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de Nys CM, Liang ES, Prior M, Woodruff MA, Novak JI, Murphy AR, Li Z, Winter CD, Allenby MC. Time-of-Flight MRA of Intracranial Aneurysms with Interval Surveillance, Clinical Segmentation and Annotations. Sci Data 2024; 11:555. [PMID: 38816429 PMCID: PMC11139857 DOI: 10.1038/s41597-024-03397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 05/21/2024] [Indexed: 06/01/2024] Open
Abstract
Intracranial aneurysms (IAs) are present in 2-6% of the global population and can be catastrophic upon rupture with a mortality rate of 30-50%. IAs are commonly detected through time-of-flight magnetic resonance angiography (TOF-MRA), however, this data is rarely available for research and training purposes. The provision of imaging resources such as TOF-MRA images is imperative to develop new strategies for IA detection, rupture prediction, and surgical training. To support efforts in addressing data availability bottlenecks, we provide an open-access TOF-MRA dataset comprising 63 patients, of which 24 underwent interval surveillance imaging by TOF-MRA. Patient scans were evaluated by a neuroradiologist, providing aneurysm and vessel segmentations, clinical annotations, 3D models, in addition to 3D Slicer software environments containing all this data for each patient. This dataset is the first to provide interval surveillance imaging for supporting the understanding of IA growth and stability. This dataset will support computational and experimental research into IA dynamics and assist surgical and radiology training in IA treatment.
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Affiliation(s)
- Chloe M de Nys
- School of Chemical Engineering, The University of Queensland, Brisbane, Australia
- Herston Biofabrication Institute, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Ee Shern Liang
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Medical Imaging, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marita Prior
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Medical Imaging, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Maria A Woodruff
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - James I Novak
- Herston Biofabrication Institute, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Architecture, Design and Planning, The University of Queensland, Brisbane, Australia
| | - Ashley R Murphy
- School of Chemical Engineering, The University of Queensland, Brisbane, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - Craig D Winter
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Kenneth G Jaimieson Department of Neurosurgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mark C Allenby
- School of Chemical Engineering, The University of Queensland, Brisbane, Australia.
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Burlakoti A, Kumaratilake J, Taylor J, Henneberg M. Trend of cerebral aneurysms over the past two centuries: need for early screening. BMJ Open 2024; 14:e081290. [PMID: 38417954 PMCID: PMC10900367 DOI: 10.1136/bmjopen-2023-081290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE Cerebral aneurysms (CAs) are linked to variations in the cerebral basal arterial network (CBAN). This study aimed to find the optimal age for screening to detect brain arterial variations and predict aneurysms before rupture. DESIGN An observational, quantitative and retrospective research. SETTING The study analysed 1127 cases of CAs published from 1761 to 1938. Additionally, CT angiography images of 173-patients at the Royal Adelaide Hospital (RAH), South Australia between 2011 and 2019 were examined for the presence and the location of aneurysms in CBAN. PARTICIPANTS The data were collected from patients at RAH and 407 published sources, including males and females across the entire age range, up to 100 years old. OUTCOME MEASURES AND RESULTS Data, CAs cases, from 1761 to 1938 included (526 males, 573 females and 28 unknown sexes). The age of these patients varied from 18 months to 89 years (mean age=42, SD=18). Approximately 11.5% of the CAs occurred in patients aged <20 years. Among the 1078 aneurysms whose location was reported, 76% were located in the internal carotid (IC), middle cerebral (MC) and anterior communicating artery complex (AcomAC) regions, while the remaining 24% were in the vertebrobasilar region. Among 173 patients from RAH aged between 18 and 100 years (male=83 and female=90, mean age=60, SD=16), 94% of the CAs were found in the IC, MC and AcomAC regions. The pattern of aneurysm occurrence, as indicated by values at the 25th, 50th and 75th percentiles, along with the minimum and maximum patient ages, has remained consistent from 1761 to 2019. CONCLUSION The distribution pattern of CAs in relation to sex, age and locations in the CBAN, remained steady over the last 260 years resulting in risk of strokes early in life. Therefore, early screening for CBAN segment variations is advised for stroke prevention if possible.
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Affiliation(s)
- Arjun Burlakoti
- Human Anatomy, University of South Australia, Adelaide, South Australia, Australia
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jaliya Kumaratilake
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jamie Taylor
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maciej Henneberg
- School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Institute of Evolutionary Medicine, The University of Zurich, Zürich, Switzerland
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Kawabata S, Takagaki M, Nakamura H, Nishida T, Terada E, Kadono Y, Izutsu N, Takenaka T, Matsui Y, Yamada S, Fukuda T, Nakagawa R, Kishima H. Association of Gut Microbiome with Early Brain Injury After Subarachnoid Hemorrhage: an Experimental Study. Transl Stroke Res 2024; 15:87-100. [PMID: 36484924 DOI: 10.1007/s12975-022-01112-6] [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: 06/29/2022] [Revised: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
The occurrence of early brain injury (EBI) following subarachnoid hemorrhage (SAH) is crucial in the prognosis of SAH; however, no effective treatment for EBI has been developed. Gut microbiome (GM) composition influences the outcome of various diseases, including ischemic stroke. Here, we evaluated whether prior GM alteration could prevent EBI following SAH. We altered the GM of 7-week-old male rats by administering antibiotic-containing water for 2 weeks and performing fecal microbiome transplantation after antibiotic induction. Composition of the GM was profiled using 16S rRNA. We induced SAH by injecting blood in the subarachnoid space of control rats and rats with altered GM. We evaluated EBI indicators such as neurological score, brain water content, Evans blue extravasation, and neuronal injury. Additionally, we studied inflammatory cells using immunohistochemistry, immunocytochemistry, quantitative PCR, and flow cytometry. EBI was significantly averted by alterations in GM using antibiotics. The altered GM significantly prevented neutrophil infiltration into the brain among inflammatory cells, and this anti-inflammatory effect was observed immediately following SAH onset. The altered GM also prevented neutrophil extracellular trap formation in the brain and blood, indicating the systemic protective effect. The cause of the protective effect was attributed to a significant decrease in aged neutrophils (CXCR4high CD62Llow) by the altered GM. These protective effects against EBI disappeared when the altered GM was recolonized with normal flora. Our findings demonstrated that EBI following SAH is associated with GM, which regulated neutrophil infiltration.
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Affiliation(s)
- Shuhei Kawabata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masatoshi Takagaki
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeo Nishida
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eisaku Terada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshinori Kadono
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuyuki Izutsu
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomofumi Takenaka
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichi Matsui
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shuhei Yamada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tatsumaru Fukuda
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryota Nakagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Yoshiura T, Takeuchi S, Toyooka T, Tomiyama A, Wada K, Nakao Y, Yamamoto T, Mori K. Effectiveness of Keyhole Clipping of Unruptured Intracranial Aneurysms Detected by "Brain Dock" in Healthy Japanese Adults. Neurol Med Chir (Tokyo) 2024; 64:28-35. [PMID: 37940568 PMCID: PMC10835578 DOI: 10.2176/jns-nmc.2023-0157] [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] [Indexed: 11/10/2023] Open
Abstract
In Japan, brain docking has enhanced the detection of unruptured intracranial aneurysms in healthy adults. At our institution, surgical clipping is the first-line treatment for unruptured intracranial aneurysms (UIA). In this study, the differences in neurological and radiological outcomes, as well as cognitive and psychological results, between standard clipping and keyhole clipping for these aneurysms detected via brain docking were evaluated. The study included 131 aneurysms detected via "brain dock." Of these, 65 were treated with keyhole clipping surgery (keyhole clipping group), and 66 were treated with standard clipping surgery (standard clipping group). Evaluations at 3 months included the National Institutes of Health Stroke Scale, modified Rankin Scale, Mini-Mental State Examination, Hasegawa's Dementia Scale-revised, Beck Depression Inventory, Hamilton Rating Scale for Depression, and radiological abnormalities. The mean operative time and postoperative hospitalization period were significantly shorter in the keyhole clipping group than in the standard clipping group (p < 0.001). Between the groups, no significant differences in postoperative neurological complications or radiological abnormalities were found. The keyhole clipping group demonstrated slightly but significantly better Beck Depression Inventory and Hamilton Rating Scale for Depression scores than the standard clipping group (Beck Depression Inventory, p = 0.046; Hamilton Rating Scale for Depression, p < 0.01). Both the Beck Depression Inventory and Hamilton Rating Scale for Depression scores at 3 months were significantly enhanced (p < 0.001) in the keyhole clipping group. These findings propose that keyhole clipping could be considered a new therapeutic option for small UIA detected via brain docking.
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Affiliation(s)
- Toru Yoshiura
- Department of Neurosurgery, National Defense Medical College
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College
| | | | - Arata Tomiyama
- Department of Neurosurgery, National Defense Medical College
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital
| | - Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital
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Shigematsu H, Yokota K, Hirayama A, Sorimachi T. Frequency and Characteristics of Paraclinoid Aneurysm in Ruptured Cerebral Aneurysms. J Korean Neurosurg Soc 2024; 67:22-30. [PMID: 37454677 PMCID: PMC10788556 DOI: 10.3340/jkns.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/16/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE This study aimed to determine the frequency of paraclinoid aneurysms among ruptured cerebral aneurysms and compare paraclinoid aneurysms with other aneurysms to clarify the characteristics of ruptured paraclinoid aneurysms. METHODS This study included 970 ruptured cerebral aneurysms treated at our hospital between 2003 and 2020. RESULTS There were 15 cases (1.3%) of paraclinoid aneurysms with maximum diameters of 5-22 mm (mean±standard deviation [SD], 11.6±5.4 mm). Treatment consisted of clipping in four patients and endovascular treatment in 11. Factors significantly different in multivariate analysis for paraclinoid aneurysms compared with those for other aneurysms were a history of hypertension (odds ratio [OR], 1.2-9.8; p=0.021) and aneurysm ≥10 mm (OR, 7.5-390.3; p<0.001). The sites of paraclinoid aneurysm were ophthalmic artery type in nine patients, anterior wall type in five, medial wall type in one, and ventral wall type in zero. The medial wall type (22 mm) was significantly larger than the ophthalmic artery type (mean±SD, 7.2±2.0 mm) (p=0.003), and the anterior wall type (mean±SD, 12.2±4.8 mm) was significantly larger than the ophthalmic artery type (p=0.024). CONCLUSION This study showed a low frequency of paraclinoid aneurysms among ruptured cerebral aneurysms. Most were upward-facing with relatively large aneurysms, and no aneurysms were smaller than 5 mm. With recent advances in endovascular treatment devices, paraclinoid aneurysms are easily treatable. However, the treatment indication of each paraclinoid aneurysm should be carefully considered.
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Affiliation(s)
- Hideaki Shigematsu
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Kazuma Yokota
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Akihiro Hirayama
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
| | - Takatoshi Sorimachi
- Department of Neurosurgery, Medical Science College, Tokai University, Kanagawa, Japan
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Cooke DL, Shen H, Duvvuri M, Thompson D, Neylan T, Wolfe W, Hetts S, Ovbiagele B, Whooley M, Cohen B. Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans. Front Integr Neurosci 2023; 17:1207610. [PMID: 37600234 PMCID: PMC10433370 DOI: 10.3389/fnint.2023.1207610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Brain aneurysms represent a significant cause of hemorrhagic stroke. Prior research has demonstrated links between stress and stroke, including brain aneurysms. We aimed to determine relationships between select psychiatric disorders and aneurysms and aneurysmal SAH. Methods We performed retrospective, case-control study of a National Veterans Affairs population with two experimental groups (aneurysm-only and aneurysmal SAH) and 10-fold controls per group matched by age, date, and clinical data source. The studied the presence of 4 psychiatric disorders: Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and other mood disorders. Our main outcomes Unadjusted and multivariable adjusted ORs of PTSD, MDD, GAD, and mood disorders within aneurysm-only and aSAH groups. Results In 6,320,789 US Veterans who were enrolled for at least 5 years in Medicare and/or the Veterans Health Administration, we identified 35,094 cases of aneurysm without SAH and 5,749 cases of aneurysm with SAH between 1/2005 and 12/2019. In analyses adjusted for sex, hypertension, and tobacco use, patients with aneurysm were more likely than matched controls to have a history of PTSD (OR 1.48), MDD (OR 1.33), GAD (OR 1.26), and other mood disorders (OR 1.34) (all p-values < 0.0001). Similarly, patients with aSAH were more likely than controls to have a history of PTSD (OR 1.35), MDD (OR 1.38), GAD (OR 1.18), and other mood disorders (OR 1.30) (all p-values < 0.0001). Conclusion The study, the largest of its kind, further suggests links between psychiatric disorders and stroke. This is important as patients with aneurysms are not routinely screened for such psychiatric risk factors. Additional research on this topic could lead to novel strategies to improve stroke prevention.
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Affiliation(s)
- Daniel L. Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Hui Shen
- San Francisco Veterans Affairs Medical Center, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Madhavi Duvvuri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Thompson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Thomas Neylan
- Department of Psychiatry, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - William Wolfe
- Department of Psychiatry, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Steven Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Ovbiagele
- Department of Neurology, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Mary Whooley
- Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
| | - Beth Cohen
- Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, United States
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Rajamani L, Basetti B, Rangasami R, Chandrasekharan A, Ramachandran R. Magnetic resonance imaging in the evaluation of the pathologies affecting large intracranial arteries. J Neurosci Rural Pract 2023; 14:35-40. [PMID: 36891123 PMCID: PMC9944317 DOI: 10.25259/jnrp_28_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives Our aim is to describe the utility of magnetic resonance imaging (MRI) in the evaluation of pathologies affecting large intracranial arteries. Materials and Methods We performed a prospective and observational study from 2018 to 2020 using 1.5 T MRI. Our study included 75 patients who were referred for MRI brain with clinical features of stroke or having tumors/infection involving large intracranial arteries (vertebral, basilar, and internal carotid arteries) on initial MRI. Correlation of MRI diagnosis was done with final diagnosis. Results Atherothrombosis was the most common pathology involving all the intracranial large arteries and was most commonly seen in elderly male patients. The second most common pathology involving the internal carotid, vertebral, and basilar arteries was tumors, dissection, and aneurysms, respectively. The most common artery involved by atherothrombosis, tumor, and infection/inflammation was internal carotid artery, whereas it was basilar artery and vertebral artery in cases of aneurysm and dissection, respectively. Conclusion MRI is an extremely useful modality to study large intracranial arteries. It is useful to demonstrate the site of abnormality, vessel lumen and caliber, vessel wall changes, and perivascular areas. This can help in arriving at correct diagnosis and thereby guide appropriate timely management.
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Affiliation(s)
- Logesh Rajamani
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Bhavya Basetti
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Anupama Chandrasekharan
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajoo Ramachandran
- Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Prevalence and risk factors of unruptured intracranial saccular aneurysms in hospital population by 3D-TOF-MRA with VR reconstruction. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cras TY, Hunink MMG, Dammers R, van Es ACGM, Volovici V, Burke JF, Kremers FCC, Dippel DWJ, Roozenbeek B. Surveillance of Unruptured Intracranial Aneurysms: Cost-Effectiveness Analysis for 3 Countries. Neurology 2022; 99:e890-e903. [PMID: 35654593 DOI: 10.1212/wnl.0000000000200785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES No consensus exists on adequate surveillance of conservatively managed unruptured intracranial aneurysms (UIAs). We aimed to determine optimal MRI surveillance strategies for the growth of UIAs using cost-effectiveness analysis. A secondary aim was to develop a clinical tool for personalizing UIA surveillance. METHODS We designed a microsimulation model from a health care perspective simulating 100,000 55-year-old women to estimate costs and quality-adjusted life years (QALYs) over a lifetime horizon in the United States, the United Kingdom, and the Netherlands, using literature-derived model parameters. Country-specific costs and willingness-to-pay thresholds ($100,000/QALY for the United States, £30,000/QALY for the United Kingdom, and €80,000/QALY for the Netherlands) were used. Lifetime costs and QALYs were annually discounted at 3% for the United States, 3.5% for the United Kingdom, or 4% (costs) and 1.5% (QALYs) for the Netherlands. Strategies were no follow-up surveillance, follow-up with MRI in the first and fifth year after UIA discovery, every 5 years, every 2 years, or annually, or immediate intervention (i.e., clipping or coiling). Using the microsimulation model, we developed a tool for personalizing UIA surveillance for men and women, with different ages and varying aneurysm characteristics. Uncertainty in the input parameters was modeled with probabilistic sensitivity analysis. RESULTS Among 55-year-old women, 2,222 individuals in the United States, 1,910 in the United Kingdom, and 2,040 in the Netherlands needed to undergo an annual MRI scan to prevent 1 case of subarachnoid hemorrhage per year. No surveillance MRI was most cost-effective in the United States (in 47% of the simulations) and United Kingdom (in 54% of simulations), whereas annual MRI was most cost-effective in the Netherlands (in 53% of simulations). In the United States and United Kingdom, annual surveillance or surveillance in the first and fifth year after discovery was cost-effective in patients <60 years and at increased risk of aneurysm growth. The optimal, personalized, surveillance strategies were summarized in a look-up table for use in clinical practice. DISCUSSION Generally, the US and UK physicians should refrain from assigning patients, particularly older patients and those with few risk factors for aneurysm growth or rupture, to frequent MRI surveillance. In the Netherlands, annual follow-up is generally most cost-effective.
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Affiliation(s)
- Tim Yannick Cras
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Myriam M G Hunink
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Ruben Dammers
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Adriaan C G M van Es
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Victor Volovici
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - James F Burke
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Femke C C Kremers
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Diederik W J Dippel
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor
| | - Bob Roozenbeek
- From the Departments of Neurology (T.Y.C., F.C.C.K., D.W.J.D., B.R.), Epidemiology (M.M.G.H.), Radiology & Nuclear Medicine (M.M.G.H., B.R.), Neurosurgery (R.D., V.V.), and Erasmus MC University Medical Center (T.Y.C., F.C.C.K., D.W.J.D., B.R., R.D.), Rotterdam, the Netherlands; Centre for Health Decision Sciences (M.M.G.H.), Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Radiology (A.C.G.M.v.E.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.F.B.), University of Michigan, Ann Arbor.
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10
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Johnsen LH, Herder M, Vangberg T, Kloster R, Ingebrigtsen T, Isaksen JG, Mathiesen EB. Prevalence of unruptured intracranial aneurysms: impact of different definitions - the Tromsø Study. J Neurol Neurosurg Psychiatry 2022; 93:902-907. [PMID: 35688631 DOI: 10.1136/jnnp-2022-329270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Management of incidental unruptured intracranial aneurysms (UIAs) remains challenging and depends on their risk of rupture, estimated from the assumed prevalence of aneurysms and the incidence of aneurysmal subarachnoid haemorrhage. Reported prevalence varies, and consistent criteria for definition of UIAs are lacking. We aimed to study the prevalence of UIAs in a general population according to different definitions of aneurysm. METHODS Cross-sectional population-based study using 3-dimensional time-of-flight 3 Tesla MR angiography to identify size, type and location of UIAs in 1862 adults aged 40-84 years. Size was measured as the maximal distance between any two points in the aneurysm sac. Prevalence was estimated for different diameter cutoffs (≥1, 2 and 3 mm) with and without inclusion of extradural aneurysms. RESULTS The overall prevalence of intradural saccular aneurysms ≥2 mm was 6.6% (95% CI 5.4% to 7.6%), 7.5% (95% CI 5.9% to 9.2%) in women and 5.5% (95% CI 4.1% to 7.2%) in men. Depending on the definition of an aneurysm, the overall prevalence ranged from 3.8% (95% CI 3.0% to 4.8%) for intradural aneurysms ≥3 mm to 8.3% (95% CI 7.1% to 9.7%) when both intradural and extradural aneurysms ≥1 mm were included. CONCLUSION Prevalence in this study was higher than previously observed in other Western populations and was substantially influenced by definitions according to size and extradural or intradural location. The high prevalence of UIAs sized <5 mm may suggest lower rupture risk than previously estimated. Consensus on more robust and consistent radiological definitions of UIAs is warranted.
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Affiliation(s)
- Liv-Hege Johnsen
- Department of Radiology, University Hospital of North Norway, Tromso, Norway .,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Marit Herder
- Department of Radiology, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway
| | - Torgil Vangberg
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,PET Imaging Center, University Hospital of North Norway, Tromso, Norway
| | - Roar Kloster
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Jørgen Gjernes Isaksen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromso, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University, Tromso, Norway.,Department of Neurology, University Hospital of North Norway, Tromso, Norway
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11
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Prevalence of cerebral aneurysms in autopsy studies: a review of the literature. Neurosurg Rev 2022; 45:2565-2582. [PMID: 35460044 DOI: 10.1007/s10143-022-01783-7] [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: 01/05/2022] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Cerebral aneurysms (CAs) are one of the most important causes of stroke, but details of their prevalence remain under-researched. Autopsy data for CAs were reviewed using standard search engines. Based on previously published autopsy and clinical studies, the prevalence of CAs with respect to age, gender, and aneurysm site, size, and multiplicity was investigated, and the natural course of CA prevalence was estimated. In autopsy studies, the prevalence of CAs across all age groups was 0.3-4.0% for unruptured cerebral aneurysms (UCAs) and 1.3-7.6% for CAs including UCAs and ruptured cerebral aneurysms (RCAs). Patients with UCAs were generally older than those with RCAs. Middle cerebral artery aneurysms were more predominant in autopsy studies than in clinical studies. UCAs tended to be smaller than RCAs, and minute UCAs (< 2 mm), diagnosed microscopically at autopsy and thought to be in the very early stages of formation, were present in 10-20% of the general population. Taking into consideration the clinical data for UCAs and RCAs, 10% of minute UCAs enlarge to major UCAs (≥ 2 mm) detectable by conventional imaging techniques, and 10% of major UCAs eventually rupture within 10 years. The high prevalence of UCAs and RCAs in the elderly and women can be attributed to the more frequent occurrence of minute UCAs in these populations. Minute UCAs occur at a high rate, but only a few enlarge to become major UCAs and rupture. Further advances in diagnostic technology are essential for revealing the true natural course of CA prevalence.
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12
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Wang Y, Jiao H, Peng H, Liu J, Ma L, Wang J. Study of Vertebral Artery Dissection by Ultrasound Superb Microvascular Imaging Based on Deep Neural Network Model. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9713899. [PMID: 35256903 PMCID: PMC8898129 DOI: 10.1155/2022/9713899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022]
Abstract
To assess the diagnostic value of ultrasound Superb Microvascular Imaging (SMI) and versus Doppler ultrasound (TCD) for microvascular structure and aerodynamic changes in vertebral artery dissection (VAD). In this paper, we firstly simulate the process of clinician recognition of vertebral artery dissection and propose a combination of a priori shape information of vertebral artery dissection and deep folly convolutional networks (DFCNs) for IVUS. In this paper, 15 patients with vertebral artery dissection confirmed by SMI, digital subtraction angiography (DSA), or computed tomography angiography (CTA) from 2020 to 2021 were selected, and the true and false lumen diameters, peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV) and PSV, EDV, and plasticity index (PI) of the intracranial vertebral artery were measured. Among the 15 patients with VAD, 4 (27%, 4/15) had trauma-induced secondary vertebral artery entrapment and 11 (73%, 11/15) had spontaneous entrapment without a clear cause. According to the structural characteristics of the vessels, there were 11 cases (73%, 11/15) of double-lumen, intramural hematoma, and vertebral artery dissection aneurysm, and 11 cases (73%, 11/15) of V1 segment. SMI not only provides an objective assessment of the vascular morphology and aerodynamic changes in VAD but also, in combination with TCD, can further determine the opening of the traffic branches in the posterior circulation, providing reliable information for the early diagnosis and treatment of microvascular dissection of the vertebral artery.
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Affiliation(s)
- Yanjuan Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Huajie Jiao
- Department of Medical Imaging, Ningxia People's Hospital, Yinchuan, NingXia 750001, China
| | - Huihui Peng
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jinfang Liu
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Liyuan Ma
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
| | - Jianjun Wang
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, NingXia 750001, China
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13
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He G, Wang J, Zhang Y, Li M, Lu H, Cheng Y, Zhu Y. Diagnostic Performance of MRA for UnrupturedAneurysms at the Distal ICA. Clin Neuroradiol 2022; 32:507-515. [DOI: 10.1007/s00062-021-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022]
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14
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Kim BS. Unruptured Intracranial Aneurysm: Screening, Prevalence and Risk Factors. Neurointervention 2021; 16:201-203. [PMID: 34689458 PMCID: PMC8561037 DOI: 10.5469/neuroint.2021.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Burlakoti A, Kumaratilake J, Taylor J, Henneberg M. Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit. BMJ Open 2021; 11:e051028. [PMID: 34531215 PMCID: PMC8449962 DOI: 10.1136/bmjopen-2021-051028] [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] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Segments of cerebral basal arterial network (CBAN) dampen the peak pressure in blood flowing through these arteries, thus minimising the chances of development of cerebral aneurysms. The objective of this research was to find the relationship of occurrence of intracranial aneurysms to variations of the components of the CBAN. DESIGN AND SETTING This is an observational, quantitative and retrospective research, which used cerebral CT angiography (CCTA) images. PARTICIPANTS Cerebral CTA of 145 adult patients of both sexes were studied. MAIN OUTCOME MEASURES Diameters of segments of CBAN were measured in CCTA images and the relative size of each vessel was calculated to standardise for differences in overall arterial sizes among patients. Relationships among sizes of CBAN components were analysed. Presence of aneurysms in different parts of the CBAN was recorded. RESULTS Forty-six aneurysms in right internal carotid artery (ICA) and middle cerebral artery (MCA) and 32 aneurysms in left ICA and MCA segments were noted in 42 and 30 patients, respectively. Aneurysms in anterior communicating artery complex and vertebral-basilar arterial segments were seen in 27 and 8 patients, respectively, while they were not detected in parts of posterior cerebral artery (PCA). The significant (p<0.001) inverse relationships between sizes of posterior communicating artery and the first segment of PCA on both sides indicated that blood inputs to the second part of PCA were similar. Difference in means of the index of arterial size variation for people with aneurysms (mean 0.96, SD 0.23) and without aneurysms (mean 0.86, SD 0.22) was significant (p=0.015). CONCLUSION Variation in segments of CBAN was quantified. The peak pressure dampening mechanism in such arterial segments reduces the chances of development of aneurysms.
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Affiliation(s)
- Arjun Burlakoti
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jaliya Kumaratilake
- Anatomy and Pathology, The University of Adelaide Adelaide Medical School, Adelaide, South Australia, Australia
| | - Jamie Taylor
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maciej Henneberg
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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16
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Yoshida K, Uwano I, Sasaki M, Takahashi O, Sakai N, Tsuruta W, Nakase H, Ogasawara K, Osato T, Takahashi JC, Hatano T, Kinouchi H, Miyamoto S. Small Unruptured Aneurysm Verification-prevention Effect against Growth of Cerebral Aneurysm Study Using Statin. Neurol Med Chir (Tokyo) 2021; 61:442-451. [PMID: 34024878 PMCID: PMC8280329 DOI: 10.2176/nmc.oa.2021-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several basic experimental studies have demonstrated that statins have beneficial effects for intracranial aneurysm (IA). Clinical studies on unruptured IAs, however, remain limited to four retrospective studies that have reached different conclusions. This study was the first open-label, multicenter, randomized controlled trial to assess the preventive effects of atorvastatin. Patients with unruptured small saccular IAs were randomly assigned to statin and control groups. The primary endpoint was a composite of aneurysm growth of ≥0.5 mm, new bleb formation confirmed from magnetic resonance (MR) angiography, and rupture. Enrollment was prematurely terminated due to unexpectedly slow enrollment. Of 231 patients (275 target IAs), 110 patients (128 IAs) were randomly assigned to the statin group and 121 patients (147 IAs) to the control group. After excluding 22 dropout patients, 107 IAs in the 93 statin group patients and 140 IAs in the 116 control group patients were finally analyzed. No significant differences of basic characteristics were evident between groups, except for significantly higher systolic pressure in the statin group (P = 0.03). The primary endpoint occurred in 28 IAs (20.0%) in the control group and in 17 IAs (15.9%) in the statin group. No aneurysm rupture was confirmed in either group. Significant beneficial effects of statin for IAs were not demonstrated for the primary endpoint (log-rank P = 0.359). This randomized trial did not establish any preventive effects of atorvastatin for unruptured small IAs. Further studies of larger cohorts are required to clarify the efficacy of statins for patients with unruptured IAs. Clinical trial registration: UMIN000005135
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Affiliation(s)
- Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Ikuko Uwano
- Division of Ultra-High Field MRI, Institute for Biomedical Sciences, Iwate Medical University
| | - Makoto Sasaki
- Division of Ultra-High Field MRI, Institute for Biomedical Sciences, Iwate Medical University
| | - Osamu Takahashi
- St. Luke's International University Graduate School of Public Health
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Centre General Hospital
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital
| | | | | | | | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Taketo Hatano
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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17
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Kim JH, Lee KY, Ha SW, Suh SH. Prevalence of Unruptured Intracranial Aneurysms: A Single Center Experience Using 3T Brain MR Angiography. Neurointervention 2021; 16:117-121. [PMID: 33906286 PMCID: PMC8261115 DOI: 10.5469/neuroint.2021.00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the prevalence and risk factors of unruptured intracranial aneurysms (UIAs), which can help establish guidelines of treatment for asymptomatic Korean adults using 3T magnetic resonance angiography (MRA). Materials and Methods Our Institutional Review Board approved this retrospective study, and informed consent was waived. All patients consisted of healthy individuals who underwent brain MRA using 3T magnetic resonance imaging between January 2011 and December 2012 as part of a routine health examination. Patient data and follow-up results were obtained from medical records. Results A total of 2,118 individuals (mean age=53.9±9.6 years, male:female=1,188:930) who had undergone brain MRA were enrolled in the study. UIAs were found in 80 patients with 105 UIAs (3.77%). Female predominance (55% in UIA vs. 43.47% in non-UIA, P=0.0416) and hypertension were more common in the UIA group (43.75% vs. 28.8%, P=0.004, respectively). The mean size of the aneurysms was 3.10±1.62 mm, and they were all saccular in shape and asymptomatic. The UIAs were most common in the internal carotid artery (59.1%), internal carotid-posterior communicating artery (15.2%), middle cerebral artery (9.5%), anterior communicating artery (8.6%), anterior cerebral artery (4.8%), and vertebral artery (2.9%). Twenty-eight of 80 patients (35%) had multiple aneurysms. The incidence of UIAs increased significantly with age (P=0.014). Conclusion In single center experience, we demonstrated the characteristics and prevalence of UIAs in asymptomatic adults, which may help establish guidelines or therapeutic standards for UIAs.
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Affiliation(s)
- Jae Ho Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Woo Ha
- Department of Neurosurgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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18
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Ruigrok YM. Management of Unruptured Cerebral Aneurysms and Arteriovenous Malformations. Continuum (Minneap Minn) 2020; 26:478-498. [PMID: 32224762 DOI: 10.1212/con.0000000000000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Unruptured intracranial aneurysms and brain arteriovenous malformations (AVMs) may be detected as incidental findings on cranial imaging. This article provides a practical approach to the management of unruptured intracranial aneurysms and unruptured brain AVMs and reviews the risk of rupture, risk factors for rupture, preventive treatment options with their associated risks, and the approach of treatment versus observation for both types of vascular malformations. RECENT FINDINGS For unruptured intracranial aneurysms, scoring systems on the risk of rupture can help with choosing preventive treatment or observation with follow-up imaging. Although the literature provides detailed information on the complication risks of preventive treatment of unruptured intracranial aneurysms, individualized predictions of these procedural complication risks are not yet available. With observation with imaging, growth of unruptured intracranial aneurysms can be monitored, and prediction scores for growth can help determine the optimal timing of monitoring. The past years have revealed more about the risk of complications of the different treatment modalities for brain AVMs. A randomized clinical trial and prospective follow-up data have shown that preventive interventional therapy in patients with brain AVMs is associated with a higher rate of neurologic morbidity and mortality compared with observation. SUMMARY The risk of hemorrhage from both unruptured intracranial aneurysms and brain AVMs varies depending on the number of risk factors associated with hemorrhage. For both types of vascular malformations, different preventive treatment options are available, and all carry risks of complications. For unruptured intracranial aneurysms, the consideration of preventive treatment versus observation is complex, and several factors should be included in the decision making. Overall, it is recommended that patients with unruptured asymptomatic brain AVMs should be observed.
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19
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Tanji F, Nanbu H, Fushimi S, Shibata K, Kondo R. Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan. J Rural Med 2020; 15:183-188. [PMID: 33033539 PMCID: PMC7530595 DOI: 10.2185/jrm.2020-003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/06/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: Although it is well known that smoking is a risk factor for
subarachnoid hemorrhage, the association between smoking and unruptured intracranial
aneurysms remains unclear. The aim of the present study was to investigate whether smoking
status was associated with unruptured intracranial aneurysms among Japanese brain health
check-up examinees. Materials and Methods: We conducted a cross-sectional study of 1,496 adults
(aged 26–90 years) undergoing brain health check-ups at a single community medical support
hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily
undergo a brain health check-up for early detection of unruptured intracranial aneurysms
or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such
as smoking status, and were classified into three groups: never, former, and current
smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance
angiography was performed by an expert physician. Multiple logistic regression models were
used to estimate the odds ratio for unruptured intracranial aneurysms. We performed
statistical analyses by age, sex, and family history of stroke. Results: The number of participants with unruptured intracranial aneurysms
was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5)
years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for
unruptured intracranial aneurysms of 1.21 (0.48–3.08) among former smokers and 2.88
(1.10–7.50) among current smokers were compared to those of never smokers (p-trend =
0.041). After stratifying by age, sex, and family history of stroke, no interactions were
found. Conclusion: This cross-sectional study conducted in Japan showed that
smoking was positively associated with unruptured intracranial aneurysms among brain
health check-up examinees.
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Affiliation(s)
- Fumiya Tanji
- Faculty of Nursing, Japanese Red Cross Akita College of Nursing, Japan
| | - Hirohito Nanbu
- Faculty of Nursing, Japanese Red Cross Akita College of Nursing, Japan
| | - Susumu Fushimi
- Department of Neurosurgery, Hiraka General Hospital, Japan
| | | | - Rui Kondo
- Department of Neurosurgery, Hiraka General Hospital, Japan
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20
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The Bilateral Ovariectomy in a Female Animal Exacerbates the Pathogenesis of an Intracranial Aneurysm. Brain Sci 2020; 10:brainsci10060335. [PMID: 32486339 PMCID: PMC7349062 DOI: 10.3390/brainsci10060335] [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: 04/24/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
Considering the poor outcome of subarachnoid hemorrhage (SAH) due to the rupture of intracranial aneurysms (IA), mechanisms underlying the pathogenesis of IAs, especially the rupture of lesions, should be clarified. In the present study, a rat model of IAs in which induced lesions spontaneously ruptured resulting in SAH was used. In this model, the combination of the female sex and the bilateral ovariectomy increased the incidence of SAH, similar to epidemiological evidence in human cases. Importantly, unruptured IA lesions induced in female animals with bilateral ovariectomy were histopathologically similar to ruptured ones in the presence of vasa vasorum and the accumulation of abundant inflammatory cells, suggesting the exacerbation of the disease. The post-stenotic dilatation of the carotid artery was disturbed by the bilateral ovariectomy in female rats, which was restored by hormone replacement therapy. The in vivo study thus suggested the protective effect of estrogen from the ovary on endothelial cells loaded by wall shear stress. β-estradiol or dihydrotestosterone also suppressed the lipopolysaccharide-induced expression of pro-inflammatory genes in cultured macrophages and neutrophils. The results of the present study have thus provided new insights about the process regulating the progression of the disease.
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21
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Heo J, Park SJ, Kang SH, Oh CW, Bang JS, Kim T. Prediction of Intracranial Aneurysm Risk using Machine Learning. Sci Rep 2020; 10:6921. [PMID: 32332844 PMCID: PMC7181629 DOI: 10.1038/s41598-020-63906-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/08/2020] [Indexed: 01/09/2023] Open
Abstract
An efficient method for identifying subjects at high risk of an intracranial aneurysm (IA) is warranted to provide adequate radiological screening guidelines and effectively allocate medical resources. We developed a model for pre-diagnosis IA prediction using a national claims database and health examination records. Data from the National Health Screening Program in Korea were utilized as input for several machine learning algorithms: logistic regression (LR), random forest (RF), scalable tree boosting system (XGB), and deep neural networks (DNN). Algorithm performance was evaluated through the area under the receiver operating characteristic curve (AUROC) using different test data from that employed for model training. Five risk groups were classified in ascending order of risk using model prediction probabilities. Incidence rate ratios between the lowest- and highest-risk groups were then compared. The XGB model produced the best IA risk prediction (AUROC of 0.765) and predicted the lowest IA incidence (3.20) in the lowest-risk group, whereas the RF model predicted the highest IA incidence (161.34) in the highest-risk group. The incidence rate ratios between the lowest- and highest-risk groups were 49.85, 35.85, 34.90, and 30.26 for the XGB, LR, DNN, and RF models, respectively. The developed prediction model can aid future IA screening strategies.
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Affiliation(s)
- Jaehyuk Heo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea.,Department of Applied Statistics, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Sang Jun Park
- Big Data Center, Department of Future Innovation Research, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Si-Hyuck Kang
- Big Data Center, Department of Future Innovation Research, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea. .,Big Data Center, Department of Future Innovation Research, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
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22
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Aboukais R, Loiez C, Leclerc X, Bourgeois P, Wallet F, Menovsky T, Lejeune JP. Absence of bacteria in intracranial aneurysms. J Neurosurg 2020; 132:1197-1201. [DOI: 10.3171/2018.12.jns183044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThis study aimed to detect the presence of bacteria in the walls of both unruptured and ruptured aneurysms in a French population.METHODSPatients treated between January 2018 and July 2018 were included in a prospective study when specimens from ruptured or unruptured aneurysm walls were obtained intraoperatively. Samples from superficial temporal artery, dura mater, and middle meningeal artery were obtained from each patient during the same surgical procedure to be used as a negative control. Direct bacterial analysis, aerobic and anaerobic bacterial culture, and bacterial DNA detection were performed on each sample.RESULTSThere were 21 women and 9 men with a mean age at treatment of 54 years (range 31–70 years). Eighteen patients were smokers. Hypertension was present in 18 patients and hyperlipidemia in 5 patients. Chronic alcoholism was found in 6 patients. Polycystic kidney disease was present in 1 patient. Fifteen patients had multiple intracranial aneurysms. Ten patients had a ruptured aneurysm and 20 had an unruptured aneurysm. The mean diameter of all aneurysms was 8.5 mm (range 2.5–50 mm). No presence of bacteria was detected with direct bacterial analysis and culture in any of the samples. No bacterial DNA was detected in any of the samples.CONCLUSIONSUnlike in Finnish patients, no bacterial presence was found in the wall of aneurysms in French patients. This absence of bacterial infection might explain the lower risk of aneurysm rupture in the French population compared to the Finnish population.
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Affiliation(s)
- Rabih Aboukais
- 1Department of Neurosurgery, Lille University Hospital, Hopital Nord
- 2University Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille
| | - Caroline Loiez
- 3Laboratory of Bacteriology, Lille University Hospital, Hopital Nord
| | - Xavier Leclerc
- 4Department of Neuroradiology, Lille University Hospital, Hopital Nord, France; and
| | | | - Frederic Wallet
- 3Laboratory of Bacteriology, Lille University Hospital, Hopital Nord
| | - Tomas Menovsky
- 5Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Jean-Paul Lejeune
- 1Department of Neurosurgery, Lille University Hospital, Hopital Nord
- 2University Lille, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille
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23
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Ikawa F, Hidaka T, Yoshiyama M, Ohba H, Matsuda S, Ozono I, Iihara K, Kinouchi H, Nozaki K, Kato Y, Morita A, Michihata N, Yasunaga H, Kurisu K. Characteristics of Cerebral Aneurysms in Japan. Neurol Med Chir (Tokyo) 2019; 59:399-406. [PMID: 31462602 PMCID: PMC6867938 DOI: 10.2176/nmc.ra.2019-0099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The characteristics of cerebral aneurysms in Japan differ from other countries in the higher incidence of unruptured cerebral aneurysm detected by brain check-up screening, higher rupture rate of unruptured cerebral aneurysm, higher incidence of subarachnoid hemorrhage, and superior outcome after subarachnoid hemorrhage based on meta-analysis. Head shape, genetic features, environmental factors, demographics, and medical system in Japan are also different from other countries. Unruptured cerebral aneurysms are 2.8 times more likely to rupture in Japanese than western aneurysms, resulting in the highest incidence of subarachnoid hemorrhage in the world. The exact and specific mechanisms of de novo, growth, and rupture of cerebral aneurysms have not been elucidated. Investigations will contribute to the understanding of cerebral aneurysms and subarachnoid hemorrhage worldwide. Some features of cerebral aneurysm in Japan are discussed for possible research guidance in the elucidation of the predominance of subarachnoid hemorrhage in Japan.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | | | - Hideo Ohba
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences Kyushu University
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Faculty of Medicine, University of Yamanashi
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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24
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25
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Ikawa F, Morita A, Tominari S, Nakayama T, Shiokawa Y, Date I, Nozaki K, Miyamoto S, Kayama T, Arai H. Rupture risk of small unruptured cerebral aneurysms. J Neurosurg 2019; 132:69-78. [PMID: 30684948 DOI: 10.3171/2018.9.jns181736] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The annual rupture rate of small (3-4 mm) unruptured cerebral aneurysms (UCAs) is 0.36% per year, however, the proportion of small ruptured aneurysms < 5 mm is 35%. This discrepancy is explained by the hypothesis that most acute subarachnoid hemorrhage (SAH) is from recently formed, unscreened aneurysms, but this hypothesis is without definitive proof. The authors aimed to clarify the actual number of screened, ruptured small aneurysms and risk factors for rupture. METHODS The Unruptured Cerebral Aneurysm Study Japan, a project of the Japan Neurosurgical Society, was designed to clarify the natural course of UCAs. From January 2001 through March 2004, 6697 UCAs among 5720 patients were prospectively registered. At registration, 2839 patients (49.6%) had 3132 (46.8%) small UCAs of 3-4 mm. The registered, treated, and rupture numbers of these small aneurysms and the annual rupture rate were investigated. The rate was assessed per aneurysm. The characteristics of patients and aneurysms were compared to those of larger unruptured aneurysms (≥ 5 mm). Cumulative rates of SAH were estimated per aneurysm. Risk factors underwent univariate and multivariate analysis. RESULTS Treatment and rupture numbers of small UCAs were 1132 (37.1% of all treated aneurysms) and 23 (20.7% of all ruptured aneurysms), respectively. The registered, treated, rupture number, and annual rupture rates were 1658 (24.8%), 495 (16.2%), 11 (9.9%), and 0.30%, respectively, among 3-mm aneurysms, and 1474 (22.0%), 637 (20.9%), 12 (10.8%), and 0.45%, respectively, among 4-mm aneurysms. Multivariate risk-factor analysis revealed that a screening brain checkup (hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.2-14.4), history of SAH (HR 10.8, 95% CI 2.3-51.1), uncontrolled hypertension (HR 5.2, 95% CI 1.8-15.3), and location on the anterior communicating artery (ACoA; HR 5.0, 95% CI 1.6-15.5) were independent predictors of rupture. CONCLUSIONS Although the annual rupture rate of small aneurysms was low, the actual number of ruptures was not low. Small aneurysms that ruptured during follow-up could be detected, screened, and managed based on each risk factor. Possible selection criteria for treating small UCAs include a history of SAH, uncontrolled hypertension, location on the ACoA, and young patients. Further large prospective and longitudinal trials are needed.Clinical trial registration no.: C000000418 (https://www.umin.ac.jp/ctr).
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Affiliation(s)
- Fusao Ikawa
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Akio Morita
- 2Department of Neurological Surgery, Nippon Medical School, Tokyo
| | - Shinjiro Tominari
- 3Department of Health Informatics, Kyoto University School of Public Health, Kyoto
| | - Takeo Nakayama
- 4Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto
| | - Yoshiaki Shiokawa
- 5Department of Neurosurgery, Kyorin University School of Medicine, Tokyo
| | - Isao Date
- 6Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama
| | - Kazuhiko Nozaki
- 7Department of Neurosurgery, Shiga University of Medical Science, Shiga
| | - Susumu Miyamoto
- 8Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Takamasa Kayama
- 9Department of Advanced Medicine, Yamagata University School of Medicine, Yamagata; and
| | - Hajime Arai
- 10Department of Neurosurgery, Juntendo University, Tokyo, Japan
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