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Johnson MD, Palmisciano P, Yamani AS, Hoz SS, Prestigiacomo CJ. A Systematic Review and Meta-Analysis of 3-Dimensional Morphometric Parameters for Cerebral Aneurysms. World Neurosurg 2024; 183:214-226.e5. [PMID: 38160907 DOI: 10.1016/j.wneu.2023.12.131] [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: 10/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Imaging modalities with increased spatial resolution have allowed for more precise quantification of cerebral aneurysm shape in 3-dimensional (3D) space. We conducted a systematic review and meta-analysis to assess the correlation of individual 3D morphometric measures with cerebral aneurysm rupture status. METHODS Two independent reviewers performed a PRISMA (preferred reporting items of systematic reviews and meta-analysis)-guided literature search to identify articles reporting the association between 3D morphometric measures of intracranial aneurysms and rupture status. RESULTS A total of 15,122 articles were identified. After screening, 39 studies were included. We identified 17 3D morphometric measures, with 11 eligible for the meta-analysis. The meta-analysis showed a significant association with rupture status for the following measures: nonsphericity index (standardized mean difference [SMD], 0.66; 95% confidence interval [CI], 0.53-0.79; P < 0.0001; I2 = 55.2%), undulation index (SMD, 0.55; 95% CI, 0.26-0.85; P = 0.0017; I2 = 68.1%), ellipticity index (SMD, 0.53; 95% CI, 0.29-0.77; P = 0.0005; I2 = 70.8%), volume (SMD, 0.18; 95% CI, 0.02-0.35; P = 0.0320; I2 = 82.3%), volume/ostium ratio (SMD, 0.43; 95% CI, 0.16-0.71; P = 0.0075; I2 = 90.4%), elongation (SMD, -0.94; 95% CI, -1.12 to -0.76; P = 0.0005; I2 = 0%), flatness (SMD, -0.87; 95% CI, -1.04 to -0.71; P = 0.0005; I2 = 0%), and sphericity (SMD, -0.62; 95% CI, -1.06 to -0.17; P = 0.0215; I2 = 67.9%). A significant risk of publication bias was estimated for the ellipticity index (P = 0.0360) and volume (P = 0.0030). CONCLUSIONS Based on the results of a meta-analysis containing 39 studies, the nonsphericity index, undulation index, elongation, flatness, and sphericity demonstrated the most consistent correlation with rupture status.
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Affiliation(s)
- Mark D Johnson
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
| | - Paolo Palmisciano
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer S Hoz
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles J Prestigiacomo
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
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Zhu S, Xu X, Zou R, Lu Z, Yan Y, Li S, Wu Y, Cai J, Li L, Xiang J, Huang Q. Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features. Front Neurol 2024; 15:1304270. [PMID: 38390597 PMCID: PMC10882079 DOI: 10.3389/fneur.2024.1304270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
Background and purpose A notable prevalence of subarachnoid hemorrhage is evident among patients with anterior choroidal artery aneurysms in clinical practice. To evaluate the risk of rupture in unruptured anterior choroidal artery aneurysms, we conducted a comprehensive analysis of risk factors and subsequently developed two nomograms. Methods A total of 120 cases of anterior choroidal artery aneurysms (66 unruptured and 54 ruptured) from 4 medical institutions were assessed utilizing computational fluid dynamics (CFD) and digital subtraction angiography (DSA). The training set, consisting of 98 aneurysms from 3 hospitals, was established, with an additional 22 cases from the fourth hospital forming the external validation set. Statistical differences between the two data sets were thoroughly compared. The significance of 9 clinical baseline characteristics, 11 aneurysm morphology parameters, and 4 hemodynamic parameters concerning aneurysm rupture was evaluated within the training set. Candidate selection for constructing the nomogram models involved regression analysis and variance inflation factors. Discrimination, calibration, and clinical utility of the models in both training and validation sets were assessed using area under curves (AUC), calibration plots, and decision curve analysis (DCA). The DeLong test, net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed to compare the effectiveness of classification across models. Results Two nomogram models were ultimately constructed: model 1, incorporating clinical, morphological, and hemodynamic parameters (C + M + H), and model 2, relying primarily on clinical and morphological parameters (C + M). Multivariate analysis identified smoking, size ratio (SR), normalized wall shear stress (NWSS), and average oscillatory shear index (OSIave) as optimal candidates for model development. In the training set, model 1 (C + M + H) achieved an AUC of 0.795 (95% CI: 0.706 ~ 0.884), demonstrating a sensitivity of 95.6% and a specificity of 54.7%. Model 2 (C + M) had an AUC of 0.706 (95% CI: 0.604 ~ 0.808), with corresponding sensitivity and specificity of 82.4 and 50.3%, respectively. Similarly, AUCs for models 1 and 2 in the external validation set were calculated to be 0.709 and 0.674, respectively. Calibration plots illustrated a consistent correlation between model evaluations and real-world observations in both sets. DCA demonstrated that the model incorporating hemodynamic parameters offered higher clinical benefits. In the training set, NRI (0.224, p = 0.007), IDI (0.585, p = 0.002), and DeLong test (change = 0.089, p = 0.008) were all significant. In the external validation set, NRI, IDI, and DeLong test statistics were 0.624 (p = 0.063), 0.572 (p = 0.044), and 0.035 (p = 0.047), respectively. Conclusion Multidimensional nomograms have the potential to enhance risk assessment and patient-specific treatment of anterior choroidal artery aneurysms. Validated by an external cohort, the model incorporating clinical, morphological, and hemodynamic features may provide improved classification of rupture states.
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Affiliation(s)
- Shijie Zhu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaolong Xu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Zhiwen Lu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yazhou Yan
- Department of Neurosurgery, 971 Hospital of People's Liberation Army (PLA), Qingdao, China
| | - Siqi Li
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yina Wu
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jing Cai
- Department of Neurosurgery, Linyi People's Hospital, Linyi, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianping Xiang
- ArteryFlow Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Qinghai Huang
- Department of Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 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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Gómez-Amador JL, Guerrero-Suárez PD, Martínez-Anda JJ, Aragón-Arreola JF, Castillo-Matus A, Marian-Magaña R, Sangrador-Deitos MV, Hernández-Hernández A, Delgado-Jurado EJ, Villagrana-Sánchez RS, Gallegos-Pedraza A, Diaz-Espinoza JL. Unilateral approach for bilateral clipping of posterior communicating artery aneurysms in a hybrid operating room: A technical note. J Cerebrovasc Endovasc Neurosurg 2023; 25:468-472. [PMID: 37661758 PMCID: PMC10774686 DOI: 10.7461/jcen.2023.e2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 09/05/2023] Open
Abstract
Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.
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Affiliation(s)
- Juan Luis Gómez-Amador
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | | | | | - Jorge Fernando Aragón-Arreola
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Andrea Castillo-Matus
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Ricardo Marian-Magaña
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Marcos V Sangrador-Deitos
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Alan Hernández-Hernández
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
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Tanaka K, Furukawa K, Ishida F, Suzuki H. Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery. Acta Neurochir (Wien) 2023; 165:3697-3706. [PMID: 37870661 DOI: 10.1007/s00701-023-05840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The recanalization of posterior communicating artery (PCoA) aneurysms after endovascular treatment has been analyzed by various factors. However, the differences between adult and fetal types of posterior cerebral artery (PCA) have not been fully investigated. The main aim of this study was to investigate hemodynamic differences of PCoA aneurysms between adult and fetal types using computational fluid dynamics (CFD). METHODS Fifty-five PCoA aneurysms were evaluated by 3D CT angiography and divided into unruptured aneurysms with adult-type or fetal-type PCAs (19 cases, UA group; 9 cases, UF group) and ruptured aneurysms with adult-type or fetal-type PCAs (17 cases, RA group; 10 cases, RF group). These native aneurysms were analyzed by CFD regarding morphological and hemodynamic characteristics. To evaluate simulated endovascular treatment of aneurysms, CFD was performed using porous media modeling. RESULTS Morphologically, the RA group had significantly smaller parent artery diameter (2.91 mm vs. 3.49 mm, p=0.005) and higher size ratio (2.54 vs. 1.78, p=0.023) than the RF group. CFD revealed that the UA group had significantly lower oscillatory shear index (OSI) (0.0032 vs. 0.0078, p=0.004) than the UF group and that the RA group had lower WSS (3.09 vs. 11.10, p=0.001) and higher OSI (0.014 vs. 0.006, p=0.031) than the RF group, while the RF group presented significantly higher intra-aneurysmal flow velocity (0.19 m/s vs. 0.061 m/s, p=0.002) than the RA group. Porous media modeling of simulated treatment revealed higher residual flow volume in the fetal-type groups. CONCLUSIONS These results suggested that PCoA aneurysms with fetal-type PCAs had different morphological features and hemodynamic characteristics compared with those with adult-type PCAs, leading to high risks of recanalization.
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Affiliation(s)
- Katsuhiro Tanaka
- Department of Neurosurgery, Kuwana City Medical Center, 3-11, Kotobuki-Cho, Kuwana, Mie, 511-0061, Japan.
| | - Kazuhiro Furukawa
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Fujimaro Ishida
- Department of Neurosurgery, NHO Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Li Z, Lei P, Hua Q, Zhou L, Song P, Gao L, Zhang S, Cai Q. Surgical Clipping of Intracranial Aneurysms Using a Transcranial Neuroendoscopic Approach. Brain Sci 2023; 13:1544. [PMID: 38002504 PMCID: PMC10669543 DOI: 10.3390/brainsci13111544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE This retrospective study was performed to evaluate the feasibility and safety of surgically clipping intracranial aneurysms using a transcranial neuroendoscopic approach. METHODS A total of 229 patients with cerebral aneurysms were included in our study, all of whom were treated with clamping surgery at Wuhan University People's Hospital. They were divided into neuroendoscopic and microscopic groups, according to whether or not neuroendoscopy was used for the clamping surgery. We statistically analyzed the patients' baseline data, surgical outcomes, and complications, which were then evaluated to assess the treatment effect. RESULTS The baseline characteristics were not statistically significant, except for gender, for which the proportions of female patients in the two groups were 69 (56.1%) and 46 (43.4%). There were no patients with incomplete aneurysm clamping or parent vessel occlusion in the neuroendoscopic group, and there were 4 (3.8%) and 2 (1.9%) in the microscopic group, respectively; however, there was no statistically significant difference in the comparison of the two groups. The mean operative times of the two groups were 181 min and 154 min, respectively, and were statistically different. However, the mRS scores of the two groups showed no significant difference in patient prognosis. The differences in complications (including limb hemiplegia, hydrocephalus, vision loss, and intracranial infection) were not statistically significant, except for cerebral ischemia, for which the proportions of patients in the two groups were 8 (6.5%) and 16 (15.1%). CONCLUSIONS Neuroendoscopy can provide clear visualization and multi-angle views during aneurysm clipping, which is helpful for ensuring adequate clipping and preventing complications.
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Affiliation(s)
- Zhiyang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Pan Lei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Qiuwei Hua
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Long Zhou
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Ping Song
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Lun Gao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
| | - Silei Zhang
- Department of Neurosurgery, Xiantao First People’s Hospital Affiliated to Changjiang University, Xiantao 433000, China;
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; (Z.L.); (P.L.); (Q.H.); (L.Z.); (P.S.); (L.G.)
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Yong-Wei H, Wang XY, Li ZP, Yin XS. The rupture risk factors of mirror intracranial aneurysms: A systematic review and meta-analysis based on morphological and hemodynamic parameters. PLoS One 2023; 18:e0286249. [PMID: 37352170 PMCID: PMC10289394 DOI: 10.1371/journal.pone.0286249] [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: 10/06/2022] [Accepted: 05/11/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Intracranial aneurysms (IAs) are a prevalent form of vascular disease that can lead to fatal outcomes upon rupture. Mirror intracranial aneurysms (MIAs) are a specific type of multiple aneurysms situated symmetrically on both sides of the parent arteries. The factors contributing to the risk of MIA rupture, based on morphological and hemodynamic parameters, are currently controversial. Thus, we conducted a systematic review and meta-analysis to investigate the risk factors for MIA rupture. METHODS The study performed an electronic search of Chinese and English databases, including China national Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases, and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The morphological parameters (IA size, aspect ratio [AR], size ratio [SR], bottleneck factor [BNF], height-width ratio [HWR], irregular shape) and hemodynamic parameters (wall shear stress [WSS], low WSS area [LSA], oscillatory shear index [OSI]) were analyzed for their significance in determining the risk of MIA rupture. RESULTS The analysis comprised 18 retrospective studies involving 647 patients, with a total of 1294 IAs detected, including 605 ruptured and 689 unruptured. The meta-analysis revealed that IA size, AR, SR, and irregular shape exhibited significant differences between the ruptured and unruptured groups, but HWR did not. In terms of hemodynamic parameters, WSS, OSI, and LSA were found to have significant differences between the two groups. CONCLUSIONS Our results demonstrate that larger IAs, higher AR, SR, and BNF are associated with a higher risk of rupture in patients with MIAs, regardless of their location. there is no significant difference in HWR between the ruptured and unruptured groups. These preliminary findings offer valuable insights for clinical decision-making and a more comprehensive comprehension of the current MIA status. Nevertheless, larger and multi-center studies are indispensable for corroborating these findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/ identifier: CRD42022345587.
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Affiliation(s)
- Huang Yong-Wei
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Yi Wang
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Zong-Ping Li
- Department of Neurosurgery, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
| | - Xiao-Shuang Yin
- Department of Immunology, Mian yang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mian yang, Sichuan, People’s Republic of China
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Hu SQ, Chen RD, Xu WD, Li H, Yu JS. A predictive hemodynamic model based on risk factors for ruptured mirror aneurysms. Front Neurol 2022; 13:998557. [PMID: 36158942 PMCID: PMC9502008 DOI: 10.3389/fneur.2022.998557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify hemodynamic risk factors for intracranial aneurysm rupture and establish a predictive model to aid evaluation. Methods We analyzed the hemodynamic parameters of 91 pairs of ruptured mirror aneurysms. A conditional univariate analysis was used for the continuous variables. A conditional multivariate logistic regression analysis was performed to identify the independent risk factors. Differences where p < 0.05 were statistically significant. A predictive model was established based on independent risk factors. Odds ratios (ORs) were used to score points. The validation cohort consisted of 189 aneurysms. Receiver operating characteristic curves were generated to determine the cutoff values and area under the curves (AUCs) of the predictive model and independent risk factors. Results The conditional multivariate logistic analysis showed that the low shear area (LSA) (OR = 70.322, p = 0.044, CI = 1.112–4,445.256), mean combined hemodynamic parameter (CHP) (>0.087) (OR = 3.171, p = 0.034, CI = 1.089–9.236), and wall shear stress gradient (WSSG) ratio (>893.180) (OR = 5.740, p = 0.003, CI = 1.950–16.898) were independent risk factors. A prediction model was established: 23*LSA + 1*CHP mean (>0.087: yes = 1, no = 0) + 2 * WSSG ratio (>893.180: yes = 1, no = 0). The AUC values of the predictive model, LSA, mean CHP (>0.087), and WSSG ratio (>893.180) were 0.748, 0.700, 0.654, and 0.703, respectively. The predictive model and LSA cutoff values were 1.283 and 0.016, respectively. In the validation cohort, the predictive model, LSA, CHP (>0.087), and WSSG ratio (>893.180) were 0.736, 0.702, 0.689, and 0.706, respectively. Conclusions LSA, CHP (>0.087), and WSSG ratio (>893.180) were independent risk factors for aneurysm rupture. Our predictive model could aid practical evaluation.
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Axier A, Rexiati N, Wang Z, Cheng X, Su R, Aikeremu R, Aisha M. Effect of hemodynamic changes on the risk of intracranial aneurysm rupture: a systematic review and meta-analysis. Am J Transl Res 2022; 14:4638-4647. [PMID: 35958447 PMCID: PMC9360874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE In this study, the hemodynamic parameters of ruptured intracranial aneurysms (IAs) in various studies were summarized and analyzed to provide predictive parameters for IA rupture in clinical work. METHODS We searched PubMed, Web of science, Embase, and Cochrane databases for articles published before December 2021 to collect data on hemodynamic parameters associated with IA rupture. Differences in wall shear stress (WSS), oscillatory shear index (OSI), and low wall shear stress area (LSA) between ruptured and unruptured IAs in the literature were summarized and analyzed, and the standardized mean difference (SMD) of 95% CI was calculated by Review Manager 5.3. RESULTS By searching and screening the literature, this meta-analysis included 17 studies comprising 1,373 IA patients. In the ruptured aneurysm group, the level of WSS decreased significantly, while OSI and LSA increased obviously. CONCLUSION Low WSS, high OSI, and high LSA are closely related to the rupture of IAs, indicating the role of WSS, OSI, and LSA as important hemodynamic parameters for predicting the rupture of IAs in clinical work.
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Affiliation(s)
- Aximujiang Axier
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Nizamidingjiang Rexiati
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Zengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Xiaojiang Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Riqing Su
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Rexidan Aikeremu
- Department of Medical Record Management, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Maimaitili Aisha
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
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Wei H, Tian Q, Yao K, Wang J, He P, Guo Y, Han W, Gao W, Li M. Different Hemodynamic Characteristics and Resulting in Different Risks of Rupture Between Wide-Neck and Narrow-Neck Aneurysms. Front Neurol 2022; 13:868652. [PMID: 35547381 PMCID: PMC9082944 DOI: 10.3389/fneur.2022.868652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This study aimed to determine the ruptured rate and hemodynamic difference between wide-neck aneurysms (WNAs) and narrow-neck aneurysms (NNAs), as well as the hemodynamic parameters of risk factors for aneurysm rupture. Methods A total of 121 cases of intracranial aneurysms (IAs) were studied retrospectively between January 2019 and April 2021 at Renmin Hospital of Wuhan University. Intracranial aneurysms were classified into four types: ruptured wide-neck aneurysms (RWNAs), unruptured wide-neck aneurysms (UWNAs), ruptured narrow-neck aneurysms (RNNAs), and unruptured narrow-neck aneurysms (UNNAs). The Chi-square test was used to compare differences in rupture ratios. The clinical characteristics and hemodynamics were analyzed statistically to reveal the rupture risk factors. Moreover, significant parameters were subjected to binary logistic regression analysis to identify the independent predictive factors. The receiver operating characteristic (ROC) curve was performed to obtain cutoff values. Results WNAs ruptured more frequently than NNAs (P = 0.033). Ruptured intracranial aneurysms (RIAs) were characterized by significantly higher intra-aneurysmal pressure (IAP), wall shear stress (WSS), wall shear stress gradient (WSSG), and lower normalized wall shear stress (NWSS) than unruptured intracranial aneurysms (UIAs). RWNAs had higher IAP, WSS, and lower NWSS than UWNAs (P < 0.05). RNNAs had higher IAP, Streamwise WSSG and lower NWSS compared to UNNAs (P < 0.05). Binary logistic regression revealed that IAP and WSS were independent predictive risk factors for WNAs rupture, with cut-off values of 405.5 and 6.66 Pa, respectively. Also, IAP was an independent predictive risk factor for NNA rupture, with a cut-off value of 255.3 Pa. Conclusions Wide-neck aneurysms and narrow-neck aneurysms have diverse hemodynamics, which prompts a higher rupture ratio for WNAs. IAP could characterize the rupture risk in both WNAs and NNAs independently, but WSS could only predict the rupture risk in WNAs. This research might assist neurosurgeons with fostering a more sensible strategy for the treatment of IAs.
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Affiliation(s)
- Heng Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qi Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kun Yao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, China
| | - Jianfeng Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peibang He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yujia Guo
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenrui Han
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenhong Gao
- Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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