1
|
Yong-Wei H, Wang XY, Li ZP, Yin XS. The rupture risk factors of mirror intracranial aneurysms: A systematic review and meta-analysis based on morphological and hemodynamic parameters. PLoS One 2023; 18:e0286249. [PMID: 37352170 PMCID: PMC10289394 DOI: 10.1371/journal.pone.0286249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/11/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Intracranial aneurysms (IAs) are a prevalent form of vascular disease that can lead to fatal outcomes upon rupture. Mirror intracranial aneurysms (MIAs) are a specific type of multiple aneurysms situated symmetrically on both sides of the parent arteries. The factors contributing to the risk of MIA rupture, based on morphological and hemodynamic parameters, are currently controversial. Thus, we conducted a systematic review and meta-analysis to investigate the risk factors for MIA rupture. METHODS The study performed an electronic search of Chinese and English databases, including China national Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases, and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The morphological parameters (IA size, aspect ratio [AR], size ratio [SR], bottleneck factor [BNF], height-width ratio [HWR], irregular shape) and hemodynamic parameters (wall shear stress [WSS], low WSS area [LSA], oscillatory shear index [OSI]) were analyzed for their significance in determining the risk of MIA rupture. RESULTS The analysis comprised 18 retrospective studies involving 647 patients, with a total of 1294 IAs detected, including 605 ruptured and 689 unruptured. The meta-analysis revealed that IA size, AR, SR, and irregular shape exhibited significant differences between the ruptured and unruptured groups, but HWR did not. In terms of hemodynamic parameters, WSS, OSI, and LSA were found to have significant differences between the two groups. CONCLUSIONS Our results demonstrate that larger IAs, higher AR, SR, and BNF are associated with a higher risk of rupture in patients with MIAs, regardless of their location. there is no significant difference in HWR between the ruptured and unruptured groups. These preliminary findings offer valuable insights for clinical decision-making and a more comprehensive comprehension of the current MIA status. Nevertheless, larger and multi-center studies are indispensable for corroborating these findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/ identifier: CRD42022345587.
Collapse
Affiliation(s)
- Huang Yong-Wei
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Yi Wang
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Zong-Ping Li
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Shuang Yin
- Department of Immunology, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| |
Collapse
|
2
|
Xu WD, Chen RD, Hu SQ, Hou YY, Yu JS. Morphological evaluation of the risk of posterior communicating artery aneurysm rupture: a mirror aneurysm model. J Neurosurg 2023; 138:185-190. [PMID: 36067385 DOI: 10.3171/2022.4.jns22490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/20/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to use morphological parameters of mirror posterior communicating artery (PCoA) aneurysms to evaluate aneurysm rupture risk. METHODS The morphological parameters of 45 pairs of ruptured mirror PCoA aneurysms were analyzed. Conditional univariate and multivariate logistic regression of the following paired morphological parameters was performed: aneurysm with a daughter sac, aneurysm height, aneurysm width, neck width, internal carotid artery diameter, PCoA diameter, flow angle, PCoA angle, aspect ratio, bottleneck factor, size ratio, height/width ratio, fetal posterior cerebral artery, and aneurysm with height > width. A scoring system was established according to the odds ratios (ORs). The receiver operating characteristic was used to test the prediction accuracy of this scoring system in the authors' database of 523 PCoA aneurysms and the threshold value was used to define higher risk. RESULTS Aneurysm width (OR 1.676, p = 0.014), aneurysm with daughter sac (OR 7.775, p = 0.016), and aneurysm with height > width (OR 9.067, p = 0.012) were independent risk factors for rupture. The scoring system consisted of aneurysm width (1 point per mm), aneurysm with a daughter sac (5 points), and aneurysm with height > width (5 points). The area under the curve (AUC) of the scoring system was 0.842, and its threshold value was 7.97. A score ≥ 8 points was defined as higher risk. The AUC using this definition was 0.802. CONCLUSIONS Aneurysm width, aneurysms with height > width, and aneurysms with a daughter sac were independent risk factors for PCoA aneurysm rupture. The scoring system devised in this study accurately predicts rupture risk.
Collapse
|
3
|
Lou H, Nie K, Yang J, Zhang T, Wang J, Fan W, Gu C, Yan M, Chen T, Zhang T, Min J, Zhan R, Pan J. Nomogram-Based Risk Model of Small (≤5 mm) Intracranial Aneurysm Rupture in an Eastern Asian Study. Front Aging Neurosci 2022; 14:872315. [PMID: 35645777 PMCID: PMC9132250 DOI: 10.3389/fnagi.2022.872315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeRisk stratification of small unruptured intracranial aneurysms (IAs) (< =5 mm) is important for clinical decision-making and management. The aim of this study was to develop an individualized rupture risk model for small IAs in an eastern Asian population.MethodsThis study retrospectively enrolled 343 patients with ruptured (n = 96) and unruptured (n = 285) small IAs. Clinical data and aneurysmal morphology were taken into consideration, regression analysis was performed to identify significant variables, and these variables were then incorporated into a predictive nomogram. The diagnostic performance of the nomogram was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plot. Clinical effectiveness was validated by decision curve analysis (DCA). The PHASES score calculated for each case was used for comparison.ResultsThe nomogram achieved an AUC of 0.849 (95% CI: 0.805–0.893), with a sensitivity of 86.5%, a specificity of 70.9%, and accuracy of 74.7%, which was superior to PHASES score system (AUC = 0.693, sensitivity = 83.6%, specificity = 48.8%, and accuracy = 57.5%). A good agreement between predicted rupture risk and actual rupture status in the small aneurysms was observed, and DCA illustrated the benefit of using the nomogram when decisions needed to be made clinically.ConclusionsThe nomogram based on clinical and morphological risk factors can be useful in assisting clinicians with individualized assessments and benefit-risk balancing in patients with small IAs (< =5 mm).
Collapse
Affiliation(s)
- Haiyan Lou
- Department of Radiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kehui Nie
- Taimei Medical Technology, Shanghai, China
| | - Jun Yang
- Taimei Medical Technology, Shanghai, China
| | - Tiesong Zhang
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jincheng Wang
- Department of Radiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weijian Fan
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenjie Gu
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Min Yan
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Tao Chen
- Department of Radiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Tingting Zhang
- Department of Radiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Junxia Min
- Institute of Translational Medicine, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Renya Zhan
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianwei Pan
- Department of Neurosurgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Jianwei Pan
| |
Collapse
|
4
|
Kim JH, Choi JI, Lim DJ. Radiologic assessment of rupture risk in small (<5 mm) posterior communicating artery aneurysms. Medicine (Baltimore) 2022; 101:e28696. [PMID: 35089225 PMCID: PMC8797568 DOI: 10.1097/md.0000000000028696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023] Open
Abstract
Although previous studies have investigated the predictors of posterior communicating artery (PCoA) aneurysm rupture with clinical and radiologic parameters, the accessibility of "small PCoA aneurysms (<5 mm)" has rarely been reported. Here, we designed a study to identify the factors which are thought to be risky and prone to rupture in small PCoA aneurysms (<5 mm).A total of 114 patients diagnosed with PCoA aneurysm under 5 mm in size on digital subtraction angiography were retrospectively enrolled and divided into ruptured (n = 51) and unruptured (n = 63) groups. Clinical variables were reviewed, and 10 radiologic parameters were obtained, including maximum diameter, height, width, neck width, aspect ratio, dome-to-neck ratio, bleb formation, size ratio, presence of fetal-type PCoA, and inflow angle. Statistical analyses were conducted to compare the groups (ruptured vs unruptured) and identify the risk factors for rupture.High rupture rate of small PCoA aneurysm is noted (51/114, 44.7%). In the comparison analysis, parameters of size ratio (P = .045), aspect ratio (P = .001), and bleb formation (P = .015) were significantly different between the 2 groups. In the regression model, the aspect ratio (P = .045) and bleb formation (P = .004) were significantly associated with the rupture of aneurysm.In respect of small (<5 mm) PCoA aneurysms of our cohort, morphologic parameters of "bleb formation" and "a high aspect ratio" are present more often in ruptured aneurysms as compared to unruptured aneurysms.
Collapse
Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| |
Collapse
|
5
|
Yuan J, Huang C, Li Z, Jiang X, Zhao X, Wu D, Lai N, Liu J, Zhang B, Qin F, Xia D, Fang X. Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms. Front Neurol 2021; 12:653589. [PMID: 34646225 PMCID: PMC8504488 DOI: 10.3389/fneur.2021.653589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Morphological and hemodynamic parameters might predict rupture of intracranial aneurysms (IAs). A practical model for the study is patients with ruptured mirror IAs in which one is ruptured and the other is unruptured. Although there have been analyses of the morphology and hemodynamics of ruptured mirror posterior communicating artery aneurysms (PComAAs), the sample sizes in these studies were small and only considered hemodynamics or morphological characters. Therefore, this study aimed to investigate the morphological and hemodynamic parameters associated with ruptured mirror PComAAs. Methods: We considered 72 patients with ruptured mirror PComAAs using computational fluid dynamics (CFDs). Ruptured mirror PComAAs were divided into ruptured and unruptured groups. Fourteen morphological and eight hemodynamic parameters were calculated and compared. Significant parameters were analyzed by the multivariate logistic regression to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all independent risk factors to determine the predictability and identify the optimal threshold. Results: Four hemodynamic and three morphological parameters were significantly different between ruptured and unruptured groups: normalized wall shear stress (NWSS), mean WSS, low wall shear WSS area (LSA%), size, aspect ratio (AR), size ratio (SR), and inflow angle (IA). Multivariate logistic regression analysis showed that AR, SR, NWSS, mean WSS, and LSA% were all independent factors significantly associated with PComAAs rupture. The ROC analysis for independent risk factors indicated that AR (0.751), NWSS (0.755), mean WSS (0.69), and LSA (0.778) had merely acceptable AUC values. Only SR (0.803) had a high acceptable AUC value. The threshold value of SR was 1.96. Conclusions: SR (>1.96) was the most significant parameter associated with IA rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture.
Collapse
Affiliation(s)
- Jinlong Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Chenlei Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xintong Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Nianshen Lai
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Jiaqiang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Bingbing Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Feiyun Qin
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Dayong Xia
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, China
| |
Collapse
|
6
|
Shang W, Chang X, Wang X, Li J, Xu Y. Risk factors for intraprocedural rupture during emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Interv Neuroradiol 2021; 28:426-432. [PMID: 34515559 PMCID: PMC9326866 DOI: 10.1177/15910199211039689] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anterior communicating artery aneurysms are the second most common type of intracranial aneurysm and have a high incidence of rupture. Intraprocedural rupture can lead to a high mortality and morbidity rate, representing a major challenge in emergency endovascular treatment of ruptured anterior communicating artery aneurysms. METHODS We performed a retrospective review of 344 consecutive patients with emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Patients were grouped into intraprocedural rupture and non-intraprocedural rupture groups according to whether intraprocedural rupture occurred. Demographic and clinical factors, vessel-related factors and therapy-related factors were compared between the two groups. RESULTS Intraprocedural rupture occurred in 11 patients (3.2%). Univariate analysis showed that hypertension, the occurrence of vasospasm, aneurysm size, aneurysm angle and a high aspect ratio value were significantly associated with intraprocedural rupture (P < 0.05). Multivariate analysis showed that hypertension odds ratio (OR, 9.799; P = 0.007), the occurrence of vasospasm (OR, 10.121; P = 0.002) and a high aspect ratio value (OR, 10.571; P = 0.006) were independent risk factors for intraprocedural rupture. CONCLUSIONS A history of hypertension, the occurrence of vasospasm and a high aspect ratio value are independent risk factors for intraprocedural rupture among patients with ruptured anterior communicating artery aneurysms.
Collapse
Affiliation(s)
- Wei Shang
- 36674Dalian Medical University, China.,Department of Neurosurgery, 74710The First Affiliated Hospital of Dalian Medical University, China
| | - Xiaoting Chang
- Department of Neurology, 540418the Second Affiliated Hospital of Dalian Medical University, China
| | - Xiaotong Wang
- 36674Dalian Medical University, China.,Department of Neurosurgery, 74710The First Affiliated Hospital of Dalian Medical University, China
| | - Jun Li
- 36674Dalian Medical University, China
| | | |
Collapse
|
7
|
Chung J, Ko JH. An Efficient Method for Aneurysm Volume Quantification Applicable in Any Shape and Modalities. J Korean Neurosurg Soc 2021; 64:514-523. [PMID: 34185985 PMCID: PMC8273770 DOI: 10.3340/jkns.2020.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023] Open
Abstract
Objective Aneurysm volume quantification (AVQ) using the equation of ellipsoid volume is widely used although it is inaccurate. Furthermore, AVQ with 3-dimensional (3D) rendered data has limitations in general use. A novel universal method for AVQ is introduced for any diagnostic modality and application to any shape of aneurysms.
Methods Relevant AVQ studies published from January 1997 to June 2019 were identified to determine common methods of AVQ. The basic idea is to eliminate the normal artery volume from 3D model with the aneurysm. After Digital Imaging and Communications in Medicine (DICOM) data is converted and exported to stereolithography (STL) file format, the 3D STL model is modified to remove the aneurysm and the volume difference between the 3D model with/without the aneurysm is defined as the aneurysm volume. Fifty randomly selected aneurysms from DICOM database were used to validate the different AVQ methods.
Results We reviewed and categorized AVQ methods in 121 studies. Approximately 60% used the ellipsoid method, while 24% used the 3D model. For 50 randomly selected aneurysms, volumes were measured using 3D Slicer, RadiAnt, and ellipsoid method. Using 3D Slicer as the reference, the ratios of mean difference to mean volume obtained by RadiAnt and ellipsoid method were -1.21±7.46% and 4.04±30.54%, respectively. The deviations between RadiAnt and 3D Slicer were small despite of aneurysm shapes, but those of ellipsoid method and 3D Slicer were large.
Conclusion In spite of inaccuracy, ellipsoid method is still mostly used. We propose a novel universal method for AVQ that is valid, low cost, and easy to use.
Collapse
Affiliation(s)
- Jaewoo Chung
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
8
|
Leemans EL, Cornelissen BMW, Said M, van den Berg R, Slump CH, Marquering HA, Majoie CBLM. Intracranial aneurysm growth: consistency of morphological changes. Neurosurg Focus 2020; 47:E5. [PMID: 31261128 DOI: 10.3171/2019.4.focus1987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have shown a relation between growth and rupture of intracranial aneurysms. Additionally, several morphological characteristics are frequently measured to estimate rupture risk. Little is known about how the rupture risk is associated with morphological characteristic changes during growth. The aim of this study was to provide insights into how morphological characteristics, associated with rupture, change during an aneurysm's growth. METHODS The authors retrospectively identified patients with longitudinal MRA images of unruptured growing aneurysms. The MRA images had an in-plane resolution of 0.2-0.5 mm and a slice thickness of 0.2-0.75 mm. Therefore, growth was defined as an increase of at least 0.5 mm in two directions or 1 mm in one direction. Using the MRA images, the authors semiautomatically segmented the aneurysm and the perianeurysmal vasculature. Twelve morphological characteristics were automatically measured. These characteristics were related to size (diameter, height, width, neck diameter, volume, surface area, aspect ratio, height-width ratio, and bottleneck factor) and shape (ellipticity index, nonsphericity index, and undulation index) of the aneurysm. Morphological characteristics before and after growth were compared using the Wilcoxon signed-rank test. RESULTS The authors included 31 patients with 38 growing aneurysms. The aneurysms' growth was detected after a mean of 218 weeks (range 23-567 weeks). A significant increase was seen in all size-related characteristics, and the bottleneck factor also significantly increased (from a median of 1.00 [IQR 0.85-1.04] to 1.03 [IQR 0.93-1.18]), while the ellipticity index decreased (from a median of 0.26 [IQR 0.25-0.28] to 0.25 [IQR 0.24-0.26]). The changes in size ratios and shape indices varied largely among patients. Larger aneurysms more often showed an increase in shape ratios. CONCLUSIONS Although aneurysm growth, size-related characteristics, bottleneck factor, and ellipticity index changed significantly during growth, most size ratios and shape indices showed inconsistent changes among aneurysms. This suggests that, for an accurate rupture prediction, morphological parameters need to be reassessed after growth.
Collapse
Affiliation(s)
- Eva L Leemans
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Bart M W Cornelissen
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and.,3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Miran Said
- Departments of1Biomedical Engineering and Physics, and
| | - René van den Berg
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Cornelis H Slump
- 3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Henk A Marquering
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Charles B L M Majoie
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| |
Collapse
|
9
|
Yuan J, Li Z, Jiang X, Lai N, Wang X, Zhao X, Wu D, Liu J, Xia D, Huang C, Fang X. Hemodynamic and Morphological Differences Between Unruptured Carotid-Posterior Communicating Artery Bifurcation Aneurysms and Infundibular Dilations of the Posterior Communicating Artery. Front Neurol 2020; 11:741. [PMID: 32793106 PMCID: PMC7393924 DOI: 10.3389/fneur.2020.00741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Posterior communicating artery bifurcation aneurysms (PcomA-BAs) and infundibular dilations (PcomA-IDs) are found at the junction between the internal carotid artery (ICA) and the posterior communicating artery (PcomA). Several studies found that PcomA-IDs potentially progress to aneurysms and can even rupture. In our clinical practice, digital subtraction angiography (DSA) helps differentiate PcomA-IDs from unruptured PcomA-BAs. However, when PcomA-IDs are >3 mm in diameter or PcomA are absent on DSA, it is challenging to use DSA to differentiate PcomA-IDs from unruptured PcomA-BAs. Hemodynamic and morphological factors are thought to play important roles in the pathogenesis, progression, and rupture of cerebral aneurysms. We compared hemodynamic and morphological differences in unruptured PcomA-BAs and PcomA-IDs to better manage PcomA-IDs. Methods: We included 83 PcomA-IDs and 115 unruptured PcomA-BAs dignosed and measured using DSA from January 2015 to January 2019. Computational fluid dynamics was performed on these patient-specific models reconstructed using axial slices in DICOM format. Clinical, hemodynamic, and morphological factors were compared between the PcomA-IDs and PcomA-BAs. Significant parameters were analyzed using binary logistic regression analysis to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed on the independent risk factors to acquire cutoff values. Results: One hemodynamic and four morphyological parameters were significantly different between PcomA-IDs and PcomA-BAs: normalized wall shear stress (NWSS), size, the angle between the ophthalmic segment of the ICA and the PcomA (APcomA), the angle between the ophthalmic and the communicating segment of the ICA (AICA) and the diameter of the PcomA (DPcomA). Binary logistic regression analysis showed that small size and DPcomA as well as APcomA were all independent significant factors characterizing the status of PcomA-IDs and the ROC analysis for independent risk factors indicated the cutoff values of size, APcomA, and DPcomA were 3.45 mm, 66.27°, and 1.24 mm, respectively. Conclusions: Size, DpcomA, and ApcomA could independently characterize the status of PcomA-IDs. These might help us better differentiate them from real aneurysms and guide its management.
Collapse
Affiliation(s)
- Jinlong Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Niansheng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xuanzhi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xintong Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Jiaqiang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Dayong Xia
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Chenlei Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| |
Collapse
|
10
|
Xu WD, Wang H, Wu Q, Wen LL, You ZQ, Yuan B, Chen SJ, Wang HD, Zhang X. Morphology parameters for rupture in middle cerebral artery mirror aneurysms. J Neurointerv Surg 2020; 12:858-861. [DOI: 10.1136/neurintsurg-2019-015620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/25/2022]
Abstract
ObjectiveTo identify the morphological parameters correlated with the rupture of middle cerebral artery (MCA) aneurysms.MethodsWe retrospectively analyzed the digital subtraction angiography (DSA) data of 48 patients with ruptured mirror MCA aneurysms. Morphological parameters included aneurysm with wall protrusion, maximum diameter (Dmax), height, neck width, aneurysm width, dome projection, parent artery average diameter (Dp), aspect ratio (AR), bottleneck factor (BNF), size ratio (SR), M1/M2 ratio, and height/width (H/W) ratio. These paired parameters were analyzed by conditional univariate and multivariate logistic regressions to screen out the independent risk factors. We established a score based on the independent risk factors. Receiver operating characteristics (ROC) were generated to estimate the prediction performance of the score in our large database of 763 aneurysms.ResultsIn the univariate regressions, Dmax, height, aneurysm width, neck width, AR, BNF, H/W ratio, SR, anterior dome projection and aneurysm with wall protrusion were significant risk factors. Aneurysm width (OR 3.296, p=0.015), AR (OR 11.594, p=0.014) and anterior dome projection (OR 9.385, p=0.016) were independent risk factors in multivariate regression. The area under the curve (AUC) value of the score based on the three independent risk factors was 0.829.ConclusionAneurysm width, AR and anterior dome projection were independent risks factors of rupture.
Collapse
|
11
|
Skodvin TØ, Evju Ø, Sorteberg A, Isaksen JG. Prerupture Intracranial Aneurysm Morphology in Predicting Risk of Rupture: A Matched Case-Control Study. Neurosurgery 2020. [PMID: 29529238 DOI: 10.1093/neuros/nyy010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maximal size and other morphological parameters of intracranial aneurysms (IAs) are used when deciding if an IA should be treated prophylactically. These parameters are derived from postrupture morphology. As time and rupture may alter the aneurysm geometry, possible morphological predictors of a rupture should be established in prerupture aneurysms. OBJECTIVE To identify morphological parameters of unruptured IAs associated with later rupture. METHODS Nationwide matched case-control study. Twelve IAs that later ruptured were matched 1:2 with 24 control IAs that remained unruptured during a median follow-up time of 4.5 (interquartile range, 3.7-8.2) yr. Morphological parameters were automatically measured on 3-dimensional models constructed from angiograms obtained at time of diagnosis. Cases and controls were matched by aneurysm location and size, patient age and sex, and the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, and site of aneurysm) score did not differ between the 2 groups. RESULTS Only inflow angle was significantly different in cases vs controls in univariate analysis (P = .045), and remained significant in multivariable analysis. Maximal size correlated with size ratio in both cases and controls (P = .015 and <.001, respectively). However, maximal size and inflow angle were correlated in cases but not in controls (P = .004. and .87, respectively). CONCLUSION A straighter inflow angle may predispose an aneurysm to changes that further increase risk of rupture. Traditional parameters of aneurysm morphology may be of limited value in predicting IA rupture.
Collapse
Affiliation(s)
- Torbjørn Øygard Skodvin
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery, Univer-sity Hospital of Northern Norway, Tromsø, Norway
| | - Øyvind Evju
- Center for Biomedical Computing, Simula Research Laboratory, Oslo, Norway
| | - Angelika Sorteberg
- Department of Neuro-surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jørgen Gjernes Isaksen
- Faculty of Health, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery, Univer-sity Hospital of Northern Norway, Tromsø, Norway
| |
Collapse
|
12
|
Rajagopal N, Balaji A, Yamada Y, Kawase T, Kato Y. Etiopathogenesis, clinical presentation and management options of mirror aneurysms: A comparative analysis with non-mirror multiple aneurysms. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
13
|
Liu HJ, Zhou H, Lu DL, Jiao YB, Chen SF, Cheng J, Yao XJ, Ren JY, Li SF, Liu W, Gao JC, Yue Y, Xu JX, Zhang PN, Feng YG. Intracranial Mirror Aneurysm: Epidemiology, Rupture Risk, New Imaging, Controversies, and Treatment Strategies. World Neurosurg 2019; 127:165-175. [PMID: 30954748 DOI: 10.1016/j.wneu.2019.03.275] [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: 02/20/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
There are some controversies about the surgical treatment strategy of mirror aneurysms. Whether to choose 1-stage or 2-stage surgery, bilateral or unilateral craniotomy, or surgical or interventional treatment are the main points in dispute. In this review, the different surgery strategies faced by patients are discussed. Different surgical methods are adopted based on the patient's individual state and the location and size of the aneurysm. A new imaging method is introduced using 3D Slicer, which clearly recognizes the relationship among aneurysm, brain tissue, skull, and nerve. The 3D Slicer can help surgeons undertake adequate preoperative preparation. In addition, we also introduce some ruptured factors (e.g., age, gender, hypertension, morphologic, and hemodynamic) concerning mirror aneurysm. Systematic discussion of the controversies and methods in surgical treatment of mirror aneurysms may provide new perspectives in future research for the prevention and treatment of mirror aneurysms.
Collapse
Affiliation(s)
| | - Han Zhou
- Qingdao University, Qingdao, China
| | | | - Ying-Bin Jiao
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Jing Cheng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | | | | | - Shi-Fang Li
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Liu
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Yong Yue
- Qingdao University, Qingdao, China
| | | | - Pi-Ning Zhang
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Gong Feng
- Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
14
|
Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms. Neurosurg Rev 2018; 42:539-547. [DOI: 10.1007/s10143-018-0998-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 11/27/2022]
|
15
|
Wang GX, Liu J, Chen YQ, Wen L, Yang MG, Gong MF, Zhang D. Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms. J Neurointerv Surg 2018; 10:995-998. [DOI: 10.1136/neurintsurg-2017-013553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/21/2017] [Accepted: 01/16/2018] [Indexed: 11/03/2022]
Abstract
ObjectivePatient related clinical factors and intracranial aneurysms (IAs) at different locations may lead to statistical bias when investigating the rupture risk of IAs. Thus the purpose of this study was to identify the morphological parameters that are related to the rupture of mirror posterior communicating artery aneurysms (PComAAs).MethodsBetween August 2011 and July 2017, 68 patients with mirror PComAAs and aneurysmal subarachnoid hemorrhage were diagnosed by CT angiography at three medical centers. Morphological characteristics for PComAAs included bifurcation, shape, neck width, width, depth, maximum size, flow angle, parent vessel diameter, aspect ratio (AR), depth/width ratio, bottleneck factor, and size ratio (SR). Multiple logistic regression analysis was performed to determine the independent risk factors for rupture. Receiver operating characteristic curve analysis was performed to obtain the optimal thresholds.ResultsAR (OR 5.623) and SR (OR 5.570) were more commonly observed in the ruptured cohort. The threshold values of AR and SR were 0.98 and 1.21, respectively.ConclusionsMirror PComAAs are a useful model to investigate the rupture risk of PComAAs. AR (≥0.98) and SR (≥1.21) are better predictors of ruptured PComAAs.
Collapse
|
16
|
Rafiei A, Hafez A, Jahromi BR, Kivisaari R, Canato B, Choque J, Colasanti R, Fransua S, Lehto H, Andrade-Barazarte H, Hernesniemi J. Anatomic Features of Paraclinoid Aneurysms: Computed Tomography Angiography Study of 144 Aneurysms in 136 Consecutive Patients. Neurosurgery 2017; 81:949-957. [PMID: 28419295 DOI: 10.1093/neuros/nyx157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/17/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Paraclinoid aneurysms are among the most challenging aneurysms to treat. Computed tomography (CT) angiography helps in evaluating the radiological characteristics of these aneurysms next to bony structures. OBJECTIVE To present the CT angiography characteristics of paraclinoid aneurysms in order to better understand such pathology. METHODS The study examined CT angiography-based anatomical characteristics obtained retrospectively from 136 patients with 144 paraclinoid aneurysms selected from single-defined catchment populations in Finland. We examined the diameters of the parent artery (internal carotid artery), the location of the aneurysm, its dimensions (width, height, neck), and aneurysm wall irregularity. RESULTS We analyzed 144 paraclinoid aneurysms in 136 patients admitted to the hospital during 2000-2014. Multivariable analysis reveals that rupture aneurysms have the following radiological features: aneurysm larger than 5 mm in diameter (P = .006), irregular wall (P = .046), superior location, larger aspect ratio (P = .039), and neck wider than parent artery (P < .001). CONCLUSION Smaller diameter of the internal carotid artery and superior location, as well as a large and irregular aneurysm wall, are radiological characteristics of ruptured paraclinoid aneurysms, which CT angiography can measure easily.
Collapse
Affiliation(s)
- Ahmadreza Rafiei
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Bruno Canato
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Joham Choque
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Roberto Colasanti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Sharafeddin Fransua
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
17
|
Chen XL, Chen Y, Ma L, Burkhardt JK, Wardell T, Wang C, Guo G, Wang S, Zhao YL. Translucent Appearance of Middle Cerebral Artery Bifurcation Aneurysms Is Risk Factor for Intraoperative Aneurysm Rupture During Clipping. World Neurosurg 2017; 101:149-154. [PMID: 28189862 DOI: 10.1016/j.wneu.2017.01.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The rupture rate of unruptured intracranial aneurysms is influenced by certain angioarchitectural and hemodynamic characteristics. Recently the translucent appearance of aneurysms was described as a possible risk factor for aneurysm rupture. In this study, we investigate the intraoperative rupture risk of surgically clipped unruptured translucent aneurysms (TAs). METHOD Clinical and radiologic data of microsurgically treated unruptured middle cerebral artery (MCA) bifurcation aneurysms between 2013 and 2015 were collected and analyzed. Aneurysms were divided into TA as defined as >90% reddish pigmentation appearance of the aneurysm wall or non-TA (NTA) according to the observation under microscope by a single neurosurgeon. Parameters were analyzed using univariate and multivariate statistical analyses. RESULT A total of 41 unruptured MCA bifurcation aneurysms were included in the analysis, and 68.2% (28/41) were defined as TA. The univariate analysis showed that aneurysm characteristics (Dmax, Wmax, height, and lower size ratio [SR]) that were small in nature were associated with TAs. TAs were associated with intraoperative rupture (28.6% vs. 0%, P = 0.04). Multivariate logistic regression analysis found that the lower SR is the independent risk factor for TAs. CONCLUSION The results demonstrate that a lower SR correlates with TA in the MCA bifurcation and the thinner wall of the TA causes intraoperative rupture more likely. These results provide important information on the fragility of TAs and might influence the treatment decisions in unruptured MCA bifurcation aneurysms with lower SRs.
Collapse
Affiliation(s)
- Xiao-Lin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | | | - Chao Wang
- Department of Neurosurgery, Affiliated Hospital, Binzhou Medical University, Binzhou, Shandong, China
| | - Geng Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, P. R. China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, P. R. China.
| |
Collapse
|