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Zeng C, Wang J. Risk factors for intraoperative in-stent thrombosis during stent-assisted coiling of paraclinoid aneurysms. Front Neurol 2024; 14:1333075. [PMID: 38283676 PMCID: PMC10811721 DOI: 10.3389/fneur.2023.1333075] [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: 11/04/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives To identify independent risk factors for intraoperative in-stent thrombosis (IST) in paraclinoid aneurysms (PAs). Methods 172 PA patents undergoing stent-assisted coiling (SAC) were divided into an IST group (n = 12) and a non-IST group (n = 160). Clinical characteristics, aneurysm morphologies, and laboratory parameters were measured. We performed independent t tests (for normally distributed data) or non-parametric tests (for non-normally distributed data) to compare continuous parameters. Multivariate logistic regression analysis with a stepwise forward method was conducted to determine independent risk factors. Receiver operating characteristic curves were generated, and the Delong test was employed for comparisons. Results Independent risk factors for IST included size ratio (SR) (p < 0.001, odds ratio [OR] = 3.909, confidence interval [CI] = 1.925-7.939), adenosine diphosphate (ADP) inhibition (p = 0.028, OR = 0.967, CI = 0.938-0.996), and reaction time (R) (p = 0.006, OR = 0.326, CI = 0.147-0.725). The combined factors (SR, ADP inhibition, and R) exhibited area under the curves of 0.870, 0.720, 0.716, and 0.697, with cutoff values of 2.46, 69.90%, and 4.65, respectively. Conclusion The SR, ADP inhibition, and R values were independent risk factors for the IST in the PAs undergoing SAC. For PAs with a large SR, surgeons could prepare for long-term dual antiplatelet therapy before SAC.
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Affiliation(s)
- Chun Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Wang
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
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Shigematsu H, Yokota K, Hirayama A, Sorimachi T. Frequency and Characteristics of Paraclinoid Aneurysm in Ruptured Cerebral Aneurysms. J Korean Neurosurg Soc 2024; 67:22-30. [PMID: 37454677 PMCID: PMC10788556 DOI: 10.3340/jkns.2023.0059] [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: 03/20/2023] [Revised: 05/16/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE This study aimed to determine the frequency of paraclinoid aneurysms among ruptured cerebral aneurysms and compare paraclinoid aneurysms with other aneurysms to clarify the characteristics of ruptured paraclinoid aneurysms. METHODS This study included 970 ruptured cerebral aneurysms treated at our hospital between 2003 and 2020. RESULTS There were 15 cases (1.3%) of paraclinoid aneurysms with maximum diameters of 5-22 mm (mean±standard deviation [SD], 11.6±5.4 mm). Treatment consisted of clipping in four patients and endovascular treatment in 11. Factors significantly different in multivariate analysis for paraclinoid aneurysms compared with those for other aneurysms were a history of hypertension (odds ratio [OR], 1.2-9.8; p=0.021) and aneurysm ≥10 mm (OR, 7.5-390.3; p<0.001). The sites of paraclinoid aneurysm were ophthalmic artery type in nine patients, anterior wall type in five, medial wall type in one, and ventral wall type in zero. The medial wall type (22 mm) was significantly larger than the ophthalmic artery type (mean±SD, 7.2±2.0 mm) (p=0.003), and the anterior wall type (mean±SD, 12.2±4.8 mm) was significantly larger than the ophthalmic artery type (p=0.024). CONCLUSION This study showed a low frequency of paraclinoid aneurysms among ruptured cerebral aneurysms. Most were upward-facing with relatively large aneurysms, and no aneurysms were smaller than 5 mm. With recent advances in endovascular treatment devices, paraclinoid aneurysms are easily treatable. However, the treatment indication of each paraclinoid aneurysm should be carefully considered.
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Affiliation(s)
- Hideaki Shigematsu
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Kazuma Yokota
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Akihiro Hirayama
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
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Hall S, Abouharb A, Anderson I, Bacon A, Bahl A, Brydon H, Dow G, Fouyas I, Galea J, Ghosh A, Gurusinghe N, Kamel M, Minhas P, Mitchell P, Mowle D, Mukerji N, Nair R, Norris J, Patel H, Patel J, Patel K, St George J, Teo M, Toma A, Trivedi R, Uff C, Visca A, Walsh DC, White E, Whitfield P, Bulters D. A survey of the radiological follow-up of unruptured intracranial aneurysms in the United Kingdom. Br J Neurosurg 2023; 37:163-169. [PMID: 34738491 DOI: 10.1080/02688697.2021.1995587] [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: 10/19/2022]
Abstract
OBJECTIVE Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom. METHODS A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods. RESULTS Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it. CONCLUSIONS There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.
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Affiliation(s)
- Samuel Hall
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Ashraf Abouharb
- Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Ian Anderson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Bacon
- Sheffield Centre for Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anuj Bahl
- Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Howard Brydon
- Department of Neurosurgery, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK
| | - Graham Dow
- Department of Neurosurgery, Queens Medical Centre, Nottingham, UK
| | - Ioannis Fouyas
- Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - James Galea
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Anthony Ghosh
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Nihal Gurusinghe
- Department of Neurourgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Pawan Minhas
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - David Mowle
- Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK
| | - Nitin Mukerji
- Department of Neurosurgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Ramesh Nair
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - John Norris
- Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Hiren Patel
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jash Patel
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Krunal Patel
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Mario Teo
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Toma
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chris Uff
- Department of Neurosurgery, Barts Health NHS Trust, London, UK
| | - Anna Visca
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Edward White
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Peter Whitfield
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Sahlein DH, Gibson D, Scott JA, DeNardo A, Amuluru K, Payner T, Rosenbaum-Halevi D, Kulwin C. Artificial intelligence aneurysm measurement tool finds growth in all aneurysms that ruptured during conservative management. J Neurointerv Surg 2022:jnis-2022-019339. [PMID: 36180207 DOI: 10.1136/jnis-2022-019339] [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: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cerebral aneurysm rupture is associated with high rates of morbidity and mortality. Detecting aneurysms at high risk of rupture is critical in management decision making. Rupture risk has traditionally been associated with size-measured as a maximum dimension. However, aneurysms are morphologically dynamic, a characteristic ignored by large prospective aneurysm risk studies. Manual measurement is challenging and fraught with error. We used an artificial intelligence (AI) measurement tool to study aneurysms that ruptured during conservative management to detect changes in size not appreciated by manual linear measurement. METHODS A single practice database with >5000 aneurysms was queried. Patients followed conservatively for an unruptured aneurysm were identified using appropriate diagnosis codes. This cohort was screened for subsequent rupture using procedure codes. Only patients with two vascular imaging studies before rupture were included. RESULTS Five patients met the criteria. All patients had aneurysm enlargement, two of which were not detected from manual linear measurements, including adjudication and analysis, during a multidisciplinary neurovascular conference in a high volume practice. Maximum dimension increased at a minimum of 1.8% (range 1.8-63.3%) from the first scan to the last, and aneurysm volume increased at a minimum of 5.9% (5.9-385.5%), highlighting the importance of volumetric measurement. CONCLUSIONS AI-enabled volumetric measurements are more sensitive to changes in size and detected enlargement in all aneurysms that ruptured during conservative management. This finding has major implications for clinical practice and methods used for interval aneurysm measurement in patients being conservatively followed.
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Affiliation(s)
- Daniel H Sahlein
- Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, Indiana, USA
| | - Daniel Gibson
- Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin, USA
| | - John A Scott
- Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, Indiana, USA
| | - Andrew DeNardo
- Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, Indiana, USA
| | - Krishna Amuluru
- Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, Indiana, USA
| | - Troy Payner
- Neurosurgery, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, IN, USA
| | - David Rosenbaum-Halevi
- Neurointerventional Radiology, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, Indiana, USA
| | - Charles Kulwin
- Neurosurgery, Goodman Campbell Brain and Spine at Ascension St. Vincent, Indianapolis, IN, USA
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Wang Y, Yu J. Endovascular treatment of aneurysms of the paraophthalmic segment of the internal carotid artery: Current status. Front Neurol 2022; 13:913704. [PMID: 36188411 PMCID: PMC9523143 DOI: 10.3389/fneur.2022.913704] [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: 04/06/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
The paraophthalmic segment of the internal carotid artery (ICA) originates from the distal border of the cavernous ICA and terminates at the posterior communicating artery. Aneurysms arising from the paraophthalmic segment represent ~5–10% of intradural aneurysms. Due to the advent of endovascular treatment (EVT) techniques, specifically flow-diverting stents (FDSs), EVT has become a good option for these aneurysms. A literature review on EVT for paraophthalmic segment aneurysms is necessary. In this review, we discuss the anatomy of the paraophthalmic segment, classification of the paraophthalmic segment aneurysms, EVT principle and techniques, and prognosis and complications. EVT techniques for paraophthalmic segment aneurysms include coil embolization, FDSs, covered stents, and Woven EndoBridge devices. Currently, coiling embolization remains the best choice for ruptured paraophthalmic segment aneurysms, especially to avoid long-term antiplatelet therapy for young patients. Due to the excessive use of antiplatelet therapy, unruptured paraophthalmic segment aneurysms that are easy to coil should not be treated with FDS. FDS is appropriate for uncoilable or failed aneurysms. Other devices cannot act as the primary choice but can be useful auxiliary tools. Both coiling embolization and FDS deployment can result in a good prognosis for paraophthalmic segment aneurysms. The overall complication rate is low. Therefore, EVT offers promising treatments for paraophthalmic segment aneurysms. In addition, surgical clipping continues to be a good choice for paraophthalmic segment aneurysms in the endovascular era.
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Tian Z, Li X, Wang C, Feng X, Sun K, Tu Y, Su H, Yang X, Duan C. Association Between Aneurysmal Hemodynamics and Rupture Risk of Unruptured Intracranial Aneurysms. Front Neurol 2022; 13:818335. [PMID: 35528737 PMCID: PMC9068966 DOI: 10.3389/fneur.2022.818335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Assessing rupture risk in patients with unruptured intracranial aneurysms (UIAs) remains challenging. Hemodynamics plays an important role in the natural history of intracranial aneurysms. This study aimed to compare aneurysmal hemodynamic features between patients with different rupture risk as determined by PHASES score. Methods We retrospectively examined 238 patients who harbored a solitary saccular UIA. Patients were stratified by rupture risk into low-, intermediate-, and high-risk groups according to PHASES score. Flow simulations were performed to compare differences in hemodynamics among the groups. Results Aneurysmal time-averaged wall shear stress (WSSa) and normalized WSS (WSSn) decreased progressively as PHASES score increased. WSSa and WSSn significantly differed among the low-, intermediate-, and high-risk groups (p < 0.001). WSSa was significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.004). WSSn was also significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.001). Conclusions Low WSS was significantly associated with higher risk of intracranial aneurysm rupture as determined by PHASES score, indicating that hemodynamics may play an important role in aneurysmal rupture. In the future, a multidimensional rupture risk prediction model that includes hemodynamic parameters should be investigated.
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Affiliation(s)
- Zhongbin Tian
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xifeng Li
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chao Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Xin Feng
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaijian Sun
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Tu
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hengxian Su
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chuanzhi Duan
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Han SW, Kim BJ, Kim TY, Lim SH, Youn DH, Hong EP, Rhim JK, Park JJ, Lee JJ, Cho YJ, Gaastra B, Galea I, Jeon JP. Association of Haptoglobin Phenotype With Neurological and Cognitive Outcomes in Patients With Subarachnoid Hemorrhage. Front Aging Neurosci 2022; 14:819628. [PMID: 35386117 PMCID: PMC8978790 DOI: 10.3389/fnagi.2022.819628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTo assess the association of haptoglobin (Hp) phenotype with neurological and cognitive outcomes in a large cohort of patients with subarachnoid hemorrhage (SAH).MethodsThis prospective multicenter study enrolled patients with aneurysmal SAH between May 2015 and September 2020. The Hp phenotype was confirmed via Western blots. The relative intensities of α1 in individuals carrying Hp2-1 were compared with those of albumin. Multivariable logistic and Cox proportional-hazard regression analyses were used to identify the risk factors for 6-month and long-term outcomes, respectively.ResultsA total of 336 patients including the phenotypes Hp1-1 (n = 31, 9.2%), Hp2-1 (n = 126, 37.5%), and Hp2-2 (n = 179, 53.3%) were analyzed. The Hp phenotype was closely associated with 6-month outcome (p = 0.001) and cognitive function (p = 0.013), and long-term outcome (p = 0.002) and cognitive function (p < 0.001). Compared with Hp1-1 as the reference value, Hp2-2 significantly increased the risk of 6-month poor outcome (OR: 7.868, 95% CI: 1.764–35.093) and cognitive impairment (OR: 8.056, 95% CI: 1.020–63.616), and long-term poor outcome (HR: 5.802, 95% CI: 1.795–18.754) and cognitive impairment (HR: 7.434, 95% CI: 2.264–24.409). Long-term cognitive impairment based on the Hp phenotype was significantly higher in patients under 65 years of age (p < 0.001) and female gender (p < 0.001). A lower relative α1/albumin intensity (OR: 0.010, 95% CI: 0.000–0.522) was associated with poor outcome at 6 months but not cognitive impairment in patients with SAH expressing Hp2-1.ConclusionHp2-2 increased the risk of poor neurological outcomes and cognitive impairment compared with Hp1-1. For Hp2-1, higher relative α1 intensities were related to 6-month favorable outcomes.
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Affiliation(s)
- Sung Woo Han
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Bong Jun Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Tae Yeon Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Seung Hyuk Lim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Dong Hyuk Youn
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Eun Pyo Hong
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jong Kook Rhim
- Department of Neurosurgery, Jeju National University School of Medicine, Jeju, South Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, South Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea
| | - Ben Gaastra
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea
- *Correspondence: Jin Pyeong Jeon,
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8
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Paraclinoid aneurysms: Outcome analysis and technical remarks of a microsurgical series. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Chandra RV, Maingard J, Slater LA, Cheung NK, Lai LT, Gall SL, Thrift AG, Phan TG. A Meta-Analysis of Rupture Risk for Intracranial Aneurysms 10 mm or Less in Size Selected for Conservative Management Without Repair. Front Neurol 2022; 12:743023. [PMID: 35250788 PMCID: PMC8893017 DOI: 10.3389/fneur.2021.743023] [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: 07/17/2021] [Accepted: 12/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Small unruptured intracranial aneurysms (UIAs) are considered to have low risk of rupture. The proportion of UIAs measuring 10 mm or less in size that rupture when selected for conservative management without repair is not well known. The aim of this study is to determine the proportion of UIAs that rupture by size threshold from ≤10 to ≤3 mm when selected for management without repair and to determine the level of precision and sources of heterogeneity in the rupture risk estimate. METHODS This study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019121522). The Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched (inception to August 2020). Studies with longitudinal follow-up of patients with UIAs ( ≤10 mm to ≤3 mm) without endovascular or neurosurgical repair were eligible. We included studies, which provided details of aneurysm size and in which UIA rupture was reported as an outcome. The primary outcome of the pooled proportion of UIA rupture during follow-up was synthesized with random-effects meta-analysis; heterogeneity was explored using meta-regression. RESULTS A total of 31 studies that included 13,800 UIAs ≤10 mm in size were eligible for data synthesis. The pooled proportion of ≤10 mm UIAs that ruptured when managed without repair was 1.1% (95% CI 0.8-1.5; I 2 = 52.9%) over 3.7 years. Findings were consistent in sensitivity analyses at all the size stratified thresholds including ≤5 and ≤3 mm; rupture occurred in 1.0% (95% CI 0.8-1.3; I 2 = 0%) of 7,280 ≤5 mm UIAs and 0.8% (95% CI 0.4-1.5; I 2 = 0%) of 1,228 ≤3 mm UIAs managed without repair. In higher quality studies with lower risk of bias, rupture occurred in 1.8% (95% CI 1.5-2.0; I 2 = 0%) over 3.9 years. In meta-regression, aneurysm size, shape, anatomical location, and exposure to prior subarachnoid hemorrhage were not identified as sources of heterogeneity. CONCLUSION For every 1,000 UIAs that are 10 mm or less in size and selected for conservative management without repair, between 8 and 15 UIAs are estimated to rupture over 3.7 years. When stratified by size, these pooled rupture risk estimates are consistent and clinically applicable for ≤5 mm UIAs selected for management without repair. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42019121522.
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Affiliation(s)
- Ronil V. Chandra
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian Maingard
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Nicholas K. Cheung
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Leon T. Lai
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Seana L. Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Amanda G. Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
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10
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Fine-mapping of intracranial aneurysm susceptibility based on a genome-wide association study. Sci Rep 2022; 12:2717. [PMID: 35177760 PMCID: PMC8854430 DOI: 10.1038/s41598-022-06755-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/04/2022] [Indexed: 12/22/2022] Open
Abstract
In addition to conventional genome-wide association studies (GWAS), a fine-mapping analysis is increasingly used to identify the genetic function of variants associated with disease susceptibilities. Here, we used a fine-mapping approach to evaluate candidate variants based on a previous GWAS involving patients with intracranial aneurysm (IA). A fine-mapping analysis was conducted based on the chromosomal data provided by a GWAS of 250 patients diagnosed with IA and 296 controls using posterior inclusion probability (PIP) and log10 transformed Bayes factor (log10BF). The narrow sense of heritability (h2) explained by each candidate variant was estimated. Subsequent gene expression and functional network analyses of candidate genes were used to calculate transcripts per million (TPM) values. Twenty single-nucleotide polymorphisms (SNPs) surpassed a genome-wide significance threshold for creditable evidence (log10BF > 6.1). Among them, four SNPs, rs75822236 (GBA; log10BF = 15.06), rs112859779 (TCF24; log10BF = 12.12), rs79134766 (OLFML2A; log10BF = 14.92), and rs371331393 (ARHGAP32; log10BF = 20.88) showed a completed PIP value in each chromosomal region, suggesting a higher probability of functional candidate variants associated with IA. On the contrary, these associations were not shown clearly under different replication sets. Our fine-mapping analysis suggested that four functional candidate variants of GBA, TCF24, OLFML2A, and ARHGAP32 were linked to IA susceptibility and pathogenesis. However, this approach could not completely replace replication sets based on large-scale data. Thus, caution is required when interpreting results of fine-mapping analysis.
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Rhim JK, Park JJ, Ahn JH, Kim HC, Na D, Chai CL, Jeon JP. Influence of renal impairment on neurologic outcomes following mechanical thrombectomy in acute vertebrobasilar stroke. Neuroradiology 2021; 64:807-815. [PMID: 34665269 DOI: 10.1007/s00234-021-02838-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Renal impairment (RI) has been regarded as a risk factor for unfavorable neurologic outcomes after mechanical thrombectomy (MT) in acute ischemic stroke. However, most of the previous studies were conducted on patients with anterior circulation stroke. Accordingly, the influence of RI on MT outcomes has not been well elucidated in detail in acute vertebrobasilar stroke. METHODS Consecutive stroke patients with MT due to acute vertebrobasilar artery occlusion between March 2015 and December 2020 at four institutions were included. Multivariable logistic regression analysis was conducted to assess the associations between RI and outcomes and mortality at 3 months, and the development of intracerebral hemorrhage (ICH) after the procedure. Additionally, the multivariable Cox proportional hazards model was performed to determine the influence of RI on survival probability after patient discharge. RESULTS A total of 110 patients were included in the final analysis. The presence of RI (OR = 0.268, 95% CI: 0.077-0.935), National Institute of Health Stroke Scale scores (OR = 0.849, 95% CI: 0.791-0.910), and puncture-to-recanalization time (OR = 0.981, 95% CI: 0.966-0.997) were related to outcomes. There was no significant association between RI and 3-month mortality or ICH. The cumulative survival probability after adjusting for relevant risk factors demonstrated that RI remained significantly associated with poorer survival after MT compared to patients without RI (HR = 2.111, 95% CI: 0.919-4.847). CONCLUSION RI was an independent risk factor for poor 3-month neurologic outcomes and survival probability after MT in patients with acute vertebrobasilar stroke.
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Affiliation(s)
- Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Doyoung Na
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Chung Liang Chai
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea.
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Wang GX, Liu LL, Yang Y, Wen L, Duan CM, Yin JB, Zhang D. Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography. Quant Imaging Med Surg 2021; 11:4115-4124. [PMID: 34476192 DOI: 10.21037/qims-21-32] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/13/2021] [Indexed: 11/06/2022]
Abstract
Background The progression of an unruptured intracranial aneurysm (UIA) is associated with a higher rupture risk. The aim of this study was to identify the risk factors for the progression of UIAs among Chinese adults and compare them with the ELAPSS (Earlier subarachnoid hemorrhage, IA Location, Age, Population, IA Size and Shape) score. Methods Four hundred thirty-eight consecutive patients with 491 UIAs were followed and reviewed retrospectively from August 2011 to November 2019. Follow-up images of the UIAs were used to determine changes in IA size and shape. Patients and IAs were divided into non-progression and progression groups. In addition to the clinical characteristics of the patients, the features of the IAs (e.g., size and shape) were evaluated by computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Independent risk factors for UIA progression were studied using multiple Cox proportional hazards regression analysis. In addition, the diagnostic value of the ELAPSS score for the prediction of UIA progression was calculated. Results Seventy-two IAs in 68 patients progressed during a mean follow-up time of 24.2±19.68 months. IAs located at the bifurcation [odds ratio (OR) 2.600], with an irregular shape (OR 2.981) or having a high aspect ratio (AR, OR 2.430) were correlated with progression. Based on these three factors, the threshold value of our predictive score was 0.5, and the area under the curve (AUC), sensitivity and specificity were 0.756, 93.1% and 40.6%, respectively, while the AUC, sensitivity and specificity of the ELAPSS score were 0.711, 55.6%, and 75.2%, respectively. Conclusions IAs located at the bifurcation, with an irregular shape and with an elevated AR are risk factors for UIA progression in the Chinese population. Our predictive score is of great value in predicting the risk of UIA progression.
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Affiliation(s)
- Guang-Xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lan-Lan Liu
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yan Yang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Chun-Mei Duan
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jin-Bo Yin
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Zheng J, Zhou R, Meng B, Li F, Liu H, Wu X. Knowledge framework and emerging trends in intracranial aneurysm magnetic resonance angiography: a scientometric analysis from 2004 to 2020. Quant Imaging Med Surg 2021; 11:1854-1869. [PMID: 33936970 DOI: 10.21037/qims-20-729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background As magnetic resonance angiography (MRA) has been increasingly used in the follow-up of intracranial aneurysms (IAs) as a non-invasive technique, the knowledge framework and areas of research interest in intracranial aneurysms magnetic resonance angiography (IAMRA) change approximately every 10 years. However, few studies have quantitatively analyzed the published literature in this field. In the present study, we used scientometrics to survey the knowledge field, development trends, and research focus of IAMRA with the aim of providing a reference for further study. Methods We collected articles on IAMRA published from 2004 (Jan 1, 2004) to 2020 (May 24, 2020). Web of Science Core Collection databases (WoSCCd) including the Science Citation Index Expanded were searched. An experienced staff member from the Department of Radiology at Southern Medical University, assisted in screening articles for relevant articles. We used ArcGIS (a mapping and location analytics platform) to perform geographic visualization. Excel 2016 was used to analyze the literature data, including number of publications, impact factor (IF), and publication year. CiteSpace V was used to conduct a series of literature feature clustering, including author co-citation analysis, reference co-citation analysis (RCA), and burst keywords analysis. Results A total of 1,272 articles on IAMRA published between 2004 and 2020 were included. Of 257 journals, American Journal of Neuroradiology (IF 2018: 3.256) published the most IAMRA articles (109 publications, 8.57%), followed by Journal of Neurosurgery (IF 2018: 4.131, 51 publications, 4.16%), and Neuroradiology (IF 2018: 2.504, 51 publications, 4.01%). Of 56 countries, the USA published the most, with 347 articles [27.28%, IF: 3.14 (average IF of all journals in the country)], followed by Japan (242 articles, 19.03%, IF: 2.38), Germany (135 articles, 10.61%, IF: 3.21), and China (101 articles, 7.94%, IF: 2.86). A total of 1387 institutions published articles, with the Mayo Clinic publishing the most (33 articles, 2.59%), followed by Shanghai Jiao Tong University (25 article, 1.97%), Seoul National University (23 articles, 1.81%), and University Medical Center Utrecht (19 articles, 1.49%). Of 399 authors, Rinkel ranked first with 19 articles, followed by Li MH (18 articles), Uchino A (15 articles), and Saito N (13 articles). Cluster RCA showed that the first cluster was "#0 growth", followed by "#1 Guglielmi detachable coils". Timeline views showed that the time span of "#0 growth" was the closest to today. The modularity value was 0.6971, and the mean silhouette value was 0.5477. According to the burst keyword analysis, "risk factors associated to rupture" was the topic with the strongest burst since 2017. Studies conducted in several countries suggested that age is inversely related to the risk of rupture, which implies the importance of MRA follow-up for patients of different age. Conclusions From 2004 to 2020, the number of published IAMRA-related articles gradually increased. The USA and Western Europe lead in the field, with a concentration of cutting-edge talents and high-level scientific research institutions. A synthesis of the clustering results of RCA and burst keyword analysis indicated that unruptured IA growth, stent-assisted coil embolization, and risk factors associated to rupture were the current hotspots in IAMRA research.
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Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Bingyao Meng
- Department of Radiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Furong Li
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
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Lee CH, Ahn C, Ryu H, Kang HS, Jeong SK, Jung KH. Clinical Factors Associated with the Risk of Intracranial Aneurysm Rupture in Autosomal Dominant Polycystic Kidney Disease. Cerebrovasc Dis 2021; 50:339-346. [PMID: 33706308 DOI: 10.1159/000513709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The occurrence of intracranial aneurysms is higher in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the healthy population. However, research concerning the factors related to the risk of intracranial aneurysm rupture in patients with ADPKD is still insufficient. OBJECTIVES The aim of the study was to investigate the prevalence of intracranial aneurysms and aneurysmal subarachnoid hemorrhage (SAH) and to analyze the systemic factors associated with high-risk aneurysms in patients with ADPKD. METHODS We screened patients who underwent cerebral angiography between January 2007 and May 2017 in the ADPKD registry. Patients were examined for the presence of intracranial aneurysms and subsequently reclassified into 3 groups based on the risk of aneurysmal rupture: the aneurysm-negative (group 1), low-risk aneurysm (group 2), or high-risk aneurysm (group 3). Various systemic factors were compared, and independent factors associated with high-risk aneurysms were analyzed. RESULTS Among the 926 patients, 148 (16.0%) had intracranial aneurysms and 11 (1.2%) had previous aneurysmal SAH. Patients with intracranial aneurysms were further classified into group 2 (low-risk aneurysms, 15.5%) or group 3 (high-risk aneurysms, 84.5%). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p = 0.004), female sex (OR 3.13, 95% CI 1.94-5.0 6, p < 0.001), dolichoectasia (OR 8.57, 95% CI 1.53-48.17, p = 0.015), and mitral inflow deceleration time (DT) (OR 1.01, 95% CI 1.00-1.01, p = 0.046) were independently associated with high-risk aneurysms, whereas hypercholesterolemia (OR 0.46, 95% CI 0.29-0.72, p = 0.001) was negatively associated. CONCLUSION In the present study among patients with ADPKD, the prevalence of intracranial aneurysms and aneurysmal SAH was 16 and 1.2%, respectively. Age, female sex, dolichoectasia, and mitral inflow DT were positively associated with high-risk aneurysms, whereas hypercholesterolemia was negatively associated. A subsequent large-scaled longitudinal study is needed to define the plausibility of the clinical parameters.
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Affiliation(s)
- Chan-Hyuk Lee
- Department of Neurology, Jeonbuk National University Hospital and Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Curie Ahn
- Department of Nephrology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunjin Ryu
- Department of Nephrology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seul-Ki Jeong
- Visual Intelligence Laboratory, Seul-Ki Jeong Neurology Clinic, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea,
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15
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Feng X, Tong X, Peng F, Niu H, Qi P, Lu J, Zhao Y, Jin W, Wu Z, Zhao Y, Liu A, Wang D. Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study. Stroke Vasc Neurol 2021; 6:433-440. [PMID: 33547231 PMCID: PMC8485246 DOI: 10.1136/svn-2020-000480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022] Open
Abstract
Background and purpose Approximately 15%–45% of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms (MIAs). Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients. This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients. Methods A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets. Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set. The discriminative accuracy, calibration performance and clinical usefulness of this nomogram were assessed. We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage (SAH) patients and compared its performance with the nomogram model. Results Multivariate analyses identified seven variables that were significantly associated with IA rupture (history of SAH, alcohol consumption, female sex, aspect ratio >1.5, posterior circulation, irregular shape and bifurcation location). The clinical and morphological-based MIAs (CMB-MIAs) nomogram model showed good calibration and discrimination (derivation set: area under the curve (AUC)=0.740 validation set: AUC=0.772). Decision curve analysis demonstrated that the nomogram was clinically useful. Compared with the nomogram model, the AUC of multivariate model developed from SAH patients had lower value of 0.730. Conclusions This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort. This nomogram could be used in decision-making and risk stratification in MIAs patients.
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Affiliation(s)
- Xin Feng
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Xin Tong
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Fei Peng
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Hao Niu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Peng Qi
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Jun Lu
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Yang Zhao
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Weitao Jin
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Zhongxue Wu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China
| | - Yuanli Zhao
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Aihua Liu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China .,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Daming Wang
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
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Risk of Rupture of Small Intracranial Aneurysms (≤5 mm) Among the Chinese Population. World Neurosurg 2020; 147:e275-e281. [PMID: 33326857 DOI: 10.1016/j.wneu.2020.12.034] [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: 09/25/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to develop a model to predict the risk of small intracranial aneurysm (SIA; ≤5 mm) rupture among Chinese adults and to compare the score predicted by our model with the PHASES (population, hypertension, age, size, earlier subarachnoid hemorrhage, aneurysm site) score. METHODS From August 2011 to June 2015, 366 patients with 394 SIAs were retrospectively evaluated and followed up for ≥5 years. The clinical characteristics of the patients were reviewed from their medical records, and the SIA features were evaluated from the imaging studies. The independent risk factors for SIA rupture were studied using multiple Cox proportional hazards regression analysis. The diagnostic value of the PHASES score for the prediction of SIA rupture was also calculated. RESULTS Six SIAs in 6 different patients had ruptured during a mean follow-up of 6.4 years. An irregular shape (odds ratio [OR], 31.464), a high aspect ratio (OR, 40.573), and a high size ratio (OR, 20.541) increased the risk of rupture. The predictive score incorporated these three factors. The threshold was 1.5, and the area under the curve, sensitivity, and specificity were 0.986, 100%, and 94.6%, respectively. For the PHASES score, the area under the curve, sensitivity, and specificity were 0.702, 83.3%, and 62.1%, respectively. CONCLUSIONS An irregular shape, a high aspect ratio, and a high size ratio were associated with SIA rupture in the Chinese population. Our predictive score is of great value in predicting the risk of SIA rupture.
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17
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Lee KS, Zhang JJY, Alalade AF, Vine R, Lanzino G, Park N, Roberts G, Gurusinghe NT. Radiological surveillance of small unruptured intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of 8428 aneurysms. Neurosurg Rev 2020; 44:2013-2023. [PMID: 33094423 DOI: 10.1007/s10143-020-01420-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/08/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
With the widespread use of imaging techniques, the possibility that an asymptomatic unruptured intracranial aneurysm (UIA) is detected has increased significantly. There is no established consensus regarding follow-up, duration, and frequency of such imaging surveillance. The objectives of this study include assessing the growth rate and rupture risk of small (less than 7mm) UIAs, identifying associated risk factors and providing an aneurysm surveillance protocol in appropriately selected patients. Systematic searches of Medline, Embase, and Cochrane Central were undertaken from database inception to March 2020 for published studies reporting the growth and rupture risks of small UIAs. Twenty-one studies reporting 8428 small UIAs were included in our meta-analysis. The pooled mean age was 61 years (95% CI: 55-67). The mean follow-up period for growth and rupture ranged from 11 to 108 months, with the pooled mean follow-up period across 14 studies being 42 months (95% CI: 33-51). Pooled overall growth rate was 6.0% (95% CI: 3.8-8.7). Pooled growth rates for aneurysms < 5mm and < 3 mm were 5.2% (95% CI: 3.0-7.9) and 0.8% (95% CI: 0.0-6.1), respectively. Pooled overall rupture rate was 0.4% (95% CI: 0.2-0.7). From the meta-regression analysis, having multiple aneurysms, smoking, hypertension, and personal history of SAH did not significantly predict growth, and a personal history of SAH, smoking, hypertension, and multiple aneurysms were not statistically significant predictors of rupture. Our findings suggest that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture. In the setting of incidental small UIAs, patients with multiple and/or posterior circulation aneurysms require more regular radiological monitoring.
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Affiliation(s)
- Keng Siang Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Folusho Alalade
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK.
| | - Roanna Vine
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Park
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK
| | - Gareth Roberts
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK
| | - Nihal T Gurusinghe
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR2 9HT, UK
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Molenberg R, Aalbers MW, Metzemaekers JDM, Mazuri A, Luijckx GJ, Groen RJM, Uyttenboogaart M, van Dijk JMC. Clinical relevance of short-term follow-up of unruptured intracranial aneurysms. Neurosurg Focus 2020; 47:E7. [PMID: 31261130 DOI: 10.3171/2019.4.focus1995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unruptured intracranial aneurysms are common incidental findings on brain imaging. Short-term follow-up for conservatively treated aneurysms is routinely performed in most cerebrovascular centers, although its clinical relevance remains unclear. In this study, the authors assessed the extent of growth as well as the rupture risk during short-term follow-up of conservatively treated unruptured intracranial aneurysms. In addition, the influence of patient-specific and aneurysm-specific factors on growth and rupture risk was investigated. METHODS The authors queried their prospective institutional neurovascular registry to identify patients with unruptured intracranial aneurysms and short-term follow-up imaging, defined as follow-up MRA and/or CTA within 3 months to 2 years after initial diagnosis. Medical records and questionnaires were used to acquire baseline information. The authors measured aneurysm size at baseline and at follow-up to detect growth. Rupture was defined as a CT scan-proven and/or CSF-proven subarachnoid hemorrhage (SAH). RESULTS A total of 206 consecutive patients with 267 conservatively managed unruptured aneurysms underwent short-term follow-up at the authors' center. Seven aneurysms (2.6%) enlarged during a median follow-up duration of 1 year (range 0.3-2.0 years). One aneurysm (0.4%) ruptured 10 months after initial discovery. Statistically significant risk factors for growth or rupture were autosomal-dominant polycystic kidney disease (RR 8.3, 95% CI 2.0-34.7), aspect ratio > 1.6 or size ratio > 3 (RR 10.8, 95% CI 2.2-52.2), and initial size ≥ 7 mm (RR 10.7, 95% CI 2.7-42.8). CONCLUSIONS Significant growth of unruptured intracranial aneurysms may occur in a small proportion of patients during short-term follow-up. As aneurysm growth is associated with an increased risk of rupture, the authors advocate that short-term follow-up is clinically relevant and has an important role in reducing the risk of a potential SAH.
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Affiliation(s)
| | | | | | - Aryan Mazuri
- 3Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Maarten Uyttenboogaart
- 2Neurology, and.,3Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Asymptomatic Intracranial Aneurysms in the Elderly: Long-Term Clinical and Radiologic Follow-Up of 193 Consecutive Patients. World Neurosurg 2020; 133:e600-e608. [DOI: 10.1016/j.wneu.2019.09.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022]
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20
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Hudson JS, Marincovich AJ, Roa JA, Zanaty M, Samaniego EA, Hasan DM. Aspirin and Intracranial Aneurysms. Stroke 2019; 50:2591-2596. [DOI: 10.1161/strokeaha.119.026094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph S. Hudson
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Anthony J. Marincovich
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Jorge A. Roa
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - Mario Zanaty
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Edgar A. Samaniego
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Radiology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - David M. Hasan
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
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Jin D, Song C, Leng X, Han P. A systematic review and meta-analysis of risk factors for unruptured intracranial aneurysm growth. Int J Surg 2019; 69:68-76. [PMID: 31356963 DOI: 10.1016/j.ijsu.2019.07.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/23/2019] [Accepted: 07/12/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many risk factors are associated with the growth of unruptured intracranial aneurysm; however, the effects of these risk factors on intracranial aneurysm growth remain poorly understood. Here, we performed a meta-analysis to evaluate the effects of these risk factors on intracranial aneurysm growth, incorporating different data types to provide comprehensive estimates of individual effects. METHODS We searched the Cochrane Library, PubMed, Embase, and Web of Science for cohort studies analyzing risk factors for aneurysm growth prior to January 10, 2019. The hazard ratio (HR) and odds ratio (OR) with its 95% confidence interval (CI) were calculated to assess the effect of individual risk factors on intracranial aneurysm growth. Both univariate analysis (UVA) and multivariate analysis (MVA) were performed. Two reviewers independently assessed the quality of the trials and the associated data. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2. RESULTS We included 23 studies (N = 7208 participants) in this meta-analysis. A total of 944 patients (13.1%) experienced intracranial aneurysm growth during their follow-up times. Aneurysm size and smoking may have significant effects on the growth of intracranial aneurysm, with pooled ORs of 2.73 (95% CI 2.21-3.36; P < 0.00001) and 1.45 (95% CI 1.07-1.98; P = 0.02) respectively. However, our results indicated that subarachnoid hemorrhage (SAH) had a negative effect on the growth of intracranial aneurysm (OR 0.64; 95% CI 0.48-0.86; P = 0.003). Other risk factors such as irregular shape of intracranial aneurysm, female sex, and multiple aneurysms were inconsistent across studies due to differences in data types and effect estimates. CONCLUSIONS Our meta-analysis identified aneurysm size and smoking as independent risk factors for the growth of intracranial aneurysm, while prior SAH had a negative effect on the growth of intracranial aneurysm. The roles of other risk factors for intracranial aneurysm growth were inconsistent, with further research necessary to assess fully the roles of these factors in disease outcomes.
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Affiliation(s)
- Dianshi Jin
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China.
| | - Chong Song
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China
| | - Xiaolei Leng
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China
| | - Peng Han
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China
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Predictors for ophthalmic segment aneurysms recanalization after coiling and flow diverter embolization in 6- and 12-month follow-up. J Clin Neurosci 2019; 68:151-157. [PMID: 31307854 DOI: 10.1016/j.jocn.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 05/23/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
Abstract
Carotid-ophthalmic aneurysms are indication for endovascular treatment. Coil embolization is associated with a high recanalization rate and thus usage of flow diverter (FD) could constitute the treatment of choice. Although implementation of FD is very effective, it carries a significant risk of complications. The goal of our study was to find a radiological recanalization marker in order to facilitate decision process which would result in fewer treatment-related complications and in this way, to personalize endovascular therapy. We made a retrospective analysis of seventy-five patients with saccular carotid-ophthalmic aneurysms treated endovascularly. Morphometric measurements were performed in CTA 3D aneurysm models. The aneurysm size and volume were measured on the base of digital subtraction angiography (DSA) images. The treatment effectiveness was determined visually using the modified Raymond Roy classification after embolization and on the 6- and 12-month follow-up DSA. Statistica 13.1 software was used. Multivariate analyses showed that the aneurysm neck size (OR 2.51; 95%CI: 1.20-5.26), aspect ratio (OR 2.60; 95%CI: 1.27-5.21) and neck to parent artery ratio (OR 2.68; 95%CI: 1.26-5.70) were risk factors for carotid-ophthalmic aneurysms recanalization after 6 months. Of those factors, aneurysm neck size remained the only significant risk factor for carotid-ophthalmic aneurysms recanalization after 12 months (OR 5.23, 95%CI: 1.71-15.93). Various factors seem to influence recanalization. Preoperatively, if the above-mentioned predictors of recanalization are present, coiling is burdened with a high recanalization rate. In those cases, FD embolization should be considered.
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Kim HC, Rhim JK, Ahn JH, Park JJ, Moon JU, Hong EP, Kim MR, Kim SG, Lee SH, Jeong JH, Choi SW, Jeon JP. Machine Learning Application for Rupture Risk Assessment in Small-Sized Intracranial Aneurysm. J Clin Med 2019; 8:jcm8050683. [PMID: 31096607 PMCID: PMC6572384 DOI: 10.3390/jcm8050683] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022] Open
Abstract
The assessment of rupture probability is crucial to identifying at risk intracranial aneurysms (IA) in patients harboring multiple aneurysms. We aimed to develop a computer-assisted detection system for small-sized aneurysm ruptures using a convolutional neural network (CNN) based on images of three-dimensional digital subtraction angiography. A retrospective data set, including 368 patients, was used as a training cohort for the CNN using the TensorFlow platform. Aneurysm images in six directions were obtained from each patient and the region-of-interest in each image was extracted. The resulting CNN was prospectively tested in 272 patients and the sensitivity, specificity, overall accuracy, and receiver operating characteristics (ROC) were compared to a human evaluator. Our system showed a sensitivity of 78.76% (95% CI: 72.30%-84.30%), a specificity of 72.15% (95% CI: 60.93%-81.65%), and an overall diagnostic accuracy of 76.84% (95% CI: 71.36%-81.72%) in aneurysm rupture predictions. The area under the ROC (AUROC) in the CNN was 0.755 (95% CI: 0.699%-0.805%), better than that obtained from a human evaluator (AUROC: 0.537; p < 0.001). The CNN-based prediction system was feasible to assess rupture risk in small-sized aneurysms with diagnostic accuracy superior to human evaluators. Additional studies based on a large data set are necessary to enhance diagnostic accuracy and to facilitate clinical application.
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Affiliation(s)
- Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon 24252, Korea.
| | - Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63241, Korea.
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24252, Korea.
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul 05030, Korea.
| | - Jong Un Moon
- Department of Neurosurgery, National Medical Center, Seoul 04564, Korea.
| | - Eun Pyo Hong
- Molecular Neurogenetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | | | | | | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24252, Korea.
- Institute of New Frontier Stroke Research, Hallym University College of Medicine, Chuncheon 24252, Korea.
- Genetic and Research Inc., Chuncheon 24252, Korea.
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Hadi M, Maxwell AW, Hirsch JA, Gonzalez RG, Maza N, Romero JM. Clinico-radiologic factors in paraclinoid aneurysms associated with aneurysm rupture: A CTA study. Clin Imaging 2019; 53:225-229. [DOI: 10.1016/j.clinimag.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/03/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022]
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25
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Hong EP, Kim BJ, Kim C, Choi HJ, Jeon JP. Association of SOX17 Gene Polymorphisms and Intracranial Aneurysm: A Case-Control Study and Meta-Analysis. World Neurosurg 2018; 110:e823-e829. [DOI: 10.1016/j.wneu.2017.11.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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26
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Hong EP, Jeon JP, Kim SE, Yang JS, Choi HJ, Kang SH, Cho YJ. A Novel Association between Lysyl Oxidase Gene Polymorphism and Intracranial Aneurysm in Koreans. Yonsei Med J 2017; 58:1006-1011. [PMID: 28792146 PMCID: PMC5552627 DOI: 10.3349/ymj.2017.58.5.1006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/17/2017] [Accepted: 06/27/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Lysyl oxidase (LOX) controls the cross-linking and maturation of elastin and collagen fibers. In this study, we investigated the association between LOX gene polymorphisms and intracranial aneurysm (IA) formation in a homogeneous Korean population. MATERIALS AND METHODS This cross-sectional study involved 80 age-sex matched patients with IA and controls. Fisher's exact test was performed to analyze allelic associations between ten single nucleotide polymorphisms (SNPs) and IA, including 41 ruptured and 39 unruptured cases. Haplotype-specific associations were analyzed using the omnibus test estimating asymptotic chi-square statistics. RESULTS Of ten SNPs, three SNPs (rs2303656, rs3900446, and rs763497) were significantly associated with IA (p<0.01). The C allele of rs3900446 was significantly related to increased IA risk with a significant threshold [odds ratio (OR)=20.15, p=4.8×10⁻⁵]. Meanwhile, the A allele of rs2303656 showed a preventive effect against IA formation (p=8.2×10⁻⁴). Seventeen of 247 haplotype structures showed a suggestive association with IA (asymptotic p<0.001). Of ten SNP haplotype combinations, the CG combination of rs3900446 and rs763497 reached Bonferroni-adjusted significant threshold in IA patients (minor haplotype frequency=0.113, asymptotic p=1.3×10⁻⁵). However, there was no association between aneurysm rupture and the LOX gene. CONCLUSION This preliminary study indicated that LOX gene polymorphisms, such as rs2303656, rs3900446, and rs763497, may play crucial roles in IA formation in the Korean population. Our novel findings need to be validated in a large-scale independent population.
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Affiliation(s)
- Eun Pyo Hong
- Department of Medical Genetics, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.
| | - Sung Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Suk Hyung Kang
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
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Malhotra A, Wu X, Forman HP, Grossetta Nardini HK, Matouk CC, Gandhi D, Moore C, Sanelli P. Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review. Ann Intern Med 2017; 167:26-33. [PMID: 28586893 DOI: 10.7326/m17-0246] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Small unruptured intracranial aneurysms (UIAs) are increasingly diagnosed. Management depends on growth and rupture risks, which may vary by aneurysm size. PURPOSE To summarize evidence about the growth and rupture risk of UIAs 7 mm and smaller and to explore differences in growth and rupture risks of very small (≤3 mm) and small (≤5 mm) aneurysms. DATA SOURCES MEDLINE, EMBASE, Scopus, and the Cochrane Library from inception to 2017 (with no language restrictions). STUDY SELECTION Published case series and observational studies that reported natural history data on UIAs 7 mm and smaller. DATA EXTRACTION 2 reviewers abstracted study information, evaluated study quality, and graded strength of evidence. DATA SYNTHESIS Of 26 studies, 5, 10, and 8 described the growth rate of aneurysms 3 mm and smaller, 5 mm and smaller, and 7 mm and smaller, respectively, whereas rupture rates were reported in 7, 11, and 13 studies for aneurysms 3 mm and smaller, 5 mm and smaller, and 7 mm and smaller, respectively. The annualized growth rate was less than 3% in all but 1 study for all 3 size categories. The annualized rupture rate was 0%, less than 0.5%, and less than 1% for the 3 size categories, respectively. Strength of evidence was very low quality for growth rates and low quality for rupture rates. LIMITATION Heterogeneous definitions of growth; heterogeneous and selective treatment and follow-up methods, particularly in high-risk patients. CONCLUSION Poor-quality evidence suggests that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Ajay Malhotra
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Xiao Wu
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Howard P Forman
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Holly K Grossetta Nardini
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Charles C Matouk
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Dheeraj Gandhi
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Christopher Moore
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
| | - Pina Sanelli
- From Yale School of Medicine and Yale University, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; and Northwell Health, Manhasset, New York
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Pahl FH, de Oliveira MF, Brock RS, Lucio JEDC, Rotta JM. Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:314-9. [PMID: 27097005 DOI: 10.1590/0004-282x20150215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
Abstract
UNLABELLED Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. METHOD From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. RESULTS Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). CONCLUSION Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
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Affiliation(s)
- Felix Hendrik Pahl
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Sao Paulo, SP, Brazil
| | | | - Roger Schmidt Brock
- Departamento de Neurocirurgia, Hospital Sirio Libanês, Sao Paulo, SP, Brazil
| | | | - José Marcus Rotta
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, IAMSPE, Sao Paulo, SP, Brazil
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Guan J, Karsy M, Couldwell WT, Schmidt RH, Taussky P, MacDonald JD, Park MS. Factors influencing management of unruptured intracranial aneurysms: an analysis of 424 consecutive patients. J Neurosurg 2016; 127:96-101. [PMID: 27715433 DOI: 10.3171/2016.7.jns16975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The choice between treating and observing unruptured intracranial aneurysms is often difficult, with little guidance on which variables should influence decision making on a patient-by-patient basis. Here, the authors compared demographic variables, aneurysm-related variables, and comorbidities in patients who received microsurgical or endovascular treatment and those who were conservatively managed to determine which factors push the surgeon toward recommending treatment. METHODS A retrospective chart review was conducted of all patients diagnosed with an unruptured intracranial aneurysm at their institution between January 1, 2013, and January 1, 2016. These patients were dichotomized based on whether their aneurysm was treated. Demographic, geographic, socioeconomic, comorbidity, and aneurysm-related information was analyzed to assess which factors were associated with the decision to treat. RESULTS A total of 424 patients were identified, 163 who were treated surgically or endovascularly and 261 who were managed conservatively. In a multivariable model, an age < 65 years (OR 2.913, 95% CI 1.298-6.541, p = 0.010), a lower Charlson Comorbidity Index (OR 1.536, 95% CI 1.274-1.855, p < 0.001), a larger aneurysm size (OR 1.176, 95% CI 1.100-1.257, p < 0.001), multiple aneurysms (OR 2.093, 95% CI 1.121-3.907, p = 0.020), a white race (OR 2.288, 95% CI 1.245-4.204, p = 0.008), and living further from the medical center (OR 2.125, 95% CI 1.281-3.522, p = 0.003) were all associated with the decision to treat rather than observe. CONCLUSIONS Whereas several factors were expected to be considered in the decision to treat unruptured intracranial aneurysms, including age, Charlson Comorbidity Index, aneurysm size, and multiple aneurysms, other factors such as race and proximity to the medical center were unanticipated. Further studies are needed to identify such biases in patient treatment and improve treatment delineation based on patient-specific aneurysm rupture risk.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Joel D MacDonald
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Zanaty M, Daou B, Chalouhi N, Starke RM, Jabbour P, Hasan D. Evidence That a Subset of Aneurysms Less Than 7 mm Warrant Treatment. J Am Heart Assoc 2016; 5:JAHA.116.003936. [PMID: 27509908 PMCID: PMC5015310 DOI: 10.1161/jaha.116.003936] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA
| | - Badih Daou
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA
| | - Robert M Starke
- Department of Neurological Surgery and Radiology, University of Miami, FL
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA
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Liao CH, Lin CJ, Lin CF, Huang HY, Chen MH, Hsu SPC, Shih YH. Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography. J Neurosurg 2016; 125:275-82. [DOI: 10.3171/2015.7.jns151046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE
The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA).
METHODS
Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks.
RESULTS
Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional aneurysm (sensitivity 0.806; specificity 0.792).
CONCLUSIONS
High-resolution thin-cut CTA is a fast and crucial tool for diagnosing paraclinoid aneurysms. The OS serves as an effective landmark in CTA source images for distinguishing between intradural and extradural paraclinoid aneurysms. The DDR is supposed to be located 2 mm above the base of the OS in axial planes.
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Affiliation(s)
| | - Chung-Jung Lin
- 2Radiology and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Chun-Fu Lin
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Hsin-Yi Huang
- 4Biostatistics Task Force (under Department of Medical Research and Education), Taipei Veterans General Hospital; and
| | - Min-Hsiung Chen
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Sanford P. C. Hsu
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
| | - Yang-Hsin Shih
- Departments of 1Neurosurgery, Neurological Institute, and
- 3National Yang Ming University, School of Medicine, Taipei, Taiwan, Republic of China
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32
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Huang ZQ, Meng ZH, Hou ZJ, Huang SQ, Chen JN, Yu H, Feng LJ, Wang QJ, Li PA, Wen ZB. Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study. AJNR Am J Neuroradiol 2016; 37:1413-7. [PMID: 27102312 PMCID: PMC7960285 DOI: 10.3174/ajnr.a4764] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/28/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies of geometric and morphologic parameters of intracranial aneurysms have been conducted to determine rupture risk, which remains incompletely defined due to patient-specific risk factors, such as sex, hypertension, and age. To this end, we compared characteristics of ruptured and unruptured aneurysms in the same patients with symmetric bilateral intracranial aneurysms. MATERIALS AND METHODS Between January 2008 and March 2014, 2361 patients with 2674 aneurysms were diagnosed by CT angiography or surgical findings at 4 medical centers. Geometric and morphologic parameters examined for symmetric bilateral intracranial aneurysms comprised aneurysm wall regularity, size, neck width, aspect ratio, size ratio, neck-to-parent artery ratio, and area ratio. Univariate and multivariate statistical analyses were performed to determine independent risk factors for rupture. RESULTS Sixty-three patients (48 women, 15 men; mean age, 62.5 ± 9.8 years) with symmetric bilateral aneurysms were eligible for the study and were included. The most frequent aneurysm location was the posterior communicating artery. Univariate analysis disclosed that aneurysm size, aspect ratio, size ratio, area ratio, and irregular wall differed between patients with ruptured and unruptured aneurysms. Multivariate analysis indicated that aspect ratio of ≥1.6 (adjusted OR, 9.521; 95% CI, 2.182-41.535), area ratio of ≥1.5 (adjusted OR, 4.089; 95% CI, 1.247-13.406), and irregular shape (adjusted OR, 10.443; 95% CI 3.394-32.135) were significant predictive factors for aneurysm rupture after adjustment for aneurysm size. CONCLUSIONS An aspect ratio of ≥1.6, area ratio of ≥1.5, and irregular wall are associated with aneurysm rupture independent of aneurysm size and patient characteristics. These characteristics alone can help in distinguishing ruptured bilateral intracranial aneurysms from unruptured ones.
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Affiliation(s)
- Z-Q Huang
- From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.) Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.)
| | - Z-H Meng
- Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.)
| | - Z-J Hou
- Department of Radiology (Z.-J.H.), The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - S-Q Huang
- Department of Radiology (S.-Q.H.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - J-N Chen
- Medical Image Center (Z.-Q.H., Z.-H.M., J.-N.C.)
| | - H Yu
- From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.)
| | - L-J Feng
- From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.)
| | - Q-J Wang
- Department of Neurosurgery (Q.-J.W.), Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - P-A Li
- Department of Neurosurgery (P.-A.L.), Yuebei People's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Z-B Wen
- From the Medical Image Center (Z.-Q.H., H.Y., L.-J.F., Z.-B.W.)
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Backes D, Rinkel GJ, Laban KG, Algra A, Vergouwen MD. Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth. Stroke 2016; 47:951-7. [DOI: 10.1161/strokeaha.115.012162] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Daan Backes
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriel J.E. Rinkel
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kamil G. Laban
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ale Algra
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mervyn D.I. Vergouwen
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands
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Liu H, Park D, Hwang SM, Lee GY, Lim OK, Kim M, Lee DH, Park W, Koo HW, Yang K, Suh DC. Outpatient Day-care Neuroangiography and Neurointervention of Unruptured Intracranial Aneurysms. Neurointervention 2016; 11:37-41. [PMID: 26958411 PMCID: PMC4781915 DOI: 10.5469/neuroint.2016.11.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose Day-care management of unruptured intracranial aneurysms can shorten hospital stay, reduce medical cost and improve outcome. We present the process, outcome and duration of hospital stay for the management of unruptured intracranial aneurysms via a neurointervention clinic in a single center during the past four years. Materials and Methods We analyzed 403 patients who were referred to Neurointervention Clinic at Asan Medical Center for aneurysm evaluation between January 1, 2011 and December 31, 2014. There were 141 (41%) diagnostic catheter angiographies, 202 (59%) neurointerventional procedures and 2 (0.6%) neurointerventional procedures followed by operation. We analyzed the process, outcome of angiography or neurointervention, and duration of hospital stay. Results There was no aneurysm in 58 patients who were reported as having an aneurysm in MRA or CTA (14 %). Among 345 patients with aneurysm, there were 283 patients with a single aneurysm (82%) and 62 patients with multiple aneurysms (n=62, 18%). Aneurysm coiling was performed in 202 patients (59%), surgical clipping in 14 patients (4%), coiling followed by clipping in 2 patients (0.6%) and no intervention was required in 127 patients (37%). The hospital stay for diagnostic angiography was less than 6 hours and the mean duration of hospital stay was 2.1 days for neurointervention. There were 4 procedure-related adverse events (2%) including 3 minor and 1 major ischemic strokes. Conclusion Our study revealed that day-care management of unruptured intracranial aneurysms could be performed without an additional risk. It could enable rapid patient flow, shorten hospital stay and thus reduce hospital costs.
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Affiliation(s)
- Hairi Liu
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province 225300, P. R. China
| | - Danbi Park
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sun Moon Hwang
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ga Young Lee
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Minjae Kim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hae-Won Koo
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kuhyun Yang
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Jeon JP, Cho YD, Rhim JK, Yoo DH, Kang HS, Kim JE, Cho WS, Han MH. Extended monitoring of coiled aneurysms completely occluded at 6-month follow-up: late recanalization rate and related risk factors. Eur Radiol 2016; 26:3319-26. [PMID: 26747259 DOI: 10.1007/s00330-015-4176-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/27/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate long-term durability in coiled aneurysms completely occluded at 6-month follow-up imaging, focusing on late recanalization rate and the risk factors involved. METHODS A cohort of 620 patients harbouring 698 completely occluded coiled aneurysms at 6-month follow-up was subjected to extended monitoring (mean, 24.5 ± 7.9 months). Cumulative recanalization rate and related risk factors were analysed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator. RESULTS Forty-three aneurysms (6.2 %) occluded completely at 6-months displayed recanalization (3.02 % per aneurysm-year) during continued surveillance (1425.5 aneurysm-years), with 26 (60.5 %) surfacing in another 6 months, 15 (34.9 %) within 18 months and 2 (4.6 %) within 30 months. Cumulative survival rates without recanalization were significantly lower in subjects with aneurysms >7 mm (p = 0.014), with bifurcation aneurysms (p = 0.009) and with subarachnoid haemorrhage (SAH) at presentation (p < 0.001). Multivariate analysis indicated that aneurysms >7 mm (HR = 2.37, p = 0.02) and bifurcation aneurysms (HR = 2.70, p = 0.03) were significant factors in late recanalization, whereas a link with SAH at presentation was marginal (HR = 1.92, p = 0.06) and stent placement fell short of statistical significance (HR = 0.47; p = 0.12). CONCLUSION Most (93.8 %) coiled aneurysms showing complete occlusion at 6 months post-procedure were stable in long-term monitoring. However, aneurysms >7 mm and bifurcation aneurysms were predisposed to late recanalization. KEY POINTS • Most coiled aneurysms showing complete occlusion at 6 months were stable. • Forty-three aneurysms (6.2 %) occluded completely at 6-month follow-up displayed late recanalization. • Late recanalization rate was 3.02 % per aneurysm-year during follow-up of 1425.5 aneurysm-years. • Aneurysms over 7 mm and bifurcation aneurysms were predisposed to late recanalization.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. .,Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul, Korea, 110-744.
| | - Jong Kook Rhim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Brinjikji W, Zhu YQ, Lanzino G, Cloft HJ, Murad MH, Wang Z, Kallmes DF. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2015; 37:615-20. [PMID: 26611992 DOI: 10.3174/ajnr.a4575] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a meta-analysis examining risk factors for intracranial aneurysm growth in longitudinal studies and examined the association between aneurysm growth and rupture. MATERIALS AND METHODS We searched the literature for longitudinal studies of patients with unruptured aneurysms. We examined the associations of demographics, multiple aneurysms, prior subarachnoid hemorrhage, family history of aneurysm or subarachnoid hemorrhage, smoking, and hypertension; and aneurysm shape, size, and location with aneurysm growth. We studied the association between aneurysm growth and rupture. A meta-analysis was performed by using a random-effects model by using summary statistics from included studies. RESULTS Twenty-one studies including 3954 patients with 4990 aneurysms with 13,294 aneurysm-years of follow-up were included. The overall proportion of growing aneurysms was 3.0% per aneurysm-year (95% CI, 2.0%-4.0%). Patient risk factors for growth included age older than 50 years (3.8% per year versus 0.9% per year, P < .01), female sex (3.2% per year versus 1.3% per year, P < .01), and smoking history (5.5% per year versus 3.5% per year, P < .01). Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P < .01), and aneurysm size (P < .01). Aneurysm growth was associated with a rupture rate of 3.1% per year compared with 0.1% per year for stable aneurysms (P < .01). CONCLUSIONS Observational evidence provided multiple clinical and anatomic risk factors for aneurysm growth, including age older than 50 years, female sex, smoking history, and nonsaccular shape. These findings should be considered when counseling patients regarding the natural history of unruptured intracranial aneurysms.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - Y-Q Zhu
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - H J Cloft
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - M H Murad
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - Z Wang
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
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Yoon SJ, Shin NY, Lee JW, Huh SK, Park KY. Localization and Treatment of Unruptured Paraclinoid Aneurysms: A Proton Density MRI-based Study. J Cerebrovasc Endovasc Neurosurg 2015; 17:180-4. [PMID: 26523253 PMCID: PMC4626340 DOI: 10.7461/jcen.2015.17.3.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/01/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate the usefulness of proton density magnetic resonance (PD MR) imaging for localization of paraclinoid internal carotid artery aneurysms. Materials and Methods From April 2014 to April 2015, 76 unruptured paraclinoid aneurysms in 66 patients were evaluated using PD MR and angiography (CT/MR angiography or digital subtraction angiography). The locations (extradural, transdural, intradural) in relation to the distal dural ring (DDR) and projection (superior, inferior/posterior, medial, lateral) of the aneurysms were assessed and compared. Results The most common location of paraclinoid aneurysms was extradural (n = 48, 63.2%), followed by intradural (n = 18, 23.7%), and transdural (n = 10, 13.2%). In the medial projection group (n = 49, 64.5%), 31 were extradural (63.3%), 5 were transdural (10.2%), and 13 were intradural (26.5%). In the inferior/posterior projection group (n = 19, 25.0%), there were 14 extradural (73.7%), 4 transdural (21.0%), and 1 intradural (5.3%). In the superior (n = 4, 5.3%)/lateral (n = 4, 5.3%) projection groups, there were 0/3 extradural (0/75.0%), 1/0 transdural (25.0/0%), and 3/1 intradural (75.0/25.0%). Conclusion PD MR showed sufficient contrast difference to distinguish paraclinoid aneurysms from surrounding dural structures.
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Affiliation(s)
- Seon Jin Yoon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Liu H, Choe J, Jung SC, Song Y, Yang KH, Park KJ, Goo HW, Park WH, Suh DC. Does a Low-wall Coverage Stent Have a Flow Diverting Effect in Small Aneurysms? Neurointervention 2015; 10:89-93. [PMID: 26389012 PMCID: PMC4571559 DOI: 10.5469/neuroint.2015.10.2.89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKBROUND AND PURPOSE The flow diverting effect of a low-wall coverage stent remains controversial. We evaluted patients who underwent stenting for small aneurysms with a low but potential risk of growth and reviewed related literature. MATERIALS AND METHODS We evaluated 9 small aneurysms among 19 unruptured intracranial aneurysms from eight patients who underwent stenting. The patients had unexplainable severe headache (n = 8), aneurysm originating from the anterior choroidal artery (n = 3), potential growth or rupture risks including hypertension (n = 5), and multiple aneurysms (n = 6). Stents with a relatively low-wall coverage ratio (8-10%) were used. Clinical and angiographic outcomes were assessed. RESULTS One (n = 8) or two stents (n = 1) were used without any procedural difficulties or complications. Although no immediate changes of aneurysm morphology were observed, aneurysms decreased in size (n = 8) when examined by DSA (n = 8) or MRA (n = 1) during a median 28.9-month follow-up. There were no adverse events, including thromboembolism, aneurysm rupture, or stent movement during a median 31.9-month clinical follow-up (range: 17-69 months). CONCLUSION Although a variable degree of aneurysm size decrease may not prevent further growth or rupture of small aneurysms, stenting with a low-wall coverage ratio may have some advantageous hemodynamic effect. Flow modification of stent architecture vs. aneurysm characteristics, including size and location, on long-term outcome, requires further clarification.
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Affiliation(s)
- Hairi Liu
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. ; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province 225300, P. R. China
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chul Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yunsun Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ku Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hae Won Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Hyong Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Matano F, Tanikawa R, Kamiyama H, Ota N, Tsuboi T, Noda K, Miyata S, Matsukawa H, Murai Y, Morita A. Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome. World Neurosurg 2015; 85:169-76. [PMID: 26344635 DOI: 10.1016/j.wneu.2015.08.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass. MATERIAL AND METHODS We retrospectively analyzed findings from 127 consecutive patients (19 males, mean age at surgery: 56.8 years, range: 19-81 years) at our hospital. The size of aneurysms ranged from 2.7-43.2 mm (mean: 6.9 mm). Extradural anterior clinoidectomy was used to clip small aneurysms. As large or giant aneurysms required a longer temporal occlusion period and often could not undergo simple clipping, high-flow bypass with anterior clinoidectomy or cervical internal carotid ligation was performed to reduce aneurysm blood flow and induce thrombosis. We reviewed a postoperative modified Rankin Scale (mRS), radiographic outcomes, cerebral infarction, and visual disturbance. In addition, we analyzed factors relating to the outcomes and complications, with focus on the aneurysm size, location, and type of surgical treatment. RESULTS Good outcomes were achieved in all patients, as follows: mRS 0:100, mRS 1:16, mRS 2:11, and mRS 3-6:0. Among the 127 patients, complete exclusion of aneurysm was achieved in 119 cases (93.7%). Postoperative morbidity included ischemic lesions in 11 (8.6%) and visual disturbance in 24 (18.8%). Significant statistical differences were observed between ischemic complication and aneurysm size and location (P = 0.0001) and surgical treatment (P < 0.0001). CONCLUSION Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
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Affiliation(s)
- Fumihiro Matano
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan; Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
| | - Rokuya Tanikawa
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan
| | | | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Murai Y, Ishisaka E, Tsukiyama A, Matano F, Morita A. Internal Carotid Artery Aneurysm Anomalously Originating from the Posterior Communicating Artery. World Neurosurg 2015; 84:2078.e9-11. [PMID: 26325211 DOI: 10.1016/j.wneu.2015.08.026] [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: 07/05/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND We report a case of an internal carotid artery (ICA) aneurysm anomalously originating from the posterior communicating artery (PComA). CASE DESCRIPTION Preoperative radiologic findings revealed a paraclinoid carotid artery aneurysm at the level of the distal dural ring. Because of the low rupture risk, there are no treatment indications for small paraclinoid or ICA-superior hypophyseal artery unruptured aneurysms. In this case, because of the patient's age and the irregular shape of the aneurysm, treatment was considered necessary. Intraoperative findings using microscopic and endoscopic angiography showed that the aneurysm originated from the proximal branched PComA. The PComA originated from the same level as the ophthalmic artery, and the superior hypophyseal artery originated from the distal side of the PComA. CONCLUSIONS According to numerous reports, small incidental paraclinoid aneurysms have a lower risk of rupture and growth than PComA aneurysms. Preoperative radiologic examination of unruptured small aneurysms was performed using magnetic resonance angiography and three-dimensional computed tomography angiography. Because the ability of magnetic resonance angiography and three-dimensional computed tomography angiography to detect small branches of the ICA is inferior to digital subtraction angiography, the location of an unruptured ICA aneurysm should be evaluated with other diagnostic modalities besides magnetic resonance angiography and three-dimensional computed tomography angiography.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Changes of size and shape of small, unruptured intracranial aneurysms in repeated computed tomography angiography studies. Wideochir Inne Tech Maloinwazyjne 2015; 10:178-88. [PMID: 26240617 PMCID: PMC4520858 DOI: 10.5114/wiitm.2015.52707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/22/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Unruptured intracranial aneurysms (UIAs) are frequently detected in noninvasive imaging studies such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). If small, UIAs are observed in these modalities in order to detect growth or shape change, but there are many questions about proper protocol of the follow-up. Aim To assess changes of small (< 7 mm) UIAs dome size and shape in repeated CTA studies as predictors of growth and rupture. Material and methods One hundred and ten UIAs (10 posterior circulation) in 70 patients (55 women) were observed, with a cumulative observation time of 333.32 years. Aneurysms’ dome and neck perpendicular dimensions were measured in the first and the last CTA study at least twice with the developed application. Confidence intervals (CI) for measurements and dome shape parameters were calculated. For aneurysms ruptured during follow-up intermediate studies were analyzed. Patients’ clinical information was recorded. The aneurysm growth detection algorithm integrated CI and spatial resolution of the CT scanner. Results Twenty-three aneurysms increased in volume, 10 in height and 14 in dome width. Volume increased in 90% of cases of height and 93% of width increase. Posterior circulation aneurysms grew faster than anterior ones (p < 0.003), but calculated time to significant size increase (eT) did not differ between the groups due to higher CI in the posterior circulation. Analysis of eT with Kaplan-Meier curves showed that 75% of growing aneurysms could be detected in the first 3 years of observation. During the follow-up 3 aneurysms bled, and they grew faster than other growing aneurysms. Two of the bleeding aneurysms formed daughter sacs. Conclusions Dome volume assessment is superior to single dimension assessment in aneurysm growth detection. Confidence intervals assessment helps to avoid overestimation of growth. Seventy-five percent of growing aneurysms could be detected in the first 3 years of observation. Daughter sac formation and fast increase in size are strong predictors of aneurysm rupture.
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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 633] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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