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Løvik K, Laupsa-Borge J, Logallo N, Helland CA. Dyslipidemia and rupture risk of intracranial aneurysms-a systematic review. Neurosurg Rev 2021; 44:3143-3150. [PMID: 33704595 PMCID: PMC8593048 DOI: 10.1007/s10143-021-01515-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
Dyslipidemia is a well-established risk factor for coronary artery disease. However, the effect on cerebral artery disease, and more specifically the rupture risk of intracranial aneurysms, is unclear and has not yet been reviewed. We therefore performed a systematic review to investigate associations between different types of dyslipidemia and incidence of aneurysmal subarachnoid hemorrhage (aSAH). We used the MEDLINE, Embase, and Web of Science databases to identify clinical trials that compared the rupture risk among SAH patients with or without dyslipidemia. The risk of bias in each included study was evaluated using the Critical Appraisal Skills Program (CASP). Of 149 unique citations from the initial literature search, five clinical trials with a case-control design met our eligibility criteria. These studies compared aSAH patients to patients with unruptured aneurysms and found an overall inverse relationship between hypercholesterolemia and rupture risk of intracranial aneurysms. The quality assessment classified all included studies as high risk of bias. The evidence indicates that hypercholesterolemia is associated with a reduced rupture risk of intracranial aneurysms. However, it is not clear whether this relation is due to the dyslipidemic condition itself or the use of antihyperlipidemic medication.
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Affiliation(s)
- Katja Løvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Benomar A, Farzin B, Volders D, Gevry G, Zehr J, Fahed R, Boisseau W, Gentric JC, Magro E, Nico L, Roy D, Weill A, Mounayer C, Guilbert F, Létourneau-Guillon L, Jacquin G, Chaalala C, Kotowski M, Nguyen TN, Kallmes D, White P, Darsaut TE, Raymond J. Angiographic results of surgical or endovascular treatment of intracranial aneurysms: a systematic review and inter-observer reliability study. Neuroradiology 2021; 63:1511-9. [PMID: 33625550 DOI: 10.1007/s00234-021-02676-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
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Chen C, Liang F, Zhang Y, Jiang C. Zoopery study on the treatment of intracranial aneurysms with a new blood flow guide device. Ann Palliat Med 2021; 10:2815-2823. [PMID: 33549020 DOI: 10.21037/apm-20-1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and effectiveness of arterial embolism device system produced by Taijie Weiye Technology Co., Ltd. METHODS Twenty healthy adult New Zealand white rabbits weighting from 3 to 4 kg were taken. Ligation and Elastic induction were used to build the aneurysm model of right common carotid artery in rabbits. The angiography and the arterial embolization device were implanted four weeks after the animal models were established. This device has excellent manufacturing, good controllability, and smooth pushing process. Five rabbits were randomly selected for angiography test to observe the healing of aneurysms in the first month, the third month and the sixth month after operation. Three other animal models with successful implantation were examined by arteriography in the first month, the third month and the sixth month, and the effect of implantation device on intercostal artery was recorded and analyzed. RESULTS In the process of making aneurysm models, sixteen animals were successfully implanted with one device, two animals were given overlapping devices, and only two animals died in the process. The success rate of arterial embolic device system in the treatment of aneurysm was more than 80%. Among them, the two animals with 2 devices also achieved satisfactory therapeutic effect. CONCLUSIONS According to this study, we found that the arterial embolization device system manufactured by Beijing Tajie Weiye Science and Technology Co., Ltd. was excellent in the immediate postoperative aneurysm occlusion rate and the long-term outcomes.
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Affiliation(s)
- Chunguang Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Liaoyang central hospital, Liaoyang, China
| | - Fei Liang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Velvaluri P, Hensler J, Wodarg F, Jansen O, Quandt E. Torsional Characterization of Braided Flow Diverter Stents : A New Method to Evaluate Twisting Phenomenon. Clin Neuroradiol 2021; 31:1181-1186. [PMID: 33491133 DOI: 10.1007/s00062-020-00991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE In the interventional treatment of cerebral aneurysms, flow diverter (FD) stents have played a significant role for more than a decade. Many studies have shown good aneurysm occlusion rates and low complication profiles. However, feared complications include acute thrombotic vessel occlusion due to stenotic deformation of the FD during release, the so-called twisting. This work investigates the behavior of different stent types to causative torsion forces in a mechanical model. MATERIALS AND METHODS Torsion characterization equipment was custom built, and two different FD stents (Derivo, Acandis and P64, Phenox) with n = 3 were tested. One end of the FD was fixed while the other end was twisted while measuring the torsion force. RESULTS In torsional force vs. the twisting angle graph, a very sharp decrease and increase in force was recorded when the stent collapsed or reopened, respectively, making it possible to characterize for twisting. All six devices showed partial/complete collapse on torsion and showed significant delayed reopening on untwisting. Interestingly on repeated testing, the stent collapsed at earlier angles, probably due to microscopic material defects. Slight variations between stents of the same type suggest that more extensive data sets are needed. CONCLUSIONS We report a new method to characterize torsion for braided FD stents, which is reliable and reproducible. Additionally, the delayed reopening and the tendency to collapse at earlier angles on consequent testing maneuvers can be significant for clinical usage.
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Affiliation(s)
- Prasanth Velvaluri
- Chair for Inorganic Functional Materials, Kiel University, Kiel, Germany.
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Eckhard Quandt
- Chair for Inorganic Functional Materials, Kiel University, Kiel, Germany
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105
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Perez-Raya I, Fathi MF, Baghaie A, Sacho R, D'Souza RM. Modeling and Reducing the Effect of Geometric Uncertainties in Intracranial Aneurysms with Polynomial Chaos Expansion, Data Decomposition, and 4D-Flow MRI. Cardiovasc Eng Technol 2021; 12:127-143. [PMID: 33415699 DOI: 10.1007/s13239-020-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Variations in the vessel radius of segmented surfaces of intracranial aneurysms significantly influence the fluid velocities given by computer simulations. It is important to generate models that capture the effect of these variations in order to have a better interpretation of the numerically predicted hemodynamics. Also, it is highly relevant to develop methods that combine experimental observations with uncertainty modeling to get a closer approximation to the blood flow behavior. METHODS This work applies polynomial chaos expansion to model the effect of geometric uncertainties on the simulated fluid velocities of intracranial aneurysms. The radius of the vessel is defined as the uncertainty variable. Proper orthogonal decomposition is applied to characterize the solution space of fluid velocities. Next, a process of projecting the 4D-Flow MRI velocities on the basis vectors followed by coefficient mapping using generalized dynamic mode decomposition enables the merging of 4D-Flow MRI with the uncertainty propagated fluid velocities. RESULTS Polynomial chaos expansion propagates the fluid velocities with an error of 2% in velocity magnitude relative to computer simulations. Also, the bifurcation region (or impingement location) shows a standard deviation of 0.17 m/s (since an available reported variance in the vessel radius is adopted to model the uncertainty, the expected standard deviation may be different). Numerical phantom experiments indicate that the proposed approach reconstructs the fluid velocities with 0.3% relative error in presence of geometric uncertainties. CONCLUSION Polynomial chaos expansion is an effective approach to propagate the effect of the uncertainty variable in the blood flow velocities of intracranial aneurysms. Merging 4D-Flow MRI and uncertainty propagated fluid velocities leads to more realistic flow trends relative to ignoring the uncertainty in the vessel radius.
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Affiliation(s)
- Isaac Perez-Raya
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA.
| | - Mojtaba F Fathi
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
| | - Ahmadreza Baghaie
- Department of Electrical and Computer Engineering, New York Institute of Technology, Old Westbury, NY, 11568, USA
| | - Raphael Sacho
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Roshan M D'Souza
- Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, 53211, USA
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106
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Southerland AM, Green IE, Worrall BB. Cerebral aneurysms and cervical artery dissection: Neurological complications and genetic associations. Handb Clin Neurol 2021; 177:241-251. [PMID: 33632443 DOI: 10.1016/b978-0-12-819814-8.00033-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dissections and aneurysms are two of the more common nonatherosclerotic arteriopathies of the cerebrovascular system and a significant contributor to neurovascular complications, particularly in the young. Specifically, ruptured intracranial aneurysms (IA) account for nearly 500,000 cases of subarachnoid hemorrhage annually with a 30-day mortality approaching 40% and survivors suffering often permanent neurologic deficits and disability. Unruptured IAs require dedicated assessment of risk and often warrant serial radiologic monitoring. Cervical artery dissection, affecting the carotid and vertebral arteries, accounts for nearly 20% of strokes in young and middle-aged adults. While approximately 70% of cervical artery dissection (CeAD) cases present with stroke or TIA, additional neurologic complications include severe headache and neck pain, oculosympathetic defect (i.e., partial Horner's syndrome), acute vestibular syndrome, and rarely lower cranial nerve palsies. Both aneurysms and dissections of the cerebrovascular system may occur frequently in patients with syndromic connective tissue disorders; however, the majority of cases are spontaneously occurring or mildly heritable with both polygenic and environmental associations. Fibromuscular dysplasia, in particular, is commonly associated with both risk of CeAD and IA formation. Further research is needed to better understand the pathophysiology of both IA and CeAD to better understand risk, improve treatments, and prevent devastating neurologic complications.
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Affiliation(s)
- Andrew M Southerland
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
| | - Ilana E Green
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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107
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Skodvin TØ, Kloster R, Sorteberg W, Isaksen JG. Survey of European neurosurgeons' management of unruptured intracranial aneurysms: inconsistent practice and organization. Acta Neurochir (Wien) 2021; 163:113-121. [PMID: 32870423 PMCID: PMC7778617 DOI: 10.1007/s00701-020-04539-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022]
Abstract
Background The discovery of an unruptured intracranial aneurysm creates a dilemma between observation and treatment. Neurosurgeons’ routines for risk assessment and treatment decision-making are unknown. The position of evidence-based medicine in European neurosurgery is considered to be weak, high-grade guidelines do not exist and variations between institutions are probable. We aimed to explore European neurosurgeons’ management routines for newly discovered unruptured intracranial aneurysms. Methods In cooperation with the European Association of Neurosurgical Societies (EANS), we conducted an online, cross-sectional survey of 420 European neurosurgeons during Spring/Summer 2016 (1533 non-Norwegians invited through the EANS, and 16 Norwegians invited through heads of departments because of the need for additional information for a separate study). We asked about demographic variables, routines for management and risk assessment of newly discovered unruptured intracranial aneurysms and presented a case. We collected information about gross domestic product (GDP) per capita from the International Monetary Fund. Results The response rate to the invite from the EANS was 26%, with respondents from 47 countries. More than half of the respondents (n = 226 [54%]) reported that their department treated less than 25 unruptured aneurysms yearly. Forty percent said their department used aneurysm size cut-off to guide treatment decisions, with a mean size of 6 mm. Presented with a case, respondents from countries with a lower GDP per capita recommended intervention more often than respondents from higher-income countries. Vascular neurosurgeons more commonly recommended observation. Conclusion The answers to this self-reported survey indicate that many centers have a treatment volume lower than recommended by international guidelines, and that there are socioeconomic differences in care. Better documentation of treatment and outcome, for example with clinical quality registries, is needed to drive improvements of care. Electronic supplementary material The online version of this article (10.1007/s00701-020-04539-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Torbjørn Øygard Skodvin
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.
- Hospital of Southern Norway, Kristiansand, Norway.
| | - Roar Kloster
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Wilhelm Sorteberg
- Department of Neurosurgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jørgen Gjernes Isaksen
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
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Tian X, Cai G, Zhi D, Fan K, Song ZL, Qiu B, Jia L, Gao R. A Transparent Vessel-on-a-Chip Device for Hemodynamic Analysis and Early Diagnosis of Intracranial Aneurysms by CFD and PC-MRI. ACS Sens 2020; 5:4064-4071. [PMID: 33289559 DOI: 10.1021/acssensors.0c02164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hemodynamics plays a critical role in early diagnosis and investigating the growth mechanism of intracranial aneurysms (IAs), which usually induce hemorrhagic stroke, serious neurological diseases, and even death. We developed a transparent blood vessel-on-a-chip (VOC) device for magnetic resonance imaging (MRI) to provide characteristic flow fields of early IAs as the reference for early diagnosis. This VOC device takes advantage of the transparent property to clearly exhibit the internal structure and identify the needless air bubbles in the biomimetic fluid experiment, which significantly affects the MRI image quality. Furthermore, the device was miniaturized and easily assembled with arbitrary direction using a 3D-printed scaffold in a radiofrequency coil. Computational fluid dynamics (CFD) simulations of the flow field were greatly consistent with those data from MRI. Both internal flow and wall shear stress (WSS) exhibited very low levels during the IA growth, thus leading to the growth and rupture of IAs. PC-MRI images can also provide a reasonable basis for the early diagnosis of IAs. Therefore, we believed that this proposed VOC-based MR imaging technique has great potential for early diagnostic of intracranial aneurysms.
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Affiliation(s)
- Xin Tian
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Guochao Cai
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
| | - Debo Zhi
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Ka Fan
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Zhi-ling Song
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, Qingdao University of Science and Technology, Qingdao 266042, China
| | - Bensheng Qiu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Longbin Jia
- Department of Medical Imaging and Neurology, Jincheng People’s Hospital, Jincheng 048000, China
| | - Rongke Gao
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, China
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Wang GX, Yang Y, Liu LL, Wen L, Duan MC, Yin JB, Zhang D. Risk of Rupture of Small Intracranial Aneurysms (≤5 mm) Among the Chinese Population. World Neurosurg 2021; 147:e275-81. [PMID: 33326857 DOI: 10.1016/j.wneu.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to develop a model to predict the risk of small intracranial aneurysm (SIA; ≤5 mm) rupture among Chinese adults and to compare the score predicted by our model with the PHASES (population, hypertension, age, size, earlier subarachnoid hemorrhage, aneurysm site) score. METHODS From August 2011 to June 2015, 366 patients with 394 SIAs were retrospectively evaluated and followed up for ≥5 years. The clinical characteristics of the patients were reviewed from their medical records, and the SIA features were evaluated from the imaging studies. The independent risk factors for SIA rupture were studied using multiple Cox proportional hazards regression analysis. The diagnostic value of the PHASES score for the prediction of SIA rupture was also calculated. RESULTS Six SIAs in 6 different patients had ruptured during a mean follow-up of 6.4 years. An irregular shape (odds ratio [OR], 31.464), a high aspect ratio (OR, 40.573), and a high size ratio (OR, 20.541) increased the risk of rupture. The predictive score incorporated these three factors. The threshold was 1.5, and the area under the curve, sensitivity, and specificity were 0.986, 100%, and 94.6%, respectively. For the PHASES score, the area under the curve, sensitivity, and specificity were 0.702, 83.3%, and 62.1%, respectively. CONCLUSIONS An irregular shape, a high aspect ratio, and a high size ratio were associated with SIA rupture in the Chinese population. Our predictive score is of great value in predicting the risk of SIA rupture.
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110
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Jiranukool J, Thiarawat P, Galassi W. Prevalence of intracranial aneurysms among acute ischemic stroke patients. Surg Neurol Int 2020; 11:341. [PMID: 33194275 PMCID: PMC7656034 DOI: 10.25259/sni_506_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The prevalence of unruptured intracranial aneurysms varies with age, sex, and genetic diseases, including atherosclerotic diseases. The objectives of this study are to determine the prevalence of intracranial aneurysms among acute ischemic stroke patients and the clinical outcomes of the patients. Methods: The authors included patients with acute ischemic stroke within 7 days of onset. Demographic data, stroke subtypes, risk factors, and modified Rankin scale (mRS) scores at 6 months after stroke were collected. Magnetic resonance angiography was performed to diagnose intracranial aneurysms. The occurrence of aneurysmal subarachnoid hemorrhage (aSAH) was recorded during the follow-up at 6 months. Results: Thirteen (7%) of the 186 patients were found to have incidental intracranial aneurysms. Age and sex were not different between the patients with and without aneurysms (P > 0.999, P > 0.999). Ten patients (76.9%) had a saccular aneurysm. The most common site of the aneurysm was the cavernous part of the internal carotid artery (n = 6). Nine patients (69.2%) had very small (<4 mm) aneurysms. No aSAH was detected until 6 months after stroke. Favorable outcomes (mRS 0–2) at 6 months were not different between the patients with and without aneurysms (69.2% vs. 75.1%, P = 0.665). Conclusion: A higher prevalence of intracranial aneurysms was observed among acute ischemic stroke patients than among the general population. However, the variability of the general population should be considered. The functional outcomes of acute ischemic stroke patients are not affected by the presence of an intracranial aneurysm.
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Affiliation(s)
- Jiroje Jiranukool
- Department of Neurosurgery, Naresuan University, Phitsanulok, Thailand
| | | | - Waneerat Galassi
- Department of Radiology, Naresuan University, Phitsanulok, Thailand
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111
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Gareev I, Beylerli O, Yang G, Izmailov A, Shi H, Sun J, Zhao B, Liu B, Zhao S. Diagnostic and prognostic potential of circulating miRNAs for intracranial aneurysms. Neurosurg Rev 2020; 44:2025-2039. [PMID: 33094424 DOI: 10.1007/s10143-020-01427-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022]
Abstract
Intracranial aneurysm (IA) is an abnormal focal dilation of an artery in the brain that results from a weakening of the inner muscular layer of a blood vessel wall. IAs represent the most common etiology of nontraumatic subarachnoid hemorrhage (SAH). Despite technological advances in the treatment and use of new diagnostic methods for IAs, they continue to pose a significant risk of mortality and disability. Thus, early recognition of IA with a high risk of rupture is crucial for the stratification of patients with such a formidable disease. MicroRNAs (miRNA) are endogenous noncoding RNAs of 18-22 nucleotides that regulate gene expression at the post-transcriptional level through interaction with 3'-untranslated regions (3'UTRs) of the target mRNAs. MiRNAs are involved in the pathogenesis of IAs, including in the mechanisms of formation, growth, and rupture. It is known that in many biological fluids of the human body, such as blood or cerebrospinal fluid (CSF), numerous miRNAs, called circulating miRNAs, have been detected. The expression profile of circulating miRNAs represents a certain part of the cells in which they are modified and secreted in accordance with the physiological or pathological conditions of these cells. Circulating miRNAs can be secreted from cells into human biological fluids in extracellular vesicles or can be bound to Ago2 protein, which makes them resistant to the effects of RNAse. Therefore, circulating miRNAs are considered as new potential biomarkers of interest in many diseases, including IA.
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Affiliation(s)
| | | | - Guang Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China.
- Institute of Brain Science, Harbin Medical University, Harbin, China.
| | - Adel Izmailov
- Republican Clinical Oncological Dispensary, Ufa, Republic of Bashkortostan, Russia
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Jinxian Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Boxian Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Binbing Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
| | - Shiguang Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23, Nangang District, Harbin, Heilongjiang Province, China.
- Institute of Brain Science, Harbin Medical University, Harbin, China.
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Asgharzadeh H, Shahmohammadi A, Varble N, Levy EI, Meng H, Borazjani I. A Simple Flow Classification Parameter Can Discriminate Rupture Status in Intracranial Aneurysms. Neurosurgery 2020; 87:E557-E564. [PMID: 32421804 PMCID: PMC7566542 DOI: 10.1093/neuros/nyaa189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A simple dimensionless aneurysm number ($An$), which depends on geometry and flow pulsatility, was previously shown to distinguish the flow mode in intracranial aneurysms (IA): vortex mode with a dynamic vortex formation/evolution if $An > 1$, and cavity mode with a steady shear layer if $An < 1$. OBJECTIVE To hypothesize that $An\ > \ 1$ can distinguish rupture status because vortex mode is associated with high oscillatory shear index, which, in turn, is statistically associated with rupture. METHODS The above hypothesis is tested on a retrospective, consecutively collected database of 204 patient-specific IAs. The first 119 cases are assigned to training and the remainder to testing dataset. $An$ is calculated based on the pulsatility index (PI) approximated either from the literature or solving an optimization problem (denoted as$\ \widehat {PI}$). Student's t-test and logistic regression (LR) are used for hypothesis testing and data fitting, respectively. RESULTS $An$ can significantly discriminate ruptured and unruptured status with 95% confidence level (P < .0001). $An$ (using PI) and $\widehat {An}$ (using $\widehat {PI}$) significantly predict the ruptured IAs (for training dataset $An\!:\ $AUC = 0.85, $\widehat {An}\!:\ $AUC = 0.90, and for testing dataset $An\!:\ $sensitivity = 94%, specificity = 33%, $\widehat {An}\!:\ $sensitivity = 93.1%, specificity = 52.85%). CONCLUSION $An > 1$ predicts ruptured status. Unlike traditional hemodynamic parameters such as wall shear stress and oscillatory shear index, $An$ has a physical threshold of one (does not depend on statistical analysis) and does not require time-consuming flow simulations. Therefore, $An$ is a simple, practical discriminator of IA rupture status.
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Affiliation(s)
- Hafez Asgharzadeh
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York
| | - Ali Shahmohammadi
- Department of Chemical Engineering, Queen's University, Kingston, Canada
| | - Nicole Varble
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York
- Cannon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
| | - Elad I Levy
- Cannon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Hui Meng
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York
- Cannon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York
| | - Iman Borazjani
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, New York
- J. Mike Walker ’66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas
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113
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Mehta VA, Spears CA, Abdelgadir J, Wang TY, Sankey EW, Griffin A, Goodwin CR, Zomorodi A. Management of unruptured incidentally found intracranial saccular aneurysms. Neurosurg Rev 2020; 44:1933-1941. [PMID: 33025187 DOI: 10.1007/s10143-020-01407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
Unruptured intracranial saccular aneurysms occur in 3-5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system.
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Affiliation(s)
- Vikram A Mehta
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA.
| | - Charis A Spears
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Jihad Abdelgadir
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Andrew Griffin
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, 20 Duke Medicine Circle, Box 3807, Durham, NC, 27710, USA
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Sun Y, Wen Y, Ruan Q, Yang L, Huang S, Xu X, Cai Y, Li H, Wu S. Exploring the association of long noncoding RNA expression profiles with intracranial aneurysms, based on sequencing and related bioinformatics analysis. BMC Med Genomics 2020; 13:147. [PMID: 33023605 PMCID: PMC7542138 DOI: 10.1186/s12920-020-00805-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background The present study aims to investigate the complete long non-coding RNA (lncRNA) and messenger RNA (mRNA) expression profiles in Intracranial aneurysm (IA) patients and controls by RNA sequencing, which reveals the lncRNA with predictive value for IA risk. Methods The comprehensive lncRNA and mRNA expression profiles were detected by RNA-Seq in human IA walls and superficial temporal arteries (STAs), followed by bioinformatics analyses, such as GO analysis, KEGG pathway analysis, and CNC network construction. Subsequently, qRT-PCR was used to profile the expression levels of selected lncRNA (lncRNA ENST000000576153, lncRNA ENST00000607042, lncRNA ENST00000471220, lncRNA ENST00000478738, lncRNA MALAT1, lncRNA ENST00000508090 and lncRNA ENST00000579688) in 30 (small) or 130 (large) peripheral blood leukocytes, respectively. Multivariate logistic regression was utilized to analyze the effects of lncRNA on IA. Receiver operating characteristic (ROC) curve was further drawn to explore the value of lncRNA in predicting IA. Results Totally 900 up-regulated and 293 down-regulated lncRNAs, as well as 1297 up-regulated and 831 down-regulated mRNAs were discovered in sequencing. Enrichment analyses revealed that they were actively involved in immune/inflammatory response and cell adhesion/extracellular matrix. Co-expression analysis and further enrichment analyses showed that five candidate lncRNAs might participate in IA’s inflammatory response. Besides, after controlling other conventional risk factors, multivariate logistic regression analysis disclosed that low expression of lncRNA ENST00000607042, lncRNA ENST00000471220, lncRNA ENST00000478738, lncRNA MALAT1 in peripheral blood leukocytes were independent risk factors for IA. LncRNA ENST00000607042 has superior diagnostic value for IA. Conclusions This study reveals the complete lncRNAs expression profiles in IA. The inflammatory response was closely related to IA. Besides, lncRNA ENST00000607042 might be a novel biomarker for IA risk.
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Affiliation(s)
- Yi Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Yeying Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Qishuang Ruan
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Le Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Shuna Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Yingying Cai
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China.
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Minhou County, Fuzhou, 350122, China.
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Xin WQ, Sun PJ, Li F, Cheng MX, Yang SX, Cui BL, Wang ZG, Yang XY. Risk factors involved in the formation of multiple intracranial aneurysms. Clin Neurol Neurosurg 2020; 198:106172. [PMID: 32942133 DOI: 10.1016/j.clineuro.2020.106172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although several risk factors of the multiple intracranial aneurysms (MIAs) formation has been reported, the results are controversial. We aimed to find out the risk factors of MIAs formation by analyzing our clinic data combined with a meta-analysis. MATERIAL AND METHODS A retrospective review work of medical records for the patients with aneurysms was undertaken. Univariate analysis was used to examine all mentioned variables. Binary logistic regression analysis was used to identify the risk factors of MIAs formation. RESULTS In the retrospective review work, a total of 565 patients with aneurysm were included in this study. Of these 565 participants, 449 patients suffered SIAs and 116 patients suffered MIAs. Univariate analysis showed a significant difference in terms of female, cigarette smoking, family history of hypertension, and primary hypertension between the SIAs and MIAs group. The binary logistic regression analysis showed that the female (OR = 1.624), primary hypertension (OR = 1.563), and family history of hypertension (OR = 2.496) were independent risk factors of the formation of MIAs (for each P < 0.05). With regard to the meta-analysis results, it revealed that there was significant difference in the rates of female (P < 0.001), cigarette smoking (P < 0.001), primary hypertension (P = 0.001), and higher age (P = 0.011) among the MIAs patients. CONCLUSIONS A higher rate of the formation of MIAs is closely associated with the elder and female. Patients with hypertension history, cigarette smoking, and family primary hypertension history also affected the formation of MIAs, these risk factors should be a guard against.
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Affiliation(s)
- Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China; Department of Neurology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Peng-Ju Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Fan Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Ming-Xun Cheng
- Department of Vascular Surgery, The First Affiliated Hospital of Jiamusi University Jiamusi, Heilongjiang Province, 154002, PR China.
| | - Shi-Xue Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Bao-Long Cui
- Department of Neurology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Zeng-Guang Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
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Kocur D, Paździora P, Baron J, Rudnik A. Role of transcranial Doppler ultrasonography in assessing stenosis after flow diversion. Clin Neurol Neurosurg 2020; 198:106219. [PMID: 32932030 DOI: 10.1016/j.clineuro.2020.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/23/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients after implantation of flow diverters (FD) due to intracranial aneurysms require radiological and clinical follow-up in view of in-stent stenosis. The aim of the study was to evaluate transcranial Doppler ultrasonography (TCD) as an alternative to more invasive digital subtraction angiography in monitoring patients with FD. PATIENTS AND METHODS Twenty-five patients after FD deployment due to internal carotid artery (ICA) aneurysms were reviewed. The degree stenosis found on TCD was compared with the results of catheter angiography. The TCD examinations were recorded from two sides at the extracranial ICA and the most proximal and distal segment of intracranial ICA. Analyzed TCD factors included: peak systolic blood flow velocity, end diastolic velocity, mean velocity, pulsatility index, and resistivity index. The side-to-side differences and ratios between particular TCD indices were calculated. RESULTS The cumulative frequency of angiographic in-stent stenosis was 5 of 25 (20 %). The analysis showed that pulsatility index measured on the most proximal intracranial segment of ICA is a predictor for angiographic instent stenosis (AUC = 0.854; p = 0.04; 95 % CI 0.59-1.00). The threshold of pulsatility index separating stenosis and non-stenosis groups was 1.05 with a sensitivity of 50 % and a specificity of 100 %. As the cut-off threshold of PI was set 0.75 the sensitivity and specificity was 100 % and 16.7 %, respectively. CONCLUSIONS The increased TCD-derived pulsatility index measured on the most proximal intracranial segment of ICA is associated with in-stent stenosis demonstrated on angiograms.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland.
| | - Piotr Paździora
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
| | - Jan Baron
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Katowice, Poland
| | - Adam Rudnik
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
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Juchler N, Schilling S, Bijlenga P, Morel S, Rüfenacht D, Kurtcuoglu V, Hirsch S. Shape irregularity of the intracranial aneurysm lumen exhibits diagnostic value. Acta Neurochir (Wien) 2020; 162:2261-2270. [PMID: 32500254 DOI: 10.1007/s00701-020-04428-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Morphological irregularity is linked to intracranial aneurysm wall instability and manifests in the lumen shape. Yet there is currently no consent on how to assess shape irregularity. The aims of this work are to quantify irregularity as perceived by clinicians, to break down irregularity into morphological attributes, and to relate these to clinically relevant factors such as rupture status, aneurysm location, and patient age or sex. METHODS Thirteen clinicians and 26 laypersons assessed 134 aneurysm lumen segmentations in terms of overall perceived irregularity and five different morphological attributes (presence/absence of a rough surface, blebs, lobules, asymmetry, complex geometry of the parent vasculature). We examined rater agreement and compared the ratings with clinical factors by means of regression analysis or binary classification. RESULTS Using rank-based aggregation, the irregularity ratings of clinicians and laypersons did not differ statistically. Perceived irregularity showed good agreement with curvature (coefficient of determination R2 = 0.68 ± 0.08) and was modeled very accurately using the five morphological rating attributes plus shape elongation (R2 = 0.95 ± 0.02). In agreement with previous studies, irregularity was associated with aneurysm rupture status (AUC = 0.81 ± 0.08); adding aneurysm location as an explanatory variable increased the AUC to 0.87 ± 0.09. Besides irregularity, perceived asymmetry, presence of blebs or lobules, aneurysm size, non-sphericity, and curvature were linked to rupture. No association was found between morphology and any of patient sex, age, and history of smoking or hypertension. Aneurysm size was linked to morphology. CONCLUSIONS Irregular lumen shape carries significant information on the aneurysm's disease status. Irregularity constitutes a continuous parameter that shows a strong association with the rupture status. To improve the objectivity of morphological assessment, we suggest examining shape through six different morphological attributes, which can characterize irregularity accurately.
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Affiliation(s)
- Norman Juchler
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland.
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | - Sabine Schilling
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland
- Institute of Tourism ITW, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Sandrine Morel
- Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Vartan Kurtcuoglu
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- National Center of Competence in Research, Kidney.CH, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Sven Hirsch
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland.
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Jiang Z, Huang J, You L, Zhang J, Li B. STAT3 Contributes to Intracranial Aneurysm Formation and Rupture by Modulating Inflammatory Response. Cell Mol Neurobiol 2020; 41:1715-1725. [PMID: 32804311 DOI: 10.1007/s10571-020-00941-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/08/2020] [Indexed: 02/04/2023]
Abstract
Intracranial aneurysm (IA) is a common type of refractory cerebrovascular diseases. Inflammatory responses have been reported to be associated with the pathogenesis of IA. We aimed to study the role of STAT3 on IA formation and inflammatory response. STAT3 expression and clinicopathological factors were analyzed in IA and normal cerebral arteries. mRNA level of STAT3 was detected in normal, unruptured, and ruptured IA tissues by RT-PCR and Western blot. Inflammatory cytokines were examined by ELISA in unruptured, ruptured IA tissues, as well as cells with STAT3 overexpression or knockdown. mRNA of phenotypic modulation-related factors was tested by RT-PCR in STAT3 overexpressing or knockdown VSMCs. STAT3 expression was upregulated in ruptured IA tissues and highly associated with IA diameter and IA type. Inflammatory cytokine secretion was increased in ruptured IA samples and positively correlated with STAT3 expression. STAT3 overexpression led to enhanced expression of SM-α actin, SM-MHC, MMP2, and MMP9, and increased secretion of inflammatory cytokines. Our findings have demonstrated that STAT3 is a key regulator in IA formation by modulating inflammatory cytokine expression.
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Affiliation(s)
- Zhixian Jiang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Jiaxin Huang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lingtong You
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Jinning Zhang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Bingyu Li
- Geriatrics Dept District 7, Dongjie Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China.
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Ding A, Braschkat A, Guber A, Cattaneo G. New Concept of Patient-specific Flow Diversion Treatment of Intracranial Aneurysms : Design Aspects and in vitro Fluid Dynamics. Clin Neuroradiol 2020; 31:671-679. [PMID: 32651611 DOI: 10.1007/s00062-020-00930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Current flow diverter (FD) designs limit the possibilities to achieve ideal functional parameters for intra-aneurysmal flow alteration in the implanted state. In this work, we evaluate the technical feasibility of a new patient-specific FD concept and the impact on intra-aneurysmal flow reduction compared to standard FD. METHODS Based on a literature review, we defined functional requirements, followed by the design and manufacturing of two different prototypes, which we implanted in a patient-specific phantom model. Functional porosity distributions and contour parameters were evaluated in the implanted state and compared to standard FD. Subsequently, we carried out a series of particle image velocimetry (PIV) measurements, in order to assess the impact on intra-aneurysmal flow. RESULTS With both patient-specific prototypes, it was possible to achieve stronger intra-aneurysmal flow reductions in terms of maximum and mean velocity and vorticity than a standard FD; however, one design showed a strong sensitivity against malpositioning. Overall, fluid dynamics parameters correlated with geometrical aspects such as the porosity and its grade of homogeneity. Beyond that, we found influences by the FD contour projection within the aneurysm, especially connected to the formation of in-jets. CONCLUSION Our results show that there is a technically feasible concept, which enables a more specific adjustment of functional FD parameters and more effective intra-aneurysmal flow reduction. This could potentially lead to improvements in the efficacy of aneurysm occlusion in cases with challenging fluid dynamics.
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Affiliation(s)
- Andreas Ding
- Acandis GmbH, R&D, Pforzheim, Baden-Württemberg, Germany. .,, Weltzienstr. 24, 76135, Karlsruhe, Germany.
| | | | - Andreas Guber
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, Karlsruhe, Baden-Württemberg, Germany
| | - Giorgio Cattaneo
- Institute of Biomedical Engineering, University of Stuttgart, Stuttgart, Baden-Württemberg, Germany
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Spitz L, Niemann U, Beuing O, Neyazi B, Sandalcioglu IE, Preim B, Saalfeld S. Combining visual analytics and case-based reasoning for rupture risk assessment of intracranial aneurysms. Int J Comput Assist Radiol Surg 2020; 15:1525-35. [PMID: 32623613 DOI: 10.1007/s11548-020-02217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
Purpose Medical case-based reasoning solves problems by applying experience gained from the outcome of previous treatments of the same kind. Particularly for complex treatment decisions, for example, incidentally found intracranial aneurysms (IAs), it can support the medical expert. IAs bear the risk of rupture and may lead to subarachnoidal hemorrhages. Treatment needs to be considered carefully, since it may entail unnecessary complications for IAs with low rupture risk. With a rupture risk prediction based on previous cases, the treatment decision can be supported. Methods We present an interactive visual exploration tool for the case-based reasoning of IAs. In presence of a new aneurysm of interest, our application provides visual analytics techniques to identify the most similar cases with respect to morphology. The clinical expert can obtain the treatment, including the treatment outcome, for these cases and transfer it to the aneurysm of interest. Our application comprises a heatmap visualization, an adapted scatterplot matrix and fully or partially directed graphs with a circle- or force-directed layout to guide the interactive selection process. To fit the demands of clinical applications, we further integrated an interactive identification of outlier cases as well as an interactive attribute selection for the similarity calculation. A questionnaire evaluation with six trained physicians was used. Result Our application allows for case-based reasoning of IAs based on a reference data set. Three classifiers summarize the rupture state of the most similar cases. Medical experts positively evaluated the application. Conclusion Our case-based reasoning application combined with visual analytic techniques allows for representation of similar IAs to support the clinician. The graphical representation was rated very useful and provides visual information of the similarity of the k most similar cases.
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Gariel F, Marnat G, Barreau X, Menegon P, Bourcier R, Pierot L, Spelle L, Bonafé A, Turjman F, Gory B, Berge J. Safety and efficacy of the Silk flow diverter: Insight from the DIVERSION prospective cohort study. J Neuroradiol 2020; 48:293-298. [PMID: 32615206 DOI: 10.1016/j.neurad.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverters are considered as an essential tool in the stent-based treatment of complex intracranial aneurysms. We report here a subgroup analysis of the nationwide prospective DIVERSION study to investigate the safety and efficacy of the Silk flow diverter at 12 months follow-up. METHODS We performed a subgroup analysis of patients included in the DIVERSION, a national prospective cohort study including all flow diverters placement between 2012 and 2014 in France, and treated with the Silk. The primary outcome was the morbi-mortality at 12 months, including death, morbidity event and aneurysm retreatment within 12 months post-treatment. All reported serious events were adjudicated by an independent Data Safety and Monitoring Board. Satisfactory occlusion was defined as 3 or 4 on Kamran's scale by an independent imaging core laboratory during follow-up. RESULTS A total of 102 procedures involving 101 patients (mean age±standard deviation, 54.3±13.5 years) harbouring 118 aneurysms (113/118 located in the anterior circulation; mean size 8.2±7.1mm) were included. During the 12-month follow-up, 34 (33.3%) procedures experienced at least one morbi-mortality event: 3 deaths, 27 morbidity events and 4 retreatments. Overall, 1/3 deaths and 10/27 morbidity events were related to the device and/or the procedure, leading to a specific survival rate and a specific free-morbidity survival rate at 12 months of 98.98% [95% confidence interval, 92.98%-99.86%] and 89.73% [95%CI, 81.71%-94.36%], respectively. The rate of permanent-related neurological deficit was 5.9% within 12 months. One year follow-up imaging showed satisfactory occlusion in 82.2% of cases. CONCLUSION Flow diversion with the Silk device has a reasonable safety and effectiveness profile for the endovascular treatment of intracranial aneurysms.
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Affiliation(s)
- Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
| | - Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
| | - Xavier Barreau
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
| | - Patrice Menegon
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France.
| | - Laurent Pierot
- Department of Neuroradiology, CHU of Reims, Reims, France.
| | - Lauren Spelle
- Department of Interventional Neuroradiology, CHU of Bicêtre, Le Kremlin-Bicêtre, France.
| | - Alain Bonafé
- Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France.
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU of Nancy, 54000 Nancy, France; Université de Lorraine, IADI, INSERM U1254, 54000 Nancy, France.
| | - Jérôme Berge
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
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Ambrosanio G, Arthimulam G, Leone G, Guarnieri G, Muto M, Muto M. Bailouts During Neurointervention; Novel Techniques in Tackling Coil Migration and Premature Intravascular Detachment of Microcatheter Tip. World Neurosurg 2020; 142:167-170. [PMID: 32615295 DOI: 10.1016/j.wneu.2020.06.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications. METHODS We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far. RESULTS Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter. CONCLUSIONS These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.
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Affiliation(s)
| | - Ganesan Arthimulam
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy; Neurointerventional Unit, Department of Diagnostic Imaging, Kuala Lumpur General Hospital, Malaysia.
| | - Giuseppe Leone
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | | | - Massimo Muto
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Mario Muto
- Department of Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
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Li W, Wang S, Tian Z, Zhu W, Zhang Y, Zhang Y, Wang Y, Wang K, Yang X, Liu J. Discrimination of intracranial aneurysm rupture status: patient-specific inflow boundary may not be a must-have condition in hemodynamic simulations. Neuroradiology 2020; 62:1485-1495. [PMID: 32588092 DOI: 10.1007/s00234-020-02473-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Computational fluid dynamics (CFD) are important in evaluating the hemodynamics of intracranial aneurysm rupture, and the setting of inflow boundary conditions is critical. We evaluated intracranial aneurysm hemodynamics based on generalized versus patient-specific inflow boundary conditions to examine the effect of different hemodynamic results on the discrimination of intracranial aneurysm rupture status. METHODS We enrolled 148 patients with 156 intracranial aneurysms. For each included aneurysm, we performed CFD simulation once based on patient-specific and once based on generalized inflow boundary conditions. First, we compared the hemodynamics of intracranial aneurysms based on different inflow boundary conditions. Then, we divided the included aneurysms into a ruptured and unruptured group and compared the hemodynamics between the two groups under patient-specific and generalized inflow boundary conditions. RESULTS For the hemodynamic parameters using specific inflow boundary conditions, more complex flow (p = 0.002), larger minimum WSS (p = 0.024), lower maximum low WSS area (LSA) (p = 0.038), and oscillatory shear index (p = 0.002) were found. Furthermore, we compared the hemodynamics between ruptured and unruptured groups based on different inflow boundary conditions. We found that the significant hemodynamic parameters associated with rupture status were the same, including the proportion of aneurysms with flow complex and unstable flow and the minimum and maximum of LSA (p = 0.011, p = 0.003, p = 0.001 and p = 0.004, respectively). CONCLUSION Patient-specific and generalized inflow boundary conditions of aneurysmal hemodynamics resulted in significant differences. However, the significant parameters associated with rupture status were the same in both conditions, indicating that patient-specific inflow boundary conditions may not be necessary for predicting rupture risk.
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Affiliation(s)
- Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Shengzhang Wang
- Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, NansanhuanXilu 119, Fengtai District, Beijing, 100070, China.
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Yerramilli SK, Kokula P, Gupta SK, Radotra BD, Aggarwal A, Aggarwal D, Chatterjee D. Connective Tissue Abnormalities in Patients with Ruptured Intracranial Aneurysms and No Known Systemic Connective Tissue Disorder. World Neurosurg 2020; 141:e829-e835. [PMID: 32553603 DOI: 10.1016/j.wneu.2020.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Defect in internal elastic lamina, defect in tunica media, and the amount of collagen and elastin play a role in vessel wall weakening leading to aneurysm formation. A similar picture may be found in connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome (EDS), neurofibromatosis type 1, and Loeys-Dietz syndrome (LDS), where there is a predominant disorder of collagen formation/maturation. METHODS Histopathology of skin and the superficial temporal artery (STA) was done. All specimens were obtained during craniotomy for ruptured aneurysm clipping or other indicated procedures (for control subjects). Parameters in skin biopsy seen were epithelial thickness, dermal collagen thickness, and so forth. For the STA, parameters such as intimal thickness, intimal proliferation, thickness of media, and so forth were studied. RESULTS Twenty cases and twenty control subjects were studied. The mean age of the study population was 40.5 years. Salient findings on skin biopsy in patients of intracranial aneurysms (IAs) (cases) were haphazard orientation of collagen, inflammation in the subepidermal layer, increased dermal collagen thickness, and reduced and/or fragmented elastic fibers. Prominent findings on vessel wall biopsy were intimal proliferation, reduplication of internal elastic lamina, reduced and/or fragmented elastin, and vacuolation of smooth muscle cells. The average number of aberrations per patient was significantly higher in cases than control subjects. CONCLUSIONS The histologic changes seen in skin and the STA in cases of IAs signify a weak connective tissue. Some of these findings are also seen in known connective tissue disorders such as Marfan syndrome, EDS, neurofibromatosis type 1, and LDS. The connective tissue abnormalities found in patients with IAs may be congenital, which gets further accentuated by known risk factors leading to weak vessel wall and subsequent aneurysm formation.
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Affiliation(s)
| | | | - Sunil K Gupta
- Department of Neurosurgery, PGIMER Chandigarh, Chandigarh, India
| | - Bishan D Radotra
- Department of Histopathology, PGIMER Chandigarh, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, PGIMER Chandigarh, Chandigarh, India.
| | - Divya Aggarwal
- Department of Histopathology, PGIMER Chandigarh, Chandigarh, India
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Yao A, Jia L, Li J, Wang B, Zhang J, Xue Z, Zhao K, Zhao Y, You N, Zhang J, Xu B. Fusion of subarachnoid hemorrhage data and computed tomography angiography data is helpful to identify the rupture source in patients with multiple intracranial aneurysms. Neurosurg Rev 2020; 44:1411-1416. [PMID: 32506389 DOI: 10.1007/s10143-019-01221-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 10/24/2022]
Abstract
Determining the rupture source is imperative in patient with aneurysmal subarachnoid hemorrhage (SAH). About one third of SAH cases with multiple intracranial aneurysms cannot be certain of the rupture source according to the hemorrhage pattern. This study aims to identify of the rupture source in patients with multiple intracranial aneurysms by fusing SAH data and computed tomography angiography (CTA) data. This retrospective study included 52 aneurysmal SAH patients with multiple intracranial aneurysms. In the 52 patients, 36 had definitive hemorrhage patterns on computed tomography imaging. And the other 16 patients had non-definitive hemorrhage patterns, which were bewildered for us to determine the ruptured aneurysms. Fusion of SAH data and CTA data was performed to demonstrate the spatial relationship between the SAH with each aneurysm by using the 3D Slicer software. For the patients with definitive bleed patterns, all of the suspected ruptured aneurysms were confirmed to be accurate according to the surgical records. Interestingly, the suspected rupture sources were correct in 14 of 16 patients with non-definitive hemorrhage patterns. For all 52 patients with multiple intracranial aneurysms, the ruptured aneurysms were identified in 50 cases (96.2%). In conclusion, fusion of SAH data and CTA data can precisely demonstrate the spatial relationship between the SAH with each aneurysm, which is helpful to determine the ruptured aneurysm in patients with multiple intracranial aneurysms.
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Affiliation(s)
- Anhui Yao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.,Department of Neurosurgery, the 988 Hospital of PLA, Zhengzhou, Henan Province, China
| | - Liyun Jia
- Department of Medical Genetics & Cell Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jun Li
- Department of Medical Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Benhan Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Jiashu Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhe Xue
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Kai Zhao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Yue Zhao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Na You
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
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Tan X, Li T, Zhu S, Zhong W, Li F, Wang Y. Induction of SPARC on Oxidative Stress, Inflammatory Phenotype Transformation, and Apoptosis of Human Brain Smooth Muscle Cells Via TGF-β1-NOX4 Pathway. J Mol Neurosci 2020; 70:1728-1741. [PMID: 32495004 DOI: 10.1007/s12031-020-01566-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
Secreted protein acidic and rich in cysteine (SPARC) has a close association with inflammatory response and oxidative stress in tissues and is widely expressed in intracranial aneurysms (IAs), especially in smooth muscle cells. Therefore, it is inferred that SPARC might be involved in the formation and development of IAs through the inflammatory response pathway or oxidative stress pathway. The aim of this study is to investigate the pathological mechanism of SPARC in oxidative stress, inflammation, and apoptosis during the formation of IAs, as well as the involvement of TGF-β1 and NOX4 molecules. Human brain vascular smooth muscle cells (HBVSMCs) were selected as experimental objects. After the cells were stimulated by recombinant human SPARC protein in vitro, the ROS level in the cells was measured using an ID/ROS fluorescence analysis kit combined with fluorescence microscope and flow cytometry. The related protein expression in HBVSMCs was measured using western blotting. The mitochondrial membrane potential change was detected using a mitochondrial membrane potential kit and laser confocal microscope. The mechanism was explored by intervention with reactive oxygen scavengers N-acetylcysteine (NAC), TGF-β1 inhibitor (SD-208), and siRNA knockout. The results showed that SPARC upregulated the expression of NOX4 through the TGF-β1-dependent signaling pathway, leading to oxidative stress and pro-inflammatory matrix behavior and apoptosis in HBVSMCs. These findings demonstrated that SPARC may promote the progression of IAs.
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Affiliation(s)
- Xianjun Tan
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurosurgery, People's Hospital of Chiping City, Liaocheng City, Shandong Province, China.,Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong Province, China
| | - Tao Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong Province, China.,Department of Neurosurgery, the No.4 People's Hospital of Jinan, Jinan City, Shandong Province, China
| | - Shaowei Zhu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong Province, China
| | - Weiying Zhong
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong Province, China
| | - Feng Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. .,Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong Province, China.
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Zhu W, Li W, Tian Z, Zhang Y, Wang K, Zhang Y, Liu J, Yang X. Stability Assessment of Intracranial Aneurysms Using Machine Learning Based on Clinical and Morphological Features. Transl Stroke Res 2020; 11:1287-1295. [PMID: 32430796 DOI: 10.1007/s12975-020-00811-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023]
Abstract
Machine learning (ML) as a novel approach could help clinicians address the challenge of accurate stability assessment of unruptured intracranial aneurysms (IAs). We developed multiple ML models for IA stability assessment and compare their performances. We enrolled 1897 consecutive patients with unstable (n = 528) and stable (n = 1539) IAs. Thirteen patient-specific clinical features and eighteen aneurysm morphological features were extracted to generate support vector machine (SVM), random forest (RF), and feed-forward artificial neural network (ANN) models. The discriminatory performances of the models were compared with statistical logistic regression (LR) model and the PHASES score in IA stability assessment. Based on the receiver operating characteristic (ROC) curve and area under the curve (AUC) values for each model in the test set, the AUC values for RF, SVM, and ANN were 0.850 (95% CI 0.806-0.893), 0.858 (95 %CI 0.816-0.900), and 0.867 (95% CI 0.828-0.906), demonstrating good discriminatory ability. All ML models exhibited superior performance compared with the statistical LR and the PHASES score (the AUC values were 0.830 and 0.589, respectively; RF versus PHASES, P < 0.001; RF versus LR, P = 0.038). Important features contributing to the stability discrimination included three clinical features (location, sidewall/bifurcation type, and presence of symptoms) and three morphological features (undulation index, height-width ratio, and irregularity). These findings demonstrate the potential of ML to augment the clinical decision-making process for IA stability assessment, which may enable more optimal management for patients with IAs in the future.
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Affiliation(s)
- Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.
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Gudelj M, Bruyère PJ, Tebache M, Collignon L, Lubicz B. Endovascular Treatment of Intracranial Aneurysms: Initial Experience in a Low-Volume Center. J Belg Soc Radiol 2020; 104:19. [PMID: 32405610 DOI: 10.5334/jbsr.1918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: Endovascular treatment (EVT) is the first-line treatment for ruptured and unruptured intracranial aneurysms (IA). EVT may be performed by interventional neuroradiologist (INR) with different levels of experience. This study aimed at evaluating clinical and anatomic results of IA embolisations performed by a INR with a short experience. Materials and Methods: Within a 26-month period, 35 IA embolisations were managed by a young INR, 26 of these IA being ruptured. Different EVT techniques were used: coiling alone, stent-assisted coiling and remodeling techniques. Initial angiographic results, clinical outcomes and mid-term anatomic results were evaluated. Results: Out of 35 procedures, there were seven per-procedural complications leading to one ischemic stroke and one death. Immediate post-procedural complete occlusion was obtained in 91% of procedures (32/35). Good clinical results (modified Rankin Scale Score of 0 or 1) were obtained in 79% of patients (26/33). In a mean follow-up time of 9.5 months, stable occlusion was shown in 88% of IA (21/24). Conclusion: This study suggests that IA embolisation may be performed by a recently trained INR with good clinical and anatomical outcomes.
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Sauvigny T, Alawi M, Krause L, Renner S, Spohn M, Busch A, Kolbe V, Altmüller J, Löscher BS, Franke A, Brockmann C, Lieb W, Westphal M, Schmidt NO, Regelsberger J, Rosenberger G. Exome sequencing in 38 patients with intracranial aneurysms and subarachnoid hemorrhage. J Neurol 2020; 267:2533-2545. [PMID: 32367296 PMCID: PMC7419486 DOI: 10.1007/s00415-020-09865-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 01/14/2023]
Abstract
Objective Genetic risk factors for unruptured intracranial aneurysms (UIA) and aneurysmal subarachnoid hemorrhage (aSAH) are poorly understood. We aimed to verify recently reported risk genes and to identify novel sequence variants involved in the etiology of UIA/aSAH. Methods We performed exome sequencing (ES) in 35 unrelated individuals and 3 family members, each with a history of UIA and/or aSAH. We searched for sequence variants with minor allele frequency (MAF) ≤ 5% in the reported risk genes ADAMTS15, ANGPTL6, ARHGEF17, LOXL2, PCNT, RNF213, THSD1 and TMEM132B. To identify novel putative risk genes we looked for unknown (MAF = 0) variants shared by the three relatives. Results We identified 20 variants with MAF ≤ 5% in 18 individuals: 9 variants in PCNT (9 patients), 4 in RNF213 (3 patients), 3 in THSD1 (6 patients), 2 in ANGPTL6 (3 patients), 1 in ADAMTS15 (1 patient) and 1 in TMEM132B (1 patient). In the affected family, prioritization of shared sequence variants yielded five novel putative risk genes. Based on predicted pathogenicity of identified variants, population genetics data and a high functional relevance for vascular biology, EDIL3 was selected as top candidate and screened in additional 37 individuals with UIA and/or aSAH: a further very rare EDIL3 sequence variant in two unrelated sporadic patients was identified. Conclusions Our data support a role of sequence variants in PCNT, RNF213 and THSD1 as susceptibility factors for cerebrovascular disease. The documented function in vascular wall integrity, the crucial localization of affected amino acids and gene/variant association tests suggest EDIL3 as a further valid candidate disease gene for UIA/aSAH. Electronic supplementary material The online version of this article (10.1007/s00415-020-09865-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Malik Alawi
- Bioinformatics Core, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sina Renner
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Michael Spohn
- Bioinformatics Core, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany.,Department of Oncology, Hematology and Bone Marrow Transplantation With Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alice Busch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Verena Kolbe
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Janine Altmüller
- Cologne Center for Genomics, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Britt-Sabina Löscher
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Germany
| | - Christian Brockmann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University Kiel, Niemannsweg 11, 24105, Kiel, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Georg Rosenberger
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Rajabzadeh-Oghaz H, van Ooij P, Veeturi SS, Tutino VM, Zwanenburg JJ, Meng H. Inter-patient variations in flow boundary conditions at middle cerebral artery from 7T PC-MRI and influence on Computational Fluid Dynamics of intracranial aneurysms. Comput Biol Med 2020; 120:103759. [PMID: 32421656 DOI: 10.1016/j.compbiomed.2020.103759] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Computational fluid dynamics(CFD) of intracranial aneurysms requires flow boundary conditions(BCs) as inputs. Patient-specific BCs are usually unavailable and substituted by literature-derived generic BCs. Therefore, we investigated inter-patient BC variations and their influence on middle cerebral artery aneurysmal hemodynamics. METHOD We retrospectively collected CT angiography and 7-T Phase-Contrast(PC)-MRI data from eight middle-cerebral-artery bifurcation aneurysms to reconstruct the geometry and measure the arterial flowrates, respectively. The coefficient of variation(CoV) was calculated for the inlet flowrate and the pulsatility index(PI). The outflow split estimated by Murray's law was compared with PC-MRI measurements. For each aneurysm, we performed seven simulations: "baseline" using PC-MRI-derived BCs and the other six with changing BCs to explore the influence of BC variations on hemodynamics. RESULTS From PC-MRI, the inlet flowrate was 1.94 ± 0.71 cm3/s(CoV = 36%) and PI was 0.37 ± 0.13(CoV = 34%). The outflow split estimated by Murray's law deviated by 15.3% compared to PC-MRI. Comparing to "baseline" models, ±36% variations in inlet flowrate caused -61% to +89% changes in time-averaged wall shear stress(WSS), -37% to +32% in normalized WSS(NWSS; by parent-artery), and -42% to +126% in oscillatory shear index(OSI). The ±34% variations in PI caused, -46% to +67% in OSI. Applying ±15% variations in outflow split led to inflow jet deflection and -41% to +52% changes in WSS, -41% to +47% in NWSS, and -44% to +144% in OSI. CONCLUSION Inflow rate and outflow split have a drastic impact on hemodynamics of intracranial aneurysms. Inlet waveform has a negligible impact on WSS and NWSS but major impact on OSI. CFD-based models need to consider such sensitivity.
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Affiliation(s)
- Hamidreza Rajabzadeh-Oghaz
- Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Pim van Ooij
- Department of Radiology& Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Sricharan S Veeturi
- Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Pathology and Anatomical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Jaco Jm Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hui Meng
- Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA.
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131
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Lauric A, Greim-Kuczewski K, Antonov A, Dardik G, Magida JK, Hippelheuser JE, Kono K, Malek AM. Proximal Parent Vessel Tapering is Associated With Aneurysm at the Middle Cerebral Artery Bifurcation. Neurosurgery 2020; 84:1082-1089. [PMID: 29846722 DOI: 10.1093/neuros/nyy152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cerebral aneurysm initiation and evolution have been linked to hemodynamic and morphological factors. Stenotic morphology upstream to a bifurcation can alter hemodynamic patterns and lead to destructive vessel wall remodeling and aneurysm initiation. The effect of more subtle proximal variations in vessel diameter on bifurcation aneurysm development has not been evaluated. OBJECTIVE To investigate whether vessel tapering is associated with aneurysmal presence at the middle cerebral artery (MCA) bifurcation. METHODS Bilateral catheter three-dimensional rotational angiographic datasets from 33 patients with unilateral unruptured MCA aneurysms and 44 datasets from healthy patients were analyzed. Equidistant cross-sectional cuts were generated along the MCA M1 segment with cross-sectional area measurement using edge-detection filtering. Relative tapering of the M1 segment was evaluated as the TaperingRatio. Computational fluid dynamics (CFD) simulations were performed on bilateral patient models and parametric MCAs of constant and tapered inflow vessel. RESULTS MCA leading to aneurysms had significantly lower TaperingRatio (0.88 ± 0.15) compared to contralateral (1.00 ± 0.16, P = .002) and healthy MCAs (1.00 ± 0.15, P > .001, area under the curve = 0.73), which showed little to no tapering. CFD simulations showed that vessel tapering leads to flow acceleration with higher wall shear stress (WSS) and WSS gradients at the bifurcation apex. CONCLUSION Aneurysmal but not contralateral or control MCA M1 segments demonstrate a previously undescribed progressive distal tapering phenomenon. This upstream vessel narrowing leads to flow acceleration that accentuates WSS and spatial gradients at the bifurcation apex, a pattern previously shown to favor aneurysm initiation and progression.
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Affiliation(s)
- Alexandra Lauric
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Kilian Greim-Kuczewski
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Alexei Antonov
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Gabriel Dardik
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Jane K Magida
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - James E Hippelheuser
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Kenichi Kono
- Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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132
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Binh NT, Luu VD, Thong PM, Cuong NN, Anh NQ, Tuan TA, Linh LT, Thien NT, Uddin MJ, Dinh TC, Chu DT. Flow diverter stent for treatment of cerebral aneurysms: A report of 130 patients with 134 aneurysms. Heliyon 2020; 6:e03356. [PMID: 32055743 PMCID: PMC7005424 DOI: 10.1016/j.heliyon.2020.e03356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/03/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
Abstract
Background This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the flow-diverter stent and follow up. Methods This study was conducted in a consecutive series of 130 patients. 134 procedures were performed for treating these patients in Hanoi Medical University Hospital and Bach Mai Hospital from January 2012 to April 2017. 143 flow diverter stents (Pipeline, FRED and SILK) were used. Aneurysm morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3-6 months and 12 months were recorded. Results In 130 patients (31 men, 99 women), aneurysms of internal carotid artery were mostly common (92.6%), especially in cavernous (35.1%) and in para-ophthalmic (40.3%) segments. 83 cases (61.9%) had wide-neck aneurysms, and 16 cases (11.9%) had multiple aneurysms, and only 5 cases (3.7%) had blister-liked aneurysms. Endovascular treatment was successfully performed at rate of 94.8%. In 3 patients, the stent could not be delivered. Mortality and morbidity rates were 1.5% and 3.7%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 7.4% or 17.5%, respectively. 3 patients experienced a thromboembolic event (4.3%). Conclusions Intracranial aneurysms of cavernous and para-ophthalmic segments of internal carotid artery are mostly common with wide-neck and multi aneurysms. Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications.
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Affiliation(s)
- Nguyen Thai Binh
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Viet Nam.,Hanoi Medical University, Hanoi, Viet Nam
| | - Vu Dang Luu
- Hanoi Medical University, Hanoi, Viet Nam.,Bach Mai Hospital, Hanoi, Viet Nam
| | - Pham Minh Thong
- Hanoi Medical University, Hanoi, Viet Nam.,Bach Mai Hospital, Hanoi, Viet Nam
| | - Nguyen Ngoc Cuong
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Nguyen Quang Anh
- Hanoi Medical University, Hanoi, Viet Nam.,Bach Mai Hospital, Hanoi, Viet Nam
| | | | - Le Tuan Linh
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Viet Nam.,Hanoi Medical University, Hanoi, Viet Nam
| | | | - Md Jamal Uddin
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Viet Nam
| | - Dinh-Toi Chu
- Hanoi National University of Education, Hanoi, Viet Nam.,School of Odonto Stomatology, Hanoi Medical University, Hanoi, Viet Nam
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Lv N, Karmonik C, Chen S, Wang X, Fang Y, Huang Q, Liu J. Wall Enhancement, Hemodynamics, and Morphology in Unruptured Intracranial Aneurysms with High Rupture Risk. Transl Stroke Res 2020; 11:882-9. [PMID: 31960286 DOI: 10.1007/s12975-020-00782-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/31/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022]
Abstract
The purpose of this study is to investigate the relationship between morphology, hemodynamics, and aneurysm wall enhancement (AWE) on vessel wall MRI and their potential role in rupture of intracranial aneurysms. Fifty-seven patients (22 males and 35 females; mean age of 58.4) harboring 65 unruptured intracranial aneurysms were retrospectively recruited. Vessel wall MRI images were reviewed and differentiated as no (NAWE), partial (PAWE), and circumferential (CAWE) wall enhancement. Computational geometry and computational fluid dynamics were used to calculate morphological and hemodynamic parameters. The PHASES score was calculated for each case to estimate its rupture risk. Univariate and multivariate logistic regression analysis was performed to investigate the relationship between morphological-hemodynamic pattern and AWE as well as their association with rupture risk. AWE was present in 26 (40.0%) lesions, including 14 (21.5%) PAWE and 12 (18.5%) CAWE. Aneurysm size (odds ratio = 7.46, 95% confidence interval = 1.56–35.77, p = 0.012), size ratio (odds ratio = 12.90, 95% confidence interval = 2.28–72.97, p = 0.004), and normalized wall shear stress (odds ratio = 0.11, 95% confidence interval = 0.02–0.69, p = 0.018) were independently associated with the presence of AWE. With increasing PHASES score, size-related parameters and the frequency of irregular shape increased significantly, and a hemodynamic pattern of lower and oscillating wall shear stress was observed. Simultaneously, the proportion of NAWE aneurysms decreased, and PAWE and CAWE aneurysms increased significantly (p < 0.001). Unruptured intracranial aneurysms with a higher rupture risk presented with a significantly larger size, lower wall shear stress, and more intense AWE, which might support the interaction between morphology, hemodynamics, and inflammation and their potential role in aneurysm rupture prediction.
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134
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Júnior JR, Telles JPM, da Silva SA, Iglesio RF, Brigido MM, Pereira Caldas JGM, Teixeira MJ, Figueiredo EG. Epidemiological analysis of 1404 patients with intracranial aneurysm followed in a single Brazilian institution. Surg Neurol Int 2020; 10:249. [PMID: 31893150 PMCID: PMC6935967 DOI: 10.25259/sni_443_2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 01/01/2023] Open
Abstract
Background: We sought to evaluate the epidemiology of intracranial aneurysms in relation to location, gender, age, presence of multiple aneurysms, and comorbidities in the Brazilian population. Methods: We performed a prospective analysis of a cohort of 1404 patients diagnosed with intracranial aneurysm admitted to the Hospital das Clinicas of the University of Sao Paulo, a referral hospital for the treatment of cerebrovascular diseases in Brazil. Patients admitted between September 2009 and September 2018 with radiological diagnosis of intracranial aneurysm were included in the study. Results: A total of 2251 aneurysms were diagnosed. Females accounted for 1090 aneurysms (77.6%) and the mean age at diagnosis was 54.9 years (ranging 15–88). The most common location was middle cerebral artery (MCA) with 593 aneurysms (26.3%) followed by anterior cerebral artery (ACA) with 417 aneurysms (18.5%) and internal carotid artery in the posterior communicating segment with 405 aneurysms (18.0%). Males had higher rates of ACA aneurysms (29.7%) while females had higher rates of MCA aneurysms (26.1%). Sorting by size, 492 aneurysms were <5 mm (21.8%), 1524 measured 5–10 mm (67.7%), 119 size 11–24 mm (5.3%), and 116 were >24 mm (5.2%). The occurrence of multiple aneurysms was associated with female gender (P < 0.001) and smoking (P < 0.001), but not with hypertension (P = 0.121). Conclusion: In this population, the occurrence of intracranial aneurysm is related to several factors, including gender, age, smoking, and hypertension. Our study brought to light important characteristics of a large number of Brazilian patients regarding epidemiology, location, size, and multiplicity of intracranial aneurysms.
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Affiliation(s)
- Jefferson Rosi Júnior
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo
| | | | - Saul Almeida da Silva
- Division of Neurological Surgery, Hospital das Clinicas HCFMUSP, University of Sao Paulo
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Xin WQ, Wang WH, Yin Q, Xin QQ, Cai SF, Yang XY. Meta-Analysis of Pterional Versus Supraorbital Keyhole Approach for Clipping Intracranial Aneurysms: Direct Comparison of Approach-Related Complications. World Neurosurg 2019; 135:e246-e257. [PMID: 31790840 DOI: 10.1016/j.wneu.2019.11.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The supraorbital keyhole approach (SKA) and pterional approach (PA) have been recommended for clipping intracranial aneurysms (IAs). We conducted a meta-analysis to systematically and comprehensively compare the clinical outcomes between the 2 approaches. METHODS We retrieved potential academic studies that had compared the clinical outcomes of SKA and PA for clipping IAs from the Cochrane Library, Medline, PubMed, and EMBASE databases. The references of the identified studies were carefully reviewed to ensure that all available documents had been included in the present study. The meta-analysis was conducted in accordance with the acknowledged PRISMA (prioritized reported items for systematic review and meta-analysis) guidelines. RESULTS A total of 8 studies with 1016 participants were included in our study. Of these 1016 patients with IAs, 518 were assigned to the SKA group and 498 to the PA group. Our results showed that the SKA is preferable for clipping IAs compared with the PA because of its shorter operative time (weighted mean difference, -3.163; 95% confidence interval [CI], -5.577 to -0.749; P = 0.01) and length of stay, especially for the patients with unruptured IAs (weighted mean difference, -52.107; 95% CI, -81.597 to -22.618). However, a lower risk of postoperative infection was found in the SKA group (4.6% vs. 8.5%; odds ratio, 0.398; 95% CI, 0.186-0.850; P = 0.017), which seemed to derive from the ruptured IAs (OR, 0.330; 95% CI, 0.136-0.800; P = 0.014). However, no significant difference was found in the incidence of frontal sinus opening, completed occlusion, procedural complications, intraoperative rupture, postoperative hematoma, or cerebral vessel spasm. CONCLUSIONS The SKA was associated with a shorter length of stay and operation time and a lower risk of postoperative infection. Hence, the SKA seems to be equally effective and safe for clipping IAs compared with PA and should be recommended for surgeons who have acquired sufficient experience with this technique owing to its advantages compared with the PA.
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Affiliation(s)
- Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Wei-Han Wang
- Department of Neurosurgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Qiang Yin
- Neuro-Oncology and Neurosurgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Qi-Qiang Xin
- Department of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Shi-Fei Cai
- Department of Neurosurgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
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136
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Niemann A, Weigand S, Hoffmann T, Skalej M, Tulamo R, Preim B, Saalfeld S. Interactive exploration of a 3D intracranial aneurysm wall model extracted from histologic slices. Int J Comput Assist Radiol Surg 2019; 15:99-107. [PMID: 31705419 DOI: 10.1007/s11548-019-02083-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Currently no detailed in vivo imaging of the intracranial vessel wall exists. Ex vivo histologic images can provide information about the intracranial aneurysm (IA) wall composition that is useful for the understanding of IA development and rupture risk. For a 3D analysis, the 2D histologic slices must be incorporated in a 3D model which can be used for a spatial evaluation of the IA's morphology, including analysis of the IA neck. METHODS In 2D images of histologic slices, different wall layers were manually segmented and a 3D model was generated. The nuclei were automatically detected and classified as round or elongated, and a neural network-based wall type classification was performed. The information was combined in a software prototype visualization providing a unique view of the wall characteristics of an IA and allowing interactive exploration. Furthermore, the heterogeneity (as variance of the wall thickness) of the wall was evaluated. RESULT A 3D model correctly representing the histologic data was reconstructed. The visualization integrating wall information was perceived as useful by a medical expert. The classification produces a plausible result. CONCLUSION The usage of histologic images allows to create a 3D model with new information about the aneurysm wall. The model provides information about the wall thickness, its heterogeneity and, when performed on cadaveric samples, includes information about the transition between IA neck and sac.
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Affiliation(s)
- Annika Niemann
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Simon Weigand
- Ludwig-Maximilians-Universität Klinikum, Munich, Germany
| | | | | | - Riikka Tulamo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Bernhard Preim
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Sylvia Saalfeld
- Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Magdeburg, Germany
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137
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Peng F, Feng X, Tong X, Zhang B, Wang L, Guo E, Qi P, Lu J, Wu Z, Wang D, Liu A. Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm) : Long-term Clinical and Angiographic Outcomes and Related Predictors. Clin Neuroradiol 2019; 30:817-826. [PMID: 31696281 PMCID: PMC7728636 DOI: 10.1007/s00062-019-00835-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/23/2019] [Indexed: 11/28/2022]
Abstract
Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.
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Affiliation(s)
- Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Xin Feng
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, 100730, Beijing, China.,Graduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, 100730, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Luyao Wang
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Erkang Guo
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China.,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, 100730, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, 100730, Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, 100730, Beijing, China. .,Graduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, 100730, Beijing, China.
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China. .,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, No. 119, South 4th Ring West Road, Fengtai District, 100070, Beijing, China.
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138
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Pesce A, Palmieri M, Zancana G, Salvati M, Santoro A, Raco A, Frati A. Radiation-Induced Brain Aneurysms: Institutional Experience and State of the Art in the Contemporary Literature. World Neurosurg 2020; 135:339-51. [PMID: 31605840 DOI: 10.1016/j.wneu.2019.09.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant features of BA related to a previous cranial RT. METHODS Data deriving from 1 patient treated for RT-induced BA in our institution were added to reports of another 66 BAs retrieved from the literature. The following parameters were evaluated: age, sex, location, primary lesion, clinical presentation, dosage/amount of radiation delivered, type of treatment for the BA, dimension, morphology, chemotherapy, comorbidities, risk factors, and number of BAs. RESULTS The most commonly involved vessel was the internal carotid artery (34%). In general, the anterior circulation showed higher vulnerability compared with the posterior circulation and middle cerebral artery (56.7%). The average latency between RT and the first imaging showing the BA was 9.01 ± 6.85 years. Vessels coursing in the posterior cranial fossa showed a significant univariate association with lower X-ray dosages (P = 0.014) compared with the other locations. No statistically significant correlation between the continuous variables age, latency of BA appearance, RT delivered dose, and dimension of the BA was shown. CONCLUSIONS The apparent higher fragility of the vascular structures of the posterior cranial fossa was statistically outlined, and the X-ray dosage, the primary condition target of the RT, the age of the patients, and no statistically significant correlation were outlined. Biological factors could play a significant role.
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139
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Tyagi G, Srinivas D, Nanjaiah ND, Purushottam M, Somanna S, Santosh V, Jain S. Gene Expression in Intracranial Aneurysms-Comparison Analysis of Aneurysmal Walls and Extracranial Arteries with Real-Time Polymerase Chain Reaction and Immunohistochemistry. World Neurosurg 2019; 130:e117-e126. [PMID: 31371266 DOI: 10.1016/j.wneu.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was aimed at evaluating the gene expression levels of 4 genes in the intracranial aneurysm wall and comparing them with extracranial arteries. The analysis was done using real-time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). Also, a correlation of the differential genetic expression was done with various patient clinical and radiologic factors. METHODS The quantitative assessment of ribonucleic acid levels was done with RT-PCR and was validated with IHC. The genes studied were collagen 1A2 (COL1A2), tissue inhibitor of metalloproteinase 4 (TIMP4), cathepsin B (CTSB), and alpha-1 antitrypsin (α-1 AT). The analysis was done on 24 aneurysm sacs and superficial temporal/occipital artery samples from patients undergoing surgical clipping. RESULTS The mean fold change of COL1A2 in the aneurysm sample was 8.89, that of TIMP4 was 10.16, that of CTSB was 1.02, and that of α-1 AT was 1.46 when compared with normal control vessel on PCR. On semiquantitative IHC, COL1A2 was 94.44%, α-1 AT was 77.8% overexpressed, CTSB was positive in 50%, and the expression of TIMP4 was 94.4% underexpressed in aneurysmal walls. There was no statistically significant correlation between patient profile and gene expression. CONCLUSIONS On RT-PCR and IHC analysis, COL1A2 and α-1 AT were overexpressed, CTSB was marginally overexpressed, and TIMP4 had equivocal expression in the aneurysmal sac when compared with the normal extracranial vessel. This is the first study of its kind in the Indian population with the largest sample size on live human patients.
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Affiliation(s)
- Gaurav Tyagi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | | | - Meera Purushottam
- Department of Molecular Genetics Lab, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Pagiola I, Mihalea C, Caroff J, Ikka L, Chalumeau V, Iacobucci M, Ozanne A, Gallas S, Marques M, Nalli D, Carrete H, Caldas JG, Frudit ME, Moret J, Spelle L. The PHASES score: To treat or not to treat? Retrospective evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. J Neuroradiol 2019; 47:349-352. [PMID: 31400432 DOI: 10.1016/j.neurad.2019.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The PHASES score was formulated to predict the 5-year risk of rupture for intracranial aneurysms. We retrospectively analyzed all patients treated in our institution for aneurysmal SAH and applied the PHASES score to estimate the probable predicted risk of bleeding in this group of patients. METHODS Between February 2015 and August 2018, all patients with aneurysmal SAH were retrospectively analyzed and the PHASES score was applied. A total of 155 patients were included with a mean age of 53.8years, including 60 males and 95 females. RESULTS Of our patients 110 (70.9%) had a PHASES score of below or equal to 5, with a hemorrhagic risk of up to 1.3% over 5years. If we analyze the patients with a risk of below 2% this figure increases to 122 patients (78.7%). Of these 99.3% were European and 0.6% were Japanese (1 patient). In 86 patients (55.4%), the aneurysm was smaller than 5mm and in 10 patients (6.4%) the aneurysm was located in the posterior circulation. CONCLUSION Of our patients 78.7% had less than a 2% 5-year rupture risk based on their PHASES score, highlighting the discrepancy of the rupture risk calculated with the PHASES score when hypothetically applied to this group of patients. In the hypothetical scenario that our patients had unruptured aneurysms, our retrospective analysis shows that the PHASES score may only provide a weak tool for clinicians to use in the decision-making process as to whether or not to treat these aneurysms.
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Affiliation(s)
- Igor Pagiola
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil.
| | - Cristian Mihalea
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Leon Ikka
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marta Iacobucci
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marcio Marques
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Darcio Nalli
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Henrique Carrete
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Universidade de São Paulo, São Paulo SP, Brazil
| | - Michel Eli Frudit
- Department of Interventional Neuroradiology, Universidade Federal de São Paulo, São Paulo SP, Brazil
| | - Jacques Moret
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology Neuro Brain Vascular Center, Hôpital Bicêtre, Paris Sud Université, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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Saalfeld S, Voß S, Beuing O, Preim B, Berg P. Flow-splitting-based computation of outlet boundary conditions for improved cerebrovascular simulation in multiple intracranial aneurysms. Int J Comput Assist Radiol Surg 2019; 14:1805-13. [PMID: 31363984 DOI: 10.1007/s11548-019-02036-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/18/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Image-based hemodynamic simulations have great potential for precise blood flow predictions in intracranial aneurysms. Due to model assumptions and simplifications with respect to boundary conditions, clinical acceptance remains limited. METHODS Within this study, we analyzed the influence of outflow-splitting approaches on multiple aneurysm studies and present a new outflow-splitting approach that takes the precise morphological vessel cross sections into account. We provide a detailed comparison of five outflow strategies considering eight intracranial aneurysms: zero-pressure configuration (1), a flow splitting inspired by Murray's law with a square (2) and a cubic (3) vessel diameter, a flow splitting incorporating vessel bifurcations based on circular vessel cross sections (4) and our novel flow splitting including vessel bifurcations and anatomical vessel cross sections (5). Other boundary conditions remain constant. For each simulation and each aneurysm, we conducted an evaluation based on common hemodynamic parameters, e.g., normalized wall shear stress and inflow concentration index. RESULTS The comparison of five outflow strategies for image-based simulations shows a large variability regarding the parameters of interest. Qualitatively, our strategy based on anatomical cross sections yields a more uniform flow rate distribution with increased aneurysm inflow rates. The commonly used zero-pressure approach shows the largest variations, especially for more distal aneurysms. A rank ordering of multiple aneurysms in one patient might still be possible, since the ordering appeared to be independent of the outflow strategy. CONCLUSIONS The results reveal that outlet boundary conditions have a crucial impact on image-based blood flow simulations, especially for multiple aneurysm studies. We could confirm the advantages of the more complex outflow-splitting model (4) including an incremental improvement (5) compared to strategies (1), (2) and (3) for this application scenario. Furthermore, we discourage from using zero-pressure configurations that lack a physiological basis.
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Laukka D, Pan E, Fordell T, Alpay K, Rahi M, Hirvonen J, Rinne J, Gunn J. Prevalence of thoracic aortic aneurysms and dilatations in patients with intracranial aneurysms. J Vasc Surg 2019; 70:1801-1808. [PMID: 31327605 DOI: 10.1016/j.jvs.2019.01.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/31/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The prevalence of intracranial aneurysms (IAs) is higher in patients with aortic aneurysms. However, there are lack of studies investigating prevalence of thoracic aortic aneurysms (TAAs) in patients with IAs. The objective of this study was to evaluate the prevalence and risk factors for thoracic aortic dilatations (TADs) and TAAs in patients with IAs. METHODS We retrospectively reviewed data from 1777 patients with diagnosed IAs at our institution between 2006 and 2016. We included 411 patients with saccular IAs and available imaging studies (computed tomography or magnetic resonance imaging) of all thoracic aortic segments. TAD was defined according to age- and sex-matched normograms, and TAA as a diameter of greater than 4.0 cm. RESULTS A total of 83 patients (20%) had TAD or TAA. The prevalence of TADs and TAAs were 18% (n = 74) and 8% (n = 31) without significant difference between unruptured and ruptured IAs (P = .7). Of the 74 patients with TAD, 22 (30%) had multiple TADs and 66% of the TADs located in the aortic arch. Older age (odds ratio [OR], 1.04; P = .006), rheumatic disease (OR, 4.73; P = .009) and alcohol abuse (OR, 4.77; P = .01) were significant risk factors for TAD/TAA. CONCLUSIONS The prevalence of TADs and TAAs is considerably greater in patients with IAs compared with reports from the general population, suggesting that IAs might be associated with aortopathy and might share a similar pathogenetic background with TADs/TAAs. Especially patients with IAs and a history of rheumatic disease and/or alcohol abuse are at high risk for TADs/TAAs.
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Affiliation(s)
- Dan Laukka
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland.
| | - Emily Pan
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Terhi Fordell
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Kemal Alpay
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Melissa Rahi
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Jaakko Rinne
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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Al-Tamimi YZ, Bhargava D, Orsi NM, Teraifi A, Cummings M, Ekbote UV, Quinn AC, Homer-Vanniasinkam S, Ross S. Compartmentalisation of the inflammatory response following aneurysmal subarachnoid haemorrhage. Cytokine 2019; 123:154778. [PMID: 31323526 DOI: 10.1016/j.cyto.2019.154778] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/30/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There is some evidence to suggest that a systemic and central nervous system (CNS) inflammatory response occurs following aneurysmal subarachnoid haemorrhage (aSAH) which may be related to the pathophysiology of early brain injury and delayed ischaemic neurological deficit (DIND). The aim of this study was to measure inflammatory mediator levels in plasma and cerebrospinal fluid (CSF) in the days following aSAH and to determine their association with aSAH, DIND and clinical outcome. MATERIAL AND METHODS Plasma and CSF samples were obtained prospectively from patients with aSAH on days 1-3, 5, 7 and 9 and profiled for interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, IL-17, IL-18, macrophage chemotactic protein (MCP)-1, vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF)-α. Plasma and CSF samples from non-aSAH patients undergoing spinal anaesthesia were used as controls. RESULTS The CSF levels of all cytokines investigated except for IL-1α were significantly higher in aSAH compared to controls in the first seven days of ictus. CSF levels of IL-1α (p = 0.014), IL-18 (p = 0.016), IL-6 (p = 0.0006) and IL-8 (p = 0.006) showed significant increases in the days following aSAH. Conversely IL-17 demonstrated a decrease. In particular, IL-4 was higher in the CSF of patients who had DIND at all time-points (p = 0.032). Plasma IL-6 and IL-8 levels were higher, and IL-1α levels lower, than controls at most time-points. All mediators demonstrated persistent elevation in the CSF compared to plasma apart from IL-1α and IL-18 which followed the opposite trend. Day 3 plasma IL-6 levels predicted poor outcome at six months (Exp(B) 1.12 1.03-1.22, P = 0.012), although this association was lost in the second analysis incorporating Fisher grade, WFNS grade and age. CONCLUSION The post aSAH inflammatory response peaks on days 5-7 post ictus and remains largely compartmentalised within the CNS. IL-4 may have a particular association with DIND although its precise role in the pathophysiology of the disorder remains unclear. IL-6 predicted poor outcome but not independently of clinical grade, suggesting that it may be a surrogate marker of early brain injury.
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Affiliation(s)
- Yahia Z Al-Tamimi
- Department of Neurosurgery, Sheffield Teaching Hospital NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, United Kingdom; Department of Neurosurgery, Level G Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
| | - Deepti Bhargava
- Department of Neurosurgery, Level G Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Nicolas M Orsi
- Leeds Institute of Cancer & Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - Anmar Teraifi
- University of Liverpool School of Medicine, Cedar House, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - Michele Cummings
- Leeds Institute of Cancer & Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - Uma V Ekbote
- Leeds Institute of Cancer & Pathology, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom
| | - Audrey C Quinn
- Department of Anaesthesia, Level C Brotherton Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Shervanthi Homer-Vanniasinkam
- Department of Vascular Surgery, Level B Brotherton Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Stuart Ross
- Department of Neurosurgery, Level G Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
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Ge H, Yang H, Ren H, Li W, Lv X, Jin H, Liu D, Liu X, He H, Miao Z, Li Y. Association of Thrombelastographic Parameters with Complications in Patients with Intracranial Aneurysm After Stent Placement. World Neurosurg 2019; 127:e30-e38. [PMID: 30790737 DOI: 10.1016/j.wneu.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A prospective trial was conducted to investigate the platelet function and association between thrombelastographic (TEG) parameters and embolic or hemorrhagic complications in patients with intracranial aneurysm undergoing stent treatment. METHODS Between September 2013 and June 2016, we prospectively recruited patients with intracranial aneurysm who were treated with stent-assisted coiling. TEG parameters were used to assess the platelet function before stenting procedures. The primary study end point was the onset of ischemic stroke, transient ischemic attack, or silent ischemic events in the territory of the stented artery within 6 months after the procedure. The secondary end point was assessed by bleeding events. RESULTS Four hundred and thirty-one patients with 453 intracranial aneurysms were enrolled. A total of 519 neurovascular stents were implanted. During the follow-up, a total of 70 primary end points (16.2%) and 59 secondary end points (13.7%) were detected. Thromboembolic complications such as symptomatic and slient ischemic complications were more frequently observed in patients with large aneurysms (>10 mm, P = 0.01), lower adenosine diphosphate (ADP) inhibition rate (P < 0.0001), and higher ADP-induced platelet-fibrin clot strength (maximum amplitude of adenosine diphosphate [MA-ADP]) (P < 0.0001). Besides, based on multivariate analysis, a higher ADP inhibition ratio was identified as a significant independent predictor of subsequent bleeding events (P < 0.0001). According to the receiver operating characteristic curve analysis, the safe range of the ADP inhibition ratio and MA-ADP of the TEG analysis were identified as 29.45%-55.4% and <46.15, respectively. CONCLUSIONS The ADP inhibition ratio and MA-ADP of TEG analysis were associated with subsequent cerebral ischemic events and intracranial or extracranial bleeding events in patients with intracranial aneurysm after stent treatment.
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Affiliation(s)
- Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hongchao Yang
- Department of Interventional Neuroradiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hui Ren
- Laboratory Diagnosis Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China; Neurosurgery Department, The Second Affiliated Hospital of Xingtai Medical College, Hebei, China
| | - Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Dong Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China.
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Starnoni D, Maduri R, Al Taha K, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D'Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study. Acta Neurochir (Wien) 2019; 161:1325-1334. [PMID: 31025178 DOI: 10.1007/s00701-019-03894-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms. METHODS This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009-2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups. RESULTS Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08). CONCLUSIONS In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms.
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Affiliation(s)
- Daniele Starnoni
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Khalid Al Taha
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Walter Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Robert
- Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Baylor Medical Center and College of Medicine, Houston, TX, USA
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital of Zurich and Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland
| | | | - Kristine A Blackham
- Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Donato D'Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Paolo Machi
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Jan Gralla
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
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Tsianaka E, Al-Shawish A, Potapov A, Fountas K, Spyrou M, Konovalov N. Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis. Chin Neurosurg J 2019; 5:16. [PMID: 32922916 PMCID: PMC7398246 DOI: 10.1186/s41016-019-0163-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 05/17/2019] [Indexed: 11/29/2022] Open
Abstract
Background Posterior circulation intracranial aneurysm (IA) treatment remains challenging, due to the anatomy of the area and the high rupture possibility. Endovascular treatment seems to be more suitable for these aneurysms, but studies focused on endovascular treatment demonstrate a high rate of re-intervention needing. A meta-analysis might offer a clearer view, being useful in a more effective treatment planning. Methods A systematic search was performed, using the PubMed database platform. The final article pool contained 20 articles. Studied parameters were operative mortality, late mortality, permanent neurologic deficit (PND), and the need for re-intervention (Re-int). We divided patients into two subgroups, those with ruptured and those with unruptured aneurysm. Statistical analysis was performed using appropriate software. Results In the total population (645 patients), there was a superiority of coiling over clipping in terms of PND and of coiling in terms of Re-int. As regards mortality, there was no clear superiority of one method over the other. Conclusions The current study came to the conclusion that there is a superiority of coiling over clipping in terms of PND. On the other hand, clipping seems to be superior to coiling in terms of the need for re-intervention. As regards mortality (both operative and late), there is no clear superiority of one method over the other. Studying subgroups of patients (ruptured and unruptured posterior circulation IAs), in terms of PND, there is no superiority of one method over the other. The same goes for Op-Mo on ruptured aneurysms.
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Affiliation(s)
- Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Larissa, Viopolis, 41111 Larissa, Greece.,Department of Spine Neurosurgery, "N.N. Burdenko" Neurosurgery Institute, 16 4th Tverskaya - Yamskaya Str., Moscow, Russia
| | - Abdullah Al-Shawish
- Department of Neurosurgery, Ibn Sina Hospital, Sabah Medical Area, Shuwaikh, Kuwait
| | - Alexander Potapov
- Department of Neurotraumatology, "N.N. Burdenko" Neurosurgery Institute, 16 4th Tverskaya - Yamskaya Str., Moscow, Russia
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Larissa, Viopolis, 41111 Larissa, Greece
| | - Michael Spyrou
- Department of Neurosurgery, Ygeia Private Hospital, Golgon 33, 3025 Limassol, Cyprus
| | - Nikolay Konovalov
- Department of Spine Neurosurgery, "N.N. Burdenko" Neurosurgery Institute, 16 4th Tverskaya - Yamskaya Str., Moscow, Russia
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Wang JC, Chien WC, Chung CH, Lin CY, Chen YH, Liao MT, Liao WI, Hsu CC, Tsai SH. Association between surgical repair of aortic aneurysms and the diagnosis of intracranial aneurysms. J Vasc Surg 2019; 71:481-489. [PMID: 31204216 DOI: 10.1016/j.jvs.2019.04.466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/10/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Aortic aneurysms (AAs) and intracranial aneurysms (IAs) share several clinical risk factors, a genetic predisposition, and molecular signaling pathways. Nonetheless, associations between IAs and AAs remain to be thoroughly validated in large-scale studies. In addition, no effective medical therapies exist for unruptured IAs or AAs. METHODS Data for this nationwide, population-based, retrospective, cohort study described herein were obtained from the National Health Insurance Research Database in Taiwan. The study outcomes assessed were (1) the cumulative incidence of IAs, which was compared between AA and patients without an AA and (2) the cumulative incidence of IAs in patients with AAs during the 13-year follow-up period, which was further compared among those who underwent open surgical repair (OSR), endovascular aneurysm repair or nonsurgical treatment (NST). RESULTS Our analyses included 20,280 patients with an AA and 20,280 propensity score-matched patients without an AA. Compared with the patients without an AA, patients with AA exhibited a significantly increased risk of an IA diagnosis (adjusted hazard ratio [HR], 3.395; P < .001). Furthermore, 6308 patients with AAs were treated with surgical intervention and another 6308 propensity score-matched patients with AAs were not. Patients with an AA who underwent OSR had a significantly lower risk of being diagnosed with an IA than patients with an AA who underwent endovascular aneurysm repair or NST (adjusted HR, 0.491 [P < .001] and adjusted HR, 0.473 [P < .001], respectively). CONCLUSIONS We demonstrated an association between IAs and AAs, even after adjusting for several comorbidities. We also found that OSR was associated with fewer recognized IAs than NST.
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Affiliation(s)
- Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Hao Chen
- Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ching Hsu
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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148
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Dayyani M, Zabihyan S, Salehi M, Baharvahdat H, Ahmadi S, Etemadrezaie H. Association of Opium Addiction with Rupture of Intracranial Aneurysms: A Case-Control Study. World Neurosurg 2019; 126:e492-e499. [PMID: 30825629 DOI: 10.1016/j.wneu.2019.02.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Disorders related to opioid use account for the most substantial burden of disease attributable to drug use disorders. We aimed to justify if there is an association between either opium consumption or addiction and rupture of intracranial aneurysms. METHODS In this case-control study, we enrolled 50 cases with ruptured intracranial aneurysms and 43 control subjects with an incidental finding of an intracranial aneurysm without history of subarachnoid hemorrhage (SAH). Four major risk factors of rupture including age, sex, size, and site of aneurysm were matched among both groups. All participants were asked about cigarette smoking state, opium addiction, opium consumption, and duration and route of opium consumption. Eight other trigger factors were assessed in the period soon before SAH (hazard period). The odds ratio (OR) of all factors was calculated separately, and then a logistic regression for the factors with significant odds was calculated. RESULTS Sixty-two percent of cases and 32.6% of control subjects were addicted to opium. The OR for opium consumption in the hazard period was 8.1 (95% confidence interval [CI], 2.2-30.1) and for opium addiction was 3.3 (95% CI, 1.4-7.9). Of those trigger factors, cola consumption was included in the logistic regression model. After adjustment, results demonstrated an OR of 9.2 (95% CI, 2.4-34.7) for opium consumption in the hazard period. CONCLUSIONS There is an association between opium addiction and opium consumption in the hazard period with the occurrence of aneurysmal SAH. Replication of the study with a larger sample size and conduction of prospective studies is suggested.
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Affiliation(s)
- Mojtaba Dayyani
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Salehi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Humain Baharvahdat
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sina Ahmadi
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Etemadrezaie
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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149
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Sarrami-Foroushani A, Lassila T, Hejazi SM, Nagaraja S, Bacon A, Frangi AF. A computational model for prediction of clot platelet content in flow-diverted intracranial aneurysms. J Biomech 2019; 91:7-13. [PMID: 31104921 DOI: 10.1016/j.jbiomech.2019.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 03/14/2019] [Accepted: 04/30/2019] [Indexed: 01/30/2023]
Abstract
Treatment of intracranial aneurysms with flow-diverting stents is a safe and minimally invasive technique. The goal is stable embolisation that facilitates stent endothelialisation, and elimination of the aneurysm. However, it is not fully understood why some aneurysms fail to develop a stable clot even with sufficient levels of flow reduction. Computational prediction of thrombus formation dynamics can help predict the post-operative response in such challenging cases. In this work, we propose a new model of thrombus formation and platelet dynamics inside intracranial aneurysms. Our novel contribution combines platelet activation and transport with fibrin generation, which is key to characterising stable and unstable thrombus. The model is based on two types of thrombus inside aneurysms: red thrombus (fibrin- and erythrocyte-rich) can be found in unstable clots, while white thrombus (fibrin- and platelet-rich) can be found in stable clots. The thrombus generation model is coupled to a CFD model and the flow-induced platelet index (FiPi) is defined as a quantitative measure of clot stability. Our model is validated against an in vitro phantom study of two flow-diverting stents with different sizing. We demonstrate that our model accurately predicts the lower thrombus stability in the oversized stent scenario. This opens possibilities for using computational simulations to improve endovascular treatment planning and reduce adverse events, such as delayed haemorrhage of flow-diverted aneurysms.
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Affiliation(s)
- Ali Sarrami-Foroushani
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Toni Lassila
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Seyed Mostafa Hejazi
- Department of Electronic and Electrical Engineering, The University of Sheffield, Sheffield, UK
| | | | - Andrew Bacon
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK; Biomedical Imaging Department, Leeds Institute for Cardiovascular and Metabolic Medicine (LICAMM), School of Medicine, University of Leeds, Leeds, UK.
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150
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Maduri R, Starnoni D, Rocca A, Bervini D, Zumofen DW, Stienen MN, Schatlo B, Fung C, Robert T, Seule MA, Burkhardt JK, Maldaner N, Rothlisberger M, Blackham KA, Marbacher S, D’Alonzo D, Remonda L, Machi P, Gralla J, Bijlenga P, Saliou G, Ballabeni P, Levivier M, Messerer M, Daniel RT. Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry. Acta Neurochir (Wien) 2019; 161:769-779. [PMID: 30680461 DOI: 10.1007/s00701-019-03812-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques. OBJECTIVE To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes. METHODS This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined. RESULTS From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year. CONCLUSIONS In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
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