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Biomedical subjects

Menno Sluzewski

Publications and source records attributed to Menno Sluzewski.

26 records · Page 2Linked to original sources
PubMed2003

Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study.

BACKGROUND: Relatively high rates of complications occur after operation for unruptured intracranial aneurysms. Published data on endovascular treatment suggest lower rates of complications. We measured the impact of treatment of unruptured aneurysms by clipping or coiling on functional health, quality of life, and the level of anxiety and depression. METHODS: In three centres, we prospectively collected data on patients with an unruptured aneurysm who were treated by clipping or coiling. Treatment assignment was left to the discretion of the treating physicians. Before, 3 and 12 months after treatment, we used standardised questionnaires to assess functional health (Rankin Scale score), quality of life (SF-36, EuroQol), and the level of anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS: Nineteen patients were treated by coiling and 32 by clipping. In the surgical group, 4 patients (12%) had a permanent complication; 36 of all 37 aneurysms (97%) were successfully clipped. Three months after operation, quality of life was worse than before operation; 12 months after operation, it had improved but had not completely returned to baseline levels. Scores for depression were higher than in the general population. In the endovascular group, no complications with permanent deficits occurred; 16 of 19 aneurysms (84%) were occluded by more than 90%. One patient died from rupture of the previously coiled aneurysm. In the others, quality of life after 3 months and after 1 year was similar to that before treatment. CONCLUSIONS: In the short term, operation of patients with an unruptured aneurysm has a considerable impact on functional health and quality of life. After 1 year, recovery occurs but it is incomplete. Coil embolisation does not affect functional health and quality of life.

Adult↗
PubMed2003

Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results.

PURPOSE: To evaluate the stability of aneurysm occlusion over time, the need for additional treatments, and the long-term clinical outcome of patients, with emphasis on late recurrences of bleeding. MATERIALS AND METHODS: The records of 160 patients with aneurysmal subarachnoid hemorrhage who were treated with coils were retrospectively reviewed. Follow-up angiography was performed 6 and 18 months after coil placement, and the results were classified as complete, near complete, and incomplete occlusion. RESULTS: Six (4%) of the 160 patients experienced procedural mortality or dependency. After a mean follow-up of 36 months, 134 (84%) patients had a good outcome. Outcome was independent of aneurysm size and location and timing of treatment. Reopening of the aneurysm occurred exclusively during the first 6 months after coil placement, mainly in aneurysms larger than 15 mm. Between 6 and 18 months, no change in aneurysm occlusion was observed. Additional coil placement was performed in 15 (9%) patients. After this second coil placement, nine (7%) aneurysms were still incompletely occluded. Additional therapy was performed in eight (5%) patients. Two recurrences of bleeding were observed in two incompletely occluded large aneurysms. No recurrences of bleeding occurred in patients with completely or near completely occluded aneurysms. CONCLUSION: Coil placement is an effective and safe treatment strategy for patients with aneurysmal subarachnoid hemorrhage. If aneurysm occlusion is sufficient at 6 months, the yield of further follow-up angiography is very low.

Aneurysm, Ruptured↗
PubMed2003

Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results.

BACKGROUND AND PURPOSE: Initial complete occlusion of very large or giant aneurysms often cannot be accomplished, and most will partially reopen over time. This study was performed to assess the clinical and angiographic outcome of patients with very large or giant cerebral aneurysms treated with detachable coils. METHODS: During 6 years, 29 patients with 31 very large or giant (20-55-mm) cerebral aneurysms were initially treated with detachable coils. Nineteen patients presented with subarachnoid hemorrhage (SAH), and eight patients had symptoms of mass effect. One patient had an incidental aneurysm, and one patient had an additional aneurysm. RESULTS: Twenty-three (79%) of 29 patients had a good clinical outcome at a median follow-up of 50 months. One of 19 patients presenting with SAH had repeat bleed (annual rebleeding rate, 1.45%). After initial coiling, seven of 31 aneurysms were incompletely occluded; this rate increased to 20 of 29 aneurysms at 6-month follow-up angiography. After 16 repeat coiling procedures in 13 aneurysms, 12 of 29 aneurysms in surviving patients were still incompletely occluded. After additional treatment other than coiling (parent-vessel occlusion and/or surgery) in eight aneurysms, three of 25 aneurysms in 24 surviving patients were incompletely occluded. Only 13 (42%) of 31 aneurysms had one coiling as a sole therapy. CONCLUSION: Coiling of very large or giant aneurysms can be considered. Long-term clinical outcomes were good in 79% of patients. The stability of the coil mesh over time was poor, requiring repeat coiling, surgery, and/or parent-vessel balloon occlusion in 58% of the aneurysms primarily treated with coils.

Adult↗
PubMed2002

Coiling of ruptured pericallosal artery aneurysms.

OBJECTIVE: To assess the technical feasibility of treating ruptured pericallosal artery aneurysms with detachable coils and to evaluate the anatomic and clinical results. METHODS: Over a period of 27 months, 12 patients with a ruptured pericallosal artery aneurysm were treated with detachable coils. A retrospective review was performed to assess the clinical and angiographic results. The three men and nine women had a mean age of 46.6 years (range, 35-75 yr). Seven patients presented in Hunt and Hess Grade II, three in Grade III, and two in Grade IV. Six patients had a concomitant intracerebral hematoma, and four had at least one additional aneurysm. RESULTS: In all 12 patients, the pericallosal aneurysm could be reached with a microcatheter and the coils delivered. No procedure-related complications occurred. Angiography demonstrated that the initial occlusion was complete in 11 aneurysms and near-complete in 1. At follow-up angiography at 6 months, one aneurysm had become partially recanalized owing to coil compaction. At a mean clinical follow-up of 9.2 months, 11 patients had an excellent outcome and one patient had mild hemiparesis and aphasia. CONCLUSION: Coiling of ruptured pericallosal artery aneurysms can be considered an alternative to surgical clipping.

Adult↗
PubMedDate not supplied

MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils.

BACKGROUND AND PURPOSE: Digital subtraction angiography (DSA) is used to follow-up intracranial aneurysms treated with detachable coils to identify recurrence and determine need for additional treatment. However, DSA is invasive and involves a small risk of neurologic complications. We assessed the feasibility and usefulness of 3D time-of-flight (TOF) MR angiography (MRA) performed at 3T compared with DSA for the follow-up of coil-treated intracranial aneurysms. METHODS: In a prospective study, 20 consecutive patients with 21 intracranial aneurysms treated with coils underwent DSA and nonenhanced and enhanced multiple overlapping thin-slab acquisition 3D TOF MRA at 3T on the same day at a mean follow-up of 6 months (range, 4-14 months) after coil placement. MRA images were evaluated for presence of artifacts, presence and size of aneurysm remnants and recurrences, patency of parent and branch vessels, and added value of contrast material enhancement. MRA and DSA findings were compared. RESULTS: Interobserver agreement of MRA was good, as was agreement between MRA and DSA. All three recurrences that needed additional treatment were detected with MRA. Minor disagreement occurred in four cases: three coil-treated aneurysms were scored on MRA images as having a small remnant, whereas on DSA images these aneurysms were occluded; the other aneurysm was scored on MRA images as having a small remnant, whereas on DSA images this was a small recurrence. Use of contrast material had no additional value. Coil-related MR imaging artifacts were minimal and did not interfere with evaluation of the occlusion status of the aneurysm. CONCLUSION: High-spatial-resolution 3D TOF MRA at 3T is feasible and useful in the follow-up of patients with intracranial aneurysms treated with coil placement.

Adolescent↗
PubMedDate not supplied

Late rebleeding of ruptured intracranial aneurysms treated with detachable coils.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of late rebleeding of ruptured intracranial aneurysms treated with detachable coils. PATIENTS AND METHODS: A clinical follow-up study was conducted in 393 consecutive patients with a ruptured aneurysm treated with detachable coils between January 1995 and January 2003. Late rebleeding was defined as recurrent hemorrhage from a coiled aneurysm >1 month after coiling. One patient was lost to follow-up. Total clinical follow-up of the 392 patients who were coiled for ruptured cerebral aneurysms was 18,708 months (1559 patient years; median, 48 months; mean, 47.7 months; range, 0-120 months). RESULTS: Four patients suffered late rebleeding from the coiled aneurysm at 8, 12, 30, and 40 months after coiling, respectively. Two of these patients died. Another patient died of probable rebleeding 4 months after coiling. The incidence of late rebleeding was 1.27% (5/393) and mortality of late rebleeding was 0.76% (3/393). The annual late rebleeding rate was 0.32%, and the annual mortality rate from late rebleeding was 0.19%. During the follow-up period, 53 coiled aneurysms in 53 patients (13%) were additionally treated: 35 aneurysms (8.9%) were additionally treated with coils, 16 aneurysms (4.1%) were additionally clipped, and 2 aneurysms (0.5%) were additionally treated with parent vessel balloon occlusion. CONCLUSION: The late rebleeding rate after coiling of ruptured cerebral aneurysms is very low. Follow-up of patients with a coiled aneurysm is mandatory to identify aneurysms that need additional treatment after reopening.

Adult↗
PubMedDate not supplied

Volume measurement of intracranial aneurysms from 3D rotational angiography: improvement of accuracy by gradient edge detection.

Manual volume measurement of intracranial aneurysms from 3D rotational angiography varies on different threshold settings and, therefore, is operator-dependent. We developed and validated a method based on automatic gradient edge detection that is independent on threshold settings and provides an accurate and reproducible volume measurement. This method was compared with manual volume calculation in 13 aneurysm phantoms, and the results were significantly more accurate.

Cerebral Angiography↗