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Medicina
Special Issues
Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia
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Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Neurology".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 3633

Special Issue Editors

Prof. Dr. Leszek Michał Sagan

E-Mail Website
Guest Editor
Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Unii Lubelskiej 1, 71-252 Szczecin, Poland
Interests: neurosurgery; brain; intracranial aneurysms; awake surgery; craniocervical junction
Dr. Tomasz Klepinowski

E-Mail Website
Guest Editor Assistant
Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Unii Lubelskiej 1, 71-252 Szczecin, Poland
Interests: neurosurgery; brain; intracranial aneurysms

Special Issue Information

Dear Colleagues,

Intracranial aneurysms can be found in up to 3% of the global population and their rupture leads to the most dangerous subtype of stroke, affecting approximately 450,000 people worldwide per year. One of the most dangerous and dreaded sequelae of aneurysmal subarachnoid hemorrhage is cerebral vasospasm with delayed cerebral ischemia.

In this Special Issue, we aim to collect research studies outlining advances in the diagnosis and management of intracranial aneurysms (embolization, clipping), subarachnoid hemorrhage or delayed cerebral ischemia. This will help explore challenges and identify priorities for clinicians and researchers.

We welcome both clinical and pre-clinical research manuscripts, including systematic reviews, meta-analyses, RCTs, animal models, retrospective or prospective observational studies, and unique case reports.

Prof. Dr. Leszek Michał Sagan
Guest Editors

Dr. Tomasz Klepinowski
Guest Editor Assistant

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. Medicina is an international peer-reviewed open access monthly 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 2200 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

  • intracranial aneurysm
  • subarachnoid hemorrhage
  • vasospasm
  • delayed cerebral ischemia
  • stroke
  • embolization
  • coiling
  • clipping

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Published Papers (3 papers)

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12 pages, 1219 KiB  
Article
Outcomes of Symptomatic Extracranial Carotid Artery Stenting in Octogenarians: A Single-Center Retrospective Study on Restenosis, Risk Factors, and Complications
by Özgür Zülfükar Ertuğrul, Fırat Karaaslan, Reşit Yılmaz and Mehmet Cudi Tuncer
Medicina 2025, 61(3), 519; https://doi.org/10.3390/medicina61030519 - 17 Mar 2025
Viewed by 456
Abstract
Objectives: This study aimed to evaluate the 6-month restenosis rate, risk factors, and complications following carotid artery stenting (CAS) in patients aged 80 years and older, assessing the efficacy and safety of CAS in this population. Materials and Methods: Fifty-six patients aged ≥80 [...] Read more.
Objectives: This study aimed to evaluate the 6-month restenosis rate, risk factors, and complications following carotid artery stenting (CAS) in patients aged 80 years and older, assessing the efficacy and safety of CAS in this population. Materials and Methods: Fifty-six patients aged ≥80 years with symptomatic extracranial carotid stenosis who underwent CAS between May 2023 and August 2024 were retrospectively analyzed. Follow-up at 6 months included Doppler ultrasonography to assess restenosis. Demographic, clinical, and procedure-related complications were recorded, and risk factors for in-stent restenosis were evaluated. Results: Among the patients, 42.9% were female (n = 24) and 57.1% were male (n = 32), with a mean age of 85.3 ± 4.40 years. The restenosis rate was 12.5%. Restenosis was significantly associated with smoking (p = 0.002), severe stenosis (p = 0.016), and advanced age (p = 0.045). The minor complication rate was 5.3%, and no major complications were observed. Smoking and advanced age were identified as independent risk factors for restenosis. Conclusions: CAS is a safe and effective treatment option for elderly patients. However, those with a history of smoking, advanced age, or severe stenosis are at an increased risk of restenosis. These findings provide valuable insights into the outcomes and safety of CAS in patients aged 80 and older. Full article
(This article belongs to the Special Issue Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia)
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16 pages, 2922 KiB  
Article
Multidimensional Comparison of Microsurgical Clipping and Endovascular Techniques for Anterior Communicating Artery Aneurysms: Balancing Occlusion Rates and Periprocedural Risks
by Vanessa Magdalena Swiatek, Amir Amini, Claudia Alexandra Dumitru, Lena Spitz, Klaus-Peter Stein, Sylvia Saalfeld, Ali Rashidi, I. Erol Sandalcioglu and Belal Neyazi
Medicina 2025, 61(3), 498; https://doi.org/10.3390/medicina61030498 - 13 Mar 2025
Viewed by 522
Abstract
Background and Objectives: The anterior communicating artery is a common location for intracranial aneurysms. Anterior communicating artery aneurysms (AcomA) pose a significant risk of rupture. Treatment options include microsurgical clipping and endovascular techniques, but the optimal approach remains controversial. This study aims [...] Read more.
Background and Objectives: The anterior communicating artery is a common location for intracranial aneurysms. Anterior communicating artery aneurysms (AcomA) pose a significant risk of rupture. Treatment options include microsurgical clipping and endovascular techniques, but the optimal approach remains controversial. This study aims to compare the outcomes of these two treatment modalities in a single-center patient cohort using a comprehensive matching process based on clinical and morphological parameters. Materials and Methods: A retrospective analysis was conducted on 1026 patients with 1496 intracranial aneurysms treated between 2000 and 2018. After excluding cases lacking 3D angiography or aneurysms in other locations or without treatment, 140 AcomA were selected. The study matched 24 surgically treated AcomA cases with 116 endovascularly treated cases based on 21 morphological and clinical criteria, including age, sex, Hunt and Hess score, and Fisher grade. Results: The microsurgical clipping group demonstrated a significantly higher rate of complete aneurysm occlusion compared to the endovascular group (p = 0.007). However, this was associated with a higher incidence of postoperative ischemic complications in the surgical group (13 out of 24 cases) compared to the endovascular group (2 out of 116 cases). Despite these complications, no significant differences were found in clinical outcomes at discharge or follow-up, as measured by the modified Rankin Scale (p > 0.999). Both groups had comparable rates of hydrocephalus, vasospasm, and delayed cerebral ischemia. Conclusions: Microsurgical clipping resulted in higher aneurysm occlusion rates but carried an increased risk of ischemic complications compared to endovascular treatment. Clinical outcomes were comparable between the two modalities, suggesting that treatment decisions should be individualized based on aneurysm characteristics and patient factors. Further prospective studies are warranted to optimize treatment strategies for AcomA. Full article
(This article belongs to the Special Issue Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia)
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Other

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8 pages, 4366 KiB  
Case Report
Symptomatic Vasospasm Refractory to Clazosentan after Subarachnoid Hemorrhage of Ruptured Vertebral Artery Dissecting Aneurysm: Clinical Implications from Two Contrasting Cases
by Yasuyuki Yoshida, Tatsushi Mutoh, Junta Moroi and Tatsuya Ishikawa
Medicina 2024, 60(9), 1543; https://doi.org/10.3390/medicina60091543 - 20 Sep 2024
Cited by 1 | Viewed by 1708
Abstract
Clazosentan prevents vasospasms after aneurysmal subarachnoid hemorrhage (SAH). However, clinical data on patients with SAH with ruptured vertebral artery dissecting aneurysms (VADAs) are limited. We report the case of a 49-year-old male patient with mild-grade (WFNS grade 1) thick and diffuse (modified Fisher [...] Read more.
Clazosentan prevents vasospasms after aneurysmal subarachnoid hemorrhage (SAH). However, clinical data on patients with SAH with ruptured vertebral artery dissecting aneurysms (VADAs) are limited. We report the case of a 49-year-old male patient with mild-grade (WFNS grade 1) thick and diffuse (modified Fisher grade 3) SAH who underwent endovascular trapping of a ruptured VADA, resulting in a poor functional outcome with a modified Rankin Scale score of 4 due to severe symptomatic vasospasm refractory to clazosentan, requiring repeated rescue endovascular therapies and chronic communicating hydrocephalus. A retrospective analysis of the clot density in the basal and Sylvian cisterns, assessed by the Hounsfield unit (HU) values of serial CT scans, in this patient showed persistent higher values, distinct from another VADA case that showed a decline in HU values with a good clinical course. These results imply the limited effectiveness of clazosentan in cases of thick and diffuse SAH after a ruptured VADA, even in good-clinical-grade patients treated with less invasive modalities. The HU values may become a simple quantitative marker for predicting symptomatic vasospasms and chronic hydrocephalus. Full article
(This article belongs to the Special Issue Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia)
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