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Journal of Korean Neurosurgical Society 2006;40(3): 159-163.
"Misery Collaterals" as Poor Angiographic Findings: Definition, Classification, and Practical Application.
Young Joon Kim
Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea. kimyj@dku.edu
Unique internal carotid artery angiographic findings have been found especially in very poor grade aneurysmal subarachnoid hemorrhage(SAH) patients before and during the endovascular coiling. The author investigates their patterns and classifies them into four subtypes.
Among Hunt&Hess grade IV, V SAH patients, the author could gather eight patients who showed abnormal intracranial circulation in cerebral catheter-based angiography.
The author introduces new term 'misery collaterals' first and has classified them into four types with the case illustrations. Type 1 is the worst condition defined as almost no intracranial circulation. Type 2 is the condition of little intracranial circulation with contrast filling just only at vessels of brain base, type 3 is of no or little cortical circulation with contrast filling at bilateral large vessels of brain base through circle of Willis channel and type 4 is of visible bilateral cortical circulation but delayed intracranial circulation time. The prognosis of these eight patients showed misery collaterals were disappointed.
These finding can be used as the supportive information in deciding a management plan in poor grade SAH patients.
Key Words: Misery collaterals; Angiographic findings; Poor grade SAH; Aneurysm coiling
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