Rupture Risk of Small Unruptured Intracranial Aneurysms in Japanese Adults

Suzuki, Takashi; Takao, Hiroyuki; Rapaka, Saikiran; Fujimura, Soichiro; Nita, Cosmin; Uchiyama, Yuya; Ohno, Hiroshi; Otani, Katharina; Dahmani, Chihebeddine; Mihalef, Viorel; Sharma, Puneet; Mohamed, Ashraf; Redel, Thomas; Ishibashi, Toshiyuki; Yamamoto, Makoto; Murayama, Yuichi

doi:10.1161/strokeaha.119.027664

Cited by 42 publications

(38 citation statements)

References 14 publications

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“…Although incidental small paraclinoid UIAs (≤5 mm) have a relatively lower rupture and growth risk, Jeon et al (25) indicated that arterial branch-related location was a significant predictive factor for UIA progression. Recently, Suzuki et al showed that UIA (<10 mm) located at a bifurcation was a risk factor for rupture (26). These reports are also consistent with our study in that UIA located at a bifurcation was a risk factor for progression.…”

Section: Discussionsupporting

confidence: 93%

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Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography

Wang¹,

Liu²,

Yang³

et al. 2021

Quant Imaging Med Surg

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The progression of an unruptured intracranial aneurysm (UIA) is associated with a higher rupture risk. The aim of this study was to identify the risk factors for the progression of UIAs among Chinese adults and compare them with the ELAPSS (Earlier subarachnoid hemorrhage, IA Location, Age, Population, IA Size and Shape) score.Methods: Four hundred thirty-eight consecutive patients with 491 UIAs were followed and reviewed retrospectively from August 2011 to November 2019. Follow-up images of the UIAs were used to determine changes in IA size and shape. Patients and IAs were divided into non-progression and progression groups.In addition to the clinical characteristics of the patients, the features of the IAs (e.g., size and shape) were evaluated by computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Independent risk factors for UIA progression were studied using multiple Cox proportional hazards regression analysis. In addition, the diagnostic value of the ELAPSS score for the prediction of UIA progression was calculated.Results: Seventy-two IAs in 68 patients progressed during a mean follow-up time of 24.2±19.68 months.IAs located at the bifurcation [odds ratio (OR) 2.600], with an irregular shape (OR 2.981) or having a high aspect ratio (AR, OR 2.430) were correlated with progression. Based on these three factors, the threshold value of our predictive score was 0.5, and the area under the curve (AUC), sensitivity and specificity were 0.756, 93.1% and 40.6%, respectively, while the AUC, sensitivity and specificity of the ELAPSS score were 0.711, 55.6%, and 75.2%, respectively. Conclusions: IAs located at the bifurcation, with an irregular shape and with an elevated AR are risk factors for UIA progression in the Chinese population. Our predictive score is of great value in predicting the risk of UIA progression.

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Section: Discussionsupporting

confidence: 93%

“…Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi. org/10.21037/qims- [21][22][23][24][25][26][27][28][29][30][31][32]. The authors have no conflicts of interest to declare.…”

Section: Footnotementioning

confidence: 99%

Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography

Wang¹,

Liu²,

Yang³

et al. 2021

Quant Imaging Med Surg

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“…Current scoring systems are not robust, especially for small aneurysms, which have to be modelled specifically due to their unique histologic characteristics. [10][11][12] Therefore, novel methodologies are required to construct rupture-risk models for small aneurysms to facilitate clinical decisions. 13,14 Aneurysms were often treated only if any change in size or morphology of the aneurysm was detected during follow-up, which would result in a serious bias in the longitudinal study.…”

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confidence: 99%

Machine Learning–Based Prediction of Small Intracranial Aneurysm Rupture Status Using CTA-Derived Hemodynamics: A Multicenter Study

Shi

Chen

Mao³

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Small intracranial aneurysms are being increasingly detected while the rupture risk is not well-understood. We aimed to develop rupture-risk models of small aneurysms by combining clinical, morphologic, and hemodynamic information based on machine learning techniques and to test the models in external validation datasets. MATERIALS AND METHODS:From January 2010 to December 2016, five hundred four consecutive patients with only small aneurysms (,5 mm) detected by CTA and invasive cerebral angiography (or surgery) were retrospectively enrolled and randomly split into training (81%) and internal validation (19%) sets to derive and validate the proposed machine learning models (support vector machine, random forest, logistic regression, and multilayer perceptron). Hemodynamic parameters were obtained using computational fluid dynamics simulation. External validation was performed in other hospitals to test the models. RESULTS:The support vector machine performed the best with areas under the curve of 0.88 (95% CI, 0.85-0.92) and 0.91 (95% CI, 0.74-0.98) in the training and internal validation datasets, respectively. Feature ranks suggested hemodynamic parameters, including stable flow pattern, concentrated inflow streams, and a small (,50%) flow-impingement zone, and the oscillatory shear index coefficient of variation, were the best predictors of aneurysm rupture. The support vector machine showed an area under the curve of 0.82 (95% CI, 0.69-0.94) in the external validation dataset, and no significant difference was found for the areas under the curve between internal and external validation datasets (P = .21). CONCLUSIONS:This study revealed that machine learning had a good performance in predicting the rupture status of small aneurysms in both internal and external datasets. Aneurysm hemodynamic parameters were regarded as the most important predictors. ABBREVIATIONS: AUC ¼ area under the curve; AWSS ¼ averaged WSS; CFD ¼ computational fluid dynamics; CV ¼ coefficient of variation; LR ¼ logistic regression; ML ¼ machine learning; MLP ¼ multilayer perceptron; OSI ¼ oscillatory shear index; ROC ¼ receiver operating characteristic; SVM ¼ support vector machine; WSS ¼ wall shear stress

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“…Other possible causes include differences in basic patient characteristics related to risk factors for IA. 26) The proportion of patients with multiple IAs was 47.4% in the present trial and 33.2% in the SUAVe study while hypertensive patients comprised 40% and 24.9%, respectively.…”

Section: Discussionmentioning

confidence: 44%

Small Unruptured Aneurysm Verification-prevention Effect against Growth of Cerebral Aneurysm Study Using Statin

Yoshida

Uwano

Sasaki

et al. 2021

Neurol. Med. Chir.(Tokyo)

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Several basic experimental studies have demonstrated that statins have beneficial effects for intracranial aneurysm (IA). Clinical studies on unruptured IAs, however, remain limited to four retrospective studies that have reached different conclusions. This study was the first open-label, multicenter, randomized controlled trial to assess the preventive effects of atorvastatin. Patients with unruptured small saccular IAs were randomly assigned to statin and control groups. The primary endpoint was a composite of aneurysm growth of ≥0.5 mm, new bleb formation confirmed from magnetic resonance (MR) angiography, and rupture. Enrollment was prematurely terminated due to unexpectedly slow enrollment. Of 231 patients (275 target IAs), 110 patients (128 IAs) were randomly assigned to the statin group and 121 patients (147 IAs) to the control group. After excluding 22 dropout patients, 107 IAs in the 93 statin group patients and 140 IAs in the 116 control group patients were finally analyzed. No significant differences of basic characteristics were evident between groups, except for significantly higher systolic pressure in the statin group (P = 0.03). The primary endpoint occurred in 28 IAs (20.0%) in the control group and in 17 IAs (15.9%) in the statin group. No aneurysm rupture was confirmed in either group. Significant beneficial effects of statin for IAs were not demonstrated for the primary endpoint (log-rank P = 0.359). This randomized trial did not establish any preventive effects of atorvastatin for unruptured small IAs. Further studies of larger cohorts are required to clarify the efficacy of statins for patients with unruptured IAs.

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Rupture Risk of Small Unruptured Intracranial Aneurysms in Japanese Adults

Cited by 42 publications

References 14 publications

Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography

Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography

Machine Learning–Based Prediction of Small Intracranial Aneurysm Rupture Status Using CTA-Derived Hemodynamics: A Multicenter Study

Small Unruptured Aneurysm Verification-prevention Effect against Growth of Cerebral Aneurysm Study Using Statin

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