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Robert D Brown - One of the best experts on this subject based on the ideXlab platform.
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management of patients with an Unruptured Intracranial Aneurysm and a history of malignancy
Journal of Neurosurgical Sciences, 2020Co-Authors: Ondra Petr, Robert D Brown, Anthony M Burrows, Waleed Brinjikji, Giuseppe LanzinoAbstract:BACKGROUND Management of a patient with an Unruptured Intracranial Aneurysm (UIA) who has a history of malignancy can be challenging due to considerations related to the natural history of the Aneurysm and risk of recurrence or progression of malignancy. The current study presents our experience with both conservative management and interventional treatment of patients with UIAs and a remote or recent history of cancer. METHODS Consecutive patients with a history of malignancy and UIA were classified into the following groups: Group I (diagnoses of both UIA and cancer within 3 years) and Group II (known cancer with new UIA diagnosed ≥3 years after cancer). Patient demographics, clinical characteristics, Aneurysm/treatment characteristics, and outcomes were collected prospectively. We studied the following outcomes: perioperative and mid-/long-term complications, Aneurysm rupture, retreatment/recurrence rates, long-term neurological outcome, and possible impact of cancer history on decision-making for treatment. RESULTS A total of 122 patients were included in this study (55 in Group I and 67 in Group II). Patients in Group I underwent Aneurysm treatment significantly less often than those in Group II (20.0% versus 46.3%, P=0.002). There was no difference in neurological morbidity rates between the two groups after a mean follow-up of 22.3 months (3.6% versus 3.0%, P=0.29). Overall, untreated patients experienced an annualized rupture rate of 1.6% (95% CI=0.0%-3.4%, 3/187.6 ruptures/person years). CONCLUSIONS Patients with an UIA and a history of cancer should be considered for management with either conservative management or invasive techniques. The optimal UIA management is defined on a case-by-case basis carefully comparing the prognosis of the patient's malignancy with the natural history of the Aneurysm and the risk of interventional treatment.
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common data elements for Unruptured Intracranial Aneurysms and subarachnoid hemorrhage clinical research a national institute for neurological disorders and stroke and national library of medicine project
Neurocritical Care, 2019Co-Authors: Jose I Suarez, Airton Leonardo De Oliveira Manoel, Loch R Macdonald, Nima Etminan, Robert D Brown, Colin P Derdeyn, Muniza K Sheikh, Sepideh Aminhanjani, Emanuela Keller, Peter D LerouxAbstract:Objectives The goal for this project was to develop a comprehensive set of common data elements (CDEs), data definitions, case report forms and guidelines for use in Unruptured Intracranial Aneurysm (UIA) and subarachnoid hemorrhage (SAH) clinical research, as part of a new joint effort between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Library of Medicine of the US National Institutes of Health. These UIA and SAH CDEs will join several other neurological disease-specific CDEs that have already been developed and are available for use by research investigators.
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Aneurysm morphology and prediction of rupture an international study of Unruptured Intracranial Aneurysms analysis
Neurosurgery, 2018Co-Authors: J Mocco, Robert D Brown, James C Torner, David G Piepgras, Irene Meissner, Ana W Capuano, Kyle M Fargen, Madhavan L Raghavan, John HustonAbstract:Abstract BACKGROUND: There are conflicting data between natural history studies suggesting a very low risk of rupture for small, Unruptured Intracranial Aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured Aneurysms than expected. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of Unruptured Intracranial Aneurysm rupture. METHODS: A case-control design was used to analyze morphological characteristics associated with Aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured Aneurysms during follow-up were matched (by size and location) with 198 patients with Unruptured Intracranial Aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS: Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of Aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, Aneurysm angle, neck diameter, parent vessel diameter, and calculated Aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). CONCLUSION: This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence Unruptured Intracranial Aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.
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the Unruptured Intracranial Aneurysm treatment score a multidisciplinary consensus
Neurology, 2015Co-Authors: Nima Etminan, Akio Morita, Robert D Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, James C Torner, Colin P Derdeyn, Andreas Raabe, J MoccoAbstract:Objective: We endeavored to develop an Unruptured Intracranial Aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* 5 0 indicating excellent agreement and vr* 5 1 indicating poor agreement). Results: The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1–4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1–4.4) for panel members and 4.5 (95% CI 4.3–4.6) for external reviewers (p 5 0.017). Mean Likert scores were 4.2 (95% CI 4.1–4.3) for interventional reviewers (n 5 56) and 4.1 (95% CI 3.9–4.4) for noninterventional reviewers (n 5 12) (p 5 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019–0.033). Conclusions: This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA. Neurology® 2015;85:881–889
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abstract 106 validation of the Unruptured Intracranial Aneurysm treatment score uiats to guide management of Unruptured Intracranial Aneurysms
Stroke, 2015Co-Authors: Nima Etminan, Akio Morita, Robert D Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, James C Torner, Colin P Derdeyn, Andreas Raabe, J MoccoAbstract:Objective: We previously derived the Unruptured Intracranial Aneurysm Treatment Score (UIATS), designed using a multidisciplinary consensus approach among neurovascular specialists from diverse geographic and practice backgrounds. Here, we report on the development and validation of the final version of UIATS. Method: An international, multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 (39 panel members and 30 blinded external reviewers) specialists in the research and treatment of UIAs was convened. A web survey-based Delphi consensus process consisting of 7 rounds was utilized to rate numerous features of potential relevance in the assessment and treatment of UIAs and to develop the UIATS. Mean ratings were repeatedly used to determine statistical weight for each factor and then transformed into corresponding scores for every item to create the UIATS. For internal and blinded external validation, 30 representative cases of patients with UIAs were used to test the level of agreement (5 point Likert Scale) with treatment recommendations based on the UIATS. Results: The final UIATS system was designed in three domains (patient-, Aneurysm - and treatment-related), comprising 13 different categories and 29 different features (Figure 1). Mean agreement based on Likert scores (5 indicating strong agreement and 1 indicating strong disagreement) was 4·2 for both reviewer cohorts, whereas mean agreement per case was 4·2 (panel members) and 4·5 (external reviewers) (p=0·017, Mann-Whitney-U Test). Conclusion: The final version of UIATS system was internally and externally validated by a large multidisciplinary group of neurovascular specialists, which suggests that the UIATS reflects contemporary decision-making regarding management of a patient with an UIA. The UIATS may aid clinicians in deciding on the appropriate management for an UIA.
J Mocco - One of the best experts on this subject based on the ideXlab platform.
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o 007 trends in mortality and morbidity after treatment of Unruptured Intracranial Aneurysm in the united states 2006 2016
Journal of NeuroInterventional Surgery, 2020Co-Authors: S Majidi, Amol Mehta, R De Leacy, J Mocco, Johanna T FifiAbstract:Background We aimed to assess nationally representative trends of in-hospital mortality and clinical outcome after treatment of Unruptured Intracranial Aneurysms (UIA). Methods The Nationwide Inpatient Sample (NIS) database from 2006 to 2016 was reviewed. Patients with Unruptured Intracranial Aneurysm (UIA) who underwent Aneurysm treatment during hospitalization were identified. Patients’ demographics, comorbid conditions, length of hospital stay, rate of in-hospital mortality, discharge destination for each treatment group (microsurgical clipping and endovascular embolization). Poor clinical outcome was defined as discharge to skilled nursing facility or hospice instead of home or acute rehabilitation facility. Multivariate regression model was used to identify independent predictors of mortality and poor clinical outcome. Results A total of 21,609 patients with UIA were identified from 2006 to 2016. The overall rate of in-hospital mortality decreased from 0.9% in 2006 to 0.2% in 2016. Overall, 83% of the patients had favorable clinical outcome. The utilization of endovascular embolization increased from 60% in 2006 to 64% in 2016. Patients who had endovascular embolization had 3 days shorter hospital stay (1 vs 4, p Conclusions Mortality rate from treatment of Unruptured Intracranial Aneurysm has substantially decreased in the past decade. Higher rate of morbidity and mortality is seen in patients ≥80 years old, patients with multiple comorbidities and those who were treated with microsurgical clipping. Disclosures S. Majidi: 1; C; SNIS Foundation. A. Mehta: None. R. De Leacy: None. J. Mocco: None. J. Fifi: None.
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Common Data Element for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage: Recommendations from Assessments and Clinical Examination Workgroup/Subcommittee
Neurocritical Care, 2019Co-Authors: Rahul Damani, Stephan Mayer, Raj Dhar, Renee H. Martin, Paul Nyquist, Daiwai M. Olson, Jorge H. Mejia-mantilla, Susanne Muehlschlegel, Edward C. Jauch, J MoccoAbstract:Background Clinical studies of subarachnoid hemorrhage (SAH) and Unruptured cerebral Aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future Unruptured Intracranial Aneurysm and SAH research. Methods This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into “core,” “supplemental—highly recommended,” “supplemental” and “exploratory.” Results We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as “Core.” The Glasgow Coma Scale was classified as “Supplemental—Highly Recommended.” All other Assessments and Clinical Examination variables were categorized as “Supplemental.” Conclusion The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.
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common data element for Unruptured Intracranial Aneurysm and subarachnoid hemorrhage recommendations from assessments and clinical examination workgroup subcommittee
Neurocritical Care, 2019Co-Authors: Rahul Damani, Raj Dhar, Renee H. Martin, Daiwai M. Olson, Susanne Muehlschlegel, Edward C. Jauch, Stephan A Mayer, Paul A Nyquist, Jorge H Mejiamantilla, J MoccoAbstract:Clinical studies of subarachnoid hemorrhage (SAH) and Unruptured cerebral Aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future Unruptured Intracranial Aneurysm and SAH research. This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into “core,” “supplemental—highly recommended,” “supplemental” and “exploratory.” We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as “Core.” The Glasgow Coma Scale was classified as “Supplemental—Highly Recommended.” All other Assessments and Clinical Examination variables were categorized as “Supplemental.” The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.
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Aneurysm morphology and prediction of rupture an international study of Unruptured Intracranial Aneurysms analysis
Neurosurgery, 2018Co-Authors: J Mocco, Robert D Brown, James C Torner, David G Piepgras, Irene Meissner, Ana W Capuano, Kyle M Fargen, Madhavan L Raghavan, John HustonAbstract:Abstract BACKGROUND: There are conflicting data between natural history studies suggesting a very low risk of rupture for small, Unruptured Intracranial Aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured Aneurysms than expected. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of Unruptured Intracranial Aneurysm rupture. METHODS: A case-control design was used to analyze morphological characteristics associated with Aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured Aneurysms during follow-up were matched (by size and location) with 198 patients with Unruptured Intracranial Aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS: Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of Aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, Aneurysm angle, neck diameter, parent vessel diameter, and calculated Aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). CONCLUSION: This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence Unruptured Intracranial Aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.
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the Unruptured Intracranial Aneurysm treatment score a multidisciplinary consensus
Neurology, 2015Co-Authors: Nima Etminan, Akio Morita, Robert D Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, James C Torner, Colin P Derdeyn, Andreas Raabe, J MoccoAbstract:Objective: We endeavored to develop an Unruptured Intracranial Aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* 5 0 indicating excellent agreement and vr* 5 1 indicating poor agreement). Results: The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1–4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1–4.4) for panel members and 4.5 (95% CI 4.3–4.6) for external reviewers (p 5 0.017). Mean Likert scores were 4.2 (95% CI 4.1–4.3) for interventional reviewers (n 5 56) and 4.1 (95% CI 3.9–4.4) for noninterventional reviewers (n 5 12) (p 5 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019–0.033). Conclusions: This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA. Neurology® 2015;85:881–889
Peter Gooderham - One of the best experts on this subject based on the ideXlab platform.
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Headache Outcomes After Treatment of Unruptured Intracranial Aneurysm: A Systematic Review and Meta-Analysis.
Stroke, 2019Co-Authors: Charlotte Dandurand, Harman S. Parhar, Faysal Naji, Swetha Prakash, Gary Redekop, Charles S. Haw, Eitan Prisman, Peter GooderhamAbstract:Background and Purpose- While Unruptured Intracranial Aneurysms may be discovered incidentally in the workup of chronic headache, it remains unclear whether their treatment ultimately impacts headache severity. We aim to conduct a systematic review and meta-analysis assessing headache severity after treatment of Unruptured Intracranial Aneurysm. Methods- MEDLINE and EMBASE were systematically reviewed. Results- Data from 7 studies met inclusion criteria (309 nonduplicated patients). The standard mean difference in pre- and post-intervention headache severity was estimated at -0.448 (95% CI, -0.566 to -0.329) under a random effects model. No significant heterogeneity was noted nor was any significant publication bias demonstrated. Conclusions- This is the first systematic review assessing postoperative headache severity following treatment of Unruptured Intracranial Aneurysm. While a significant reduction in headache severity was observed, further investigation into this phenomenon is recommended before it influences clinical practice. Future study should stratify headache outcomes by Aneurysm size, location, and treatment modality.
Seung Chyul Hong - One of the best experts on this subject based on the ideXlab platform.
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abstract wmp28 association between diffusion positive lesion and antiplatelet drug resistance after coiling for Unruptured Intracranial Aneurysm
Stroke, 2016Co-Authors: Je Young Yeon, Jong-soo Kim, Seung Chyul HongAbstract:Background: The purpose of this study was to verify the association between immediate post-procedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for Unruptured Intracranial Aneurysm. Method: This study included 338 Aneurysm cases between October 2012 and March 2015. All patients received post-procedural MRI within 48 hours after endovascular coil embolization. Antiplatelet drug resistance was checked a day before the procedure using the VerifyNow system. Abnormal antiplatelet response was defined as more than 550 aspirin response units (ARU) and more than 240 P2Y12 receptor reaction units (PRU). Also, we explored the optimal cutoff values of ARU and PRU. The primary outcome was radiologic infarction based on post-procedural MRI. Results: Among 338 Unruptured Intracranial Aneurysms, 32 (9.5%) and 105 (31.1%) had abnormal ARU and PRU values, respectively. Radiologic infarction was associated with old age (≥65, adjusted odds ratio (OR)1.777, 95% confidence interval (CI) 1.080-2.925) only with defined abnormal antiplatelet response (ARU≥550, PRU≥240). PRU values in the top 10 th percentile (>294) were associated with radiologic infarction ( p =0.003, OR 4.8, 95% CI 1.708-13.492). Using this cutoff value, age (OR 2.287, 95% CI 1.282-4.079), PRU (>294, OR 3.431 95% CI 1.528-7.706), and hyperlipidemia (OR 2.046 95% CI 1.041-4.020) were associated with radiologic infarction in multivariate analysis. Conclusions: Radiologic infarction after coiling for Unruptured Aneurysm was closely associated with age. Only very high PRU values (>294) predicted post-procedural infarction. Further controlled studies are needed to determine precise cutoff values which could provide information regarding the optimal antiplatelet regimen for Aneurysm coiling.
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Predictor and Prognosis of Procedural Rupture during Coil Embolization for Unruptured Intracranial Aneurysm.
Journal of Korean Neurosurgical Society, 2016Co-Authors: Kyung Min Lee, Pyoung Jeon, Keon Ha Kim, Jong-soo Kim, Seung Chyul HongAbstract:Objective The objectives of this study was to determine the incidence and outcomes of procedural rupture (PR) during coil embolization of Unruptured Intracranial Aneurysm (UIA) and to explore potential risk factors.
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Predictors of thromboembolism during coil embolization in patients with Unruptured Intracranial Aneurysm.
Acta neurochirurgica, 2013Co-Authors: Je Yeoung Yeon, Pyoung Jeon, Jong-soo Kim, Kun Ha Kim, Seung Chyul HongAbstract:Objectives To identify the incidence of thromboembolic complications based on magnetic resonance imaging (MRI) and to explore the potential risk factors for thromboembolism (TE) during the periprocedural period of elective coil embolization for Unruptured Intracranial Aneurysms.
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Characteristic features of Unruptured Intracranial Aneurysms: Predictive risk factors for Aneurysm rupture
Journal of neurology neurosurgery and psychiatry, 2009Co-Authors: Seung Hoon You, Keon Ha Kim, Jong-soo Kim, Doo-sik Kong, Pyong Jeon, Hong Ki Roh, Gyeong-moon Kim, Kwang Ho Lee, Seung Chyul HongAbstract:Background and purpose The purpose of this study was to identify the risk factors predisposing to Aneurysm rupture and to provide a reliable estimation for likelihood of rupture in Unruptured Intracranial Aneurysms. Methods The authors performed a nested case-control study of 290 Aneurysms (123 Unruptured Aneurysms and 167 ruptured Aneurysms) occurring during a prospective cohort study in 1493 consecutive patients with newly diagnosed Intracranial Aneurysm and were treated in a single institute between January 1995 and December 2006. Controls were matched for age, treatment group, number of lesion, sex, region and study period in which the incidence of ruptured and Unruptured Intracranial Aneurysm was equivalently balanced. The authors assessed the predictive risk factors associated with Aneurysmal rupture based on the clinical and angiographic findings reported in the patients9 medical records. Results Between January 1997 and December 2002, 167 patients with ruptured Intracranial Aneurysms were assigned to group 1, and 123 patients with Unruptured Intracranial Aneurysms during the same period were assigned to group 2. Aspect ratio (OR 3.76), maximum diameter of neck (N max ) ≤3 mm (OR 2.56) and family history of cerebrovascular disease (OR 5.63) were strongly correlated with Aneurysm rupture (p Conclusions There are differences between the clinical and intrinsic characteristics of patients with Unruptured and ruptured Intracranial Aneurysm. It will be helpful to make rational decisions regarding the optimal therapeutic strategy for Unruptured Intracranial Aneurysm.
James C Torner - One of the best experts on this subject based on the ideXlab platform.
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common data elements for Unruptured Intracranial Aneurysm and subarachnoid hemorrhage clinical research recommendations from the working group on long term therapies
Neurocritical Care, 2019Co-Authors: George K C Wong, Adnan H Siddiqui, James C Torner, Janis J Daly, Denise H Rhoney, Joseph P Broderick, Christopher S Ogilvy, Yvo B W E M Roos, Unruptured Intracranial AneurysmAbstract:The goal for the long-term therapies (LTT) working group (WG) of the Unruptured Intracranial Aneurysm (UIA) and Subarachnoid Hemorrhage (SAH) common data elements (CDEs) was to develop a comprehensive set of CDEs, data definitions, case report forms, and guidelines for use in UIA and SAH LTT clinical research, as part of a new joint effort between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Library of Medicine of the US National Institutes of Health. These UIA and SAH CDEs will join other neurological disease-specific CDEs already developed and available for use by research investigators. The eight LTT WG members comprised international UIA, and SAH experts reviewed existing NINDS CDEs and instruments, created new elements when needed, and provided recommendations for future LTT clinical research. The recommendations were compiled, internally reviewed by the all UIA and SAH WGs and steering committee members. The NINDS CDE team also reviewed the final version before posting the SAH Version 1.0 CDE recommendations on the NINDS CDE website. The NINDS UIA and SAH LTT CDEs and supporting documents are publicly available on the NINDS CDE ( https://www.commondataelements.ninds.nih.gov/#page=Default ) and NIH Repository ( https://cde.nlm.nih.gov/home ) websites. The subcommittee members discussed and reviewed various parameters, outcomes, and endpoints in UIA and SAH LTT studies. The following meetings with WG members, the LTT WG’s recommendations are incorporated into the disease/injury-related events, assessments and examinations, and treatment/intervention data domains. Noting gaps in the literature regarding medication and rehabilitation parameters in UIA and SAH clinical studies, the current CDE recommendations aim to arouse interest to explore the impact of medication and rehabilitation treatments and therapies and encourage the convergence of LTT clinical study parameters to develop a harmonized standard.
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Aneurysm morphology and prediction of rupture an international study of Unruptured Intracranial Aneurysms analysis
Neurosurgery, 2018Co-Authors: J Mocco, Robert D Brown, James C Torner, David G Piepgras, Irene Meissner, Ana W Capuano, Kyle M Fargen, Madhavan L Raghavan, John HustonAbstract:Abstract BACKGROUND: There are conflicting data between natural history studies suggesting a very low risk of rupture for small, Unruptured Intracranial Aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured Aneurysms than expected. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of Unruptured Intracranial Aneurysm rupture. METHODS: A case-control design was used to analyze morphological characteristics associated with Aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured Aneurysms during follow-up were matched (by size and location) with 198 patients with Unruptured Intracranial Aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS: Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of Aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, Aneurysm angle, neck diameter, parent vessel diameter, and calculated Aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). CONCLUSION: This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence Unruptured Intracranial Aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.
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the Unruptured Intracranial Aneurysm treatment score a multidisciplinary consensus
Neurology, 2015Co-Authors: Nima Etminan, Akio Morita, Robert D Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, James C Torner, Colin P Derdeyn, Andreas Raabe, J MoccoAbstract:Objective: We endeavored to develop an Unruptured Intracranial Aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. Methods: An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* 5 0 indicating excellent agreement and vr* 5 1 indicating poor agreement). Results: The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1–4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1–4.4) for panel members and 4.5 (95% CI 4.3–4.6) for external reviewers (p 5 0.017). Mean Likert scores were 4.2 (95% CI 4.1–4.3) for interventional reviewers (n 5 56) and 4.1 (95% CI 3.9–4.4) for noninterventional reviewers (n 5 12) (p 5 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019–0.033). Conclusions: This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA. Neurology® 2015;85:881–889
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abstract 106 validation of the Unruptured Intracranial Aneurysm treatment score uiats to guide management of Unruptured Intracranial Aneurysms
Stroke, 2015Co-Authors: Nima Etminan, Akio Morita, Robert D Brown, Kerim Beseoglu, Seppo Juvela, Jean Raymond, James C Torner, Colin P Derdeyn, Andreas Raabe, J MoccoAbstract:Objective: We previously derived the Unruptured Intracranial Aneurysm Treatment Score (UIATS), designed using a multidisciplinary consensus approach among neurovascular specialists from diverse geographic and practice backgrounds. Here, we report on the development and validation of the final version of UIATS. Method: An international, multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 (39 panel members and 30 blinded external reviewers) specialists in the research and treatment of UIAs was convened. A web survey-based Delphi consensus process consisting of 7 rounds was utilized to rate numerous features of potential relevance in the assessment and treatment of UIAs and to develop the UIATS. Mean ratings were repeatedly used to determine statistical weight for each factor and then transformed into corresponding scores for every item to create the UIATS. For internal and blinded external validation, 30 representative cases of patients with UIAs were used to test the level of agreement (5 point Likert Scale) with treatment recommendations based on the UIATS. Results: The final UIATS system was designed in three domains (patient-, Aneurysm - and treatment-related), comprising 13 different categories and 29 different features (Figure 1). Mean agreement based on Likert scores (5 indicating strong agreement and 1 indicating strong disagreement) was 4·2 for both reviewer cohorts, whereas mean agreement per case was 4·2 (panel members) and 4·5 (external reviewers) (p=0·017, Mann-Whitney-U Test). Conclusion: The final version of UIATS system was internally and externally validated by a large multidisciplinary group of neurovascular specialists, which suggests that the UIATS reflects contemporary decision-making regarding management of a patient with an UIA. The UIATS may aid clinicians in deciding on the appropriate management for an UIA.
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abstract 3694 competing risk for long term mortality in patients with Unruptured Intracranial Aneurysm
Stroke, 2012Co-Authors: James C Torner, Robert D Brown, Michael P Jones, Diqiong Xie, David G Piepgras, John Huston, Irene Meissner, Jie Zhang, Isuia InvestigatorsAbstract:Introduction: Mortality in patients with Unruptured Intracranial Aneurysm (UIA) is significantly higher than the general population. However a minority of the deaths are due to subarachnoid hemorrhage. Hypothesis: There are differential characteristics of patients that might predict specific causes of death that would be informative in counseling patients about Aneurysm risk. Methods: 4059 patients with UIA who were enrolled prospectively between 1991 and 1998 were followed by 61 medical centers in North America, Canada, and Europe. Patients have at least one UIA, which may or may not be symptomatic. Patients were Rankin grade 1 or 2 at enrollment. Patients were followed annually from enrollment to 2007. For patients who died a death certificate search was done and information was requested from local physicians and other contacts. A National Death Index search in 2008 determined cases who died and cause of death. Foreign centers also did a national search where possible. Patients who died before 30 days post treatment or lost to follow up before 30 days post enrollment were excluded. Results: Twenty-five percent of patients died during follow-up. The life expectancy was significantly less than age-, sex-, and country-matched expected estimates. Among the total of 4004 patients with UIA who survived 30 days after enrollment, 2331 were treated and 1673 were not. There were 965 deaths after 30 days after treatment, of which 320 died from vascular disease (252 died from non-SAH vascular disease), 114 died from respiratory tract disease, 255 died from cancer, and the rest died of other or unknown reasons. Predictors of SAH death were Aneurysm size, site, age and convulsive disorders at enrollment. Factors related to vascular death were UIA treatment, age, gender, race, hypertension, Rankin at discharge and diminishing influence of Aneurysm characteristics over time. Respiratory deaths were related to treatment, race, smoking, age, initial Rankin and presentation with convulsive disorder. Cancer deaths were related to gender, race, smoking and age. Conclusions: In patients with UIA, an assessment of risk for death underscores the importance of age, race and gender and several modifiable risk factors. Patient management should include not only Aneurysm rupture prevention but also modification of smoking and hypertension.
