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Rilianto B, Prasetyo BT, Kurniawan RG, Gotama KT, Windiani PR, Arham A, Kusdiansah M. Clinical and Morphological Factors for Ruptured Anterior Communicating Artery Aneurysms. Vasc Health Risk Manag 2023; 19:371-377. [PMID: 37408543 PMCID: PMC10319283 DOI: 10.2147/vhrm.s415213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction The anterior communicating artery (ACoA) aneurysm, the most frequent cerebral aneurysm to rupture, carries a significant clinical burden, yet the factors influencing its rupture are limited in Indonesia. This study aims to determine the clinical and morphological features associated with ruptured ACoA compared to non-AcoA aneurysms among Indonesians. Patients and Methods We retrospectively reviewed our center's aneurysm patient registry from January 2019 to December 2022, and compared the clinical and morphological features between ruptured ACoA aneurysms and ruptured aneurysms elsewhere with univariate and multivariate analyses. Results Of the 292 patients with 325 ruptured aneurysms, 89 were from ACoA. The mean age of patients was 54.99 years, with female preponderance in the non-ACoA group (non-ACoA: 73.31%, ACoA: 46.07%). On univariate analysis, ages ≥60 [ages 60-69: OR = 0.311 (0.111-0.869), p=0.026; ages ≥70: OR = 0.215 (0.056-0.819), p=0.024], female gender [OR = 0.311 (0.182-0.533), p<0.001], and smoking [OR=2.069 (1.036-4.057), p=0.022] exhibited significant association with ruptured ACoA aneurysm. On multivariate analysis, only the female gender was independently associated with ruptured ACoA aneurysm (aOR 0.355 [0.436-1.961], p=0.001). Conclusion In our study, ruptured ACoA aneurysm was inversely associated with advanced age, female gender, presence of daughter aneurysm, and directly associated with smoking. After multivariate adjustment, the female gender showed an independent association with ruptured ACoA aneurysm.
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Affiliation(s)
- Beny Rilianto
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bambang Tri Prasetyo
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ricky Gusanto Kurniawan
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Kelvin Theandro Gotama
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Pratiwi Raissa Windiani
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Abrar Arham
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Neurosurgery Department, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Neurosurgery Department, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
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Luckrajh JS, Harrichandparsad R, Satyapal KS, Lazarus L. A clinical investigation of the anatomy of the proximal anterior cerebral artery and its association with anterior communicating artery aneurysm. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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Zhang J, Lai PMR, Can A, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Tobacco use and age are associated with different morphologic features of anterior communicating artery aneurysms. Sci Rep 2021; 11:4791. [PMID: 33637879 PMCID: PMC7910488 DOI: 10.1038/s41598-021-84315-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
We present a cohort of patients with anterior communicating artery (ACoA) aneurysms to investigate morphological characteristics and clinical factors associated with rupture of the aneurysms. 505 patients with ACoA aneurysms were identified at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016, with available CT angiography (CTA). Three-dimensional (3D) reconstructions were performed to evaluate aneurysmal morphologic features, including location, projection, irregularity, the presence of daughter dome, height, height/width ratio, and relationships between surrounding vessels. Patient risk factors assessed included patient age, sex, tobacco use, alcohol use, and family history of aneurysms and aneurysmal subarachnoid hemorrhage. Logistic regression was used to build a predictive ACoA score for rupture. Morphologic features associated with ruptured ACoA aneurysms were the presence of a daughter dome (OR 21.4, 95% CI 10.6-43.1), smaller neck diameter (OR 0.55, 95% CI 0.42-0.71), larger aspect ratio (OR 3.57, 95% CI 2.05-6.24), larger flow angle (OR 1.03, 95% CI 1.02-1.05), and smaller ipsilateral A2-ACoA angle (OR 0.98, 95% CI 0.97-1.00). Tobacco use was predominantly associated with morphological factors intrinsic to the aneurysm that were associated with rupture while younger age was also associated with morphologic features extrinsic to the aneurysm that were associated with rupture. The ACoA score had good predictive capacity for rupture with AUC = 0.92 using the 0.632 bootstrap cross-validation for correction of overfitting bias. Ruptured ACoA aneurysms were associated with morphological features that are simple to assess using a simple scoring system. Tobacco use and younger age were predominantly associated with intrinsic and extrinsic morphological features characteristic of rupture, respectively.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Victor M Castro
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA
- Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Impact of smoking on course and outcome of aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2020; 162:3117-3128. [PMID: 32728905 PMCID: PMC7593300 DOI: 10.1007/s00701-020-04506-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023]
Abstract
Background While the smoking-related risk of experiencing an aneurysmal subarachnoid hemorrhage (aSAH) is well established, it remains unclear whether smoking has an unexpected “protective effect” in aSAH, or if smokers are more at risk for complications and poor outcomes. Methods Prospective, observational study investigating the course and outcome of aSAH in patients admitted during the years 2011 and 2012. Smoking status at admittance, demographic, medical, and radiological variables were registered along with management, complications, and outcome at 1 year in terms of mortality, modified Rankin score, and Glasgow outcome score extended. We compared current smokers with nonsmokers on group level and by paired analysis matched by aSAH severity, age, and severity of vasospasm. Results We included 237 patients, thereof 138 current smokers (58.2%). Seventy-four smoker/nonsmoker pairs were matched. Smokers presented more often in poor clinical grade, had less subarachnoid blood, and were younger than nonsmokers. Ruptured aneurysms were larger, and multiple aneurysms more common in smokers. Severe multi-vessel vasospasm was less frequent in smokers, whereas all other complications occurred at similar rates. Mortality at 30 days was lower in smokers and functional outcome was similar in smokers and nonsmokers. Poor clinical grade, age, cerebral infarction, and vertebrobasilar aneurysms were independent predictors of 1-year mortality and of poor functional outcome. Serious comorbidity was a predictor of 1-year mortality. Smoking did not predict mortality or poor functional outcome. Conclusions Notwithstanding clinically more severe aSAH, smokers developed less frequently severe vasospasm and had better outcome than expected. The risk for complications after aSAH is not increased in smokers.
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Chen Y, Xing H, Lin B, Zhou J, Ding S, Wan J, Yang Y, Pan Y, Zhao B. Morphological risk model assessing anterior communicating artery aneurysm rupture: Development and validation. Clin Neurol Neurosurg 2020; 197:106158. [PMID: 32836062 DOI: 10.1016/j.clineuro.2020.106158] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prediction of the rupture risk in anterior communicating artery (ACoA) aneurysms remains challenging. We aimed to investigate the association of detailed morphologies with ACoA aneurysm rupture. PATIENT AND METHODS 759 consecutive patients with ACoA aneurysms were identified from December 2007 to January 2016. An independent cohort was collected for validation from March 2017 to October 2019. Morphological parameters of the aneurysms were measured using CT angiography. Univariable and multivariable analyses were used to investigate the association of morphological characteristics with aneurysm rupture. Area under receiver operating characteristic curves (AUC) were used to assess the performance of the model. RESULTS A total of 650 patients with 650 ACoA aneurysms were included for the derivation, and 41 patients with 41 ACoA aneurysms were included for the validation. Aneurysm size, neck size, aspect ratio, size ratio, vessel angle, anterior projection, dominant A1 segment, irregular shape, the presence of a daughter dome, vessel size, and aneurysm angle were risk factors for rupture. The multivariable analysis showed that a larger aneurysm, anterior projection of aneurysms, dominant A1 segment, and irregular aneurysms were associated with aneurysm rupture, whereas larger vessel size was inversely associated with rupture. The morphological risk score showed good discrimination of ruptured and unruptured aneurysms with an AUC of 0.73 in the derivation and an AUC of 0.80 in the validation, and good calibration in both cohorts, signifying a good fit. CONCLUSION The morphological risk model may contribute to evaluating the risk of rupture of ACoA aneurysms.
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Affiliation(s)
- Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China; Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Haixia Xing
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Boli Lin
- 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
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Chen Y, Lin B, Zhou J, Chen L, Yang Y, Zhao B. Morphological predictors of middle cerebral artery bifurcation aneurysm rupture. Clin Neurol Neurosurg 2020; 192:105708. [PMID: 32058208 DOI: 10.1016/j.clineuro.2020.105708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/09/2020] [Accepted: 02/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Middle cerebral artery (MCA) bifurcation aneurysms are more likely to be associated with severe hemorrhage or hematoma in a clinical setting. We aimed to investigate the morphological predictors of MCA bifurcation aneurysm rupture. PATIENTS AND METHODS We conducted a retrospective analysis of 317 patients with MCA aneurysms between January 2009 and October 2016. Aneurysm status was grouped into ruptured and unruptured groups. The MCA bifurcation was defined as the bifurcation of the main trunk (the origin of the M2 trunks). Aneurysm morphologies were determined using CT angiography. We performed univariate and multivariable regression analyses to investigate the association of morphological characteristics with ruptured MCA bifurcation aneurysms. RESULTS A total of 268 (84.5 %) patients with 280 MCA bifurcation aneurysms were included. 207 (73.9 %) aneurysms had ruptured. In the univariate analysis, a larger aneurysm (p = 0.042), a larger size ratio (p = 0.001), a larger aspect ratio (p = 0.017), a greater bottleneck ratio (p = 0.047), an irregular aneurysm (p = 0.004) and the presence of a daughter dome (p = 0.002) were associated with aneurysm rupture. The multivariate analysis showed that a larger size ratio (OR 1.324, 95 % CI, 1.062-1.651; p = 0.013) and the presence of daughter dome (OR 2.462, 95 % CI, 1.123-5.398; p = 0.024) were independently associated with ruptured aneurysms. The threshold of the size ratio for discriminating ruptured and unruptured aneurysms was 2.53 (p < 0.001). CONCLUSIONS The size ratio and the presence of a daughter dome were independent predictors of the rupture of MCA bifurcation aneurysms. These parameters may contribute to the evaluation of the risk of rupture of aneurysms.
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Affiliation(s)
- Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China; Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Boli Lin
- 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
| | - Lifang Chen
- 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.
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Xu L, Wang H, Chen Y, Dai Y, Lin B, Liang F, Wan J, Yang Y, Zhao B. Morphological and Hemodynamic Factors Associated with Ruptured Middle Cerebral Artery Mirror Aneurysms: A Retrospective Study. World Neurosurg 2020; 137:e138-e143. [PMID: 32004740 DOI: 10.1016/j.wneu.2020.01.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mirror intracranial aneurysms with different rupture status is a useful model to investigate features associated with aneurysm rupture. Morphological and hemodynamic analyses of ruptured middle cerebral artery (MCA) mirror aneurysms are rarely reported. The purpose of this study was to determine the morphological or hemodynamic characteristics associated with ruptured MCA mirror aneurysms. METHODS We performed a retrospective analysis of consecutive 317 patients with MCA aneurysms. Ruptured MCA mirror aneurysms (1 ruptured and mirror unruptured aneurysm) were included. In the matched pairs of ruptured and unruptured mirror aneurysms, 13 morphological parameters were measured using 3-dimensional computed tomography angiography and 6 hemodynamic parameters were evaluated using high-resolution computational fluid dynamic simulations. The association of morphological and hemodynamic characteristics with the rupture of MCA mirror aneurysms was determined. RESULTS A total of 20 (6.31%) patients with 40 MCA mirror aneurysms were included in this study. There were significant differences in morphological and hemodynamic parameters between the ruptured and unruptured mirror aneurysms. Irregular aneurysms were 3 times more common in the ruptured aneurysms than in the unruptured aneurysms. A larger aneurysm (P = 0.025), a higher aneurysm (P = 0.020), a larger size ratio (P = 0.009), a higher bottleneck ratio (P = 0.033), an irregular aneurysm (P = 0.022), a higher maximum intra-aneurysmal wall shear stress (WSS; P = 0.020), and a lower normalized average WSS (P = 0.008) were associated with MCA mirror aneurysm rupture. CONCLUSIONS Larger aneurysms, a larger size ratio, irregular aneurysms, a lower spatial average WSS, and a higher maximum WSS may contribute to evaluating the risk of rupture of MCA aneurysms independent of patient characteristics.
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Affiliation(s)
- Lijian Xu
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuchen Dai
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Role of bioclimate conditions on cerebral aneurysm rupture in the Brittany region of France. Neurochirurgie 2019; 66:9-15. [PMID: 31836487 DOI: 10.1016/j.neuchi.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/30/2019] [Accepted: 11/03/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Subarachnoid hemorrhage (SAH) from intracranial aneurysm rupture is an unpredictable event responsible for significant morbidity and mortality. Despite inconsistencies, some studies suggest a potential role of climate conditions in SAH onset. The purpose of this study was to determine the impact of climatic and lunar factors on onset of SAH in an oceanic climate such as that of Brittany, France. METHODS All adults with SAH admitted to the neurosurgery department and intensive care unit of the University Hospital of Rennes (France) between January 1st, 2011 and December 31st, 2012 were included. Meteorological variables, their variations, lunar phases and tidal coefficients were compared between days with and without SAH. RESULTS We retrospectively included 295 patients with SAH. Mean minimum temperature was significantly lower during days with SAH (7.7±4.7°C versus 8.3±4.6°C; P=0.039); temperature variation between 2 successive days was significantly greater for days with SAH (8.6±4.1°C versus 7.9±3.8°C; P<0.01). Multivariate analysis showed that a 2-day temperature drop greater than or equal to 8°C was associated with 35% increased risk of SAH (odds ratio 1.35 [1.03-1.77]). There were no significant effects of other meteorological variables, lunar phase or tidal coefficient on SAH occurrence. CONCLUSION Low temperature and sudden temperature drop were associated with increased occurrence of SAH in Brittany, France.
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Zhao B, Xing H, Fan L, Tan X, Zhong M, Pan Y, Wan J. Endovascular Coiling versus Surgical Clipping of Very Small Ruptured Anterior Communicating Artery Aneurysms. World Neurosurg 2019; 126:e1246-e1250. [DOI: 10.1016/j.wneu.2019.03.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022]
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Liu J, Chen Y, Lan L, Lin B, Chen W, Wang M, Li R, Yang Y, Zhao B, Hu Z, Duan Y. Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network. Eur Radiol 2018; 28:3268-3275. [DOI: 10.1007/s00330-017-5300-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/22/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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Bifurcation Location and Growth of Aneurysm Size Are Significantly Associated with an Irregular Shape of Unruptured Intracranial Aneurysms. World Neurosurg 2017; 107:255-262. [PMID: 28735142 DOI: 10.1016/j.wneu.2017.07.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies firmly proved that an irregular aneurysmal shape was associated strongly with intracranial aneurysm (IA) rupture, but it is unclear how irregularly shaped IAs form. We aimed to identify the factors related to irregular shape of IAs. METHODS We retrospectively analyzed of consecutive patients evaluated or treated for IA at our institution from June 2015 to July 2016. According to the imaging morphology of aneurysm, the enrolled patients were divided into irregular and regular group. Demographic data and imaging data of the 2 groups were compared to identify the factors related to aneurismal irregular shape. RESULTS There were 429 aneurysms (180 irregular and 249 regular aneurysms), including 315 unruptured aneurysms and 114 ruptured aneurysms. Most unruptured aneurysms occurred in the internal carotid arteries (53.3%), anterior communicating artery (10.8%), and posterior communicating artery (10.8%), anterior cerebral artery (5.4%), middle cerebral artery (9.8%), and posterior circulation (9.8%). In univariate analysis, for unruptured aneurysm, irregular aneurysmal shape was significantly related to aneurysm size (P = 0.009), aspect ratio (P = 0.003), size ratio (P = 0.002), and location at the bifurcation (P = 0.009) but not with smoking status, hypertension, hyperlipidemia, or diabetes mellitus. In multivariate logistic analysis, irregular aneurysms occurred mainly in unruptured aneurysms with a larger size (diameter ≥5 mm; odds ratio [OR] 2.106; 95% confidence interval [CI] 1.183-3.749; P = 0.011); location at a bifurcation (OR 2.017; 95% CI 1.191-3.413; P = 0.006), and aspect ratio (≥0.8; OR 4.992; 95% CI 1.318-18.915; P = 0.018). CONCLUSIONS Location at a bifurcation, an increased aneurysm size, and greater aspect ratio are significant independent factors associated with an irregular shape in unruptured IAs but not with smoking status, hypertension, hyperlipidemia, or diabetes mellitus.
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Elderly age associated with poor functional outcome after rupture of anterior communicating artery aneurysms. J Clin Neurosci 2016; 34:108-111. [PMID: 27436764 DOI: 10.1016/j.jocn.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/15/2016] [Indexed: 11/20/2022]
Abstract
The effect of age on patient outcomes after rupture of the anterior communicating artery (Acom) aneurysms is not well-defined. We performed a retrospective cohort study of patients presenting to our institution with a ruptured Acom aneurysm between 2003 and 2012. Patients were divided into two groups on the basis of age at presentation, with patients 65years and older categorized as the elderly group. The effect of elderly age on patient outcomes was then evaluated using multivariate logistic regression analysis. There were 147 patients presenting with a ruptured Acom aneurysm. Of these, 41 (27.9%) were 65years or older. Patients in the elderly group were more likely to be female (68.3% vs. 40.6%, p=0.0026), and less likely to be active smokers (22.0% vs. 60.4%, p<0.0001) or to abuse alcohol (7.3% vs. 21.7%, p=0.0404). Elderly patients were more likely to have a history of hypertension (70.7% vs. 52.8%, p=0.0487) and coronary artery disease (19.5% vs. 2.8%, p=0.0006). Elderly patients were more likely to require a ventriculostomy (61.0% vs. 37.7%, p=0.0109) and ultimately to require permanent cerebrospinal fluid diversion (36.6% vs. 17.0%, p=0.0106). On adjusted analysis, age 65 years or older was associated with a greater likelihood of poor outcome at last follow-up within 1year of aneurysmal subarachnoid hemorrhage (odds ratio=3.76, 95% confidence interval: 1.30-11.78, p=0.0144). Our results suggest that elderly age is an independent risk factor for poor functional outcome after rupture of an Acom aneurysm.
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Lin B, Chen W, Ruan L, Chen Y, Zhong M, Zhuge Q, Fan LH, Zhao B, Yang Y. Sex differences in aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery aneurysms: a retrospective study. BMJ Open 2016; 6:e009920. [PMID: 27084272 PMCID: PMC4838700 DOI: 10.1136/bmjopen-2015-009920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Ruptured anterior communicating artery (ACoA) aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in aneurysm morphologies and clinical outcomes in patients with ruptured ACoA aneurysms. SETTING A tertiary referral hospital. PARTICIPANTS A total of 574 consecutive patients with ACoA aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA aneurysms were included in the study. MAIN OUTCOME MEASURES Aneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge. RESULTS The aneurysm sizes (p=0.001), aneurysm heights (p=0.011), size ratios (p<0.001), flow angles (p=0.047) and vessel angles (p=0.046) were larger in the male patients than in the females. The female patients more often had larger vessel sizes (p=0.002). Multivariate logistic analysis revealed that significant differences in aneurysm morphologies between men and women were aneurysm size (OR 1.1, 95% CI 1.0 to 1.3; p=0.036), aneurysm height (OR 0.8, 95% CI 0. to 0.9; p=0.006) and size ratio (OR 1.4, 95% CI 0.5 to 1.7; p=0.001). There were no statistically significant differences in the outcomes between men and women (OR 1.0, 95% CI 0.6 to 1.7, p=0.857). CONCLUSIONS The men were independently associated with larger aneurysm sizes, greater aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA aneurysms.
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Affiliation(s)
- Boli Lin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weijian Chen
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Ruan
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ming Zhong
- Department of Neurosurgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Neurosurgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Liang Hao Fan
- Department of Neurosurgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bing Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yunjun Yang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
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Fan L, Lin B, Xu T, Xia N, Shao X, Tan X, Zhong M, Yang Y, Zhao B. Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms. J Neurointerv Surg 2016; 9:370-375. [DOI: 10.1136/neurintsurg-2016-012335] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/06/2016] [Accepted: 03/12/2016] [Indexed: 11/03/2022]
Abstract
BackgroundIntraprocedural rupture and thrombus formation are serious complications during coiling of ruptured intracranial aneurysms, and they more often occur in patients with anterior communicating artery (ACoA) aneurysms.ObjectiveTo identify independent predictors of intraprocedural rupture and thrombus formation during coiling of ruptured ACoA aneurysms.MethodsBetween January 2008 and February 2015, 254 consecutive patients with 255 ACoA aneurysms were treated with coiling. We retrospectively reviewed intraoperative angiograms and medical records to identify intraprocedural rupture and thrombus formation, and re-measured aneurysm morphologies using CT angiography images. Multivariate logistic regression models were used to determine independent predictors of intraprocedural rupture and thrombus formation.ResultsOf the 231 patients included, intraprocedural rupture occurred in 10 (4.3%) patients, and thrombus formation occurred in 15 (6.5%) patients. Patients with smaller aneurysms more often experienced intraprocedural rupture than those with larger aneurysms (3.5±1.3 mm vs 5.7±2.3 mm). Multivariate analysis showed that smaller ruptured aneurysms (p=0.003) were independently associated with intraprocedural rupture. The threshold of aneurysm size separating rupture and non-rupture groups was 3.5 mm. Multivariate analysis showed that a history of hypertension (p=0.033), aneurysm neck size (p=0.004), and parent vessel angle (p=0.023) were independent predictors of thrombus formation. The threshold of parent vessel angle separating thrombus and non-thrombus groups was 60.0°.ConclusionsRuptured aneurysms <3.5 mm were associated with an increased risk of intraprocedural rupture, and parent vessel angle <60.0°, wider-neck aneurysms, and a history of hypertension were associated with increased risk of thrombus formation during coiling of ruptured ACoA aneurysms.
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Xu T, Lin B, Liu S, Shao X, Xia N, Zhang Y, Xu H, Yang Y, Zhong M, Zhuge Q, Zhao B, Chen W. Larger size ratio associated with the rupture of very small (≤3 mm) anterior communicating artery aneurysms. J Neurointerv Surg 2016; 9:278-282. [DOI: 10.1136/neurintsurg-2016-012294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/03/2022]
Abstract
BackgroundAnterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.MethodsWe conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.ResultsOf the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.ConclusionsAbout one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.
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