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Frączek MJ, Błoński MJ, Kliś KM, Krzyżewski RM, Polak J, Stachura K, Kwinta BM. Predictors of intraoperative intracranial aneurysm rupture in patients with subarachnoid hemorrhage: a retrospective analysis. Acta Neurol Belg 2023; 123:1717-1724. [PMID: 35759212 DOI: 10.1007/s13760-022-02005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Intraoperative cerebral aneurysm rupture (IOR) is a common phenomenon with a frequency of around 19%. Research regarding IOR lacks an analysis of its predictors. METHODS We retrospectively examined all saccular aneurysms, in 198 patients with subarachnoid hemorrhage, surgically treated from 2013 to 2019. Operative reports, patient histories, blood test results, discharge summaries, and radiological data were reviewed. IOR was defined as any bleeding from the aneurysm during surgery, preceding putting a clip on its neck, regardless of how trivial. RESULTS The frequency of IOR was 20.20%. Patients with IOR had higher aneurysm dome size (9.43 ± 8.39 mm vs. 4.96 ± 2.57 mm; p < 0.01). The presence of blood clot on the aneurysm dome was significantly associated with IOR (12.50% vs. 2.53%; p < 0.01). We also associated lamina terminalis fenestration during surgery (7.50% vs. 21.52%; p = 0.04) and multiple aneurysms (5.00% vs. 18.35%; p = 0.038) with a lower risk of IOR. Glucose blood levels were also elevated in patients with IOR (7.47 ± 2.78 mmol/l vs. 6.90 ± 2.22 mmol/l; p = 0.04). Multivariate analysis associated that urea blood levels (OR 0.55, 0.33 to 0.81, p < 0.01) and multiple aneurysms (OR 0.04, 0.00 to 0.37, p = 0.014) were protective factors against the occurrence of IOR. CONCLUSION Large dome size of an aneurysm, a blood clot on the aneurysm dome and elevated glucose blood levels can be IOR predictive. Lamina terminalis fenestration, the appearance of multiple aneurysms, and high urea blood levels may be associated with a lower risk of such an event.
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Affiliation(s)
- Maciej J Frączek
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12 Street 31-008, Kraków, Poland.
| | - Miłosz J Błoński
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12 Street 31-008, Kraków, Poland
| | - Kornelia M Kliś
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław Polak
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
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2
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Samuelsson J, Rentzos A, Rawshani A, Karlsson A, Ståleby M, Nilsson D. Risk of de novo aneurysm formation in patients previously diagnosed with a ruptured or unruptured aneurysm: 18-year follow-up. Clin Neurol Neurosurg 2023; 233:107980. [PMID: 37717358 DOI: 10.1016/j.clineuro.2023.107980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Data on de novo aneurysm formation after treatment for intracranial aneurysms remains scarce. We studied the incidence of de novo aneurysm formation in patients who had undergone aneurysm treatment more than 18 years prior to follow-up. As it is a disease affecting a younger patient population more specific guidelines are needed when planning a follow-up regime. METHODS The rate of de novo aneurysm formation was assessed with Magnetic Resonance Angiography (MRA) follow-up >18 years after endovascular or microsurgical treatment for an intracranial aneurysm. Variables associated with de novo aneurysm formation were studied using logistic regression. Missing data were imputed using chained random forests. A data-driven model for the prediction of de novo aneurysm was created to calculate the relative variable importance of ten clinical features. RESULTS De novo aneurysms were identified in 11/81 (13.6 %) patients, of whom 1 was male, over a median follow-up of 20 years. Sex was the most important variable associated with de novo aneurysm formation. Regarding the development of de novo aneurysm, men displayed an odds ratio (OR) of 0.16 (0.01-0.97), compared with women. OR for mRS score 2 or more was 0.20 (95 % CI 0.01-1.34), and OR for smokers was 3.70 (0.54-31.18). Six out of 11 patients (54.5 %) needed treatment; 1 underwent endovascular treatment (EVT) and 5 underwent microsurgical treatment (MST). The overall annual de novo aneurysm formation rate was 0.92 %. CONCLUSIONS This study highlights the need for a longer follow-up imaging monitoring of patients that have previously undergone treatment for an intracranial aneurysm. These data are useful to take into consideration when planning a follow-up strategy.
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Affiliation(s)
- Jennifer Samuelsson
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Alexandros Rentzos
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Karlsson
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Ståleby
- Department of Radiology, Section of diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Region Vastra Gotaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Nilsson
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Eldawoody HAF, Aziz MM, Abouhashem S. Volume embolization ratio of coiled cerebral aneurysms, does awake technique affect the results? EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-022-00180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Despite the great innovations in the neuroendovascular techniques and related materials, there are still notable percentages of recurrent cerebral aneurysms after aneurysm coiling. Aneurysm packing density is well known to affect the initial angiographic result of aneurysm embolization and has a crucial role in the stability of aneurysm obliteration. Although aneurysm coiling is commonly performed under general anesthesia, it could be performed under local anesthesia in certain circumstances.
Objective
The purpose of this study is to compare the volume embolization ratio (VER) and angiographic results of cerebral aneurysm embolization performed under local and general anesthesia.
Materials and methods
This is a retrospective cohort analysis of 20 consecutive cases of coiled cerebral aneurysms that were coiled under LA. Further, 15 cerebral aneurysm coil embolization cases have been collected from our data as matched control group.
Results
Embolization was performed under local anesthesia (Group A) in 20 patients (57.1%) and under general anesthesia (Group B) in 15 patients (42.9%). At the end of the procedure, control angiogram revealed complete obliteration in 13 patients (37.1%), while incomplete obliteration was detected in 22 patients (62.9%). The mean VER 27.9 ± 11.8 without a significant difference between both groups of the study as the VER of Group (A) was 26.05 ± 8.4 and that of Group B was 30.44 ± 15.2. Follow-up angiography at 1 year revealed complete obliteration in 17 (48.6%) of the coiled aneurysms, while incomplete obliteration was detected in 18 patients (51.4%).
Conclusions
Endovascular coiling of cerebral aneurysms under local anesthesia is a safe and feasible procedure without significant effects on the VER.
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Incidence rate and predictors of recurrent aneurysms after clipping: long-term follow-up study of survivors of subarachnoid hemorrhage. Neurosurg Rev 2022; 45:3209-3217. [PMID: 35739336 DOI: 10.1007/s10143-022-01828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Recurrent aneurysms are a major cause of re-aneurysmal subarachnoid hemorrhage (aSAH), but information on long-term clip durability and predictors is insufficient. This study aimed to present the incidence rate of > 10 years and investigate predictors of a recurrent aneurysm in aSAH survivors. We included 1601 patients admitted with aSAH and treated by microsurgical clipping between January 1993 and May 2010. Of these patients, 435 aSAH survivors were included in this study (27.2%). The total follow-up time was 5680.9 patient-years, and the overall incidence rate was 0.77% per patient-year. The cumulative probability of recurrence without residua and regrowth of the neck remnant was 0.7% and 13.9% at 10 years, respectively. Neck remnant (hazard ratio [HR], 10.311; 95% confidence interval [CI], 5.233-20.313) and alcohol consumption over the moderate amount (HR, 3.166; 95% CI, 1.313-7.637) were independent risk factors of recurrent aneurysm. Current smoking and multiplicity at initial aSAH presentation were significant factors in a univariate analysis. Furthermore, de novo intracranial aneurysms (DNIAs) were more common in the recurrent group than in the non-recurrent group (40.9% vs. 11.5%, P < 0.001). In the present study, we noted the long-term clip durability and predictor of recurrence after microsurgical clipping. These findings can assist clinicians in identifying patients at a high risk of recurrent aneurysm and recommending selective long-term surveillance after microsurgical clipping.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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5
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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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Fujimura S, Tanaka K, Takao H, Okudaira T, Koseki H, Hasebe A, Suzuki T, Uchiyama Y, Ishibashi T, Otani K, Karagiozov K, Fukudome K, Hayakawa M, Yamamoto M, Murayama Y. Computational fluid dynamic analysis of the initiation of cerebral aneurysms. J Neurosurg 2022; 137:335-343. [PMID: 34933277 DOI: 10.3171/2021.8.jns211452] [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: 06/14/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Relationships between aneurysm initiation and hemodynamic factors remain unclear since de novo aneurysms are rarely observed. Most previous computational fluid dynamics (CFD) studies have used artificially reproduced vessel geometries before aneurysm initiation for analysis. In this study, the authors investigated the hemodynamic factors related to aneurysm initiation by using angiographic images in patients with cerebral aneurysms taken before and after an aneurysm formation. METHODS The authors identified 10 cases of de novo aneurysms in patients who underwent follow-up examinations for existing cerebral aneurysms located at a different vessel. The authors then reconstructed the vessel geometry from the images that were taken before aneurysm initiation. In addition, 34 arterial locations without aneurysms were selected as control cases. Hemodynamic parameters acting on the arterial walls were calculated by CFD analysis. RESULTS In all de novo cases, the aneurysmal initiation area corresponded to the highest wall shear stress divergence (WSSD point), which indicated that there was a strong tensile force on the arterial wall at the initiation area. The other previously reported parameters did not show such correlations. Additionally, the pressure loss coefficient (PLc) was statistically significantly higher in the de novo cases (p < 0.01). The blood flow impact on the bifurcation apex, or the secondary flow accompanied by vortices, resulted in high tensile forces and high total pressure loss acting on the vessel wall. CONCLUSIONS Aneurysm initiation may be more likely in an area where both tensile forces acting on the vessel wall and total pressure loss are large.
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Affiliation(s)
- Soichiro Fujimura
- 1Department of Mechanical Engineering, Tokyo University of Science
- Departments of2Innovation for Medical Information Technology and
| | - Kazutoshi Tanaka
- Departments of2Innovation for Medical Information Technology and
| | - Hiroyuki Takao
- Departments of2Innovation for Medical Information Technology and
- 3Neurosurgery, The Jikei University School of Medicine
- 4Graduate School of Mechanical Engineering, Tokyo University of Science
| | - Takuma Okudaira
- Departments of2Innovation for Medical Information Technology and
| | | | - Akiko Hasebe
- 6Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Takashi Suzuki
- Departments of2Innovation for Medical Information Technology and
- 5Siemens Healthcare K. K., Tokyo; and
| | - Yuya Uchiyama
- Departments of2Innovation for Medical Information Technology and
- 4Graduate School of Mechanical Engineering, Tokyo University of Science
| | | | - Katharina Otani
- 3Neurosurgery, The Jikei University School of Medicine
- 5Siemens Healthcare K. K., Tokyo; and
| | | | - Koji Fukudome
- 1Department of Mechanical Engineering, Tokyo University of Science
| | | | - Makoto Yamamoto
- 1Department of Mechanical Engineering, Tokyo University of Science
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7
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Akimoto T, Ito Y, Akutagawa K, Sato M, Hayakawa M, Marushima A, Takigawa T, Tsuruta W, Kato N, Suzuki K, Uemura K, Yamamoto T, Matsumaru Y. Perioperative and long-term complications following therapeutic internal carotid artery occlusion. Interv Neuroradiol 2022:15910199221095786. [PMID: 35450482 PMCID: PMC10399501 DOI: 10.1177/15910199221095786] [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: 10/18/2022] Open
Abstract
BACKGROUND Parent artery occlusion (PAO) is an effective treatment for hemorrhagic diseases associated with the internal carotid artery. There are several reports of long-term cerebral infarction or the formation of de novo cerebral aneurysms following PAO. MATERIALS AND METHODS We retrospectively reviewed these complications in 38 patients who underwent PAO for therapeutic treatment. We investigated perioperative cerebral infarctions, long-term cerebral infarctions, and de novo aneurysms. RESULTS The mean age of the patients was 64.0 years, and 25 patients (65.8%) were female. The causative diseases were unruptured (n = 19; 50.0%) and ruptured (n = 8; 21.1%) aneurysms. PAO was performed after ischemic tolerance was assessed with balloon test occlusion (BTO), and BTO was performed in 34 patients, of whom 25 (73.5%) had ischemic tolerance. Twenty-six patients (68.4%) were treated with PAO alone, eight (23.5%) with low-flow bypass, and six (17.6%) with high-flow bypass. Perioperative complications occurred in five patients (13.2%): two of the 26 patients (7.7%) who underwent scheduled treatment and three of the 12 patients (25.0%) who underwent emergency treatment. One patient (2.6%) had long-term de novo aneurysm, and none developed cerebral infarction. CONCLUSIONS These results showed that the assessment of ischemic tolerance by performing BTO and appropriate revascularization in scheduled treatments are important to reduce perioperative and long-term cerebral infarctions. PAO must be performed with greater caution in emergency treatment.
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Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Department of Neurosurgery, 26437Yokomhama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Kazuki Akutagawa
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Wataro Tsuruta
- Department of Neuroendovascular Therapy, 13600Toranomon Hospital, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center Hospital, Ibaraki, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, 26420Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, 13155Yokomhama City University, Yokohama, Kanagawa, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
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8
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Mu L, Liu X, Liu M, Long L, Chi Q, He Y, Pan Y, Ji C, Gao G, Li X. In Vitro Study of Endothelial Cell Morphology and Gene Expression in Response to Wall Shear Stress Induced by Arterial Stenosis. Front Bioeng Biotechnol 2022; 10:854109. [PMID: 35497360 PMCID: PMC9043283 DOI: 10.3389/fbioe.2022.854109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: We examined the correlation between changes in hemodynamic characteristics induced by arterial stenosis and vascular endothelial cell (EC) morphology and gene expression in straight silicone arteries. Materials and methods: Transparent silicone straight artery models with four degrees of stenosis (0, 30, 50, and 70%) were fabricated. Particle image velocimetry was performed to screen silicone vessel structures with good symmetry and to match the numerical simulations. After the inner surface of a symmetric model was populated with ECs, it was perfusion-cultured at a steady flow rate. A computational fluid dynamics (CFD) study was conducted under the same perfusion conditions as in the flow experiment. The high-WSS region was then identified by CFD simulation. EC morphology in the high-WSS regions was characterized by confocal microscopy. ECs were antibody-stained to analyze the expression of inflammatory factors, including matrix metalloproteinase (MMP)-9 and nuclear factor (NF)-κB, which were then correlated with the CFD simulations. Results: As the degree of vascular stenosis increases, more evident jet flow occurs, and the maximum WSS position moves away first and then back. ECs were irregularly shaped at vortex flow regions. The number of gaps between the cells in high-WSS regions increased. The MMP-9 and NF-κB expression did not differ between vessels with 30 and 0% stenosis. When arterial stenosis was 70%, the MMP-9 and NF-κB expression increased significantly, which correlated with the regions of substantially high WSS in the CFD simulations. Conclusion: Stenotic arteries induce hemodynamic stress variations, which contribute to differences in EC morphology and gene expression. A high degree of vascular stenosis can directly increase inflammatory factor expression.
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Affiliation(s)
- Lizhong Mu
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Xiaolong Liu
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Mengmeng Liu
- Schood of Chemical Engineering, Dalian University of Technology, Dalian, China
| | - Lili Long
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Qingzhuo Chi
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Ying He
- Key Laboratory of Ocean Energy Utilization and Energy Conservation of Ministry of Education, School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Yue Pan
- Schood of Chemical Engineering, Dalian University of Technology, Dalian, China
- Ningbo Institute, Dalian University of Technology, Ningbo, China
- *Correspondence: Yue Pan,
| | - Changjin Ji
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Ge Gao
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xiaona Li
- Key Laboratory of Industrial Ecology and Environmental Engineering (MOE), School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
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9
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A stroke detection and discrimination framework using broadband microwave scattering on stochastic models with deep learning. Sci Rep 2021; 11:24222. [PMID: 34930921 PMCID: PMC8688451 DOI: 10.1038/s41598-021-03043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Stroke poses an immense public health burden and remains among the primary causes of death and disability worldwide. Emergent therapy is often precluded by late or indeterminate times of onset before initial clinical presentation. Rapid, mobile, safe and low-cost stroke detection technology remains a deeply unmet clinical need. Past studies have explored the use of microwave and other small form-factor strategies for rapid stroke detection; however, widespread clinical adoption remains unrealized. Here, we investigated the use of microwave scattering perturbations from ultra wide-band antenna arrays to learn dielectric signatures of disease. Two deep neural networks (DNNs) were used for: (1) stroke detection (“classification network”), and (2) characterization of the hemorrhage location and size (“discrimination network”). Dielectric signatures were learned on a simulated cohort of 666 hemorrhagic stroke and control subjects using 2D stochastic head models. The classification network yielded a stratified K-fold stroke detection accuracy > 94% with an AUC of 0.996, while the discrimination network resulted in a mean squared error of < 0.004 cm and < 0.02 cm, for the stroke localization and size estimation, respectively. We report a novel approach to intelligent diagnostics using microwave wide-band scattering information thus circumventing conventional image-formation.
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10
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Formation, Growth, or Rupture of De Novo Intracranial Aneurysms: Long-Term Follow-up Study of Subarachnoid Hemorrhage Survivors. Neurosurgery 2021; 89:1104-1111. [PMID: 34634821 DOI: 10.1093/neuros/nyab364] [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: 11/22/2020] [Accepted: 08/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The survival rate of aneurysmal subarachnoid hemorrhage (aSAH) has gradually increased, leading to more clinical cases of de novo intracranial aneurysms (DNIAs). OBJECTIVE To identify the characteristics of patients with DNIA growth or rupture. METHODS We included 1601 patients with aSAH treated by clipping from January 1993 to May 2010. According to the inclusion and exclusion criteria, 233 patients had no DNIAs, and 63 patients had 77 DNIAs. We assessed the incidence rate of DNIAs and risk factors for DNIA formation. After dichotomizing the DNIA group into the heed (patients with DNIA rupture or growth) and stable groups (patients without DNIA growth), we assessed the risk factors for DNIA growth or rupture. RESULTS The total follow-up period was 4427.9 patient-years. The incidence rate per patient-year was 1.42%. Age ≤50 yr, family history of aneurysm, and multiplicity at initial aSAH were significant risk factors for DNIA formation. Multivariate regression analysis revealed that female sex (odds ratio [OR], 5.566; 95% confidence interval [CI], 1.241-24.952), duration from initial aSAH to DNIA detection <120 mo (OR, 5.043; 95% CI, 1.362-18.668), multiplicity at initial aSAH (OR, 4.859; 95% CI, 1.207-19.563), and maximum DNIA diameter ≥4 mm (OR, 11.104; 95% CI, 2.337-52.772) were significant risk factors for DNIA growth or rupture. CONCLUSION DNIAs had a higher incidence rate than expected. Taking into account the presented incidence rate and risk factors, long-term surveillance in aSAH survivors for more than a decade may be worth considering, at least on a case-by-case basis.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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11
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Takase K, Tetsuo Y, Umesaki A, Masuo O. A Case of De Novo Basilar Artery Aneurysm Associated with Proximal Stenosis Treated by Coil Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:366-370. [PMID: 37502342 PMCID: PMC10370913 DOI: 10.5797/jnet.cr.2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/03/2021] [Indexed: 07/29/2023]
Abstract
Objective This report highlights a case of a de novo aneurysm assumed to be caused by hemodynamic stress resulting from proximal basilar artery stenosis. Case Presentation A 76-year-old woman presented at our hospital with tinnitus. Although MRI did not reveal the cause of her tinnitus, it did uncover an incidental finding of basilar artery stenosis. The patient reported a history of cerebral infarction, diabetes, and hypertension. Six years following the initial discovery of basilar artery stenosis, a saccular aneurysm was detected at the bifurcation of the basilar artery and the right anterior inferior cerebellar artery, corresponding to the distal portion of the basilar artery stenosis. Upon revelation of an enlarged aneurysm on the subsequent two-year follow-up MRI, the patient received coil embolization treatment. No signs of recurrence were observed on the next two-year follow-up MRI. Conclusion It was assumed that proximal basilar artery arteriosclerotic stenosis had caused hemodynamic stress on the distal vessel wall, and that this was responsible for the formation and growth of a de novo aneurysm. This case suggests that cerebrovascular arteriosclerotic changes may be associated with de novo aneurysm formation and therefore requires careful follow-up.
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Affiliation(s)
- Kana Takase
- Department of Neuroendovascular Therapy, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Yoshiaki Tetsuo
- Department of Neuroendovascular Therapy, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Arisa Umesaki
- Department of Neuroendovascular Therapy, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Osamu Masuo
- Department of Neuroendovascular Therapy, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
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12
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Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc 2021; 96:1970-2000. [PMID: 33992453 DOI: 10.1016/j.mayocp.2021.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
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Affiliation(s)
- Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
| | - Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport
| | | | | | - William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL; Department of Neurology, Mayo Clinic, Jacksonville, FL; Department of Critical Care, Mayo Clinic, Jacksonville, FL
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13
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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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14
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HONDA E, OHISHI T, MARUIWA H, TANAKA T. A De Novo Aneurysm of the Anterior Cerebral Azygos Artery Following a Middle Cerebral Arterial Aneurysm with Subarachnoid Hemorrhage. NMC Case Rep J 2021; 8:309-314. [PMID: 35079480 PMCID: PMC8769412 DOI: 10.2176/nmccrj.cr.2020-0120] [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: 04/15/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
A de novo aneurysm of a cerebral artery, defined as a newly growing aneurysm after aneurysmal clipping, but not close to a previously clipped one, is relatively rare. Five studies have reported that the annual incidence of de novo aneurysm formation ranged from 0.3% to 1.8%. A 56-year-old man presented with headache. Magnetic resonance angiography (MRA) and computed tomography (CT) showed an aneurysm with arachnoid hemorrhage located at the left middle cerebral artery (MCA) associated with an azygos anterior cerebral artery (ACA). Eight years later, the patient complained of dizziness, and MRA demonstrated no visualization of the MCA on the left due to metal artifact, but a new lesion, an azygos ACA aneurysm, 9 mm in diameter, was seen. Clipping was performed using multiple clips through the interhemispheric space. Late follow-up examination with MRA or three-dimensional CT to detect de novo aneurysms should be considered in a patient with this vascular anomaly after subarachnoid hemorrhage.
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Affiliation(s)
- Eiichiro HONDA
- Department of Neurospinal Surgery, Shiroishi Kyoritsu Hospital, Shiroishicho, Saga, Japan
| | - Tsuyoshi OHISHI
- Department of Neurospinal Surgery, Shiroishi Kyoritsu Hospital, Shiroishicho, Saga, Japan
| | | | - Tatsuya TANAKA
- Department of Neurosurgery, Imari-Arita Kyoritsu Hospital, Aritamachi, Saga, Japan
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15
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Gokbel A, Secer M, Polat O. Assessment of risk factors in de novo aneurysm development. Brain Circ 2020; 6:208-210. [PMID: 33210047 PMCID: PMC7646385 DOI: 10.4103/bc.bc_2_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/22/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Aneurysms that occur anywhere in intracranial except where primary aneurysms develop, are called “de novo aneurysms”. The risk factors and formation time of de novo aneurysms are not fully known. Congenital, environmental and hemodynamic factors can play a role in aneurysm development. The 43-year-old female patient was operated with the middle cerebral artery superior trunk aneurysm in our clinic. She came to us again after 17 months with a severe headache. In computed cranial tomography angiography, the middle cerebral artery superior trunk placement aneurysm was found to have a partial clip and “de novo aneurysm” was developed. She was re-operated for “de novo aneurysm”. In this study, the risk factors in development of “de novo aneurysms” were discussed in the light of literature through this patient.
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Affiliation(s)
- Aykut Gokbel
- Department of Neurosurgery, Kocaeli Provincial Health Directorate Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Mehmet Secer
- Department of Neurosurgery, Kocaeli Provincial Health Directorate Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
| | - Omer Polat
- Department of Neurosurgery, Duzce University Faculty of Medicine Hospital, Duzce, Turkey
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16
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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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17
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Yeon EK, Cho YD, Yoo DH, Lee SH, Kang HS, Cho WS, Kim JE, Han MH. De Novo Intracranial Aneurysms Detected on Imaging Follow-Up of Coiled Aneurysms in a Korean Population. Korean J Radiol 2020; 20:1390-1398. [PMID: 31464117 PMCID: PMC6715560 DOI: 10.3348/kjr.2018.0914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/12/2019] [Indexed: 11/29/2022] Open
Abstract
Objective Coiled aneurysms are known to recanalize over time, making follow-up evaluations mandatory. Although de novo intracranial aneurysms (DNIAs) are occasionally detected during routine patient monitoring, such events have not been thoroughly investigated to date. Herein, we generated estimates of DNIA development during long-term observation of coiled cerebral aneurysms, focusing on incidence and the risk factors involved. Materials and Methods In total, 773 patients undergoing coil embolization of intracranial aneurysms between 2008 and 2010 were reviewed retrospectively. Their medical records and radiologic data accrued over the extended period (mean, 52.7 ± 29.7 months) were analyzed. For the detection of DNIA, follow-up magnetic resonance angiography and/or conventional angiography were used. The incidence of DNIAs and related risk factors were analyzed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator. Results In 19 (2.5%) of the 773 patients with coiled aneurysms, DNIAs (0.56% per patient-year) developed during continued long-term monitoring (3395.3 patient-years). Of these, 9 DNIAs (47.4%) were detected within 60 months, with 10 (52.6%) emerging thereafter. The most common site involved was the posterior communicating artery (n = 6), followed by the middle cerebral artery (n = 5) and the basilar top (n = 4). Multivariate analysis indicated that younger age (< 50 years) (hazard ratio [HR] = 1.045; p = 0.010) and recanalization of coiled aneurysms (HR = 2.560; p = 0.047) were significant factors in DNIA formation, whereas female sex, smoking, and hypertension fell short of statistical significance. Cumulative survival rates without DNIA were significantly higher in older subjects (> 60 years; p < 0.001) and in the absence of post-coiling aneurysm recurrence (p = 0.006). Conclusion In most patients with coiled aneurysms, development of DNIAs during long-term monitoring is rare. However, younger patients (< 50 years) or patients with recurring aneurysms appear to be predisposed to DNIAs.
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Affiliation(s)
- Eung Koo Yeon
- Department of Radiology, KyungHee University Medical Center, KyungHee University College of Medicine, Seoul, Korea
| | - Young Dae Cho
- 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
| | - Su Hwan Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hyun Seung Kang
- 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
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hee Han
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea
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18
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Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, Choque-Velasquez J, Niemelä M, Hernesniemi J. Are Fetal-Type Posterior Cerebral Arteries Associated With an Increased Risk of Posterior Communicating Artery Aneurysms? Neurosurgery 2020; 84:1306-1312. [PMID: 29788502 DOI: 10.1093/neuros/nyy186] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fetal-type posterior cerebral arteries (F-PCAs) might result in alterations in hemodynamic flow patterns and may predispose an individual to an increased risk of posterior communicating artery aneurysms (PCoAAs). OBJECTIVE To determine the association between PCoAAs and the presence of ipsilateral F-PCAs. METHODS We retrospectively reviewed the radiographic findings from 185 patients harboring 199 PCoAAs that were treated at our institution between 2005 and 2015. Our study population consisted of 4 cohorts: (A) patients with 171 internal carotid arteries (ICAs) harboring unilateral PCoAAs; (B) 171 unaffected ICAs in the same patients from the first group; (C) 28 ICAs of 14 patients with bilateral PCoAAs; and (D) 180 ICAs of 90 patients with aneurysms in other locations. We then determined the presence of ipsilateral F-PCAs and recorded all aneurysm characteristics. RESULTS Group A had the highest prevalence of F-PCAs (42%) compared to 19% in group B, 3% in group C, and 14% in group D (odds ratio A : B = 3.041; A : C = 19.626; and A : D = 4.308; P < .001). PCoAAs were associated with larger diameters of the posterior communicating arteries (median value 1.05 vs 0.86 mm; P = .001). The presence of F-PCAs was associated with larger sizes of the aneurysm necks (median value 3.3 vs 3.0 mm; P = .02). CONCLUSION PCoAAs were associated with a higher prevalence of ipsilateral F-PCAs. This variant was associated with larger sizes of the aneurysm necks but was not associated with the sizes of the aneurysm domes or with their rupture statuses.
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Affiliation(s)
- Peeraphong Thiarawat
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,De-partment of Surgery, Naresuan University, Phitsanulok, Thailand
| | | | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Paediatric Neurology and Neurosurgery, North-western State Medical University, St. Petersburg, Russia
| | - Patcharin Intarakhao
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Anesthesiology, Naresuan University, Phitsanulok, Thailand
| | - Mario K Teo
- Bristol Institute of Clinical Neurosciences, North Bristol University Hospital, Bristol, United Kingdom
| | | | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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19
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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: 16] [Impact Index Per Article: 3.2] [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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20
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Giordan E, Lanzino G, Rangel-Castilla L, Murad MH, Brinjikji W. Risk of de novo aneurysm formation in patients with a prior diagnosis of ruptured or unruptured aneurysm: systematic review and meta-analysis. J Neurosurg 2019; 131:14-24. [PMID: 29979115 DOI: 10.3171/2018.1.jns172450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE De novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation. METHODS The authors searched multiple databases for studies of patients with unruptured and ruptured aneurysms describing the rate of de novo aneurysm formation. The primary outcome was incidence of de novo aneurysm formation. A meta-analysis was performed using a random-effects model. The authors examined the associations of multiple aneurysms, prior subarachnoid hemorrhage, smoking, sex, age at presentation, and hypertension with de novo aneurysm formation. RESULTS The meta-analysis included 14,968 aneurysm patients who received imaging follow-up from 35 studies. The overall incidence of de novo aneurysm formation was 2% (95% CI 2%-3%) over a mean follow-up time of 8.3 years. The estimated incidence density was 0.3%/patient-year. There was no statistically significant difference in rates of de novo aneurysm formation between patients who had ruptured aneurysms and those with unruptured aneurysms. In 8 studies, 11.2% of de novo aneurysms were found in patients with ≤ 5 years of follow-up and 88.8% were found at > 5 years. The mean time to rupture for de novo aneurysms was 10 years. CONCLUSIONS This systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.
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21
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Li Y, Corriveau M, Aagaard-Kienitz B, Ahmed A, Niemann D. Differences in Pressure Within the Sac of Human Ruptured and Nonruptured Cerebral Aneurysms. Neurosurgery 2019; 84:1261-1268. [PMID: 29741656 DOI: 10.1093/neuros/nyy182] [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: 10/30/2017] [Accepted: 04/10/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hemodynamics plays a critical role in the development, growth, and rupture of intracranial aneurysms. This data could be vital in determining individual aneurysm rupture risk and could facilitate our understanding of aneurysms. OBJECTIVE To present the largest prospective cross-sectional cohort study of intrasaccular pressure recordings of ruptured and nonruptured intracranial aneurysms and describe the hemodynamic differences that exist between ruptured and nonruptured aneurysms. METHODS During endovascular treatment, a standard 1.8-Fr 200 m length microcatheter was navigated into the dome of the aneurysm prior to coil embolization. With the microcatheter centralized within the dome of the aneurysm, an arterial pressure transducer was attached to the proximal end of the microcatheter to measure the stump pressure inside the aneurysm dome. RESULTS In 68 aneurysms (28 ruptured, 40 nonruptured), we observed that ruptured cerebral aneurysms had a lower systolic and mean arterial pressure compared to nonruptured cohort (P = .0008). Additionally, the pulse pressures within the dome of ruptured aneurysms were significantly more narrow than that of unruptured aneurysms (P = .0001). These findings suggest that there may be an inherent difference between ruptured and nonruptured aneurysms and such recordings obtained during routine digital subtraction angiography could potentially become a widely applied technique to augment risk stratification of aneurysms. CONCLUSION Our preliminary data present new evidence distinguishing ruptured from unruptured aneurysms that may have a critical role as a predictive parameter to stratify the natural history of nonruptured intracranial aneurysms and as a new avenue for future investigation.
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Affiliation(s)
- Yiping Li
- Department of Neurological Surgery, Neuro Interventional Radiology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Mark Corriveau
- Department of Neurological Surgery, Neuro Interventional Radiology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Beverly Aagaard-Kienitz
- Department of Neurological Surgery, Neuro Interventional Radiology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Azam Ahmed
- Department of Neurological Surgery, Neuro Interventional Radiology, University of Wisconsin Medical School, Madison, Wisconsin
| | - David Niemann
- Department of Neurological Surgery, Neuro Interventional Radiology, University of Wisconsin Medical School, Madison, Wisconsin
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22
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Sunderland K, Huang Q, Strother C, Jiang J. Two closely-spaced Aneurysms of the Supraclinoid Internal Carotid Artery: How Does One Influence the Other? J Biomech Eng 2019; 141:2735303. [PMID: 31141586 DOI: 10.1115/1.4043868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 11/08/2022]
Abstract
The objective of this study was to use image-based CFD simulation techniques to analyze the impact that multiple closely spaced IAs of the supra-clinioid segment of the ICA have on each other's hemodynamic characteristics. The vascular geometry of fifteen (15) subjects with 2 IAs were gathered using a 3D clinical system. Two groups of computer models were created for each subject's vascular geometry: both IAs present (Model A) and after removal of one IA (Model B). Models were separated into two groups based on IA separation: tandem (one proximal and one distal) and tandem (aneurysms directly opposite on a vessel). Simulations using a pulsatile velocity waveform were solved by a commercial CFD solver. Proximal IAs altered flow into distal IAs (5 of 7), increasing flow energy and spatial-temporally averaged wall shear stress (STA-WSS: 3-50\% comparing Model A to B) while decreasing flow stability within distal IAs. Thus, proximal IAs may ``protect" a distal aneurysm from destructive remodeling due to flow stagnation. Among adjacent IAs, the presence of both IAs decreased each other's flow characteristics, lowering WSS (Model A to B) and increasing flow stability: all changes statistically significant (t-test p < 0.05). A negative relationship exists between the mean percent change in flow stability in relation to adjacent IA volume and ostium area. Closely spaced IAs impact hemodynamic alterations onto each other concerning flow energy, stressors and stability. Understanding these alterations may improve clinical management of closely-spaced IAs.
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Affiliation(s)
- Kevin Sunderland
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931
| | - Qinghai Huang
- Department of Neurosurgery, Chonghai Hospital, Second Military University, Shanghai, China
| | - Charlie Strother
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931
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23
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Chien A, Callender RA, Yokota H, Salamon N, Colby GP, Wang AC, Szeder V, Jahan R, Tateshima S, Villablanca J, Duckwiler G, Vinuela F, Ye Y, Hildebrandt MAT. Unruptured intracranial aneurysm growth trajectory: occurrence and rate of enlargement in 520 longitudinally followed cases. J Neurosurg 2019; 132:1077-1087. [PMID: 30835694 DOI: 10.3171/2018.11.jns181814] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As imaging technology has improved, more unruptured intracranial aneurysms (UIAs) are detected incidentally. However, there is limited information regarding how UIAs change over time to provide stratified, patient-specific UIA follow-up management. The authors sought to enrich understanding of the natural history of UIAs and identify basic UIA growth trajectories, that is, the speed at which various UIAs increase in size. METHODS From January 2005 to December 2015, 382 patients diagnosed with UIAs (n = 520) were followed up at UCLA Medical Center through serial imaging. UIA characteristics and patient-specific variables were studied to identify risk factors associated with aneurysm growth and create a predicted aneurysm trajectory (PAT) model to differentiate aneurysm growth behavior. RESULTS The PAT model indicated that smoking and hypothyroidism had a large effect on the growth rate of large UIAs (≥ 7 mm), while UIAs < 7 mm were less influenced by smoking and hypothyroidism. Analysis of risk factors related to growth showed that initial size and multiplicity were significant factors related to aneurysm growth and were consistent across different definitions of growth. A 1.09-fold increase in risk of growth was found for every 1-mm increase in initial size (95% CI 1.04-1.15; p = 0.001). Aneurysms in patients with multiple aneurysms were 2.43-fold more likely to grow than those in patients with single aneurysms (95% CI 1.36-4.35; p = 0.003). The growth rate (speed) for large UIAs (≥ 7 mm; 0.085 mm/month) was significantly faster than that for UIAs < 3 mm (0.030 mm/month) and for males than for females (0.089 and 0.045 mm/month, respectively; p = 0.048). CONCLUSIONS Analyzing longitudinal UIA data as continuous data points can be useful to study the risk of growth and predict the aneurysm growth trajectory. Individual patient characteristics (demographics, behavior, medical history) may have a significant effect on the speed of UIA growth, and predictive models such as PAT may help optimize follow-up frequency for UIA management.
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Affiliation(s)
| | - Rashida A Callender
- 2Department of Epidemiology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | | | - Geoffrey P Colby
- Departments of1Radiology and.,3Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - Anthony C Wang
- 3Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | | | | | | | | | | | | | - Yuanqing Ye
- 2Department of Epidemiology, MD Anderson Cancer Center, University of Texas, Houston, Texas
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24
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Shekhtman OD, Gorozhanin VA, Kulikov AS, Okisheva EA. [Proximal clipping of a large fusiform aneurysm of the A2 segment of the left anterior cerebral artery with awakening of the patient (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:97-102. [PMID: 30137043 DOI: 10.17116/neiro201882497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.
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Affiliation(s)
| | | | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E A Okisheva
- Sechenov First Moscow State Medical University, Moscow, Russia
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25
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Malhotra A, Wu X, Geng B, Hersey D, Gandhi D, Sanelli P. Management of Small Unruptured Intracranial Aneurysms: A Survey of Neuroradiologists. AJNR Am J Neuroradiol 2018; 39:875-880. [PMID: 29650787 DOI: 10.3174/ajnr.a5631] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The long-term history and management of unruptured intracranial aneurysms is not well understood. Our aim was to determine current practice patterns in the management of unruptured intracranial aneurysms, especially regarding imaging surveillance for conservatively managed aneurysms of this type. MATERIALS AND METHODS An on-line survey was designed to examine physician practice and preference regarding the management of small unruptured intracranial aneurysms (≤7 mm in diameter). The survey was circulated to members of the American Society of Neuroradiology. Participation was voluntary, and all responses were anonymous. RESULTS A total of 227 individual survey responses were obtained and included in the analysis with 54.6% (124/227) from diagnostic neuroradiologists (practicing >50% neuroradiology) and one-third (29%) from neurointerventional radiologists. One hundred seventy-three of 227 responded that routine, periodic imaging surveillance would be appropriate for conservatively managed unruptured intracranial aneurysms, and 84% of respondents recommended surveillance frequency of at least once a year. Fifty-nine percent favored indefinite, life-long follow-up for small unruptured intracranial aneurysms, and a similar number of respondents favored noncontrast MR angiography for aneurysm follow-up. Significant heterogeneity was found in size measurements used to assess aneurysms and criteria used to define growth on surveillance imaging. CONCLUSIONS The natural history of intracranial aneurysms is not well-understood. A large proportion of incidentally detected, unruptured aneurysms are small (<7 mm). The survey results show significant heterogeneity in practice even among neuroradiologists and underlies the need to standardize imaging practice. Further studies are needed to assess the optimal frequency and duration of surveillance imaging for unruptured intracranial aneurysms. The criteria used to measure aneurysms and define growth on imaging also need to be standardized.
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Affiliation(s)
- A Malhotra
- From the Department of Radiology and Biomedical Imaging (A.M.), Yale School of Medicine, New Haven, Connecticut
| | - X Wu
- Yale School of Medicine (X.W., B.G.), New Haven, Connecticut
| | - B Geng
- Yale School of Medicine (X.W., B.G.), New Haven, Connecticut
| | - D Hersey
- Clinical Information Services (D.H.), Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - D Gandhi
- Department of Interventional Neuroradiology (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Sanelli
- Department of Radiology (P.S.), Northwell Health, New York, New York
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26
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Risk of de novo aneurysm formation in patients with unruptured intracranial aneurysms. Acta Neurochir (Wien) 2018; 160:747-751. [PMID: 29417227 DOI: 10.1007/s00701-018-3472-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE The rate of de novo aneurysm formation in patients with unruptured aneurysm without history of subarachnoid hemorrhage is scarcely defined in literature. We report the incidence of de novo aneurysm formation in a large contemporary series of patients with unruptured intracranial aneurysm (UIA) undergoing serial neurovascular imaging. METHODS Neurovascular imaging studies of 321 consecutive UIA patients with no prior history of subarachnoid hemorrhage, with at least 3 years of follow-up imaging, were reviewed by a neuroradiologist and a neurosurgeon. Rate of de novo aneurysm formation was reported on a per-patient and per-patient-year basis. RESULTS Of the 321 included patients, three patients (0.9%) developed a de novo aneurysm over a mean follow-up period of 5.2 years, for an incidence rate of 0.18% per patient-year. No de novo aneurysms ruptured and all three were 2 mm in size. CONCLUSIONS The rate of de novo aneurysm formation in patients with unruptured aneurysms and no history of subarachnoid hemorrhage is very low. These data are useful to advice patients with unruptured aneurysms from another aneurysm and to plan imaging follow-ups in these patients.
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27
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Watanabe Z, Tomura N, Akasu I, Munakata R, Horiuchi K, Watanabe K. Comparison of Rates of Growth between Unruptured and Ruptured Aneurysms Using Magnetic Resonance Angiography. J Stroke Cerebrovasc Dis 2017; 26:2849-2854. [PMID: 28826580 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/09/2017] [Accepted: 07/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Growth is a key risk factor for rupture of unruptured cerebral aneurysms. There are few reports of investigations into the actual growth of ruptured intracranial aneurysms. The aim of the present study was to ascertain the risk of rupture of aneurysms based on the growth of unruptured and ruptured aneurysms. METHODS Changes in size on magnetic resonance angiography (MRA) were examined in 50 patients with ruptured cerebral aneurysms. Images obtained before and after subarachnoid hemorrhage were used. Moreover, changes in aneurysm size were retrospectively examined in 73 patients with 100 unruptured cerebral aneurysms that were followed serially with MRA that was performed using a 1.5-T or 3-T system. The size of the aneurysm was determined by measuring the maximum diameter on maximum intensity projection MRA images. Based on these data, the annual growth rates (mm growth/year) of unruptured and ruptured aneurysms were calculated and compared. RESULTS The median annual growth rate of ruptured aneurysms was significantly greater than that of unruptured aneurysms (.69 versus .077 mm/year, P < .01). The annual growth rates of ruptured aneurysms showed a negative correlation between the duration from initial MRA to the time of rupture. CONCLUSION A high annual growth rate is a key risk factor for aneurysm rupture. This finding provides strong evidence for the treatment of unruptured cerebral aneurysms.
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Affiliation(s)
- Zenichiro Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan.
| | - Noriaki Tomura
- Department of Neuroradiology, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Isao Akasu
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Ryoji Munakata
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Kazuomi Horiuchi
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
| | - Kazuo Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Japan
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28
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Estevão IA, Camporeze B, Araujo Jr ASD, Nery B, Antunes ÁCM, Smith TR, Aguiar PHPD. Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:523-532. [DOI: 10.1590/0004-282x20170082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/30/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate. Conclusion In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Paulo Henrique Pires de Aguiar
- Hospital Santa Paula, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Pontifícia Universidade Católica de São Paulo, Brasil
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29
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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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30
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Futchko J, Starr J, Lau D, Leach MR, Roark C, Pandey AS, Thompson BG. Influence of smoking on aneurysm recurrence after endovascular treatment of cerebrovascular aneurysms. J Neurosurg 2017. [PMID: 28644100 DOI: 10.3171/2016.12.jns161625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Smoking is a known risk factor for aneurysm development and aneurysmal subarachnoid hemorrhage, as well as subsequent vasospasm in both untreated individuals and patients who have undergone surgical clipping of cerebrovascular aneurysms. However, there is a lack of data in the current scientific literature about the long-term effects that smoking has on the integrity of endovascular repairs of cerebral aneurysms. This study was designed to determine if any smoking history increased the risk of poorer outcomes and/or aneurysm recurrence in patients who have had endovascular repair of cerebral aneurysms. METHODS The authors retrospectively analyzed the medical records of patients admitted to the University of Michigan Health System from January 1999 to December 2011 with coiled aneurysms and angiography, CT angiography, or MR angiography follow-up. Patients were identified and organized based on many criteria including age, sex, smoking history, aneurysm recurrence, aneurysm location, and Hunt and Hess grade. Analysis was targeted to the patient population with a history of smoking. Bivariate chi-square tests were used to analyze the association between a positive smoking history and documented aneurysm recurrence and were adjusted for potential confounders by fitting multivariate logistic regression models of recurrence. RESULTS A total of 247 patients who had undergone endovascular treatment of 296 documented cerebral aneurysms were included in this study. The recurrence rate among all patients treated with endovascular repair was 24.3%, and the average time to the most recent follow-up imaging studies was 1.62 years. Smokers accounted for 232 aneurysms and were followed up for an average of 1.57 years, with a recurrence rate of 26.3%. Never smokers accounted for the remaining 64 aneurysms and were followed up for an average of 1.82 years, with a recurrence rate of 17.2%. Multivariate analysis revealed that, after controlling for potential confounders, a history of smoking-whether current or former-was associated with a significantly increased risk of aneurysm recurrence. The odds ratios for aneurysm recurrence for current and former smokers were 2.739 (95% CI 1.127-7.095, p = 0.0308) and 2.698 (95% CI 1.078-7.212, p = 0.0395), respectively, compared with never smokers. CONCLUSIONS A positive smoking history is associated with a significantly increased risk of aneurysm recurrence in patients who have undergone endovascular repair of a cerebral aneurysm, compared with the risk in patients who have never smoked.
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Affiliation(s)
- John Futchko
- 1Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York
| | - Jordan Starr
- 2Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Darryl Lau
- 3Department of Neurosurgery, University of California, San Francisco, California
| | | | - Christopher Roark
- 5Department of Neurosurgery, University of Colorado-Denver, Colorado; and
| | - Aditya S Pandey
- 6Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - B Gregory Thompson
- 6Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
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Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Tani S, Arimura K, Beppu M, Sakai N. Endovascular parent-artery occlusion of large or giant unruptured internal carotid artery aneurysms. A long-term single-center experience. J Clin Neurosci 2016; 37:73-78. [PMID: 27956171 DOI: 10.1016/j.jocn.2016.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022]
Abstract
The development of stent-like devices has increased treatment options for complex internal carotid artery (ICA) aneurysms, but the optimal treatment remains unclear. The purpose of this study was to evaluate the safety and efficacy of endovascular parent-artery occlusion (PAO) for ICA aneurysms. We retrospectively reviewed 28 patients with unruptured ICA aneurysms ⩾10mm treated with PAO between April 2002 and March 2015 at our institution. Patients who developed neurologic symptoms or with venous-phase delay >2s during balloon test occlusion were not treated by PAO. Patients with venous-phase delays of 1-2s underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass prior to PAO. The median patient age was 65 (range, 26-84)years. Nineteen aneurysms (68%) were located in the cavernous segment. The median aneurysm size was 25 (range 11-40)mm. Venous-phase delay of 1-2s was observed in five patients. Perioperative ischemic complications (N=9, 32%), which occurred within 30days after treatment, were significantly associated with venous-phase delays of 1-2s (p<0.01) and history of hypertension (p<0.01). Six-month morbidity was observed in one (3.6%) patient. Complete occlusion at final follow-up and delayed (i.e. ⩾31days after treatment) ischemic events were observed in 100% and 0% of patients, respectively, over a median period of 63 (range, 6-147) months. Despite the high frequency of perioperative ischemic episodes, endovascular PAO with selective use of STA-MCA bypass showed excellent long-term outcomes in patients with unruptured ICA aneurysms ⩾10mm.
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Affiliation(s)
- Kampei Shimizu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Chiaki Sakai
- Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Mikiya Beppu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
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Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12:699-713. [DOI: 10.1038/nrneurol.2016.150] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jou L, Britz G. Correlation Between Aneurysm Size and Hemodynamics in One Individual with Multiple Small Intracranial Aneurysms. Cureus 2016; 8:e683. [PMID: 27555981 PMCID: PMC4981414 DOI: 10.7759/cureus.683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective A large number of cases are needed in the patient-specific modeling of intracranial aneurysms to establish the statistical significance due to individual variation of risk factors that are difficult to account for. However, these risk factors are critical in hemorrhage risk as demonstrated in large clinical studies. Rupture risks for aneurysms in an individual are easier to compare because these aneurysms are under the same physiological environment, and their only differences are the local hemodynamic factors associated with their anatomic locations. Methods Eight small aneurysms (< 7 mm) from one individual were analyzed using patient-specific hemodynamic modeling. Four scenarios with different perfusion assumptions were performed to account for the flow rate at two smaller communicating arteries. Wall shear stresses (WSS) at these aneurysms were compared to determine their relationship with the aneurysm size. Results Each of the three largest aneurysms is either the most proximal or distal aneurysm in a given artery so that blood pressure does not have a direct influence on aneurysm size. No wall shear stress-derived hemodynamic variables are found to be related to aneurysm size. Discussion A study of multiple aneurysms from one individual offers a unique opportunity to examine various hemodynamic factors without selection biases. Aneurysms greater than 4 mm (Group 1) have a higher product of maximum WSS and area of low WSS; aneurysms smaller than 4 mm (Group 2) have a lower product of maximum WSS and area of low WSS. In addition, aneurysm size is linearly correlated with the flow rate at the parent artery in each group.
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Affiliation(s)
- Liangder Jou
- Department of Neurosurgery, Houston Methodist Hospital
| | - Gavin Britz
- Department of Neurosurgery, Houston Methodist Hospital
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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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Lindgren AE, Räisänen S, Björkman J, Tattari H, Huttunen J, Huttunen T, Kurki MI, Frösen J, Koivisto T, Jääskeläinen JE, von Und Zu Fraunberg M. De Novo Aneurysm Formation in Carriers of Saccular Intracranial Aneurysm Disease in Eastern Finland. Stroke 2016; 47:1213-8. [PMID: 27026632 DOI: 10.1161/strokeaha.115.012573] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Formation of new (de novo) aneurysms in patients carrying saccular intracranial aneurysm (sIA) disease has been published, but data from population-based cohorts are scarce. METHODS Kuopio sIA database (http://www.uef.fi/ns) contains all unruptured and ruptured sIA patients admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We studied the incidence and risk factors for de novo sIA formation in 1419 sIA patients with ≥5 years of angiographic follow-up, a total follow-up of 18 526 patient-years. RESULTS There were 42 patients with a total of 56 de novo sIAs, diagnosed in a median of 11.7 years after the first sIA diagnosis. The cumulative incidence of de novo sIAs was 0.23% per patient-year and that of subarachnoid hemorrhage from a ruptured de novo sIA 0.05% per patient-year. The risk of de novo sIA discovery per patient-year increased with younger age at the first sIA diagnosis: 2.2% in the patients aged <20 years and 0.46% in the patients aged between 20 and 39 years. In Cox regression analysis, smoking history and younger age at the first sIA diagnosis significantly associated with de novo sIA formation, but female sex, multiple sIAs, and sIA family did not. CONCLUSIONS Patients aged < 40 years at the first sIA diagnosis are in a significant risk of developing de novo sIAs, and they should be scheduled for long-term angiographic follow-up. Smoking increases the risk of de novo sIA formation, suggesting long-term follow-up for smokers. Antismoking efforts are highly recommended for sIA patients.
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Affiliation(s)
- Antti E Lindgren
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Sari Räisänen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joel Björkman
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Tattari
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mitja I Kurki
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Serrone JC, Tackla RD, Gozal YM, Hanseman DJ, Gogela SL, Vuong SM, Kosty JA, Steiner CA, Krueger BM, Grossman AW, Ringer AJ. Aneurysm growth and de novo aneurysms during aneurysm surveillance. J Neurosurg 2016; 125:1374-1382. [PMID: 26967775 DOI: 10.3171/2015.12.jns151552] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many low-risk unruptured intracranial aneurysms (UIAs) are followed for growth with surveillance imaging. Growth of UIAs likely increases the risk of rupture. The incidence and risk factors of UIA growth or de novo aneurysm formation require further research. The authors retrospectively identify risk factors and annual risk for UIA growth or de novo aneurysm formation in an aneurysm surveillance protocol. METHODS Over an 11.5-year period, the authors recommended surveillance imaging to 192 patients with 234 UIAs. The incidence of UIA growth and de novo aneurysm formation was assessed. With logistic regression, risk factors for UIA growth or de novo aneurysm formation and patient compliance with the surveillance protocol was assessed. RESULTS During 621 patient-years of follow-up, the incidence of aneurysm growth or de novo aneurysm formation was 5.0%/patient-year. At the 6-month examination, 5.2% of patients had aneurysm growth and 4.3% of aneurysms had grown. Four de novo aneurysms formed (0.64%/patient-year). Over 793 aneurysm-years of follow-up, the annual risk of aneurysm growth was 3.7%. Only initial aneurysm size predicted aneurysm growth (UIA < 5 mm = 1.6% vs UIA ≥ 5 mm = 8.7%, p = 0.002). Patients with growing UIAs were more likely to also have de novo aneurysms (p = 0.01). Patient compliance with this protocol was 65%, with younger age predictive of better compliance (p = 0.01). CONCLUSIONS Observation of low-risk UIAs with surveillance imaging can be implemented safely with good adherence. Aneurysm size is the only predictor of future growth. More frequent (semiannual) surveillance imaging for newly diagnosed UIAs and UIAs ≥ 5 mm is warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Andrew J Ringer
- Department of Neurosurgery.,Department of Radiology, University of Cincinnati College of Medicine.,Comprehensive Stroke Center at the University of Cincinnati Neuroscience Institute; and.,Mayfield Clinic, Cincinnati, Ohio
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Nery B, Araujo R, Burjaili B, Smith TR, Rodrigues JC, Silva MN. "True" posterior communicating aneurysms: Three cases, three strategies. Surg Neurol Int 2016; 7:2. [PMID: 26862441 PMCID: PMC4722528 DOI: 10.4103/2152-7806.173307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/24/2015] [Indexed: 11/25/2022] Open
Abstract
Background: The authors provide a review of true aneurysms of the posterior communicating artery (PCoA). Three cases admitted in our hospital are presented and discussed as follows. Case Descriptions: First patient is a 51-year-old female presenting with a Fisher II, Hunt-Hess III (headache and confusion) subarachnoid hemorrhage (SAH) from a ruptured true aneurysm of the right PCoA. She underwent a successful ipsilateral pterional craniotomy for aneurysm clipping and was discharged on postoperative day 4 without neurological deficit. Second patient is a 53-year-old female with a Fisher I, Hunt-Hess III (headache, mild hemiparesis) SAH and multiple aneurisms, one from left ophthalmic carotid artery and one (true) from right PCoA. These lesions were approached and successfully treated by a single pterional craniotomy on the left side. The patient was discharged 4 days after surgery, with complete recovery of muscle strength during follow-up. Third patient is a 69-year-old male with a Fisher III, Hunt-Hess III (headache and confusion) SAH, from a true PCoA on the right. He had a left subclavian artery occlusion with flow theft from the right vertebral artery to the left vertebral artery. The patient underwent endovascular treatment with angioplasty and stent placement on the left subclavian artery that resulted in aneurysm occlusion. Conclusion: In conclusion, despite their seldom occurrence, true PCoA aneurysms can be successfully treated with different strategies.
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Affiliation(s)
- Breno Nery
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Ricardo Araujo
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Bruno Burjaili
- Department of Neurosurgery, Hospital Heliópolis, São Paulo, Brazil
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, MA, USA
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Ibrahim TF, Hafez A, Andrade-Barazarte H, Raj R, Niemela M, Lehto H, Numminen J, Jarvelainen J, Hernesniemi J. De novo giant A2 aneurysm following anterior communicating artery occlusion. Surg Neurol Int 2015; 6:S560-5. [PMID: 26664872 PMCID: PMC4653326 DOI: 10.4103/2152-7806.168074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/23/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND De novo intracranial aneurysms are reported to occur with varying incidence after intracranial aneurysm treatment. They are purported to be observed, however, with increased incidence after Hunterian ligation; particularly in cases of carotid artery occlusion for giant or complex aneurysms deemed unclippable. CASE DESCRIPTION We report a case of right-sided de novo giant A2 aneurysm 6 years after an anterior communicating artery (ACoA) aneurysm clipping. We believe this de novo aneurysm developed in part due to patient-specific risk factors but also a significant change in cerebral hemodynamics. The ACoA became occluded after surgery that likely altered the cerebral hemodynamics and contributed to the de novo aneurysm. We believe this to be the first reported case of a giant de novo aneurysm in this location. Following parent vessel occlusion (mostly of the carotid artery), there are no reports of any de novo aneurysms in the pericallosal arteries let alone a giant one. The patient had a dominant right A1 and the sudden increase in A2 blood flow likely resulted in increased wall shear stress, particularly in the medial wall of the A2 where the aneurysm occurred 2 mm distal to the A1-2 junction. CONCLUSION ACoA preservation is a key element of aneurysm surgery in this location. Suspected occlusion of this vessel may warrant closer radiographic follow-up in patients with other risk factors for aneurysm development.
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Affiliation(s)
- Tarik F Ibrahim
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA ; Department of Neurosurgery, Loyola University Medical Center, Maywood, IL, USA
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA
| | | | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA
| | - Mika Niemela
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA
| | - Jussi Numminen
- Department of Neuroradiology, Helsinki University Hospital, Helsinki, Finland, USA
| | - Juha Jarvelainen
- Department of Neuroradiology, Helsinki University Hospital, Helsinki, Finland, USA
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland, USA
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Wang JY, Smith R, Ye X, Yang W, Caplan JM, Radvany MG, Colby GP, Coon AL, Tamargo RJ, Huang J. Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm. Neurosurgery 2015; 77:32-42; discussion 42-3. [DOI: 10.1227/neu.0000000000000730] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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: 599] [Impact Index Per Article: 66.6] [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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Labeyrie MA, Lenck S, Bresson D, Desilles JP, Bisdorff A, Saint-Maurice JP, Houdart E. Parent artery occlusion in large, giant, or fusiform aneurysms of the carotid siphon: clinical and imaging results. AJNR Am J Neuroradiol 2015; 36:140-5. [PMID: 25082818 DOI: 10.3174/ajnr.a4064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parent artery occlusion has long been considered the reference treatment for large/giant or fusiform aneurysms of the carotid siphon. However, meager recent data exist on this technique, which tends to be replaced by stent-assisted reconstructive techniques. In our department since 2004, we have assessed the safety, efficacy, and complication risk factors of parent artery occlusion by using coils for trapping these aneurysms. MATERIALS AND METHODS We determined retrospectively the complication rate, factors associated with the occurrence of an ischemic event, changes in symptoms of mass effect, evolution of the aneurysmal size, and the growth of an additional aneurysm after treatment. RESULTS Fifty-six consecutive patients were included, with a median age of 54 years (range, 25-85 years; 92% women), 48% with giant aneurysms and 75% with infraclinoid aneurysms. There was a permanent morbidity rate of 5% exclusively due to ischemia, a zero mortality rate, an aneurysmal retraction rate of 91%, and an improvement rate for pain of 98% and for cranial nerve palsy of 72%, with a median follow-up of >3 years. Para-/supraclinoid topography of the aneurysm (P = .043) and the presence of cardiovascular risk factors (P = .024) were associated with an excessive risk of an ischemic event, whereas the presence of a mural thrombus had a protective role (P = .033). CONCLUSIONS In this study, parent artery occlusion by using coils to treat large/giant or fusiform aneurysms of the carotid siphon was safe and effective, especially for giant infraclinoid aneurysms. According to recent meta-analyses, these results suggest that the validation of stent-assisted reconstructive treatments for these aneurysms requires controlled studies with parent occlusion artery.
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Affiliation(s)
- M-A Labeyrie
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - S Lenck
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - D Bresson
- Neurosurgery (D.B.), Université Paris Diderot, Pôle Neurosensoriel, Lariboisière Hospital, Paris, France
| | - J-P Desilles
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - A Bisdorff
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - J-P Saint-Maurice
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - E Houdart
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
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Kono K, Fujimoto T, Terada T. Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:942-950. [PMID: 24706583 DOI: 10.1002/cnm.2637] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 02/02/2014] [Accepted: 03/10/2014] [Indexed: 06/03/2023]
Abstract
Hemodynamic parameters, such as wall shear stress (WSS), WSS gradient (WSSG), aneurysm formation indicator (AFI), or gradient oscillatory number (GON), have been proposed to be linked to initiation of cerebral aneurysms. However, how such conditions occur in humans is unclear. We encountered a rare and interesting case to address this issue. A patient had a newly formed aneurysm with proximal stenosis, which was confirmed by serial imagings. We made two pre-aneurysm models: one with stenosis and the other without stenosis. We performed computational fluid dynamics simulations for these models. Owing to jet flow caused by the stenosis, the maximum WSS and WSSG on the aneurysm initiation site were approximately doubled and tripled, respectively. However, the oscillatory shear index (OSI), AFI, and GON did not change substantially by the stenosis. Computer simulations using artificial vascular models with different degrees of proximal stenosis at different distances demonstrated that oscillatory shear index, AFI, and GON did not change substantially by the stenosis. These results showed that proximal stenosis caused high WSS and high WSSG at the aneurysm initiation site, possibly leading to aneurysm initiation. Proximal stenosis may be a potential factor to induce initiation of one class of cerebral aneurysms by increasing WSS and WSSG.
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Affiliation(s)
- Kenichi Kono
- Department of Neurosurgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama 640-8505, Japan
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Kubo Y, Koji T, Kashimura H, Otawara Y, Ogawa A, Ogasawara K. Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients. J Neurosurg 2014; 121:599-604. [DOI: 10.3171/2014.5.jns132048] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Object
The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) increases with the advancing age of the general population. The goal of the present study was to identify risk factors for the growth of UIAs detected with serial MR angiography (MRA) in patients 70 years of age or older.
Methods
This prospective study enrolled 79 patients (age range 70–84 years) with 98 UIAs. Patients were followed up every 4 months, including an assessment of the aneurysm diameter and morphological changes on MRA, neurological status, and other medical conditions. Aneurysm growth was categorized into two different patterns on the basis of the MRA findings: 1) maximum increase in aneurysm diameter of 2 mm or more; and 2) obvious morphological change, such as the appearance of a bleb.
Results
The mean duration of follow-up was 38.5 months (250.2 patient-years). Aneurysm rupture did not occur, but aneurysm growth was observed in 8 aneurysms (8 patients) during the study period. Univariate analysis showed that female sex, patient age ≥ 75 years, and an aneurysm location in the internal carotid artery (ICA) or middle cerebral artery (MCA) were associated with aneurysm growth (p = 0.04, p = 0.04, and p < 0.001, respectively). Multivariate analysis demonstrated that female sex was the only independent predictor of aneurysm growth (p = 0.0313, OR 2.3, 95% CI 1.3–30.2).
Conclusions
Female sex is an independent risk factor for the growth of UIAs in elderly patients. In addition, an age ≥ 75 years and aneurysm location in the ICA or MCA are characteristics that may warrant additional attention during follow-up imaging.
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Howard BM, Barrow DL. Screening for Unruptured Intracranial Aneurysms: Who and When? World Neurosurg 2014; 82:e163-5. [DOI: 10.1016/j.wneu.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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Schneiders JJ, Marquering HA, van den Berg R, VanBavel E, Velthuis B, Rinkel GJE, Majoie CB. Rupture-associated changes of cerebral aneurysm geometry: high-resolution 3D imaging before and after rupture. AJNR Am J Neuroradiol 2014; 35:1358-62. [PMID: 24557706 DOI: 10.3174/ajnr.a3866] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Comparisons of geometric data of ruptured and unruptured aneurysms may yield risk factors for rupture. Data on changes of geometric measures associated with rupture are, however, sparse, because patients with ruptured aneurysms rarely have undergone previous imaging of the intracranial vasculature. We had the opportunity to assess 3D geometric differences of aneurysms before and after rupture. The purpose of this study was to evaluate possible differences between prerupture and postrupture imaging of a ruptured intracranial aneurysm. MATERIALS AND METHODS Using high-quality 3D image data, we generated 3D geometric models before and after rupture and compared these for changes in aneurysm volume and displacement. A neuroradiologist qualitatively assessed aneurysm shape change, the presence of perianeurysmal hematoma, and subsequent mass effect exerted on aneurysm and parent vessels. RESULTS Aneurysm volume was larger in the postrupture imaging in 7 of 9 aneurysms, with a median increase of 38% and an average increase of 137%. Three aneurysms had new lobulations on postrupture imaging; 2 other aneurysms were displaced up to 5 mm and had changed in geometry due to perianeurysmal hematoma. CONCLUSIONS Geometric comparisons of aneurysms before and after rupture show a large volume increase, origination of lobulations, and displacement due to perianeurysmal hematoma. Geometric and hemodynamic comparison of series of unruptured and ruptured aneurysms in the search for rupture-risk-related factors should be interpreted with caution.
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Affiliation(s)
- J J Schneiders
- From the Departments of Radiology (J.J.S., H.A.M., R.v.d.B., C.B.M.)
| | - H A Marquering
- From the Departments of Radiology (J.J.S., H.A.M., R.v.d.B., C.B.M.)Biomedical Engineering and Physics (H.A.M., E.V.), Academic Medical Center, Amsterdam, the Netherlands
| | - R van den Berg
- From the Departments of Radiology (J.J.S., H.A.M., R.v.d.B., C.B.M.)
| | - E VanBavel
- Biomedical Engineering and Physics (H.A.M., E.V.), Academic Medical Center, Amsterdam, the Netherlands
| | - B Velthuis
- Department of Radiology (B.V.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - G J E Rinkel
- Department of Neurology and Neurosurgery (G.J.E.R.), Brain Center Rudolf Magnus
| | - C B Majoie
- From the Departments of Radiology (J.J.S., H.A.M., R.v.d.B., C.B.M.)
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Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown RD, Connolly ES, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H, Kirkpatrick PJ, Knuckey N, Koivisto T, Lanzino G, Lawton MT, LeRoux P, McDougall CG, Mee E, Mocco J, Molyneux A, Morgan MK, Mori K, Morita A, Murayama Y, Nagahiro S, Pasqualin A, Raabe A, Raymond J, Rinkel GJ, Rüfenacht D, Seifert V, Spears J, Steiger HJ, Steinmetz H, Torner JC, Vajkoczy P, Wanke I, Wong GK, Wong JH, Macdonald RL. Multidisciplinary Consensus on Assessment of Unruptured Intracranial Aneurysms. Stroke 2014; 45:1523-30. [DOI: 10.1161/strokeaha.114.004519] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nima Etminan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Kerim Beseoglu
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel L. Barrow
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Joshua Bederson
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Robert D. Brown
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - E. Sander Connolly
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Colin P. Derdeyn
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel Hänggi
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - David Hasan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Seppo Juvela
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Hidetoshi Kasuya
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter J. Kirkpatrick
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Neville Knuckey
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Timo Koivisto
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Giuseppe Lanzino
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Michael T. Lawton
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter LeRoux
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Cameron G. McDougall
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Edward Mee
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - J Mocco
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Andrew Molyneux
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Michael K. Morgan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Kentaro Mori
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Akio Morita
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Yuichi Murayama
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Shinji Nagahiro
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Alberto Pasqualin
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Andreas Raabe
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Jean Raymond
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Gabriel J.E. Rinkel
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel Rüfenacht
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Volker Seifert
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Julian Spears
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Hans-Jakob Steiger
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Helmuth Steinmetz
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - James C. Torner
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter Vajkoczy
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Isabel Wanke
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - George K.C. Wong
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - John H. Wong
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - R. Loch Macdonald
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
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47
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Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lai LT, Morgan MK, Patel NJ. Smoking increases the risk of de novo intracranial aneurysms. World Neurosurg 2014; 82:e195-201. [PMID: 24518886 DOI: 10.1016/j.wneu.2014.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/16/2013] [Accepted: 02/06/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Case series have identified that de novo intracranial aneurysms occur. However, the risk for this occurrence has not been established. We examined the risk for the de novo intracranial aneurysm detection in a consecutive surgical case series. METHODS A prospectively collected surgical database of intracranial aneurysms was retrospectively examined. Patients were analyzed if they were followed for more than 6 months postoperatively with angiography. Kaplan-Meier curve analysis of de novo aneurysms detection included the comparison of smoking vs. never smoked; those with and without a family history; single vs. multiple aneurysms at initial presentation; and original presentation with rupture vs. nonrupture. RESULTS Of the 1366 surgically treated patients (1942 aneurysms), 472 patients (702 aneurysms) were followed with angiography for more than 6 months (average, 54 months). Thirty-three patients (6.99%) were detected to have de novo aneurysms. Multivariate analysis found a smoking history significantly increases the likelihood of de novo aneurysm detection. Kaplan-Meier analysis found the 5- and 10-year de novo aneurysm detection rate to be 4.21% (95% confidence interval [CI] 3.86-12.8) and 15% (95% CI 10-16), respectively. A smoking history increases the 5- and 10-year detection rate to 5.81% and 17% (hazard ratio 2.58; 95% CI 1.13-5.90) respectively. No increased risk was present for an initial presentation that included multiple aneurysms, a family history, or rupture. CONCLUSION There is a 10-year de novo aneurysm detection rate of between 10% and 16% after surgery. Smoking increases the risk of de novo aneurysm detection. Consideration needs to be given to surveillance angiography after aneurysm treatment.
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Affiliation(s)
- Leon Tat Lai
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
| | - Michael Kerin Morgan
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Nirav J Patel
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
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49
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Kono K, Masuo O, Nakao N, Meng H. De Novo Cerebral Aneurysm Formation Associated With Proximal Stenosis. Neurosurgery 2013; 73:E1080-90. [DOI: 10.1227/neu.0000000000000065] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Etminan N, Buchholz BA, Dreier R, Bruckner P, Torner JC, Steiger HJ, Hänggi D, Macdonald RL. Cerebral aneurysms: formation, progression, and developmental chronology. Transl Stroke Res 2013; 5:167-73. [PMID: 24323717 DOI: 10.1007/s12975-013-0294-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/06/2013] [Accepted: 10/08/2013] [Indexed: 02/08/2023]
Abstract
The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we review the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Dusseldorf, Germany,
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