Risk Factors for Intracranial Aneurysm Rupture: A Systematic Review

Kleinloog, Rachel; Mul, Nikki de; Verweij, Bon H.; Post, Jan Andries; Rinkel, Gabriël J.E.; Ruigrok, Ynte M.

doi:10.1093/neuros/nyx238

Cited by 101 publications

(68 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, a larger aneurysm size is commonly related to an increased rupture risk [14,17], which is conflicting with the negative association with aneurysm width in our model. However, some research indicates that the ratio between aneurysm and parent vessel size is a better discriminant between ruptured and unruptured aneurysms [12]. Moreover, aneurysm width did not differ significantly between ruptured and unruptured aneurysms in our univariate comparison.…”

Section: Discussionmentioning

confidence: 52%

“…It is known that hemodynamics play an important role in the aneurysm pathogenesis [10]. Hemodynamics in turn are influenced by aneurysm geometry, and several morphological parameters have been related to aneurysm rupture [11, 12]. Further risk factors include aneurysm location, symptoms caused by the aneurysm, as well as the patient’s age and smoking and hypertension status [7, 13–16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Several investigators found strong correlations between greater SR and rupture status. 61,68 In their systematic review and meta-analysis, Kleinloog et al 33 identified irregular aneurysm shape, larger AR, larger SR, higher bottleneck factor (aneurysm width divided by the diameter of the neck), and aneurysm height-to-width ratio as morphological characteristics with strong levels of evidence for increased risk of rupture. Morphological characteristics with moderate levels of evidence for association with rupture included downward/inferior direction of the dome and volume-toostium ratio (ratio of the aneurysm volume to the area of the neck).…”

mentioning

confidence: 99%

The biophysical role of hemodynamics in the pathogenesis of cerebral aneurysm formation and rupture

Soldozy¹,

Norat²,

Elsarrag³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

The pathogenesis of intracranial aneurysms remains complex and multifactorial. While vascular, genetic, and epidemiological factors play a role, nascent aneurysm formation is believed to be induced by hemodynamic forces. Hemodynamic stresses and vascular insults lead to additional aneurysm and vessel remodeling. Advanced imaging techniques allow us to better define the roles of aneurysm and vessel morphology and hemodynamic parameters, such as wall shear stress, oscillatory shear index, and patterns of flow on aneurysm formation, growth, and rupture. While a complete understanding of the interplay between these hemodynamic variables remains elusive, the authors review the efforts that have been made over the past several decades in an attempt to elucidate the physical and biological interactions that govern aneurysm pathophysiology. Furthermore, the current clinical utility of hemodynamics in predicting aneurysm rupture is discussed.

show abstract

“…12,17,23 The pathophysiological mechanisms leading to aneurysm rupture are not yet fully understood; however, a plethora of risk factors have been suggested in the literature. 13 These risk factors include patient-related variables such as sex or smoking status, genetics, geometric factors describing the shape of an IA, and hemodynamic factors. Hemodynamics are believed to play an important role in aneurysm development, growth, and rupture through biomechanical signaling processes in the vessel wall.…”

mentioning

confidence: 99%

Extending statistical learning for aneurysm rupture assessment to Finnish and Japanese populations using morphology, hemodynamics, and patient characteristics

Detmer¹,

Hadad²,

Chung

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEIncidental aneurysms pose a challenge for physicians, who need to weigh the rupture risk against the risks associated with treatment and its complications. A statistical model could potentially support such treatment decisions. A recently developed aneurysm rupture probability model performed well in the US data used for model training and in data from two European cohorts for external validation. Because Japanese and Finnish patients are known to have a higher aneurysm rupture risk, the authors’ goals in the present study were to evaluate this model using data from Japanese and Finnish patients and to compare it with new models trained with Finnish and Japanese data.METHODSPatient and image data on 2129 aneurysms in 1472 patients were used. Of these aneurysm cases, 1631 had been collected mainly from US hospitals, 249 from European (other than Finnish) hospitals, 147 from Japanese hospitals, and 102 from Finnish hospitals. Computational fluid dynamics simulations and shape analyses were conducted to quantitatively characterize each aneurysm’s shape and hemodynamics. Next, the previously developed model’s discrimination was evaluated using the Finnish and Japanese data in terms of the area under the receiver operating characteristic curve (AUC). Models with and without interaction terms between patient population and aneurysm characteristics were trained and evaluated including data from all four cohorts obtained by repeatedly randomly splitting the data into training and test data.RESULTSThe US model’s AUC was reduced to 0.70 and 0.72, respectively, in the Finnish and Japanese data compared to 0.82 and 0.86 in the European and US data. When training the model with Japanese and Finnish data, the average AUC increased only slightly for the Finnish sample (to 0.76 ± 0.16) and Finnish and Japanese cases combined (from 0.74 to 0.75 ± 0.14) and decreased for the Japanese data (to 0.66 ± 0.33). In models including interaction terms, the AUC in the Finnish and Japanese data combined increased significantly to 0.83 ± 0.10.CONCLUSIONSDeveloping an aneurysm rupture prediction model that applies to Japanese and Finnish aneurysms requires including data from these two cohorts for model training, as well as interaction terms between patient population and the other variables in the model. When including this information, the performance of such a model with Japanese and Finnish data is close to its performance with US or European data. These results suggest that population-specific differences determine how hemodynamics and shape associate with rupture risk in intracranial aneurysms.

show abstract

Risk Factors for Intracranial Aneurysm Rupture: A Systematic Review

Cited by 101 publications

References 29 publications

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics

The biophysical role of hemodynamics in the pathogenesis of cerebral aneurysm formation and rupture

Extending statistical learning for aneurysm rupture assessment to Finnish and Japanese populations using morphology, hemodynamics, and patient characteristics

Contact Info

Product

Resources

About