Key point: The presence of a severe, sudden headache, often referred to as a warning leak, minor leak, or sentinel headache (SH), during the days or weeks before subarachnoid hemorrhage (SAH) has been reported in 15% to 60% of all patients admitted with an SAH. The clinical significance and pathophysiology of SH have been a Read more about Sentinel headache in intracranial aneurysms: this stranger[…]
Dr. Guido Guglielmi, father of the endovascular coiling of brain aneurysms.
Key point: In the last post, we have concluded that when an unruptured intracranial aneurysm is identified we have to decide whether the “patient” (and not only the aneurysm) should be treated and whether it should be treated with endovascular or neurosurgical techniques. But for years our decision making has been influenced by results of Read more about ISUIA: the old problem.[…]
Key point: The widespread use of neurovascular imaging has increased the amount of intracranial aneurysms eccidentally detected. Although the lifetime risk of aneurysmal rupture in many cases is relatively small (approximately 1% per year), rupture can results in permanent neurological deficits or death, the reason why often patients may desire the treatment of unruptured aneurysms Read more about An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms[…]
Key points: According to prospective cohort studies, smoking is the most important risk factor for unruptured intracranial aneurysms, correlating with their appearance, growth and rupture. In addition, earlier studies report that women are at higher risk for SAH with adjusted hazard ratios (HRs) from 1.4 to 1.9 compared with men. In this paper, published August, 2016, Read more about Sex, Smoking, and Risk for Subarachnoid Hemorrhage[…]
Happy Easter from Neurovascolare Team. Francesco Diana, M.D. Francesco Biraschi, M.D. Simone Peschillo, M.D., Ph.D.
Key points: Despite microsurgical treatment of cerebral aneurysms has a documented history, the impressive progression of endovascular technology, techniques and skills, and the results of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT) has altered the paradigm for treating intracranial aneurysms. These neurointerventional option have raised the bar for aneurysm surgery, in an era when most Read more about A raised bar for aneurysm surgery in the endovascular era[…]
Key points: Coiling, simple or balloon-/stent-assisted, is an endosaccular technique of treatment and a long-term follow-up is mandatory: the problem of aneurysmal recanalization remains and according to a systematic review, recanalization occurs in 20.8% of patients. The volume embolization ratio (VER) has recently been reported to be associated with aneurysmal recanalization. It is a general Read more about Optimal first coil selection to avoid aneurysmal recanalization in endovascular intracranial aneurysmal coiling[…]
Chen CW1, Wong HF2, Ye YL1, Chen YL3, Chen WL4, Ou CH5, Tsai YH1. Key points: As everyone knows the flow diverter stent (FDS) disrupts blood flow into the aneurysm sac, maintaining normal blood flow through the parent vessel; sometimes, there is a neointimal proliferation across the device strut, that contributes to the aneurysm closure. Read more about Multiple FD stents for treatment of large and giant aneurysms: is it really useful? Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm[…]
Arena JE1, Hawkes MA2, Farez MF1, Pertierra L1, Kohler AA1, Marrodán M1, Benito D3, Goicochea MT1, Miranda JC3, Ameriso SF4. Key points: Despite several studies have mentioned the presence of headache (cluster headache, hemicrania continua, and migraine) in subjects with UIAs, in 18%-34% of cases, in general practice chronic primary headache is not usually Read more about Headache and Treatment of Unruptured Intracranial Aneurysms[…]