Intracranial Aneurysmal Subarachnoid Hemorrhage Research Articles

Diagnosis and endovascular management of vasospasm after aneurysmal subarachnoid hemorrhage — survey of real-life practices

BackgroundVasospasm and delayed cerebral ischemia (DCI) are the leading causes of morbidity and mortality after intracranial aneurysmal subarachnoid hemorrhage (aSAH). Vasospasm detection, prevention and management, especially endovascular management varies from...

Application of zone classification in multiple intracranial aneurysmal subarachnoid hemorrhage treatment strategies

BackgroundThe options of surgical approach and treatment stage are two challenging treatment strategy issues with multiple intracranial aneurysmal subarachnoid hemorrhage (MIA-SAH). MethodsWe retrospectively analyzed data from patients with MIA-SAH who underwent surgery in our center between January 1, 2014 and September 1, 2022. To define “zone classification”, the cranial cavity was divided into four zones by the planes of cerebral falx and tentorium cerebelli. Aneurysms isolated to one zone were defined as zone classification I; those crossing two zones were defined as zone classification II; those crossing three zones were defined as zone classification III; and those crossing four zones were defined as zone classification IV. General and aneurysmal-related characteristics of patients with different zone classifications were collected and compared between two surgical approaches. Multivariate logistic regression analysis was used to identify factors independently associated with multistage treatment options. ResultsA total of 226 patients with 523 aneurysms were included. The proportion of patients undergoing endovascular treatment increased with higher zone classification (I: 85.4%; II: 94.0%; III: 100.0%; IV: 100.0%). The proportion of patients receiving one-stage treatment decreased with higher zone classification (I: 60.2%; II: 33.6%; III: 0.0%; IV: 0.0%). Compared with patients undergoing microsurgical clipping, more patients undergoing endovascular treatment had zone classification II–IV (56.9% vs. 31.8%, p = 0.025). Zone classification II–IV (odds ratio [OR] = 3.821, 95% confidence interval [CI]: 2.041–7.154, p < 0.001), endovascular treatment (OR = 8.756, 95% CI: 2.589–29.609, p < 0.001), and size of all unruptured aneurysms <3 mm (OR = 4.531, 95% CI: 2.315–8.871, p < 0.001) were each independently associated with multistage treatment. ConclusionsZone classification provides a new idea in MIA-SAH treatment strategies, especially regarding surgical approach and treatment stage options.

Mood swings are causally associated with intracranial aneurysm subarachnoid hemorrhage: A Mendelian randomization study.

Mood swings have been observed in patients with intracranial aneurysm (IA), but it is still unknown whether mood swings can affect IA. To explore the causal association between mood swings or experiencing mood swings and IA through a two-sample Mendelian randomization (MR) study. Summary-level statistics of mood swings, experiencing mood swings, IA, aneurysm-associated subarachnoid hemorrhage (aSAH), and non-ruptured IA (uIA) were collected from the genome-wide association study. Two-sample MR and various sensitivity analyses were employed to explore the causal association between mood swings or experiencing mood swings and IA, or aSAH, or uIA. The inverse-variance weighted method was used as the primary method. Genetically determined mood swings (odds ratio [OR]=5.23, 95% confidence interval (95%CI): 1.65-16.64, p=.005) and experiencing mood swings (OR=2.50, 95%CI: 1.37-4.57, p=.003) were causally associated with an increased risk of IA. Mood swings (OR=5.67, 95%CI: 1.40-23.04, p=.015) and experiencing mood swings were causally associated with the risk of aSAH (OR=2.91, 95%CI: 1.47-5.75, p=.002). Neither mood swings (OR=1.95, 95%CI: .31-12.29, p=.478) nor experiencing mood swings (OR=1.20, 95%CI: .48-3.03, p=.693) were associated with uIA. Mood swings and experiencing mood swings increased the risk of IA and aSAH incidence. These results suggest that alleviating mood swings may reduce IA rupture incidence and aSAH incidence.

Influence of humanized nursing on patients with intracranial aneurysm subarachnoid hemorrhage undergoing interventional embolization

ObjectiveTo investigate the effect of nursing intervention on patients with intracranial aneurysm subarachnoid hemorrhage who underwent interventional embolization. MethodsAccording to the random number table method, 80 patients with subarachnoid hemorrhage caused by intracranial aneurysm who received interventional embolization in our hospital from September 2018 to May 2021 were randomly divided into a control group of 40 cases and an observation group of 40 cases. 40 cases, the two groups were implemented routine nursing and humanized nursing. ResultsCompared with before nursing, the anxiety score, depression score, compliance rate, complication rate and PSQI score of the observation group were significantly lower than those of the control group after nursing (P < 0.05); Karnofsky Performance Status Scale score, Activity of daily living scale of the observation group and quality of life scores were significantly higher than those in the control group (P < 0.05). ConclusionHumanized nursing can effectively improve the psychological state of patients with subarachnoid hemorrhage caused by intracranial aneurysm during the perioperative period of interventional embolization, enhance their compliance with treatment, reduce complications, and make patients more satisfied with nursing services.

Inflammation and immune cell abnormalities in intracranial aneurysm subarachnoid hemorrhage (SAH): Relevant signaling pathways and therapeutic strategies.

Intracranial aneurysm subarachnoid hemorrhage (SAH) is a cerebrovascular disorder associated with high overall mortality. Currently, the underlying mechanisms of pathological reaction after aneurysm rupture are still unclear, especially in the immune microenvironment, inflammation, and relevant signaling pathways. SAH-induced immune cell population alteration, immune inflammatory signaling pathway activation, and active substance generation are associated with pro-inflammatory cytokines, immunosuppression, and brain injury. Crosstalk between immune disorders and hyperactivation of inflammatory signals aggravated the devastating consequences of brain injury and cerebral vasospasm and increased the risk of infection. In this review, we discussed the role of inflammation and immune cell responses in the occurrence and development of aneurysm SAH, as well as the most relevant immune inflammatory signaling pathways [PI3K/Akt, extracellular signal-regulated kinase (ERK), hypoxia-inducible factor-1α (HIF-1α), STAT, SIRT, mammalian target of rapamycin (mTOR), NLRP3, TLR4/nuclear factor-κB (NF-κB), and Keap1/nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/ARE cascades] and biomarkers in aneurysm SAH. In addition, we also summarized potential therapeutic drugs targeting the aneurysm SAH immune inflammatory responses, such as nimodipine, dexmedetomidine (DEX), fingolimod, and genomic variation-related aneurysm prophylactic agent sunitinib. The intervention of immune inflammatory responses and immune microenvironment significantly reduces the secondary brain injury, thereby improving the prognosis of patients admitted to SAH. Future studies should focus on exploring potential immune inflammatory mechanisms and developing additional therapeutic strategies for precise aneurysm SAH immune inflammatory regulation and genomic variants associated with aneurysm formation.

Impact of kidney function and kidney volume on intracranial aneurysms in patients with autosomal dominant polycystic kidney disease

Presently, only personal or family history of intracranial aneurysm/subarachnoid hemorrhage (IA/SAH) has been established as a risk factor for IA in autosomal dominant polycystic kidney disease (ADPKD). This study aimed to verify the association between kidney function/volume and IAs in patients with ADPKD. This study included 519 patients with ADPKD. At baseline IA screening, the median age and estimated glomerular filtration rate were 44 years and 54.5 mL/min/1.73 m2, respectively. Family IA/SAH history was confirmed in 18.1% of the patients, and 54.3% of the patients had hypertension. The IA point prevalence was 12.5%. During clinical follow up of 3104 patient-years, de novo IA was detected in 29 patients (0.93% patient-years). The IA period prevalence was 18.1% (median age, 60 years). Multivariable logistic regression demonstrated that total kidney volume (TKV) ≥ 1000 mL (odds ratio [OR] = 2.81), height-adjusted TKV ≥ 500 mL (OR = 2.81), Mayo imaging classification Class 1D–1E (OR = 2.52), and chronic kidney disease stages 3–5 (OR = 2.31) were significantly associated with IA formation. IAs in patients with ADPKD may be associated not only with general risk factors for IAs but also with declining kidney function and increased KV. Kidney disease progression may contribute to effective IA screening and treatment planning in patients with ADPKD.

Identifying and validating key genes mediating intracranial aneurysm rupture using weighted correlation network analysis and exploration of personalized treatment

Intracranial aneurysmal subarachnoid hemorrhage (aSAH) is a dangerous and highly fatal condition if ruptured. Significant advances have been made in the treatment of unruptured intracranial aneurysms (UIAs), but risk assessment methods for early diagnosis of intracranial aneurysm (IA) rupture remain limited. The datasets of IA GSE13353, GSE15629, and GSE54083 were downloaded through the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) in unruptured and ruptured aneurysms were identified by R software using methods such as gene set enrichment analysis (GSEA) and weighted gene co-expression network analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on the DEGs, and logistic regression models were used to construct a prediction model to discriminate UIA from healthy samples. We then performed GSEA on the genes in the model, followed by model validation using the GSE54083 dataset. Finally, we used the single-sample (ss)GSEA method to investigate the relationship between the diagnostic model genes and immune cells and immune function. A total of 79 DEGs were obtained in patients with IA rupture compared to unruptured controls. The results of KEGG and GO enrichment analysis showed that neutrophil activation is involved in immune response, neutrophil mediated immunity, and positive regulation of angiogenesis. Interestingly, the results of immunoassays demonstrated that the break in IA may be associated with immune T cells. We used DEGs and WGCNA to determine common genes. The logistic regression model was trained based on 24 intersecting genes, and eventually retained 2 genes, KIAA0226L and UPP1, which we found to be reliable using the validation set, and GSEA revealed that the diagnostic model was associated with the Hippo signaling pathway and vascular smooth muscle contraction, and viral protein interaction with cytokine and cytokine were also associated. Finally explored using the CMap database, Tivozanib could be a potential small molecule drug for the treatment of ruptured intracranial aneurysms (RIAs). We identified new diagnostic genes associated with IA rupture, which may provide a new way of aneurysm diagnosis.

Comparison of Aggressive Surgical Treatment and Palliative Treatment in Elderly Patients with Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage.

Objective To compare the current treatment approach in elderly patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) and identify the independent predictors of the outcome after aggressive surgical treatment. Method This prospective, multicenter cohort study included 104 poor-grade aneurysmal SAH elderly patients, 60 years or older, treated in our institution from October 2010 to March 2013. Patients were grouped according to three treatment arms. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at baseline and at a 12-month follow-up. Univariate and multivariate analysis were performed using the following factors: sex, age, smoking history, breathing ability, alcohol consumption, cerebral hernia, aneurysm location, aneurysm diameter, WFNS grade, CT Fisher grade, treatment approach, and the timing of the aneurysm surgery. Results At the 12-month follow-up, patients in the coiling group and clipping group had better prognosis than patients in the palliative treatment group. Univariate analysis confirmed that the treatment approach, WFNS grade, CT Fisher grade, and age are critical factors for neurological outcomes in poor-grade SAH. Multivariate analysis indicated that WFNS grade V, CT Fisher grades 3–5, and palliative treatment were independent predictors of poor prognoses. Conclusion Aggressive surgical treatment improves the prognoses in poor-grade aneurysm elderly patients with SAH. Elderly Patients of WFNS grade IV and CT Fisher grades 1-2 are more likely to have a better outcome.

Takotsubo cardiomyopathy after intracranial aneurysmal subarachnoid hemorrhage

Objective To investigate the clinical characteristics of Takotsubo cardiomyopathy (TTC) following intracranial aneurysmal subarachnoid hemorrhage (SAH). Methods Review all patients with intracranial aneurysmal SAH from January 2013 to January 2015 in our hospital, and finally a total of 14 patients who complicated TTC were selected. Their clinical data, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), N-terminal pro-B-type natriuretic peptide (NT-proBNP), ECG and echocardiographic findings were analyzed. Results For 14 patients of TTC following aneurysmal SAH, the value of CK was (591.93 ± 248.78) IU/L in the first 24 h on admission, and significantly decreased to (137.79 ± 29.93) IU/L 2 weeks later ( t = 7.090, P = 0.000); the value of CK-MB was (27.07 ± 7.66) IU/L in the first 24 h (3 cases were at normal levels), and significantly decreased to (14.36 ± 5.58) IU/L 2 weeks later ( t = 4.897, P = 0.000); the value of NT-proBNP was (8685.36 ± 3963.44) IU/L in the first 24 h, and significantly decreased to (577.14 ± 203.37) IU/L 2 weeks later ( t = 7.778, P = 0.000). ECG on admission mainly showed ST segment alternation, T wave inversion and QT interval prolongation. Echocardiograghic findings showed segmental left ventricular wall motion abnormalities. The average left ventricular ejection fraction (LVEF) was (36.07 ± 6.15)%, and increased to (56.43 ± 3.18)% 2 weeks later ( t = 13.381, P = 0.000). The results of ECG and echocardiographic findings were normal after one month. Conclusions Intracranial aneurysmal SAH can lead to Takotsubo cardiomyopathy, the incidence of which is 4.58% approximately, and the prognosis is good. Echocardiographic findings are significantly important for early screening of Takotsubo cardiomyopathy, and coronary angiography (CAG) can be used to make a clear diagnosis in acute phase. DOI: 10.3969/j.issn.1672-6731.2016.06.010

Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography

Copyrights © 2011 The Korean Society of Radiology Purpose: To evaluate the usefulness of multidetector-row CT angiography (MDCTA) for the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) by comparison of digital subtraction angiography (DSA) and to compare the bone subtraction CT angiography (BS-CTA) and standard CT angiography (S-CTA). Materials and Methods: Thirty-three patients who were treated with intraarterial nimodipine infusion for the cerebral vasospasm after aneurysmal SAH were evaluated with MDCTA and DSA. BS-CTA images were reconstructed from the S-CTA and unenhanced CT source images. A total of 207 vascular segments were evaluated. A fourstep scale for the degree of stenosis was applied for each segment. With DSA as the standard images, BS-CTA and S-CTA images were comparied. Results: On DSA, 56 segments (27%) presented vasospasm. Concordance between the DSA and S-CTA and between DSA and BS-CTA were 94.7% and 82.1%, respectively. Overestimation for the degree of stenosis was shown in 37 segments on BS-CTA and in 8 segments on S-CTA, but underestimated segments were only shown on SCTA (n = 4). Conclusion: MDCTA with standard technique seems to be a useful imaging tool for the evaluation of the cerebral vasospasm after aneurysmal SAH. However, BS-CTA is not needed because of additional radiation and overestimation of the degree of stenosis. Index terms Intracranial Aneurysm Subarachnoid Hemorrhage Vasospasm, Intracranial Cerebral Angiography Tomography, X-Ray Computed Multidetector-Row CT Angiography of Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Comparison of Bone Subtraction and Standard CT Angiography with Digital Subtraction Angiography 동맥류성 거미막밑출혈 후 발생한 뇌혈관 연축의 다중검출기 CT 혈관조영술: 골감산 및 표준기법의 CT 혈관조영술과 디지털감산혈관조영술의 비교

Ultra-Early Surgery for Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study

PurposeTo describe the therapeutic effect and possibility of the ultra-early surgery for poor-grade aneurysmal subarachnoid hemorrhage (Hunt-Hess grades IV - V).Materials and MethodsNine cases with intracranial aneurysms, demonstrated by computed tomographic angiography (CTA), were treated by ultra-early surgery under general anesthesia within 24 hours from subarachnoid hemorrhage (SAH), 5 cases were treated within 6 hours and 4 cases in 6 - 24 hours. Preoperative Hunt-Hess grade: 6 cases were IV and 3 cases were V. The clinical outcome was evaluated by Glasgow Outcome Scores (GOS).ResultsIn operation, difficult dissection occurred in 5 cases (55.6%), and rupture of aneurysm occurred and temporary obstructions were performed in 4 cases (44.4%). After clipping of aneurysm, 2 cases underwent V-P shunt because of hydrocephalus, pulmonary infection occurred in 3 cases, hypothalamus reaction accompanied with upper gastrointestinal hemorrhage in 2 cases. The clinical outcome were favorable (GOS 4 - 5) in 4 cases (44.4%), dissatisfied (GOS 2 - 3) in 3 cases (33.3%), and dead (GOS 1) in 2 cases (22.2%) when patients departed from our hospital.ConclusionThe ultra-early surgery can avoid early rebleeding of intracranial aneurysm, therefore, should be considered in the treatment of Hunt-Hess grade IV-V intracranial aneurysms. The appliance of CTA can make it possible to use of ultra-early surgery and improve the therapeutic effect.