The impact of temporary artery occlusion during intracranial aneurysm surgery on long-term clinical outcome

Part II. the patient who undergoes elective clipping

Christoph J. Griessenauer, Tyler L. Poston, Mohammadali Mohajel Shoja, Martin M. Mortazavi, Michael Falola, R. Shane Tubbs, Winfield S. Fisher

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

BACKGROUND: Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon.

Methods: Patients managed for an intracranial aneurysm were followed from 2000-2009. This study included a cohort of patients found to have unruptured intracranial aneurysms who underwent TAO during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of TAO on long-term clinical outcome were evaluated using the Glasgow Outcome Scale (GOS) obtained retrospectively by analyzing medical records at the last follow-up visit or discharge. Analyses included descriptive statistics, binary logistic regression, and ordinal logistic regression.

Results: Inclusion criteria were met by 246 patients (75.2% female, age 54 years ±10.9) with electively clipped, unruptured aneurysms. Mean follow-up was 53 months ± 67.5. Mean temporary artery clipping time was 16.1 minutes±14.7. Of patients, 86% had a good outcome and made a complete recovery at last follow-up (GOS 5); 9% of patients were moderately disabled (GOS 4); 5% of patients were severely disabled (GOS 3), were in a vegetative state (GOS 2), or had died (GOS 1). TAO time had no effects on overall long-term clinical outcomes (P = 0.59). Although patients with posterior circulation aneurysms had a worse outcome compared with patients with anterior circulation aneurysms (P = 0.008), age (P=0.176) and aneurysm size (P=0.497) were not significantly associated with clinical outcome.

Conclusions: This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.

Original languageEnglish (US)
Pages (from-to)402-408
Number of pages7
JournalWorld Neurosurgery
Volume82
Issue number3
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

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Intracranial Aneurysm
Arteries
Glasgow Outcome Scale
Aneurysm
Logistic Models
Persistent Vegetative State
Medical Records
Dissection
Safety

Keywords

  • Elective aneurysm clipping
  • Temporary artery occlusion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The impact of temporary artery occlusion during intracranial aneurysm surgery on long-term clinical outcome : Part II. the patient who undergoes elective clipping. / Griessenauer, Christoph J.; Poston, Tyler L.; Mohajel Shoja, Mohammadali; Mortazavi, Martin M.; Falola, Michael; Tubbs, R. Shane; Fisher, Winfield S.

In: World Neurosurgery, Vol. 82, No. 3, 01.09.2014, p. 402-408.

Research output: Contribution to journalReview article

Griessenauer, Christoph J. ; Poston, Tyler L. ; Mohajel Shoja, Mohammadali ; Mortazavi, Martin M. ; Falola, Michael ; Tubbs, R. Shane ; Fisher, Winfield S. / The impact of temporary artery occlusion during intracranial aneurysm surgery on long-term clinical outcome : Part II. the patient who undergoes elective clipping. In: World Neurosurgery. 2014 ; Vol. 82, No. 3. pp. 402-408.
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abstract = "BACKGROUND: Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon.Methods: Patients managed for an intracranial aneurysm were followed from 2000-2009. This study included a cohort of patients found to have unruptured intracranial aneurysms who underwent TAO during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of TAO on long-term clinical outcome were evaluated using the Glasgow Outcome Scale (GOS) obtained retrospectively by analyzing medical records at the last follow-up visit or discharge. Analyses included descriptive statistics, binary logistic regression, and ordinal logistic regression.Results: Inclusion criteria were met by 246 patients (75.2{\%} female, age 54 years ±10.9) with electively clipped, unruptured aneurysms. Mean follow-up was 53 months ± 67.5. Mean temporary artery clipping time was 16.1 minutes±14.7. Of patients, 86{\%} had a good outcome and made a complete recovery at last follow-up (GOS 5); 9{\%} of patients were moderately disabled (GOS 4); 5{\%} of patients were severely disabled (GOS 3), were in a vegetative state (GOS 2), or had died (GOS 1). TAO time had no effects on overall long-term clinical outcomes (P = 0.59). Although patients with posterior circulation aneurysms had a worse outcome compared with patients with anterior circulation aneurysms (P = 0.008), age (P=0.176) and aneurysm size (P=0.497) were not significantly associated with clinical outcome.Conclusions: This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.",
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T2 - Part II. the patient who undergoes elective clipping

AU - Griessenauer, Christoph J.

AU - Poston, Tyler L.

AU - Mohajel Shoja, Mohammadali

AU - Mortazavi, Martin M.

AU - Falola, Michael

AU - Tubbs, R. Shane

AU - Fisher, Winfield S.

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N2 - BACKGROUND: Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon.Methods: Patients managed for an intracranial aneurysm were followed from 2000-2009. This study included a cohort of patients found to have unruptured intracranial aneurysms who underwent TAO during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of TAO on long-term clinical outcome were evaluated using the Glasgow Outcome Scale (GOS) obtained retrospectively by analyzing medical records at the last follow-up visit or discharge. Analyses included descriptive statistics, binary logistic regression, and ordinal logistic regression.Results: Inclusion criteria were met by 246 patients (75.2% female, age 54 years ±10.9) with electively clipped, unruptured aneurysms. Mean follow-up was 53 months ± 67.5. Mean temporary artery clipping time was 16.1 minutes±14.7. Of patients, 86% had a good outcome and made a complete recovery at last follow-up (GOS 5); 9% of patients were moderately disabled (GOS 4); 5% of patients were severely disabled (GOS 3), were in a vegetative state (GOS 2), or had died (GOS 1). TAO time had no effects on overall long-term clinical outcomes (P = 0.59). Although patients with posterior circulation aneurysms had a worse outcome compared with patients with anterior circulation aneurysms (P = 0.008), age (P=0.176) and aneurysm size (P=0.497) were not significantly associated with clinical outcome.Conclusions: This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.

AB - BACKGROUND: Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon.Methods: Patients managed for an intracranial aneurysm were followed from 2000-2009. This study included a cohort of patients found to have unruptured intracranial aneurysms who underwent TAO during their elective clipping procedure. Potential risk factors to affect outcome were considered. Effects of TAO on long-term clinical outcome were evaluated using the Glasgow Outcome Scale (GOS) obtained retrospectively by analyzing medical records at the last follow-up visit or discharge. Analyses included descriptive statistics, binary logistic regression, and ordinal logistic regression.Results: Inclusion criteria were met by 246 patients (75.2% female, age 54 years ±10.9) with electively clipped, unruptured aneurysms. Mean follow-up was 53 months ± 67.5. Mean temporary artery clipping time was 16.1 minutes±14.7. Of patients, 86% had a good outcome and made a complete recovery at last follow-up (GOS 5); 9% of patients were moderately disabled (GOS 4); 5% of patients were severely disabled (GOS 3), were in a vegetative state (GOS 2), or had died (GOS 1). TAO time had no effects on overall long-term clinical outcomes (P = 0.59). Although patients with posterior circulation aneurysms had a worse outcome compared with patients with anterior circulation aneurysms (P = 0.008), age (P=0.176) and aneurysm size (P=0.497) were not significantly associated with clinical outcome.Conclusions: This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.

KW - Elective aneurysm clipping

KW - Temporary artery occlusion

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