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Yang H, Ni W, Xu L, Geng J, He X, Ba H, Yu J, Qin L, Yin Y, Huang Y, Zhang H, Gu Y. Computer-assisted microcatheter shaping for intracranial aneurysm embolization: evaluation of safety and efficacy in a multicenter randomized controlled trial. J Neurointerv Surg 2024; 16:177-182. [PMID: 37080769 DOI: 10.1136/jnis-2023-020104] [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: 01/29/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND This study aimed to evaluate the efficacy, stability, and safety of computer-assisted microcatheter shaping (CAMS) in patients with intracranial aneurysms. METHODS A total of 201 patients with intracranial aneurysms receiving endovascular coiling therapy were continuously recruited and randomly assigned to the CAMS and manual microcatheter shaping (MMS) groups. The investigated outcomes included the first-trial success rate, time to position the microcatheter in aneurysms, rate of successful microcatheter placement within 5 min, delivery times, microcatheter stability, and delivery performance. RESULTS The rates of first-trial success (96.0% vs 66.0%, P<0.001), successful microcatheter placement within 5 min (96.04% vs 72.00%, P<0.001), microcatheter stability (97.03% vs 84.00%, P=0.002), and 'excellent' delivery performance (45.54% vs 24.00%, P<0.001) in the CAMS group were significantly higher than those in the MMS group. Additionally, the total microcatheter delivery and positioning time (1.05 minutes (0.26) vs 1.53 minutes (1.00)) was significantly shorter in the CAMS group than in the MMS group (P<0.001). Computer assistance (OR 14.464; 95% CI 4.733 to 44.207; P<0.001) and inflow angle (OR 1.014; 95% CI 1.002 to 1.025; P=0.021) were independent predictors of the first-trial success rate. CAMS could decrease the time of microcatheter position compared with MMS, whether for junior or senior surgeons (P<0.001). Moreover, computer assistance technology may be more helpful in treating aneurysms with acute angles (p<0.001). CONCLUSIONS The use of computer-assisted procedures can enhance the efficacy, stability, and safety of surgical plans for coiling intracranial aneurysms.
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Affiliation(s)
- Heng Yang
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China
| | - Wei Ni
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China
| | - Liquan Xu
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China
| | - Jiewen Geng
- China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuying He
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huajun Ba
- Department of Neurosurgery, The Central Hospital of Wenzhou City, Wenzhou, People's Republic of China
| | - Jianjun Yu
- Department of Neurosurgery, Linyi People's Hospital, Linyi, People's Republic of China
| | - Lan Qin
- Department of R&D, UnionStrong (Beijing) Technology Co.Ltd, Beijing, People's Republic of China
| | - Yin Yin
- Department of R&D, UnionStrong (Beijing) Technology Co.Ltd, Beijing, People's Republic of China
| | - Yufei Huang
- Department of R&D, UnionStrong (Beijing) Technology Co.Ltd, Beijing, People's Republic of China
| | - Hongqi Zhang
- China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuxiang Gu
- Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, People's Republic of China
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Duan J, Zhao Q, He Z, Tang S, Duan J, Xing W. Current understanding of macrophages in intracranial aneurysm: relevant etiological manifestations, signaling modulation and therapeutic strategies. Front Immunol 2024; 14:1320098. [PMID: 38259443 PMCID: PMC10800944 DOI: 10.3389/fimmu.2023.1320098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Macrophages activation and inflammatory response play crucial roles in intracranial aneurysm (IA) formation and progression. The outcome of ruptured IA is considerably poor, and the mechanisms that trigger IA progression and rupture remain to be clarified, thereby developing effective therapy to prevent subarachnoid hemorrhage (SAH) become difficult. Recently, climbing evidences have been expanding our understanding of the macrophages relevant IA pathogenesis, such as immune cells population, inflammatory activation, intra-/inter-cellular signaling transductions and drug administration responses. Crosstalk between macrophages disorder, inflammation and cellular signaling transduction aggravates the devastating consequences of IA. Illustrating the pros and cons mechanisms of macrophages in IA progression are expected to achieve more efficient treatment interventions. In this review, we summarized the current advanced knowledge of macrophages activation, infiltration, polarization and inflammatory responses in IA occurrence and development, as well as the most relevant NF-κB, signal transducer and activator of transcription 1 (STAT1) and Toll-Like Receptor 4 (TLR4) regulatory signaling modulation. The understanding of macrophages regulatory mechanisms is important for IA patients' clinical outcomes. Gaining insight into the macrophages regulation potentially contributes to more precise IA interventions and will also greatly facilitate the development of novel medical therapy.
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Affiliation(s)
- Jian Duan
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Qijie Zhao
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zeyuan He
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Shuang Tang
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Jia Duan
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Wenli Xing
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
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Habibi MA, Fakhfouri A, Mirjani MS, Razavi A, Mortezaei A, Soleimani Y, Lotfi S, Arabi S, Heidaresfahani L, Sadeghi S, Minaee P, Eazi S, Rashidi F, Shafizadeh M, Majidi S. Prediction of cerebral aneurysm rupture risk by machine learning algorithms: a systematic review and meta-analysis of 18,670 participants. Neurosurg Rev 2024; 47:34. [PMID: 38183490 DOI: 10.1007/s10143-023-02271-2] [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: 11/15/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/08/2024]
Abstract
It is possible to identify unruptured intracranial aneurysms (UIA) using machine learning (ML) algorithms, which can be a life-saving strategy, especially in high-risk populations. To better understand the importance and effectiveness of ML algorithms in practice, a systematic review and meta-analysis were conducted to predict cerebral aneurysm rupture risk. PubMed, Scopus, Web of Science, and Embase were searched without restrictions until March 20, 2023. Eligibility criteria included studies that used ML approaches in patients with cerebral aneurysms confirmed by DSA, CTA, or MRI. Out of 35 studies included, 33 were cohort, and 11 used digital subtraction angiography (DSA) as their reference imaging modality. Middle cerebral artery (MCA) and anterior cerebral artery (ACA) were the commonest locations of aneurysmal vascular involvement-51% and 40%, respectively. The aneurysm morphology was saccular in 48% of studies. Ten of 37 studies (27%) used deep learning techniques such as CNNs and ANNs. Meta-analysis was performed on 17 studies: sensitivity of 0.83 (95% confidence interval (CI), 0.77-0.88); specificity of 0.83 (95% CI, 0.75-0.88); positive DLR of 4.81 (95% CI, 3.29-7.02) and the negative DLR of 0.20 (95% CI, 0.14-0.29); a diagnostic score of 3.17 (95% CI, 2.55-3.78); odds ratio of 23.69 (95% CI, 12.75-44.01). ML algorithms can effectively predict the risk of rupture in cerebral aneurysms with good levels of accuracy, sensitivity, and specificity. However, further research is needed to enhance their diagnostic performance in predicting the rupture status of IA.
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Affiliation(s)
- Mohammad Amin Habibi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Amirata Fakhfouri
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Mohammad Sina Mirjani
- Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Alireza Razavi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Mortezaei
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Yasna Soleimani
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Sohrab Lotfi
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Shayan Arabi
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Ladan Heidaresfahani
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Poriya Minaee
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - SeyedMohammad Eazi
- School of Medicine, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Farhang Rashidi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Kliś KM, Wójtowicz D, Kwinta BM, Stachura K, Popiela TJ, Frączek MJ, Łasocha B, Gąsowski J, Milczarek O, Krzyżewski RM. Association of Arterial Tortuosity with Hemodynamic Parameters-A Computational Fluid Dynamics Study. World Neurosurg 2023; 180:e69-e76. [PMID: 37544598 DOI: 10.1016/j.wneu.2023.07.152] [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: 07/23/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. METHODS We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1-3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). RESULTS We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = -0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = -0.333; P < 0.01), TAWSSG (R = -0.473 P < 0.01), OSI (R = -0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = -0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = -0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01). CONCLUSIONS Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs.
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Affiliation(s)
- Kornelia M Kliś
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
| | - Dominika Wójtowicz
- Anaesthesiology and Intensive Care Clinical Department, University Hospital of Krakow, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej J Frączek
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Olga Milczarek
- Department of Children's Neurosurgery, Jagiellonian University Medical College, Faculty of Medicine, Institute of Pediatrics, Kraków, Poland
| | - Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
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Khan A, Khunte M, Wu X, Bajaj S, Payabvash S, Wintermark M, Matouk C, Seidenwurm DJ, Gandhi D, Parizel P, Mezrich J, Malhotra A. Malpractice Litigation Related to Diagnosis and Treatment of Intracranial Aneurysms. AJNR Am J Neuroradiol 2023; 44:460-466. [PMID: 36997286 PMCID: PMC10084911 DOI: 10.3174/ajnr.a7828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND PURPOSE Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes. MATERIALS AND METHODS We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm. RESULTS Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively). CONCLUSIONS Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- A Khan
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Khunte
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - X Wu
- Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California
| | - S Bajaj
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - S Payabvash
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - M Wintermark
- Department of Radiology (M.W.), MD Anderson Cancer Center, Houston, Texas
| | - C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
- Neurosurgery (C.M.), Yale School of Medicine, New Haven, Connecticut
| | - D J Seidenwurm
- Department of Neuroradiology (D.J.S.), Sutter Health, Sacramento, California
| | - D Gandhi
- Departments of Interventional Neuroradiology, Radiology, and Nuclear Medicine (D.G.)
- Neurology (D.G.)
- Neurosurgery (D.G.), University of Maryland School of Medicine, Baltimore, Maryland
| | - P Parizel
- Department of Radiology (P.P.), University of Western Australia, Perth, Australia
| | - J Mezrich
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
| | - A Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.)
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Tian Z, Li W, Feng X, Sun K, Duan C. Prediction and analysis of periprocedural complications associated with endovascular treatment for unruptured intracranial aneurysms using machine learning. Front Neurol 2022; 13:1027557. [PMID: 36313499 PMCID: PMC9596813 DOI: 10.3389/fneur.2022.1027557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background The management of unruptured intracranial aneurysm (UIA) remains controversial. Recently, machine learning has been widely applied in the field of medicine. This study developed predictive models using machine learning to investigate periprocedural complications associated with endovascular procedures for UIA. Methods We enrolled patients with solitary UIA who underwent endovascular procedures. Periprocedural complications were defined as neurological adverse events resulting from endovascular procedures. We incorporated three machine learning algorithms into our prediction models: artificial neural networks (ANN), random forest (RF), and logistic regression (LR). The Shapley Additive Explanations (SHAP) approach and feature importance analysis were used to identify and prioritize significant features associated with periprocedural complications. Results In total, 443 patients were included. Forty-eight (10.83%) procedure-related complications occurred. In the testing set, the ANN model produced the largest value (0.761) for area under the curve (AUC). The RF model also achieved an acceptable AUC value of 0.735, while the AUC value of the LR model was 0.668. SHAP and feature importance analysis identified distal aneurysm, aneurysm size and treatment modality as most significant features for the prediction of periprocedural complications following endovascular treatment for UIA. Conclusion Periprocedural complications after endovascular treatment for UIA are not negligible. Prediction of periprocedural complications via machine learning is feasible and effective. Machine learning can serve as a promising tool in the decision-making process for UIA treatment.
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Affiliation(s)
- Zhongbin Tian
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Feng
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Kaijian Sun
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chuanzhi Duan
- National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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