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Sturiale CL, Auricchio AM, Skrap B, Stifano V, Albanese A. The clinical challenge of subarachnoid hemorrhage associated with multiple aneurysms when the bleeding source is not certainly identifiable. J Neurosurg Sci 2024; 68:301-309. [PMID: 34763396 DOI: 10.23736/s0390-5616.21.05609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiple intracranial aneurysms (IAs) are encountered in 20-30% of the subarachnoid hemorrhages (SAH). Neuroimaging and clinical examination are usually sufficient to detect the bleeding source, but sometimes it can be misdiagnosed with catastrophic consequences. METHODS We reviewed our diagnostic work-up for all patients admitted from January 2016 to December 2020 for SAH with multiple IAs accounting for our rate of diagnostic failure. Then, we grouped the patients into 4 categories according to aneurysms topography and described our operative protocol in case of uncertain bleeding origin. RESULTS Sixty-two patients harboring 161 IAs were included. The bleeding source was identified in 56 patients (90.3%), who harbored other 81 bystander aneurysms. In 6 cases (9.7%) with a total of 24 aneurysms we failed the bleeding source identification. According to IAs topography, we grouped the IAs multiplicity in: 1) anterior plus posterior circulation IAs; 2) multiple posterior circulation IAs; 3) bilateral anterior circulation IAs; and 4) multiple ipsilateral anterior circulation IAs. In case of unidentified bleeding source, key-elements favoring the simultaneous multiple IAs treatment were their number, morphology, topography, clinicians' experience, and management modality as endovascular treatment allows a faster exclusion of multiple IAs distant one each other compared with surgery. MCA involvement represented the more frequent reason to prefer multiple clipping rather than multiple coiling. CONCLUSIONS In a small percentage of patients with SAH with multiple IAs, bleeding source identification can be difficult. Until the routinely availability of new tools such as vessel wall imaging or computational fluid dynamics, an experienced neurovascular team and strategies aiming to simultaneously exclude multiple IAs remain mandatory.
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Affiliation(s)
- Carmelo L Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Anna M Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benjamin Skrap
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Li P, Liu Y, Zhou J, Tu S, Zhao B, Wan J, Yang Y, Xu L. A deep-learning method for the end-to-end prediction of intracranial aneurysm rupture risk. PATTERNS (NEW YORK, N.Y.) 2023; 4:100709. [PMID: 37123440 PMCID: PMC10140611 DOI: 10.1016/j.patter.2023.100709] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/09/2022] [Accepted: 02/22/2023] [Indexed: 05/02/2023]
Abstract
It is critical to accurately predict the rupture risk of an intracranial aneurysm (IA) for timely and appropriate treatment because the fatality rate after rupture is 50 % . Existing methods relying on morphological features (e.g., height-width ratio) measured manually by neuroradiologists are labor intensive and have limited use for risk assessment. Therefore, we propose an end-to-end deep-learning method, called TransIAR net, to automatically learn the morphological features from 3D computed tomography angiography (CTA) data and accurately predict the status of IA rupture. We devise a multiscale 3D convolutional neural network (CNN) to extract the structural patterns of the IA and its neighborhood with a dual branch of shared network structures. Moreover, we learn the spatial dependence within the IA neighborhood with a transformer encoder. Our experiments demonstrated that the features learned by TransIAR are more effective and robust than handcrafted features, resulting in a 10 % - 15 % improvement in the accuracy of rupture status prediction.
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Affiliation(s)
- Peiying Li
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yongchang Liu
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Shikui Tu
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Corresponding author
| | - 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
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Corresponding author
| | - Lei Xu
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Guangdong Institute of Intelligence Science and Technology, Zhuhai, Guangdong 519031, China
- Corresponding author
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3
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Kim JH, Choi JI, Lim DJ. Radiologic assessment of rupture risk in small (<5 mm) posterior communicating artery aneurysms. Medicine (Baltimore) 2022; 101:e28696. [PMID: 35089225 PMCID: PMC8797568 DOI: 10.1097/md.0000000000028696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023] Open
Abstract
Although previous studies have investigated the predictors of posterior communicating artery (PCoA) aneurysm rupture with clinical and radiologic parameters, the accessibility of "small PCoA aneurysms (<5 mm)" has rarely been reported. Here, we designed a study to identify the factors which are thought to be risky and prone to rupture in small PCoA aneurysms (<5 mm).A total of 114 patients diagnosed with PCoA aneurysm under 5 mm in size on digital subtraction angiography were retrospectively enrolled and divided into ruptured (n = 51) and unruptured (n = 63) groups. Clinical variables were reviewed, and 10 radiologic parameters were obtained, including maximum diameter, height, width, neck width, aspect ratio, dome-to-neck ratio, bleb formation, size ratio, presence of fetal-type PCoA, and inflow angle. Statistical analyses were conducted to compare the groups (ruptured vs unruptured) and identify the risk factors for rupture.High rupture rate of small PCoA aneurysm is noted (51/114, 44.7%). In the comparison analysis, parameters of size ratio (P = .045), aspect ratio (P = .001), and bleb formation (P = .015) were significantly different between the 2 groups. In the regression model, the aspect ratio (P = .045) and bleb formation (P = .004) were significantly associated with the rupture of aneurysm.In respect of small (<5 mm) PCoA aneurysms of our cohort, morphologic parameters of "bleb formation" and "a high aspect ratio" are present more often in ruptured aneurysms as compared to unruptured aneurysms.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
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4
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Wu X, Duan Z, Liu Y, Zhou C, Jiao Z, Zhao Y, Tang T. Incidental Unruptured Intracranial Aneurysms Do Not Impact Outcome in Patients With Acute Cerebral Infarction. Front Neurol 2021; 12:613027. [PMID: 33981282 PMCID: PMC8107683 DOI: 10.3389/fneur.2021.613027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background: This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes. Methods: The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0–2 points) and poor outcome (mRS score of 3–6 points). Results: UIAs were found in 260 (6.5%) of 4,033 patients with ACI; 2,543 (63.1%) had a good outcome, and 1,490 (36.9%) had a poor outcome. There was no difference in outcomes between the two groups (P = 0.785). The multivariable analysis showed that age (OR = 1.009, 95%CI: 1.003–1.014, P = 0.003), diabetes (OR = 1.179, 95%CI: 1.035–1.342, P = 0.013), ischemic stroke history (OR = 1.451, 95%CI: 1.256–1.677, P < 0.001), and baseline NIHSS score (OR = 1.034, 95%CI: 1.018–1.050, P < 0.001) were independently associated with the 90-day outcomes in patients with ACI. The presence of incidental UIA was not associated with outcomes after ACI. Conclusions: Age, diabetes, ischemic stroke history, and baseline NIHSS score were independently associated with the early outcomes of patients with ACI.
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Affiliation(s)
- Xuan Wu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Zuowei Duan
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yihui Liu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Changwu Zhou
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Zhiyun Jiao
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yi Zhao
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Tieyu Tang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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5
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Feng X, Tong X, Peng F, Niu H, Qi P, Lu J, Zhao Y, Jin W, Wu Z, Zhao Y, Liu A, Wang D. Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study. Stroke Vasc Neurol 2021; 6:433-440. [PMID: 33547231 PMCID: PMC8485246 DOI: 10.1136/svn-2020-000480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/11/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022] Open
Abstract
Background and purpose Approximately 15%–45% of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms (MIAs). Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients. This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients. Methods A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets. Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set. The discriminative accuracy, calibration performance and clinical usefulness of this nomogram were assessed. We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage (SAH) patients and compared its performance with the nomogram model. Results Multivariate analyses identified seven variables that were significantly associated with IA rupture (history of SAH, alcohol consumption, female sex, aspect ratio >1.5, posterior circulation, irregular shape and bifurcation location). The clinical and morphological-based MIAs (CMB-MIAs) nomogram model showed good calibration and discrimination (derivation set: area under the curve (AUC)=0.740 validation set: AUC=0.772). Decision curve analysis demonstrated that the nomogram was clinically useful. Compared with the nomogram model, the AUC of multivariate model developed from SAH patients had lower value of 0.730. Conclusions This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort. This nomogram could be used in decision-making and risk stratification in MIAs patients.
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Affiliation(s)
- Xin Feng
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Xin Tong
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Fei Peng
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Hao Niu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China.,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Peng Qi
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Jun Lu
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
| | - Yang Zhao
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Weitao Jin
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Zhongxue Wu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China
| | - Yuanli Zhao
- Neurosurgery Department, Peking University International Hospital, Beijing, China
| | - Aihua Liu
- Neurointervention Center, Beijing Neurosurgical Institute, Beijing, China .,Neurointervention Center, Beijing Tiantan Hospital, Beijing, China
| | - Daming Wang
- Neurosurgery Department, Beijing Hospital, Beijing, Beijing, China
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6
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Lee WJ, Kim MK, Lim YC. Clinical analysis of young adult patients with ruptured intracranial aneurysms: a single-center study of 113 consecutive patients. J Cerebrovasc Endovasc Neurosurg 2020; 22:127-133. [PMID: 32971571 PMCID: PMC7522388 DOI: 10.7461/jcen.2020.22.3.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Intracranial aneurysm most frequently occurs in old aged patients; however, aneurysmal subarachnoid hemorrhage (SAH) has been occasionally reported in young adults. This study aimed to compare patients with intracranial aneurysms younger than 40 years with those ≥40 years and investigates the characteristics of their ruptured aneurysm. METHODS We retrospectively collected the data of 389 patients (103 patients aged 20 to 39 years; 286 patients aged above 40 years) who were treated for ruptured cerebral aneurysms between January 2008 and December 2018 at our institution. RESULTS The young adult patients were more often men and were smokers as compared to controls (63.1% vs. 39.2%, 40.5% vs. 36.0%, respectively). The young adult patients showed a tendency for lower Hunt and Hess grade, modified Fisher grade, less postoperative morbidity, and better clinical outcome. Aneurysm ruptures occurred most frequently in the anterior cerebral artery in both groups, but aneurysms ruptures in the internal carotid artery and posterior circulation was infrequent among young adult patients. The aneurysms in young adult patients were more often elongated or irregularly shaped (82.5% vs. 64.0%, respectively) and were significantly smaller (5.9 mm) than that in controls (6.8 mm). CONCLUSIONS Ruptured aneurysms of young adult patients have unique characteristics with regard to its preponderance in male smoker, elongated or irregular shape and relatively smaller size.
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Affiliation(s)
- Won Jae Lee
- Department of Neurosurgery, Ajou School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Mi Kyung Kim
- Department of Neurosurgery, Ajou School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou School of Medicine, Ajou University Hospital, Suwon, Korea
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7
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Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:1353-1362. [PMID: 32215742 DOI: 10.1007/s00701-020-04291-z] [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: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is wide variation in the reported size of ruptured intracranial aneurysms and methods of size estimation. There is widespread belief that small aneurysms < 7 mm do not rupture. Therefore, we performed a systematic review and meta-analysis of the literature to determine the size of ruptured aneurysms according to aneurysm locations and methods of size estimation. METHODS We searched PubMed, Cochrane, CINAHL, and EMBASE databases using a combination of Medical Subject Headings (MeSH) terms. We included articles that reported mean aneurysm size in consecutive series of ruptured intracranial. We excluded studies limited to a specific aneurysm location or type. The random-effects model was used to calculate overall mean size and location-specific mean size. We performed meta-regression to explain observed heterogeneity and variation in reported size. RESULTS The systematic review included 36 studies and 12,609 ruptured intracranial aneurysms. Overall mean aneurysm size was 7.0 mm (95% confidence interval [CI 6.2-7.4]). Pooled mean size varied with location. Overall mean size of 2145 ruptured anterior circulation aneurysms was 6.0 mm (95% CI 5.6-6.4, residual I2 = 86%). Overall mean size of 743 ruptured posterior circulation aneurysms was 6.2 mm (95% CI 5.3-7.0, residual I2 = 93%). Meta-regression identified aneurysm location and definition of size (i.e., maximum dimension vs. aneurysm height) as significant determinants of aneurysm size reported in the studies. CONCLUSIONS The mean size of ruptured aneurysms in most studies was approximately 7 mm. The general wisdom that aneurysms of this size do not rupture is incorrect. Location and size definition were significant determinants of aneurysm size.
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8
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Ahmad S. Epidemiology of intracranial aneurysms in Pakistani population. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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9
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Zheng J, Xu R, Guo Z, Sun X. Small ruptured intracranial aneurysms: the risk of massive bleeding and rebleeding. Neurol Res 2019; 41:312-318. [PMID: 30638157 DOI: 10.1080/01616412.2018.1563737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The risk of hemorrhagic events in small ruptured aneurysms remains unclear. Due to less arterial wall, small ruptured aneurysms may be correlated with massive bleeding and rebleeding. Therefore, it may contribute to treatment to evaluate the amount of bleeding and the risk of rebleeding in small ruptured aneurysms. METHODS A retrospective cohort study of all consecutive patients with intracranial aneurysms admitted to our hospital from February 2013 to December 2017 was carried out. Ruptured aneurysms were divided into small ruptured aneurysm (0-5 mm) group and large ruptured aneurysm (5 mm) group for analysis. The difference of bleeding volume, rebleeding and clinical outcome were analyzed between the two groups. RESULTS A total of 738 patients with aneurysmal subarachnoid hemorrhage (SAH) were included in this study and small ruptured aneurysms accounted for 49.2% of all ruptured aneurysms. Univariate analysis showed that the amount of bleeding (14.5 ± 7.1 vs. 14.4 ± 7.3; P = 0.867), rebleeding (8.3% vs. 10.9%; P = 0.261) and poor outcome (29.6% vs. 23.1%; P = 0.055) were similar between the two groups. Multivariable analysis showed that hypertension was obviously associated with the amount of bleeding (adjusted odds ratio (aOR), 3.25 [1.81-4.69]; P < 0.001) and rebleeding (aOR, 3.31 [1.10-9.99]; P = 0.034) in small ruptured aneurysms, and its effect on rebleeding of small ruptured aneurysms is greater than that of large ruptured aneurysms. CONCLUSIONS The risk of hemorrhagic events in small ruptured aneurysms is similar to that in large ruptured aneurysms, especially those patients with small ruptured aneurysms that complicated with hypertension are at an increased risk of massive SAH and rebleeding.
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Affiliation(s)
- Jianfeng Zheng
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Rui Xu
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zongduo Guo
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Xiaochuan Sun
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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10
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Zheng Y, Zhou B, Wang X, Chen H, Fang X, Jiang P, Yang H, He C, Yang G, Song Y, An Q, Leng B. Size, Aspect Ratio and Anatomic Location of Ruptured Intracranial Aneurysms: Consecutive Series of 415 Patients from a Prospective, Multicenter, Observational Study. Cell Transplant 2018; 28:739-746. [PMID: 30514102 PMCID: PMC6686434 DOI: 10.1177/0963689718817227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
To analyze the size and location distribution of ruptured intracranial aneurysms (IAs) helps to provide evidence for clinical treatment of unruptured IAs using this feature of aneurysms. In this study, 415 patients who presented with an acute subarachnoid hemorrhage caused by IAs were enrolled from eight tertiary referral centers between June 2016 and March 2018. The size, aspect ratio and anatomic location of ruptured IAs were defined and reported by patient sex. In the study cohort of 415 patients (60.5% women) with saccular ruptured IAs, the three most common locations of ruptured IAs were posterior communicating artery (32.0%), anterior communicating artery (28.7%), and middle cerebral artery (13.5%). The mean size of all ruptured IAs was 5.3±3.1 mm (range 1.1-28.5 mm), but the size varied considerably by location. For example, ruptured IAs of the posterior communicating artery had a mean size of 5.8±3.1 mm, whereas the mean size of ruptured anterior communicating artery aneurysms was 4.6±1.7 mm. The mean AR in all ruptured IAs was 1.66±0.76. Of those aneurysms, 243 (58.6%) had an AR smaller than 1.6 and 318 (76.6%) had an AR smaller than 2.0. Our results suggested that the size of the most ruptured IAs are smaller than 7 mm or even 5 mm. The size and AR varied by sex and location. With the knowledge of size, location and AR, multiplicity should be considered for treatment strategies of unruptured IAs.
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Affiliation(s)
- Y Zheng
- 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - B Zhou
- 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Wang
- 2 Department of Neurosurgery, Puning People's Hospital, China
| | - H Chen
- 3 Department of Neurosurgery, Nanjing First Hospital, China
| | - X Fang
- 4 Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - P Jiang
- 5 Department of Neurosurgery, Laizhou City People's Hospital, China
| | - H Yang
- 6 Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - C He
- 7 Department of Neurosurgery, The first affiliated hospital of Chongqing medical college, Chongqing, China
| | - G Yang
- 8 Department of Neurosurgery, Wuhan Hanyang Hospital, China
| | - Y Song
- 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Q An
- 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - B Leng
- 1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Herzberg M, Forbrig R, Schichor C, Brückmann H, Dorn F. Preoperative Digital Subtraction Angiography in Incidental Unruptured Intracranial Aneurysms. Clin Neuroradiol 2018; 28:429-435. [DOI: 10.1007/s00062-018-0689-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
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12
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ACR Appropriateness Criteria ® Cerebrovascular Disease. J Am Coll Radiol 2018; 14:S34-S61. [PMID: 28473091 DOI: 10.1016/j.jacr.2017.01.051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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13
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Rahmanian A, Ghaffarpasand F, Alibai E, Choque-Velasquez J, Jahromi BR, Hernesniemi J. Surgical Outcome of Very Small Intracranial Aneurysms Utilizing the Double Clip Technique. World Neurosurg 2017; 110:e605-e611. [PMID: 29162525 DOI: 10.1016/j.wneu.2017.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To report the outcome of patients with very small intracranial aneurysm (VSIA) undergoing surgical clipping using a double-clip technique. METHODS This cross-sectional study was conducted in Namazi Hospital, the main referral neurovascular center in Southern Iran during a 6-year period from September 2010 to March 2016. All patients with VSIAs (≤3 mm) undergoing surgery with double-clip technique were included. This technique reduces the clip slippage. The short- and long-term outcomes determined by Glasgow outcome score (GOS), modified Rankin Scale (MRS), and complications. RESULTS Operations were performed on 32 VSIAs in 26 patients with a mean ± SD age of 55.7 ± 10.1 years. Middle cerebral artery was the most common location for VSIA (50.0%). There was no neck remnant, and the complete occlusion rate was 100%. The rate of intraoperative aneurysm rupture was 30.8%, and none of the patients experienced rebleeding. The 6-month mortality rate was 0% in ruptured VSIAs and 6.25% in unruptured VSIAs. Most of the patients had favorable outcomes (88.5%), and the overall mortality rate was 11.5%. The rate of permanent neurologic deficit was 10.0% in ruptured and 12.5% in unruptured VSIAs. Multivariate logistic regression analysis revealed no association between baseline and clinical characteristics and outcome in this series. CONCLUSION VSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.
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Affiliation(s)
| | | | - Ehsanali Alibai
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Joham Choque-Velasquez
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Björkman J, Frösen J, Tähtinen O, Backes D, Huttunen T, Harju J, Huttunen J, Kurki MI, von Und Zu Fraunberg M, Koivisto T, Manninen H, Jääskeläinen JE, Lindgren AE. Irregular Shape Identifies Ruptured Intracranial Aneurysm in Subarachnoid Hemorrhage Patients With Multiple Aneurysms. Stroke 2017; 48:1986-1989. [PMID: 28468927 DOI: 10.1161/strokeaha.117.017147] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated which aneurysm-related risk factors for rupture best discriminate ruptured versus unruptured saccular intracranial aneurysms (sIAs) in subarachnoid hemorrhage patients with multiple sIAs. METHODS We included 264 subarachnoid hemorrhage patients with a ruptured sIA and at least one additional unruptured sIA, from the Kuopio Intracranial Aneurysm database from 2003 to 2015. These patients had 268 ruptured and 445 unruptured sIAs. Angiograms of the 713 sIAs were reevaluated for multiple variables describing aneurysm shape. Multivariate generalized linear mixed models were used to calculate odds ratios with corresponding 95% confidence intervals for the independent risk factors for aneurysm rupture. RESULTS In the multivariate analysis, only sIA size (P<0.004) and irregular shape (P<0.000) independently associated with sIA rupture. As an independent risk factor, irregular shape showed the strongest association with rupture (odds ratio 90.3; 95% confidence interval, 47.0-173.5). The sIA location, flow angles, bottleneck factor, or aspect ratio were not significantly associated with rupture. CONCLUSIONS Irregular shape may identify the ruptured sIA better than size in patients presenting with aSAH and multiple sIAs.
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Affiliation(s)
- Joel Björkman
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Juhana Frösen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Olli Tähtinen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Daan Backes
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Terhi Huttunen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Jaakko Harju
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Jukka Huttunen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Mitja I Kurki
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Mikael von Und Zu Fraunberg
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Timo Koivisto
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Hannu Manninen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Juha E Jääskeläinen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Antti E Lindgren
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.).
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Swartbooi A, Meyer C, De Vries C. Digital subtraction angiography findings and population demographics of patients with subarachnoidal haemorrhage and subsequent causative aneurysms at Universitas Academic Hospital, Bloemfontein. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Subarachnoid haemorrhage (SAH) secondary to aneurysmal rupture may be associated with serious neurological sequelae or even mortality. According to international literature, only aneurysms >7 mm or aneurysms in the posterior circulation require treatment. Retrospective single-centre studies have, however, disputed this after demonstrating that the average size of ruptured aneurysms are <7 mm. More recent guidelines place less emphasis on size and more on associated risk factors.Objectives: The aim of this investigation was to assess the aneurysm characteristics and demographics of patients who presented to our institution with SAH secondary to an aneurysm detected at digital subtraction angiography (DSA).Method: A retrospective descriptive study was conducted. Patients who presented with SAH over a 6-year period, from 2008 to 2013, were included. The average size of the intracranial aneurysms at the time of rupture was analysed. Data about aneurysm characteristics and patient demographics were obtained from patient files. Data were analysed by the researchers with assistance from the Department of Biostatistics.Results: In total, 161 of 374 patients who underwent DSA had ruptured aneurysms. Most patients were women with ages ranging from 18 to 73 years (mean 45 years). The mean size of aneurysms were 5.8 mm (range 1.2 mm – 20 mm), with 74.5% of aneurysms <7 mm. Most aneurysms were noted involving the anterior circulation (72%), with the majority arising from the anterior communicating artery (36.7%).Conclusion: We found that aneurysms rupture at sizes <7 mm and are commonly located in the anterior circulation. Our findings emphasise the importance of conducting institutional reviews to consider adapting international treatment guidelines for the local South African situation.
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Abstract
Rupture of an intracranial aneurysm is the most common cause of subarachnoid haemorrhage (SAH), which is a life-threatening acute cerebrovascular event that typically affects working-age people. The exact prevalence of unruptured intracranial aneurysms (UIAs) is unknown, but at least one in 20 to 30 adults is likely to carry an asymptomatic UIA. Approximately one quarter of these UIAs rupture in a lifetime. Complex methodological challenges in conducting studies of epidemiology and risk factors for UIAs and SAH might have led to conclusions being drawn on the basis of epidemiological data of variable quality. We believe that, as a result, misconceptions about UIAs and SAH may have arisen. In this Perspectives article, we discuss three possible misconceptions about the epidemiology of UIAs and SAH, and suggest how the quality of future research could be improved.
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Affiliation(s)
- Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. BOX 266, FI-00029 HUS, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, P.O. BOX 41, FI-00014 Helsinki, Finland
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17
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Jaja BNR, Lingsma H, Steyerberg EW, Schweizer TA, Thorpe KE, Macdonald RL. Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort. J Neurosurg 2015; 124:1703-11. [PMID: 26495952 DOI: 10.3171/2015.4.jns142753] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. METHODS The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R(2). RESULTS Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each of the studied predictors accounted for less than 1% of the explained variance in outcome. CONCLUSIONS This study, which is based on the largest cohort of patients so far analyzed, has more precisely determined the prognostic value of the studied neuroimaging factors. Treatment choice has strong influence on the prognostic effect of aneurysm size and location. These findings should guide the development of reliable prognostic models and inform the design and analysis of future prospective studies, including clinical trials.
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Affiliation(s)
- Blessing N R Jaja
- Division of Neurosurgery and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital;,Institute of Medical Science
| | - Hester Lingsma
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands
| | - Tom A Schweizer
- Division of Neurosurgery and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital;,Institute of Medical Science
| | - Kevin E Thorpe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital;,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
| | - R Loch Macdonald
- Division of Neurosurgery and.,Li Ka Shing Knowledge Institute, St. Michael's Hospital;,Institute of Medical Science
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18
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Aracki-Trenkić A, Stojanov D, Ristić S, Radovanović Z, Ignjatović J, Lazović L, Petrović S, Trenkić M, Trenkic-Božinović M. DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE ANGIOGRAPHY FOR UNRUPTURED CEREBRAL ANEURYSMS IN CORRELATION WITH DIGITAL SUBTRACTION ANGIOGRAPHY. ACTA MEDICA MEDIANAE 2015. [DOI: 10.5633/amm.2015.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Jiang H, Shen J, Weng YX, Pan JW, Yu JB, Wan ZA, Zhan R. Morphology Parameters for Mirror Posterior Communicating Artery Aneurysm Rupture Risk Assessment. Neurol Med Chir (Tokyo) 2015; 55:498-504. [PMID: 26041624 PMCID: PMC4628202 DOI: 10.2176/nmc.oa.2014-0390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent studies have shown that posterior communicating artery (PComA) aneurysms are more likely to rupture. However, surgical intervention for PComA aneurysms may be associated with increased treatment-related morbidity rate. Therefore, it is meaningful to investigate the factors related to PComA aneurysm rupture. The purpose of this study was to identify morphological parameters that significantly correlate with PComA aneurysm rupture. We divided 14 pairs of mirror posterior communicating artery aneurysms (PComA-MANs) into ruptured and unruptured groups. Computed tomography angiography (CTA) imaging was evaluated with three-dimensional (3D) Slicer to generate models of the aneurysms and surrounding vasculature. Nine morphological parameters [size, height, width, neck width, aspect ratio (AR), bottleneck factor (BNF), height/width ratio (H/W), size ratio (SR), and bleb formation] were examined in the two groups for significance with respect to rupture. By contrast, statistically significant differences were found in ruptured and unruptured group for size, AR, BNF, SR, and bleb formation (P < 0.05). Parameters that had no significant differences between the two groups were height (P = 0.103), width (P = 0.078), neck width (P = 0.808), and H/W (P = 0.417). We conclude that MANs may be a useful model for the morphological analysis of intracranial aneurysm rupture. Larger size, higher AR, BNF, SR, and bleb formation may be related to rupture of PComA aneurysms. Larger sample studies minimizing the interference from patient-related factors and aneurysm type were expected for acquiring more accurate assessment of the relationship between these parameters and PComA aneurysm rupture.
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Affiliation(s)
- Hao Jiang
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University
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20
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Influence of morphology and hemodynamic factors on rupture of multiple intracranial aneurysms: matched-pairs of ruptured-unruptured aneurysms located unilaterally on the anterior circulation. BMC Neurol 2014; 14:253. [PMID: 25551809 PMCID: PMC4301794 DOI: 10.1186/s12883-014-0253-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The authors evaluated the impact of morphological and hemodynamic factors on the rupture of matched-pairs of ruptured-unruptured intracranial aneurysms on one patient's ipsilateral anterior circulation with 3D reconstruction model and computational fluid dynamic method simulation. METHODS 20 patients with intracranial aneurysms pairs on the same-side of anterior circulation but with different rupture status were retrospectively collected. Each pair was divided into ruptured-unruptured group. Patient-specific models based on their 3D-DSA images were constructed and analyzed. The relative locations, morphologic and hemodynamic factors of these two groups were compared. RESULTS There was no significant difference in the relative bleeding location. The morphological factors analysis found that the ruptured aneurysms more often had irregular shape and had significantly higher maximum height and aspect ratio. The hemodynamic factors analysis found lower minimum wall shear stress (WSSmin) and more low-wall shear stress-area (LSA) in the ruptured aneurysms than that of the unruptured ones. The ruptured aneurysms more often had WSSmin on the dome. CONCLUSIONS Intracranial aneurysms pairs with different rupture status on unilateral side of anterior circulation may be a good disease model to investigate possible characteristics linked to rupture independent of patient characteristics. Irregular shape, larger size, higher aspect ratio, lower WSSmin and more LSA may indicate a higher risk for their rupture.
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21
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Štepán-Buksakowska IL, Accurso JM, Diehn FE, Huston J, Kaufmann TJ, Luetmer PH, Wood CP, Yang X, Blezek DJ, Carter R, Hagen C, Hořínek D, Hejčl A, Roček M, Erickson BJ. Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting. AJNR Am J Neuroradiol 2014; 35:1897-902. [PMID: 24924543 DOI: 10.3174/ajnr.a3996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. MATERIALS AND METHODS Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. RESULTS For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. CONCLUSIONS In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm.
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Affiliation(s)
- I L Štepán-Buksakowska
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.) International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - J M Accurso
- Department of Radiology (J.M.A.), Mayo Clinic, Jacksonville, Florida
| | - F E Diehn
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - J Huston
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - T J Kaufmann
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - P H Luetmer
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - C P Wood
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - X Yang
- Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - D J Blezek
- Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - R Carter
- Division of Biomedical Statistics and Informatics (R.C., C.H.)
| | - C Hagen
- Division of Biomedical Statistics and Informatics (R.C., C.H.)
| | - D Hořínek
- International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic Department of Neurosurgery (D.H.), Central Military Hospital, Prague, Czech Republic
| | - A Hejčl
- International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - M Roček
- Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - B J Erickson
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
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