Intracranial Mirror Aneurysm: Epidemiology, Rupture Risk, New Imaging, Controversies, and Treatment Strategies

Liu, Heng-Jian; Zhou, Han; Lu, Dong-Lin; Jiao, Yingbin; Chen, Songfeng; Cheng, Jing; Yao, Xianhua; Ren, Jizhen; Li, Shifang; Liu, Wei; Gao, Jingchen; Yue, Yong; Xu, Jinxiang; Zhang, Pi-Ning; Feng, Yugong

doi:10.1016/j.wneu.2019.03.275

Cited by 19 publications

(16 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Second, most previous studies were limited only to hemodynamics or morphology parameters. Third, mirror aneurysms are rare, comprising ~5% of all IAs, while ruptured mirror aneurysms located in the same location are rarer ( 14 ). Although previous studies selected mirror aneurysms located in different locations to avoid statistical bias, the accuracy of their results might be weakened by the location.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms

Yuan

Huang

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Objective: Morphological and hemodynamic parameters might predict rupture of intracranial aneurysms (IAs). A practical model for the study is patients with ruptured mirror IAs in which one is ruptured and the other is unruptured. Although there have been analyses of the morphology and hemodynamics of ruptured mirror posterior communicating artery aneurysms (PComAAs), the sample sizes in these studies were small and only considered hemodynamics or morphological characters. Therefore, this study aimed to investigate the morphological and hemodynamic parameters associated with ruptured mirror PComAAs.Methods: We considered 72 patients with ruptured mirror PComAAs using computational fluid dynamics (CFDs). Ruptured mirror PComAAs were divided into ruptured and unruptured groups. Fourteen morphological and eight hemodynamic parameters were calculated and compared. Significant parameters were analyzed by the multivariate logistic regression to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all independent risk factors to determine the predictability and identify the optimal threshold.Results: Four hemodynamic and three morphological parameters were significantly different between ruptured and unruptured groups: normalized wall shear stress (NWSS), mean WSS, low wall shear WSS area (LSA%), size, aspect ratio (AR), size ratio (SR), and inflow angle (IA). Multivariate logistic regression analysis showed that AR, SR, NWSS, mean WSS, and LSA% were all independent factors significantly associated with PComAAs rupture. The ROC analysis for independent risk factors indicated that AR (0.751), NWSS (0.755), mean WSS (0.69), and LSA (0.778) had merely acceptable AUC values. Only SR (0.803) had a high acceptable AUC value. The threshold value of SR was 1.96.Conclusions: SR (>1.96) was the most significant parameter associated with IA rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Ruptured mirror aneurysms are defined as the situation in which one is ruptured, and the other is not. This is an ideal model to identify parameters associated with rupture (12)(13)(14). Posterior communicating artery aneurysms (PComAAs) account for about 15-25% of all IAs and are one of the most likely to rupture (15).…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms

Yuan

Huang

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Symptomatic vasospasm usually occurs 3 days after aSAH, reaching its peak on the 7th day and continuing for 2-3 weeks [8,9]. The overall incidence of IA is 4-6 %, and asymptomatic IA is at least 10 times more prevalent than ruptured IA [10]. IA has high mortality and morbidity rates, and the risk of poor outcome increases because of initial hemorrhage, recurrent hemorrhage, or symptomatic vasospasm [11].…”

Section: Discussionmentioning

confidence: 99%

Bioinformatic Identification of Differentially Expressed Genes and Pathways in Intracranial Aneurysm

Tian¹,

Han²,

Zhang³

et al. 2021

austinjcerebrovascdisstroke

View full text Add to dashboard Cite

Background: Intracranial Aneurysm (IA) is a serious disease with high mortality and high morbidity rates, but the pathophysiological mechanisms of IA remain unclear. This study aimed to identify the Differentially Expressed Genes (DEGs) between IA tissues and Superficial Temporal Artery (STA) tissues using bioinformatic analysis. Methods: To investigate the key genes that are important for IAs, we analyzed microarray datasets (GSE75436) from the Gene Expression Omnibus (GEO) database, including 15 IA samples and 15 normal STA samples. First, we used the GEO2R tool to screen for DEGs (P-value<0.01 and |log2 FC| ≥2) between IA and STA tissues. Subsequently, the Database for Annotation, Visualization, and Integrated Discover software was used to perform function and pathway enrichment analyses. Finally, protein-protein interaction network analysis was performed using the Search Tool for Retrieval of Interacting Genes and Cytoscape software. Real-Time Quantitative Polymerase Chain Reaction (RT-QPCR) was performed to prove our assumption. Results: A total of 829 DEGs, of which 399 were upregulated and 430 were downregulated, were identified. The upregulated genes were mostly associated with Staphylococcus aureus infection, amoebiasis, rheumatoid arthritis, phagocytosis, and tuberculosis. The downregulated genes were mainly involved in vascular smooth muscle contraction, calcium signaling, histidine metabolism, cGMP-PKG signaling, and cAMP signaling. From the DEGs, five genes were selected as hub genes on the basis of the connection degree, which is one of 12 calculation methods from a plugin of Cytoscape called cytoHubba. The PCR results demonstrated that the expression levels of the top five hub genes, namely, Tumor Necrosis Factor (TNF), interleukin 8 (IL-8), Protein Tyrosine Phosphatase Receptor Type C (PTPRC), interleukin 1β (IL-1β), and Toll-like receptor 4 (TLR 4), were significantly higher in the IA samples than in the STA samples. Conclusion: TNF showed higher expression in the IA samples than in the STA samples. Thus, this gene may be involved in the occurrence and development of IA. The immune response and inflammation play important roles in the progression of IA. However, the specific pathophysiological mechanism needs further study.

show abstract

“…Mirror aneurysms of the bilateral internal carotid artery are not uncommon. 15,16 When aneurysms on both sides are large, it is preferable to perform FDDP for the lesions on both sides. However, the larger the aneurysms are, and the more difficult the access to the affected vessels is, the more complications such as the device falling into the aneurysm and/or poor expansion of the device are likely to occur during FDDP, which is often technically difficult.…”

Section: Discussionmentioning

confidence: 99%

Flow diverter device placement for cerebral aneurysm is not effective for the patient with parent artery occlusion for contralateral aneurysm

et al. 2020

View full text Add to dashboard Cite

Purpose There have been many reports on the risks of enlargement and rupture of residual aneurysms and de novo aneurysm formation in the contralateral internal carotid artery after parent artery occlusion (PAO). In the present study, we investigated the efficacy of flow diverter device placement (FDDP) for the treatment of contralateral internal carotid artery aneurysms after PAO. Methods After 11 patients, who had bilateral large or giant internal carotid aneurysms, were treated for either side with PAO or FDDP, they underwent FDDP for residual lesions in our hospital between October 2015 and June 2018. The patients were divided into two groups, depending on the prior procedure: PAO or FDDP. The embolic state after subsequent FDDP was evaluated by angiography. The embolic state was graded using the O’Kelly Marotta scale. Patients’ characteristics and the embolic state of intracranial aneurysms after FDDP were compared between the two groups. Results Comparing patients’ characteristics between the PAO group and FDDP group, statistically significant differences were observed in laterality of the lesions and the interval between prior treatment and FDDP for residual aneurysms ( p < 0.05). The embolic state at the one-year follow-up revealed that there could be significantly sufficient embolisation in the FDDP group ( p < 0.05). Conclusion When FDDP is performed for the contralateral lesion after PAO treatment, it is difficult to attain sufficient embolisation of intracranial aneurysms because haemodynamic load in this procedure is large compared to that in a regular FDDP.

show abstract

Intracranial Mirror Aneurysm: Epidemiology, Rupture Risk, New Imaging, Controversies, and Treatment Strategies

Cited by 19 publications

References 53 publications

Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms

Hemodynamic and Morphological Parameters of Ruptured Mirror Posterior Communicating Artery Aneurysms

Bioinformatic Identification of Differentially Expressed Genes and Pathways in Intracranial Aneurysm

Flow diverter device placement for cerebral aneurysm is not effective for the patient with parent artery occlusion for contralateral aneurysm

Contact Info

Product

Resources

About