Non-ruptured intracranial aneurysms in patients from Sancti Spíritus province
Keywords:
Intracranial aneurysm and epidemiology, subarachnoid hemorrhageAbstract
Background:Intracranial aneurysms when ruptured cause subarachnoid hemorrhage. However, not always they rupture and some may be found by chance in an imaging study and they are called incidental or asymptomatic depending on whether or not the patient has a prior event of additional ruptured sac formerly. Treating a non-ruptured intracranial aneurysm is a challenge for foremost clinical physicians and surgeons.
Objective:To describe the characteristics and evolution of a series of 91 incidental and asymptomatic intracranial aneurysms in patients treated at the General Hospital Camilo Cienfuegos in Sancti Spíritus between 2010 and 2020.
Methodology:Descriptive and quantitative study with a non-probabilistic sample of 91 incidental and asymptomatic aneurysms found in 72 patients through imaging studies. The
variables studied were: age, sex, dimensions, irregular shape, site of location, method of treatment used, mortality and morbidity.
Results:Patients aged between 45 and 65 years predominated with a predominance of female sex. The majority were medium-sized aneurysms and the most frequent location was the anterior connecting aneurysm. Clinical and morphological variables predictive of complications were detected. Patients who did not undergo surgery had a better evolution. Several patients with first and second relatives’ degree affected by intracranial aneurysms were detected.
Conclusions:Non-ruptured intracranial aneurysms predominate in women in the fifth and sixth decade of life. Morphological factors such as sac size, maximum dome height and aspect ratio were related to the happening of complications in operated patients. Family intracranial aneurysm syndrome should be considered in patients with a history of first and second relatives’ degree affected by intracranial aneurysms.
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1. Rhoton AL. Aneurysms. Neurosurgery [Internet]. 2002 [cited 2022 Jun 28];Oct;51(4 Suppl):S121-58. PMID:12234448. Available from: https://docer.com.ar/doc/ee5n55
2. Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, Badjatia N, Agarwal S, Claassen J, Connolly ES, Mayer SA. Subarachnoid hemorrhage: who dies, and why? Crit Care [Internet]. 2015 Aug 31 [cited 2002 Jun 28];19(1):309. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556224/
3. Inagawa T, Hirano A. Autopsy study of unruptured incidental intracranial aneurysms, Surgical Neurology. [Internet]. 1990 [cited 2022 Jul 23];34(6):361-5. Available from: https://www.sciencedirect.com/science/article/pii/009030199090237J. https://doi.org/10.1016/0090-3019(90)90237-J
4. Milet LE. Historia natural de los aneurismas intracraneales: Aneurismas sin ruptura. Rev argent neurocir [Internet]. 2006 Mar [citado 23 Ago 2022];20(1):19-24. Disponible en: http://www.scielo.org.ar/pdf/ranc/v20n1/v20n1a05.pdf
5. Ito H, Kawaminami T, Asano K, Fukubaga T, Karai C, Okuma S, et al. The Prevalence of Unruptured Cerebral Aneurysms in Okinoerabu: A Japanese Hospital-Based Study. J Neurol Neurosci [Internet]. 2018 [cited 2022 Jul 29];9(5):273. Available from: https://www.jneuro.com/abstract/the-prevalence-of-unruptured-cerebral-aneurysms-in-okinoerabu-a-japanese-hospitalbased-study-23649.html
6. Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol [Internet]. 2016 Dec [cited 2022 Jul 29];12(12):699-713. Available from: https://doi.org/10.1038/nrneurol.2016.150
7. Rajabzadeh-Oghaz H, Wang J, Varble N, Sugiyama SI, Shimizu A, Jing L, Liu J, Yang X, Siddiqui AH, Davies JM, Meng H. Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms. AJNR Am J Neuroradiol [Internet]. 2019 Nov [cited 2022 Jul 29];40(11):1939-46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6871507/
8. Zhu W, Li W, Tian Z, Zhang M, Zhang Y, Wang K, Zhang Y, Yang X, Liu J. Nomogram for Stability Stratification of Small Intracranial Aneurysm Based on Clinical and Morphological Risk Factors. Front Neurol [Internet]. 2021 Jan 15 [cited 2022 Jul 29];11:598740. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2020.598740/full
9. Feng X, Tong X, Peng F, Niu H, Qi P, Lu J, et al. Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study. Stroke Vasc Neurol [Internet]. 1 de September de 2021 [cited 2022 jul 29];6(3):433-40. Available from: https://svn.bmj.com/content/svnbmj/6/3/e000480.full.pdf
10. The international study of unruptured intracranial aneurysms investigators. Unruptured intracranial aneurysms - risk of rupture and risks of surgical intervention. N Engl J Med [Internet] 1998 [cited 2022 Jul 29];339(24):1725-33. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJM199812103392401?articleTools=true
11. UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med [Internet] 2012 [cited 2022 Jul 29];366:2474-82. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1113260?articleTools=true
12. Mayer TE, Etminan N, Morita A, Juvela S.. The unruptured intracranial aneurysm treatment score a multidisciplinary consensus. Neurology [Internet] 2016 [cited 2022 Jul 29];86(8):792. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560059/ https://doi.org/10.1212/01.wnl.0000481228.68055.71
13. Molyneux A. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet [Internet]. 2002 [cited 2022 Jul 29];360(9342):1267-74. Available from: https://pubmed.ncbi.nlm.nih.gov/16139655/ https://doi.org/10.1016/S0140-6736(02)11314-6 https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(02)11314-6.pdf
14. David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg [Internet]. 1999 Sep [cited 2022 Jul 29];91(3):396-401. Available from: https://doi.org/10.3171/jns.1999.91.3.0396.
15. Watt J, Watt C, Van Schoor A. Gender-Based Comparative Aneurysm Study Regarding Age at Presentation, Location,and Possible Causative Factors. Anatol J Family Med [Internet] 2020 [cited 2022 Jul 29];3(3):211-21. Available from: https://anatoljfm.org/jvi.aspx?un=ANATOLJFM-52297
16. Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F. Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery [Internet]. 1999 Jul [cited 2022 Jul 29];45(1):119-29. Available from: https://doi.org/10.1097/00006123-199907000-00028
17. Tremmel M, Dhar S, Levi EI, Mocco J, Meng H. Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study. Neurosurgery [Internet]. 2009 [cited 2022 Jul 29];(64):622-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775481/
18. Mohd Nazri NN, Uzair Matalif M, Mohd Adib MAH. Effects of blood flow patent and cross-sectional area on hemodynamic into patient-specific cerebral aneurysm via fluid-structure interaction method: A review. Mater Sci Eng [Internet]. 2020 [cited 2022 Jul 29];788. Available from: https://iopscience.iop.org/article/10.1088/1757-899X/788/1/012022/pdf
19. Bor ASE, Rinkel GJE, Adami J, Koffijberg H, Ekbom A, Buskens E, et al. Risk of subarachnoid haemorrhage according to number of affected relatives: a population based case–control study. Brain [Internet]. 1 de octubre de 2008 [cited 2022 Jul 29];131(10):2662-5. Available from: https://doi.org/10.1093/brain/awn187
20. Etminan N, Dörfler A, Steinmetz H: Unruptured intracranial aneurysms pathogenesis and individualized management. Dtsch Arztebl Int [Internet]. 2020 [cited 2022 Jul 29];117:235-42. Available from: https://doi.org/10.3238/arztebl.2020.0235 https://www.aerzteblatt.de/pdf.asp?id=213348
21. Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 [cited 2022 Jul 29];46(8):2368-400. Available from: https://doi.org/10.1161/STR.0000000000000070 https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000070
22. Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC, Brott T, et al. Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms. Stroke [Internet]. 1 de noviembre de 2000 [cited 2022 Jul 29];31(11):2742-50. Available from: https://www.ahajournals.org/doi/epub/10.1161/01.STR.31.11.2742 https://doi.org/10.1161/01.STR.32.3.815
23. Guglielmi G, Viñuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg [Internet]. 1992 [cited 2022 Jul 29];77(4):515-24. Available from: https://doi.org/10.3171/jns.1992.77.4.0515
24. Brinjikji W, Rabinstein AA, Nasr DM, Lanzino G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. AJNR Am J Neuroradiol [Internet]. 2011 Jun-Jul [cited 2022 Jul 29];32(6):1071-5. Available from: http://www.ajnr.org/content/ajnr/32/6/1071.full.pdf https://doi.org/10.3174/ajnr.A2453
25. Yang H, Jiang H, Ni W, Leng B, Bin X, Chen G, et al. Treatment Strategy for Unruptured Intracranial Aneurysm in Elderly Patients: Coiling, Clipping, or Conservative?. Cell Transplant [Internet]. 2019 Jun [cited 2022 Jul 29];28(6):767-74. Available from: https://doi.org/10.1177/0963689718823517 https://journals.sagepub.com/doi/epub/10.1177/0963689718823517
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