Vaskulär

Question 1

Phases Score Greving JP Lancet 2014

Answer 1

Population: 0 American/European, 3 Japanisch, 5 Finnisch
Hypertonus
Age: 70
Size: 0 < 7 mm, 3 0.7-1 cm, 6 1-2, 10 2 cm
Early SAH
Site: 0 ICA, 2 MCA, 4 ACA + posterior

< 2 = 0,4%
6 = 1,7%

Question 2

ISAT (international subarachnoida aneurysm trial) Molyneux et al

Answer 2

10 to 18 years follow-up
after 1 year dead + dependenet 24% coil, 31% clip
die Kurven gleichen sich nach 15 Jahren aus

Question 3

Hunt and Hess Classification

Answer 3

classification of a surgical risk
I: keine Symptome
II: meningeale Reizzeichen, keine Neurologie außer Hirnnervenparesen
III: GCS < 15, mildes neurologisches Defizit
IV: GCS < 15, schweres neurologisches Defizit
V: GCS 3, Dezerebration, Morbibund

Mortalitätsraten:
Platz 1: Infarkt durch Vasospasmus
Platz 2: Re-Bleeding (6% < 24h, dann insg. 2%)

Question 4

ISUIA (international study of unruptured intracranial aneurysm), Molyneux 2010

Answer 4

Rupturrisiko:
- Size
- Site

Question 5

Fisher Scale: Risk für Vasospasmus

Answer 5

grade 0: no SAH, no IVH –> 0%
grade 1: thin SAH, no IVH –> 24%
grade 2: thin SAH, IVH –> 33%
grade 3: thick SAH, no IVH –> 33%
grade 4: thick SAH, IVH –> 40%

Question 6

BRAT (Barrow Ruptured Aneurysm Trial) Spetzler_2015

Answer 6

• poor outcome clip > coil at 1 year, after 6 years no significant relevance
  Critizism:
• no randomisation
• only 62% assigned to coiling had coiling
• lost to follow-up 11%
• mRS don´t assess cognitive function (AcomA clip perforators)

Question 7

ARUBA (A Randomised trial of Unruptured Brain Arteriovenous malformations) _ Mohr 2014 + 2020

Answer 7

• primary endpoint: death or symptomatic stroke
• conservative > intervention

Critizism:
- follow-up 4.5 years
- small percentage of intervention/surgery
- keine Auswertung verschiedener Therapiemodalitäten
- Zentren mit geringer Expertise

Question 8

Spetzler & Martin and Supplementary Scoring for Surgical Risk (Lawton 2010)

Answer 8

Spetzler Martin
Eloquence: 1 eloquente
Size: 1 < 3 cm, 2 3-6 cm, 3 > 6 cm
Drainage: 0 oberflächliche Venen, 1 tiefe Venen

Predictors of good surgical outcome:
- hemorrhagic presentation
- young age
- compactness
- absesnse of deep perforator supply

Question 9

Cognard & Borden Classification

Answer 9

• prognostic classification for a risk of bleeding

Borden: 4 year follow-up
Typ 1: dural venous sinus, meningeal vein, ICB 2%
Typ 2: dural venous sinus with cortical venous reflux, ICB 40%
Typ 3: cortical venous reflux only, ICB 80%

Risk of re-bleeding 35% in 2 Jahren

Standard: endovaskuläre Therapie durch Embolisation der venösen Drainage außer für ethmoidale und petrosal/tentorial dAVFs.

Einteilung:
- 60% transverse/sigmoid
- 12% CCF
- 8% SSS

Question 10

STICH I + II (surgical trial in intracerebral haemorrhage) Mendelow

Answer 10

hematoma ex 24 h
surgery = conservative (Glasgow outcome scale, 6 month)
STITCH I: supratentorial
STITCH II: superficial lobar

Question 11

MISTIE (minimally invasive surgery plus alteplase in intracerebral hemorrhage evacuation) Hanley_2019

Answer 11

Phase 2 trial = safety
is safe

Question 12

CARAT Study (cerebral aneurysm rupture after treatment) Johnstone_2013

Answer 12

Risk of consequent bleeding 2% after occlusion
degree of aneurysma occlusion after initial treatment is a strong predictor of the risk of subsequent bleeding

Question 13

British aneurysm nimodipine trial 1989

Answer 13

Reduction of vasospasm from 30% to 20%
reduction of poor outcome from 40% to 34%

Question 14

DESTINY 2007 Jüttler

Headdfirst 2014 (Hemicraniectomy and Durotomy upon Deterioration from infarction-related swellling trial)

Answer 14

Destiny: 30-Tage Mortalität 10% Hemikraniektomie vs 50% konservativ

Headdfirst:
Einschlusskriterien: NIHSS > 18, Middline and pineal shift, deterioration
21-Tage Mortalität 21% Hemikraniektomie vs 40% konservativ (nicht signifikant)

Question 15

RESCUE trial Hutchinson 2016

Answer 15

TBI, ICP>20
Op senkt Todesraten, erhöht die Anzahl von vegetativen Zuständen

Question 16

SUAVE Trial Small unruptured intracranial aneurysm verification study Japan 2010

Answer 16

natural history of aneurysms < 5 mm
Rupturrisiko 0.5%/Jahr
erhöhtes Risiko: > 4 mm, Alter > 50, hypertension, aneurysma multiplicity

Question 17

Smith_2015 Coiling vs Clipping for unruptured MCA Aneurysm

Answer 17

Unfavorable outcomes 2% clippping, 6% coiling

Question 18

UCAS Unruptured Cerebral Aneurysms Japan

Answer 18

Risiko:
- Size
- Site
- Tochteraneurysma