Posts Tagged ‘subarachnoid hemorrhage’
Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning.
Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage.
Methods: A multicenter retrospective cohort of patients with aneurysmal subarachnoid hemorrhage was examined for ischemic preconditioning stimulus: preexisting steno-occlusive cerebrovascular disease (CVD) and/or previous cerebral infarct. Generalized estimating equation models were performed to determine the effect of the preconditioning stimulus on the primary end points of radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction and the secondary end point of discharge modified Rankin Scale score.
Background: Recent experimental evidence indicates that endogenous mechanisms against cerebral vasospasm can be induced via preconditioning (PC).
Objective: To determine whether these vascular protective mechanisms are also present in vivo in humans with aneurysmal subarachnoid hemorrhage (aSAH)
Methods: A multicenter retrospective cohort of aSAH patients was examined for ischemic PC stimulus: pre-existing steno-occlusive cerebrovascular disease and/or previous cerebral infarct (CVD). Generalized estimating equation models were performed to determine the effect of the PC stimulus on the primary endpoints: radiographic vasospasm, symptomatic vasospasm, and vasospasm-related delayed cerebral infarction, and the secondary endpoint: discharge modified Rankin Scale.
Advances and Innovations in Vascular Neurosurgery: Advances in Endovascular Approaches to Cerebral Aneurysms
Recent advancements in all phases of endovascular aneurysm treatment, including medical therapy, diagnostics, devices, and implants, abound. Advancements in endovascular technologies and techniques have enabled treatment of a wide variety of intracranial aneurysms. In this article, technical advances in endovascular treatment of cerebral aneurysms are discussed, with an effort to incorporate a clinically relevant perspective. Advancements in diagnostic tools, medical therapy, and implants are reviewed and discussed.
Advances and Innovations in Vascular Neurosurgery is online and full-text access is free.
Background: Adenosine-induced flow arrest is a technique that is used to assist in the surgical clipping of complex aneurysms.
Objective: To assess the safety associated with adenosine-assisted intracranial aneurysm surgery.
Methods: Medical records of all patients presenting between January 1st, 2009 and December 31st, 2012 for intracranial aneurysm surgery were analyzed. Patients were divided in two groups based on the intraoperative administration of Adenosine: Non-Adenosine group (n=262) and Adenosine group (n=64). The primary outcome compared between groups included a composite of 30-day mortality and incidences of perioperative cardiac complications (perioperative myocardial infarction or perioperative cardiac arrhythmias).
Background: Cerebral microbleeds (CMBs) are commonly found after stroke, but have not been previously studied in patients with subarachnoid hemorrhage (SAH).
Objective: To study the prevalence, radiographic patterns, predictors, and impact on outcome of CMBs in patients with SAH.
Methods: We analyzed retrospectively 39 consecutive patients who underwent T2*-weighted gradient-echo imaging within seven days after onset of spontaneous SAH. We report frequency and location of CMBs and show their association with demographics, vascular risk factors, the Hunt-Hess grade, the modified Fisher Scale, the Acute Physiologic and Chronic Health Evaluation II, MRI findings including diffusion-weighted imaging lesions (DWILs), and laboratory data, as well as data on rebleeding, global cerebral edema, delayed cerebral ischemia, seizures, the Telephone Interview for Cognitive Status, and the modified Rankin Scale.
Background: Computed tomographic angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, though digital subtraction angiography is often required for more detailed aneurysm shape delineation.
Objective: To determine if a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making prior to intervention.
Methods: 15 patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared to contemporaneous catheter three-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line-plots of identical projections on all imaging datasets and compared by matched-pair statistics.
Background: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown.
Objective: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications.
Methods: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications.