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Tanaka K, Furukawa K, Ishida F, Suzuki H. Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery. Acta Neurochir (Wien) 2023; 165:3697-3706. [PMID: 37870661 DOI: 10.1007/s00701-023-05840-y] [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: 06/23/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The recanalization of posterior communicating artery (PCoA) aneurysms after endovascular treatment has been analyzed by various factors. However, the differences between adult and fetal types of posterior cerebral artery (PCA) have not been fully investigated. The main aim of this study was to investigate hemodynamic differences of PCoA aneurysms between adult and fetal types using computational fluid dynamics (CFD). METHODS Fifty-five PCoA aneurysms were evaluated by 3D CT angiography and divided into unruptured aneurysms with adult-type or fetal-type PCAs (19 cases, UA group; 9 cases, UF group) and ruptured aneurysms with adult-type or fetal-type PCAs (17 cases, RA group; 10 cases, RF group). These native aneurysms were analyzed by CFD regarding morphological and hemodynamic characteristics. To evaluate simulated endovascular treatment of aneurysms, CFD was performed using porous media modeling. RESULTS Morphologically, the RA group had significantly smaller parent artery diameter (2.91 mm vs. 3.49 mm, p=0.005) and higher size ratio (2.54 vs. 1.78, p=0.023) than the RF group. CFD revealed that the UA group had significantly lower oscillatory shear index (OSI) (0.0032 vs. 0.0078, p=0.004) than the UF group and that the RA group had lower WSS (3.09 vs. 11.10, p=0.001) and higher OSI (0.014 vs. 0.006, p=0.031) than the RF group, while the RF group presented significantly higher intra-aneurysmal flow velocity (0.19 m/s vs. 0.061 m/s, p=0.002) than the RA group. Porous media modeling of simulated treatment revealed higher residual flow volume in the fetal-type groups. CONCLUSIONS These results suggested that PCoA aneurysms with fetal-type PCAs had different morphological features and hemodynamic characteristics compared with those with adult-type PCAs, leading to high risks of recanalization.
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Affiliation(s)
- Katsuhiro Tanaka
- Department of Neurosurgery, Kuwana City Medical Center, 3-11, Kotobuki-Cho, Kuwana, Mie, 511-0061, Japan.
| | - Kazuhiro Furukawa
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Hu X, Deng P, Ma M, Tang X, Qian J, Wu G, Gong Y, Gao L, Zou R, Leng X, Xiang J, Wu J, Ding Z. How does the recurrence-related morphology characteristics of the Pcom aneurysms correlated with hemodynamics? Front Neurol 2023; 14:1236757. [PMID: 37869148 PMCID: PMC10585265 DOI: 10.3389/fneur.2023.1236757] [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: 06/08/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Posterior communicating artery (Pcom) aneurysm has unique morphological characteristics and a high recurrence risk after coil embolization. This study aimed to evaluate the relationship between the recurrence-related morphology characteristics and hemodynamics. Method A total of 20 patients with 22 Pcom aneurysms from 2019 to 2022 were retrospectively enrolled. The recurrence-related morphology parameters were measured. The hemodynamic parameters were simulated based on finite element analysis and computational fluid dynamics. The hemodynamic differences before and after treatment caused by different morphological features and the correlation between these parameters were analyzed. Result Significant greater postoperative inflow rate at the neck (Qinflow), relative Qinflow, inflow concentration index (ICI), and residual flow volume (RFV) were reported in the aneurysms with wide neck (>4 mm). Significant greater postoperative RFV were reported in the aneurysms with large size (>7 mm). Significant greater postoperative Qinflow, relative Qinflow, and ICI were reported in the aneurysms located on the larteral side of the curve. The bending angle of the internal carotid artery at the initiation of Pcom (αICA@PCOM) and neck diameter had moderate positive correlations with Qinflow, relative Qinflow, ICI, and RFV. Conclusion The morphological factors, including aneurysm size, neck diameter, and αICA@PCOM, are correlated with the recurrence-inducing hemodynamic characteristics even after fully packing. This provides a theoretical basis for evaluating the risk of aneurysm recurrence and a reference for selecting a surgical plan.
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Affiliation(s)
- Xiaolong Hu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Peng Deng
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Mian Ma
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaoyu Tang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jinghong Qian
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Gang Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuhui Gong
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Liping Gao
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | | | - Jiandong Wu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhiliang Ding
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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3
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Tsutsui T, Ikedo T, Kitazawa Y, Otsuka R, Nishiwaki T, Kushi Y, Niwa A, Ozaki S, Hattori EY, Shimonaga K, Hamano E, Yamada K, Imamura H, Mori H, Iihara K, Kataoka H. Impact of Morphological Factors on the Future Growth of Unruptured Posterior Communicating Artery Aneurysms. World Neurosurg 2023; 175:e897-e903. [PMID: 37075892 DOI: 10.1016/j.wneu.2023.04.039] [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: 11/19/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND No previous study has established the factors associated with intracranial aneurysm growth using imaging data obtained before the appearance of morphological changes. Therefore, we investigated the factors related to future aneurysm growth in posterior communicating artery (Pcom) aneurysms. METHODS Using a longitudinal database of intracranial aneurysm cases, we reviewed the findings for consecutive patients with unruptured Pcom aneurysms admitted to our institute from 2012 to 2021. Magnetic resonance images obtained over time were used to evaluate aneurysm growth. Aneurysms showing growth over time (group G) and unchanged aneurysms (group U) were compared in terms of background data and morphological factors. RESULTS 93 Pcom aneurysms (group G: 25 aneurysms, 25%; group U: 68 aneurysms, 75%) were eligible for the present study. Six aneurysm rupture events occurred in group G (24%). Among morphological factors, Pcom diameter (1.2 ± 0.3 mm vs. 0.8 ± 0.7 mm, P < 0.01), bleb formation (group G: 39% vs. group U: 10%; odds ratio, 5.6; P = 0.01), and the lateral projection of the dome (group G: 52% vs. group U: 13%; odds ratio, 3.2; P = 0.023) were significantly different between the 2 groups. The sensitivity and specificity of a cutoff Pcom diameter of 0.73 mm for predicting enlargement were 96% and 53%, respectively. CONCLUSIONS Pcom diameter, bleb formation, and lateral dome projection were associated with growth of Pcom aneurysms. Aneurysms with these risk factors require careful follow-up imaging, which may facilitate early detection of aneurysm growth and prevention of rupture through therapeutic interventions.
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Affiliation(s)
- Takeyoshi Tsutsui
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yoshiaki Kitazawa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryotaro Otsuka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takayuki Nishiwaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akihiro Niwa
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Koji Shimonaga
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Eika Hamano
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisae Mori
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Arrambide-Garza FJ, Alvarez-Lozada LA, de León-Gutiérrez H, Villarreal-Silva EE, Alvarez-Villalobos NA, Quiroga-Garza A, Elizondo-Omaña RE, Guzman-Lopez S. Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 231:107815. [PMID: 37301004 DOI: 10.1016/j.clineuro.2023.107815] [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: 03/07/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The morbidity and mortality of intracranial aneurysm rupture motivate the risk evaluation of the patient´s characteristics and aneurysm's morphology. Brain vessel variants lead to hemodynamic changes that could increase risk. This study aims to evaluate the fetal posterior cerebral artery (fPCA) as a risk factor for the formation, rupture, and recurrence of the posterior communicating artery (PComA) aneurysm. METHODS A search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE databases for studies that evaluated the risk of appearance, rupture, and recurrence of PComA aneurysms with the presence of fPCA. Newcastle-Ottawa Scale and AXIS were used for quality assessment. The primary and secondary outcomes were evaluated and interpreted with an odds ratio (OR) and their 95% confidence intervals (CI). RESULTS A total of 577 articles were reviewed. Thirteen studies were included for the qualitative analysis, and ten studies for the meta-analysis. All cohort studies were classified as poor quality, and all cross-sectional studies with moderate risk. The unadjusted OR resulted in 1.57 (n = 6, 95% CI 1.13-2.19, p = <0.001, I2 =0%) between the presence of fPCA and PComA aneurysm rupture. CONCLUSION There is a significant association of aneurysm formation and rupture of PComA aneurysms in the presence of fPCA. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall.
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Affiliation(s)
| | | | - Humberto de León-Gutiérrez
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico.
| | | | - Neri Alejandro Alvarez-Villalobos
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, KER Unit, México, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, United States.
| | - Alejandro Quiroga-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano del Seguro Social, Delegación Nuevo Leon, Monterrey, Mexico.
| | | | - Santos Guzman-Lopez
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, Mexico.
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Han J, Chen J, Tong X, Han M, Peng F, Niu H, Liu L, Liu F, Liu A. Morphological characteristics associated with ruptured intracranial vertebral artery dissecting aneurysms. J Neurointerv Surg 2023; 15:321-324. [PMID: 35387859 DOI: 10.1136/neurintsurg-2022-018744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Morphological risk factors for the rupture of intracranial vertebral artery dissecting aneurysms (IVADAs) have not been well characterized. In this study, we aim to identify morphological characteristics associated with IVADA rupture. METHODS We conducted a retrospective study of 249 consecutive patients with single IVADAs (31 ruptured and 218 unruptured) admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Various morphological parameters were measured using three-dimensional digital subtraction angiography images. Univariate and multivariate logistic regression analyses were performed to identify morphological characteristics associated with IVADA rupture. RESULTS Univariate regression analysis revealed that the coexistence of significant proximal and distal stenosis and posterior inferior cerebellar artery (PICA) involvement were associated with IVADA rupture, while the origin from the dominant vertebral artery was inversely associated with the rupture. Multivariate regression analysis demonstrated that the coexistence of significant proximal and distal stenosis (OR 22.00, 95% CI 5.60 to 86.70, p<0.001) and PICA involvement (OR 4.55, 95% CI 1.36 to 15.20, p=0.014) were independently associated with IVADA rupture. CONCLUSION The coexistence of significant proximal and distal stenosis and PICA involvement were independently associated with IVADA rupture. These morphological characteristics may facilitate the assessment of rupture risk in patients with IVADAs.
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Affiliation(s)
- Jiangli Han
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jigang Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fei Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fei Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China .,Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Aihua Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China .,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Centre for Neurological Diseases, Beijing, China
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6
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Lu Y, Leng X, Zou R, Chen Q, Li W, Zhou X, Tan S, Huang X, Ding C, Gong F, Xiang J, Wang Y. Non-contrast enhanced silent MR angiography to evaluate hemodynamics and morphology of unruptured intracranial aneurysms: a comparative computational fluid dynamics study. J Neurointerv Surg 2022:jnis-2022-018901. [PMID: 35882551 DOI: 10.1136/jnis-2022-018901] [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: 03/06/2022] [Accepted: 07/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Silent MR angiography (silent MRA) is a new generation of non-contrast enhanced angiography with outstanding advantages in visualizing cerebrovascular lesions and the follow-up after endovascular treatment for intracranial aneurysms (IAs). This study aims to investigate the reliability of silent MRA-based three-dimensional (3D) geometric description and hemodynamic calculation of IAs. METHODS 19 patients with 23 unruptured IAs, who underwent both silent MRA and 3D rotational angiography (3DRA), were included in this study. Computational fluid dynamics simulations were performed on all patient-specific 3D reconstruction images to compare the morphology and hemodynamics of the two different imaging models for IAs. RESULTS Silent MRA models had smaller maximum and perpendicular height (mm), aneurysmal surface area (mm2), and aneurysmal volume (mm3) than 3DRA (p<0.05); the differences of the above parameters between the two models were 9.0±6.2%, 7.7±7.4%, 15.9±13.0%, and 21.4±17.5%, respectively. However, correlation analysis of morphological parameters in various dimensions and model comparison showed good overall consistency in geometrical characteristics between the two models. Moderate coherence was observed between models in time-averaged wall shear stress of aneurysm and parent vessel (TAWSS, PAWSS), aneurysm velocity (AV), parent vessel velocity, and oscillatory shear index (OSI). However, strong correlations were observed among normalized aneurysm wall shear stress (NWSS), low shear area (LSA), inflow concentration index (ICI), and normalized aneurysm velocity (NAV). CONCLUSION Both morphological and hemodynamic assessments of IAs for silent MRA are comparable to 3DRA. Additionally, normalized indicators such as NWSS, LSA, ICI, and NAV were better than TAWSS, AV, and OSI in silent MRA-related hemodynamic evaluation.
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Affiliation(s)
- Yuzhao Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Rong Zou
- ArteryFlow Technology Co Ltd, Hangzhou, Zhejiang, China
| | - Qi Chen
- ArteryFlow Technology Co Ltd, Hangzhou, Zhejiang, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Song Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaofei Huang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cong Ding
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Feixiang Gong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Yang Wang
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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7
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Axier A, Rexiati N, Wang Z, Cheng X, Su R, Aikeremu R, Aisha M. Effect of hemodynamic changes on the risk of intracranial aneurysm rupture: a systematic review and meta-analysis. Am J Transl Res 2022; 14:4638-4647. [PMID: 35958447 PMCID: PMC9360874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE In this study, the hemodynamic parameters of ruptured intracranial aneurysms (IAs) in various studies were summarized and analyzed to provide predictive parameters for IA rupture in clinical work. METHODS We searched PubMed, Web of science, Embase, and Cochrane databases for articles published before December 2021 to collect data on hemodynamic parameters associated with IA rupture. Differences in wall shear stress (WSS), oscillatory shear index (OSI), and low wall shear stress area (LSA) between ruptured and unruptured IAs in the literature were summarized and analyzed, and the standardized mean difference (SMD) of 95% CI was calculated by Review Manager 5.3. RESULTS By searching and screening the literature, this meta-analysis included 17 studies comprising 1,373 IA patients. In the ruptured aneurysm group, the level of WSS decreased significantly, while OSI and LSA increased obviously. CONCLUSION Low WSS, high OSI, and high LSA are closely related to the rupture of IAs, indicating the role of WSS, OSI, and LSA as important hemodynamic parameters for predicting the rupture of IAs in clinical work.
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Affiliation(s)
- Aximujiang Axier
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Nizamidingjiang Rexiati
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Zengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Xiaojiang Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Riqing Su
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Rexidan Aikeremu
- Department of Medical Record Management, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Maimaitili Aisha
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
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8
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Zhong P, Lu Z, Li T, Lan Q, Liu J, Wang Z, Chen S, Huang Q. Association Between Regular Blood Pressure Monitoring and the Risk of Intracranial Aneurysm Rupture: a Multicenter Retrospective Study with Propensity Score Matching. Transl Stroke Res 2022; 13:983-994. [PMID: 35314955 DOI: 10.1007/s12975-022-01006-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Although hypertension is a known risk factor for intracranial aneurysm rupture, the benefit of the management of blood pressure in reducing the rupture risk of intracranial aneurysms remains largely unknown, especially for regular blood pressure monitoring. We conducted a retrospective analysis of a prospectively maintained database of 3965 patients with saccular intracranial aneurysms from 20 medical centers in China. The patients were divided into the non-hypertensive group and hypertensive group. Propensity score matching was applied to identify a cohort of patients with similar baseline characteristics. Univariable and multivariable logistic regression analyses were performed to determine the association between intracranial aneurysm rupture and the management of blood pressure. After matching, hypertension was significantly associated with an increased rupture risk of intracranial aneurysms (OR = 2.559, 95%CI = 2.161-3.030, P = 0.000). For the management of blood pressure, controlled hypertension (OR = 1.803, 95%CI = 1.409-2.307, P = 0.000), uncontrolled hypertension (OR = 2.178, 95%CI = 1.756-2.700, P = 0.000), and hypertension without regular blood pressure monitoring (OR = 5.000, 95%CI = 3.823-6.540, P = 0.000) were all significantly associated with a higher rupture risk compared with the absence of hypertension. Moreover, hypertension without regular blood pressure monitoring was associated with a higher rupture risk compared with either controlled hypertension (OR = 3.807, 95%CI = 2.687-5.395, P = 0.000) or hypertension with regular blood pressure monitoring (including controlled and uncontrolled hypertension) (OR = 2.893, 95%CI = 2.319-3.609, P = 0.000). The absence of regular blood pressure monitoring was significantly associated with an increased risk of intracranial aneurysm rupture, emphasizing the importance of implementation of regular blood pressure monitoring in hypertensive patients with intracranial aneurysms.
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Affiliation(s)
- Ping Zhong
- BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiwen Lu
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China
| | - Tianxiao Li
- Neurovascular Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qing Lan
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, the First Affiliated Hospital of Xiamen University, Xiamen, China.,Department of Neuroscience, Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, China
| | - Sifang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No. 55 Zhenhai Road, Xiamen, 361003, Fujian, China.
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, 200433, China.
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9
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Chen X, Li H, Wang MZ, Li MG, Cao Y, Zhang D, Zhang Y, Wang H, Wang S. Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution. Chin Neurosurg J 2020; 6:23. [PMID: 32922952 PMCID: PMC7398228 DOI: 10.1186/s41016-020-00200-6] [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: 03/14/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to retrospectively analyze our experience with the patients who underwent surgical treatment of posterior communicating artery (PComA) aneurysms originating from fetal posterior cerebral artery (fPCA) and analyze the risk factors for the postoperative radiological infarction and outcome. Methods From 2011 to 2020, we retrospectively reviewed 74 PComA aneurysms originating from fPCA in terms of the clinical and radiological features and obtained the follow-up data from the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. The relationships between these features and follow-up data were assessed with the univariate and multivariate analysis. Results In this series, 74 aneurysms were occurring at the origin of fPCAs. All the patients showed complete obliteration of their aneurysms. Full fPCA type tends to be a predictive factor for radiological infarction (univariate χ2 = 5.873, P = 0.027; multivariate OR = 0.264, P = 0.060). Postoperative radiological infarction (univariate χ2 = 12.611, P = 0.001; multivariate OR = 6.033, P = 0.043), rupture (univariate χ2 = 4.514, P = 0.047; multivariate OR = 57.966, P = 0.044), and hypertension (univariate χ2 = 5.301, P = 0.024; multivariate OR = 24.462, P = 0.029) tend to be the independent predictive factors for poor prognosis at 3 months after discharge. Conclusions In conclusion, we report a series of patients harboring aneurysms originating from the fPCA. Surgical clipping is a reliable strategy. Full fPCA type is related to postsurgical infarction. Postoperative radiological infarction, rupture, and hypertension tend to be the independent predictive factor for poor prognosis at 3 months after discharge.
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Affiliation(s)
- Xin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Ming-Ze Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Mao-Gui Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070 China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100070 China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100070 China
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10
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Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, Choque-Velasquez J, Niemelä M, Hernesniemi J. Are Fetal-Type Posterior Cerebral Arteries Associated With an Increased Risk of Posterior Communicating Artery Aneurysms? Neurosurgery 2020; 84:1306-1312. [PMID: 29788502 DOI: 10.1093/neuros/nyy186] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fetal-type posterior cerebral arteries (F-PCAs) might result in alterations in hemodynamic flow patterns and may predispose an individual to an increased risk of posterior communicating artery aneurysms (PCoAAs). OBJECTIVE To determine the association between PCoAAs and the presence of ipsilateral F-PCAs. METHODS We retrospectively reviewed the radiographic findings from 185 patients harboring 199 PCoAAs that were treated at our institution between 2005 and 2015. Our study population consisted of 4 cohorts: (A) patients with 171 internal carotid arteries (ICAs) harboring unilateral PCoAAs; (B) 171 unaffected ICAs in the same patients from the first group; (C) 28 ICAs of 14 patients with bilateral PCoAAs; and (D) 180 ICAs of 90 patients with aneurysms in other locations. We then determined the presence of ipsilateral F-PCAs and recorded all aneurysm characteristics. RESULTS Group A had the highest prevalence of F-PCAs (42%) compared to 19% in group B, 3% in group C, and 14% in group D (odds ratio A : B = 3.041; A : C = 19.626; and A : D = 4.308; P < .001). PCoAAs were associated with larger diameters of the posterior communicating arteries (median value 1.05 vs 0.86 mm; P = .001). The presence of F-PCAs was associated with larger sizes of the aneurysm necks (median value 3.3 vs 3.0 mm; P = .02). CONCLUSION PCoAAs were associated with a higher prevalence of ipsilateral F-PCAs. This variant was associated with larger sizes of the aneurysm necks but was not associated with the sizes of the aneurysm domes or with their rupture statuses.
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Affiliation(s)
- Peeraphong Thiarawat
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,De-partment of Surgery, Naresuan University, Phitsanulok, Thailand
| | | | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Paediatric Neurology and Neurosurgery, North-western State Medical University, St. Petersburg, Russia
| | - Patcharin Intarakhao
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Anesthesiology, Naresuan University, Phitsanulok, Thailand
| | - Mario K Teo
- Bristol Institute of Clinical Neurosciences, North Bristol University Hospital, Bristol, United Kingdom
| | | | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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11
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Choi HH, Cho YD, Yoo DH, Lee HS, Kim SH, Jang D, Lee SH, Cho WS, Kang HS, Kim JE. Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case-control study. J Neurointerv Surg 2020; 12:783-787. [PMID: 31915206 DOI: 10.1136/neurintsurg-2019-015531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/26/2019] [Accepted: 12/29/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND It is well known that hemodynamic stress may impact the recanalization of coiled aneurysms. One of the most common sites for aneurysms to develop is the posterior communicating artery (PcoA), the variants of which are defined by diameter ratios (PcoA/P1 segment). OBJECTIVE This study was undertaken to investigate the impact of a fetal-type posterior cerebral artery (PCA) on recanalization of PcoA aneurysms after coil embolization based on matched-pair (fetal vs non-fetal PCA) analysis. METHODS A total of 480 consecutive PcoA aneurysms (PCA: fetal, n=156; non-fetal, n=324) subjected to coil embolization between January 2007 and June 2017 were selected for study. All lesions were followed for ≥6 months via radiologic imaging, grouped by adjacent PCAs as fetal (PcoA/P1 >1) or non-fetal (PcoA/P1 ≤1) type. Paired subjects were matched (1:1) for several relevant variables. RESULTS Of the 480 coiled aneurysms, 159 (33.1%) showed recanalization (minor, 76; major, 83) in the course of follow-up (mean 33.8±21.9 months), developing significantly more often in fetal (37.8%) than in non-fetal (26.9%; p=0.020) PCA types. Once matched, however, 6-month and cumulative recanalization rates did not differ significantly by group (p=0.531 and p=0.568, respectively). Complications (hemorrhage, p=0.97; thromboembolism, p=0.94) during endovascular coil embolization also showed similar rates in these groups. CONCLUSIONS The chances of recanalization after coil embolization seem to be greater in PcoA aneurysms than in intracranial aneurysms overall, thus calling for careful follow-up monitoring. Surprisingly, PcoA type appeared unrelated in this regard.
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Affiliation(s)
- Hyun Ho Choi
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heui Seung Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Donghwan Jang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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12
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Machine Learning Models can Detect Aneurysm Rupture and Identify Clinical Features Associated with Rupture. World Neurosurg 2019; 131:e46-e51. [PMID: 31295616 DOI: 10.1016/j.wneu.2019.06.231] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Machine learning (ML) has been increasingly used in medicine and neurosurgery. We sought to determine whether ML models can distinguish ruptured from unruptured aneurysms and identify features associated with rupture. METHODS We performed a retrospective review of patients with intracranial aneurysms detected on vascular imaging at our institution between 2002 and 2018. The dataset was used to train 3 ML models (random forest, linear support vector machine [SVM], and radial basis function kernel SVM). Relative contributions of individual predictors were derived from the linear SVM model. RESULTS Complete data were available for 845 aneurysms in 615 patients. Ruptured aneurysms (n = 309, 37%) were larger (mean 6.51 mm vs. 5.73 mm; P = 0.02) and more likely to be in the posterior circulation (20% vs. 11%; P < 0.001) than unruptured aneurysms. Area under the receiver operating curve was 0.77 for the linear SVM, 0.78 for the radial basis function kernel SVM models, and 0.81 for the random forest model. Aneurysm location and size were the 2 features that contributed most significantly to the model. Posterior communicating artery, anterior communicating artery, and posterior inferior cerebellar artery locations were most highly associated with rupture, whereas paraclinoid and middle cerebral artery locations had the strongest association with unruptured status. CONCLUSIONS ML models are capable of accurately distinguishing ruptured from unruptured aneurysms and identifying features associated with rupture. Consistent with prior studies, location and size show the strongest association with aneurysm rupture.
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13
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Berg P, Voß S, Janiga G, Saalfeld S, Bergersen AW, Valen-Sendstad K, Bruening J, Goubergrits L, Spuler A, Chiu TL, Tsang ACO, Copelli G, Csippa B, Paál G, Závodszky G, Detmer FJ, Chung BJ, Cebral JR, Fujimura S, Takao H, Karmonik C, Elias S, Cancelliere NM, Najafi M, Steinman DA, Pereira VM, Piskin S, Finol EA, Pravdivtseva M, Velvaluri P, Rajabzadeh-Oghaz H, Paliwal N, Meng H, Seshadhri S, Venguru S, Shojima M, Sindeev S, Frolov S, Qian Y, Wu YA, Carlson KD, Kallmes DF, Dragomir-Daescu D, Beuing O. Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH)-phase II: rupture risk assessment. Int J Comput Assist Radiol Surg 2019; 14:1795-1804. [PMID: 31054128 DOI: 10.1007/s11548-019-01986-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Assessing the rupture probability of intracranial aneurysms (IAs) remains challenging. Therefore, hemodynamic simulations are increasingly applied toward supporting physicians during treatment planning. However, due to several assumptions, the clinical acceptance of these methods remains limited. METHODS To provide an overview of state-of-the-art blood flow simulation capabilities, the Multiple Aneurysms AnaTomy CHallenge 2018 (MATCH) was conducted. Seventeen research groups from all over the world performed segmentations and hemodynamic simulations to identify the ruptured aneurysm in a patient harboring five IAs. Although simulation setups revealed good similarity, clear differences exist with respect to the analysis of aneurysm shape and blood flow results. Most groups (12/71%) included morphological and hemodynamic parameters in their analysis, with aspect ratio and wall shear stress as the most popular candidates, respectively. RESULTS The majority of groups (7/41%) selected the largest aneurysm as being the ruptured one. Four (24%) of the participating groups were able to correctly select the ruptured aneurysm, while three groups (18%) ranked the ruptured aneurysm as the second most probable. Successful selections were based on the integration of clinically relevant information such as the aneurysm site, as well as advanced rupture probability models considering multiple parameters. Additionally, flow characteristics such as the quantification of inflow jets and the identification of multiple vortices led to correct predictions. CONCLUSIONS MATCH compares state-of-the-art image-based blood flow simulation approaches to assess the rupture risk of IAs. Furthermore, this challenge highlights the importance of multivariate analyses by combining clinically relevant metadata with advanced morphological and hemodynamic quantification.
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Affiliation(s)
| | - Samuel Voß
- University of Magdeburg, Magdeburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Csippa
- Budapest University of Technology and Economics, Budapest, Hungary
| | - György Paál
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Gábor Závodszky
- Budapest University of Technology and Economics, Budapest, Hungary
| | | | | | | | | | | | | | - Saba Elias
- Houston Methodist Research Institute, Houston, TX, USA
| | | | | | | | | | - Senol Piskin
- The University of Texas at San Antonio, San Antonio, TX, USA
| | - Ender A Finol
- The University of Texas at San Antonio, San Antonio, TX, USA
| | | | | | | | | | - Hui Meng
- State University of New York, Buffalo, NY, USA
| | | | | | | | | | | | - Yi Qian
- Macquarie University, Sydney, Australia
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14
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Shimano K, Serigano S, Ikeda N, Yuchi T, Shiratori S, Nagano H. Understanding of boundary conditions imposed at multiple outlets in computational haemodynamic analysis of cerebral aneurysm. ACTA ACUST UNITED AC 2019. [DOI: 10.17106/jbr.33.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kenjiro Shimano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Shota Serigano
- Graduate School of Integrative Science and Engineering, Tokyo City University
| | - Naoki Ikeda
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Tomoki Yuchi
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Suguru Shiratori
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
| | - Hideaki Nagano
- Department of Mechanical Systems Engineering, Faculty of Engineering, Tokyo City University
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15
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Detmer FJ, Chung BJ, Jimenez C, Hamzei-Sichani F, Kallmes D, Putman C, Cebral JR. Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology 2018; 61:275-284. [PMID: 30456458 DOI: 10.1007/s00234-018-2135-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The mechanisms of cerebral aneurysm rupture are not fully understood. We analyzed the associations of hemodynamics, morphology, and patient age and gender with aneurysm rupture stratifying by location. METHODS Using image-based models, 20 hemodynamic and 17 morphological parameters were compared in 1931 ruptured and unruptured aneurysms with univariate logistic regression. Rupture rates were compared between males and females as well as younger and older patients and bifurcation versus sidewall aneurysms for different aneurysm locations. Subsequently, associations between hemodynamics and morphology and patient as well as aneurysm characteristics were analyzed for aneurysms at five locations. RESULTS Compared to unruptured aneurysms, ruptured aneurysms were characterized by a more irregular shape and were exposed to a more adverse hemodynamic environment described by faster flow, higher wall shear stress, more oscillatory shear, and more unstable and complex flows. These associations with rupture status were consistent for different aneurysm locations. Rupture rates were significantly higher in males at the internal carotid artery (ICA) bifurcation, ophthalmic ICA, and the middle cerebral artery (MCA) bifurcation. At the anterior communicating artery (ACOM) and MCA bifurcation, they were significantly higher for younger patients. Bifurcation aneurysms had significantly larger rupture rates at the MCA and posterior communicating artery (PCOM). In these groups with higher rupture rates, aneurysms were characterized by adverse hemodynamics and more complex shapes. CONCLUSION Hemodynamic and morphological differences between ruptured and unruptured aneurysms are consistent across locations. Adverse morphology and hemodynamics are related to rupture as well as younger age, male gender, and bifurcation aneurysms.
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Affiliation(s)
- Felicitas J Detmer
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Bong Jae Chung
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Carlos Jimenez
- Neurosurgery Department, University of Antioquia, Medellin, Colombia
| | - Farid Hamzei-Sichani
- Department of Neurological Surgery, University of Massachusetts, Worcester, MA, USA
| | - David Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Christopher Putman
- Interventional Neuroradiology Unit, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Juan R Cebral
- Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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16
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Xu L, Liang F, Zhao B, Wan J, Liu H. Influence of aging-induced flow waveform variation on hemodynamics in aneurysms present at the internal carotid artery: A computational model-based study. Comput Biol Med 2018; 101:51-60. [PMID: 30099239 DOI: 10.1016/j.compbiomed.2018.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/03/2018] [Accepted: 08/04/2018] [Indexed: 01/10/2023]
Abstract
The variation of blood flow waveform in the internal carotid artery (ICA) with age is a well-documented hemodynamic phenomenon, but little is known about how such variation affects the characteristics of blood flow in aneurysms present in the region. In the study, hemodynamic simulations were conducted for 26 ICA aneurysms, with flow waveforms measured in the ICAs of young and older adults being used respectively to set the inflow boundary conditions. Obtained results showed that replacing the young-adult flow waveform with the older-adult one led to little changes (<10%) in simulated time-averaged wall shear stress (WSS), transient maximum WSS, relative residence time and trans-aneurysm pressure loss coefficient, but resulted in a marked increase (32.36 ± 17.24%) in oscillatory shear index (OSI). Frequency-domain wave analysis revealed that the progressive enhancement of low-frequency harmonics dominated the observed flow waveform variation with age and was a major factor contributing to the increase in OSI. Cross-sectional comparisons among the aneurysms further revealed that the degree of increase in OSI correlated positively with some specific morphological features of aneurysm, such as aspect ratio and size ratio. In summary, the study demonstrates that the variation in flow waveform with age augments the oscillation of WSS in ICA aneurysms, which underlies the importance of setting patient-specific boundary conditions in hemodynamic studies on cerebral aneurysms, especially those involving long-term patient follow-up or cross-sectional comparison among patients of different ages.
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Affiliation(s)
- Lijian Xu
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China; Collaborative Innovation Center for Advanced Ship and Deep-Sea Exploration (CISSE), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China; Collaborative Innovation Center for Advanced Ship and Deep-Sea Exploration (CISSE), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China; Sechenov University, Moscow, 119991, Russia.
| | - Bing Zhao
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jieqing Wan
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Hao Liu
- Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba-shi, Chiba, 2638522, Japan
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17
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Development of a statistical model for discrimination of rupture status in posterior communicating artery aneurysms. Acta Neurochir (Wien) 2018; 160:1643-1652. [PMID: 29922867 DOI: 10.1007/s00701-018-3595-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intracranial aneurysms at the posterior communicating artery (PCOM) are known to have high rupture rates compared to other locations. We developed and internally validated a statistical model discriminating between ruptured and unruptured PCOM aneurysms based on hemodynamic and geometric parameters, angio-architectures, and patient age with the objective of its future use for aneurysm risk assessment. METHODS A total of 289 PCOM aneurysms in 272 patients modeled with image-based computational fluid dynamics (CFD) were used to construct statistical models using logistic group lasso regression. These models were evaluated with respect to discrimination power and goodness of fit using tenfold nested cross-validation and a split-sample approach to mimic external validation. RESULTS The final model retained maximum and minimum wall shear stress (WSS), mean parent artery WSS, maximum and minimum oscillatory shear index, shear concentration index, and aneurysm peak flow velocity, along with aneurysm height and width, bulge location, non-sphericity index, mean Gaussian curvature, angio-architecture type, and patient age. The corresponding area under the curve (AUC) was 0.8359. When omitting data from each of the three largest contributing hospitals in turn, and applying the corresponding model on the left-out data, the AUCs were 0.7507, 0.7081, and 0.5842, respectively. CONCLUSIONS Statistical models based on a combination of patient age, angio-architecture, hemodynamics, and geometric characteristics can discriminate between ruptured and unruptured PCOM aneurysms with an AUC of 84%. It is important to include data from different hospitals to create models of aneurysm rupture that are valid across hospital populations.
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18
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Morphometry and hemodynamics of posterior communicating artery aneurysms: Ruptured versus unruptured. J Biomech 2018; 76:35-44. [DOI: 10.1016/j.jbiomech.2018.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 01/12/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022]
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