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Feng J, Tang Y, You W, Jiang Y, Xu Z, Zhao Y, Liu X, Lv J, Liu P, Wei H, Mossa-Basha M, Li Y, Wang Y, Zhu C. Risk analysis of intracranial aneurysm rupture based on the arterial segment of origin. Front Neurol 2024; 15:1339144. [PMID: 39233674 PMCID: PMC11371744 DOI: 10.3389/fneur.2024.1339144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Background and objective The rupture risk of intracranial aneurysms (IAs) is related to their arterial origin, but whether the different segments of the artery have different risks and act as independent risk factors is still unknown. Our study aimed to investigate the rupture risk of IAs in different arterial segments in a large Chinese cohort. Methods Imaging and clinical data of consecutive patients with IAs diagnosed by Computed Tomography angiography (CTA) from January 2013 to December 2022 were collected. Two neuroradiologists independently identified ruptured and unruptured IAs based on imaging and medical records. The internal carotid artery (ICA), middle cerebral artery (MCA), anterior cerebral artery (ACA), vertebral artery (VA), and posterior cerebral artery (PCA) were segmented according to the Bouthillier and Fischer segmentation methods. Stenoses of the proximal parent vessel were evaluated and documented. The Institutional Review Board (IRB) at Beijing Tiantan Hospital approved this retrospective study. Results A total of 3,837 aneurysms {median size 3.5 mm [interquartile range (IQR) 2.6-5.1 mm]; 532 ruptured} were included in this study from 2,968 patients [mean age: 57 years (IQR 50-64); male patients: 1,153]. Ruptured aneurysms were most commonly located in the posterior inferior cerebellar artery (PICA) (52.9%), anterior communicating artery (ACoA) (33.8%), other locations (33.3%), ACA (22.4%), and basilar artery (BA) (21.4%). The locations with the highest likelihood of rupture were the C7 ICA (21.3%), M2 MCA (24.0%), distal MCA (25.0%), and A2 ACA (28.1%). IAs originating from the C7 (p < 0.001), dM1 (p = 0.022), and dA1 (p = 0.021) segments were independent risk factors for rupture. IAs without stenosis of the proximal parent vessel were associated with a higher risk of rupture (p = 0.023). Conclusion There are unique associations between the origins of aneurysms from various arterial segments. Aneurysms originating from the anterior communicating artery (ACoA), BA, PICA, A2, dA, C7, and M2 indicate a higher risk of rupture. Aneurysms originating from C4, C5, and C6 indicate a lower risk of rupture. C7 IAs, ACoA IAs, and PICA IAs seem to be independent risk factors.
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Affiliation(s)
- Junqiang Feng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yudi Tang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei You
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhengkun Xu
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, China
| | - Yan Zhao
- School of Mechanical Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haining Wei
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Medical School, Tsinghua University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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Chen JC, Luo C, Li Y, Tan DH. Knowledge domain and emerging trends in the rupture risk of intracranial aneurysms research from 2004 to 2023. World J Clin Cases 2024; 12:5382-5403. [PMID: 39156083 PMCID: PMC11238678 DOI: 10.12998/wjcc.v12.i23.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Intracranial aneurysms (IAs) pose significant health risks, attributable to their potential for sudden rupture, which can result in severe outcomes such as stroke and death. Despite extensive research, the variability of aneurysm behavior, with some remaining stable for years while others rupture unexpectedly, remains poorly understood. AIM To employ bibliometric analysis to map the research landscape concerning risk factors associated with IAs rupture. METHODS A systematic literature review of publications from 2004 to 2023 was conducted, analyzing 3804 documents from the Web of Science Core Collection database, with a focus on full-text articles and reviews in English. The analysis encompassed citation and co-citation networks, keyword bursts, and temporal trends to delineate the evolution of research themes and collaboration patterns. Advanced software tools, CiteSpace and VOSviewer, were utilized for comprehensive data visualization and trend analysis. RESULTS Analysis uncovered a total of 3804 publications on IA rupture risk factors between 2006 and 2023. Research interest surged after 2013, peaking in 2023. The United States led with 28.97% of publications, garnering 37706 citations. Notable United States-China collaborations were observed. Capital Medical University produced 184 publications, while Utrecht University boasted a citation average of 69.62 per publication. "World Neurosurgery" published the most papers, contrasting with "Stroke", the most cited journal. The PHASES score from "Lancet Neurology" emerged as a vital rupture risk prediction tool. Early research favored endovascular therapy, transitioning to magnetic resonance imaging and flow diverters. "Subarachnoid hemorrhage" stood out as a recurrent keyword. CONCLUSION This study assesses global IA research trends and highlights crucial gaps, guiding future investigations to improve preventive and therapeutic approaches.
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Affiliation(s)
- Jun-Chen Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Cheng Luo
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Yong Li
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Dian-Hui Tan
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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Lu W, Shiwei Y, Aimin L, Kang X. Clinical relevance of critical plasma homocysteine levels in predicting rupture risk for small and medium-sized intracranial aneurysms. Sci Rep 2024; 14:18192. [PMID: 39107517 PMCID: PMC11303782 DOI: 10.1038/s41598-024-69219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
Plasma homocysteine (Hcy) has been globally recognized as an independent risk factor for various neurovascular diseases. In this study, the authors investigated the relationship between critical Hcy concentration and the risk of rupture in intracranial aneurysms (IAs). This study collected data from 423 patients with both ruptured and unruptured IAs. We compared demographic data, vascular rupture risk factors, and laboratory test results between the two groups. Multivariable logistic regression analysis was employed to determine the correlation between critical plasma Hcy levels and the risk of rupture in small to medium-sized IAs. A total of 330 cases of ruptured intracranial aneurysms (RIA) and 93 cases of unruptured intracranial aneurysms (UIA) were included. Univariate analysis revealed statistically significant differences between the ruptured and unruptured groups in terms of hypertension, hyperlipidemia, plasma Hcy levels, and IA morphology (all P < 0.05). Multivariable logistic regression analysis indicated that hypertension (odds ratio [OR] 0.504; 95% confidence interval [CI] 0.279-0.911; P = 0.023), hyperlipidemia (OR 1.924; 95% CI 1.079-3.429; P = 0.027), and plasma Hcy levels (OR 1.420; 95% CI 1.277-1.578; P < 0.001) were independently associated with the rupture of small to medium-sized IAs, all with statistical significance (P < 0.05). Our study suggests that critical plasma Hcy levels are an independent risk factor for increased rupture risk in small to medium-sized intracranial aneurysms. Therefore, reducing plasma Hcy levels may be considered a valuable strategy to mitigate the risk of intracranial vascular abnormalities rupture and improve patient prognosis.
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Affiliation(s)
- Wang Lu
- Department of Neurosurgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222002, Jiangsu, China
- Jinzhou Medical University, Jinzhou, China
| | - Yan Shiwei
- Department of Neurosurgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222002, Jiangsu, China
| | - Li Aimin
- Department of Neurosurgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222002, Jiangsu, China.
- Jinzhou Medical University, Jinzhou, China.
| | - Xie Kang
- Department of Neurosurgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222002, Jiangsu, China.
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Wen Z, Nie X, Chen L, Liu P, Lan C, Mossa-Basha M, Levitt MR, He H, Wang S, Li J, Zhu C, Liu Q. A Decision Tree Model to Help Treatment Decision-Making for Unruptured Intracranial Aneurysms: A Multi-center, Long-Term Follow-up Study in a Large Chinese Cohort. Transl Stroke Res 2024:10.1007/s12975-024-01280-7. [PMID: 39037513 DOI: 10.1007/s12975-024-01280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024]
Abstract
Chinese population have a high prevalence of unruptured intracranial aneurysm (UIA). Clinical and imaging risk factors predicting UIA growth or rupture are poorly understood in the Chinese population due to the lack of large-scale longitudinal studies, and the treatment decision for UIA patients was challenging. Develop a decision tree (DT) model for UIA instability, and validate its performance in multi-center studies. Single-UIA patients from two prospective, longitudinal multicenter cohort studies were analyzed, and set as the development cohort and validation cohort. The primary endpoint was UIA instability (rupture, growth, or morphological change). A DT was established within the development cohort and validated within the validation cohort. The performance of clinicians in identifying unstable UIAs before and after the help of the DT was compared using the area under curve (AUC). The development cohort included 1270 patients with 1270 UIAs and a follow-up duration of 47.2 ± 15.5 months. Aneurysm instability occurred in 187 (14.7%) patients. Multivariate Cox analysis revealed hypertension (hazard ratio [HR], 1.54; 95%CI, 1.14-2.09), aspect ratio (HR, 1.22; 95%CI, 1.17-1.28), size ratio (HR, 1.31; 95%CI, 1.23-1.41), bifurcation configuration (HR, 2.05; 95%CI, 1.52-2.78) and irregular shape (HR, 4.30; 95%CI, 3.19-5.80) as factors of instability. In the validation cohort (n = 106, 12 was unstable), the DT model incorporating these factors was highly predictive of UIA instability (AUC, 0.88 [95%CI, 0.79-0.97]), and superior to existing UIA risk scales such as PHASES and ELAPSS (AUC, 0.77 [95%CI, 0.67-0.86] and 0.76 [95%CI, 0.66-0.86], P < 0.001). Within all 1376 single-UIA patients, the use of the DT significantly improved the accuracy of junior neurosurgical clinicians to identify unstable UIAs (AUC from 0.63 to 0.82, P < 0.001). The DT incorporating hypertension, aspect ratio, size ratio, bifurcation configuration and irregular shape was able to predict UIA instability better than existing clinical scales in Chinese cohorts. CLINICAL TRIAL REGISTRATION: IARP-CP cohort were included (unique identifier: ChiCTR1900024547. Published July 15, 2019. Completed December 30, 2020), with 100-Project phase-I cohort (unique identifier: NCT04872842, Published May 5, 2021. Completed November 8, 2022) as the development cohort. The 100-Project phase-II cohort (unique identifier: NCT05608122. Published November 8, 2022) as the validation cohort.
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Affiliation(s)
- Zheng Wen
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Xin Nie
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Lei Chen
- Department of Neurosurgery, the First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, China
| | - Peng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institution, Capital Medical University, Beijing, China
| | - Chuanjin Lan
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | | | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Hongwei He
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institution, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Department of Emergency, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Jiangan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Department of Emergency, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.
- Department of Neurosurgery, Department of Emergency, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
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Concannon J, Máirtín EÓ, FitzGibbon B, Hynes N, Sultan S, McGarry JP. On the Importance of Including Cohesive Zone Models in Modelling Mixed-Mode Aneurysm Rupture. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00740-3. [PMID: 38987509 DOI: 10.1007/s13239-024-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/21/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION The precise mechanism of rupture in abdominal aortic aneurysms (AAAs) has not yet been uncovered. The phenomenological failure criterion of the coefficient of proportionality between von Mises stress and tissue strength does not account for any mechanistic foundation of tissue fracture. Experimental studies have shown that arterial failure is a stepwise process of fibrous delamination (mode II) and kinking (mode I) between layers. Such a mechanism has not previously been considered for AAA rupture. METHODS In the current study we consider both von Mises stress in the wall, in addition to interlayer tractions and delamination using cohesive zone models. Firstly, we present a parametric investigation of the influence of a range of AAA anatomical features on the likelihood of elevated interlayer traction and delamination. RESULTS We observe in several cases that the location of peak von Mises stress and tangential traction coincide. Our simulations also reveal however, that peak von Mises and intramural tractions are not coincident for aneurysms with Length/Radius less than 2 (short high-curvature aneurysms) and for aneurysms with symmetric intraluminal thrombus (ILT). For an aneurysm with (L/R = 2.0), the peak σ vm moves slightly towards the origin while the peak T t is near the peak bulge with a separation distance of ~ 17 mm. Additionally, we present three patient-specific AAA models derived directly from CT scans, which also illustrate that the location of von Mises stress does not correlate with the point of interlayer delamination. CONCLUSION This study suggests that incorporating cohesive zone models into clinical based FE analyses may capture a greater proportion of ruptures in-silico.
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Affiliation(s)
- J Concannon
- Biomedical Engineering, University of Galway, Galway, Ireland.
| | - E Ó Máirtín
- Biomedical Engineering, University of Galway, Galway, Ireland
| | - B FitzGibbon
- Biomedical Engineering, University of Galway, Galway, Ireland
| | - N Hynes
- Department of Vascular and Endovascular Surgery, Galway University Hospitals, Galway, Ireland
| | - S Sultan
- Department of Vascular and Endovascular Surgery, Galway University Hospitals, Galway, Ireland
| | - J P McGarry
- Biomedical Engineering, University of Galway, Galway, Ireland
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Shou Y, Chen Z, Feng P, Wei Y, Qi B, Dong R, Yu H, Li H. Integrating PointNet-Based Model and Machine Learning Algorithms for Classification of Rupture Status of IAs. Bioengineering (Basel) 2024; 11:660. [PMID: 39061742 PMCID: PMC11273784 DOI: 10.3390/bioengineering11070660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The rupture of intracranial aneurysms (IAs) would result in subarachnoid hemorrhage with high mortality and disability. Predicting the risk of IAs rupture remains a challenge. METHODS This paper proposed an effective method for classifying IAs rupture status by integrating a PointNet-based model and machine learning algorithms. First, medical image segmentation and reconstruction algorithms were applied to 3D Digital Subtraction Angiography (DSA) imaging data to construct three-dimensional IAs geometric models. Geometrical parameters of IAs were then acquired using Geomagic, followed by the computation of hemodynamic clouds and hemodynamic parameters using Computational Fluid Dynamics (CFD). A PointNet-based model was developed to extract different dimensional hemodynamic cloud features. Finally, five types of machine learning algorithms were applied on geometrical parameters, hemodynamic parameters, and hemodynamic cloud features to classify and recognize IAs rupture status. The classification performance of different dimensional hemodynamic cloud features was also compared. RESULTS The 16-, 32-, 64-, and 1024-dimensional hemodynamic cloud features were extracted with the PointNet-based model, respectively, and the four types of cloud features in combination with the geometrical parameters and hemodynamic parameters were respectively applied to classify the rupture status of IAs. The best classification outcomes were achieved in the case of 16-dimensional hemodynamic cloud features, the accuracy of XGBoost, CatBoost, SVM, LightGBM, and LR algorithms was 0.887, 0.857, 0.854, 0.857, and 0.908, respectively, and the AUCs were 0.917, 0.934, 0.946, 0.920, and 0.944. In contrast, when only utilizing geometrical parameters and hemodynamic parameters, the accuracies were 0.836, 0.816, 0.826, 0.832, and 0.885, respectively, with AUC values of 0.908, 0.922, 0.930, 0.884, and 0.921. CONCLUSION In this paper, classification models for IAs rupture status were constructed by integrating a PointNet-based model and machine learning algorithms. Experiments demonstrated that hemodynamic cloud features had a certain contribution weight to the classification of IAs rupture status. When 16-dimensional hemodynamic cloud features were added to the morphological and hemodynamic features, the models achieved the highest classification accuracies and AUCs. Our models and algorithms would provide valuable insights for the clinical diagnosis and treatment of IAs.
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Affiliation(s)
- Yilu Shou
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Zhenpeng Chen
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Pujie Feng
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Yanan Wei
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Beier Qi
- Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, No. 1, Dongjiaominxiang, Dongcheng District, Beijing 100010, China
| | - Ruijuan Dong
- Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, No. 1, Dongjiaominxiang, Dongcheng District, Beijing 100010, China
| | - Hongyu Yu
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
| | - Haiyun Li
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, No. 10, Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China
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Liu Q, Liu P, Zhang Y, Mossa-Basha M, Hasan DM, Li J, Zhu C, Wang S. Serum Interleukin-1 Levels Are Associated with Intracranial Aneurysm Instability. Transl Stroke Res 2024; 15:433-445. [PMID: 36792794 DOI: 10.1007/s12975-023-01140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
Serum interleukin-1 (IL-1) are possibly indicative of the inflammation in the intracranial aneurysm (IA) wall. This study aimed to investigate whether IL-1 could discriminate the unstable IAs (ruptured intracranial aneurysms (RIAs) and symptomatic unruptured intracranial aneurysms (UIAs)) from stable, asymptomatic UIAs. IA tissues and blood samples from 35 RIA patients and 35 UIA patients were collected between January 2017 and June 2020 as the derivation cohort. Blood samples from 211 patients with UIAs were collected between January 2021 and June 2022 as the validation cohort (including 63 symptomatic UIAs). Blood samples from 35 non-cerebral-edema meningioma patients (non-inflammatory control) and 19 patients with unknown-cause subarachnoid hemorrhage (hemorrhagic control) were also collected. IL-1β and IL-1.ra (IL-1 receptor antagonist) were measured in serum and IA tissues, and the IL-1 ratio was calculated as log10 (IL-1.ra/IL-1β). Based on the derivation cohort, multivariate logistic analysis showed that IL-1β (odds ratio, 1.48, P = 0.001) and IL-1.ra (odds ratio, 0.74, P = 0.005) were associated with RIAs. The IL-1 ratio showed an excellent diagnostic accuracy for RIAs (c-statistic, 0.91). Histological analysis confirmed the significant correlation of IL-1 between serum and aneurysm tissues. IL-1 ratio could discriminate UIAs from non-inflammatory controls (c-statistic, 0.84), and RIAs from hemorrhagic controls (c-statistic, 0.95). Based on the validation cohort, the combination of IL-1 ratio and PHASES score had better diagnostic accuracy for symptomatic UIAs than PHASES score alone (c-statistic, 0.88 vs 0.80, P < 0.001). Serum IL-1 levels correlate with aneurysm tissue IL-1 levels and unstable aneurysm status, and could serve as a potential biomarker for IA instability.
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Affiliation(s)
- Qingyuan Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - David M Hasan
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Jiangan Li
- Department of Emergency, the Affiliated Wuxi NO.2 People's Hospital of Jiangnan University, Wuxi, Jiangsu, China.
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA.
| | - Shuo Wang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Emergency, the Affiliated Wuxi NO.2 People's Hospital of Jiangnan University, Wuxi, Jiangsu, China.
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Cao H, Zeng H, Lv L, Wang Q, Ouyang H, Gui L, Hua P, Yang S. Assessment of intracranial aneurysm rupture risk using a point cloud-based deep learning model. Front Physiol 2024; 15:1293380. [PMID: 38426204 PMCID: PMC10901972 DOI: 10.3389/fphys.2024.1293380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Background and Purpose: Precisely assessing the likelihood of an intracranial aneurysm rupturing is critical for guiding clinical decision-making. The objective of this study is to construct and validate a deep learning framework utilizing point clouds to forecast the likelihood of aneurysm rupturing. Methods: The dataset included in this study consisted of a total of 623 aneurysms, with 211 of them classified as ruptured and 412 as unruptured, which were obtained from two separate projects within the AneuX morphology database. The HUG project, which included 124 ruptured aneurysms and 340 unruptured aneurysms, was used to train and internally validate the model. For external validation, another project named @neurIST was used, which included 87 ruptured and 72 unruptured aneurysms. A standardized method was employed to isolate aneurysms and a segment of their parent vessels from the original 3D vessel models. These models were then converted into a point cloud format using open3d package to facilitate training of the deep learning network. The PointNet++ architecture was utilized to process the models and generate risk scores through a softmax layer. Finally, two models, the dome and cut1 model, were established and then subjected to a comprehensive comparison of statistical indices with the LASSO regression model built by the dataset authors. Results: The cut1 model outperformed the dome model in the 5-fold cross-validation, with the mean AUC values of 0.85 and 0.81, respectively. Furthermore, the cut1 model beat the morphology-based LASSO regression model with an AUC of 0.82. However, as the original dataset authors stated, we observed potential generalizability concerns when applying trained models to datasets with different selection biases. Nevertheless, our method outperformed the LASSO regression model in terms of generalizability, with an AUC of 0.71 versus 0.67. Conclusion: The point cloud, as a 3D visualization technique for intracranial aneurysms, can effectively capture the spatial contour and morphological aspects of aneurysms. More structural features between the aneurysm and its parent vessels can be exposed by keeping a portion of the parent vessels, enhancing the model's performance. The point cloud-based deep learning model exhibited good performance in predicting rupture risk while also facing challenges in generalizability.
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Affiliation(s)
- Heshan Cao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Zeng
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Lv
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Wang
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hua Ouyang
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Gui
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Hua
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Songran Yang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Biobank and Bioinformatics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Aoki K, Murayama Y, Tanaka Y, Ishibashi T, Irie K, Fuga M, Kato N, Kan I, Nishimura K, Nagayama G. Risk factors and management of intraprocedural rupture during coil embolization of unruptured intracranial aneurysms: role of balloon guiding catheter. Front Neurol 2024; 15:1343137. [PMID: 38299017 PMCID: PMC10828020 DOI: 10.3389/fneur.2024.1343137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Intraprocedural rupture (IPR) is a serious complication of endovascular coil embolization of unruptured intracranial aneurysms (UIAs). Although outcomes after IPR are poor, methods to prevent subsequent neurological deterioration have not yet been investigated. We evaluated the risk factors and management strategies for IPR, particularly the role of balloon guiding catheters (BGCs) in rapid hemostasis. Methods We retrospectively reviewed all UIA cases treated with coil embolization at three institutions between 2003 and 2021, focusing on preoperative radiological data, operative details, and outcomes. Results In total, 2,172 aneurysms were treated in 2026 patients. Of these, 19 aneurysms in 19 patients (0.8%) ruptured during the procedure. Multivariate analysis revealed that aneurysms with a bleb (OR: 3.03, 95% CI: 1.21 to 7.57, p = 0.017), small neck size (OR: 0.56, 95% CI: 0.37 to 0.85, p = 0.007), and aneurysms in the posterior communicating artery (PcomA) (OR: 4.92, 95% CI: 1.19 to 20.18, p = 0.027) and anterior communicating artery (AcomA) (OR: 12.08, 95% CI: 2.99 to 48.79, p < 0.001) compared with the internal carotid artery without PcomA were significantly associated with IPR. The incidence of IPR was similar between the non-BGC and BGC groups (0.9% vs. 0.8%, p = 0.822); however, leveraging BGC was significantly associated with lower morbidity and mortality rates after IPR (0% vs. 44%, p = 0.033). Discussion The incidence of IPR was relatively low. A bleb, small aneurysm neck, and location on PcomA and AcomA are independent risk factors for IPR. The use of BGC may prevent fatal clinical deterioration and achieve better clinical outcomes in patients with IPR.
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Affiliation(s)
- Ken Aoki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Tanaka
- Division of Epidemiology, Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koreaki Irie
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Michiyasu Fuga
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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10
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Cui X, Wang L, Zhao Y, Wang B, Wu Z, Zhao Z, Zhang H, Chen L, Yang X. Risk Factors and Location of Intracranial Aneurysm Rupture in a Consecutive Chinese Han Population. World Neurosurg 2024; 181:e214-e221. [PMID: 37813333 DOI: 10.1016/j.wneu.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The aim of the present study was to retrospectively analyze and investigate the clinical data of 704 cases of ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The risk factors predicting aneurysm rupture were explored from the perspective of the clinical characteristics of intracranial aneurysm (IA). METHODS The clinical data of 704 patients with RIAs (494 patients) and UIAs (210 patients) admitted to the Department of Neurosurgery of Tianjin Medical University General Hospital and Tianjin Fifth Central Hospital between January 2016 and May 2022 were analyzed. A detailed analysis of sex, age, history, personal history, drug intake, and site of aneurysm occurrence was performed. Age was analyzed in segments and strata, and parameters with significant differences in the preliminary analysis results were analyzed by logistic regression to predict factors associated with the risk of aneurysm rupture. RESULTS Among 494 patients with RIA (70.2%) and 210 patients with UIA (29.8%), the logistic regression showed that IA location appeared to be the most significant factor associated with RIA (OR, 95% CI: internal carotid artery (ICA), reference; anterior communicating artery,27.864,12.548-61.878; posterior communicating artery,12.408,6.658-23.124; anterior cerebral artery,5.804,2.333-14.440; middle cerebral artery,9.284,4.599-18.744; posterior circulation arteries, 4.224,2.011-8.871). Age was not a significant factor associated with RIA in the model and Hyperlipidemia (OR: 0.365; 95% CI: 0.171-0.779), Atherosclerosis (OR: 0.277; 95% CI: 0.172-0.446) and Multiple aneurysms (OR: 0.275; 95% CI: 0.177-0.425) patients were less likely to have RIA.IA location and age were the best predictors of RIA using the model. CONCLUSIONS The present findings indicated that hyperlipidemia and atherosclerosis have a protective effect on aneurysm rupture, and different anatomical sites of IA may be risk factors for the occurrence of IA rupture. Among the anatomical sites of IA, the anterior communicating artery and posterior communicating artery have a higher fracture risk.
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Affiliation(s)
- Xiaopeng Cui
- Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin, China; Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Liang Wang
- Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin, China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangyue Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhuolin Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zilin Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hengrui Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Chen
- Department of Neurosurgery, Tianjin Fifth Central Hospital, Tianjin, China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
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11
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Niemann A, Tulamo R, Netti E, Preim B, Berg P, Cebral J, Robertson A, Saalfeld S. Multimodal exploration of the intracranial aneurysm wall. Int J Comput Assist Radiol Surg 2023; 18:2243-2252. [PMID: 36877287 PMCID: PMC10480333 DOI: 10.1007/s11548-023-02850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Intracranial aneurysms (IAs) are pathological changes of the intracranial vessel wall, although clinical image data can only show the vessel lumen. Histology can provide wall information but is typically restricted to ex vivo 2D slices where the shape of the tissue is altered. METHODS We developed a visual exploration pipeline for a comprehensive view of an IA. We extract multimodal information (like stain classification and segmentation of histologic images) and combine them via 2D to 3D mapping and virtual inflation of deformed tissue. Histological data, including four stains, micro-CT data and segmented calcifications as well as hemodynamic information like wall shear stress (WSS), are combined with the 3D model of the resected aneurysm. RESULTS Calcifications were mostly present in the tissue part with increased WSS. In the 3D model, an area of increased wall thickness was identified and correlated to histology, where the Oil red O (ORO) stained images showed a lipid accumulation and the alpha-smooth muscle actin (aSMA) stained images showed a slight loss of muscle cells. CONCLUSION Our visual exploration pipeline combines multimodal information about the aneurysm wall to improve the understanding of wall changes and IA development. The user can identify regions and correlate how hemodynamic forces, e.g. WSS, are reflected by histological structures of the vessel wall, wall thickness and calcifications.
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Affiliation(s)
- Annika Niemann
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
- STIMULATE Research Campus, Magdeburg, Germany
| | - Riikka Tulamo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eliisa Netti
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
- STIMULATE Research Campus, Magdeburg, Germany
| | - Philipp Berg
- STIMULATE Research Campus, Magdeburg, Germany
- Department of Medical Engineering, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Juan Cebral
- Computational Hemodynamics Lab, Georg Mason University, Fairfax, USA
| | - Anne Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, USA
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany.
- STIMULATE Research Campus, Magdeburg, Germany.
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12
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Yang H, Cho KC, Kim JJ, Kim YB, Oh JH. New morphological parameter for intracranial aneurysms and rupture risk prediction based on artificial neural networks. J Neurointerv Surg 2023; 15:e209-e215. [PMID: 36163346 DOI: 10.1136/jnis-2022-019201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Numerous studies have evaluated the rupture risk of intracranial aneurysms using morphological parameters because of their good predictive capacity. However, the limitation of current morphological parameters is that they do not always allow evaluation of irregularities of intracranial aneurysms. The purpose of this study is to propose a new morphological parameter that can quantitatively describe irregularities of intracranial aneurysms and to evaluate its performance regarding rupture risk prediction. METHODS In a retrospective study, conventional morphological parameters (aspect ratio, bottleneck ratio, height-to-width ratio, volume to ostium ratio, and size ratio) and a newly proposed morphological parameter (mass moment of inertia) were calculated for 125 intracranial aneurysms (80 unruptured and 45 ruptured aneurysms). Additionally, hemodynamic parameters (wall shear stress and strain) were calculated using computational fluid dynamics and fluid-structure interaction. Artificial neural networks trained with each parameter were used for rupture risk prediction. RESULTS All components of the mass moment of inertia (Ixx, Iyy, and Izz) were significantly higher in ruptured cases than in unruptured cases (p values for Ixx, Iyy, and Izz were 0.032, 0.047, and 0.039, respectively). When the conventional morphological and hemodynamic parameters as well as the mass moment of inertia were considered together, the highest performance for rupture risk prediction was obtained (sensitivity 96.3%; specificity 85.7%; area under the receiver operating characteristic curve 0.921). CONCLUSIONS The mass moment of inertia would be a useful parameter for evaluating aneurysm irregularity and hence its risk of rupture. The new approach described here may help clinicians to predict the risk of aneurysm rupture more effectively.
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Affiliation(s)
- Hyeondong Yang
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan, Gyeonggi-do, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Je Hoon Oh
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan, Gyeonggi-do, Korea
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13
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Abi-Aad KR, Rahme RJ, Syal A, De La Peña NM, Turcotte EL, Patra DP, Jones B, Chong B, Krishna C, Bendok BR. Predictive Model Evaluating Risk of Hemorrhage in Intracranial Aneurysms: Analysis from Prospectively Collected HEAT Trial Database. World Neurosurg 2023; 178:e315-e322. [PMID: 37479031 DOI: 10.1016/j.wneu.2023.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE We analyzed the data of patients enrolled in the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to develop and validate a model to predict the risk of aneurysmal hemorrhage. METHODS Analysis included data from 600 patients enrolled for the HEAT trial and included single saccular aneurysms of 3-14 mm size. Baseline characteristics were compared between patients with ruptured and unruptured aneurysms. Regression analysis was performed in the training set to identify significant risk factors and was validated in the validation dataset. The complete dataset was used to formulate a scoring model in which positive and negative predictors were assigned 1 and -1 points, respectively. RESULTS Data from 593 patients were analyzed in which 169 (28.5%) patients had ruptured aneurysms. The training (n = 297) and validation dataset (n = 296) had a comparable proportion of ruptured aneurysms (29.3% and 27.7%). Dome-to-neck ratio >2.5 (odds ratio [OR] 3.66), irregular shape (OR 3.79), daughter sac (OR 5.89), and anterior and posterior communicating artery locations (OR 3.32 and 3.56, respectively) had a higher rupture rate. Use of aspirin was associated with lower risk of hemorrhage (OR 0.16). The area under the curve from the receiver operating curve analysis was 0.88, 0.87, and 0.87 in the training, validation, and combined data set, respectively. The scoring model created a score of -1 to 2, yielding an of aneurysmal hemorrhage probability from 1.5% (score -1) to 70% (score 2). CONCLUSIONS This prospective study identifies dome-to-neck ratio >2.5, irregular shape, presence of daughter sac, absence of aspirin use, and aneurysm location at anterior communicating and posterior communicating artery as factors associated with increased risk of hemorrhagic presentation in small- to medium-sized intracranial aneurysms. Our model provides an estimate of rupture risk based on the presence or absence of these factors.
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Affiliation(s)
- Karl R Abi-Aad
- Department of Neurosurgery, SUNY Upstate University, New York, New York, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA
| | - Rudy J Rahme
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Global Neurosciences Institute, Pennington, New Jersey, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Nicole M De La Peña
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Evelyn L Turcotte
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Devi P Patra
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Breck Jones
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Chong
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.
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14
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Sanchez S, Essibayi MA, Hickerson M, Ojeda DJ, Kasab SA, Yoshimura S, Jabbour PM, Mascitelli J, Levitt MR, Cuellar-Saenz HH, Brinjikji W, Spiotta AM, Shaban A, Samaniego EA. Morphological characteristics of brain aneurysms among age groups. Interv Neuroradiol 2023:15910199231201520. [PMID: 37715650 DOI: 10.1177/15910199231201520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Patient's age is an important factor in determining the risk of aneurysm rupture. However, there is limited data on how aneurysm morphology differs among age groups. We studied morphological characteristics of brain aneurysms among age groups in a large cohort. METHODS Aneurysms from the Stroke Thrombectomy and Aneurysm Registry (STAR) were analyzed. The following parameters were included: location, size, neck, width, height, aspect ratio, and regular versus irregular morphology. The risk of rupture presentation was estimated using logistic regression. RESULTS A total of 1407 unruptured and 607 ruptured saccular aneurysms were included. The most common locations of ruptured aneurysms in patients younger than 70 years-old were the middle cerebral artery (MCA) and the anterior communicating artery (ACOM). The most common location of ruptured aneurysms in patients older than 70 years-old were the posterior communicating artery (PCOM) and ACOM. The size of unruptured aneurysms increased with age (p < .001). Conversely, the size of ruptured aneurysms was similar among age groups (p = .142). Unruptured and ruptured aneurysms became more irregular at presentation with older age (p < .001 and p .025, respectively). Irregular morphology and location were associated with rupture status across all age groups in multivariate regression. CONCLUSIONS Younger patients have small unruptured and ruptured aneurysms, and ruptured aneurysms are mostly located in the MCA and ACOM. Older patients have larger and more irregular unruptured aneurysms, and ruptured aneurysms are mostly located in the PCOM and ACOM. An irregular morphology increases the risk of rupture in all age groups.
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Affiliation(s)
| | | | | | | | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, USA
| | | | | | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, USA
| | | | | | | | | | - Amir Shaban
- Department of Neurology, University of Iowa, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, USA
- Department of Neurosurgery, University of Iowa, USA
- Department of Radiology, University of Iowa, USA
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15
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Irfan M, Malik KM, Ahmad J, Malik G. StrokeNet: An automated approach for segmentation and rupture risk prediction of intracranial aneurysm. Comput Med Imaging Graph 2023; 108:102271. [PMID: 37556901 DOI: 10.1016/j.compmedimag.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023]
Abstract
Intracranial Aneurysms (IA) present a complex challenge for neurosurgeons as the risks associated with surgical intervention, such as Subarachnoid Hemorrhage (SAH) mortality and morbidity, may outweigh the benefits of aneurysmal occlusion in some cases. Hence, there is a critical need for developing techniques that assist physicians in assessing the risk of aneurysm rupture to determine which aneurysms require treatment. However, a reliable IA rupture risk prediction technique is currently unavailable. To address this issue, this study proposes a novel approach for aneurysm segmentation and multidisciplinary rupture prediction using 2D Digital Subtraction Angiography (DSA) images. The proposed method involves training a fully connected convolutional neural network (CNN) to segment aneurysm regions in DSA images, followed by extracting and fusing different features using a multidisciplinary approach, including deep features, geometrical features, Fourier descriptor, and shear pressure on the aneurysm wall. The proposed method also adopts a fast correlation-based filter approach to drop highly correlated features from the set of fused features. Finally, the selected fused features are passed through a Decision Tree classifier to predict the rupture severity of the associated aneurysm into four classes: Mild, Moderate, Severe, and Critical. The proposed method is evaluated on a newly developed DSA image dataset and on public datasets to assess its generalizability. The system's performance is also evaluated on DSA images annotated by expert neurosurgeons for the rupture risk assessment of the segmented aneurysm. The proposed system outperforms existing state-of-the-art segmentation methods, achieving an 85 % accuracy against annotated DSA images for the risk assessment of aneurysmal rupture.
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Affiliation(s)
- Muhammad Irfan
- SMILES LAB, Department of Computer Science and Engineering, Oakland University, Rochester, MI, 48309, USA
| | - Khalid Mahmood Malik
- SMILES LAB, Department of Computer Science and Engineering, Oakland University, Rochester, MI, 48309, USA.
| | - Jamil Ahmad
- Department of Computer Vision, Mohamed Bin Zayed University of Artificial Intelligence (MBZUAI), Abu Dhabi, United Arab Emirates
| | - Ghaus Malik
- Executive Vice-Chair at Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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16
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Tsutsui T, Ikedo T, Kitazawa Y, Otsuka R, Nishiwaki T, Kushi Y, Niwa A, Ozaki S, Hattori EY, Shimonaga K, Hamano E, Yamada K, Imamura H, Mori H, Iihara K, Kataoka H. Impact of Morphological Factors on the Future Growth of Unruptured Posterior Communicating Artery Aneurysms. World Neurosurg 2023; 175:e897-e903. [PMID: 37075892 DOI: 10.1016/j.wneu.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND No previous study has established the factors associated with intracranial aneurysm growth using imaging data obtained before the appearance of morphological changes. Therefore, we investigated the factors related to future aneurysm growth in posterior communicating artery (Pcom) aneurysms. METHODS Using a longitudinal database of intracranial aneurysm cases, we reviewed the findings for consecutive patients with unruptured Pcom aneurysms admitted to our institute from 2012 to 2021. Magnetic resonance images obtained over time were used to evaluate aneurysm growth. Aneurysms showing growth over time (group G) and unchanged aneurysms (group U) were compared in terms of background data and morphological factors. RESULTS 93 Pcom aneurysms (group G: 25 aneurysms, 25%; group U: 68 aneurysms, 75%) were eligible for the present study. Six aneurysm rupture events occurred in group G (24%). Among morphological factors, Pcom diameter (1.2 ± 0.3 mm vs. 0.8 ± 0.7 mm, P < 0.01), bleb formation (group G: 39% vs. group U: 10%; odds ratio, 5.6; P = 0.01), and the lateral projection of the dome (group G: 52% vs. group U: 13%; odds ratio, 3.2; P = 0.023) were significantly different between the 2 groups. The sensitivity and specificity of a cutoff Pcom diameter of 0.73 mm for predicting enlargement were 96% and 53%, respectively. CONCLUSIONS Pcom diameter, bleb formation, and lateral dome projection were associated with growth of Pcom aneurysms. Aneurysms with these risk factors require careful follow-up imaging, which may facilitate early detection of aneurysm growth and prevention of rupture through therapeutic interventions.
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Affiliation(s)
- Takeyoshi Tsutsui
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yoshiaki Kitazawa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryotaro Otsuka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takayuki Nishiwaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Koji Shimonaga
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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17
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Xie Y, Liu S, Lin H, Wu M, Shi F, Pan F, Zhang L, Song B. Automatic risk prediction of intracranial aneurysm on CTA image with convolutional neural networks and radiomics analysis. Front Neurol 2023; 14:1126949. [PMID: 37456640 PMCID: PMC10345199 DOI: 10.3389/fneur.2023.1126949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Background Intracranial aneurysm (IA) is a nodular protrusion of the arterial wall caused by the localized abnormal enlargement of the lumen of a brain artery, which is the primary cause of subarachnoid hemorrhage. Accurate rupture risk prediction can effectively aid treatment planning, but conventional rupture risk estimation based on clinical information is subjective and time-consuming. Methods We propose a novel classification method based on the CTA images for differentiating aneurysms that are prone to rupture. The main contribution of this study is that the learning-based method proposed in this study leverages deep learning and radiomics features and integrates clinical information for a more accurate prediction of the risk of rupture. Specifically, we first extracted the provided aneurysm regions from the CTA images as 3D patches with the lesions located at their centers. Then, we employed an encoder using a 3D convolutional neural network (CNN) to extract complex latent features automatically. These features were then combined with radiomics features and clinical information. We further applied the LASSO regression method to find optimal features that are highly relevant to the rupture risk information, which is fed into a support vector machine (SVM) for final rupture risk prediction. Results The experimental results demonstrate that our classification method can achieve accuracy and AUC scores of 89.78% and 89.09%, respectively, outperforming all the alternative methods. Discussion Our study indicates that the incorporation of CNN and radiomics analysis can improve the prediction performance, and the selected optimal feature set can provide essential biomarkers for the determination of rupture risk, which is also of great clinical importance for individualized treatment planning and patient care of IA.
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Affiliation(s)
- Yuan Xie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyu Liu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hen Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Min Wu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Feng Pan
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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18
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Chen X, Gui S, Deng D, Dong L, Zhang L, Wei D, Jiang J, Ge H, Liu P, Lv M, Li Y. Alcohol flushing syndrome is significantly associated with intracranial aneurysm rupture in the Chinese Han population. Front Neurol 2023; 14:1118980. [PMID: 37006480 PMCID: PMC10065193 DOI: 10.3389/fneur.2023.1118980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveAlthough alcohol flushing syndrome (AFS) has been associated with various diseases, its association with intracranial aneurysm rupture (IAR) is unclear. We aimed to examine this association in the Chinese Han population.MethodsWe retrospectively reviewed Chinese Han patients with intracranial aneurysms who were evaluated and treated at our institution between January 2020 and December 2021. AFS was determined using a semi-structured telephone interview. Clinical data and aneurysm characteristics were assessed. Univariate and multivariate logistic regression were conducted to determine independent factors associated with aneurysmal rupture.ResultsA total of 1,170 patients with 1,059 unruptured and 236 ruptured aneurysms were included. The incidence of aneurysm rupture was significantly higher in patients without AFS (p < 0.001). Meanwhile, there was a significantly difference between the AFS and non-AFS group in habitual alcohol consumption (10.5 vs. 27.2%, p < 0.001). In the univariate analyses, AFS [odds ratio (OR) 0.49; 95% confidence interval (CI), 0.34–0.72] was significantly associated with IAR. In the multivariate analysis, AFS was an independent predictor of IAR (OR 0.50; 95%, CI, 0.35–0.71). Multivariate analysis revealed that AFS was an independent predictor of IAR in both habitual (OR 0.11; 95% CI, 0.03–0.45) and non-habitual drinkers (OR 0.69; 95% CI, 0.49–0.96).ConclusionAlcohol flushing syndrome may be a novel clinical marker to assess the risk of IAR. The association between AFS and IAR exists independently of alcohol consumption. Further single nucleotide polymorphism testing and molecular biology studies are warranted.
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Affiliation(s)
- Xiheng Chen
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Siming Gui
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Dingwei Deng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Linggen Dong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Dachao Wei
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Jia Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Huijian Ge
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Peng Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Ming Lv
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
- *Correspondence: Ming Lv,
| | - Youxiang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
- Youxiang Li,
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Salimi Ashkezari SF, Mut F, Robertson AM, Cebral JR. Differences Between Ruptured Aneurysms With and Without Blebs: Mechanistic Implications. Cardiovasc Eng Technol 2023; 14:92-103. [PMID: 35819581 PMCID: PMC10029732 DOI: 10.1007/s13239-022-00640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Blebs are known risk factors for intracranial aneurysm (IA) rupture. We analyzed differences between IAs that ruptured with blebs and those that ruptured without developing blebs to identify distinguishing characteristics among them and suggest possible mechanistic implications. METHODS Using image-based models, 25 hemodynamic and geometric parameters were compared between ruptured IAs with and without blebs (n = 673), stratified by location. Hemodynamic and geometric differences between bifurcation and sidewall aneurysms and for aneurysms at five locations were also analyzed. RESULTS Ruptured aneurysms harboring blebs were exposed to higher flow conditions than aneurysms that ruptured without developing blebs, and this was consistent across locations. Bifurcation aneurysms were exposed to higher flow conditions than sidewall aneurysms. They had larger maximum wall shear stress (WSS), more concentrated WSS distribution, and larger numbers of critical points than sidewall aneurysms. Additionally, bifurcation aneurysms were larger, more elongated, and had more distorted shapes than sidewall aneurysms. Aneurysm morphology was associated with aneurysm location (p < 0.01). Flow conditions were different between aneurysm locations. CONCLUSION Aneurysms at different locations are likely to develop into varying morphologies and thus be exposed to diverse flow conditions that may predispose them to follow distinct pathways towards rupture with or without bleb development. This could explain the diverse rupture rates and bleb presence in aneurysms at different locations.
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Affiliation(s)
- Seyedeh Fatemeh Salimi Ashkezari
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Fernando Mut
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan R Cebral
- Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Department of Mechanical Engineering, George Mason University, Fairfax, VA, USA
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20
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Yang H, Cho KC, Kim JJ, Kim JH, Kim YB, Oh JH. Rupture risk prediction of cerebral aneurysms using a novel convolutional neural network-based deep learning model. J Neurointerv Surg 2023; 15:200-204. [PMID: 35140167 DOI: 10.1136/neurintsurg-2021-018551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cerebral aneurysms should be treated before rupture because ruptured aneurysms result in serious disability. Therefore, accurate prediction of rupture risk is important and has been estimated using various hemodynamic factors. OBJECTIVE To suggest a new way to predict rupture risk in cerebral aneurysms using a novel deep learning model based on hemodynamic parameters for better decision-making about treatment. METHODS A novel convolutional neural network (CNN) model was used for rupture risk prediction retrospectively of 123 aneurysm cases. To include the effect of hemodynamic parameters into the CNN, the hemodynamic parameters were first calculated using computational fluid dynamics and fluid-structure interaction. Then, they were converted into images for training the CNN using a novel approach. In addition, new data augmentation methods were devised to obtain sufficient training data. A total of 53,136 images generated by data augmentation were used to train and test the CNN. RESULTS The CNNs trained with wall shear stress (WSS), strain, and combination images had area under the receiver operating characteristics curve values of 0.716, 0.741, and 0.883, respectively. Based on the cut-off values, the CNN trained with WSS (sensitivity: 0.5, specificity: 0.79) or strain (sensitivity: 0.74, specificity: 0.71) images alone was not highly predictive. However, the CNN trained with combination images of WSS and strain showed a sensitivity and specificity of 0.81 and 0.82, respectively. CONCLUSION CNN-based deep learning algorithm using hemodynamic factors, including WSS and strain, could be an effective tool for predicting rupture risk in cerebral aneurysms with good predictive accuracy.
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Affiliation(s)
- Hyeondong Yang
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan, Gyeonggi-do, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Yonsei University, Yongin Severance Hospital, Yongin, Korea
| | - Jung-Jae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Jae Ho Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Chosun University Hospital, Gwangju, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Je Hoon Oh
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan, Gyeonggi-do, Korea
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21
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Fan XX, Geng JW, He C, Hu P, Sun LY, Zhang HQ. Analysis of the wall thickness of intracranial aneurysms: Can computational fluid dynamics detect the translucent areas of saccular intracranial aneurysms and predict the rupture risk preoperatively? Front Neurol 2023; 13:1075078. [PMID: 36698880 PMCID: PMC9869126 DOI: 10.3389/fneur.2022.1075078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Background and purpose The translucent area on the surface of intracranial aneurysms (IAs) is associated with rupture risk. In the present study, the Polyflow module of the Ansys software was used to simulate and analyze the thickness of the aneurysm wall to detect whether it was "translucent" and to assess the rupture risk. Methods Forty-five patients with 48 IAs who underwent microsurgery were retrospectively reviewed. The medical records, radiographic data, and intraoperative images of the patients were collected. The image data were analyzed using computational fluid dynamics (CFD) simulations to explore the relationship between the simulated thickness of the aneurysm wall, the translucent area, and the rupture point of the real aneurysm's surface to predict the rupture risk and provide a certain reference basis for clinical treatment. Results The Polyflow simulation revealed that the location of the minimum extreme point of the simulated aneurysm wall thickness was consistent with the translucent area or rupture point on the surface of the real aneurysm. There was a downward trend in the correlation between the change rate (IS) in the wall area and volume during aneurysm growth and rupture. Ruptured aneurysms have a greater inhomogeneity coefficient Iδ than the unruptured ones. In the unruptured group, translucent aneurysms also had greater inhomogeneity coefficients Iδ and more significant thickness changes (multiple IBA) than non-translucent ones. Conclusions The Ansys software Polyflow module could detect whether the unruptured aneurysms were translucent and predict the rupture risk and rupture point. Clinical trial registration https://clinicaltrials.gov/, Identifier, NCT03133624.
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Affiliation(s)
- Xin-xin Fan
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie-wen Geng
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuan He
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Hu
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li-yong Sun
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-qi Zhang
- China International Neuroscience Institute (China-INI), Beijing, China,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,*Correspondence: Hong-qi Zhang ✉
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22
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Niemann A, Behme D, Larsen N, Preim B, Saalfeld S. Deep learning-based semantic vessel graph extraction for intracranial aneurysm rupture risk management. Int J Comput Assist Radiol Surg 2023; 18:517-525. [PMID: 36626087 PMCID: PMC9939495 DOI: 10.1007/s11548-022-02818-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Intracranial aneurysms are vascular deformations in the brain which are complicated to treat. In clinical routines, the risk assessment of intracranial aneurysm rupture is simplified and might be unreliable, especially for patients with multiple aneurysms. Clinical research proposed more advanced analysis of intracranial aneurysm, but requires many complex preprocessing steps. Advanced tools for automatic aneurysm analysis are needed to transfer current research into clinical routine. METHODS We propose a pipeline for intracranial aneurysm analysis using deep learning-based mesh segmentation, automatic centerline and outlet detection and automatic generation of a semantic vessel graph. We use the semantic vessel graph for morphological analysis and an automatic rupture state classification. RESULTS The deep learning-based mesh segmentation can be successfully applied to aneurysm surface meshes. With the subsequent semantic graph extraction, additional morphological parameters can be extracted that take the whole vascular domain into account. The vessels near ruptured aneurysms had a slightly higher average torsion and curvature compared to vessels near unruptured aneurysms. The 3D surface models can be further employed for rupture state classification which achieves an accuracy of 83.3%. CONCLUSION The presented pipeline addresses several aspects of current research and can be used for aneurysm analysis with minimal user effort. The semantic graph representation with automatic separation of the aneurysm from the parent vessel is advantageous for morphological and hemodynamical parameter extraction and has great potential for deep learning-based rupture state classification.
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Affiliation(s)
- Annika Niemann
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany ,STIMULATE Research Campus, Magdeburg, Germany
| | - Daniel Behme
- University Clinic for Neuroradiology, Otto von Guericke University, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany ,STIMULATE Research Campus, Magdeburg, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany. .,STIMULATE Research Campus, Magdeburg, Germany.
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Zhang Z, Mu X, Zhou X. Dexmedetomidine alleviates inflammatory response and oxidative stress injury of vascular smooth muscle cell via α2AR/GSK-3β/MKP-1/NRF2 axis in intracranial aneurysm. BMC Pharmacol Toxicol 2022; 23:81. [PMID: 36273189 PMCID: PMC9588221 DOI: 10.1186/s40360-022-00607-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
Vascular smooth muscle cell (VSMC) phenotypic modulation regulates the initiation and progression of intracranial aneurysm (IA). Dexmedetomidine (DEX) is suggested to play neuroprotective roles in patients with craniocerebral injury. Therefore, we investigated the biological functions of DEX and its mechanisms against IA formation and progression in the current study. The rat primary VSMCs were isolated from Sprague-Dawley rats. IA and superficial temporal artery (STA) tissue samples were obtained from patients with IA. Flow cytometry was conducted to identify the characteristics of isolated VSMCs. Hydrogen peroxide (H2O2) was used to mimic IA-like conditions in vitro. Cell viability was detected using CCK-8 assays. Wound healing and Transwell assays were performed to detect cell motility. ROS production was determined by immunofluorescence using DCFH-DA probes. Western blotting and RT-qPCR were carried out to measure gene expression levels. Inflammation responses were determined by measuring inflammatory cytokines. Immunohistochemistry staining was conducted to measure α2-adrenergic receptor levels in tissue samples. DEX alleviated the H2O2-induced cytotoxicity, attenuated the promoting effects of H2O2 on cell malignancy, and protected VSMCs against H2O2-induced oxidative damage and inflammation response. DEX regulated the GSK-3β/MKP-1/NRF2 pathway via the α2AR. DEX alleviates the inflammatory responses and oxidative damage of VSMCs by regulating the GSK-3β/MKP-1/NRF2 pathway via the α2AR in IA.
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Affiliation(s)
- Ze Zhang
- grid.452458.aDepartment of Anesthesiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050000 Hebei China
| | - Xiue Mu
- grid.452458.aDepartment of Anesthesiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050000 Hebei China
| | - Xiaohui Zhou
- grid.452458.aDepartment of Anesthesiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, 050000 Hebei China
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24
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Kirkpatrick L, Waters J, O'Neal MA. Preventive Approaches in Women's Neurology: Prepartum, Pregnancy, and Postpartum. Semin Neurol 2022; 42:665-678. [PMID: 36216357 DOI: 10.1055/a-1958-0633] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Women's neurology is the subspecialty within neurology concerned with the distinct healthcare needs of women. In this article, we review current literature and expert management strategies regarding disease-specific neurologic concerns of women, with an emphasis on issues related to contraception, pregnancy, and lactation. Health conditions that we discuss in this article include epilepsy, headache, stroke, multiple sclerosis, and Chiari I malformation. Current findings on neurologic disease in women suggest that many women with neurologic disease can safely manage their disease during pregnancy and have healthy children, though pregnancy planning is important in many conditions to mitigate risks and effective contraceptive management is important when pregnancy prevention is desired.
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Affiliation(s)
- Laura Kirkpatrick
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Janet Waters
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Angela O'Neal
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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25
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Risk factors for aneurysm rupture among Kazakhs: findings from a national tertiary. BMC Neurol 2022; 22:357. [PMID: 36127629 PMCID: PMC9487045 DOI: 10.1186/s12883-022-02892-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/14/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rupture of intracranial aneurysms (RIA) leads to subarachnoid hemorrhage (SAH) with severe consequences. Although risks for RIA are established, the results vary between ethnic groups and were never studied in Kazakhstan. This study aimed to establish the risk factors of RIA in the Kazakh population. METHODS: Retrospective analysis of 762 patients with single IAs, who attended the neurosurgical center from 2008 until 2018, was conducted. Demographic characteristics, such as age, sex, smoking status, and hypertension were considered. Descriptive and bivariate analyses were performed. A multivariable logistic regression model was built to identify factors correlated with RIA. RESULTS The mean age of participants was 48.49 ± 0.44 years old. The majority (68.37%) of IAs have ruptured. Of the ruptured aneurysms, 43.76% were < 6 mm, and 38.39% were located on the anterior cerebral and anterior communicating arteries (ACA). Logistic regression model indicates younger age group (16-40 years), smoking, having stage 3 hypertension, smaller IA size and its location on ACA increase the odds of rupture. CONCLUSIONS This study has revealed that younger, smoking patients with stage 3 arterial hypertension are at higher risk for RIA. Small aneurysms (< 6 mm) and location on ACA had increased odds of rupture, while larger aneurysms on internal carotid arteries had lower odds.
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He Y, Duan L, Lu T, Jia R, Guo D, Ma C, Li T, He Y. Investigation of surface endothelialization on nitinol: Effects of composite hydrogel coatings. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.129074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Liu Q, Leng X, Yang J, Yang Y, Jiang P, Li M, Mo S, Yang S, Wu J, He H, Wang S. Stability of unruptured intracranial aneurysms in the anterior circulation: nomogram models for risk assessment. J Neurosurg 2022; 137:675-684. [PMID: 35061990 DOI: 10.3171/2021.10.jns211709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The probable stability of the lesion is critical in guiding treatment decisions in unruptured intracranial aneurysms (IAs). The authors aimed to develop multidimensional predictive models for the stability of unruptured IAs. METHODS Patients with unruptured IAs in the anterior circulation were prospectively enrolled and regularly followed up. Clinical data were collected, IA morphological features were assessed, and adjacent hemodynamic features were quantified with patient-specific computational fluid dynamics modeling. Based on multivariate logistic regression analyses, nomograms incorporating these factors were developed in a primary cohort (patients enrolled between January 2017 and February 2018) to predict aneurysm rupture or growth within 2 years. The predictive accuracies of the nomograms were compared with the population, hypertension, age, size, earlier rupture, and site (PHASES) and earlier subarachnoid hemorrhage, location, age, population, size, and shape (ELAPSS) scores and validated in the validation cohort (patients enrolled between March and October 2018). RESULTS Among 231 patients with 272 unruptured IAs in the primary cohort, hypertension, aneurysm location, irregular shape, size ratio, normalized wall shear stress average, and relative resident time were independently related to the 2-year stability of unruptured IAs. The nomogram including clinical, morphological, and hemodynamic features (C+M+H nomogram) had the highest predictive accuracy (c-statistic 0.94), followed by the nomogram including clinical and morphological features (C+M nomogram; c-statistic 0.89), PHASES score (c-statistic 0.68), and ELAPSS score (c-statistic 0.58). Similarly, the C+M+H nomogram had the highest predictive accuracy (c-statistic 0.94) in the validation cohort (85 patients with 97 unruptured IAs). CONCLUSIONS Hemodynamics have predictive values for 2-year stability of unruptured IAs treated conservatively. Multidimensional nomograms have significantly higher predictive accuracies than conventional risk prediction scores.
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Affiliation(s)
- Qingyuan Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xinyi Leng
- 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junhua Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Yi Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Pengjun Jiang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Maogui Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shaohua Mo
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuzhe Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
| | - Jun Wu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Hongwei He
- 3Department of Neurointervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and
| | - Shuo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
- 2China National Clinical Research Center for Neurological Diseases, Beijing
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Wang Q, Qiu W. Evaluating the impact of personalized rehabilitation nursing management in the perioperative nursing of patients with intracranial aneurysm: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29121. [PMID: 35839044 PMCID: PMC11132368 DOI: 10.1097/md.0000000000029121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients who suffer from aneurysmal subarachnoid hemorrhage continue to die at a high rate, despite large geographical and risk factor-related variability in death rates. Hemorrhagic stroke has a greater death rate than ischemic stroke, which is often permanent, although patients who survive have less impairment than those who do not. Because of this, nurses must offer appropriate nursing care throughout the perioperative period for patients suffering from this prevalent neurological condition. Patients with intracranial aneurysms (IA) will be the subjects of this research, which will be carried out to thoroughly investigate the effect of tailored rehabilitative nurse treatment throughout the perioperative period. METHODS The influence of customized rehabilitative nurse management in the perioperative nursing of patients with IA has been studied in both randomized controlled trials and observation studies, according to the authors. From the time of the database's creation until February 2022, information about studies will be gathered from 3 Chinese databases (Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical database) and 4 English databases (PubMed, EMBASE, Cochrane Library, and CINAHL database). After the data extraction and risk of bias evaluation of the included studies are completed, the data synthesis will be carried out using the RevMan 5.3 program. Egger's regression test and funnel plots will be used to determine whether or not there is any publication bias. The I2 statistics will be used to determine the degree of heterogeneity. A sensitivity analysis will be conducted to determine the robustness as well as stability of our results and conclusions. RESULTS This research is anticipated to offer high-quality evidence of tailored rehabilitative nurse treatment in the perioperative nursing of patients with IA. CONCLUSION Results of this research will synthesize the current data to determine whether or not tailored rehabilitation nursing treatment may enhance the surgical recovery of patients with IA.
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Affiliation(s)
- Qiong Wang
- The First People’s Hospital of Jiangxia District, Wuhan City (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Wei Qiu
- The First People’s Hospital of Jiangxia District, Wuhan City (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
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Wei S, Yuan X, Li D, Guo X, Guan S, Xu Y. Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms. Front Neurosci 2022; 16:945537. [PMID: 35911998 PMCID: PMC9330164 DOI: 10.3389/fnins.2022.945537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Homocysteine (Hcy) levels may be associated with the development of intracranial aneurysms (IAs). However, whether it increases the risk of rupture of IAs is unknown. This study aimed to determine the association between homocysteine levels and IA rupture. Methods We retrospectively reviewed patients with IAs and subarachnoid hemorrhage (SAH) at our hospital between January 2019 and May 2021. Clinical data, including Hcy levels and IA images, were assessed. The association between Hcy level and IA rupture was investigated using multivariate logistic regression analyses in patients with IAs and SAH. Results A total of 589 patients were included. 546 patients with IAs, including 331 UIA (Unruptured IA) and 215 RIA (Ruptured IA). The average age was 57.43 ± 10.86 years old, and 67.03% were women. Among them, all 215 RIAs lead to SAH. In addition, we also enrolled 43 non-aneurysmal subarachnoid hemorrhage (Na-SAH) patients. The average age was 54.12 ± 10.55 years old, and 53.48% were female. After adjusting for confounders in the multivariate model, Hcy levels were correlated with the rupture of IA (odds ratio [OR] 1.069; 95% confidence interval [CI] 1.025–1.114, p = 0.002) and a-SAH (OR 1.083; 95% CI 1.002–1.170, p = 0.046). Conclusion Hcy levels were associated with IA rupture. These findings provide novel insights into IAs rupture, and future studies are needed to confirm this relationship.
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Affiliation(s)
- Sen Wei
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Xin Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Dongdong Li
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Xinbin Guo
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Sheng Guan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
- *Correspondence: Sheng Guan,
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
- Yuming Xu,
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Wen D, Chen R, Zhang T, Li H, Zheng J, Fu W, You C, Ma L. “Atypical” Mild Clinical Presentation in Elderly Patients With Ruptured Intracranial Aneurysm: Causes and Clinical Characteristics. Front Surg 2022; 9:927351. [PMID: 35874135 PMCID: PMC9304704 DOI: 10.3389/fsurg.2022.927351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThunderclap-like severe headache or consciousness disturbance is the common “typical” clinical presentation after aneurysmal subarachnoid hemorrhage (aSAH); however, a slowly developing “atypical” clinical pattern, with mild headache, vomiting, or dizziness, is frequently noted in elderly patients. The aim of this study was to evaluate the clinical characteristics of this “atypical” subgroup, as well as related factors associated with the presence of these mild symptoms.MethodsThe data of 176 elderly patients (≥70 years old) with ruptured intracranial aneurysms (IAs) treated at our center from January 2016 to January 2020 were retrospectively collected and analyzed. The patients were divided into “typical” and “atypical” groups based on their initial and development of clinical symptoms after the diagnosis of aSAH. Intergroup differences were analyzed, and factors related to the presence of these two clinical patterns were explored through multiple logistic regression analyses.ResultsDespite significant admission delay (P < 0.001) caused by mild initial symptoms with slow development, patients in the “atypical” group achieved better clinical prognosis, as indicated by a significantly higher favourable outcome ratio and lower death rate upon discharge and at different time points during the 1-year follow-up, than the “typical” group (P < 0.05). Multiple logistic regression analysis revealed that modified Fisher grade III-IV (OR = 11.182, P = 0.003), brain atrophy (OR = 10.010, P = 0.001), a larger lesion diameter (OR = 1.287, P < 0.001) and current smoking (OR = 5.728, P < 0.001) were independently associated with the presence of “typical” symptoms. Aneurysms with wide necks (OR = 0.013, P < 0.001) were independently associated with the presence of “atypical” symptoms.Conclusions“Atypical” presentations, with mild clinical symptoms and slow development, were commonly recorded in elderly patients after the onset of aSAH. Despite the prolonged admission delay, these “atypical” patients achieved better clinical outcomes than those with “typical” symptoms. Modified Fisher grade (III-IV), current smoking, brain atrophy and larger lesion diameter were factors predictive of “typical” symptoms, while aneurysms with wide necks were independently associated with “atypical” symptoms.
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Zhu H, Hao Z, Xing Z, Tan J, Zhao Y, Li M. Impinging Flow Induces Expression of Monocyte Chemoattractant Protein-1 in Endothelial Cells Through Activation of the c-Jun N-terminal Kinase/c-Jun/p38/c-Fos Pathway. World Neurosurg 2022; 164:e681-e693. [PMID: 35580782 DOI: 10.1016/j.wneu.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Monocyte chemoattractant protein-1 (MCP-1) is an important regulator of the formation and development of intracranial aneurysms. This study explored the molecular mechanisms underlying the induction of MCP-1 and related inflammatory factors in human umbilical vein endothelial cells (HUVECs) under hemodynamic conditions. METHODS A modified T chamber was used to simulate fluid flow at the bifurcation of the artery and wall shear stress on HUVECs in vitro. Changes in HUVECs were analyzed in response to impinging flow. And HUVECs without impinging flow were used as the control group. Protein expression levels of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38, activator protein-1, and MCP-1 were detected by Western blot, and the messenger RNA expression levels of MCP-1, interleukin (IL)-1β, and IL-6 were determined by quantitative reverse transcription polymerase chain reaction. RESULTS Under impinging flow, the phosphorylation levels of ERK, JNK, and p38, as well as the protein levels of MCP-1, c-Jun, and c-Fos, increased. The messenger RNA expression of MCP-1, IL-1β, and IL-6 also increased in HUVECs. Pretreatment of the HUVECs with inhibitors of JNK and p38 significantly attenuated the increased expression of MCP-1, IL-1β, and IL-6, while ERK inhibitors had no obvious effect. CONCLUSIONS Under impinging flow, MCP-1 and inflammatory factors are regulated through the JNK/c-Jun/p38/c-Fos pathway and participate in EC inflammation.
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Affiliation(s)
- Huaxin Zhu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zheng Hao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; Trauma Center, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zelong Xing
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; Department of Neurosurgery, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, China
| | - Jiacong Tan
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yeyu Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Meihua Li
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Caton MT, Vitt J, Smith ER, Cooke D, Meisel K, Ko N, Amorim E. Geometric and Morphologic Features of Ruptured Intracranial Aneurysms Associated with Methamphetamine Use. World Neurosurg 2022; 164:e509-e517. [PMID: 35552027 DOI: 10.1016/j.wneu.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methamphetamine (MA) use is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). MA exerts both hemodynamic and inflammatory effects, but whether these manifest with altered intracranial aneurysm (IA) remodeling is unknown. The objective of this study was to compare IA geometric and morphologic features in patients with and without MA detected on urine toxicology (Utox) at presentation. METHODS 160 consecutive patients with SAH and Utox at time of admission were retrospectively reviewed. Geometric-morphologic IA characteristics were assessed by blinded neuroradiologists. Studied features were maximum sac diameter, location, size, ellipsoid volume, aspect ratio, size ratio, volume: neck ratio, dome: neck ratio, bottleneck factor, morphology (saccular, fusiform/dissecting, blister, mycotic), and presence of bleb, vasculopathy, or additional unruptured IA. RESULTS Of 139/160 patients with aSAH, 23/139 (16.5%) were Utox MA+ There was no difference in aneurysm subtype frequency, presence of bleb, vasculopathy, or presence an additional (unruptured) aneurysm with trend toward posterior circulation location and higher Hunt and Hess grade (p = 0.09 for both) in MA+ group. Maximum IA sac diameter, ellipsoid volume, dome-neck ratio, and size ratio were similar between groups. Only the aspect ratio (AR) differed between groups (MA+ = 2.20 vs. MA- = 1.74, p = 0.02). The AR remained a significant predictor of Utox MA+ in a multiple logistic regression analysis (odds ratio 1.87, 95% confidence interval 1.06-3.39). CONCLUSIONS Active use of methamphetamine is independently associated with larger AR in patients with ruptured IA. This may indicate hazardous remodeling due to hemodynamic and/or inflammatory changes.
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Affiliation(s)
- M Travis Caton
- Department of Radiology and Biomedical Imaging, Neurointerventional Section, University of California San Francisco.
| | - Jeffrey Vitt
- Departments of Neurological Surgery and Neurology, University of California Davis
| | - Eric R Smith
- Department of Radiology and Biomedical Imaging, Neurointerventional Section, University of California San Francisco
| | - Daniel Cooke
- Department of Radiology and Biomedical Imaging, Neurointerventional Section, University of California San Francisco
| | - Karl Meisel
- Department of Neurology, Neurovascular Division, University of California San Francisco
| | - Nerissa Ko
- Department of Neurology, Neurovascular Division, University of California San Francisco
| | - Edilberto Amorim
- Department of Neurology, Neurovascular Division, University of California San Francisco
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Risk factors for intracranial aneurysm rupture in pediatric patients. Acta Neurochir (Wien) 2022; 164:1145-1152. [PMID: 34415443 DOI: 10.1007/s00701-021-04957-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracranial aneurysm (IA) rupture in pediatric patients is a rare but fatal condition. Although risk factors for aneurysm rupture in adults have been well documented, they remain unknown in pediatric patients. METHODS Data for 94 pediatric patients with IAs were retrospectively analyzed. The patients were divided into ruptured and unruptured groups. Risk factors for aneurysm rupture were analyzed through univariable and multiple logistic regression analyses. Typical patients with risk factors were described. RESULTS Univariable analyses showed that the unruptured group had significantly higher percentages of giant aneurysms (43.2% vs 12.3%, P = 0.002), wide-neck aneurysms (67.6% vs 29.8%, P = 0.001), and aneurysms located in the internal carotid artery (40.5% vs 3.5%, P < 0.001), while the ruptured group had significantly higher percentages of patients younger than 5 years old (28.1% vs 5.4%, P = 0.013) and aneurysms located in the anterior cerebral artery (24.6% vs 5.4%, P = 0.032), posterior cerebral artery (14.0% vs 0%, P = 0.045), and distal arterial region (DAR) (46.8% vs 27.0%, P < 0.001). Multiple logistic regression analysis confirmed that age 0-5 years (OR = 6.844, P = 0.042) and IAs located in the DAR (OR = 4.162, P = 0.029) were independently related to an increased risk of rupture. Wide-necked aneurysms (OR = 0.235, P = 0.047) were independently associated with a lower risk of rupture. CONCLUSIONS Among pediatric patients, age younger than 5 years and lesions located in the DAR are independent risk factors for IA rupture, while an IA with a wide neck acts as a protective factor.
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Wisniewski AG, Shiraz Bhurwani MM, Sommer KN, Monteiro A, Baig A, Davies J, Siddiqui A, Ionita CN. Quantitative angiography prognosis of intracranial aneurysm treatment failure using parametric imaging and distal vessel analysis. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:120360D. [PMID: 35983494 PMCID: PMC9385187 DOI: 10.1117/12.2611550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Data-driven methods based on x-ray angiographic parametric imaging (API) have been successfully used to provide prognosis for intracranial aneurysm (IA) treatment outcome. Previous studies have mainly focused on embolization devices where the flow pattern visualization is in the aneurysm dome; however, this is not possible in IAs treated with endovascular coils due to high x-ray attenuation of the devices. To circumvent this challenge, we propose to investigate whether flow changes in the parent artery distal to the coil-embolized IAs could be used to achieve the same accuracy of surgical outcome prognosis. METHODS Eighty digital subtraction angiography sequences were acquired from patients with IA embolized with coils. Five API parameters were recorded from a region of interest (ROI) placed distal to the IA neck in the main artery. Average API values were recorded and pre-treatment values. A supervised machine learning algorithm was trained to provide a six-month post procedure binary outcome (occluded/not occluded). Receiver operating characteristic (ROC) analysis was used to assess the accuracy of the method. RESULTS Use of API parameters with data driven methods yielded an area under the ROC curve of 0.77 ±0.11 and accuracy of 78.6%. Single parameter-based analysis yielded accuracies which were suboptimal for clinical acceptance. CONCLUSIONS We determined that data-driven method based on API analysis of flow in the parent artery of IA treated with coils provide clinically acceptable accuracy for the prognosis of six months occlusion outcome.
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Affiliation(s)
- Alexander G Wisniewski
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
| | - Kelsey N Sommer
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- QAS.AI Incorporated, Buffalo NY 14203
| | - Andre Monteiro
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Ammad Baig
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
| | - Jason Davies
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
- University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Adnan Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- University Dept. of Biomedical Informatics, University at Buffalo, Buffalo, NY 14214
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY 14228
- Canon Stroke and Vascular Research Center, Buffalo, NY 14203
- University at Buffalo Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY 14228
- QAS.AI Incorporated, Buffalo NY 14203
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Mazzacane F, Mazzoleni V, Scola E, Mancini S, Lombardo I, Busto G, Rognone E, Pichiecchio A, Padovani A, Morotti A, Fainardi E. Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases. Diagnostics (Basel) 2022; 12:diagnostics12020258. [PMID: 35204348 PMCID: PMC8871392 DOI: 10.3390/diagnostics12020258] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.
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Affiliation(s)
- Federico Mazzacane
- Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Mazzoleni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Sara Mancini
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Ivano Lombardo
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Elisa Rognone
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
- Correspondence:
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Zuurbier CCM, Molenberg R, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, Jääskeläinen JE, Koivisto T, Yamazaki T, Uyttenboogaart M, van Dijk JMC, Aalbers MW, Morita A, Tominari S, Arai H, Nozaki K, Murayama Y, Ishibashi T, Takao H, Gondar R, Bijlenga P, Rinkel GJE, Greving JP, Ruigrok YM. Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis. Stroke 2022; 53:362-369. [PMID: 34983236 PMCID: PMC8785514 DOI: 10.1161/strokeaha.121.035187] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: In previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture. Methods: We searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage. Results: We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89–1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58–0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07–1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02–1.90). Conclusions: Women have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.
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Affiliation(s)
- Charlotte C M Zuurbier
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Rob Molenberg
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Liselore A Mensing
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Finland (S.J.)
| | - Antti E Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Juha E Jääskeläinen
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Timo Koivisto
- Department of Clinical Radiology, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Neurosurgery of NeuroCenter, Kuopio University Hospital, Finland. (A.E.L, J.E.J., T.K.).,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.)
| | - Maarten Uyttenboogaart
- Department of Neurology and Medical Imaging Center, University Medical Center Groningen, the Netherlands. (M.U.)
| | - J Marc C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Marlien W Aalbers
- Department of Neurosurgery, University Medical Center Groningen, the Netherlands. (R.M., J.M.C.v.D., M.W.A.)
| | - Akio Morita
- Medical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.)
| | - Shinjiro Tominari
- Department of Health Informatics, School of Public Health, Kyoto University, Japan (S.T.)
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University- Medical School, Tokyo, Japan (H.A.)
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Japan (K.N.)
| | - Yuichi Murayama
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Toshihiro Ishibashi
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Hiroyuki Takao
- Department of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.)
| | - Renato Gondar
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.)
| | - Gabriel J E Rinkel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands. (J.P.G.)
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands. (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.)
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Ivantsits M, Goubergrits L, Kuhnigk JM, Huellebrand M, Bruening J, Kossen T, Pfahringer B, Schaller J, Spuler A, Kuehne T, Jia Y, Li X, Shit S, Menze B, Su Z, Ma J, Nie Z, Jain K, Liu Y, Lin Y, Hennemuth A. Detection and analysis of cerebral aneurysms based on X-ray rotational angiography - the CADA 2020 challenge. Med Image Anal 2021; 77:102333. [PMID: 34998111 DOI: 10.1016/j.media.2021.102333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/12/2021] [Accepted: 12/07/2021] [Indexed: 01/10/2023]
Abstract
The Cerebral Aneurysm Detection and Analysis (CADA) challenge was organized to support the development and benchmarking of algorithms for detecting, analyzing, and risk assessment of cerebral aneurysms in X-ray rotational angiography (3DRA) images. 109 anonymized 3DRA datasets were provided for training, and 22 additional datasets were used to test the algorithmic solutions. Cerebral aneurysm detection was assessed using the F2 score based on recall and precision, and the fit of the delivered bounding box was assessed using the distance to the aneurysm. The segmentation quality was measured using the Jaccard index and a combination of different surface distance measures. Systematic errors were analyzed using volume correlation and bias. Rupture risk assessment was evaluated using the F2 score. 158 participants from 22 countries registered for the CADA challenge. The U-Net-based detection solutions presented by the community show similar accuracy compared to experts (F2 score 0.92), with a small number of missed aneurysms with diameters smaller than 3.5 mm. In addition, the delineation of these structures, based on U-Net variations, is excellent, with a Jaccard score of 0.92. The rupture risk estimation methods achieved an F2 score of 0.71. The performance of the detection and segmentation solutions is equivalent to that of human experts. The best results are obtained in rupture risk estimation by combining different image-based, morphological, and computational fluid dynamic parameters using machine learning methods. Furthermore, we evaluated the best methods pipeline, from detecting and delineating the vessel dilations to estimating the risk of rupture. The chain of these methods achieves an F2-score of 0.70, which is comparable to applying the risk prediction to the ground-truth delineation (0.71).
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Affiliation(s)
- Matthias Ivantsits
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany.
| | - Leonid Goubergrits
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; Einstein Center Digital Future, Wilhelmstrae 67, Berlin 10117, Germany
| | | | - Markus Huellebrand
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; Fraunhofer MEVIS, Am Fallturm 1, Bremen 28359, Germany
| | - Jan Bruening
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany
| | - Tabea Kossen
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany
| | - Boris Pfahringer
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany
| | - Jens Schaller
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany
| | - Andreas Spuler
- Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, Berlin 13125, Germany
| | - Titus Kuehne
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; German Heart Centre Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Yizhuan Jia
- Mediclouds Medical Technology, Beijing, China
| | - Xuesong Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China
| | - Suprosanna Shit
- Departments of Informatics, Technical University Munich, Germany; TranslaTUM Center for Translational Cancer Research, Munich, Germany
| | - Bjoern Menze
- Departments of Informatics, Technical University Munich, Germany; TranslaTUM Center for Translational Cancer Research, Munich, Germany; Department of Quantitative Biomedicine of UZH, Zurich, Switzerland
| | - Ziyu Su
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China
| | - Jun Ma
- Department of Mathematics, Nanjing University of Science and Technology, Nanjing, China
| | - Ziwei Nie
- Department of Mathematics, Nanjing University, Nanjing, China
| | - Kartik Jain
- Faculty of Engineering Technology, University of Twente, P.O. Box 217, Enschede 7500, AE, the Netherlands
| | - Yanfei Liu
- Jarvis Lab, Tencent, Shenzhen, China; Shenzhen United Imaging Research Institute of Innovative Medical Equipment Innovation Research, Shenzhen, China
| | - Yi Lin
- Jarvis Lab, Tencent, Shenzhen, China
| | - Anja Hennemuth
- Charit Universittsmedizin Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; Fraunhofer MEVIS, Am Fallturm 1, Bremen 28359, Germany; German Heart Centre Berlin, Augustenburger Pl. 1, Berlin 13353, Germany; DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Acosta JM, Cayron AF, Dupuy N, Pelli G, Foglia B, Haemmerli J, Allémann E, Bijlenga P, Kwak BR, Morel S. Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness. Front Cardiovasc Med 2021; 8:775307. [PMID: 34957259 PMCID: PMC8692777 DOI: 10.3389/fcvm.2021.775307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The circle of Willis is a network of arteries allowing blood supply to the brain. Bulging of these arteries leads to formation of intracranial aneurysm (IA). Subarachnoid hemorrhage (SAH) due to IA rupture is among the leading causes of disability in the western world. The formation and rupture of IAs is a complex pathological process not completely understood. In the present study, we have precisely measured aneurysmal wall thickness and its uniformity on histological sections and investigated for associations between IA wall thickness/uniformity and commonly admitted risk factors for IA rupture. Methods: Fifty-five aneurysm domes were obtained at the Geneva University Hospitals during microsurgery after clipping of the IA neck. Samples were embedded in paraffin, sectioned and stained with hematoxylin-eosin to measure IA wall thickness. The mean, minimum, and maximum wall thickness as well as thickness uniformity was measured for each IA. Clinical data related to IA characteristics (ruptured or unruptured, vascular location, maximum dome diameter, neck size, bottleneck factor, aspect and morphology), and patient characteristics [age, smoking, hypertension, sex, ethnicity, previous SAH, positive family history for IA/SAH, presence of multiple IAs and diagnosis of polycystic kidney disease (PKD)] were collected. Results: We found positive correlations between maximum dome diameter or neck size and IA wall thickness and thickness uniformity. PKD patients had thinner IA walls. No associations were found between smoking, hypertension, sex, IA multiplicity, rupture status or vascular location, and IA wall thickness. No correlation was found between patient age and IA wall thickness. The group of IAs with non-uniform wall thickness contained more ruptured IAs, women and patients harboring multiple IAs. Finally, PHASES and ELAPSS scores were positively correlated with higher IA wall heterogeneity. Conclusion: Among our patient and aneurysm characteristics of interest, maximum dome diameter, neck size and PKD were the three factors having the most significant impact on IA wall thickness and thickness uniformity. Moreover, wall thickness heterogeneity was more observed in ruptured IAs, in women and in patients with multiple IAs. Advanced medical imaging allowing in vivo measurement of IA wall thickness would certainly improve personalized management of the disease and patient care.
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Affiliation(s)
- Jason M. Acosta
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne F. Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Nicolas Dupuy
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Graziano Pelli
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Foglia
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Haemmerli
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R. Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Sandrine Morel
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39
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Zuurbier CCM, Mensing LA, Wermer MJH, Juvela S, Lindgren AE, Koivisto T, Jääskeläinen JE, Yamazaki T, Molenberg R, van Dijk JMC, Uyttenboogaart M, Aalbers M, Morita A, Tominari S, Arai H, Nozaki K, Murayama Y, Ishibashi T, Takao H, Rinkel GJE, Greving JP, Ruigrok YM. Difference in Rupture Risk Between Familial and Sporadic Intracranial Aneurysms: An Individual Patient Data Meta-analysis. Neurology 2021; 97:e2195-e2203. [PMID: 34670818 DOI: 10.1212/wnl.0000000000012885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We combined individual patient data (IPD) from prospective cohorts of patients with unruptured intracranial aneurysms (UIAs) to assess to what extent patients with familial UIA have a higher rupture risk than those with sporadic UIA. METHODS For this IPD meta-analysis, we performed an Embase and PubMed search for studies published up to December 1, 2020. We included studies that (1) had a prospective study design; (2) included 50 or more patients with UIA; (3) studied the natural course of UIA and risk factors for aneurysm rupture including family history for aneurysmal subarachnoid haemorrhage and UIA; and (4) had aneurysm rupture as an outcome. Cohorts with available IPD were included. All studies included patients with newly diagnosed UIA visiting one of the study centers. The primary outcome was aneurysmal rupture. Patients with polycystic kidney disease and moyamoya disease were excluded. We compared rupture rates of familial vs sporadic UIA using a Cox proportional hazard regression model adjusted for PHASES score and smoking. We performed 2 analyses: (1) only studies defining first-degree relatives as parents, children, and siblings and (2) all studies, including those in which first-degree relatives are defined as only parents and children, but not siblings. RESULTS We pooled IPD from 8 cohorts with a low and moderate risk of bias. First-degree relatives were defined as parents, siblings, and children in 6 cohorts (29% Dutch, 55% Finnish, 15% Japanese), totaling 2,297 patients (17% familial, 399 patients) with 3,089 UIAs and 7,301 person-years follow-up. Rupture occurred in 10 familial cases (rupture rate: 0.89%/person-year; 95% confidence interval [CI] 0.45-1.59) and 41 sporadic cases (0.66%/person-year; 95% CI 0.48-0.89); adjusted hazard ratio (HR) for familial cases 2.56 (95% CI 1.18-5.56). After adding the 2 cohorts excluding siblings as first-degree relatives, resulting in 9,511 patients, the adjusted HR was 1.44 (95% CI 0.86-2.40). DISCUSSION The risk of rupture of UIA is 2.5 times higher, with a range from a 1.2 to 5 times higher risk, in familial than in sporadic UIA. When assessing the risk of rupture in UIA, family history should be taken into account.
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Affiliation(s)
- Charlotte C M Zuurbier
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Liselore A Mensing
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Marieke J H Wermer
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Seppo Juvela
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Antti E Lindgren
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Timo Koivisto
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Juha E Jääskeläinen
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Tomosato Yamazaki
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Rob Molenberg
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - J Marc C van Dijk
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Maarten Uyttenboogaart
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Marlien Aalbers
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Akio Morita
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Shinjiro Tominari
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Hajime Arai
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Kazuhiko Nozaki
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Yuichi Murayama
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Toshihiro Ishibashi
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Hiroyuki Takao
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Gabriel J E Rinkel
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Jacoba P Greving
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan
| | - Ynte M Ruigrok
- From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan.
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Kancheva AK, Velthuis BK, Ruigrok YM. Imaging markers of intracranial aneurysm development: A systematic review. J Neuroradiol 2021; 49:219-224. [PMID: 34634299 DOI: 10.1016/j.neurad.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imaging markers of intracranial aneurysm (IA) development are not well established. PURPOSE To provide an overview of imaging markers of IA development. METHODS A systematic search of PubMed and Embase up to December 1st 2020 using predefined criteria. Thirty-six studies met our inclusion criteria. We performed a quantitative summary of the included studies. RESULTS We found converging evidence for A1 segment asymmetry as an anatomical marker of anterior communicating artery (Acom) aneurysm development, and moderate evidence for several other markers. No hemodynamic markers yielded converging or moderate evidence. There was large heterogeneity across studies, especially in the definitions of imaging markers and study outcomes used. Due to the poor methodological quality of many studies and unavailability of effect sizes or crude data to calculate effect sizes, a formal meta-analysis was not possible. Many studies had poor methodological quality and varied inmarkerdefinitions and outcome measuresused, which prevented us from performing a formal meta-analysis. CONCLUSIONS We only identified A1 segment asymmetry as an imaging marker of Acom aneurysm development with converging evidence. A meta-analysis was not possible due to the heterogeneity of marker definitions and outcomes used, and poor methodological quality of many studies. Future studies should use robust study designs and uniformly defined imaging markers and outcome measures.
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Affiliation(s)
- Angelina K Kancheva
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Ynte M Ruigrok
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands
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Swiatek VM, Neyazi B, Roa JA, Zanaty M, Samaniego EA, Ishii D, Lu Y, Sandalcioglu IE, Saalfeld S, Berg P, Hasan DM. Aneurysm Wall Enhancement Is Associated With Decreased Intrasaccular IL-10 and Morphological Features of Instability. Neurosurgery 2021; 89:664-671. [PMID: 34245147 PMCID: PMC8578742 DOI: 10.1093/neuros/nyab249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-resolution vessel wall imaging plays an increasingly important role in assessing the risk of aneurysm rupture. OBJECTIVE To introduce an approach toward the validation of the wall enhancement as a direct surrogate parameter for aneurysm stability. METHODS A total of 19 patients harboring 22 incidental intracranial aneurysms were enrolled in this study. The aneurysms were dichotomized according to their aneurysm-to-pituitary stalk contrast ratio using a cutoff value of 0.5 (nonenhancing < 0.5; enhancing ≥ 0.5). We evaluated the association of aneurysm wall enhancement with morphological characteristics, hemodynamic features, and inflammatory chemokines directly measured inside the aneurysm. RESULTS Differences in plasma concentration of chemokines and inflammatory molecules, morphological, and hemodynamic parameters were analyzed using the Welch test or Mann-Whitney U test. The concentration ΔIL-10 in the lumen of intracranial aneurysms with low wall enhancement was significantly increased compared to aneurysms with strong aneurysm wall enhancement (P = .014). The analysis of morphological and hemodynamic parameters showed significantly increased values for aneurysm volume (P = .03), aneurysm area (P = .044), maximal diameter (P = .049), and nonsphericity index (P = .021) for intracranial aneurysms with strong aneurysm wall enhancement. None of the hemodynamic parameters reached statistical significance; however, the total viscous shear force computed over the region of low wall shear stress showed a strong tendency toward significance (P = .053). CONCLUSION Aneurysmal wall enhancement shows strong associations with decreased intrasaccular IL-10 and established morphological indicators of aneurysm instability.
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Affiliation(s)
- Vanessa M Swiatek
- Deparment of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Belal Neyazi
- Deparment of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Jorge A Roa
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Deparment of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mario Zanaty
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edgar A Samaniego
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Deparment of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Daizo Ishii
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Yongjun Lu
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - I Erol Sandalcioglu
- Deparment of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Sylvia Saalfeld
- Deparment of Simulation and Graphics, University of Magdeburg, Magdeburg, Saxony Anhalt, Germany
- Research Campus STIMULATE, Magdeburg, Saxony Anhalt, Germany
| | - Philipp Berg
- Research Campus STIMULATE, Magdeburg, Saxony Anhalt, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Saxony Anhalt, Germany
| | - David M Hasan
- Deparment of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Chen S, Mao J, Chen X, Li Z, Zhu Z, Li Y, Jiang Z, Zhao W, Wang Z, Zhong P, Huang Q. Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study. Front Aging Neurosci 2021; 13:716068. [PMID: 34483885 PMCID: PMC8415748 DOI: 10.3389/fnagi.2021.716068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: It has recently emerged the concept of “obesity paradox,” a term used to describe an inverse association between obesity and clinical outcomes in cardiovascular diseases and stroke. The purpose of this study was to investigate the association between body mass index (BMI) and the risk of intracranial aneurysm rupture. Methods: In this study, we conducted a retrospective analysis of a prospectively maintained database of patients with intracranial aneurysms from 21 medical centers in China. A total of 3,965 patients with 4,632 saccular intracranial aneurysms were enrolled. Patients were separated into unruptured (n = 1,977) and ruptured groups (n = 1,988). Univariable and multivariable logistic regression analyses were performed to determine the association between BMI and intracranial aneurysm rupture. Results: Compared to the patients with normal BMI (18.5 to < 24.0 kg/m2), the odds of intracranial aneurysm rupture were significantly lower in patients with BMI 24.0 to < 28.0 kg/m2 (OR = 0.745, 95% CI = 0.638–0.868, P = 0.000) and patients with BMI ≥ 28.0 kg/m2 (OR = 0.628, 95% CI = 0.443–0.890, P = 0.009). Low BMI (<18.0 kg/m2) was not associated with intracranial aneurysm rupture (OR = 0.894, 95% CI = 0.483–1.657, P = 0.505). For males, both the BMI 24.0 to < 28.0 kg/m2 (OR = 0.606, 95% CI = 0.469–0.784, P = 0.000) and the BMI ≥ 28.0 kg/m2 (OR = 0.384, 95% CI = 0.224–0.658, P = 0.001) were associated with a lower rupture risk, whereas the inverse association was not observed in females. Both the BMI 24.0 to < 28.0 kg/m2 (OR = 0.722 for aged 50–60y, 95% CI = 0.554–0.938, P = 0.015; OR = 0.737 for aged >60y, 95% CI = 0.586–0.928, P = 0.009) and the BMI ≥ 28.0 kg/m2 (OR = 0.517 for aged 50–60y, 95% CI = 0.281–0.950, P = 0.0034; OR = 0.535 for aged >60y, 95% CI = 0.318–0.899, P = 0.0018) was associated with a lower rupture risk in patients aged ≥50 years, whereas the association was not significant in patients aged <50 years. Conclusions: Increased BMI is significantly and inversely associated with saccular intracranial aneurysm rupture in males and patients aged ≥50 years.
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Affiliation(s)
- Sifang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jianyao Mao
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xi Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhangyu Li
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhi Zhu
- Department of Neurosurgery, Heze Municipal Hospital, Heze, China
| | - Yukui Li
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhengye Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wenpeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Neuroscience, School of Medicine, Institute of Neurosurgery, Xiamen University, Xiamen, China
| | - Ping Zhong
- BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Complex and continuous change in hypothetic risk of rupture of intracranial cerebral aneurysms – Bleb mandala –. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Wang J, Liu D, Zhang S. The relationship between staying up late and risk of intracranial aneurysm rupture: A single-center study. Neurochirurgie 2021; 68:156-162. [PMID: 34331965 DOI: 10.1016/j.neuchi.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of staying up late (SUL) on the risk of intracranial aneurysm (IA) rupture. METHODS This case-control study included 452 patients diagnosed with IA. They were divided into ruptured and unruptured groups. Staying up late was categorized in three levels (11-12 o'clock, 12-1 o'clock, after 1 o'clock) according to the time of falling asleep. To explore the relationship between staying up late and risk of IA rupture, univariate and multivariate logistic regression analyses were performed. RESULTS Multivariate analysis found a significant difference in the percentage of patients falling asleep at 12-1 o'clock (OR, 2.25; 95% CI, 1.10-4.59) or after 1 o'clock (OR, 4.68; 95% CI, 1.74-12.55) between the ruptured and unruptured groups. The following risk factors differed significantly between the two groups: hypertension (OR, 2.05; 95% CI, 1.33-3.17), current smoking (OR, 1.72; 95% CI, 1.09-2.71), irregular IA (OR, 1.85; 95% CI, 1.15-3.00), IA size ≥8mm (OR, 1.92; 95% CI, 1.22-3.02), MCA location (OR, 2.45; 95% CI, 1.19-5.02), and aspect ratio (OR, 1.33; 95% CI, 1.02-1.73). CONCLUSION Patients who fell asleep later than 12 midnight on average showed higher risk of IA rupture. The reasons for this are not very clear. A review of the literature suggests that this association may be related to a series of physiological, pathophysiological, endocrine and metabolic changes.
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Affiliation(s)
- J Wang
- Emergency Department, Beijing Jingmei Group General Hospital, 102300 Beijing, P.R. China.
| | - D Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, 100070 Beijing, P.R. China.
| | - S Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, 102300 Beijing, P.R. China.
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Zimny M, Kawlewska E, Hebda A, Wolański W, Ładziński P, Kaspera W. Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients. BMC Neurol 2021; 21:281. [PMID: 34281533 PMCID: PMC8287678 DOI: 10.1186/s12883-021-02251-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Previously published computational fluid dynamics (CFD) studies regarding intracranial aneurysm (IA) formation present conflicting results. Our study analysed the involvement of the combination of high wall shear stress (WSS) and a positive WSS gradient (WSSG) in IA formation. Methods We designed a case-control study with a selection of 38 patients with an unruptured middle cerebral artery (MCA) aneurysm and 39 non-aneurysmal controls to determine the involvement of WSS, oscillatory shear index (OSI), the WSSG and its absolute value (absWSSG) in aneurysm formation based on patient-specific CFD simulations using velocity profiles obtained from transcranial colour-coded sonography. Results Among the analysed parameters, only the WSSG had significantly higher values compared to the controls (11.05 vs − 14.76 [Pa/mm], P = 0.020). The WSS, absWSSG and OSI values were not significantly different between the analysed groups. Logistic regression analysis identified WSS and WSSG as significant co-predictors for MCA aneurysm formation, but only the WSSG turned out to be a significant independent prognosticator (OR: 1.009; 95% CI: 1.001–1.017; P = 0.025). Significantly more patients (23/38) in the case group had haemodynamic regions of high WSS combined with a positive WSSG near the bifurcation apex, while in the control group, high WSS was usually accompanied by a negative WSSG (14/39). From the analysis of the ROC curve for WSSG, the area under the curve (AUC) was 0.654, with the optimal cut-off value −0.37 Pa/mm. The largest AUC was recognised for combined WSS and WSSG (AUC = 0.671). Our data confirmed that aneurysms tend to form near the bifurcation apices in regions of high WSS values accompanied by positive WSSG. Conclusions The development of IAs is determined by an independent effect of haemodynamic factors. High WSS impacts MCA aneurysm formation, while a positive WSSG mainly promotes this process.
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Affiliation(s)
- Mikołaj Zimny
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
| | - Edyta Kawlewska
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Anna Hebda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
| | - Wojciech Kaspera
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland.
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Daou BJ, Muhlestein WE, Palmateer G, Thompson BG, Pandey AS. Clipping of unruptured intracranial aneurysms in patients older than sixty: An age-based analysis. Clin Neurol Neurosurg 2021; 207:106737. [PMID: 34134009 DOI: 10.1016/j.clineuro.2021.106737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The diagnosis of unruptured intracranial aneurysms (UIAs) is being made more frequently in elderly patients. The goal of this study is to evaluate complications and clinical outcome in patients ≥ 60 years-old who underwent clipping of UIAs. METHODS We performed a retrospective cohort study. Clinical outcome (modified Rankin scale score) was determined at the latest clinical follow-up. Complications and outcomes were compared between age groups (60-69, 70-80) and subgroups (60-64, 65-69, 70-74, and >75). RESULTS The study population consisted of 255 patients (range 60-80 years-old) who underwent 262 clipping procedures for UIAs. Mean follow-up duration was 15.6 months (± 27.5). Major complications occurred in 20 patients (7.6%) and mortality in 3 patients (1.1%). Medical complications occurred in 26 patients (10%). Mean length of hospital-stay was 4.7 days (± 5.8). 89.6% were discharged to home. 87.8% had a favorable clinical outcome. The 70-80 age group had significantly more complications (P = 0.03) than the 60-69 group and a significantly longer hospital stay (6.02 vs. 4.3 days, P = 0.04). The older group was less likely to discharge to home and more likely to require rehabilitation (P = 0.002). Favorable clinical outcome did not significantly differ between the two groups (85.7% vs. 88.4%, P = 0.56). There was a trend for increasing complications from the younger to older subgroups (P = 0.008) and a reduction in the likelihood to discharge to home (P < 0.0001). The rate of ultimate favorable clinical outcome did not differ significantly between subgroups (P = 0.79). CONCLUSION Although complications, length of hospital-stay, and discharge to non-home destinations increase with older age, the majority of patients ≥ 60 may have favorable clinical outcomes.
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Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Whitney E Muhlestein
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Gregory Palmateer
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States.
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Kwak Y, Son W, Kim YS, Park J, Kang DH. Discrepancy between MRA and DSA in identifying the shape of small intracranial aneurysms. J Neurosurg 2021; 134:1887-1893. [PMID: 32707543 DOI: 10.3171/2020.4.jns20128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors evaluated the sensitivity and accuracy of MRA in identifying the shape of small-sized unruptured intracranial aneurysms. METHODS Small (< 7 mm) unruptured intracranial aneurysms initially detected by MRA and confirmed by DSA between January 2017 and December 2018 were morphologically reviewed by neuroradiologists. Regularity or irregularity of aneurysm shape was analyzed by two independent reviewers using MRA without DSA results. DSA findings served as the reference standard for aneurysm shape. Irregular shape, which in small aneurysms is associated with a higher likelihood of rupture, was defined as positive, and MRA sensitivity, specificity, and accuracy were determined by using evaluations based on location, size, and MRA magnetic strength (1.5T vs 3T MRA). Multivariate analysis was performed to determine risk factors for false-negative MRA results for irregularly shaped aneurysms. RESULTS In total, 652 unruptured intracranial aneurysms in 530 patients were reviewed for this study. For detecting aneurysm shape irregularity, the overall MRA sensitivity was 60.4% for reviewer 1 and 60.9% for reviewer 2. Anterior cerebral artery aneurysms had the lowest sensitivity for location (36.7% for reviewer 1, 46.9% for reviewer 2); aneurysms sized < 3 mm had the lowest sensitivity for size (26.7% for both reviewers); and 1.5T MRA had lower sensitivity and accuracy than 3T MRA. In multivariate analysis, location, size, and magnetic strength of MRA were independent risk factors for false-negative MRA results for irregularly shaped aneurysms. CONCLUSIONS MRA had a low sensitivity for detecting the irregular shape of small intracranial aneurysms. In particular, anterior cerebral artery location, aneurysm size < 3 mm, and detection with 1.5T MRA were associated with a higher risk of irregularly shaped aneurysms being misjudged as regular.
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Affiliation(s)
- Youngseok Kwak
- 1Department of Neurosurgery, School of Medicine, Catholic University of Daegu; and
| | | | - Yong-Sun Kim
- 3Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Liu J, Chen Y, Zhu D, Li Q, Chen Z, Zhou J, Lin B, Yang Y, Jia X. A nomogram to predict rupture risk of middle cerebral artery aneurysm. Neurol Sci 2021; 42:5289-5296. [PMID: 33860397 DOI: 10.1007/s10072-021-05255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Determining the rupture risk of unruptured intracranial aneurysm is crucial for treatment strategy. The purpose of this study was to predict the rupture risk of middle cerebral artery (MCA) aneurysms using a machine learning technique. METHODS We retrospectively reviewed 403 MCA aneurysms and randomly partitioned them into the training and testing datasets with a ratio of 8:2. A generalized linear model with logit link was developed using training dataset to predict the aneurysm rupture risk based on the clinical variables and morphological features manually measured from computed tomography angiography. To facilitate the clinical application, we further constructed an easy-to-use nomogram based on the developed model. RESULTS Ruptured MCA aneurysm had larger aneurysm size, aneurysm height, perpendicular height, aspect ratio, size ratio, bottleneck factor, and height-width ratio. Presence of a daughter-sac was more common in ruptured than in unruptured MCA aneurysms. Six features, including aneurysm multiplicity, lobulations, size ratio, bottleneck factor, height-width ratio, and aneurysm angle, were adopted in the model after feature selection. The model achieved a relatively good performance with areas under the receiver operating characteristic curves of 0.77 in the training dataset and 0.76 in the testing dataset. The nomogram provided a visual interpretation of our model, and the rupture risk probability of MCA aneurysms can be directly read from it. CONCLUSION Our model can be used to predict the rupture risk of MCA aneurysm.
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Affiliation(s)
- Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Dongqin Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Qiong Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Zhonggang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| | - Xiufen Jia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Giant Vertebrobasilar Fusiform Aneurysm Mass Effect Heralds Rapid in Situ Thrombosis and Ischemic Stroke in the Setting of Ulcerative Colitis. J Stroke Cerebrovasc Dis 2021; 30:105621. [PMID: 33581546 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Here we describe a case of brainstem infarction secondary to rapid thrombus formation in a giant vertebrobasilar fusiform aneurysm (GVBFA) that was preceded clinically by several months of headaches and dizziness initially attributable to mass effect. Less than a month after initial identification of the aneurysm, a large partially-occluding thrombus formed leading to infarction of the brainstem. Interestingly, this patient also had ulcerative colitis, which has been associated with acquired hypercoagulability. Balancing risk versus benefit in the management of GVBFA to prevent morbidity and mortality is very challenging; thus more information is needed to better stratify treatment options for patients, particularly those that may have an accelerating clinical course or co-morbidities that increase clotting risk.
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Ruigrok YM. Management of Unruptured Cerebral Aneurysms and Arteriovenous Malformations. Continuum (Minneap Minn) 2020; 26:478-498. [PMID: 32224762 DOI: 10.1212/con.0000000000000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Unruptured intracranial aneurysms and brain arteriovenous malformations (AVMs) may be detected as incidental findings on cranial imaging. This article provides a practical approach to the management of unruptured intracranial aneurysms and unruptured brain AVMs and reviews the risk of rupture, risk factors for rupture, preventive treatment options with their associated risks, and the approach of treatment versus observation for both types of vascular malformations. RECENT FINDINGS For unruptured intracranial aneurysms, scoring systems on the risk of rupture can help with choosing preventive treatment or observation with follow-up imaging. Although the literature provides detailed information on the complication risks of preventive treatment of unruptured intracranial aneurysms, individualized predictions of these procedural complication risks are not yet available. With observation with imaging, growth of unruptured intracranial aneurysms can be monitored, and prediction scores for growth can help determine the optimal timing of monitoring. The past years have revealed more about the risk of complications of the different treatment modalities for brain AVMs. A randomized clinical trial and prospective follow-up data have shown that preventive interventional therapy in patients with brain AVMs is associated with a higher rate of neurologic morbidity and mortality compared with observation. SUMMARY The risk of hemorrhage from both unruptured intracranial aneurysms and brain AVMs varies depending on the number of risk factors associated with hemorrhage. For both types of vascular malformations, different preventive treatment options are available, and all carry risks of complications. For unruptured intracranial aneurysms, the consideration of preventive treatment versus observation is complex, and several factors should be included in the decision making. Overall, it is recommended that patients with unruptured asymptomatic brain AVMs should be observed.
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