Morphology of Ruptured and Unruptured Intracranial Aneurysms

Abboud, Tammam; Rustom, Jihad; Bester, Maxim; Czorlich, Patrick; Vittorazzi, Eik; Pinnschmidt, Hans O.; Westphal, Manfred; Regelsberger, Jan

doi:10.1016/j.wneu.2016.12.053

Cited by 58 publications

(39 citation statements)

References 21 publications

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“…In general, the irregular lumen may cause blood flow to swirl locally, making a lower wall shear stress (WSS) and higher oscillatory shear index (OSI), and thus increase the risk of aneurysm rupture (15). Zhang and Abboud, studying the correlation between geometric features of the aneurysms and volume of aneurysmal hemorrhage, reported that patients with irregular aneurysms have a high volume (10,16). Our data also indicate that irregular aneurysms are an independent risk factor for the volume of aneurysmal hemorrhage (P = 0.003 < 0.01).…”

Section: Discussionsupporting

confidence: 66%

Risk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms

Zhang

Liu

et al. 2020

Front. Surg.

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Purpose: To explore the influencing factors of volume hemorrhage in ruptured anterior circulation aneurysms, so as to identify the characteristics of anterior circulation aneurysms with high volume of hemorrhage, and to provide advice for clinical diagnosis and treatment for those aneurysms. Methods: We retrospectively reviewed 437 cases of ruptured anterior intracranial aneurysms in our center between the years 2012 and 2017. According to the inclusion criteria, a total of 100 qualified patients were screened out. We collected demographic characteristics, environmental exposure, and admission status of enrolled patients. In addition, morphological parameters and location of aneurysms were also included. The semiautomatic threshold method was used to measure the volume of hemorrhage. According to the results, the patients were divided into the group with high blood volume and low blood volume. Univariate and multivariate logistic regression analyses were used to discover the related factors affecting the bleeding volume. Results: In univariable analysis, pulse pressure ( P = 0.014) showed a significant difference at the P < 0.05 test level. In terms of aneurysm morphology, the irregular shape ( P < 0.001), calcification ( P = 0.001), and flow angle ( P = 0.006) showed significant statistical differences between the two groups at the P < 0.01 level ( P < 0.01). Multivariate logistic regression analysis showed that irregular shape (OR = 5.370 P = 0.002 < 0.05), large flow angle (OR = 1.033 P = 0.016 < 0.05), and calcification (OR = 5.460 P = 0.003 < 0.05) were risk factors for volume of hemorrhage in ruptured anterior circulation aneurysms. The influence of hypertension history was at critical state (OR = 2.877 P = 0.051 > 005). Conclusions: According to our analysis results, intracranial anterior circulation aneurysms with irregular shapes, calcifications, and large flow angle are more dangerous. Aneurysms with these characteristics often have a large amount of hemorrhage, requiring timely treatment in clinical practice.

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Section: Discussionsupporting

confidence: 66%

Risk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms

Zhang

Liu

et al. 2020

Front. Surg.

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“…In contrast, irregular aneurysms or those with a daughter sac have a complex flow dynamic showing changes in the direction of the inflow jet with the generation or destruction of a single vortex or multiple vortices 47 . Thus, aneurysms with high H/W ratios or daughter sacs are likely to rupture 48 , 49 . In the present study, we didn’t observe any SIAs with obvious daughter sacs, but many of them were irregular shape, and the average H/W ratio of the ruptured SIAs was significant higher than that of the unruptured ones ( p = 0.003), indicating the potential value of using H/W ratio as a clinical predictor for SIA rupture risk.…”

Section: Discussionmentioning

confidence: 99%

Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms

Duan

Guan

et al. 2018

Sci Rep

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Characterization of the rupture risk factors for small intracranial aneurysms (SIAs, ≤5 mm) is clinically valuable. The present study aims to identify image-based morphological parameters and anatomical locations associated with the rupture status of SIAs. Two hundred and sixty-three patients with single SIAs (128 ruptured, 135 unruptured) were included, and six morphological parameters, including size, aspect ratio (AR), size ratio (SR), height–width ratio (H/W), flow angle (FA) and aneurysm width–parent artery diameter ratio, and the aneurysm locations were evaluated using three-dimensional geometry, and were used to identify a correlation with aneurysm rupture. Statistically significant differences were observed between ruptured and unruptured groups for AR, SR, H/W, FA, and aneurysm locations, from univariate analyses. Logistic regression analysis further revealed that AR (p = 0.034), SR (p = 0.004), H/W (p = 0.003), and FA (p < 0.001) had the strongest independent correlation with ruptured SIAs after adjustment for age, gender and other clinical risk factors. A future study on a larger SIA cohort need to establish to what extent the AR, SR, H/W and FA increase the risk of rupture in patients with unruptured SIAs in terms of absolute risks.

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“…[ 32 ] Other groups have shown similar associations between aneurysm irregularity and rupture. [ 1 23 33 ] The exact reason that irregularity is associated with rupture is still debated with some evidence to suggest that there is higher shear stress at or adjacent to blebs,[ 35 54 ] and an inherent weakness in the wall of the aneurysm at the site of the irregularity. Our results are similar with irregular morphology showing the strongest association with rupture.…”

Section: Discussionmentioning

confidence: 99%

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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Morphology of Ruptured and Unruptured Intracranial Aneurysms

Cited by 58 publications

References 21 publications

Risk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms

Risk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms

Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms

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

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