-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Aneurysmal subarachnoid hemorrhage (aSAH) is a cerebrovascular disease that seriously endangers human health.
The "Chinese Aneurysmal Subarachnoid Hemorrhage Diagnosis and Treatment Guidelines 2021 Edition" is based on the 2016 version of the guidelines for the diagnosis and treatment of aSAH Partially revised
.
The main recommendations are as follows
.
Diagnosis of aSAH-clinical manifestations and signs 1.
aSAH is a clinical emergency that is often misdiagnosed
.
Patients with sudden severe headaches should be highly suspicious of aSAH
.
2.
For patients suspected of aSAH, a systemic and neurological examination should be performed as soon as possible, focusing on assessing the patient's vital signs and level of consciousness; Hunt-Hess classification and WFNS classification system are simple and effective means to assess the severity of patients and judge clinical prognosis
.
2.
Auxiliary examination 1.
Patients with suspected aSAH should undergo unenhanced head CT scan as soon as possible
.
For patients with multiple intracranial aneurysms found in aSAH, CT helps to determine the responsible aneurysm
.
2.
When aSAH is highly suspected but head CT is negative, the FLAIR/DWI/gradient echo sequence of MR helps to find aSAH
.
3.
Patients with negative CT or MR but high suspicion of aSAH are recommended to undergo lumbar puncture
.
4.
CTA can be used for the etiological diagnosis of aSAH, but if the CTA diagnosis is not clear, a whole cerebral angiography is still needed
.
5.
Whole brain angiography is the gold standard for the diagnosis of intracranial aneurysms
.
For patients with a definite SAH diagnosis whose first angiography is negative, it is recommended to review cerebral angiography in about 2 weeks
.
The treatment of aSAH-general treatment 1.
Before the exact treatment of intracranial aneurysm, the patient should be closely monitored, and the patient should be kept absolutely in bed, and symptomatic treatment such as sedation, analgesia, cough relieving, and laxative treatment should be performed
.
2.
After the occurrence of aSAH and before the occlusion of the intracranial aneurysm, appropriately control blood pressure to reduce the risk of rebleeding (it is reasonable to reduce the systolic blood pressure to <160mmHg, but it is necessary to consider maintaining cerebral perfusion pressure and preventing cerebral infarction)
.
3.
At present, there is no medical treatment that can reduce the rebleeding of intracranial aneurysm to improve the outcome.
However, for patients who cannot be treated for aneurysm occlusion as soon as possible, antifibrinolytic hemostatic drugs can be used for short-term treatment (<72 hours).
Reduce the risk of early rebleeding before aneurysm occlusion treatment
.
Surgical treatment of two intracranial aneurysms 1.
For patients with a ruptured aneurysm, endovascular treatment or craniotomy should be performed as soon as possible to reduce the risk of bleeding after aSAH
.
2.
It is recommended that neurosurgeons and neurointerventionists discuss together and formulate a treatment plan
.
3.
For patients with ruptured aneurysms who are suitable for both endovascular treatment and craniotomy, endovascular treatment can be the first choice if conditions permit
.
4.
For patients with massive intracerebral hematoma (>50ml) and middle cerebral artery aneurysms, craniotomy may be given priority, while for elderly patients (>70 years old), aSAH severe disease (WFNS Ⅳ/Ⅴ), posterior circulation arteries Tumors or patients with cerebral vasospasm may give priority to endovascular treatment
.
5.
Water-swellable coils can increase the immediate embolization density of aneurysms and improve the long-term healing rate
.
6.
For wide-necked aneurysms, fusiform aneurysms, and dissecting aneurysms that cannot be treated by embolization alone, stent-assisted embolization can be considered, but the risks of stent application should be known to balance the risks and benefits of patients
.
Treatment of three related complications ➤ Cerebral vasospasm and delayed cerebral ischemia (1) The high incidence of cerebral vasospasm after aSAH is an important factor affecting the prognosis
.
(2) Transcranial Doppler ultrasound, CT or MRI cerebral perfusion imaging can help monitor the occurrence of vasospasm
.
(3) All patients with aSAH should start nimodipine therapy to help improve the clinical prognosis
.
(4) It is recommended to maintain normal circulating blood volume, and induce blood pressure therapy for patients with clinical suspected delayed cerebral ischemia
.
(5) For patients with symptomatic cerebral vasospasm, especially for patients whose controlled blood pressure therapy does not take effect quickly, cerebral angioplasty and/or selective intra-arterial infusion of vasodilators can be selected
.
➤Treatment of hydrocephalus after aSAH (1) ASAH-related acute symptomatic hydrocephalus should be drained according to the clinical situation
.
(2) Cerebrospinal fluid shunt should be adopted for chronic symptomatic hydrocephalus related to aSAH
.
➤aSAH-related epilepsy prevention and control (1) Routine use of antiepileptic drugs is not recommended
.
When the patient has known risk factors for delayed seizures, such as past seizures, cerebral parenchymal hematoma, refractory hypertension, cerebral infarction, or middle cerebral artery aneurysm, consider using it
.
(2) Patients with clinically significant seizures should be treated with antiepileptic drugs
.
Prevention of aSAH (1) Family members with aSAH and polycystic kidney disease from more than one relative of grade I are recommended to undergo routine aneurysm screening.
For patients whose first screening results are negative, regular imaging follow-up is recommended
.
(2) For patients with essential hypertension and other risk factors for intracranial aneurysms, non-invasive blood imaging screening is recommended
.
(3) Quitting smoking, quitting alcohol, routine blood pressure monitoring, and increasing vegetable intake can reduce the risk of aneurysm rupture and bleeding
.
(4) When analyzing the risk of aneurysm rupture, in addition to the location and size of the aneurysm, as well as the age and health of the patient, the morphological and hemodynamic characteristics of the aneurysm should also be considered, combined with the risks of surgery, and the decision should be made after weighing the pros and cons.
Whether to perform surgical intervention or follow-up
.
(5) For unruptured aneurysms that need to be treated, endovascular treatment can be considered as the first choice.
For complex aneurysms such as wide-necked, fusiform, and dissecting aneurysms, stent combined with coil embolization can achieve satisfactory results, and it is prone to recurrence for large and huge aneurysms.
For aneurysms, a blood flow guide device is recommended for treatment
.
The above content is extracted from: Medical Administration and Hospital Administration.
Chinese Guidelines for the Prevention and Treatment of Stroke (2021 Edition)-17.
Chinese Guidelines for the Diagnosis and Treatment of Aneurysmal Subarachnoid Hemorrhage.
2021-8-31.
The "Chinese Aneurysmal Subarachnoid Hemorrhage Diagnosis and Treatment Guidelines 2021 Edition" is based on the 2016 version of the guidelines for the diagnosis and treatment of aSAH Partially revised
.
The main recommendations are as follows
.
Diagnosis of aSAH-clinical manifestations and signs 1.
aSAH is a clinical emergency that is often misdiagnosed
.
Patients with sudden severe headaches should be highly suspicious of aSAH
.
2.
For patients suspected of aSAH, a systemic and neurological examination should be performed as soon as possible, focusing on assessing the patient's vital signs and level of consciousness; Hunt-Hess classification and WFNS classification system are simple and effective means to assess the severity of patients and judge clinical prognosis
.
2.
Auxiliary examination 1.
Patients with suspected aSAH should undergo unenhanced head CT scan as soon as possible
.
For patients with multiple intracranial aneurysms found in aSAH, CT helps to determine the responsible aneurysm
.
2.
When aSAH is highly suspected but head CT is negative, the FLAIR/DWI/gradient echo sequence of MR helps to find aSAH
.
3.
Patients with negative CT or MR but high suspicion of aSAH are recommended to undergo lumbar puncture
.
4.
CTA can be used for the etiological diagnosis of aSAH, but if the CTA diagnosis is not clear, a whole cerebral angiography is still needed
.
5.
Whole brain angiography is the gold standard for the diagnosis of intracranial aneurysms
.
For patients with a definite SAH diagnosis whose first angiography is negative, it is recommended to review cerebral angiography in about 2 weeks
.
The treatment of aSAH-general treatment 1.
Before the exact treatment of intracranial aneurysm, the patient should be closely monitored, and the patient should be kept absolutely in bed, and symptomatic treatment such as sedation, analgesia, cough relieving, and laxative treatment should be performed
.
2.
After the occurrence of aSAH and before the occlusion of the intracranial aneurysm, appropriately control blood pressure to reduce the risk of rebleeding (it is reasonable to reduce the systolic blood pressure to <160mmHg, but it is necessary to consider maintaining cerebral perfusion pressure and preventing cerebral infarction)
.
3.
At present, there is no medical treatment that can reduce the rebleeding of intracranial aneurysm to improve the outcome.
However, for patients who cannot be treated for aneurysm occlusion as soon as possible, antifibrinolytic hemostatic drugs can be used for short-term treatment (<72 hours).
Reduce the risk of early rebleeding before aneurysm occlusion treatment
.
Surgical treatment of two intracranial aneurysms 1.
For patients with a ruptured aneurysm, endovascular treatment or craniotomy should be performed as soon as possible to reduce the risk of bleeding after aSAH
.
2.
It is recommended that neurosurgeons and neurointerventionists discuss together and formulate a treatment plan
.
3.
For patients with ruptured aneurysms who are suitable for both endovascular treatment and craniotomy, endovascular treatment can be the first choice if conditions permit
.
4.
For patients with massive intracerebral hematoma (>50ml) and middle cerebral artery aneurysms, craniotomy may be given priority, while for elderly patients (>70 years old), aSAH severe disease (WFNS Ⅳ/Ⅴ), posterior circulation arteries Tumors or patients with cerebral vasospasm may give priority to endovascular treatment
.
5.
Water-swellable coils can increase the immediate embolization density of aneurysms and improve the long-term healing rate
.
6.
For wide-necked aneurysms, fusiform aneurysms, and dissecting aneurysms that cannot be treated by embolization alone, stent-assisted embolization can be considered, but the risks of stent application should be known to balance the risks and benefits of patients
.
Treatment of three related complications ➤ Cerebral vasospasm and delayed cerebral ischemia (1) The high incidence of cerebral vasospasm after aSAH is an important factor affecting the prognosis
.
(2) Transcranial Doppler ultrasound, CT or MRI cerebral perfusion imaging can help monitor the occurrence of vasospasm
.
(3) All patients with aSAH should start nimodipine therapy to help improve the clinical prognosis
.
(4) It is recommended to maintain normal circulating blood volume, and induce blood pressure therapy for patients with clinical suspected delayed cerebral ischemia
.
(5) For patients with symptomatic cerebral vasospasm, especially for patients whose controlled blood pressure therapy does not take effect quickly, cerebral angioplasty and/or selective intra-arterial infusion of vasodilators can be selected
.
➤Treatment of hydrocephalus after aSAH (1) ASAH-related acute symptomatic hydrocephalus should be drained according to the clinical situation
.
(2) Cerebrospinal fluid shunt should be adopted for chronic symptomatic hydrocephalus related to aSAH
.
➤aSAH-related epilepsy prevention and control (1) Routine use of antiepileptic drugs is not recommended
.
When the patient has known risk factors for delayed seizures, such as past seizures, cerebral parenchymal hematoma, refractory hypertension, cerebral infarction, or middle cerebral artery aneurysm, consider using it
.
(2) Patients with clinically significant seizures should be treated with antiepileptic drugs
.
Prevention of aSAH (1) Family members with aSAH and polycystic kidney disease from more than one relative of grade I are recommended to undergo routine aneurysm screening.
For patients whose first screening results are negative, regular imaging follow-up is recommended
.
(2) For patients with essential hypertension and other risk factors for intracranial aneurysms, non-invasive blood imaging screening is recommended
.
(3) Quitting smoking, quitting alcohol, routine blood pressure monitoring, and increasing vegetable intake can reduce the risk of aneurysm rupture and bleeding
.
(4) When analyzing the risk of aneurysm rupture, in addition to the location and size of the aneurysm, as well as the age and health of the patient, the morphological and hemodynamic characteristics of the aneurysm should also be considered, combined with the risks of surgery, and the decision should be made after weighing the pros and cons.
Whether to perform surgical intervention or follow-up
.
(5) For unruptured aneurysms that need to be treated, endovascular treatment can be considered as the first choice.
For complex aneurysms such as wide-necked, fusiform, and dissecting aneurysms, stent combined with coil embolization can achieve satisfactory results, and it is prone to recurrence for large and huge aneurysms.
For aneurysms, a blood flow guide device is recommended for treatment
.
The above content is extracted from: Medical Administration and Hospital Administration.
Chinese Guidelines for the Prevention and Treatment of Stroke (2021 Edition)-17.
Chinese Guidelines for the Diagnosis and Treatment of Aneurysmal Subarachnoid Hemorrhage.
2021-8-31.
