Aneurysm Patients Research Articles

Effect of Interfacility Transfer of Ruptured Abdominal Aortic Aneurysm Patients

Interfacility transfer (IFT) of patients with ruptured (r) abdominal aortic aneurysm (AAA) occurs not infrequently to allow for a higher level of care and improved outcomes. We evaluated the effect of IFT on mortality after rAAA repair using a contemporary administrative database.

Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery

BackgroundThere has not been a well-accepted prognostic model to predict the mortality of aortic aneurysm patients in intensive care unit after open surgery repair. Otherwise, our previous study found that anion gap was a prognosis factor for aortic aneurysm patients. Therefore, we wanted to investigate the relationship between anion gap and mortality of aortic aneurysm patients in intensive care unit after open surgery repair.MethodsFrom Medical Information Mart for Intensive Care III, data of aortic aneurysm patients in intensive care unit after open surgery were enrolled. The primary clinical outcome was defined as death in intensive care unit. Univariate analysis was conducted to compare the baseline data in different groups stratified by clinical outcome or by anion gap level. Restricted cubic spline was drawn to find out the association between anion gap level and mortality. Subgroup analysis was then conducted to show the association in different level and was presented as frost plot. Multivariate regression models were built based on anion gap and were adjusted by admission information, severity score, complication, operation and laboratory indicators. Receiver operating characteristic curves were drawn to compare the prognosis ability of anion gap and simplified acute physiology score II. Decision curve analysis was finally conducted to indicate the net benefit of the models.ResultsA total of 405 aortic aneurysm patients were enrolled in this study and the in-intensive-care-unit (in-ICU) mortality was 6.9%. Univariate analysis showed that elevated anion gap was associated with high mortality (P value < 0.001), and restricted cubic spline analysis showed the positive correlation between anion gap and mortality. Receiver operating characteristic curve showed that the mortality predictive ability of anion gap approached that of simplified acute physiology score II and even performed better in predicting in-hospital mortality (P value < 0.05). Moreover, models based on anion gap showed that 1 mEq/L increase of anion gap improved up to 42.3% (95% confidence interval 28.5–59.8%) risk of death.ConclusionsThe level of serum anion gap was an important prognosis factor for aortic aneurysm mortality in intensive care unit after open surgery.

Therapeutic Effects of Microsurgical Clipping at Different Time Points on Intracranial Aneurysm and Prognostic Factors

BackgroundMicrosurgical clipping is effective for treating early rupture hemorrhage in intracranial aneurysm (IA) patients. We aimed to evaluate the therapeutic effects of microsurgical clipping at different time points on IA and to explore prognostic factors.MethodsA total of 102 eligible patients were divided into good prognosis group (n = 87) and poor prognosis group (n = 15) according to Glasgow Outcome Scale (GOS) scores at discharge. The effects of microsurgical clipping at different time points (within 24 h, 48 h and 72 h) were compared. The incidence rates of postoperative complications in patients with different Hunt–Hess grades were compared. Prognostic factors were determined by multivariate logistic regression analysis. The nomogram prediction model was established based on independent risk factors and validated.ResultsThe good recovery and success rates of complete aneurysm clipping were significantly higher in patients undergoing surgery within 24 h after rupture. The incidence rate of complications was significantly higher in patients with Hunt–Hess grade IV. Good and poor prognosis groups had significantly different age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and National Institute of Health Stroke Scale (NIHSS) score, as independent risk factors for prognosis. The nomogram model predicted that poor prognosis rate was 14.71%.ConclusionTiming (within 24 h after rupture) microsurgical clipping benefits the prognosis of IA patients. Age, history of hypertension, preoperative intracranial hematoma volume, aneurysm size, preoperative Hunt–Hess grade, later surgery, postoperative complications and NIHSS score are independent risk factors for poor prognosis.

Dynamic causal modeling of the working memory system of aneurysmal subarachnoid hemorrhage patients: Searching for targets for cortical intervention

IntroductionAneurysmal subarachnoid hemorrhage (aSAH), caused by rupture of an intracranial aneurysm and bleeding into the subarachnoid space, is a life‐threatening cerebrovascular disease. Because of improvements in clinical interventions, the mortality rate of aSAH is gradually decreasing. Thus, many survivors recover from aSAH but still have sequelae. Working memory (WM) deficit is one of the most common and severe sequelae after aSAH. Interestingly, the severity of WM deficit is not identical to the extent or localization of brain damage, which implies an underlying mechanism of WM deficit other than direct hemorrhagic brain damage. Previous studies have revealed altered neural activity of several brain regions during stimulus tasks. However, the behaviors and functional organization of these corresponding areas in the resting state remain unclear. Insights into the organization of the WM network could reveal novel information about the mechanism of WM deficits, which will be of great value in developing new therapeutic strategies.MethodsIn this study, we recruited 50 aSAH patients consisting of survivors with either impaired or intact WM (two groups). Independent component analysis was performed on resting state data to extract the WM network. Dynamic causal modeling was then performed to assess the intrinsic coupling between key regions of the WM network. A model describing the neural activity and functional organization of the WM network was established, although some connections were not consistent in the resting state.ResultsWe found that effective connectivity of the precuneus (PCUN)‐middle temporal gyrus (MTG), MTG‐PCUN, and middle frontal gyrus‐inferior parietal lobule was significantly decreased in the impaired WM group, which suggests a vital and central role of affected regions or connections and provides new targets for brain stimulation.ConclusionsThe results of this study may contribute to new therapeutic or rehabilitation strategies for aSAH patients with WM deficits.

Flow diverters for the posterior inferior cerebellar artery aneurysms: A systematic review and a single-arm meta-analysis.

The treatment of posterior inferior cerebellar artery aneurysms is controversial. Recently, flow diverters have emerged as an attractive treatment option. Here, we performed a systematic review and meta-analysis of the angiographic and clinical outcomes of flow diverter-treated posterior inferior cerebellar artery aneurysms. We searched the PubMed, EMBASE and Web of Science databases for studies published from inception to January 2021. We included studies that described flow diverters procedures for posterior inferior cerebellar artery aneurysms with ≥2 patients. The outcomes were the complete occlusion rate and flow diverter-related complication rate. Meta-analysis was performed using a random or fixed effects model based on heterogeneity. We included six studies involving 46 posterior inferior cerebellar artery aneurysms. There were 14 ruptured aneurysms. All flow diverters were successfully released and the technical success rate was 100%. The complete occlusion rate was 81% (95% confidence interval = 65-93%; I2 = 0.00%; P < 0.01). The flow diverter-related complication rate was 18% (95% confidence interval = 5-36%; I2 = 0.00%; P < 0.01). One patient died of rebleeding. The mortality rate was <1% (95% confidence interval = -1-1%; I2 = 0.00%; P = 0.951). Treatment of posterior inferior cerebellar artery aneurysms with flow diverters is feasible and carries a high degree of technical success. However, this treatment is underutilized in patients with posterior inferior cerebellar artery aneurysms due to a higher complication rate and lower occlusion rate compared with clipping and traditional endovascular treatment. Further well-designed prospective and randomized studies are required to fully understand the effects of flow diverters especially in posterior inferior cerebellar artery aneurysms patients requiring endovascular treatment.

A rare case of ruptured intracranial aneurysm arising from the retro-mastoid branch of the occipital artery

Background: Aneurysms of the occipital artery (OA) are rare, with few cases published in the literature. The pathophysiology is unknown, and the presentation is variable. We present a case of a ruptured intracranial aneurysm arising from a branch of the OA.Case Description: A 36-year-old male with a history of ankylosing spondylitis presented with altered mental status after an assaulted. On examination, he was intubated, with a Glasgow coma scale of 9, and imaging of the head and neck revealed a subdural hematoma of the posterior fossa and the cervical spine. The patient underwent suboccipital craniectomy and C1-5 laminectomy with the evacuation of the subdural hematoma. Postoperative cerebral angiography showed an intracranial aneurysm arising from the retromastoid branch of the OA on the left side. Furthermore, the parent vessel of the aneurysm supplied the left lower half of the cerebellar hemisphere. The aneurysm and the parent vessel were embolized using platinum coils. The patient tolerated the procedure well, and magnetic resonance imaging of the brain showed a minor left-sided cerebellar infarct, which was asymptomatic. The patient was discharged home with a modified Rankin scale of 2. There were no outpatient follow-up data available because the patient lost to follow-up.Conclusion: Intracranial OA aneurysms are extremely rare with no clear consensus concerning the management of these aneurysms. They can be treated using endovascular and or open surgical techniques depending on the aneurysm characteristics, patient condition, rupture status, and others.

Abstract MP24: Disruption Of Actin Remodeling Intensifies Aneurysm-promoting Signals In Smooth Muscle Cells

Mutations within proteins coding for extracellular matrix assembly or those in the transforming growth factor beta (TGFβ) signaling pathway lead to aneurysm formation in patients and mice. As the SMC cytoskeletal network is intricately linked to TGFβ and ECM signaling, we sought to determine if disruption of the cytoskeletal filaments would alter how SMCs respond to angiotensin II, an important mediator of aneurysm formation. C57BL/6 mice lacking Tgbfr1 in SMCs (SMC- Tgbr1 iko ) generated by Jiang et al. have been shown to develop rapid and severe aortic aneurysm degeneration with 100% penetrance. Analysis was conducted on aneurysm and control mouse and human aortic tissue sections. We observed that SMC- Tgbr1 iko mice had reduced expression of filamentous (f-) and α-actin protein in the aortic media than control mice. Primary Tgbr1 iko SMCs also had higher levels of pRelA expression, less α-actin mRNA, and less f-actin than control SMCs. Tissue sections from aneurysm patients had reduced f-actin staining relative to controls. Disruption of f-actin with the destabilizer latrunculin A in vitro led to increased RelA and ERK activation in the presence of AngII, which was further augmented in the presence of a neutralizing antibody for TGFβ. In contrast, jasplakinolide—an f-actin stabilizer—prevented TGFβ blockade induced pRelA expression, suggesting that altered/inhibited TGFβ signaling modulates NFkB through actin depolymerization. While stabilization and disruption of microtubules led to RelA activation, no effect was observed on TGFβ blockade-induced pRelA expression. The phosphoantibody array revealed that f-actin disruption in the presence of AngII activated the CREB, AKT1/2/3, ERK1/2, and STAT3 pathways in mouse aortic SMCs. SMC- Tgbr1 iko mice treated with cytochalasin B suffered significantly greater mortality and had increased aortic growth over a 30-day follow-up period. Aortic aneurysms are coincident with reduced f-actin expression in murine and human aortic SMCs. Chemical deconstruction of actin filaments promotes an inflammatory phenotype in mouse SMCs in vitro , and aggravates aneurysm formation in vivo . Aberrant or inhibited TGFβ signaling potentiates NFkB activation in SMCs, which may be dependent on f-actin disassembly.

Factors Influencing 1-year Functional Outcome after Surgery in Aneurysmal Subarachnoid Hemorrhage Patients: A Single-center Series.

Objective:The objective of the study was to evaluate the outcome and related factors in patients with aneurysmal subarachnoid hemorrhage (aSAH).Materials and Methods:Clinical data of 221 patients who were diagnosed with spontaneous SAH due to ruptured intracranial aneurysm and surgically treated at Vajira Hospital between January 2013 and May 2016 were retrospectively reviewed. Patient and aneurysm characteristics, clinical status at presentation, treatment, and status at discharge and 1 year after discharge were recorded. Outcomes 1 year after surgery were assessed using the Glasgow Outcome Scale (GOS). Patients were divided into two groups according to the GOS score: the favorable outcome group (GOS scores 4 and 5) and unfavorable outcome group (GOS scores 1–3).Results:Among the 221 study patients, 158 were classified in the favorable outcome group and 63 in the unfavorable outcome group. Patient age, Hunt and Hess grade, aneurysm size, use of Vitamin C solution irrigation in the subarachnoid space, and GOS score 1 year after surgery significantly differed between the two groups.Conclusions:Numerous factors analyzed in this study were significantly associated with 1-year outcome in surgically treated aSAH patients, including subarachnoid Vitamin C irrigation. Further study of subarachnoid Vitamin C irrigation is warranted.

Assessing volumetric changes in abdominal aortic aneurysms following endovascular repair.

Volumetric changes in the aneurysm sac were evaluated following endovascular aortic repair (EVAR) in intact abdominal aortic aneurysm (AAA) patients who underwent EVAR. Fifty-two patients, who underwent EVAR from 2015 to 2019, were analysed retrospectively. A total of 158 computed tomography angiography scans was examined by performing reconsctructive volumetric calculations. Total aneurysm volume (TAV), patent lumen volume (PLV) and thrombuscoated aneurysm wall volume (TCAWV) were calculated. The results obtained at six, 12 and 24 months postoperatively were compared with those of the pre-operative period. Mean TAV had regressed 7% by the sixth month (p = 0.1), 27% by the 12th month (p = 0.0003) and 19% by the 24th month (p = 0.0008). Mean TCAWV had increased 2% by the sixth month (p = 0.3), and regressed 26% by the 12th month (p = 0.3) and 14% by the 24th month (p = 0.8). Mean PLV had regressed by 20% by the sixth month (p = 0.008), 29% by the 12th month (p = 0.0002) and 26% by the 24th month (p = 0.0006). For each individual proximal, middle and distal measurement, regression was observed at six and 12 months; however, an increase was observed at 24 months compared to the previous follow ups. The expansion measurements of TAV in the 24th month support the doubts on the medium- to long-term results of EVAR. The largest regression in the aneurysm sac was observed in the distal portion, then in the proximal portion, and the least regression was observed in the middle section.

Impact of COVID-19 on Patients Scheduled for Aortic Surgery

COVID-19 has had an unprecedented effect on the global delivery of vascular surgical services. The international Vascular Surgery COVID-19 Collaborative (VASCC) registry prospectively recruited patients to evaluate the impact of surgical delay and subsequent natural history of patients awaiting scheduled aortic operations. The VASCC registry identified 127 patients with aortic disease whose operations were postponed during the 2020 COVID-19 pandemic. This interim analysis was conducted approximately 10 months after commencement of the registry based on data from centers in the United States. Data was collected on 127 planned aortic cases with a mean age of 70.7 years (standard deviation, 11.3 years), and 68.5% were male. The range of procedures delayed consisted of 100 for aneurysm repair (78.7%), 7 acute aortic syndromes (5.5%) (penetrating aortic ulcer, intramural hematoma, and subacute or chronic Type B dissection), and 18 endoleak procedures (14.2%) (Fig 1). As of this analysis, 89 (70%) of patients had completed surgeries with a median delay of 63 days (interquartile range, 42-98 days), with one patient undergoing unsuccessful emergency repair for aneurysm rupture. Eighteen patients (14.2%) were still waiting for surgery at the time of completion of the case report form, consisting of 17 aneurysms and one endoleak. Thirteen patients (10.2%) had their procedure permanently cancelled. Including the aforementioned rupture, another 5 patients (3.9%) were reported as having died after postponement of their aneurysm surgery (Fig 2). Mortality among aneurysm patients alone was 6% during the 10-month analysis period. At the time of analysis, 70% of postponed aortic procedures were completed with a median delay of 63 days. Nevertheless, six patients died as a result of postponed surgery, including one aneurysm rupture. Overall mortality of 6 patients (4.7%) over 10 months from COVID-19-related health service disruption underscores the wider impacts of this pandemic, and the importance of resource and contingency planning for future epidemics and natural disasters.Fig 2Outcome of delay.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparative outcomes of open abdominal therapy after ruptured abdominal aortic aneurysm via open and endovascular approaches

Open abdomen therapy is sometimes a necessary lifesaving procedure after repair of ruptured abdominal aortic aneurysm (rAAA). OAT aims to prevent or treat abdominal compartment syndrome (ACS). This study aims to evaluate our experience with open abdomen therapy (OAT) after repair of ruptured abdominal aortic aneurysms (rAAAs). Retrospective cohort study METHODS: Medical records were retrieved for ruptured abdominal aortic aneurysm patients who underwent open surgical repair (OS) or endovascular aneurysm repair (EVAR) between January 1, 2008 and December 12, 2015 from a single center. Univariate and multivariate analysis were performed with statistical significance. The study included 171 patients. Thirty-three patients (19.3%) required OAT. A smaller percentage of patients required OAT after EVAR (9.8%) compared to OS (23.3%) (P = 0.05). Patients with OAT also had a significantly longer operation (257 vs. 202.7 minutes; P < 0.05), required more intra-operative fluids (15,700 vs. 8,050 mL; P < 0.05), had a longer hospital stay (20 vs. 8.5 days; P < 0.05), and had a higher peri-operative mortality rate (48.5% vs 25.4%; P < 0.05). On multivariate logistic regression analysis, a lower preoperative SBP (OR 0.9, P = 0.01) and history of hypertension (OR 0.3, P = 0.02) were protective against OAT, while longer operative duration increased the risk of OAT (OR: 1.27, P = 0.05). Mean duration of OAT prior to closure was 4.76 days. Comparing OS patients (transperitoneal and retroperitoneal) that underwent OAT closure, patients who had a retroperitoneal repair received less intra-operative fluids (13.79 vs. 19.11 L; P = 0.212), had earlier return of bowel function (10 vs. 16.9 days; P = 0.08), and a shorter hospital stay (19.9 vs. 32.2 days; P = 0.03). OAT is a lifesaving procedure that is associated with higher morbidity and mortality following OS and EVAR for rAAA. Patients with longer operations and extensive fluid resuscitation are at higher risk for OAT following rAAAs. Preoperative permissive hypotension may be protective against OAT. OAT following the RP approach to rAAA is associated with earlier abdominal wall closure, earlier bowel recovery, and shorter hospital stay.

Safety and effectiveness of high flow extracranial to intracranial saphenous vein bypass grafting in the treatment of complex intracranial aneurysms: a single-centre long-term retrospective study

BackgroundTo summarize the safety and effectiveness of high flow extracranial to intracranial saphenous vein bypass grafting in the treatment of complex intracranial aneurysms.MethodsThe data of complex intracranial aneurysms patients for high flow extracranial to intracranial saphenous vein bypass grafting from January 2008 to January 2020 were retrospectively collected and analyzed. Eighty-two patients (31 men and 51 women) with 89 aneurysms underwent 82 saphenous vein bypass grafts followed by immediate parent vessel occlusion. The aneurysm was located at the internal carotid artery, middle cerebral artery, and basilar artery in 75, 11, and 3 cases, respectively.ResultsThe patency rate of bypass grafting was 100, 100, 96.3 and 92.4% on intraoperation, on the first postoperative day, at discharge and 6 months follow-up, respectively. At discharge and 6 months follow-up, 3 and 6 patients had graft occlusions. The main postoperative complications were transient hemiparesis and hemianopsia. 3 patients died due to bypass complications and poor physical condition.ConclusionsHigh flow extracranial to intracranial saphenous vein bypass grafting is safe and effective in the treatment of complex intracranial aneurysms and the saphenous vein can meet the requirements of brain blood supply. A high rate of graft patency and adequate cerebral blood flow can be achieved.HighlightsA single-centre long-term retrospective study was conducted to assess the safety and effectiveness of high flow EC-IC saphenous vein bypass grafting in the treatment of complex intracranial aneurysms. The data of 82 patients from January 2008 to January 2020 were retrospectively collected and analysed.We found the patency rate of bypass grafting was 100, 100, 96.3 and 92.4% on intraoperation, on the first postoperative day, at discharge and 6 months follow-up, respectively. At discharge and 6 months follow-up, 3 and 6 patients had graft occlusions.Finally, we conclude that high flow extracranial to intracranial saphenous vein bypass grafting is safe and effective in the treatment of complex intracranial aneurysms and the selected blood supply vessels can meet the requirements of blood supply.As far as we know, this study is one of the maximum number of cases in the treatment of complex intracranial aneurysms with saphenous vein bypass.

Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome.

BackgroundLiterature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage.AimsTo investigate the association between clinical outcome and prehemorrhage use in aneurysmal subarachnoid hemorrhage patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome.MethodsData were collected from prospective databases of two European tertiary reference centers for aneurysmal subarachnoid hemorrhage patients. Patients were divided into “antiplatelet-user” and “non-user” according to the use of acetylsalicylic acid prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1–3). Secondary outcomes were in-hospital mortality and impact of thrombocyte transfusion.ResultsOf the 1033 patients, 161 (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, World Federation of Neurosurgical Societies score, infarction and heart disorder, pre-hemorrhage acetylsalicylic acid use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08–3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome.ConclusionIn this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months.

Computed Tomography Images under Optimized Iterative Reconstruction Algorithm for Blood Flow Field Characteristics in Cerebral Aneurysm before and after Stent Implantation

In order to study the analysis of blood flow field characteristics of cerebral aneurysm patients before and after stent implantation based on CT images of ART-TV-PI, this paper firstly improved the ART-TV algorithm of algebraic reconstruction technology and obtained the ART-TV-PI algorithm, which was compared with the ART algorithm and ART-TV algorithm. Afterwards, the CT images based on the above three algorithms were used to analyze the changes of average blood flow velocity, average wall pressure, average wall deformation, and average shear force of 48 cases of cerebral aneurysm patients before and after stent implantation. The results showed that the mean square error and radiation dose of the ART-TV-PI algorithm (0.00012 and 1.65 mSv) were significantly lower than those of the ART algorithm (0.0031 and 3.09 mSv) and ART-TV algorithm (0.00082 and 2.52 mSv), and the signal-to-noise ratio (23.94) was significantly higher than those of the ART algorithm (11.32) and ART-TV algorithm (16.89), with statistically significant differences ( P &lt; 0.05 ). The differences of mean blood flow velocity, mean wall pressure, mean wall deformation, and mean shear force before and after stent implantation among the three algorithms were not statistically significant ( P &gt; 0.05 ), and the average index of the ART-TV-PI algorithm was the highest. Under the ART-TV-PI algorithm, the mean blood flow velocity (0.044 m/s), the mean wall pressure (71.7 Pa), the mean wall deformation (0.057 mm), and the mean shear force (889 Pa) after stent implantation were significantly lower than those before stent implantation (0.165 m/s, 160.8 Pa, 0.721 mm, and 2690 Pa), with average decreases of 73.3%, 55.4%, 92.1%, and 64.3%, respectively, and the differences were statistically significant ( P &lt; 0.05 ). In conclusion, the images reconstructed by the ART-TV-PI algorithm have good image quality, which provides great convenience for surgical examination of cerebral aneurysm stent implantation and is worthy of clinical application.

Cerebral circulation time on DSA during endovascular treatment in WFNS grade I aneurysmal SAH patients-a predictor of DCI?

Delayed cerebral ischemia (DCI) remains a contributor to poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We evaluated cerebral circulation time (CCT) on digital subtraction angiography (DSA) during endovascular treatment (EVT) in WFNS grade I aSAH patients as a predictor of DCI. Of 135 consecutive WNFS grade I aSAH patients, 90 were included. Age, gender, time of DSA from ictus (< 72h or > 72h), Fisher scale, severe vasospasm, development of DCI, EVD-dependent hydrocephalus, re-bleeding, and procedural complications were recorded. CCT was calculated retrospectively from multiphase DSA. Association with DCI was established through univariate and, subsequently, multivariable logistic regression. An optimal threshold value was identified using ROC curve analysis. Patient groups defined by threshold CCT value, DCI, and, subsequently, time of DSA from ictus were analyzed using χ2 and Fisher's exact test. CCT was the only significant factor in the multivariable logistic regression for the outcome development of DCI (OR/second increase in CCT = 1.46 [95% CI 1.14-1.86, p = .003]). When CCT was dichotomized at 8.5s, the odds ratio for developing DCI was 7.12 (95% CI 1.93-26.34, p = .003) for CCT > 8.5s compared with < 8.5s. There was a significant difference for DCI in all patient groups dichotomized by CCT < 8.5s and > 8.5s (all patients, p = .001; patients imaged before and after 72h of ictus, p = .024 and p = .034, respectively). A CCT > 8.5s on DSA during EVT in WFNS grade I aSAH patients is associated with an increased risk of developing DCI and may aid in the management of high-risk patients.

What is the role of neurosurgeons in the current management of intracranial aneurysm in France? An analysis of professional practices

Study DesignRetrospective observational survey-based study. IntroductionIn France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. MethodA 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. ResultsTwenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. ConclusionDespite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.

Outcomes of high-grade aneurysmal subarachnoid hemorrhage patients treated with coiling and ventricular intracranial pressure monitoring.

BACKGROUNDHigh-grade aneurysmal subarachnoid hemorrhage is a devastating disease with a low favorable outcome. Elevated intracranial pressure is a substantial feature of high-grade aneurysmal subarachnoid hemorrhage that can result to secondary brain injury. Early control of intracranial pressure including decompressive craniectomy and external ventricular drainage had been reported to be associated with improved outcomes. But in recent years, little is known whether external ventricular drainage and intracranial pressure monitoring after coiling could improve outcomes in high-grade aneurysmal subarachnoid hemorrhage.AIMTo investigate the outcomes of high-grade aneurysmal subarachnoid hemorrhage patients with coiling and ventricular intracranial pressure monitoring.METHODSA retrospective analysis of a consecutive series of high-grade patients treated between Jan 2016 and Jun 2017 was performed. In our center, followed by continuous intracranial pressure monitoring, the use of ventricular pressure probe for endovascular coiling and invasive intracranial pressure monitoring in the acute phase is considered to be the first choice for the treatment of high-grade patients. We retrospectively analyzed patient characteristics, radiological features, intracranial pressure monitoring parameters, complications, mortality and outcome.RESULTSA total of 36 patients were included, and 32 (88.89%) survived. The overall mortality rate was 11.11%. No patient suffered from aneurysm re-rupture. The intracranial pressure in 33 patients (91.67%) was maintained within the normal range by ventricular drainage during the treatment. A favorable outcome was achieved in 18 patients (50%) with 6 mo follow-up. Delayed cerebral ischemia and Glasgow coma scale were considered as significant predictors of outcome (2.066 and -0.296, respectively, P < 0.05). CONCLUSIONVentricular intracranial pressure monitoring may effectively maintain the intracranial pressure within the normal range. Despite the small number of cases in the current work, high-grade patients may benefit from a combination therapy of early coiling and subsequent ventricular intracranial pressure monitoring.

Emergent aneurysm treatment compared with treatment on neurological improvement in patients with ruptured poor-grade aneurysmal subarachnoid haemorrhage: the TOPSAT2 RCT

Background Aneurysmal subarachnoid haemorrhage is a major cause of haemorrhagic stroke. The incidence is ≈ 80 per million population per year; it peaks in the 40–60 years age range and often has a poor prognosis with the outcome linked to severity of the initial haemorrhage. Aneurysmal subarachnoid haemorrhage accounts for 5% of strokes, but 20% of quality-adjusted life-years are lost to stroke and much of that loss is concentrated in World Federation of Neurosurgical Societies grade 4–5 (or poor-grade) aneurysmal subarachnoid haemorrhage patients. Before endovascular coiling was available, the conventional management strategy for poor-grade aneurysmal subarachnoid haemorrhage patients was to treat the ruptured aneurysm on neurological improvement. That incurs a risk of aneurysm rebleeding, which is highest soon after the first bleed; if rebleed occurs prior to aneurysm treatment, prognosis is dismal. Reducing rebleeding with early treatment might improve outcome. Therefore, an early coiling strategy in grade 4–5 patients is appealing, but not robustly evidenced. Early treatment in all grade 4–5 patients might prevent death from rebleeding but possibly at the expense of creating severely disabled survivors, with attendant societal costs. Many neuroclinicians have expressed genuine uncertainty regarding whether or not to treat all grade 4–5 aneurysmal subarachnoid haemorrhage patients emergently (as soon as possible regardless of neurological status). A pilot trial, the treatment of poor-grade subarachnoid haemorrhage trial 1 (TOPSAT1), indicated that recruitment to a randomised trial to address this uncertainty was feasible. Methods We investigated a management policy in aneurysmal subarachnoid haemorrhage World Federation of Neurosurgical Societies grades 4 or 5 of securing the ruptured aneurysm emergently (within 24 hours of randomisation) compared with the strategy to treat the aneurysm on neurological improvement (to World Federation of Neurosurgical Societies grades 1–3), irrespective of when that improvement occurred. The treatment of poor-grade subarachnoid haemorrhage trial 2 (TOPSAT2) was a pragmatic, randomised, open-blinded, end-point design trial aiming to recruit 346 adult patients (aged 18–80 years) in 30 UK and European neuroscience centres. Randomisation was web based, with minimisation criteria relating to age, grade, presence of hydrocephalus and UK location (vs. non-UK). Fifteen sites were opened to recruitment, 12 of which were in the UK. Standard institutional procedures for securing aneurysms were followed. An exploratory magnetic resonance biomarker substudy of 100 UK participants was planned but not opened. The primary end point was functional outcome at 12 months, determined by analysis of the modified Rankin Scale score. The secondary end points relating to safety were assessed. Results Of the 305 World Federation of Neurosurgical Societies grade 4–5 patients screened, 23 were randomised: 11 to the emergent treatment arm and 12 to the treatment on neurological improvement (control) arm. Trial recruitment was suspended when it was judged to have failed a feasibility assessment. The median time from ictus to treatment (where aneurysm was treated) was 26 hours in the emergent treatment arm and 163 hours in the treatment on neurological improvement arm. There were no statistically significant differences between arms in mortality (p = 0.4) or functional outcome at 365 days [modified Rankin Scale score 0–3 vs. 4–6 (p = 0.32)]. Sensitivity analysis was performed to examine the effect of missing data but differences remained non-significant. Limitations A limitation was the failure to recruit to time/target. Conclusions The randomised trial approach to investigating whether poor-grade aneurysmal subarachnoid haemorrhage patients should receive emergent treatment or be treated on neurological improvement proved unfeasible. No statistically significant differences were identified between the trial arms in mortality or functional outcome, but the small number of patients enrolled limits drawing firm conclusions. Future work No future work is currently planned. Trial registration Current Controlled Trials ISRCTN15960635. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 8. See the NIHR Journals Library website for further project information.

Effect of Aortic Stent Implantation in the Treatment of Thoracic Aortic Disease

Objective: To explore the effect of aortic stent implantation on patients in the treatment of thoracic aortic diseases. Methods: Selected patients from Yunnan Fuwai Cardiovascular (YFC) Hospital as a sample group to carry out the study, the main participants were thoracic aortic aneurysm patients admitted from June 2020 to June 2021. The number of patients involved were 80. The patients are divided into two groups and different treatment methods were adopted. A comparative analysis of the effects of aortic stent placement on patients was conducted. Results: Before treatment, there was no significant difference in the levels of various inflammatory factors between the two groups of patients, P&gt;0.05. After treatment, the data indicators of the two groups were significantly different, as there were significant differences in the surgical indicators among the two groups of patients, P&lt;0.05. As a result, the experimental group had shorter operation time, less intraoperative blood loss, shorter ICU observation time, lower levels of inflammatory factors, and better results. Conclusion: In the treatment of patients with thoracic aortic disease, the application of aortic stent implantation has significant clinical effects and are more conducive to the recovery of patients. It can be promoted and used in clinical trials.

Based on bioinformatics analysis lncrna SNHG5 modulates the function of vascular smooth muscle cells through mir-205-5p/SMAD4 in abdominal aortic aneurysm.

ObjectiveThe aim of this study was to explore expression profiles of long noncoding RNA (lncRNA)‐messenger RNA (mRNA) in abdominal aortic aneurysm (AAA) patients. Further, we explored the mechanisms by which lncRNA SNHG5 modulates the function of vascular smooth muscle cells (VSMC) in AAA.MethodsHuman gene expression profile GSE57691 dataset, was retrieved from Gene Expression Omnibus database. The dataset included gene expression array data of 49 AAA patients and 10 control aortic specimens from organ donors. To explore the main roles of the biological network, differentially expressed lncRNA and mRNAs in the aortic aneurysm (AAA) and normal aortic specimens were determined. Differentially expressed lncRNA and mRNAs were then used to construct a competing endogenous RNA (ceRNA) network using Cytoscape software, and the five key lncRNA were identified. SNHG5 which was significantly downregulated in the AAA was chosen and analysis showed that it regulates mir‐205‐5p and SMAD4 by binding to mir‐205‐5p. Double luciferase reporter gene assays, RNA immunoprecipitation, and RNA knockdown studies were used to establish the relationship between SNHG5 and mir‐205‐5p. Apoptosis rate was determined using flow cytometry, whereas cell proliferation was evaluated using Edu, and 24 well Transwell assay. Western blot analysis was used to determine protein expression levels.ResultsThe five differentially expressed lncRNAs were significantly correlated with 34 microRNAs and 112 mRNAs. mRNAs in the ceRNA network are implicated in protein binding, signal transduction, DNA and RNA transcription, development, and cell differentiation. SNHG5 was downregulated in the AAA and acts as a molecular sponge for mir‐205. Downregulation of SNHG5 induces expression of mir‐205‐5p. Increased mir‐205‐5p expression level inhibits SMAD4 production, thus inhibiting proliferation and migration and promotes apoptosis of smooth muscle cells.ConclusionBioinformatics were used to explore molecular mechanism of AAA progression. The findings of this study show that lncRNA SNHG5 regulates proliferation and apoptosis of VSMC cells through modulation of the mir‐205‐5p/SMAD4 axis. Therefore, SNHG5 is a potential therapeutic target for AAA disease.