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Arrambide-Garza FJ, Alvarez-Lozada LA, de León-Gutiérrez H, Villarreal-Silva EE, Alvarez-Villalobos NA, Quiroga-Garza A, Elizondo-Omaña RE, Guzman-Lopez S. Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 231:107815. [PMID: 37301004 DOI: 10.1016/j.clineuro.2023.107815] [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: 03/07/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The morbidity and mortality of intracranial aneurysm rupture motivate the risk evaluation of the patient´s characteristics and aneurysm's morphology. Brain vessel variants lead to hemodynamic changes that could increase risk. This study aims to evaluate the fetal posterior cerebral artery (fPCA) as a risk factor for the formation, rupture, and recurrence of the posterior communicating artery (PComA) aneurysm. METHODS A search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE databases for studies that evaluated the risk of appearance, rupture, and recurrence of PComA aneurysms with the presence of fPCA. Newcastle-Ottawa Scale and AXIS were used for quality assessment. The primary and secondary outcomes were evaluated and interpreted with an odds ratio (OR) and their 95% confidence intervals (CI). RESULTS A total of 577 articles were reviewed. Thirteen studies were included for the qualitative analysis, and ten studies for the meta-analysis. All cohort studies were classified as poor quality, and all cross-sectional studies with moderate risk. The unadjusted OR resulted in 1.57 (n = 6, 95% CI 1.13-2.19, p = <0.001, I2 =0%) between the presence of fPCA and PComA aneurysm rupture. CONCLUSION There is a significant association of aneurysm formation and rupture of PComA aneurysms in the presence of fPCA. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall.
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Affiliation(s)
| | | | - Humberto de León-Gutiérrez
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico.
| | | | - Neri Alejandro Alvarez-Villalobos
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, United States.
| | - Alejandro Quiroga-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano del Seguro Social, Delegación Nuevo Leon, Monterrey, Mexico.
| | | | - Santos Guzman-Lopez
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico.
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Kaya V, Tahtabasi M, Yıldırım İO. Risk factors for the rupture of anterior communicating artery aneurysms: Coexistence of fetal-type posterior cerebral artery and A1 segment hypoplasia/agenesis. J Clin Neurosci 2023; 110:74-79. [PMID: 36822073 DOI: 10.1016/j.jocn.2023.02.008] [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: 12/18/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the effect of the coexistence of fetal-type posterior communicating artery (fPCA) and anterior cerebral artery (ACA) A1 segment agenesis/hypoplasia on the rupture of an anterior communicating artery (AComA) aneurysm. MATERIALS AND METHODS A total of 216 patients consecutively presenting with AComA aneurysms between January 2014 and December 2021 on digital subtraction angiography were evaluated. Patients without three-dimensional rotational angiography images, those aged under 18 years, those with suspected mycotic aneurysms, and those with dissecting and giant aneurysms were excluded from the study. The aneurysms were divided into two groups as ruptured and non-ruptured. Hemodynamic filling patterns were classified into four different types. RESULTS The study included 192 AComA aneurysms, 44.8% (n = 86) ruptured and 55.2% (n = 106) non-ruptured. According to hemodynamic filling patterns, in type 1, the frequency of non-ruptured aneurysms was statistically significantly higher than that of ruptured aneurysms (39.5% vs 18.9%; p = 0.001). In type 4, where fPCA and ACA A1 segment agenesis/hypoplasia coexists, the frequency of ruptured aneurysms was significantly higher than that of non-ruptured aneurysms (10.5% vs 22.7%; p = 0.026). The most common aneurysm size range was 4-7 mm (n = 85; 44.3%). There was no statistically significant difference in size between the ruptured and non-ruptured aneurysms (p = 0.627). CONCLUSION According to the hemodynamic filling classification, we observed that the presence of type 4 filling pattern, i.e., the coexistence of ACA A1 segment agenesis/hypoplasia and fPCA, increased the risk of rupture in AComA aneurysms.
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Affiliation(s)
- Veysel Kaya
- Department of Radiology, Harran University-Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences- Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey.
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Feng L, Mao HJ, Zhang DD, Zhu YC, Han F. Anatomical variations in the Circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis. Front Neurol 2023; 13:1098950. [PMID: 36726753 PMCID: PMC9885143 DOI: 10.3389/fneur.2022.1098950] [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: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background The anterior (AcomA) and posterior communicating arteries (PcomA) are two of the most frequent sites for intracranial aneurysms. Anatomical variations in the Circle of Willis (COW) are frequently observed in patients with AcomA and PcomA aneurysms. Strong evidence is needed to determine the pooled estimate of the effect of COW variations on the formation and rupture of these aneurysms. Aim This systematic review and meta-analysis aimed to establish the effect of COW variations on the formation and rupture of AcomA and PcomA aneurysms using available studies. Summary of review PubMed, Embase, and Web of Science databases were systematically searched for studies published in English before September 21, 2022. Studies investigating AcomA aneurysms and the hypoplastic/aplastic A1 segment of the anterior cerebral artery and PcomA aneurysms and hypoplastic/aplastic PcomA or fetal-type posterior cerebral artery (FTP) were included. The heterogeneity of the studies was assessed using Cochran Q-test and I2 statistic. Pooled estimate was assessed using either a random- or fixed-effects model based on the heterogeneity of the studies. Among the 4,932 studies, 21 were eligible and included in the analysis. The presence of hypoplastic/aplastic A1 was significantly correlated with the formation [OR (95% confidence interval [CI]) = 7.97 (5.58, 11.39), P < 0.001] and rupture [OR (95%CI) = 1.87 (1.29, 2.72), P < 0.001] of AcomA aneurysms. Significant associations between FTP and both the formation [OR (95%CI) = 2.15 (1.41, 3.30), P < 0.001] and rupture [OR (95%CI) = 1.72 (1.26, 2.36), P < 0.001] of PcomA aneurysms were observed. Conclusions Significant associations were observed between COW variations and both the formation and rupture of AcomA and PcomA aneurysms. This can help in determining interventions for patients with aneurysms. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149, identifier: CRD42021225149.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He-Jiao Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Fei Han ✉
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4
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Lee HJ, Choi JH, Lee KS, Kim BS, Shin YS. Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign. J Neurosurg 2022; 137:329-334. [PMID: 34920434 DOI: 10.3171/2021.9.jns211848] [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: 07/29/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. METHODS Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics. RESULTS The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591-16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412-12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288-11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131-9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis. CONCLUSIONS This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.
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Affiliation(s)
| | | | | | - Bum Soo Kim
- 2Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
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Wei H, Tian Q, Yao K, Wang J, He P, Guo Y, Han W, Gao W, Li M. Different Hemodynamic Characteristics and Resulting in Different Risks of Rupture Between Wide-Neck and Narrow-Neck Aneurysms. Front Neurol 2022; 13:868652. [PMID: 35547381 PMCID: PMC9082944 DOI: 10.3389/fneur.2022.868652] [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: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This study aimed to determine the ruptured rate and hemodynamic difference between wide-neck aneurysms (WNAs) and narrow-neck aneurysms (NNAs), as well as the hemodynamic parameters of risk factors for aneurysm rupture. Methods A total of 121 cases of intracranial aneurysms (IAs) were studied retrospectively between January 2019 and April 2021 at Renmin Hospital of Wuhan University. Intracranial aneurysms were classified into four types: ruptured wide-neck aneurysms (RWNAs), unruptured wide-neck aneurysms (UWNAs), ruptured narrow-neck aneurysms (RNNAs), and unruptured narrow-neck aneurysms (UNNAs). The Chi-square test was used to compare differences in rupture ratios. The clinical characteristics and hemodynamics were analyzed statistically to reveal the rupture risk factors. Moreover, significant parameters were subjected to binary logistic regression analysis to identify the independent predictive factors. The receiver operating characteristic (ROC) curve was performed to obtain cutoff values. Results WNAs ruptured more frequently than NNAs (P = 0.033). Ruptured intracranial aneurysms (RIAs) were characterized by significantly higher intra-aneurysmal pressure (IAP), wall shear stress (WSS), wall shear stress gradient (WSSG), and lower normalized wall shear stress (NWSS) than unruptured intracranial aneurysms (UIAs). RWNAs had higher IAP, WSS, and lower NWSS than UWNAs (P < 0.05). RNNAs had higher IAP, Streamwise WSSG and lower NWSS compared to UNNAs (P < 0.05). Binary logistic regression revealed that IAP and WSS were independent predictive risk factors for WNAs rupture, with cut-off values of 405.5 and 6.66 Pa, respectively. Also, IAP was an independent predictive risk factor for NNA rupture, with a cut-off value of 255.3 Pa. Conclusions Wide-neck aneurysms and narrow-neck aneurysms have diverse hemodynamics, which prompts a higher rupture ratio for WNAs. IAP could characterize the rupture risk in both WNAs and NNAs independently, but WSS could only predict the rupture risk in WNAs. This research might assist neurosurgeons with fostering a more sensible strategy for the treatment of IAs.
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Affiliation(s)
- Heng Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qi Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kun Yao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, China
| | - Jianfeng Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peibang He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yujia Guo
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenrui Han
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenhong Gao
- Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Rai AT, Turner RC, Brotman RG, Boo S. Comparison of operating room variables, radiation exposure and implant costs for WEB versus stent assisted coiling for treatment of wide neck bifurcation aneurysms. Interv Neuroradiol 2021; 27:465-472. [PMID: 33076746 PMCID: PMC8392778 DOI: 10.1177/1591019920965392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The WEB device offers another option for treating wide neck bifurcation aneurysms (WNBA). The objective was to compare procedure variables, radiation and implant cost between WEB and stent assisted coiling (SAC) for WNBA. METHODS A retrospective comparison of similarly sized WNBA treated with SAC or WEB over 5-years was performed. The operating room (arrival-departure), anesthesia (intubation-extubation), procedure duration (puncture-closure), fluoroscopy time and radiation dose(m-Gy) were recorded from the patients' charts. Implant cost per case of all implants (stents, coils, WEB) that were opened whether deployed or not was captured including any coils used in the WEB cases. The implant cost represented the true cost incurred by the institution. RESULTS There were 46 WEB and 41 SAC cases with no significant difference in aneurysm size. There were more MCA and ACOMM (p = 0.005) and more ruptured aneurysms (p = 0.02) in the WEB group. Regarding procedure variables (hours:minutes): Operating room time WEB 2:31 (±0:37) versus SAC 3:41 (±0:50) (p < 0.0001); anesthesia duration WEB 2:05 (±0:31) versus SAC 3:13 (±0:51) (p < 0.0001) and procedure duration WEB 1:16 (±0:29) versus SAC 2:09 (±0:46) (p < 0.0001). Regarding radiation: Fluoroscopy time WEB 0:34 (±0:18) versus SAC 1:06 (±0:35) (p < 0.0001) and radiation dose WEB 2392(±1086)m-Gy versus SAC 3442 (±1528)m-Gy (p = 0.0007). The implant cost was $17,028(±$5,527) for the WEB versus $23,813 (±$7,456) for the SAC group (p < 0.0001). CONCLUSION The WEB group had significantly shorter operating room, procedure and anesthesia duration compared to the SAC group. The radiation dose and fluoroscopy time was lower for the WEB group. The total implant cost per case was significantly lower for the WEB versus the SAC group.
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Affiliation(s)
- Ansaar T Rai
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Ryan C Turner
- Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ryan G Brotman
- Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA
| | - SoHyun Boo
- Interventional Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, School of Medicine, Morgantown, WV, USA
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Kim MJ, Chung J, Park KY, Kim DJ, Kim BM, Suh SH, Lee JW, Huh SK, Kim YB, Joo JY, Son NH, Jang CK. Recurrence and risk factors of posterior communicating artery aneurysms after endovascular treatment. Acta Neurochir (Wien) 2021; 163:2319-2326. [PMID: 34143318 DOI: 10.1007/s00701-021-04881-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) of posterior communicating artery aneurysms (PcomA) is challenging because of posterior communicating artery (Pcom) architecture. Additionally, these aneurysms have a high risk of recanalization compared with those located elsewhere. METHODS The radiographic findings of 171 patients treated with EVT at two institutions were retrospectively reviewed. Univariate and multivariate analyses were performed, and subgroup analyses were performed based on Pcom characteristics. RESULTS Recanalization of PcomAs occurred in 53 patients (30.9%). Seven patients (4.0%) were retreated (six endovascularly and one with microsurgical clipping). The mean follow-up duration was 27.7 months (range: 3.5-78.6). The maximum diameter (odds ratio [OR] 1.23, P = .006, 95% CI 1.07-1.44), a Raymond-Roy classification of grade II or III (OR 2.26, P = .03, 95% CI 1.08-4.82), and the presence of reinforcement (balloon or/and stent, OR 0.44, P = .03, 95% CI 0.20-0.91) were associated with recanalization using multivariate logistic regression. Significant differences were found in maximum aneurysm diameter (P = .03) between normal- and fetal-type Pcoms on analysis of variance. CONCLUSIONS The recanalization rate of PcomAs after EVT was 30.9%; the retreatment rate was 4.0%. Maximum diameter, Raymond-Roy classification, and presence of reinforcement were significantly associated with recanalization but not associated with fetal-type Pcom. Aneurysm size was larger in patients with a fetal-type Pcom than in those with a normal Pcom. Pcom size was not related to recanalization rate.
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Lee HJ, Choi JH, Shin YS, Lee KS, Kim BS. Risk Factors for the Recurrence of Posterior Communicating Artery Aneurysm: The Significance of Fetal-Type Posterior Cerebral artery. J Stroke Cerebrovasc Dis 2021; 30:105821. [PMID: 33915389 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/27/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. MATERIALS AND METHODS The clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. RESULTS Of 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087-1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179-6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330-10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999-11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373-9.089, p = 0.009) were significantly associated with recurrence after treatment. CONCLUSIONS The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.
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Affiliation(s)
- Hyeong Jin Lee
- Department of Neurosurgery, Chuncheon Army Hospital, Chuncheon, Gangwon, South Korea.
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Kwan Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South 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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Epidemiologic and anatomic aspects comparing incidental and ruptured intracranial aneurysms: A single centre experience. J Clin Neurosci 2020; 81:151-157. [PMID: 33222906 DOI: 10.1016/j.jocn.2020.09.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/30/2023]
Abstract
The feasibility of multicentric international data such as integrated in the PHASES score for patient counseling in unruptured intracranial aneurysms has recently been challenged. To determine, whether this data is applicable to local populations in a restricted catchment area, we performed a retrospective mono-centric analysis comparing patients with ruptured aneurysms to patients with incidental aneurysms. 200 patients with unruptured aneurysms and 197 patients after aneurysmal subarachnoid hemorrhage were analyzed for risk factors differing between the groups and to the general German population. Subgroup analysis was performed for 25 patients harboring multiple aneurysms, in 19 patients with intracavernous aneurysms and in 77 women of childbearing potential. While the preponderance of female patients was confirmed, significantly more men figured in the patient group with subarachnoid hemorrhage (36.4%) than among unruptured aneurysms (25%). Patients with bleeding events were significantly younger (51.6 years) than patients with incidental aneurysms (57.8 years). The rupture risk prediction of the PHASES score concerning aneurysm size below 7 mm and patient age over 70 years could not be confirmed, instead score points correlated to the clinical outcome after rupture. In our population, pregnant women were not overrepresented. Intracavernous carotid aneurysms contributed to the low risk profile of giant aneurysms. Thus, recommendations from pooled international data have to be adapted cautiously to local circumstances. We retained seven items with predictive value for outpatient counseling: age, smoking, hypertonus and concurrent vascular aberrations as patient characteristics and irregular shape, (increasing) largest diameter and the harboring vessel for the aneurysm.
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