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Special Issue "Clinical Advances in Cerebral Aneurysm Treatment"

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

Deadline for manuscript submissions: 10 June 2023 | Viewed by 5884

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Special Issue Editor

Prof. Dr. Ramazan Jabbarli

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Guest Editor

Department of Neurosurgery & Spine Surgery, University Hospital Essen, 45147 Essen, Germany
Interests: cerebral aneurysms; subarachnoid hemorrhage; arteriovenous malformations; neuro-oncology; spine surgery

Special Issue Information

Dear Colleagues,

The prevalence of cerebral aneurysms (CA) in the healthy adult population is relatively low at 2–3%. At the same time, CA are of high clinicoepidemiological relevance, linked with the risk of hemorrhagic stroke in the case of CA rupture, affecting mostly individuals in their mid-fifties. The resulting subarachnoid hemorrhage (SAH) is known for its substantial morbidity and mortality. Despite considerable achievements in neurocritical care in recent decades, certain complications of SAH contribute to poor outcome in over half of diseased individuals. This circumstance necessitates further improvements in management and prevention of secondary complications of SAH, as well as timely identification and prophylactic treatment of individuals with rupture-prone CA. As interventional (endovascular or microsurgical) closure of CA is associated with certain treatment-related morbidity, proper risk–benefit assessment requires more precise knowledge on individual risk factors for CA rupture.

This Special Issue of the Journal of Clinical Medicine will cover the following important aspects of CA management prior and after CA rupture:

Prognostic factors for CA development, growth, and rupture;
Risk–benefit assessment for the treatment of unruptured CA;
Advances in conservative and invasive management of unruptured CA;
Initial severity of SAH and early complications after CA rupture;
Diagnosis and treatment of cerebral vasospasm and delayed cerebral ischemia;
Management of intracranial pressure after SAH;
Acute and chronic hydrocephalus after SAH;
Systemic complications during and neurocritical care management of SAH;
Treating CA in the era of digital technologies: the value of artificial intelligence for the optimization of CA treatment.

Prof. Dr. Ramazan Jabbarli
Guest Editor

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

cerebral aneurysms
subarachnoid hemorrhage
infarct, outcome
risk factors
coiling
clipping

Published Papers (5 papers)

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Research

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Open AccessArticle

Aneurysmal Subarachnoid Hemorrhage in Hospitalized Patients on Anticoagulants—A Two Center Matched Case-Control Study

Michael Veldeman

Tobias Rossmann

Miriam Weiss

Catharina Conzen-Dilger

and

J. Clin. Med. 2023, 12(4), 1476; https://doi.org/10.3390/jcm12041476 - 13 Feb 2023

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Abstract

Objective—Direct oral anticoagulants (DOAC) are replacing vitamin K antagonists (VKA) for the prevention of ischemic stroke and venous thromboembolism. We set out to assess the effect of prior treatment with DOAC and VKA in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods—Consecutive SAH patients treated at two (Aachen, Germany and Helsinki, Finland) university hospitals were considered for inclusion. To assess the association between anticoagulant treatments on SAH severity measure by modified Fisher grading (mFisher) and outcome as measured by the Glasgow outcome scale (GOS, 6 months), DOAC- and VKA-treated patients were compared against age- and sex-matched SAH controls without anticoagulants. Results—During the inclusion timeframes, 964 SAH patients were treated in both centers. At the time point of aneurysm rupture, nine patients (0.93%) were on DOAC treatment, and 15 (1.6%) patients were on VKA. These were matched to 34 and 55 SAH age- and sex-matched controls, re-spectively. Overall, 55.6% of DOAC-treated patients suffered poor-grade (WFNS_4–5) SAH compared to 38.2% among their respective controls (p = 0.35); 53.3% of patients on VKA suffered poor-grade SAH compared to 36.4% in their respective controls (p = 0.23). Neither treatment with DOAC (aOR 2.70, 95%CI 0.30 to 24.23; p = 0.38), nor VKA (aOR 2.78, 95%CI 0.63 to 12.23; p = 0.18) were inde-pendently associated with unfavorable outcome (GOS_1–3) after 12 months. Conclusions—Iatrogenic coagulopathy caused by DOAC or VKA was not associated with more severe radiological or clinical subarachnoid hemorrhage or worse clinical outcome in hospitalized SAH patients. Full article

(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)

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Open AccessArticle

Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage

Marvin Darkwah Oppong

Anne-Kathrin Uerschels

Philipp Dammann

Karsten Henning Wrede

Ulrich Sure

and

Ramazan Jabbarli

J. Clin. Med. 2022, 11(21), 6258; https://doi.org/10.3390/jcm11216258 - 24 Oct 2022

Viewed by 550

Abstract

Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (n = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, p < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, p < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, p = 0.001) and duration (3 vs. 5 days, p = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients. Full article

(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)

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Open AccessArticle

Invasive Diagnostic and Therapeutic Management of Cerebral VasoSpasm after Aneurysmal Subarachnoid Hemorrhage (IMCVS)—A Phase 2 Randomized Controlled Trial

and

J. Clin. Med. 2022, 11(20), 6197; https://doi.org/10.3390/jcm11206197 - 20 Oct 2022

Viewed by 2694

Abstract

Cerebral vasospasm (CVS) is associated with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). The most frequently used form of rescue therapy for CVS is invasive endovascular therapy. Due to a lack of prospective data, we performed a prospective randomized multicenter trial (NCT01400360). A total of 34 patients in three centers were randomized to invasive endovascular treatment or conservative therapy at diagnosis of relevant CVS onset. Imaging data was assessed by a neuroradiologist blinded for treatment allocation. Primary outcome measure was development of DCI. Secondary endpoints included clinical outcome at 6 months after SAH. A total of 18 of the 34 patients were treated conservatively, and 16 patients were treated with invasive endovascular treatment for CVS. There was no statistical difference in the rate of cerebral infarctions either at initial or at the follow-up MRI between the groups. However, the outcome at 6 months was better in patients treated conservatively (mRs 2 ± 1.5 vs. 4 ± 1.8, p = 0.005). Invasive endovascular treatment for CVS does not lead to a lower rate of DCI but might lead to poorer outcomes compared to induced hypertension. The potential benefits of endovascular treatment for CVS need to be addressed in further studies, searching for a subgroup of patients who may benefit. Full article

(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)

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Open AccessArticle

Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: The Results of Induced Hypertension Only after the IMCVS Trial—A Prospective Cohort Study

and

J. Clin. Med. 2022, 11(19), 5850; https://doi.org/10.3390/jcm11195850 - 02 Oct 2022

Cited by 4 | Viewed by 771

Abstract

Delayed cerebral ischemia (DCI) is a predictor of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Treatment strategies vary and include induced hypertension and invasive endovascular treatment. After the IMCVS trial (NCT01400360), which failed to demonstrate a benefit of endovascular treatment for cerebral vasospasm (CVS) and resulted in a significantly worse outcome, we changed our treatment policy in patients with diagnosed CVS to induced hypertension only, and we present our prospective results in the subgroup of SAH patients meeting inclusion criteria of the IMCVS trial. All patients underwent screening for DIND when conscious and for CVS using CT-A/-P at day 6–8 after SAH. In the case of CVS, arterial hypertension was induced and continued until re-assessment. In total, 149 of 303 patients developed CVS. DCI developed in 35 patients (23.5%). In multivariate analyses, CVS was a predictor for the development of new infarctions. Poor admission status, re-bleeding before treatment, and DCI predicted poor outcome. The omittance of invasive endovascular rescue therapies in SAH patients with CVS, additional to induced hypertension, does not lead to a higher rate of DCI. Potential benefits of additional endovascular treatment for CVS need to be addressed in further studies searching for a subgroup of patients who may benefit. Full article

(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)

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Review

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Open AccessReview

Pathophysiology of Early Brain Injury and Its Association with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Review of Current Literature

Gustavo G. Domeniconi

Asad Ikram

Sara Y. Sabbagh

and

Afshin A. Divani

J. Clin. Med. 2023, 12(3), 1015; https://doi.org/10.3390/jcm12031015 - 28 Jan 2023

Viewed by 794

Abstract

Background: Delayed cerebral ischemia (DCI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Though many clinical trials have looked at therapies for DCI and vasospasm in aSAH, along with reducing rebleeding risks, none have led to improving outcomes in this patient population. We present an up-to-date review of the pathophysiology of DCI and its association with early brain injury (EBI). Recent Findings: Recent studies have demonstrated that EBI, as opposed to delayed brain injury, is the main contributor to downstream pathophysiological mechanisms that play a role in the development of DCI. New predictive models, including advanced monitoring and neuroimaging techniques, can help detect EBI and improve the clinical management of aSAH patients. Summary: EBI, the severity of subarachnoid hemorrhage, and physiological/imaging markers can serve as indicators for potential early therapeutics in aSAH. The microcellular milieu and hemodynamic pathomechanisms should remain a focus of researchers and clinicians. With the advancement in understanding the pathophysiology of DCI, we are hopeful that we will make strides toward better outcomes for this unique patient population. Full article

(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)

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