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Feng Y, Zhang H, Dai S, Li X. Aspirin treatment for unruptured intracranial aneurysms: Focusing on its anti-inflammatory role. Heliyon 2024; 10:e29119. [PMID: 38617958 PMCID: PMC11015424 DOI: 10.1016/j.heliyon.2024.e29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
Intracranial aneurysms (IAs), as a common cerebrovascular disease, claims a worldwide morbidity rate of 3.2%. Inflammation, pivotal in the pathogenesis of IAs, influences their formation, growth, and rupture. This review investigates aspirin's modulation of inflammatory pathways within this context. With IAs carrying significant morbidity and mortality upon IAs rupture and current interventions limited to surgical clipping and endovascular coiling, the quest for pharmacological options is imperative. Aspirin's role in cardiovascular prevention, due to its anti-inflammatory effects, presents a potential therapeutic avenue for IAs. In this review, we examine aspirin's efficacy in experimental models and clinical settings, highlighting its impact on the progression and rupture risks of unruptured IAs. The underlying mechanisms of aspirin's impact on IAs are explored, with its ability examined to attenuate endothelial dysfunction and vascular injury. This review may provide a theoretical basis for the use of aspirin, suggesting a promising strategy for IAs management. However, the optimal dosing, safety, and long-term efficacy remain to be established. The implications of aspirin therapy are significant in light of current surgical and endovascular treatments. Further research is encouraged to refine aspirin's clinical application in the management of unruptured IAs, with the ultimate aim of reducing the incidence of aneurysms rupture.
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Affiliation(s)
- Yuan Feng
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongchen Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuhui Dai
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xia Li
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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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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Li Y, Bai X, Tu H, Zou Z, Huang Y, Cai J. Multiple intracranial enlarging dissecting aneurysms: a case report. BMC Neurol 2023; 23:265. [PMID: 37438693 DOI: 10.1186/s12883-023-03303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Cases of multiple cerebral aneurysms are rare. In this case report, we describe a male patient with multiple, enlarging, and ruptured aneurysms. The two aneurysms were believed to be dissecting aneurysms. CASE DESCRIPTION A 47-year-old man presented with left limb paralysis. Magnetic resonance imaging revealed a cerebral infarction. Digital subtraction angiography (DSA) identified an aneurysm and occlusion in the right middle cerebral artery (MCA). The MCA aneurysm was remarkably enlarged on the eighth day after cerebral ischemia and was treated using endovascular techniques. Two weeks after the endovascular treatment, the patient experienced a severe headache and became comatose, and a subarachnoid re-hemorrhage was confirmed. The fourth DSA revealed an enlarging dissecting aneurysm in the posterior cerebral artery. The patient died without further treatment. CONCLUSION Some dissecting aneurysms rapidly enlarge and rupture.
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Affiliation(s)
- Yingbin Li
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Xiaoxin Bai
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China.
- Department of Neurosurgery, Hospital of Guangzhou Higher Education Mega Center, Guangdong Provincial Hospital of Chinese Medicine, 55 Neihuan Xi Road, Guangzhou, 510006, Guangdong, China.
| | - Huai Tu
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Zhimin Zou
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Yan Huang
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China
| | - Jun Cai
- Diagnosis and Treatment Center of Encephalopathy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Department of Cerebrovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, Hospital of Guangzhou University Mega Center, Guangzhou, 510006, China.
- Department of Neurosurgery, Hospital of Guangzhou Higher Education Mega Center, Guangdong Provincial Hospital of Chinese Medicine, 55 Neihuan Xi Road, Guangzhou, 510006, Guangdong, China.
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4
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Hall S, Abouharb A, Anderson I, Bacon A, Bahl A, Brydon H, Dow G, Fouyas I, Galea J, Ghosh A, Gurusinghe N, Kamel M, Minhas P, Mitchell P, Mowle D, Mukerji N, Nair R, Norris J, Patel H, Patel J, Patel K, St George J, Teo M, Toma A, Trivedi R, Uff C, Visca A, Walsh DC, White E, Whitfield P, Bulters D. A survey of the radiological follow-up of unruptured intracranial aneurysms in the United Kingdom. Br J Neurosurg 2023; 37:163-169. [PMID: 34738491 DOI: 10.1080/02688697.2021.1995587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom. METHODS A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods. RESULTS Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it. CONCLUSIONS There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.
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Affiliation(s)
- Samuel Hall
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Ashraf Abouharb
- Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, UK
| | - Ian Anderson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Bacon
- Sheffield Centre for Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anuj Bahl
- Department of Neurosurgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Howard Brydon
- Department of Neurosurgery, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK
| | - Graham Dow
- Department of Neurosurgery, Queens Medical Centre, Nottingham, UK
| | - Ioannis Fouyas
- Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - James Galea
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Anthony Ghosh
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Nihal Gurusinghe
- Department of Neurourgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Pawan Minhas
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - David Mowle
- Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK
| | - Nitin Mukerji
- Department of Neurosurgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Ramesh Nair
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - John Norris
- Hurstwood Park Neurosciences Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Hiren Patel
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jash Patel
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Krunal Patel
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Mario Teo
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Toma
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chris Uff
- Department of Neurosurgery, Barts Health NHS Trust, London, UK
| | - Anna Visca
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital NHS Trust, London, UK
| | - Edward White
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Peter Whitfield
- Department of Neurosurgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Diederik Bulters
- Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Kultanen H, Lewén A, Ronne-Engström E, Enblad P, Svedung Wettervik T. Antithrombotic agent usage before ictus in aneurysmal subarachnoid hemorrhage: relation to hemorrhage severity, clinical course, and outcome. Acta Neurochir (Wien) 2023; 165:1241-1250. [PMID: 36917361 PMCID: PMC10140004 DOI: 10.1007/s00701-023-05556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/18/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The number of patients with aneurysmal subarachnoid hemorrhage (aSAH) who are on antithrombotic agents before ictus is rising. However, their effect on early brain injury and disease development remains unclear. The primary aim of this study was to determine if antithrombotic agents (antiplatelets and anticoagulants) were associated with a worse initial hemorrhage severity, rebleeding rate, clinical course, and functional recovery after aSAH. METHODS In this observational study, those 888 patients with aSAH, treated at the neurosurgical department, Uppsala University Hospital, between 2008 and 2018 were included. Demographic, clinical, radiological (Fisher and Hijdra score), and outcome (Extended Glasgow Outcome Scale one year post-ictus) variables were assessed. RESULTS Out of 888 aSAH patients, 14% were treated with antithrombotic agents before ictus. Seventy-five percent of these were on single therapy of antiplatelets, 23% on single therapy of anticoagulants, and 3% on a combination of antithrombotic agents. Those with antithrombotic agents pre-ictus were significantly older and exhibited more co-morbidities and a worse coagulation status according to lab tests. Antithrombotic agents, both as one group and as subtypes (antiplatelets and anticoagulants), were not associated with hemorrhage severity (Hijdra score/Fisher) nor rebleeding rate. The clinical course did not differ in terms of delayed ischemic neurological deficits or last-tier treatment with thiopental and decompressive craniectomy. These patients experienced a higher mortality and lower rate of favorable outcome in univariate analyses, but this did not hold true in multiple logistic regression analyses after adjustment for age and co-morbidities. CONCLUSIONS After adjustment for age and co-morbidities, antithrombotic agents before aSAH ictus were not associated with worse hemorrhage severity, rebleeding rate, clinical course, or long-term functional recovery.
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Affiliation(s)
- Hanna Kultanen
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Anders Lewén
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Elisabeth Ronne-Engström
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Teodor Svedung Wettervik
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
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Yang HH, Sayre J, Dinh H, Nael K, Colby G, Wang A, Villablanca P, Salamon N, Chien A. Image-derived Metrics Quantifying Hemodynamic Instability Predicted Growth of Unruptured Intracranial Aneurysms. STROKE (HOBOKEN, N.J.) 2023; 3:e000426. [PMID: 37090136 PMCID: PMC10118203 DOI: 10.1161/svin.122.000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background While image-derived predictors of intracranial aneurysm (IA) rupture have been well-explored, current understanding of IA growth is limited. Pulsatility index (PI) and wall shear stress pulsatility index (WSSPI) are important metrics measuring temporal hemodynamic instability. However, they have not been investigated in IA growth research. The present study seeks to verify reliable predictors of IA growth with comparative analyses of several important morphological and hemodynamic metrics between stable and growing cases among a group of unruptured IAs. Methods Using 3D images, vascular models of 16 stable and 20 growing cases were constructed and verified using Geodesic techniques. With an overall mean follow-up period of 25 months, cases exhibiting a 10% or higher increase in diameter were considered growing. Patient-specific, pulsatile simulations were performed, and hemodynamic calculations were computed at 5 important regions of each aneurysm (inflow artery, aneurysm neck, body, dome, and outflow artery). Index values were compared between growing and stable IAs using ANCOVA controlling for aneurysm diameter. Stepwise multiple logistic regression and ROC analyses were conducted to investigate predictive models of IA growth. Results Compared to stable IAs, growing IAs exhibited significantly higher intrasaccular PI, intrasaccular WSSPI, intrasaccular spatial flow rate deviation, and intrasaccular spatial wall shear stress (WSS) deviation. Stepwise logistic regression analysis revealed a significant predictive model involving PI at aneurysm body, WSSPI at inflow artery, and WSSPI at aneurysm body. Conclusions Our results showed that high degree of hemodynamic variations within IAs is linked to growth, even after controlling for morphological parameters. Further, evaluation of PI in conjunction with WSSPI yielded a highly accurate predictive model of IA growth. Upon validation in future cohorts, these metrics may aid in early identification of IA growth and current understanding of IA remodeling mechanism.
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Affiliation(s)
- Hong-Ho Yang
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - James Sayre
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Huy Dinh
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Kambiz Nael
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Geoffrey Colby
- David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, California, USA
| | - Anthony Wang
- David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, California, USA
| | - Pablo Villablanca
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Noriko Salamon
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
| | - Aichi Chien
- David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, California, USA
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Miyata T, Kataoka H, Shimizu K, Okada A, Yagi T, Imamura H, Koyanagi M, Ishibashi R, Goto M, Sakai N, Hatano T, Chin M, Iwasaki K, Miyamoto S. Predicting the growth of middle cerebral artery bifurcation aneurysms using differences in the bifurcation angle and inflow coefficient. J Neurosurg 2022; 138:1357-1365. [PMID: 36208434 DOI: 10.3171/2022.8.jns22597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Growing intracranial aneurysms (IAs) are prone to rupture. Previous cross-sectional studies using postrupture morphology have shown the morphological or hemodynamic features related to IA rupture. Yet, which morphological or hemodynamic differences of the prerupture status can predict the growth and rupture of smaller IAs remains unknown. The purpose of this longitudinal study was to investigate the effects of morphological features and the hemodynamic environment on the growth of IAs at middle cerebral artery (MCA) bifurcations during the follow-up period.
METHODS
One hundred two patients with MCA M1–2 bifurcation saccular IAs who underwent follow-up for more than 2 years at the authors’ institutions between 2011 and 2019 were retrospectively identified. During the follow-up period, cases involving growth of MCA IAs were assigned to the event group, and those with MCA IAs unchanged in size were assigned to the control group. The morphological parameters examined were aneurysmal neck length, dome height, aspect ratio and volume, M1 and M2 diameters and their ratio, and angle configurations among M1, M2, and the aneurysm. Hemodynamic parameters were flow rate and wall shear stress in M1, M2, and the aneurysm, including the aneurysmal inflow rate coefficient (AIRC), defined as the ratio of the aneurysmal inflow rate to the M1 flow rate. Those parameters were compared statistically between the two groups. Correlations between morphological and hemodynamic parameters were also examined.
RESULTS
Eighty-three of 102 patients were included: 25 with growing MCA IAs (event group) and 58 with stable MCA IAs (control group). The median patient age at initial diagnosis was 66.9 (IQR 59.8–72.3) years. The median follow-up period was 48.5 (IQR 36.5–65.6) months. Both patient age and the AIRC were significant independent predictors of the growth of MCA IAs. Moreover, the AIRC was strongly correlated with sharper bifurcation and inflow angles, as well as wider inclination angles between the M1 and M2 arteries.
CONCLUSIONS
The AIRC was a significant independent predictor of the growth of MCA IAs. Sharper bifurcation and inflow angles and wider inclination angles between the M1 and M2 arteries were correlated with the AIRC. MCA IAs with such a bifurcation configuration are more prone to grow and rupture.
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Affiliation(s)
- Takeshi Miyata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka
| | - Kampei Shimizu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Akihiro Okada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Takanobu Yagi
- Center for Advanced Biomedical Sciences (TWIns), Waseda University, Tokyo
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo
| | | | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki General Hospital, Okayama; and
| | - Masanori Goto
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Hyogo
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki General Hospital, Okayama; and
| | - Koichi Iwasaki
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
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Li R, Zhou P, Chen X, Mossa-Basha M, Zhu C, Wang Y. Construction and Evaluation of Multiple Radiomics Models for Identifying the Instability of Intracranial Aneurysms Based on CTA. Front Neurol 2022; 13:876238. [PMID: 35481272 PMCID: PMC9037633 DOI: 10.3389/fneur.2022.876238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Aims Identifying unruptured intracranial aneurysm instability is crucial for therapeutic decision-making. This study aims to evaluate the role of Radiomics and traditional morphological features in identifying aneurysm instability by constructing and comparing multiple models. Materials and Methods A total of 227 patients with 254 intracranial aneurysms evaluated by CTA were included. Aneurysms were divided into unstable and stable groups using comprehensive criteria: the unstable group was defined as aneurysms with near-term rupture, growth during follow-up, or caused compressive symptoms; those without the aforementioned conditions were grouped as stable aneurysms. Aneurysms were randomly divided into training and test sets at a 1:1 ratio. Radiomics and traditional morphological features (maximum diameter, irregular shape, aspect ratio, size ratio, location, etc.) were extracted. Three basic models and two integrated models were constructed after corresponding statistical analysis. Model A used traditional morphological parameters. Model B used Radiomics features. Model C used the Radiomics features related to aneurysm morphology. Furthermore, integrated models of traditional and Radiomics features were built (model A+B, model A+C). The area under curves (AUC) of each model was calculated and compared. Results There were 31 (13.7%) patients harboring 36 (14.2%) unstable aneurysms, 15 of which ruptured post-imaging, 16 with growth on serial imaging, and 5 with compressive symptoms, respectively. Four traditional morphological features, six Radiomics features, and three Radiomics-derived morphological features were identified. The classification of aneurysm stability was as follows: the AUC of the training set and test set in models A, B, and C are 0.888 (95% CI 0.808–0.967) and 0.818 (95% CI 0.705–0.932), 0.865 (95% CI 0.777–0.952) and 0.739 (95% CI 0.636–0.841), 0.605(95% CI 0.470–0.740) and 0.552 (95% CI 0.401–0.703), respectively. The AUC of integrated Model A+B was numerically slightly higher than any single model, whereas Model A+C was not. Conclusions A radiomics and traditional morphology integrated model seems to be an effective tool for identifying intracranial aneurysm instability, whereas the use of Radiomics-derived morphological features alone is not recommended. Radiomics-based models were not superior to the traditional morphological features model.
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Affiliation(s)
- Ran Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengyu Zhou
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyue Chen
- Computed Tomography Angiography Collaboration, Siemens Healthineers, Chengdu, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Yuting Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Chandra RV, Maingard J, Slater LA, Cheung NK, Lai LT, Gall SL, Thrift AG, Phan TG. A Meta-Analysis of Rupture Risk for Intracranial Aneurysms 10 mm or Less in Size Selected for Conservative Management Without Repair. Front Neurol 2022; 12:743023. [PMID: 35250788 PMCID: PMC8893017 DOI: 10.3389/fneur.2021.743023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Small unruptured intracranial aneurysms (UIAs) are considered to have low risk of rupture. The proportion of UIAs measuring 10 mm or less in size that rupture when selected for conservative management without repair is not well known. The aim of this study is to determine the proportion of UIAs that rupture by size threshold from ≤10 to ≤3 mm when selected for management without repair and to determine the level of precision and sources of heterogeneity in the rupture risk estimate. METHODS This study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019121522). The Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched (inception to August 2020). Studies with longitudinal follow-up of patients with UIAs ( ≤10 mm to ≤3 mm) without endovascular or neurosurgical repair were eligible. We included studies, which provided details of aneurysm size and in which UIA rupture was reported as an outcome. The primary outcome of the pooled proportion of UIA rupture during follow-up was synthesized with random-effects meta-analysis; heterogeneity was explored using meta-regression. RESULTS A total of 31 studies that included 13,800 UIAs ≤10 mm in size were eligible for data synthesis. The pooled proportion of ≤10 mm UIAs that ruptured when managed without repair was 1.1% (95% CI 0.8-1.5; I 2 = 52.9%) over 3.7 years. Findings were consistent in sensitivity analyses at all the size stratified thresholds including ≤5 and ≤3 mm; rupture occurred in 1.0% (95% CI 0.8-1.3; I 2 = 0%) of 7,280 ≤5 mm UIAs and 0.8% (95% CI 0.4-1.5; I 2 = 0%) of 1,228 ≤3 mm UIAs managed without repair. In higher quality studies with lower risk of bias, rupture occurred in 1.8% (95% CI 1.5-2.0; I 2 = 0%) over 3.9 years. In meta-regression, aneurysm size, shape, anatomical location, and exposure to prior subarachnoid hemorrhage were not identified as sources of heterogeneity. CONCLUSION For every 1,000 UIAs that are 10 mm or less in size and selected for conservative management without repair, between 8 and 15 UIAs are estimated to rupture over 3.7 years. When stratified by size, these pooled rupture risk estimates are consistent and clinically applicable for ≤5 mm UIAs selected for management without repair. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42019121522.
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Affiliation(s)
- Ronil V. Chandra
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian Maingard
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Nicholas K. Cheung
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Leon T. Lai
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Seana L. Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Amanda G. Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
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10
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Liu X, Haraldsson H, Wang Y, Kao E, Ballweber M, Martin AJ, McCulloch CE, Faraji F, Saloner D. A Volumetric Metric for Monitoring Intracranial Aneurysms: Repeatability and Growth Criteria in a Longitudinal MR Imaging Study. AJNR Am J Neuroradiol 2021; 42:1591-1597. [PMID: 34167960 DOI: 10.3174/ajnr.a7190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The reliability of contrast-enhanced MRA in monitoring serial volumetric changes of unruptured intracranial aneurysms has not been established. We aimed to determine the coefficient of variance of contrast-enhanced MRA in measuring aneurysm volumes, thus establishing criteria for aneurysm growth and permitting identification of variables predictive of growth. MATERIALS AND METHODS Aneurysm volumes were measured from serial contrast-enhanced MRA studies of patients with untreated intracranial aneurysms who underwent >2 sequential MR imaging evaluations. After coregistering all sequential studies in 3D space for each aneurysm and signal intensity normalization, aneurysm volume was determined across all time points. A linear mixed effects model was built to estimate the coefficient of variance of the measurement as well as to determine predictive variables. Growth was defined as relative growth exceeding 2 times the measurement coefficient of variance (sudden growth, as 4 times the coefficient of variance). RESULTS A total of 95 patients with 112 aneurysms were included (5.9 scans during 4.0 years on average, 616 scan measurements in total). The coefficient of variance was 5.5% of the aneurysm volume, and the relative growth rate was dependent on the location: anterior cerebral artery, 4.52% per year; vertebral artery, 2.46% per year; middle cerebral artery, 2.74% per year; basilar artery, 2.36% per year; internal carotid artery, 1.14% per year. Thirty-six of 112 (32%) aneurysms were characterized as growing, and 11/36 of them had an episode of sudden growth. CONCLUSIONS Volume measurement of unruptured intracranial aneurysms by contrast-enhanced MRA seems a reliable metric for tracking the growth trajectory of aneurysms. Furthermore, the aneurysm growth rate differs among different locations.
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Affiliation(s)
- X Liu
- From the Department of Interventional Neuroradiology (X.L.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - H Haraldsson
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - Y Wang
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa .,Department of Radiology (Y.W.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - E Kao
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - M Ballweber
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - A J Martin
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - C E McCulloch
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - F Faraji
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
| | - D Saloner
- Departments of Radiology and Biomedical Imaging, and Epidemiology and Biostatistics (X.L., H.H., Y.W., E.K., M.B., A.J.M., C.E.M., F.F., D.S), University of California San Francisco, San Francisco, Californa
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11
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Yang S, Liu T, Wu Y, Xu N, Xia L, Yu X. The Role of Aspirin in the Management of Intracranial Aneurysms: A Systematic Review and Meta-Analyses. Front Neurol 2021; 12:646613. [PMID: 33859609 PMCID: PMC8042149 DOI: 10.3389/fneur.2021.646613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/08/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: To evaluate the association between aspirin use and the risks of unruptured intracranial aneurysm (UIA) growth and aneurysmal subarachnoid hemorrhage (aSAH). Methods: We searched PubMed and Scopus from inception to 1 September 2020. Studies evaluating the associations between aspirin prescription and the risk of UIA growth or the risk of aSAH were included. The study only included patients with intracranial aneurysms. We assessed the quality of included studies using the Newcastle-Ottawa scale. Random-effects meta-analysis was conducted to pool the estimates of effect size quantitatively. Sensitivity analyses using the leave-one-out strategy were performed to identify any potential source of heterogeneity. Results: After a review of 2,226 citations, five cohort studies, two case-control studies, and one nested case-control study involving 8,898 participants were included. Pooled analyses showed that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth (OR 0.25, 95% CI 0.11–0.54; I2 = 0.0%, p = 0.604) and aSAH (OR, 0.37, 95% CI, 0.23–0.58; I2 = 79.3%, p = 0.001) in patients presented with intracranial aneurysms. The results did not significantly change in sensitivity analyses. Conclusions: Summarizing available evidence in the literature, our findings indicate that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth and aSAH in patients with UIA. Well-designed and large-scale clinical trials are needed to help define the role of aspirin as a protective pharmaceutical for UIAs.
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Affiliation(s)
- Shuwen Yang
- Department of Neurosurgery, People's Hospital of Huangpi District, Jianghan University, Wuhan, China
| | - Tianyu Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuehui Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nina Xu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangtao Xia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyu Yu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Wang MD, Fu QH, Song MJ, Ma WB, Zhang JH, Wang ZX. Novel Subgroups in Subarachnoid Hemorrhage and Their Association With Outcomes-A Systematic Review and Meta-Regression. Front Aging Neurosci 2021; 12:573454. [PMID: 33505300 PMCID: PMC7829354 DOI: 10.3389/fnagi.2020.573454] [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: 06/17/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background and Purpose: Subarachnoid hemorrhage (SAH) has long been classified into two main forms, aneurysmal SAH (aSAH) and non-aneurysmal SAH (naSAH), but the related risk factors for aSAH and naSAH are heterogeneous. Our objective was to determine the risk factors for SAH of known or unknown origin with respect to diagnostic evaluation in a large patient cohort. We sought to determine whether our classification system can further predict middle long-term stroke and death. Methods: We performed a systematic review and meta-analysis to identify risk factors for each SAH subtype. The discovery phase analyzed 11 risk factors from case studies in the literature. Kruskal-Wallis, Cox regression, logistic regression, and Kaplan-Meier analyses were used to compare the two groups. Results: A total of 14,904 (34.53%) male and 22,801 (52.84%) female patients were eligible for this study. At a median follow-up of 45.6 months, the 5-years overall survival was 97.768% (95% CI: 0.259-0.292) for aSAH patients and 87.904% (95% CI: 1.459-1.643) for naSAH patients. The 10-years survival rate was 93.870% (95% CI: 2.075-3.086) and 78.115% (95% CI: 2.810-3.156), respectively. Multi-risk factor subgroups showed significant intergroup differences. We identified eight risk factors (drugs, trauma, neoplastic, vessels lesion, inflammatory lesion, blood disease, aneurysm, peri-mesencephalic hemorrhage) using logistic regression, which were optimally differentiated among the aSAH [aSAH-S (AUC: 1), a-d-SAH (AUC: 0.9998), aSAH-T (AUC: 0.9199), aSAH-N (AUC: 0.9433), aSAH-V (AUC: 1), aSAH-I (AUC: 0.9954), a-bd-SAH (AUC: 0.9955)] and naSAH [na-pmSAH (AUC: 0.9979), na-ni-ivl-SAH (AUC: 1), na-t-SAH (AUC: 0.9997), na-ne-SAH (AUC: 0.9475), na-d-SAH (AUC: 0.7676)] subgroups. These models were applied in a parallel cohort, showing eight risk factors plus survival rates to predict the prognosis of SAH. Conclusions: The classification of risk factors related to aSAH and naSAH is helpful in the diagnosis and prediction of the prognosis of aSAH and naSAH patients. Further validation is needed in future clinical applications.
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Affiliation(s)
- Ming-Dong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qian-Hui Fu
- School of Pharmacy, Minzu University of China, Beijing, China
| | - Ming-Jing Song
- Institute of Laboratory Animal Science, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Wen-Bin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - John-H Zhang
- Physiology Program, Department of Anesthesiology, Neurosurgery, Neurology, and Physiology, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Zhan-Xiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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13
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Characteristics of the ruptured intracranial cerebral aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD) and review of literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Acute enlargement, morphological changes, and rupture of intracranial infectious aneurysm in infective endocarditis. Serial imaging. J Clin Neurosci 2020; 82:237-240. [PMID: 33248951 DOI: 10.1016/j.jocn.2020.11.001] [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: 05/10/2020] [Revised: 09/15/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022]
Abstract
A 72-year-old man received a transcatheter aortic valve implantation (TAVI) 2 years ago for leakage of the degenerative bioprosthesis with Corevalve n°31 implantation, presented infective endocarditis (IE) (streptococcus sanguinis) of the bioprosthetic aortic valve. One month after antibiotic treatment was initiated, he presented a left-sided hemiplegia, a right frontal hematoma. MRI/contrast-enhanced magnetic resonance angiography (CE-MRA) revealed 2 infectious intracranial aneurysms (IIAs) of the right (10 mm) and left middle cerebral artery (MCA) (M2 segment, 5 mm). The right MCA IIA was treated within 1 day by glue-embolization. Seven days later, the patient acutely developed motor aphasia. CE-MRA showed significant enlargement (15 mm) and morphologic change of the ruptured left MCA IIA. This IIA was treated with Onyx-embolization. This case adds additional evidence that IIAs, during IE, can show rapid growth and morphological change over a 7 day course and emphasizes the imperative need of close imaging follow-up when IIAs are managed by antibiotic therapy.
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15
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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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16
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Fingerlin TJ, Rychen J, Roethlisberger M, Taub E, Mariani L, Guzman R, Zumofen DW. Long-term aneurysm recurrence and de novo aneurysm formation after surgical treatment of unruptured intracranial aneurysms: a cohort study and systematic review. Neurol Res 2020; 42:338-345. [PMID: 32048571 DOI: 10.1080/01616412.2020.1726587] [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: 10/25/2022]
Abstract
Objective: There is a relative lack of literature on long-term aneurysm recurrence and de novo aneurysm formation following surgical treatment of unruptured intracranial aneurysms. This retrospective single-center cohort study, therefore, analyzes the incidence of aneurysm recurrence, and the incidence of de novo aneurysms formation in patients with at least 10yrs of radiological follow-up. The data are put into the context of a systematic review of the literature.Methods: Patients that underwent surgical treatment of an unruptured intracranial aneurysm at the Basel University Hospital were retrospectively identified. The rate of recurrent or de novo aneurysm formation was assessed for all patients with imaging follow-up ≥10yrs. A systematic review including studies with a mean follow-up period of ≥10yrs was then performed.Results: A total of 95 patients had undergone surgical treatment of an unruptured intracranial aneurysm between 1994 and 2008. Twenty-one patients (22.1%) had available imaging follow-up ≥10yrs (mean: 13.1yrs). In these patients, aneurysm recurrence and de novo aneurysm formation were equally found in 23.8% (n = 5; 1.8%/yr). There was no case of aneurysm rupture from a recurrent or a de novo aneurysm. The systematic literature review covered a combined cohort of 1778 patients over a mean follow-up period of 14.0yrs. In this cohort, the aneurysm recurrence rate was 16.4% (0.7%/yr), and the rate of de novo aneurysm formation was 6.2% (0.4%/yr).Discussion: Despite some discrepancy regarding the incidence, both cohorts show a non-negligible long-term risk of aneurysm recurrence and de novo aneurysm formation, which warrants life-long imaging follow-up.Abbreviations: SD: standard deviation; DSA: digital subtraction angiography; CTA: computed tomography angiography; MRA: magnetic resonance angiography; MCA: middle cerebral artery; ACA: anterior cerebral artery; ACommA: anterior communicating artery; ICA: internal carotid artery; ADPKD: autosomal dominant polycystic kidney disease; MeSH: Medical Subject Headings.
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Affiliation(s)
- Tamara J Fingerlin
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Jonathan Rychen
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Ethan Taub
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland.,Division of Neurosurgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Zanaty M, Roa JA, Nakagawa D, Chalouhi N, Allan L, Al Kasab S, Limaye K, Ishii D, Samaniego EA, Jabbour P, Torner JC, Hasan DM. Aspirin associated with decreased rate of intracranial aneurysm growth. J Neurosurg 2019; 133:1478-1485. [PMID: 31662579 DOI: 10.3171/2019.6.jns191273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors' goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm. METHODS The authors performed a retrospective review of a prospectively maintained database covering the period July 2009 through January 2019. Patients' data were included if the following criteria were met: 1) the patient harbored multiple IAs; 2) designated primary aneurysms were treated by surgical/endovascular means; 3) the remaining aneurysms were observed for growth; and 4) a follow-up period of at least 5 years after the initial treatment was available. Demographics, earlier medical history, the rupture status of designated primary aneurysms, aneurysms' angiographic features, and treatment modalities were gathered. RESULTS The authors identified 146 patients harboring a total of 375 IAs. At the initial encounter, 146 aneurysms were treated and the remaining 229 aneurysms (2-5 mm) were observed. During the follow-up period, 24 (10.48%) of 229 aneurysms grew. All aneurysms observed to grow later underwent treatment. None of the observed aneurysms ruptured. Multivariate analysis showed that aspirin was significantly associated with a decreased rate of growth (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05-0.63). Variables associated with an increased rate of growth included hypertension (OR 14.38, 95% CI 3.83-53.94), drug abuse (OR 11.26, 95% CI 1.21-104.65), history of polycystic kidney disease (OR 9.48, 95% CI 1.51-59.35), and subarachnoid hemorrhage at presentation (OR 5.91, 95% CI 1.83-19.09). CONCLUSIONS In patients with multiple IAs, aspirin significantly decreased the rate of aneurysm growth over time. Additional prospective interventional studies are needed to validate these findings.
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Affiliation(s)
| | | | - Daichi Nakagawa
- 3Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nohra Chalouhi
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | | | | | | | - Daizo Ishii
- 6Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Pascal Jabbour
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - James C Torner
- 8Epidemiology and Public Health, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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18
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Hudson JS, Marincovich AJ, Roa JA, Zanaty M, Samaniego EA, Hasan DM. Aspirin and Intracranial Aneurysms. Stroke 2019; 50:2591-2596. [DOI: 10.1161/strokeaha.119.026094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph S. Hudson
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Anthony J. Marincovich
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Jorge A. Roa
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - Mario Zanaty
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Edgar A. Samaniego
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Radiology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - David M. Hasan
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
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19
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Yeon EK, Cho YD, Yoo DH, Lee SH, Kang HS, Kim JE, Cho WS, Choi HH, Han MH. Is 3 years adequate for tracking completely occluded coiled aneurysms? J Neurosurg 2019; 133:758-764. [PMID: 31419789 DOI: 10.3171/2019.5.jns183651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to ascertain the long-term durability of coiled aneurysms completely occluded at 36 months' follow-up given the potential for delayed recanalization. METHODS In this retrospective review, the authors examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization. RESULTS A total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization. CONCLUSIONS Almost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months.
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Affiliation(s)
- Eung Koo Yeon
- 1Department of Radiology, KyungHee University Medical Center, KyungHee University College of Medicine
| | - Young Dae Cho
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Dong Hyun Yoo
- 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Su Hwan Lee
- 3Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Ilsan
| | - Hyun-Seung Kang
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jeong Eun Kim
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Won-Sang Cho
- 4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Hyun Ho Choi
- 5Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine; and
| | - Moon Hee Han
- 6Department of Radiology, Veterans Health Service Medical Center, Seoul, Korea
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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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Cloft HJ. Forbidden Fruit: Some Berry Aneurysms Might Best Be Left Alone. Radiology 2019; 291:418-419. [DOI: 10.1148/radiol.2019190355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Harry J. Cloft
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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22
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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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23
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Wall enhancement of intracranial unruptured aneurysm is associated with increased rupture risk and traditional risk factors. Eur Radiol 2018; 28:5019-5026. [PMID: 29872913 DOI: 10.1007/s00330-018-5522-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/24/2018] [Accepted: 05/03/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Aneurysm wall enhancement (AWE) on MRI has been considered an imaging marker to indicate active aneurysm inflammation, but no prospective studies have assessed the ability of AWE to predict rupture risk or growth. We aim to study the association of AWE with traditional risk factors and the estimated rupture risk. METHODS Seventy-seven patients (mean age, 58.4 ± 10.8 years; 57% female) with 88 asymptomatic intracranial saccular aneurysms underwent both 3-T high-resolution MRI and three-dimensional (3D) rotational digital subtraction angiography (DSA). Geometric and morphologic parameters were measured on DSA, and the degree of AWE on MRI was graded. One- and 5-year rupture risks of aneurysms were estimated using the UCAS and PHASES calculator. Parameters associated with AWE were analyzed using uni- and multivariate logistic regression. RESULTS Non-internal carotid artery location (OR 3.4, 95% CI 1.6-7.1) and aneurysm size (OR 1.9, 95% CI 1.3-2.7) were independently associated with AWE (p < 0.05). Aneurysms with AWE had significantly higher estimated rupture risk (1 and 5 year, 1.9% and 5.8%) than aneurysms without AWE (0.5% and 2.1%) (p < 0.001). Stronger and larger areas of AWE were correlated with the aneurysm size, size ratio and estimated rupture risk (R2 ≥ 0.30) (p < 0.01). CONCLUSIONS Prospective assessment of asymptomatic intracranial aneurysms with MRI suggests that AWE is associated with traditional risk factors and estimated short- and medium-term rupture risk. KEY POINTS • AWE independently associates with aneurysm location and size. • Aneurysms with AWE have higher rupture risk than aneurysms without AWE. • Stronger and larger areas of AWE correlated with the aneurysm size, size ratio and rupture risk.
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24
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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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25
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Intracranial aneurysms in patients with autosomal dominant polycystic kidney disease: prevalence, risk of rupture, and management. A systematic review. Acta Neurochir (Wien) 2017; 159:811-821. [PMID: 28283868 DOI: 10.1007/s00701-017-3142-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder associated with high incidences of intracranial aneurysms. We performed a systematic review with the purpose of clarifying the prevalence, risk of rupture, and appropriate management of intracranial aneurysms in the ADPKD population. METHOD PRISMA guidelines were followed. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on all series reporting ADPKD patients with intracranial aneurysms. RESULTS Our systematic review included 16 articles with a total of 563 patients with ADPKD and intracranial aneurysms. The prevalence of unruptured aneurysms was 11.5% (95% CI = 10.1-13%), whereas 1.9% (95% CI = 1.3-2.6%) of aneurysms were ruptured. Hypertension was present in 79.3% of patients with ADPKD and renal impairment in 65%. The mean size of ruptured aneurysms was slightly higher than unruptured (6 mm vs. 4.4 mm). The most common locations of unruptured and ruptured aneurysms were the ICA (40.5%) and MCA (45%), respectively. Asymptomatic patients studied with four-vessel angiography experienced 25% transient complications. Overall, 74% unruptured aneurysms were surgically treated with lower complication rates compared to endovascular treatment (11% vs. 27.7%). Among conservatively treated aneurysms, 2.9% ruptured at follow-up (rupture rate 0.4%/patient-year). Finally, the growth rate was 0.4% per patient-year, and the incidence of de novo aneurysm formation was 1.4% per patient-year. CONCLUSIONS The prevalence of unruptured intracranial aneurysms in the ADPKD population is approximately 11%. Given the non-negligible rate of procedural complications, the management of these patients must be cautious and individualised. The rupture rate appears comparable to that of the general population. On the other hand, the 1.4% rate per patient-year of de novo aneurysms is non-negligible. These findings should be considered when counselling ADPKD patients regarding the appropriate management of intracranial aneurysms.
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Skodvin TØ, Johnsen LH, Gjertsen Ø, Isaksen JG, Sorteberg A. Cerebral Aneurysm Morphology Before and After Rupture. Stroke 2017; 48:880-886. [DOI: 10.1161/strokeaha.116.015288] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/13/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Using postrupture morphology to predict rupture risk of an intracranial aneurysm may be inaccurate because of possible morphological changes at or around the time of rupture. The present study aims at comparing morphology from angiograms obtained prior to and just after rupture and to evaluate whether postrupture morphology is an adequate surrogate for rupture risk.
Methods—
Case series of 29 aneurysms from a nationwide retrospective data collection. Two neuroradiologists who were blinded to pre- versus postrupture images assessed predefined morphological parameters independently and reached consensus regarding all measurements. Prerupture morphology and respective changes after rupture were quantified and linked to risk factors and to the risk of rupture according to the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) and unruptured intracranial aneurysm treatment (UIAT) scores.
Results—
All 1-dimensional parameter medians were significantly larger after rupture, except neck diameter. Number of aneurysms with daughter sacs was 9 (31%) before and 17 (59%) after rupture (
P
=0.005). Aneurysm growth from the images prior to and just after rupture increased with the time elapsed between images. Aneurysms in patients with hypertension were significantly larger at diagnosis. Prerupture morphology did not differ in relation to smoke status. Clinical risk factors were not significantly associated with morphological change.
Conclusions—
The changes in aneurysm morphology observed after rupture reflect the compound effect of time with successive growth and formation of irregularities and the impact of rupture per se. Postrupture morphology should not be considered an adequate surrogate for the prerupture morphology in the evaluation of rupture risk.
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Affiliation(s)
- Torbjørn Øygard Skodvin
- From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.)
| | - Liv-Hege Johnsen
- From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.)
| | - Øivind Gjertsen
- From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.)
| | - Jørgen Gjernes Isaksen
- From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.)
| | - Angelika Sorteberg
- From the UiT The Arctic University of Norway, Tromsø (T.Ø.S., J.G.I.); University Hospital of Northern Norway, Tromsø (L.-H.J., J.G.I.); Oslo University Hospital Rikshospitalet, Norway (Ø.G., A.S.); and Institute of Clinical Medicine, University of Oslo, Norway (A.S.)
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