Artery Aneurysm Rupture Research Articles

Risk factors and clinical and neurological consequences of intraoperative rupture of brain aneurysms in microsurgical operations

Objective. to assess the frequency, risk factors and clinical and neurological consequences of intraoperative rupture of arterial aneurysm (AA) of the brain (B) in clipping operations of the B AA .
 Materials and approaches. A retrospective analysis of microsurgical operations clipping of cerebral aneurysms in 1449 (100%) patients for the period from 2011 to 2018 was performed, of which 141 (9.73%) cases had intraoperative rupture of the aneurysm (IORA). Preoperative examination: clinical and neurological examination, CT of the brain, cerebral angiography( CAG), duplex scanning of the main vessels of the head and neck. The analyzed criteria are risk factors of IORA: AA size, localization, shape, duration of surgery after the primary rupture of AA, the presence of hypertension and the patient's condition before surgery.
 Results. The frequency of IORA in clipping operations of B AA was 9.73% (141 patients) in a series of observations 1441 (100%). Most often IORA-141 (100%) was registered in clipping operations of AA of complex ACA-AcomA (86 (61%) cases out of 141 (100%)). IORA is possible at all stages of the operation with the maximum frequency of contact breaks – 135 (95.74%); the rarest-6 ( 4.26%) - non - contact IORA (at the stage of craniotomy) was recorded. At the preoperative stage, the vast majority of patients with subsequent IORA were diagnosed with cerebral edema, AA of large size, atherosclerotic changes in the aneurysm-affected segment of the artery and cervical areas of the aneurysm, high blood pressure during surgery, adhesive arachnoid changes. At the time of discharge from the hospital, according to the Glasgow results scale: 69 (48.94%) full or partial restoration of labor activity, 18 (12.77%) had limited daily activities without the need for outside assistance, 37 (26 24%) deep disability ) Deaths were in the group of "contact" IORA - 17 (12.06%). At 6 ( 4.26%) of "non-contact" IORA, a deepening of initial neurological symptoms was recorded with a suppression of the level of consciousness, the addition of pyramidal insufficiency, speech impairment and psycho-organic syndrome, and a deepening of the phenomena of initial cerebral arterial vasospasm.
 Conclusions. IORA is predominantly in contact with a frequency of occurrence-9.73 %. The most common risk factors for IORA were: cerebral edema, large AA, atherosclerotic changes in the aneurysm-affected artery segment and cervical aneurysm sites, high blood pressure during surgery, adhesions arachnoid changes. IORA leads to deepening of initial neurological symptoms, phenomena of initial vasospasm of cerebral arteries with the level of total mortality-17 (12.06%).

Unruptured distal anterior cerebral artery mirror aneurysms associated with ruptured middle cerebral artery aneurysm: Case report

Introduction. Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal aneurysms are rare, while aneurysms in mirror position are extremely rare. These aneurysms have high tendency for rupture (PHASES score is always > 4). In more than a half of the patients with the DACA aneurysm rupture, imaging reveals intracerebral hematoma which is a predictor of poor outcome. Case report. A 49- year-old female patient was treated endovascularly in other institution, due to middle cerebral artery aneurysm (MCA) rupture, when the two small bilateral aneurysms at the distal segments of anterior cerebral artery (ACA) were revealed, left one measuring 4.5 mm and the right one measuring 6 mm in size, with the aneurysmal neck width of 3 mm and 4 mm, respectively. The decision was made by the interventional neuroradiologist only to treat the bleeding MCA aneurysm immediately. The patient was referred to our department six months later, and it was decided to perform microsurgical occlusion of the remaining DACA aneurysms. Unilateral interhemispheric approach was chosen to reach the distal ACAs and aneurysms at pericallosal-callosomarginal junction were clipped and completely excluded from the circulation. Conclusion. Management of DACA aneurysms is a surgical chellenge, even for experienced neurosurgeons. It is controversial whether these should be surgically clipped or coiled endovascularly, especially in cases like this one when a same-stage, endovascular coiling might look like a perfect approach. Surgical treatment should be prompt due to their tendency to early rupture. Careful evaluation for multiplicity is mandatory.

Intraoperative aneurysm rupture — the main complication in microsurgery of cerebral aneurysms

Objective: To analyze the impact of the intraoperative risk factors of intraoperative aneurysm rupture (IAR) and IRA in clipping a brain aneurysm on the results of surgical treatment.Materials and methods. A retrospective analysis of surgical treatment of 138 (11.4 %) patients, with IAR during clipping of a brain aneurysm in the period from 2011 to 2017, was performed. The total number of operations for clipping cerebral aneurysms in our observations is 1,208 (100 %). Preoperative examination of patients included clinical and neurological examination, brain CT, cerebral angiography (CAG), duplex scan of the main vessels of the head and neck. The radicality of clipping was controlled by puncture of the aneurysmal dome, using intraoperative Doppler and postoperative CAG.Results. IAR occurred at all stages of surgery preceding the exclusion of an aneurysm from the bloodstream, but prevailed in its isolation and clipping. Non-contact arterial aneurysm (AA) rupture was observed in 6 (4.35 %) patients. Ischemic lesions according to postoperative MSCT of the brain were observed in 2 (1.45 %) patients with noncontact intraoperative ruptures of AA MCA on the right. The contact intraoperative rupture of AA was observed in 132 (95.65 %) cases. The results of treatment were evaluated at hospital discharge on the Glasgow scale results, according to which we received the following data: 5 points — 67 patients (48.55 %); 4 points — 17 (12.32 %); 3 points — 37 (26.81 %); 2 points — 0; 1 point — 17 (12.32 %) cases.Conclusions:1. Intraoperative rupture brain aneurysm is the most common intraoperative complication, which threatens massive blood loss during surgery, forces the surgeon to change surgical tactics and often perform aggressive manipulations, such as forced temporal clipping.2. Analyzing the surgical interventions of clipping of cerebral AA in which IAR took place, the most common risk factors for IAR were found to be brain swelling, large AA, atherosclerotic changes of cerebral vessels, high blood pressure during surgery, pronounced arachnoid changes.3. According to our observations data, most of the IARs occurred with AA of the ACA-ACoA complex (84 cases — 60.87 %), which is related to hemodynamic features, anatomic variability of the ACA-ACoA complex and frequent localization of AA in this area.4. In our study, IAR occurs more frequently at the stage of AA excretion (116 cases — 84.06 %) and directly during AA clipping (7 cases — 5.07 %); less frequently — at the stage of AA artery extraction (6 — 4.35 %), at the stage of early arachnoid dissection (3 — 2.17 %) and at the craniotomy stage — non-contact IAR (6 — 4.35 %).

Relevant risk factors and the prognostic impact of positive resection margins after endoscopic resection of gastrointestinal neuroendocrine tumors.

IntroductionEndoscopic resection for the treatment of gastrointestinal neuroendocrine tumors has a risk of resection margin residues. The related risk factors and prognosis of post-endoscopic resection margin residues have not been fully evaluated.AimTo investigate the associated risk factors and prognostic impact of resection margin residues after endoscopic resection of gastrointestinal neuroendocrine tumors.Material and methodsWe conducted a retrospective analysis of 129 patients who underwent endoscopic resection for the treatment of gastrointestinal neuroendocrine tumors. Sex, age, location, diameter of tumor, depth of invasion, endoscopic treatment methods, endoscopic ultrasonography (EUS) evaluation, and the work experience of endoscopists were evaluated as potential risk factors. In addition, the prognoses of patients with positive resection margins were analyzed.ResultsA total of 18 (18/129, 14.0%) patients exhibited positive resection margins after endoscopic resection. Among 16 successfully followed-up patients, 1 died due to rupture of pulmonary artery aneurysms, 2 underwent supplementary surgical operations, and 2 underwent additional endoscopic submucosal dissection. The remaining 11 patients were periodically followed up, and no recurrences were found. The results of univariate analysis suggested that endoscopic treatment method, the depth of invasion, and EUS evaluation correlated with positive resection margin. Multivariate regression analysis suggested that the depth of invasion and EUS evaluation were risk factors for resection margin residues.ConclusionsThe depth of invasion and EUS evaluation are independent risk factors for positive resection margins after endoscopic resection. This finding suggests that a greater depth of invasion increases the risk for positive resection margins, while EUS evaluation before resection decreases this risk.

High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up.

Among clinical and morphological criteria, hemodynamics is the main predictor of aneurysm growth and rupture. This study aimed to identify which hemodynamic parameter in the parent artery could independently predict the rupture of anterior communicating artery (ACoA) aneurysms by using multivariate logistic regression and two-piecewise linear regression models. An additional objective was to look for a more simplified and convenient alternative to the widely used computational fluid dynamics (CFD) techniques to detect wall shear stress (WSS) as a screening tool for predicting the risk of aneurysm rupture during the follow-up of patients who did not undergo embolization or surgery. One hundred sixty-two patients harboring ACoA aneurysms (130 ruptured and 32 unruptured) confirmed by 3D digital subtraction angiography at three centers were selected for this study. Morphological and hemodynamic parameters were evaluated for significance with respect to aneurysm rupture. Local hemodynamic parameters were obtained by MR angiography and transcranial color-coded duplex sonography to calculate WSS magnitude. Multivariate logistic regression and a two-piecewise linear regression analysis were performed to identify which hemodynamic parameter independently characterizes the rupture status of ACoA aneurysms. Univariate analysis showed that WSS (p < 0.001), circumferential wall tension (p = 0.005), age (p < 0.001), the angle between the A1 and A2 segments of the anterior cerebral artery (p < 0.001), size ratio (p = 0.023), aneurysm angle (p < 0.001), irregular shape (p = 0.005), and hypertension (grade II) (p = 0.006) were significant parameters. Multivariate analyses showed significant association between WSS in the parent artery and ACoA aneurysm rupture (p = 0.0001). WSS magnitude, evaluated by a two-piecewise linear regression model, was significantly correlated with the rupture of the ACoA aneurysm when the magnitude was higher than 12.3 dyne/cm2 (HR 7.2, 95% CI 1.5-33.6, p = 0.013). WSS in the parent artery may be one of the reliable hemodynamic parameters characterizing the rupture status of ACoA aneurysms when the WSS magnitude is higher than 12.3 dyne/cm2. Analysis showed that with each additional unit of WSS (even with a 1-unit increase of WSS), there was a 6.2-fold increase in the risk of rupture for ACoA aneurysms.

Splenic artery aneurysm rupture in the pregnant patient: The importance of utilising ultrasound to differentiate the acute abdomen from obstetric causes of abdominal pain

AbstractAlthough splenic artery aneurysm (SAA) rupture in the pregnant patient is considered a rare occurrence, its consequences can be catastrophic for both mother and fetus. The mortality rate from this entity in pregnancy is disproportionately high when compared with that of the general population, with multiparity thought to be a contributing factor. Potential reasons for this may be explained by its non‐specific abdominal symptoms often misdiagnosed as common obstetric differentials, combined with a rapid deterioration of patient condition post rupture. For these reasons, SAA rupture should have a high index of suspicion when a pregnant women presents with an acute abdomen, as a favourable outcome is dependent on prompt diagnosis and appropriate medical intervention. This article reviews the incidence of SAA rupture in pregnancy, outlines the pathophysiological processes that contribute to this entity being more prevalent in the gravid population, and displays the pivotal role ultrasound can play in expediting this diagnosis. In the emergency situation, ultrasound examination of a pregnant patient should be extended from a focussed pelvic study to encompass the entire abdominal cavity. Its portability combined with its nonionising nature makes ultrasound the modality of choice to reduce the time to diagnosis and thus influence treatment pathways.

Rupture of cerebral aneurysm during pregnancy: a case report

The most common cause of subarachnoid hemorrhage at the period of pregnancy and during puerperium is rupture of an intracranial aneurysm. It is five times more common in pregnant women than in non-pregnant women. This pathology is more common in primiparous women and in the third trimester of pregnancy. A 37-year-old woman who was admitted to the emergency department with sudden-onset headache and loss of consciousness was diagnosed with intracranial hemorrhage due to middle cerebral artery aneurysm rupture. The patient, who gave birth with emergency cesarean delivery, underwent surgery for subarachnoid hemorrhage. The case is presented here because of its rarity.

“Type II Endoleak” and Popliteal Artery Aneurysm Rupture after Surgical Repair

“Type II Endoleak” and Popliteal Artery Aneurysm Rupture after Surgical Repair

Surgical treatment of frontopolar artery aneurysm: a case report

The study objective is to describe the results of surgical treatment of a patient with frontopolar artery aneurysm rupture. Materials and methods. A 22-year-old female patient in grave condition (Hunt and Hess grade 3, Glasgow coma score 14) was admitted to the Department of Neurosurgery on day 5 after hemorrhage. The patient presented with headache, nausea, weakness, and stiff neck. However, no hemodynamic, respiratory, motor, or sensitive disorders were observed. Computed tomography of the brain revealed a 35 cm3 intracerebral hemorrhage in the projection of the interhemispheric fissure and frontal lobes without transverse or axial dislocation. Computed tomography angiography demonstrated a distal aneurysm of the right frontopolar artery. Results. The patient underwent emergency osteoplastic craniotomy in the right pterional region followed by aneurysm excision and removal of intracerebral hemorrhage. The postoperative period was uneventful (Glasgow outcome score 5). The patient was discharged on day 14 postoperatively with no signs of focal neurological deficit. Conclusion. Thorough preoperative examination of patients with lobar hemorrhages prevents severe complications during surgery, such as uncontrolled intraoperative bleeding.

Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors.

The exact pathophysiological mechanisms underlying cerebral aneurysm formation remain unclear. Asymmetrical local vascular geometry may play a role in aneurysm formation and progression. The object of this study was to investigate the association between the geometric asymmetry of the middle cerebral artery (MCA) and the presence of MCA aneurysms and associated high-risk features. Using a retrospective case-control study design, the authors examined MCA anatomy in all patients who had been diagnosed with an MCA aneurysm in the period from 2008 to 2017 at the University Hospitals Cleveland Medical Center. Geometric features of the MCA ipsilateral to MCA aneurysms were compared with those of the unaffected contralateral side (secondary control group). Then, MCA geometry was compared between patients with MCA aneurysms and patients who had undergone CTA for suspected vascular pathology but were ultimately found to have normal intracranial vasculature (primary control group). Parent vessel and aneurysm morphological parameters were measured, calculated, and compared between case and control groups. Associations between geometric parameters and high-risk aneurysm features were identified. The authors included 247 patients (158 cases and 89 controls) in the study. The aneurysm study group consisted of significantly more women and smokers than the primary control group. Patients with MCA bifurcation aneurysms had lower parent artery inflow angles (p = 0.01), lower parent artery tortuosity (p < 0.01), longer parent artery total length (p = 0.03), and a significantly greater length difference between ipsilateral and contralateral prebifurcation MCAs (p < 0.01) than those in primary controls. Type 2 MCA aneurysms (n = 89) were more likely to be associated with dome irregularity or a daughter sac and were more likely to have a higher cumulative total of high-risk features than type 1 MCA aneurysms (n = 69). Data in this study demonstrated that a greater degree of parent artery asymmetry for MCA aneurysms is associated with high-risk features. The authors also found that the presence of a long and less tortuous parent artery upstream of an MCA aneurysm is a common phenotype that is associated with a higher risk profile. The aneurysm parameters are easily measurable and are novel radiographic biomarkers for aneurysm risk assessment.

A case of a hemothorax due to rupture of an intercostal arterial aneurysm in a patient with neurofibromatosis type 1

A case of a hemothorax due to rupture of an intercostal arterial aneurysm in a patient with neurofibromatosis type 1

Ruptured popliteal artery aneurysms.

Background Rupture is a recognised complication of ruptured popliteal artery aneurysms that requires emergency intervention. There is little evidence collating the presentation, intervention and outcomes of ruptured popliteal artery aneurysms. Objective The primary aim of this study was to deduce the sequelae following different management modalities of ruptured popliteal artery aneurysm. Methods We performed a systematic review of all available cases reports of ruptured popliteal artery aneurysms in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocol. Results We identified 48 cases taken from 35 case reports and series. Men were more commonly affected ( n = 96%), and mean age was 71 years. Acute limb ischemia was the commonest presentation (32%) whilst incidental deep vein thrombosis was found in 43% of patients. The mean aneurysm size was 8.2 cm (range, 2.7 to 13.3 cm). Management consisted of open surgery (58%), endovascular treatment (25%) and ‘other’ treatment (evacuation of haematoma, ligation of aneurysm, amputation or palliation) (17%). The perioperative mortality rate in the whole cohort was 13%. Perioperative mortality was similar between comparing the open and endovascular surgery groups. Re-intervention rate amongst endovascular patients was 25% over an average follow-up period of 14 months. There was one re-intervention in the re-constructive group (3%) over a follow-up period of 17 months and none in the ‘other’ group. Conclusion Popliteal artery aneurysm rupture is a serious complication associated with significant morbidity and mortality. Open surgical reconstruction and endovascular repair are both feasible for the treatment of ruptured popliteal artery aneurysms; however, open surgery is less likely to require further re-intervention.

Left colic artery aneurysm rupture after stent placement for abdominal aortic aneurysm associated with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal dominant disease of the skin and soft tissue. Aneurysms associated with NF1 can occur, but a secondary aneurysm rupture is very rare, with very few cases reported in literature.Case presentationWe describe the case of a 67-year-old female with NF1 who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) rupture. She developed a type Ib endoleak requiring a redo-EVAR. Eighteen days after her primary operation, she was found to have two new left colic artery aneurysms. She required emergency surgery consisting of a left hemicolectomy and transverse colon colostomy. Pathology showed neurofibromatous changes to the peri-vasculature tissue, consistent with her underlying disease.ConclusionsAlthough rare, secondary aneurysms can occur following AAA repair. Patients with soft tissue connective tissue disorders, like NF1, may be at an increased risk for development of these secondary aneurysms. Endovascular repair appears to be a safe approach for NF1 patients with AAA, but endovascular management can be challenging in the setting of NF1. Surgeons should be ready to convert to open surgery if the patient displays persistent signs of bleeding or structural changes related to connective tissue disorders like NF1.

A Case of Isolated Spontaneous Celiac Artery Dissection with Rupture of a Proximal Splenic Arterial Aneurysm

A Case of Isolated Spontaneous Celiac Artery Dissection with Rupture of a Proximal Splenic Arterial Aneurysm

Electrophysiological correlates of feedback processing in subarachnoid hemorrhage patients.

Patients with subarachnoid hemorrhage (SAH) secondary to anterior communicating artery (AComA) aneurysm rupture often experience deficits in executive functioning and decision-making. Effective decision-making is based on the subjects' ability to adjust their performance based on feedback processing, ascribing either positive or negative value to the actions performed reinforcing the most adaptive behavior in an appropriate temporal framework. A crucial brain structure associated to feedback processing is the medial prefrontal cortex (mPFC), a brain region frequently damaged after AComA aneurysm rupture. In the present study, we recorded electrophysiological responses (event-related potentials (ERPs') and oscillatory activity (time frequency analysis) during a gambling task in a series of 15 SAH patients. Previous studies have identified a feedback related negativity (FRN) component associated with an increase on frontal medial theta power in response to negative feedback or monetary losses, which is thought to reflect the degree of negative prediction error. Our findings show a decreased FRN component in response to negative feedback and a delayed increase of theta oscillatory activity in the SAH patient group when compared to the healthy controls, indicating a reduced sensitivity to negative feedback processing and an effortful signaling of cognitive control and monitoring processes lengthened in time, respectively. These results provide us with novel neurophysiological markers regarding feedback processing and performance monitoring patterns in SAH patients, illustrating a dysfunctional reinforcement learning system probably contributing to the maladaptive day-to-day functioning in these patients.

Splenic Artery Aneurysm (SAA) Rupture in Pregnancy: A Case Report of a Rare but Life-Threatening Obstetrical Complication.

This is the case of a 38 year-old Lebanese woman G2P1, history of previous cesarean section, presenting at 30+5 weeks of gestation with acute left-sided flank pain and a two-day history of chills and dysuria. In light of the clinical presentation, the patient was initially diagnosed with pyelonephritis and managed accordingly; however, her clinical status deteriorated with worsening hypotension and lethargy despite resuscitative measures and a normal abdominal ultrasound. Failure to revive the patient eventually led to a cardiac arrest for which a peri-mortem cesarean section was performed at bedside. Upon abdominal entry, an actively-bleeding ruptured splenic artery aneurysm (SAA) was identified, for which massive transfusion protocol was activated, and the patient was transferred to the operating room. The patient had a complicated postoperative course, the fetus was stillborn, and she was discharged home after 6 months of hospital stay. In view of the high mortality and morbidity associated with ruptured SAA in pregnancy, early recognition and prompt intervention are crucial for maternal and fetal benefit.

Erratum: CASE REPORT Four Cases of Splenic Artery Aneurysm Rupture Which Showed Different Mechanisms of Onset and Could Be Rescued by Surgery [The Japanese Journal of Gastroenterological Surgery 51(12) 775–783

Erratum: CASE REPORT Four Cases of Splenic Artery Aneurysm Rupture Which Showed Different Mechanisms of Onset and Could Be Rescued by Surgery [The Japanese Journal of Gastroenterological Surgery 51(12) 775–783

Endovascular treatment of isolated internal iliac artery aneurysm rupture associated with a pelvic giant pseudoaneurysm

Endovascular treatment of isolated internal iliac artery aneurysm rupture associated with a pelvic giant pseudoaneurysm

Four Cases of Splenic Artery Aneurysm Rupture Which Showed Different Mechanisms of Onset and Could Be Rescued by Surgery

腹部内臓動脈瘤はまれな疾患であるが，破裂した場合の致死率は依然として高く，極めて重篤な疾患である．今回緊急開腹手術で救命しえた脾動脈瘤破裂の4例を報告する．4例中2例は膵仮性囊胞を伴う瘤の破裂で，1例はhemosuccus pancreaticusによる消化管内出血，1例は孤立性特発性腹腔動脈解離に続発した瘤の破裂であり，それぞれ発症過程と出血様式が異なった．術式は2例で膵体尾部・脾臓合併切除を要し，2例は脾動脈結紮のみで脾臓を温存しえた．瘤破裂時は下血や腹痛など多彩な症状を呈すが，迅速な診断と適切な処置が予後を左右する．Interventional radiologyによる血管内治療も重要な治療戦略であるが，開腹手術は破裂時も確実に有効な手段であり，双方を行える体制で治療を行うことが望ましいと考えられる．

Analysis of biochemical laboratory values to determine etiology and prognosis in patients with subarachnoid hemorrhage: a clinical study

ABSTRACTObjectives: The aim of this study was to establish prognostic and predictive markers in patients with subarachnoid hemorrhage (SAH) using simple laboratory methods.Methods: A retrospective examination was made of patients with SAH diagnosed secondary to isolated head trauma, isolated anterior communicating artery aneurysm rupture, and angiography-negative SAH. Age, gender, Glasgow Coma Scale (GCS) scores, and Fisher’s grade scores, Glasgow Outcome Scale (GOS) scores, leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio results (PLR) were evaluated.Results: NLR and PLR values, which were similar in patients with spontaneous SAH, were significantly high in patients with traumatic SAH. NLR and PLR values could be 80% sensitive and 75% specific for distinguishing traumatic SAH from spontaneous SAH. Eosinophil count was lower in patients with angiography-negative SAH and patients with aneurysmal SAH than in patients with traumatic SAH. Initially measured GCS score, Fisher’s grade score, eosinophil, neutrophil and lymphocyte counts could be prognostic in all patients with SAH. Moreover, it was concluded that the initially measured number of eosinophils might be directly related to patient prognosis. The eosinophil count was generally found to be high in traumatic SAH patients and it was observed that this parameter could be predictive for these patients. Lymphocyte count and NLR values could be prognostic markers in patients with angiography-negative SAH.Conclusion: NLR, PLR and eosinophil count values could be predictive for etiological factors (traumatic SAH or spontaneous SAH) of patients who were admitted unconscious to the emergency room with SAH detected on radiological imaging.