Advances in aneurysm treatment with a focus on middle cerebral artery aneurysms and delayed cerebral ischemia

In this thesis different aspects of aneurysmal subarachnoid hemorrhage (aSAH) are investigated with an emphasis on middle cerebral artery (MCA) aneurysm treatment outcome, hemorrhage volume quantification on different locations, and delayed cerebral ischemia (DCI). First, the literature is reviewed to study the clinical and imaging outcome of clipping and coiling of MCA aneurysms. Next, the association of intraparenchymal hematoma volume (≤/> 50ml) after aSAH of MCA aneurysms with clinical outcome is studied. Furthermore, a new automatic hematoma quantification method is validated in a cohort of patients with MCA aneurysms. This method is used in two studies to investigate the association of hematoma volume (total and location-specific) with the occurrence of DCI in patients with aneurysms on various locations. Lastly, the difference in the occurrence of DCI and in clinical outcome of patients with endovascularly treated aneurysms receiving either high- or low-dose nadroparin after the treatment is studied

New diagnostic and treatment strategies in renal artery stenosis: A promising pursuit or disappointment foretold?

Clinical management of renal artery stenosis has seen a major shift, after randomised clinical trials have shown no group benefit of endovascular intervention relative to optimal medical control. However, the inclusion criteria of these trials have been criticised for focusing on a subset of patients with atherosclerotic renal artery stenosis where intervention was unlikely to be beneficial. Moreover, new imaging and computational techniques have become available, which have the potential to improve identification of patients that will respond to interventional treatment. This review addresses the challenges associated with clinical decision making in patients with renal artery stenosis. Opportunities for novel diagnostic techniques to improve patient selection are discussed, along with ongoing Dutch studies and network initiatives that investigate these strategies