Cerebral Aneurysm Morphology Before and After Rupture

Skodvin, Torbjørn Øygard; Johnsen, Liv-Hege; Gjertsen, Øivind; Isaksen, Jørgen Gjernes; Sorteberg, Angelika

doi:10.1161/strokeaha.116.015288

Cited by 93 publications

(63 citation statements)

References 35 publications

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“…[ 28 43 48 64 ] A recent nationwide retrospective review from Norway sought to further investigate this phenomenon. [ 49 ] In this study, Skodvin et al . retrospectively analyzed 29 aneurysms with a median time span of 12 months between the pre and post-rupture imaging.…”

Section: Discussionmentioning

confidence: 85%

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Bhogal¹,

AlMatter²,

Hellstern³

et al. 2018

Surg Neurol Int

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Background:The risk of aneurysmal rupture is dependent upon numerous factors, however, there are inconsistencies in the results between studies, which may be due to confounding factors. This can be avoided by comparing the characteristics of ruptured and unruptured aneurysms within the same patient. We sought to analyze the aneurysm characteristics of patients with acute aneurysmal subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms.Methods:We reviewed our prospectively maintained institutional database, between 01/10/2007 and 01/01/2017, for all patients with confirmed SAH and >1 aneurysm. We recorded the size, location, and morphology and calculated secondary geometric indices such as bottleneck factor and aspect ratio.Results:During the study period, a total of 694 patients with aneurysmal SAH were admitted to our institution. We identified 113 patients (74.3% female, average age 51.7 ± 12.3). The majority of patients had only one associate unruptured aneurysm (79.6%). The average unruptured aneurysm was 3.1 ± 1.5 mm and the average ruptured aneurysm was 5.7 ± 2.7 mm (P < 0.001). In the multivariate analysis, aneurysm location, aneurysm morphology, and size were independently associated with rupture. A complex aneurysm morphology was the strongest risk factor for rupture (OR, 29.27; 95% CI 14.33–59.78; P < 0.001) with size >7 mm (OR, 17.74; 95% CI 4.07–77.35; P < 0.001), and AcomA location also showing a strong independent association.Conclusion:Size plays an important part in determining rupture risk, however, other factors such as location and in particular morphology must also be considered. We believe that the introduction of vessel wall imaging will help to risk stratify aneurysms.

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Section: Discussionmentioning

confidence: 85%

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Bhogal¹,

AlMatter²,

Hellstern³

et al. 2018

Surg Neurol Int

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“…The finding is not surprising because previous many studies calculated this parameter based on the image data after rupture. However, a study analyzed the morphological change before and after aneurysm rupture and gave the conclusion that postrupture morphology should not be considered to assess the rupture risk ( Skodvin et al, 2017b ). It is essential to take this factor into consideration.…”

Section: Discussionmentioning

confidence: 99%

“…The main reason why RRS did not include these risk factors was that the aneurysm studied was the ruptured aneurysm. After the rupture, the morphology and hemodynamic characteristics of the aneurysm will change dramatically ( Skodvin et al, 2017b ). Thus, although RRS can already effectively discriminate ruptured and unruptured aneurysms, the accuracy of it could be further increased.…”

Section: Discussionmentioning

confidence: 99%

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Jiang

et al. 2018

Front. Neurosci.

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Objective: The aim of the present study is to investigate the potential morphological and hemodynamic risk factors related to intracranial aneurysms (IAs) rupture and establish a system to stratify the risk of IAs rupture to help the clinical decision-making.Methods: Patients admitted to our hospital for single-IAs were selected from January 2012 and January 2018. A propensity score matching was conducted to match patients. The morphological parameters were obtained from high solution CTA images, and the hemodynamic parameters were obtained in accordance with the outcomes of computational fluid dynamics (CFDs) simulation. Differences in the morphologic and hemodynamic parameters were compared. The significant parameters were selected to establish a novel scoring system (Intracranial Aneurysm Rupture Score, IARS). The comparison was drawn between the discriminating accuracy of IARS and the Rupture Resemblance Score (RRS) system to verify the value of IARS. Then, a group of patients with unruptured IAs was stratified into the high risk and low risk groups by IARS and RRS system separately and was followed up for 18–27 months to verify the value of IARS. The outcome of different stratifications was compared.Results: The matching process yielded 167 patients in each group. Differences of statistical significance were found in aneurysm length (p = 0.001), perpendicular height (H) (p < 0.001), aspect ratio (AR) (p < 0.001), size ratio (SR) (p < 0.001), deviated angle (DA) (p < 0.001), normalized average wall shear stress (NWSSa) (p < 0.001), wall shear stress gradient (WSSG) (p < 0.001), low shear area ratio (LSAR) (p = 0.01), and oscillatory shear index (OSI) (p = 0.01). Logistic regression analysis further demonstrated that SR, DA, NWSSa, LSAR, and OSI were the independent risk factors of IAs rupture. SR, DA, LSAR, and OSI were finally selected to establish the IARS. Our present IARS showed a higher discriminating value (AUC 0.81 vs. 0.77) in comparison with the RRS (SR, NWSSa, and OSI). After follow-up, seven patients were subject to IAs rupture. 5/26 in high risk group stratified by IARS, yet 7/57 in high risk group stratified by RRS. The accuracy of IARS was further verified (19.2% vs. 12.3%, AUC for the IARS and the RRS was 0.723 and 0.673, respectively).Conclusion: SR, DA, NWSSa, LSAR, and OSI were considered the independent risk factors of IAs rupture. Our novel IARS showed higher accuracy in discriminating IA rupture in comparison with RRS.

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“…More cases from multiple centers should be analyzed to verify the finding. The current study was retrospective in which morphology of post-rupture aneurysms may be different from their pre-rupture shapes (32). For unruptured aneurysms, they remained unruptured during follow-up.…”

Section: Limitationsmentioning

confidence: 99%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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Background: Intracranial aneurysm wall degradation can be associated with lipid infiltration. However, the relationship between lipid infiltration and aneurysm rupture has not been explored quantitatively. To investigate the correlation between lipid infiltration and aneurysm rupture, we utilized patient-specific simulation of low-density lipoprotein (LDL) transport to analyze lipid infiltration in the cerebral aneurysm wall. Methods: Sixty-two aneurysms were analyzed. Patient blood pressure, plasma LDL concentration, and three-dimensional angiographic images were obtained to simulate LDL transport in aneurysms. Morphological, hemodynamic, and lipid accumulation parameters were compared between ruptures and unruptured groups. Multivariate logistic regression was also performed to determine parameters that are independently associated with rupture. Results: Size ratio, wall shear stress, low shear area, relative residence time, area-averaged LDL infiltration rate, and maximum LDL infiltration rate were significant parameters in univariate analysis (P < 0.05). Multivariate analysis revealed that only average LDL infiltration remained as a significant variable (P < 0.05). The prediction model derived showed good performance for rupture prediction (AUC, 0.885; 95% CI, 0.794-0.976). Conclusions: Ruptured aneurysms showed significantly higher LDL infiltration compared to unruptured ones. Our results suggested that lipid infiltration may promote aneurysm rupture. Lipid infiltration characteristics should be considered when assessing aneurysm rupture risk.

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Cerebral Aneurysm Morphology Before and After Rupture

Abstract: Indexing termsintracranial aneurysm, morphology, rupture, cerebral angiography, risk factors

Cited by 93 publications

References 35 publications

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

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