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Advances in Diagnosis and Treatment of Intracranial Aneurysms
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Advances in Diagnosis and Treatment of Intracranial Aneurysms

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (30 May 2024) | Viewed by 7444

Special Issue Editors

Dr. Joseph S. Hudson

E-Mail Website
Guest Editor
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Interests: intracranial aneurysm; cerebrovascular neurosurgery; spine surgery; general neurosurgery
Dr. Prateek Agarwal

E-Mail Website
Guest Editor
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Interests: endovascular neurosurgery; cerebrovascular; minimally invasive spine surgery

Special Issue Information

Dear Colleagues,

There have been great advancements in the diagnosis and treatment of intracranial aneurysms over the last 20 years. New devices have been created to treat aneurysms in a minimally invasive fashion. Bypass techniques to treat morphologically challenging aneurysms have been developed. A more complete understanding of intracranial aneurysm biology, and inflammation's role in intracranial aneurysm formation and rupture, and vasospam has been gained through basic science and in human research. Clinical studies have suggested that this process may be modifiable with systemically ingested therapeutics. Advances in cerebrovascular imaging allow neurosurgeons and neuro-interventionalists to more precisely monitor aneurysms over time, and even correlate imaging findings with degratory histopathologic changes in the vessel wall. This Special Issue will highlight these recent advancements while focusing on new and exciting science driving modern cerebrovascular care.

We are looking forward to your submissions to this Special Issue.

Dr. Joseph S. Hudson
Dr. Prateek Agarwal
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aneurysm
  • sub-arachnoid hemorrhage
  • inflammation
  • hydrocephalus
  • microsurgery
  • endovascular
  • coiling
  • flow diversion
  • vasospasm

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Published Papers (3 papers)

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Research

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11 pages, 369 KiB  
Article
Risk Factor Analysis of Complications and Mortality Following Coil Procedures in Patients with Intracranial Unruptured Aneurysms Using a Nationwide Health Insurance Database
by So Yeon Park, So An Kim, Yu Hyeon An, Sang Won Kim, Saeyoon Kim, Jae Min Lee and Youngjin Jung
J. Clin. Med. 2024, 13(4), 1094; https://doi.org/10.3390/jcm13041094 - 15 Feb 2024
Viewed by 2766
Abstract
(1) Background: Unruptured intracranial aneurysm (UIA) occurs in 1–2% of the population and is being increasingly detected. Patients with UIA are treated with close observation, endovascular coiling or surgical clipping. The proportion of endovascular coiling has been rising. However, complications such as cerebral [...] Read more.
(1) Background: Unruptured intracranial aneurysm (UIA) occurs in 1–2% of the population and is being increasingly detected. Patients with UIA are treated with close observation, endovascular coiling or surgical clipping. The proportion of endovascular coiling has been rising. However, complications such as cerebral infarction (CI), intracranial hemorrhage (ICRH), and death remain crucial issues after coil treatment. (2) Methods: We analyzed the incidence and risk factors of complications after the use of coil in patients with UIA based on the patients’ characteristics. We utilized the Health Insurance Review and Assessment (HIRA) database. Patients treated with coils for UIA between 1 January 2015 and 1 December 2021 were retrospectively analyzed. (3) Results: Of the total 35,140 patients, 1062 developed ICRH, of whom 87 died, with a mortality rate of 8.2%. Meanwhile, 749 patients developed CI, of whom 29 died, with a mortality rate of 3.9%. The overall mortality rate was 1.8%. In a univariate analysis of the risk factors, older age, males, a higher Charlson Comorbidity Index (CCI) score, and diabetes increase the risk of CI. Meanwhile, males with higher CCI scores and hemiplegia or paraplegia show increased ICRH risk. Older age, males and metastatic solid tumors relate to increased mortality risk. (4) Conclusions: This study is significant in that the complications based on the patient’s underlying medical condition were analyzed. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Intracranial Aneurysms)
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10 pages, 3379 KiB  
Article
A Giant Stent for Giant Cerebral Aneurysms—The Accero®-Rex-Stent
by Hermann Kraehling, Burak Han Akkurt, Mohamed Elsharkawy, Ahmed Ayad, Mostafa Ergawy, Ekin Celik, René Chapot, Wolfram Schwindt and Christian Paul Stracke
J. Clin. Med. 2024, 13(2), 388; https://doi.org/10.3390/jcm13020388 - 10 Jan 2024
Cited by 1 | Viewed by 1865
Abstract
Objective: Until now, giant intracranial aneurysms (GIAs) have in many cases been a vascular disease that was difficult or impossible to treat, not least due to the lack of availability of a large-format stent. In this multicentre study, we report on the first [...] Read more.
Objective: Until now, giant intracranial aneurysms (GIAs) have in many cases been a vascular disease that was difficult or impossible to treat, not least due to the lack of availability of a large-format stent. In this multicentre study, we report on the first five clinical applications of the Accero®-Rex-Stents (Acandis, Pforzheim, Germany) in the successful treatment of fusiform cerebral giant aneurysms. Material and Methods: The Accero®-Rex-Stents are self-expanding, braided, fully radiopaque Nitinol stents designed for aneurysm treatment. The stent is available in three different sizes (diameter 7–10 mm, length 30–60 mm) and intended for endovascular implantation in vessels with diameters of 5.5–10 mm. Results: Five patients (all male, age 54.4 ± 8.1 years) with large fusiform aneurysms of the posterior circulation were treated endovascularly using the Accero®-Rex-Stents. There were no technical complications. One major ischemic complication occurred. A significant remodeling and reduction in the size of the stent-covered aneurysms was already seen in the short-term post-interventional course. Conclusions: The Accero®-Rex-Stents were successfully and safely implanted in all five patients with fusiform giant aneurysms, showing technical feasibility with promising initial results and significant aneurysm size reduction in already available follow-up imaging. Key point: With the Accero-Rex-Stents, a new device is available that offers another treatment option for rare cerebral fusiform giant aneurysms with very large parent vessels. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Intracranial Aneurysms)
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Review

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14 pages, 596 KiB  
Review
Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture
by Alex Crane, Regan M. Shanahan, Joseph S. Hudson, Kamil W. Nowicki, Zachary C. Gersey, Prateek Agarwal, Rachel C. Jacobs, Michael J. Lang and Bradley Gross
J. Clin. Med. 2024, 13(11), 3324; https://doi.org/10.3390/jcm13113324 - 5 Jun 2024
Cited by 1 | Viewed by 2318
Abstract
Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. [...] Read more.
Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs. The aim of this review is to provide an updated summary of different pharmaceutical management strategies for IAs. Acetylsalicylic acid and renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensives have some evidence supporting their protective effect. Studies of selective cyclooxygenase-2 (COX-2) inhibitors, statins, ADP inhibitors, and other metabolism-affecting drugs have demonstrated inconclusive findings regarding their association with aneurysm growth or rupture. In this manuscript, we highlight the evidence supporting each drug’s effectiveness. Full article
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Intracranial Aneurysms)
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