A New Classification of Anterior Choroidal Artery Aneurysms and Its Clinical Application

Duan, Yu; Qin, Xuanfeng; An, Qinqzhu; Liu, Yikui; Li, Jian; Chen, Gong

doi:10.3389/fnagi.2021.596829

Cited by 9 publications

(4 citation statements)

References 29 publications

(8 reference statements)

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“…Statistical analyses and graphical representations were conducted using R version 4.1.3. 1 Adherence to the TRIPOD guidelines was observed in this research (26).…”

Section: Discussionmentioning

confidence: 55%

“…The occurrence of anterior choroidal artery (AChA) aneurysms is relatively low, constituting only 2-5% of all cerebral aneurysms (1). While the incidence of rupture in AChA aneurysms is elevated within the realm of medical care (2), the PHASES score scale (considering population, hypertension, age, size, prior subarachnoid hemorrhage, and location) indicated relatively lower scores for these small aneurysms (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features

Zhu,

Xu,

Zou

et al. 2024

Front. Neurol.

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Background and purposeA 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.MethodsA 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.ResultsTwo 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.ConclusionMultidimensional 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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“…Statistical analyses and graphical representations were conducted using R version 4.1.3. 1 Adherence to the TRIPOD guidelines was observed in this research (26).…”

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features

Zhu,

Xu,

Zou

et al. 2024

Front. Neurol.

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“… 19 , 20) Duan reported that AChAs have a high probability of branching from the neck or the dome, occurring in 46.2% and 28.8% of cases, respectively. 21) …”

Section: Fd Treatment For Aneurysms With Branched Arteriesmentioning

confidence: 99%

“…19,20) Duan reported that AChAs have a high probability of branching from the neck or the dome, occurring in 46.2% and 28.8% of cases, respectively. 21) In 1905, von Monakow reported that the AChA supplies blood to the lateral geniculate body. In 1933, Abbie reported hemimotor, hemisensory, and visual field deficits as symptoms of AChA occlusion.…”

Section: Anterior Choroid Arterymentioning

confidence: 99%

Endovascular Treatments for Aneurysms Involving a Major Branch

Orito,

Hirohata,

Abe

et al. 2024

JNET

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Remarkable advances have been made in the endovascular treatment of intracranial cerebral aneurysms. These advances include various adjunctive techniques, increased indications for endovascular treatment, and improved treatment results. Furthermore, the number of cerebral aneurysm treatments using flow diverters (FDs) is expected to increase. However, the reported long-term rate of branch artery occlusion after FD treatment has been reported is 15.8%. Moreover, the complete aneurysm obliteration rate is low if normal branches arise from an aneurysm neck or dome. Flow diverter placement for ophthalmic artery, posterior communicating artery, and anterior choroidal artery aneurysms is often difficult because these normal branches often arise from the aneurysm neck or dome. Therefore, in many cases, coil embolization, which can occlude the aneurysm while preserving branch vessels, should be selected. Although not yet established, various adjunctive techniques and other endovascular treatments that can be performed safely have been reported. Treatment must be planned after understanding the advantages and disadvantages of each treatment method.

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Intracranial Aneurysms and Subarachnoid Hemorrhage

Harrigan,

Deveikis

2023

Contemporary Medical Imaging

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A New Classification of Anterior Choroidal Artery Aneurysms and Its Clinical Application

Cited by 9 publications

References 29 publications

Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features

Nomograms for assessing the rupture risk of anterior choroid artery aneurysms based on clinical, morphological, and hemodynamic features

Endovascular Treatments for Aneurysms Involving a Major Branch

Intracranial Aneurysms and Subarachnoid Hemorrhage

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