European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage
European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage
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DOI：
10.1159/000346087
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Rinkel, Gabriel
中科院分区：
文献类型：
--
作者：
Steiner, Thorsten;Juvela, Seppo;Rinkel, Gabriel
背景：伴有和不伴有蛛网膜下腔出血(SAH)的颅内动脉瘤是一个相关的健康问题：总发病率约为9/10万，范围很广，在一些国家高达20/10万。头几个月内保守治疗的死亡率为50%-60%。约三分之一的未经治疗的动脉瘤患者将在首次出血恢复后6个月内死于复发出血。血管痉挛、脑积水、迟发性脑缺血等并发症进一步影响预后。这些指南的目的是为SAH合并和不合并动脉瘤以及未破裂的颅内动脉瘤的治疗提供全面的建议。方法：我们利用Medline和Embase检索了1960-2011年间的文献。编写小组的成员举行了面对面和电话会议，讨论建议。搜索结果根据欧洲神经学会联合会的标准进行分级。欧洲中风组织指南委员会的成员审查了指南。结果：这些指南提供了关于SAH的流行病学、危险因素和预后的循证信息，并对破裂和未破裂的颅内动脉瘤的诊断和治疗方法提出了建议。已经确定了几个动脉瘤生长和破裂的危险因素。我们就诊断工作、监测和一般管理(血压、血糖、体温、血栓预防、抗癫痫治疗、类固醇的使用)提供建议。具体的治疗干预措施考虑手术的时机、夹闭和缠绕。包括脑积水、血管痉挛、迟发性脑缺血等并发症。我们还考虑增加对无动脉瘤的SAH和未破裂的动脉瘤的建议。结论：颅内动脉瘤破裂后并发症发生率高，是一种严重的疾病，需要在具有高质量治疗经验的中心及时治疗。这些指南为有或无破裂的颅内动脉瘤患者的治疗提供了实用的、循证的建议。这些措施的应用可以改善SAH的预后。版权所有(C)2013 S.Karger AG，巴塞尔
Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50-60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH. Copyright (C) 2013 S. Karger AG, Basel