Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Brinjikji, Waleed; Zhang, Donghui; Lanzino, Giuseppe; Cloft, Harry J.; Murad, M. Hassan; Wang, Z.; Kallmes, David F.

doi:10.3174/ajnr.a4575

Cited by 166 publications

(113 citation statements)

References 39 publications

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“…However, un-ruptured cerebral aneurysms are common in the general population and have an estimated prevalence of between 2% and 6% [19]. The pathophysiology of cerebral aneurysm formation and rupture has not been fully defined, but risk factors including increased age, gender, hypertension, excessive alcohol intake, and smoking have been identified [19][20][21]. Research has shown haemodynamic stress as a critical factor in the pathogenesis of cerebral aneurysm, leading to endothelial dysfunction, inflammatory cell infiltration, and remodelling of the arterial wall [22,23].…”

Section: Introductionmentioning

confidence: 99%

The structural properties of carotid arteries in carotid artery diseases – a retrospective computed tomography angiography study

Özdemir¹

2020

Pol J Radiol

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Purpose: Aim of the study was to find answers to the following questions: What haemodynamic changes may occur in patients with stenotic, aneurysmal, dissection of the carotid artery and its branches? How do these changes differ in patients with normal and carotid disease? Material and methods: In order to achieve this aim, the cranio-cervical CT angiography images of patients who were referred to our clinic for any reason and received the diagnosis of carotid stenosis, carotid dissection, and extra or intracranial aneurysm were reviewed retrospectively. Results: Significant differences were detected in the carotid arteries of normal patients and those with aneurysm and dissection. When normal and aneurismal patients were compared, right and left ICA diameters (p = 0.000, p = 0.002, respectively), total ICA diameters (p = 0.000), carotid left Ø diameters (p = 0.026), right and left total Ø diameters (p = 0.024), and Murray's and our cosine values of Ø angles (p = 0.001 and p = 0.022, respectively) were found to be different. Also, in a comparison made between normal patients and patients with dissection, right CCA (p = 0.000), ICA (p = 0.001), ECA (p = 0.004) diameters, total CCA (p = 0.001), ICA (p = 0.009), and ECA (p = 0.003) diameters were also found to be different. Conclusions: This study showed that the presence of aneurysm plays an important role in the remodelling of the carotid arteries. Also, it is understood that Murray's laws are still valid for the detection of structural deterioration in carotid artery diseases. Hence, it is believed that these data can be used in artificial intelligence studies.

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Section: Introductionmentioning

confidence: 99%

The structural properties of carotid arteries in carotid artery diseases – a retrospective computed tomography angiography study

Özdemir¹

2020

Pol J Radiol

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“…ies of UIAs are impossible to complete nowadays without treatment selection, interest has been focused on studies of aneurysm growth, assuming this to be a proxy for aneurysm rupture. 3,5 Most UIA growth studies have also been derived from patient populations with treatment selection bias, however, and most of the growing UIAs in these studies did not rupture. [3][4][5] An almost lifelong follow-up cohort of UIAs seen at the Helsinki University Central Hospital was not subject to treatment selection bias and had been considered to be the highest-quality study and to have the least sources of bias of any prospective natural history studies of both UIA rupture and growth.…”

mentioning

confidence: 99%

“…3,5 Most UIA growth studies have also been derived from patient populations with treatment selection bias, however, and most of the growing UIAs in these studies did not rupture. [3][4][5] An almost lifelong follow-up cohort of UIAs seen at the Helsinki University Central Hospital was not subject to treatment selection bias and had been considered to be the highest-quality study and to have the least sources of bias of any prospective natural history studies of both UIA rupture and growth. 3,5,9 This prospective follow-up study investigated whether risk factors for UIA growth are different for those that lead to rupture than for those that do not.…”

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confidence: 99%

Growth and rupture of unruptured intracranial aneurysms

Juvela¹

2019

Journal of Neurosurgery

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OBJECTIVE Risk factors for growth of unruptured intracranial aneurysms (UIAs) during a lifelong follow-up in relation to subsequent rupture are unknown. The author's aim in this study was to investigate whether risk factors for UIA growth are different for those that lead to rupture than for those that do not. METHODS The series consists of 87 patients with 111 UIAs diagnosed before 1979, when UIAs were not treated. A total follow-up time of the patients was 2648 person-years for all-cause death and 2182 years when patients were monitored until the first rupture, death due to unrelated causes, or the last contact (annual incidence of aneurysm rupture, 1.2%). The follow-up time between aneurysm measurements was 1669 person-years. Risk factors for UIA growth were analyzed in relation to subsequent rupture. RESULTS The median follow-up time between aneurysm measurements was 21.7 years (range 1.2-51.0 years). In 40 of the 87 patients (46%), the UIAs increased in size ≥ 1 mm, and in 31 patients (36%) ≥ 3 mm. All ruptured aneurysms in 27 patients grew during the follow-up of 324 person-years (mean growth rates 6.1 mm, 0.92 mm/year, and 37%/year), while growth without rupture occurred in 13 patients during 302 follow-up years (3.9 mm, 0.18 mm/year, and 4%/year) and no growth occurred in 47 patients during 1043 follow-up years. None of the 60 patients without aneurysm rupture experienced one during the subsequent 639 follow-up years after the last aneurysm measurement. Independent risk factors for UIA growth (≥ 1 mm) in all patients were female sex (adjusted OR 3.08, 95% CI 1.04-9.13) and smoking throughout the follow-up time (adjusted OR 3.16, 95% CI 1.10-9.10), while only smoking (adjusted OR 4.36, 95% CI 1.27-14.99) was associated with growth resulting in aneurysm rupture. Smoking was the only independent risk factor for UIA growth ≥ 3 mm resulting in aneurysm rupture (adjusted OR 4.03, 95% CI 1.08-15.07). Cigarette smoking at baseline predicted subsequent UIA growth, while smoking at the end of the follow-up was associated with growth resulting in aneurysm rupture. CONCLUSIONS Cigarette smoking is an important risk factor for UIA growth, particularly for growth resulting in rupture. Cessation of smoking may reduce the risk of devastating aneurysm growth.

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“…everal risk factors that predict increased risk of aneurysmal subarachnoid hemorrhage have been reported. 3,6,8,9,11,[14][15][16]18,22,25 Among these factors, aneurysm growth is considered one of the most reliable predictors of increased risk of aneurysmal subarachnoid hemorrhage. 3,8,11,14,22 Thus, it is crucial for clinicians to reliably measure intracranial aneurysms and accurately detect their growth.…”

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confidence: 99%

“…3,6,8,9,11,[14][15][16]18,22,25 Among these factors, aneurysm growth is considered one of the most reliable predictors of increased risk of aneurysmal subarachnoid hemorrhage. 3,8,11,14,22 Thus, it is crucial for clinicians to reliably measure intracranial aneurysms and accurately detect their growth. 2,8,13,18 Imaging intracranial aneurysms can be done using several imaging modalities that are commercially available, such as CT angiography, 2,13,23,24 MR angiography (MRA), 2,7,8,24 digital subtraction angiography, 10,12,26 and 3D rotational angiography.…”

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confidence: 99%

Accuracy of detecting enlargement of aneurysms using different MRI modalities and measurement protocols

Nakagawa

Nagahama²,

Policeni

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Aneurysm growth is considered predictive of future rupture of intracranial aneurysms. However, how accurately neuroradiologists can reliably detect incremental aneurysm growth using clinical MRI is still unknown. The purpose of this study was to assess the agreement rate of detecting aneurysm enlargement employing generally used MRI modalities. METHODS Three silicone flow phantom models, each with 8 aneurysms of various sizes at different sites, were used in this study. The aneurysm models were identical except for an incremental increase in the sizes of the 8 aneurysms, which ranged from 0.4 mm to 2 mm. The phantoms were imaged on 1.5-T and 3-T MRI units with both time-of-flight (TOF) and contrast-enhanced MR angiography. Three independent expert neuroradiologists measured the aneurysms in a blinded manner using different measurement approaches. The individual and agreement detection rates of aneurysm enlargement among the 3 experts were calculated. RESULTS The mean detection rate of any increase in any aneurysmal dimension was 95.7%. The detection rates of the 3 observers (observers A, B, and C) were 98.0%, 96.6%, and 92.7%, respectively (p = 0.22). The detection rates of each MRI modality were 91.3% using 1.5-T TOF, 97.2% using 1.5-T with Gd, 95.8% using 3.0-T TOF, and 97.2% using 3.0-T with Gd (p = 0.31). On the other hand, the mean detection rate for aneurysm enlargement was 54.8%. Specifically, the detection rates of observers A, B, and C were 49.0%, 46.1%, and 66.7%, respectively (p = 0.009). As the incremental enlargement value increased, the detection rate for aneurysm enlargement increased. The use of 1.5-T Gd improved the detection rate for small incremental enlargement (e.g., 0.4-1 mm) of the aneurysm (p = 0.04). The location of the aneurysm also affected the detection rate for aneurysm enlargement (p< 0.0001). CONCLUSIONS The detection rate and interobserver agreement were very high for aneurysm enlargement of 0.4-2 mm. The detection rate for at least 1 increase in any aneurysm dimension did not depend on the choice of MRI modality or measurement protocol. Use of Gd improved the accuracy of measurement. Aneurysm location may influence the accuracy of detecting enlargement.

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Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Cited by 166 publications

References 39 publications

The structural properties of carotid arteries in carotid artery diseases – a retrospective computed tomography angiography study

The structural properties of carotid arteries in carotid artery diseases – a retrospective computed tomography angiography study

Growth and rupture of unruptured intracranial aneurysms

Accuracy of detecting enlargement of aneurysms using different MRI modalities and measurement protocols

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