Document Detail


Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm.
MedLine Citation:
PMID:  15255255     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Nonsaccular intracranial aneurysms (NIAs) are characterized by dilation, elongation, and tortuosity of intracranial arteries. Dilemmas in management exist due to the limited regarding the natural history of this disease entity. The objective of this study was to determine the prospective risk of subarachnoid hemorrhage (SAH) in patients with vertebrobasilar NIAs. METHODS: All patients with vertebrobasilar fusiform or dolichoectatic aneurysms that had been radiographically demonstrated between 1989 and 2001 were identified. These patients' medical records were retrospectively reviewed. A prospective follow-up survey was sent and death certificates were requested. Based on results of neuroimaging studies, the maximal diameter of the involved artery, presence of SAH, and measurements of arterial tortuosity were recorded. Nonsaccular intracranial aneurysms were classified according to their radiographic appearance: fusiform, dolichoectatic, and transitional. Dissecting aneurysms were excluded. The aneurysm rupture rate was calculated based on person-years of follow up. Predictive factors for rupture were evaluated using univariate analysis (p < 0.05). One hundred fifty-nine patients, 74% of whom were men, were identified. The mean age at diagnosis was 64 years (range 20-87 years). Five patients (3%) initially presented with hemorrhage; four of these patients died during follow up. The mean duration of follow up was 4.4 years (692 person-years). Nine patients (6%) experienced hemorrhage after presentation; six hemorrhages were definitely related to the NIA. The prospective annual rupture rate was 0.9% (six patients/692 person-years) overall and 2.3% in those with transitional or fusiform aneurysm subtypes. Evidence of aneurysm enlargement or transitional type of NIA was a significant predictor of lesion rupture. Six patients died within 1 week of experiencing lesion rupture. CONCLUSIONS: Risk of hemorrhage in patients harboring vertebrobasilar NIAs is more common in those with evidence of aneurysm enlargement or a transitional type of aneurysm and carries a significant risk of death.
Authors:
Kelly D Flemming; David O Wiebers; Robert D Brown; Michael J Link; Hirofumi Nakatomi; John Huston; Robyn McClelland; Teresa J H Christianson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  101     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-16     Completed Date:  2004-09-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. flemming.kelly@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured / complications*,  radiography
Basilar Artery
Cohort Studies
Female
Humans
Intracranial Aneurysm / complications*,  radiography
Intracranial Hemorrhages / etiology*
Male
Middle Aged
Retrospective Studies
Risk Assessment
Vertebral Artery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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