, E., Gläsker, S., Klingler, J.-H., Scheiwe, C., van Velthoven, V., Zentner, J., Durner, G., König, R., Pedro, M.T., Wirtz, R., Fiss, I., Kombos, T., Guhl, S., Schroeder, H.W.S., Strowitzki, M., Eicker, S., Steiger, H., Turowski, B., Abdulazim, A., Etminan, N., Haenggi, D., Kalff, R., Walter, J., Brawanski, A., Schebesch, K.M., Ardeshiri, A., Sure, Ulrich, Wrede, Karsten, Schmidt, N.O., Regelsberger, J., Westphal, M., Hosch, H., Moskopp, D., Hohaus, C., Meisel, H.J., Lehmberg, J., Wostrack, M., Ganslandt, O., Hopf, N., Musahl, C., Graewe, A., Meier, U., Krauss, J., Nakamura, M., Grote, A., Güresir, E., Schramm, J., Simon, M., Vatter, H., Rath, S.A., Boxhammer, E., Hoffmann, K.T., Diepers, M., Fandino, J., Marbacher, S., Familiari, P., Raco, A., Schaller, K., Gruber, A., Knosp, E., Wang, W.T., Rüfenacht, D.A., Wanke, I., Piano, M., Hernesniemi, J., Lehecka, M., Niemelä, M., Nurminen, V., Burkhardt, J.K., Bozinov, O., Maldaner, N., Regli, L., Eliava, S.S., Shekhtman, O.D., Helthuis, J., van Doormaal, T., van der Zwan, A., Dammers, R., Dirven, C.M.F., Gawlitza, M., Guenego, A., Fiedler, J., Kato, N., Murayama, Y., Dabus, G., Linfante, I., Starosciak, A.K., Miran, M.S., Suri, M.F.K.
Přispěvatelé: Neurosurgery
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Risk
medicine.medical_specialty
Subarachnoid hemorrhage
Medizin
Aneurysm
Ruptured

03 medical and health sciences
0302 clinical medicine
Postoperative Complications
medicine.artery
Case fatality rate
medicine
Aphasia
Humans
Giant intracranial aneurysm
cardiovascular diseases
Aneurysm rupture
Prospective Studies
Registries
Surgical treatment
Prospective cohort study
Aged
Retrospective Studies
Movement Disorders
business.industry
Endovascular Procedures
Angiography
Digital Subtraction

Vascular disorders
Retrospective cohort study
Intracranial Aneurysm
General Medicine
Middle Aged
medicine.disease
ddc:616.8
3. Good health
Surgery
Natural history
Europe
Hospitalization
Treatment Outcome
030220 oncology & carcinogenesis
Relative risk
cardiovascular system
Female
Internal carotid artery
business
Vascular Surgical Procedures
030217 neurology & neurosurgery
Zdroj: Journal of Neurosurgery, 134(1), 49-57. American Association of Neurological Surgeons
Journal of Neurosurgery (2019) pp. 1-9
ISSN: 0022-3085
Popis: OBJECTIVEClinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs.METHODSIn this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality.RESULTSThe retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23–2.16) in ruptured GIAs and 3.96 (95% CI 2.57–6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5–30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality.CONCLUSIONSRupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov)
Databáze: OpenAIRE