1
|
Rilianto B, Prasetyo BT, Kurniawan RG, Gotama KT, Windiani PR, Arham A, Kusdiansah M. Clinical and Morphological Factors for Ruptured Anterior Communicating Artery Aneurysms. Vasc Health Risk Manag 2023; 19:371-377. [PMID: 37408543 PMCID: PMC10319283 DOI: 10.2147/vhrm.s415213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction The anterior communicating artery (ACoA) aneurysm, the most frequent cerebral aneurysm to rupture, carries a significant clinical burden, yet the factors influencing its rupture are limited in Indonesia. This study aims to determine the clinical and morphological features associated with ruptured ACoA compared to non-AcoA aneurysms among Indonesians. Patients and Methods We retrospectively reviewed our center's aneurysm patient registry from January 2019 to December 2022, and compared the clinical and morphological features between ruptured ACoA aneurysms and ruptured aneurysms elsewhere with univariate and multivariate analyses. Results Of the 292 patients with 325 ruptured aneurysms, 89 were from ACoA. The mean age of patients was 54.99 years, with female preponderance in the non-ACoA group (non-ACoA: 73.31%, ACoA: 46.07%). On univariate analysis, ages ≥60 [ages 60-69: OR = 0.311 (0.111-0.869), p=0.026; ages ≥70: OR = 0.215 (0.056-0.819), p=0.024], female gender [OR = 0.311 (0.182-0.533), p<0.001], and smoking [OR=2.069 (1.036-4.057), p=0.022] exhibited significant association with ruptured ACoA aneurysm. On multivariate analysis, only the female gender was independently associated with ruptured ACoA aneurysm (aOR 0.355 [0.436-1.961], p=0.001). Conclusion In our study, ruptured ACoA aneurysm was inversely associated with advanced age, female gender, presence of daughter aneurysm, and directly associated with smoking. After multivariate adjustment, the female gender showed an independent association with ruptured ACoA aneurysm.
Collapse
Affiliation(s)
- Beny Rilianto
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bambang Tri Prasetyo
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ricky Gusanto Kurniawan
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Kelvin Theandro Gotama
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Pratiwi Raissa Windiani
- Neurointervention Division, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Abrar Arham
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Neurosurgery Department, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Neurosurgery Department, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, East Jakarta, Indonesia
| |
Collapse
|
2
|
Sunderland K, Jia W, He W, Jiang J, Zhao F. Impact of spatial and temporal stability of flow vortices on vascular endothelial cells. Biomech Model Mechanobiol 2023; 22:71-83. [PMID: 36271263 PMCID: PMC9975038 DOI: 10.1007/s10237-022-01632-y] [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: 01/20/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Intracranial aneurysms (IAs) are pathological dilations of cerebrovascular vessels due to degeneration of the mechanical strength of the arterial wall, precluded by altered cellular functionality. The presence of swirling hemodynamic flow (vortices) is known to alter vascular endothelial cell (EC) morphology and protein expression indicative of IAs. Unfortunately, less is known if vortices with varied spatial and temporal stability lead to differing levels of EC change. The aim of this work is to investigate vortices of varying spatial and temporal stability impact on ECs. METHODS Vortex and EC interplay was investigated by a novel combination of parallel plate flow chamber (PPFC) design and computational analysis. ECs were exposed to laminar (7.5 dynes/[Formula: see text] wall shear stress) or low (<1 dynes/[Formula: see text]) stress vortical flow using PPFCs. Immunofluorescent imaging analyzed EC morphology, while ELISA tests quantified VE-cadherin (cell-cell adhesion), VCAM-1 (macrophage-EC adhesion), and cleaved caspase-3 (apoptotic signal) expression. PPFC flow was simulated, and vortex stability was calculated via the temporally averaged degree of (volume) overlap (TA-DVO) of vortices within a given area. RESULTS EC morphological changes were independent of vortex stability. Increased stability promoted VE-cadherin degradation (correlation coefficient r = [Formula: see text]0.84) and 5-fold increased cleaved caspase-3 post 24 h in stable (TA-DVO 0.736 ± 0.05) vs unstable (TA-DVO 0.606 [Formula: see text]0.2) vortices. ECs in stable vortices displayed a 4.5-fold VCAM-1 increase than unstable counterparts after 12 h. CONCLUSION This work demonstrates highly stable disturbed flow imparts increased inflammatory signaling, degraded cell-cell adhesion, and increased cellular apoptosis than unstable vortices. Such knowledge offers novel insight toward understanding IA development and rupture.
Collapse
Affiliation(s)
- Kevin Sunderland
- Biomedical Engineering, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA
| | - Wenkai Jia
- Biomedical Engineering, Texas A &M University, 400 Bizzell St, College Station, TX, 77843, USA
| | - Weilue He
- Biomedical Engineering, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA
| | - Jingfeng Jiang
- Biomedical Engineering, Michigan Technological University, 1400 Townsend Drive, Houghton, MI, 49931, USA.
| | - Feng Zhao
- Biomedical Engineering, Texas A &M University, 400 Bizzell St, College Station, TX, 77843, USA.
| |
Collapse
|
3
|
Dinger TF, Peschke J, Chihi M, Gümüs M, Said M, Santos AN, Rodemerk J, Michel A, Darkwah Oppong M, Li Y, Deuschl C, Wrede KH, Dammann PR, Frank B, Kleinschnitz C, Forsting M, Sure U, Jabbarli R. Small intracranial aneurysms of the anterior circulation: A negligible risk? Eur J Neurol 2023; 30:389-398. [PMID: 36333955 DOI: 10.1111/ene.15625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE According to the International Study of Unruptured Intracranial Aneurysms, small (<7 mm) unruptured intracranial aneurysms (IAs) of the anterior circulation (aC) carry a neglectable 5-year rupture risk. In contrast, some studies report frequencies of >20% of all ruptured IAs being small IAs of the aC. This contradiction was addressed in this study by analyzing the rates and risk factors for rupture of small IAs within the aC. METHODS Of the institutional observational cohort, 1676 small IAs of the aC were included. Different demographic, clinical, laboratory, and radiographic characteristics were collected. A rupture risk score was established using all independent prognostic factors. The score performance was checked using receiver operating characteristic curve analysis. RESULTS Of all registered small IAs of the aC, 20.1% were ruptured. The developed small IAs of the aC (SIAAC) score (range = -4 to +13 points) contained five major risk factors: IA location and size, arterial hypertension, alcohol abuse, and chronic renal failure. In addition, three putative protective factors were also included in the score: hypothyroidism, dyslipidemia, and peripheral arterial disease. Increasing rates of ruptured IA with increasing SIAAC scores were observed, from 0% (≤-1 points) through >50% (≥8 points) and up to 100% in patients scoring ≥12 points. The SIAAC score achieved excellent discrimination (area under the curveSIAAC = 0.803) and performed better than the PHASES (Population,Hypertension, Age, Size of the aneurysm, Earlier SAH from another aneurysm, Site of aneurysm) score. CONCLUSIONS Small IAs of the aC carry a considerable rupture risk. After external validation, the proposed rupture risk score might provide a basis for better decision-making regarding the treatment of small unruptured IAs of the aC.
Collapse
Affiliation(s)
- Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Jonas Peschke
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Meltem Gümüs
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Maryam Said
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Alejandro Nicolas Santos
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Rodemerk
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Michel
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Yan Li
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten Henning Wrede
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Philipp René Dammann
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, and Center for Translational Neuroscience and Behavioral Science, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Vitošević F, Milošević Medenica S, Kalousek V, Mandić-Rajčević S, Vitošević M, Lepić M, Rotim K, Rasulić L. CLINICAL CHARACTERISTICS AND MORPHOLOGICAL PARAMETERS ASSOCIATED WITH RUPTURE OF ANTERIOR COMMUNICATING ARTERY ANEURYSMS. Acta Clin Croat 2022; 61:284-294. [PMID: 36818935 PMCID: PMC9934047 DOI: 10.20471/acc.2022.61.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/22/2021] [Indexed: 02/10/2023] Open
Abstract
We analyzed aneurysm morphology, demographic and clinical characteristics in patients with anterior communicating artery (ACoA) aneurysms to investigate the risk factors contributing to aneurysm rupture. A total of 219 patients with ACoA aneurysms were admitted to our hospital between January 2016 and December 2020, and morphological and clinical characteristics were analyzed retrospectively in 153 patients (112 ruptured and 41 unruptured). Medical records were reviewed to obtain demographic and clinical data on age, gender, presence of hemorrhage, history of hypertension, diabetes, heart disease, and kidney disease. Morphological parameters examined on 3-dimensional digital subtraction angiography included aneurysm size, neck diameter, aspect ratio, size ratio, bottleneck ratio, height/width ratio, aneurysm angle, (in)flow angle, branching angle, number of aneurysms per patient, shape of the aneurysm, aneurysm wall morphology, variation of the A1 segment, and direction of the aneurysm. Male gender, aspect ratio, height/width ratio, non-spherical and irregular shape were associated with higher odds of rupture, whilst controlled hypertension was associated with lower odds of rupture, when tested using univariate logistic regression model. In multivariate model, controlled hypertension, presence of multiple aneurysms, and larger neck diameter reduced the odds of rupture, while irregular wall morphology increased the risk of rupture. Regulated hypertension represented a significant protective factor from ACoA aneurysm rupture. We found that ACoA aneurysms in male patients and those with greater aspect ratios and height/width ratios, larger aneurysm angles, presence of daughter sacs and irregular and non-spherical shapes were at a higher risk of rupture.
Collapse
Affiliation(s)
- Filip Vitošević
- Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia;,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Milošević Medenica
- Neuroradiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Kalousek
- Department of Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Stefan Mandić-Rajčević
- Institute of Social Medicine and School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mina Vitošević
- Faculty of Medicine, University of Pristina, Kosovska Mitrovica, Serbia
| | - Milan Lepić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;,Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Krešimir Rotim
- Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia;,University of Applied Health Sciences, Zagreb, Croatia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia;,Department of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
5
|
Zhang XH, Zhao XY, Liu LL, Wen L, Wang GX. Identification of ruptured intracranial aneurysms using the aneurysm-specific prediction score in patients with multiple aneurysms with subarachnoid hemorrhages- a Chinese population based external validation study. BMC Neurol 2022; 22:201. [PMID: 35650546 PMCID: PMC9158357 DOI: 10.1186/s12883-022-02727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background For patients with aneurysmal subarachnoid hemorrhages (SAHs) and multiple intracranial aneurysms (MIAs), a simple and fast imaging method that can identify ruptured intracranial aneurysms (RIAs) may have great clinical value. We sought to use the aneurysm-specific prediction score to identify RIAs in patients with MIAs and evaluate the aneurysm-specific prediction score. Methods Between May 2018 and May 2021, 134 patients with 290 MIAs were retrospectively analyzed. All patients had an SAH due to IA rupture. CT angiography (CTA) was used to assess the maximum diameter, shape, and location of IAs to calculate the aneurysm-specific prediction score. Then, the aneurysm-specific prediction score was applied to RIAs in patients with MIAs. Results The IAs with the highest aneurysm-specific prediction scores had not ruptured in 17 (12.7%) of the 134 patients with 290 MIAs. The sensitivity, specificity, false omission rate, diagnostic error rate, and diagnostic accuracy of the aneurysm-specific prediction score were higher than those of the maximum diameter, shape, and location of IAs. Conclusions The present study suggests that the aneurysm-specific prediction score has high diagnostic accuracy in identifying RIAs in patients with MIAs and SAH, but that it needs further evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02727-w.
Collapse
|
6
|
Sunderland K, Jiang J, Zhao F. Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review. J Cell Physiol 2022; 237:278-300. [PMID: 34486114 PMCID: PMC8810685 DOI: 10.1002/jcp.30569] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 01/03/2023]
Abstract
Aneurysms are malformations within the arterial vasculature brought on by the structural breakdown of the microarchitecture of the vessel wall, with aneurysms posing serious health risks in the event of their rupture. Blood flow within vessels is generally laminar with high, unidirectional wall shear stressors that modulate vascular endothelial cell functionality and regulate vascular smooth muscle cells. However, altered vascular geometry induced by bifurcations, significant curvature, stenosis, or clinical interventions can alter the flow, generating low stressor disturbed flow patterns. Disturbed flow is associated with altered cellular morphology, upregulated expression of proteins modulating inflammation, decreased regulation of vascular permeability, degraded extracellular matrix, and heightened cellular apoptosis. The understanding of the effects disturbed flow has on the cellular cascades which initiate aneurysms and promote their subsequent growth can further elucidate the nature of this complex pathology. This review summarizes the current knowledge about the disturbed flow and its relation to aneurysm pathology, the methods used to investigate these relations, as well as how such knowledge has impacted clinical treatment methodologies. This information can contribute to the understanding of the development, growth, and rupture of aneurysms and help develop novel research and aneurysmal treatment techniques.
Collapse
Affiliation(s)
- Kevin Sunderland
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843,Corresponding Authors: Feng Zhao, 101 Bizzell Street, College Station, TX 77843-312, Tel : 979-458-1239, , Jingfeng Jiang, 1400 Townsend Dr., Houghton, MI 49931, Tel: 906-487-1943
| |
Collapse
|
7
|
Sunderland K, Wang M, Pandey AS, Gemmete J, Huang Q, Goudge A, Jiang J. Quantitative analysis of flow vortices: differentiation of unruptured and ruptured medium-sized middle cerebral artery aneurysms. Acta Neurochir (Wien) 2021; 163:2339-2349. [PMID: 33067690 DOI: 10.1007/s00701-020-04616-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgical intervention for unruptured intracranial aneurysms (IAs) carries inherent health risks. The analysis of "patient-specific" IA geometric and computational fluid dynamics (CFD) simulated wall shear stress (WSS) data has been investigated to differentiate IAs at high and low risk of rupture to help clinical decision making. Yet, outcomes vary among studies, suggesting that novel analysis could improve rupture characterization. The authors describe a CFD analytic method to assess spatiotemporal characteristics of swirling flow vortices within IAs to improve characterization. METHODS CFD simulations were performed for 47 subjects harboring one medium-sized (4-10 mm) middle cerebral artery (MCA) aneurysm with available 3D digital subtraction angiography data. Alongside conventional indices, quantified IA flow vortex spatiotemporal characteristics were applied during statistical characterization. Statistical supervised machine learning using a support vector machine (SVM) method was run with cross-validation (100 iterations) to assess flow vortex-based metrics' strength toward rupture characterization. RESULTS Relying solely on vortex indices for statistical characterization underperformed compared with established geometric characteristics (total accuracy of 0.77 vs 0.80) yet showed improvements over wall shear stress models (0.74). However, the application of vortex spatiotemporal characteristics into the combined geometric and wall shear stress parameters augmented model strength for assessing the rupture status of middle cerebral artery aneurysms (0.85). CONCLUSIONS This preliminary study suggests that the spatiotemporal characteristics of flow vortices within MCA aneurysms are of value to improve the differentiation of ruptured aneurysms from unruptured ones.
Collapse
|
8
|
Chen C, Guo X, Chen Y, Zheng K, Zhou J, Wang H, Yang Y, Lin B. Predictors of Poor-Grade Aneurysmal Subarachnoid Hemorrhage Caused by Anterior Communicating Artery Aneurysm. World Neurosurg 2021; 148:e340-e345. [PMID: 33412327 DOI: 10.1016/j.wneu.2020.12.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) are considered to have a poor prognosis. However, the underlying reason for the association between the aneurysmal characteristics and poor-grade aSAH is still unclear. In the present study, we retrospectively evaluated the independent risk factors for patients with anterior communicating artery (ACoA) aneurysms with poor-grade aSAH. METHODS From January 2009 to January 2016, 477 consecutive patients with ruptured ACoA aneurysms were included in the present study. Poor-grade aSAH was defined as a World Federation of Neurosurgical Society grade of IV or V, and good-grade aSAH was defined as a grade of I-III. Univariate and multivariable regression analyses were used to investigate the differences in aneurysm morphology and clinical characteristics between the 2 groups. RESULTS On univariate analysis, older patients (P = 0.038), larger aneurysm size (P = 0.013), larger size ratio (P = 0.007), larger aspect ratio (P = 0.009), positive history of stroke (P = 0.001), and posterior projection aneurysms (P = 0.001) were associated with poor-grade aSAH. Multivariate analyses revealed that older patients (odds ratio [OR], 1.654; 95% confidence interval [CI], 1.004-2.728; P = 0.048), larger size ratio (OR, 1.280; 95% CI, 1.111-1.475; P = 0.001), positive history of stroke (OR, 6.051; 95% CI, 1.712-21.381; P = 0.005), and posterior projection aneurysms (OR, 2.718; 95% CI, 1.607-4.598; P < 0.001) were independently associated with poor-grade aSAH. CONCLUSIONS Poor-grade aSAH was independently associated with older patients, a larger size ratio, a positive history of stroke, and posterior projection aneurysms in patients with a ruptured ACoA aneurysm. These parameters could contribute to screening for patients with the potential for poor-grade aSAH.
Collapse
Affiliation(s)
- Chao Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianzhong Guo
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kuikui Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
9
|
Chen Y, Xing H, Lin B, Zhou J, Ding S, Wan J, Yang Y, Pan Y, Zhao B. Morphological risk model assessing anterior communicating artery aneurysm rupture: Development and validation. Clin Neurol Neurosurg 2020; 197:106158. [PMID: 32836062 DOI: 10.1016/j.clineuro.2020.106158] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prediction of the rupture risk in anterior communicating artery (ACoA) aneurysms remains challenging. We aimed to investigate the association of detailed morphologies with ACoA aneurysm rupture. PATIENT AND METHODS 759 consecutive patients with ACoA aneurysms were identified from December 2007 to January 2016. An independent cohort was collected for validation from March 2017 to October 2019. Morphological parameters of the aneurysms were measured using CT angiography. Univariable and multivariable analyses were used to investigate the association of morphological characteristics with aneurysm rupture. Area under receiver operating characteristic curves (AUC) were used to assess the performance of the model. RESULTS A total of 650 patients with 650 ACoA aneurysms were included for the derivation, and 41 patients with 41 ACoA aneurysms were included for the validation. Aneurysm size, neck size, aspect ratio, size ratio, vessel angle, anterior projection, dominant A1 segment, irregular shape, the presence of a daughter dome, vessel size, and aneurysm angle were risk factors for rupture. The multivariable analysis showed that a larger aneurysm, anterior projection of aneurysms, dominant A1 segment, and irregular aneurysms were associated with aneurysm rupture, whereas larger vessel size was inversely associated with rupture. The morphological risk score showed good discrimination of ruptured and unruptured aneurysms with an AUC of 0.73 in the derivation and an AUC of 0.80 in the validation, and good calibration in both cohorts, signifying a good fit. CONCLUSION The morphological risk model may contribute to evaluating the risk of rupture of ACoA aneurysms.
Collapse
Affiliation(s)
- Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China; Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Haixia Xing
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| |
Collapse
|