High-density thrombus and maximum transverse diameter on multi-spiral computed tomography angiography combine to predict abdominal aortic aneurysm rupture

Liu, Heqian; Chen, Zhipeng; Tang, Chaojing; Fan, Hui; Mai, Xiaoli; Cai, Jing; Qiao, Tong

doi:10.3389/fcvm.2022.951264

Cited by 4 publications

(4 citation statements)

References 40 publications

(25 reference statements)

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“…134 Because of the property of ILT to promote AA rupture, several studies have shown that ILT measurement by CT or three-dimensional contrast-enhanced ultrasound can predict the risk of AAA rupture and could be used for clinical purposes. 135 Similarly, data about AA, such as ILT, demonstrate that vessel radius and blood flow rate can be mined by deep learning and artificial intelligence techniques for AAA growth prediction, which can assist in diagnosis and treatment in the clinic. 136…”

Section: Endothelial Cellsmentioning

confidence: 99%

The mechanism and therapy of aortic aneurysms

Gao

Cao

et al. 2023

Sig Transduct Target Ther

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Aortic aneurysm is a chronic aortic disease affected by many factors. Although it is generally asymptomatic, it poses a significant threat to human life due to a high risk of rupture. Because of its strong concealment, it is difficult to diagnose the disease in the early stage. At present, there are no effective drugs for the treatment of aneurysms. Surgical intervention and endovascular treatment are the only therapies. Although current studies have discovered that inflammatory responses as well as the production and activation of various proteases promote aortic aneurysm, the specific mechanisms remain unclear. Researchers are further exploring the pathogenesis of aneurysms to find new targets for diagnosis and treatment. To better understand aortic aneurysm, this review elaborates on the discovery history of aortic aneurysm, main classification and clinical manifestations, related molecular mechanisms, clinical cohort studies and animal models, with the ultimate goal of providing insights into the treatment of this devastating disease. The underlying problem with aneurysm disease is weakening of the aortic wall, leading to progressive dilation. If not treated in time, the aortic aneurysm eventually ruptures. An aortic aneurysm is a local enlargement of an artery caused by a weakening of the aortic wall. The disease is usually asymptomatic but leads to high mortality due to the risk of artery rupture.

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Section: Endothelial Cellsmentioning

confidence: 99%

The mechanism and therapy of aortic aneurysms

Gao

Cao

et al. 2023

Sig Transduct Target Ther

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“…In cases where the density of the thrombus and the aneurysm wall are comparable, the oscillations of the system under the action of a pulse wave will likely be unidirectional. At the same time, with a strong difference in the density of the thrombus [ 19 , 20 ] and the aneurysm wall, the movement of the inner wall of the thrombus will be directed towards the center of the lumen due to hydrodynamic suction, otherwise a part of the thrombus must inevitably break away from the main mass due to the continuity of the blood flow in the aneurysm lumen. In cases where the movements of such a dense thrombus become unidirectional, along with the aneurysm wall (radially outward), we presume that the thrombus integrity is already compromised.…”

Section: Discussion and Perspectivesmentioning

confidence: 99%

“…Undoubtedly, one of these factors is the intraluminal thrombus, the influence of which has been repeatedly confirmed [ 16 , 17 ]. While previous observations have noted the influence of the symmetry of the intraluminal thrombus location [ 18 ]and its density [ 19 , 20 ], a mechanical representation of this influence on both aneurysm rupture and the occurrence of thromboembolic complications has not been presented. Moreover, given the operator-dependent results of ultrasound measurements [ 21 , 22 ], modern medicine needs either alternative methods for assessing deformation or the development of operator-independent protocols for ultrasound measurements of aortic aneurysm deformation.…”

Section: Introductionmentioning

confidence: 99%

The role of asymmetry and volume of thrombotic masses in the formation of local deformation of the aneurysmal-altered vascular wall: An in vivo study and mathematical modeling

Tikhvinsky,

Maus,

Lipovka

et al. 2024

PLoS ONE

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Currently, the primary factor indicating the necessity of an operation for an abdominal aortic aneurysm (AAA) is the diameter at its widest part. However, in practice, a large number of aneurysm ruptures occur before reaching a critical size. This means that the mechanics of aneurysm growth and remodeling have not been fully elucidated. This study presents a novel method for assessing the elastic properties of an aneurysm using an ultrasound technique based on tracking the oscillations of the vascular wall as well as the inner border of the thrombus. Twenty nine patients with AAA and eighteen healthy volunteers were considered. The study presents the stratification of a group of patients according to the elastic properties of the aneurysm, depending on the relative volume of intraluminal thrombus masses. Additionally, the neural network analysis of CT angiography images of these patients shows direct (r = 0.664271) correlation with thrombus volume according to ultrasound data, the reliability of the Spearman correlation is p = 0.000215. The use of finite element numerical analysis made it possible to reveal the mechanism of the negative impact on the AAA integrity of an asymmetrically located intraluminal thrombus. The aneurysm itself is considered as a complex structure consisting of a wall, intraluminal thrombus masses, and areas of calcification. When the thrombus occupies > 70% of the lumen of the aneurysm, the deformations of the outer and inner surfaces of the thrombus have different rates, leading to tensile stresses in the thrombus. This poses a risk of its detachment and subsequent thromboembolism or the rupture of the aneurysm wall. This study is the first to provide a mechanistic explanation for the effects of an asymmetrical intraluminal thrombus in an abdominal aortic aneurysm. The obtained results will help develop more accurate risk criteria for AAA rupture using non-invasive conventional diagnostic methods.

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“…Third, the number of included patients in both groups is still limited related to the relatively low numbers of patients presenting today with rAAA or large, untreated, non-ruptured AAA's. Fourth, other CTA-parameters, including density and amount of circumferential thrombus and calci cations were not analyzed [12,13,14,15]. Fifth, this is a single center study over a long study period (nearly 15 years) with ununiform referrals and scanning protocols.…”

Section: Discussionmentioning

confidence: 99%

Comparative study on clinical and imaging characteristics between patients with ruptured and large, unruptured abdominal aortic aneurysms

Hoste,

Coudyzer,

Laenen

et al. 2023

Preprint

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Purpose to determine potential clinical and computed tomography (CT) imaging predictors for abdominal aortic aneurysm (AAA) rupture based on a comparative analysis of patients presenting with large (> 6.5 cm diameter) unruptured AAA (uAAA) and patients presenting with ruptured AAA (rAAA) respectively. Methods consecutive patients presenting with large unruptured or rAAA and having undergone a contrast-enhanced CT at admission between January 2005 and June 2019 were included. Patients’ demographics and CT-imaging characteristics were collected from the institutional electronic medical records. Both patient groups were compared using Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables. Results we included 101 patients, of which 57 patients presenting with a rAAA and 44 patients with a large, uAAA. Patients in the large, uAAA group were younger, mean age of 76 years vs 83 years (P < 0.001), had less coronary artery disease (47.6% vs 72.5%; P = 0.026) and had a lower left common iliac artery to maximum aneurysm diameter ratio (0.15 vs 0.18; P = 0.034), a lower sum of right + left common iliac artery to maximum aneurysm diameter ratio (0.31 vs 0.39; P = 0.028) and a lower infrarenal neck to maximum aneurysm diameter ratio (0.29 vs 0.35; P = 0.039). Conclusion patients with large, uAAA’s were younger with less coronary artery disease and presented with lower ratio of right + left common iliac artery to maximum aneurysm diameter as well as a lower ratio of infrarenal neck to maximum aneurysm diameter on CT-imaging compared to patients with rAAA.

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High-density thrombus and maximum transverse diameter on multi-spiral computed tomography angiography combine to predict abdominal aortic aneurysm rupture

Cited by 4 publications

References 40 publications

The mechanism and therapy of aortic aneurysms

The mechanism and therapy of aortic aneurysms

The role of asymmetry and volume of thrombotic masses in the formation of local deformation of the aneurysmal-altered vascular wall: An in vivo study and mathematical modeling

Comparative study on clinical and imaging characteristics between patients with ruptured and large, unruptured abdominal aortic aneurysms

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