Functional Consequences of Aneurysms in Iraqi Patients and Describe The Prognostic Value to Patients for Risk Factor Analysis
DOI:
https://doi.org/10.51699/ijhsms.v2i11.2794Abstract
Background: An intracranial aneurysm is an abnormal inflammation of the blood vessels in the brain. We evaluated the functional consequences of aneurysms in Iraqi patients and to describe the prognostic value for patients in the risk factor analysis.
Methods: We conducted a specialised cross-sectional study to assess outcomes of Iraqi patients associated with aneurysms and analyse the effect of risk factors on patients in the long term. Our study collected data from different hospitals in Iraq between 15th July 2022 and 9th March 2023. The data enrolled clinical and demographic outcomes related to 108 cases in patients aged between 25 and 60 years. The dataset was partitioned into two categories. The first category comprised 68 people who were a part of the unruptured group. The second category comprised 40 people who belonged to the ruptured group. The secondary outcomes were devised and analysed with the assistance of the SPSS program, version 25.
Results: Our study found that the majority of elderly patients suffered from aneurysms, with a rate of 70%. Clinical outcomes indicate that females had the highest percentage of cases, with 64.8%, while males comprised 35.2%. Additionally, pre-operative comorbidities outcomes revealed that 54.6% of patients had hypertension, and 26.9% had diabetes mellitus. The study also examined aneurysm locations, with Posterior Communicating Artery cases accounting for 27.8% and Superior Cerebellar Artery cases comprising 16%. In 7% of cases, the posterior cerebral artery is affected, while in 13.9% of cases, other vessels are involved. Quality of life was evaluated, revealing improved outcomes over time for patients in the unruptured group with a rate of progression from 100% to 50%. In contrast, patients in the ruptured group showed a decline in the rate of survival, with a decrease of 33% in the last year.
Conclusion: Endovascular coiling surgery is considered the optimal surgical procedure for patients with ruptured and unruptured aneurysms.
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References
Brinjikji W, Rabinstein AA, Lanzino G, Kallmes DF, Cloft HJ. Effect of age on outcomes of treatment of unruptured cerebral aneurysms: a study of the national inpatient sample 2001-2008. Stroke. 2011 May;42 (5):1320–1324.
Carter BS, Sheth S, Chang E, Sethl M, Ogilvy CS. Epidemiology of the size distribution of intracranial bifurcation aneurysms: smaller size of distal aneurysms and increasing size of unruptured aneurysms with age. Neurosurgery. 2006 Feb;58 (2):217–223. discussion 217-23.
Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR Am J Neuroradiol. 2007 Jan;28 (1):146–151.
Horiuchi T, Tanaka Y, Hongo K. Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery. 2005 Mar;56 (3):469–475. discussion 469-75.
Hutchinson PJ, Power DM, Tripathi P, Kirkpatrick PJ. Outcome from poor grade aneurysmal subarachnoid hemorrhage-which poor grade subarachnoid haemorrhage patients benefit from aneurysm clipping? Br J Neurosurg. 2000 Apr;14 (2):105–109.
Inagawa T. Management outcome in the elderly patient following subarachnoid hemorrhage. J Neurosurg. 1993 Apr;78 (4):554–561.
Iosif C, Di Maria F, Sourour N, Degos V, Bonneville F, Biondi A, et al. Is a high initial World Federation of Neurosurgery (WFNS) grade really associated with a poor clinical outcome in elderly patients with ruptured intracranial aneurysms treated with coiling? J Neurointerv Surg. 2014 May 01;6 (4):286–290.
Jang EW, Jung JY, Hong CK, Joo JY. Benefits of surgical treatment for unruptured intracranial aneurysms in elderly patients. J Korean Neurosurg Soc. 2011 Jan;49 (1):20–25.
Josephson SA, Douglas VC, Lawton MT, English JD, Smith WS, Ko NU. Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management. J Neurosurg. 2010 Mar;112 (3):626–630.
Khosla A, Brinjikji W, Cloft H, Lanzino G, Kallmes DF. Age-related complications following endovascular treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2012 May;33 (5):953–957.
Kwon SC, Kwon OK. Endovascular coil embolization of unruptured intracranial aneurysms: a Korean multicenter study. Acta Neurochir (Wien) 2014 May;156 (5):847–854.
Moroi J, Hadeishi H, Suzuki A, Yasui N. Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at Research Institute for Brain and Blood Vessels-Akita. Neurosurgery. 2005 Feb;56 (2):224–231. discussion 224-31.
Naidech AM, Bendok BR, Tamul P, Bassin SL, Watts CM, Batjer HH, et al. medical complications drive length of stay after brain hemorrhage: a cohort study. Neurocrit Care. 2009;10 (1):11–19.
Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery. 2008 Jun;62 (6):1187–1202. discussion 1202-3.
Greving JP, Rinkel GJ, Buskens E, et al.. Cost-effectiveness of preventive treatment of intracranial aneurysms: new data and uncertainties. Neurology 2009; 73:258–65 10.1212/01.wnl.0b013e3181a2a4ea
Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014; 13:393–404 10.1016/S1474-4422 (14)70015-8
Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28:14–20 10.3171/jns.1968.28.1.0014
Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale. Neurosurgery 2006; 59:21–27; discussion 21–27 10.1227/01.NEU.0000218821.34014.1B
van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19:604–07 10.1161/01.STR.19.5.604 [
Elijovich L, Higashida RT, Lawton MT, et al.; Cerebral Aneurysm Rerupture After Treatment (CARAT) Investigators. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008; 39:1501–06 10.1161/STROKEAHA.107.504670
Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol 2002; 23:1706–09
Sluzewski M, Bosch JA, van Rooij WJ, et al. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 2001; 94:238–40 10.3171/jns.2001.94.2.0238
Tummala RP, Chu RM, Madison MT, et al. Outcomes after aneurysm rupture during endovascular coil embolization. Neurosurgery 2001; 49:1059–66; discussion 1066–67
Charpentier C, Audibert G, Guillemin F, et al. Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999; 30:1402–08 10.1161/01.STR.30.7.1402
Pierot L, Cognard C, Anxionnat R, et al. Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety. Radiology 2011; 258:546–53 10.1148/radiol.10100894
Pierot L, Spelle L, Vitry F. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008; 39:2497–504 10.1161/STROKEAHA.107.512756
