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.

PY - 2014/9/1

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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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