Journal of Vascular and Interventional Radiology
Technology assessment documentReporting Standards for Endovascular Repair of Saccular Intracranial Cerebral Aneurysms
Section snippets
Historical Context: Aneurysm Reporting
The evaluation and treatment of brain aneurysms often involve multiple medical specialties. Recent reviews by the American Heart Association have surveyed the medical literature to develop guidelines for the clinical management of ruptured (1) and unruptured (2) cerebral aneurysms. Despite efforts to synthesize existing knowledge on cerebral aneurysm evaluation and treatment, significant inconsistencies remain in nomenclature and definition for research and reporting purposes.
One of the major
General Definitions
The definition of cerebral aneurysm is an abnormal focal dilatation of a cerebral artery with attenuation of the vessel wall. There are several different pathophysiological types of aneurysms that involve the cerebral arteries. These include saccular, dolichoectatic, dissecting, serpentine, traumatic, mycotic, and giant aneurysms with or without thrombosis. Saccular aneurysms are the most common and the primary focus; other types are beyond the scope of this article.
Aneurysms may coexist with
Clinical Presentation
Clinical presentation is a component of the medical and neurological history. It is a description of the clinical event(s) that directly brought the aneurysm to medical attention. Clinical presentation includes signs, symptoms, and temporally related imaging studies. Typical symptoms might include severe headache, nausea, vomiting, photophobia, and nuchal rigidity. Commonly identified signs sometimes include altered level of consciousness, focal weakness, and cranial nerve deficits. Imaging
Patient Handedness
Handedness is obtained from the neurological history and estimates hemispheric dominance potentially influencing neurological injury/disability, functional outcome, and the choice of treatment modality.
Dates of Rupture, Diagnosis, and Treatment
Date of presentation refers to the date on which patient experienced signs or symptoms leading to medical evaluation and diagnosis of the cerebral aneurysm. Date of presentation may not be the same as the date of medical evaluation or diagnosis of the aneurysm but should be temporally related. Index date is the point at which patient initially experienced symptoms referable to the aneurysm.
Imaging of Aneurysm Hemorrhage
A description of the hemorrhage location and extent must be reported. Any intraparenchymal bleeding or hematomas with mass effect must be reported. The Fisher Grading Scale (20) (Table 4) is a commonly used CT-based grading system that has prognostic significance for the development of arteriographic vasospasm and delayed ischemic neurological deficits (21).
Evidence of new acute hemorrhage (<7 days) is present if there appears to be acute blood products on CT or MRI likely to be associated with
Therapeutic Procedural Technique
Procedural techniques vary widely and must be incorporated into every report. Arterial access procedure, anesthetic technique such as general anesthesia and agents used, the use of adjunctive medications including timing, dosages, routes of administration, assays of anticoagulation or platelet function, catheters, guide wires, contrast agents, rates and volumes with routes of administration, and fluoroscopy with measure of patient exposure should be incorporated into each report. Each embolic
Summary
These definitions span a broad range of relevant clinical and radiographic parameters to be considered in research studies. These recommendations do not represent the only criteria for all reporting of research data related to cerebral aneurysms. For example, some architectural features described here are based on the consensus of a multidisciplinary panel. Moreover, additional technological advancements in imaging equipment will likely allow evaluation of cerebral hemodynamics but are
References (68)
- et al.
Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment
Lancet
(2003) - et al.
Classification of hydrocephalus and outcome of treatment
Brain Dev
(1995) - et al.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial
Lancet
(2002) - et al.
CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysmsComparison with intra-arterial DSA and the surgical findings
Eur J Radiol
(2004) - et al.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion
Lancet
(2005) - et al.
Follow-up of treated aneurysms: the challenge of recurrences and potential solutions
Neuroimaging Clin N Am
(2006) - et al.
Assessment of coma and impaired consciousness: a practical scale
Lancet
(1974) - et al.
Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison
Lancet
(2007) - et al.
Recommendations for the endovascular treatment of intracranial aneurysms: a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology
Stroke
(2002) - et al.
Recommendations for the management of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association
Stroke
(2000)
Unruptured intracranial aneurysms—risk of rupture and risks of surgical interventionInternational Study of Unruptured Intracranial Aneurysms investigators
N Engl J Med
Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment
J Neurosurg
Natural history of autosomal dominant polycystic kidney disease
Annu Rev Med
Characteristics of brain arteriovenous malformations with coexisting aneurysms: a comparison of two referral centers
Stroke
Tissue inhibitor of metalloproteinases-1, -2, and -3 polymorphisms in a white population with intracranial aneurysms
Stroke
Fenestration of intracranial arteries with special attention to associated aneurysms and other anomalies
AJNR Am J Neuroradiol
Internal carotid aplasia/hypoplasia and intracranial saccular aneurysms: series of three new cases and systematic review of the literature
J Neuroimaging
Subarachnoid and intracerebral hemorrhage: natural history, prognosis, and precursive factors in the Framingham study
Neurology
Cigarette smoking, hypertension and the risk of subarachnoid hemorrhage: a population-based case–control study
Stroke
Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage
Neurology
Familial aneurysmal subarachnoid hemorrhage: a community-based study
J Neurosurg
Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis
Stroke
Proposal for classification of epilepsies and epileptic syndromesCommission on Classification and Terminology of the International League Against Epilepsy
Epilepsia
The International Classification of Headache Disorders, 2nd edition
Cephalalgia
Surgical risk as related to time of intervention in the repair of intracranial aneurysms
J Neurosurg
Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning
Neurosurgery
Etiology of cerebral vasospasm
Acta Neurochir Suppl
The International Cooperative Study on the Timing of Aneurysm SurgeryPart 1: overall management results
J Neurosurg
The International Cooperative Study on the Timing of Aneurysm SurgeryPart 2: surgical results
J Neurosurg
The risk of rebleeding from ruptured intracranial aneurysms
J Neurosurg
The International Cooperative Study on the Timing of Aneurysm SurgeryThe North American experience
Stroke
Clinical policy for the initial approach to adolescents and adults presenting to the emergency department with a chief complaint of headacheAmerican College of Emergency Physicians
Ann Emerg Med
The ABCs of measuring intracerebral hemorrhage volumes
Stroke
Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team
Neurosurgery
Cited by (11)
Mass transfer and blood flow in a patient-specific three-dimensional Willis circle
2021, International Communications in Heat and Mass TransferCitation Excerpt :The curved zones of the arterial segments produce flow separation and recirculation and a low shear stress on the external side of the bifurcations. Fig. 3 presents the typical locations of intracranial saccular aneurysms, [11,23,24], respectively. Fig. 3 shows that the cerebral aneurysms tend to form mostly in the regions where arterial flow is joining and bifurcating.
Association of Opium Addiction with Rupture of Intracranial Aneurysms: A Case-Control Study
2019, World NeurosurgeryCitation Excerpt :There were 44% and 35% women in the case and control groups, respectively (P = 0.37). Size of aneurysms was categorized based on a study by Meyers et al.11 into 4 groups: small (≤5 mm), medium (5–15 mm), large (15–25 mm), and giant (≥25 mm). Thirty-four percent and 15% of the cases and control subjects had small aneurysms, 58% and 66% of the cases and control subjects harbored medium aneurysms, and 7% and 15% of the cases and control subjects had large aneurysms, respectively.
An integrated, ontology-driven approach to constructing observational databases for research
2015, Journal of Biomedical InformaticsCitation Excerpt :During the elicitation process, individuals with backgrounds in neurosurgery (NRG), interventional and diagnostic neuroradiology (FV, JPV), and hemodynamic analysis (FV, AC) were asked to enumerate all known variables with relevance to aneurysm growth and rupture. In addition, a review of published systematic reviews and reporting standards was conducted to identify relevant entities documented in the literature [32–39]. In total, the top-down approach yielded 398 unique entities.
Safety and Efficacy of Flow Diverter Therapy for Unruptured Intracranial Aneurysm Compared to Traditional Endovascular Strategy: A Multi-Center, Randomized, Open-Label Trial
2022, Journal of Korean Neurosurgical SocietyNeurovascular emergencies: imaging diagnosis and neurointerventional treatment
2017, Emergency Radiology
Dr Higashida served as a consultant to Cordis Neurovascular. Dr Nesbit received honoraria from Cordis Neurovascular and Genentech, has an ownership interest in Concentric Medical, and served as a consultant to Concentric Medical. Dr Wechsler served as a consultant to Nuevelo, Inc, and Abbott Vascular. Dr Lavine received honoraria from Cordis Neurovascular. Dr Rasmussen received honoraria from the Universities of Minnesota and Pittsburgh, Microvention/Terumo, ev3, Possis Medical/Medrad, and Micrus, has an ownership interest in Chestnut Medical, and served as a consultant to Chestnut Medical.
Published in Stroke. 2009;40(5):e366–e379.
Published online before print February 26, 2009, doi: 10.1161/STROKEAHA.108.527572.