ebs_july2013_wraps
TRANSCRIPT
![Page 1: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/1.jpg)
EBS presentation 1
Risk of rupture of previously “wrapped” intracranial aneurysms
Macquarie Neurosurgery
Evidence Based Surgery presentation
11th July, 2013
Peter Wilson
![Page 2: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/2.jpg)
EBS presentation 2
Clinical case
• 60 year old lady• Smoker• Wrapping of unruptured complex calcified
MCA aneurysm 6 years ago• MCA infarct post-op
– Spastic hemiplegia
• Previously recommended 3 monthly CTAs
![Page 3: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/3.jpg)
EBS presentation 3
Searchable question (PICO format)
• P = patients with previously wrapped intracranial aneurysms
• I = wrap• C = clipping• O = haemorrhage / rupture rate
![Page 4: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/4.jpg)
EBS presentation 4
Search strategy
• Intracranial aneurysm• Wrap (or similar)
– Muslin– Gauze– Bandage– Mesh
![Page 5: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/5.jpg)
EBS presentation 5
Search results
![Page 6: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/6.jpg)
EBS presentation 6
![Page 7: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/7.jpg)
EBS presentation 7
![Page 8: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/8.jpg)
EBS presentation 8
![Page 9: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/9.jpg)
EBS presentation 9
![Page 10: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/10.jpg)
EBS presentation 10
![Page 11: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/11.jpg)
EBS presentation 11
![Page 12: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/12.jpg)
EBS presentation 12
![Page 13: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/13.jpg)
EBS presentation 13
![Page 14: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/14.jpg)
EBS presentation 14
![Page 15: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/15.jpg)
EBS presentation 15
![Page 16: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/16.jpg)
EBS presentation 16
![Page 17: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/17.jpg)
EBS presentation 17
![Page 18: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/18.jpg)
EBS presentation 18
![Page 19: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/19.jpg)
EBS presentation 19
![Page 20: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/20.jpg)
EBS presentation 20
![Page 21: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/21.jpg)
EBS presentation 21
![Page 22: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/22.jpg)
EBS presentation 22
![Page 23: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/23.jpg)
EBS presentation 23
![Page 24: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/24.jpg)
EBS presentation 24
![Page 25: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/25.jpg)
EBS presentation 25
Summary of papers
• Few large series• Risk of rupture greatest initially• ?similar to natural history in long term• Risk of local complications
![Page 26: Ebs_July2013_wraps](https://reader036.vdocuments.us/reader036/viewer/2022070313/55498acdb4c905c26a8b505a/html5/thumbnails/26.jpg)
EBS presentation 26
Conclusions
• Wrapping is not an ideal treatment strategy• “Unclippable” defined by treating surgeon
– ?small clips for aneurysms <3 mm– ?bypass alternatives