Risk factors for the progression of unruptured intracranial aneurysms in patients followed by CT/MR angiography

Abstract

The progression of an unruptured intracranial aneurysm (UIA) is associated with a higher rupture risk. The aim of this study was to identify the risk factors for the progression of UIAs among Chinese adults and compare them with the ELAPSS (Earlier subarachnoid hemorrhage, IA Location, Age, Population, IA Size and Shape) score.Methods: Four hundred thirty-eight consecutive patients with 491 UIAs were followed and reviewed retrospectively from August 2011 to November 2019. Follow-up images of the UIAs were used to determine changes in IA size and shape. Patients and IAs were divided into non-progression and progression groups.In addition to the clinical characteristics of the patients, the features of the IAs (e.g., size and shape) were evaluated by computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Independent risk factors for UIA progression were studied using multiple Cox proportional hazards regression analysis. In addition, the diagnostic value of the ELAPSS score for the prediction of UIA progression was calculated.Results: Seventy-two IAs in 68 patients progressed during a mean follow-up time of 24.2±19.68 months.IAs located at the bifurcation [odds ratio (OR) 2.600], with an irregular shape (OR 2.981) or having a high aspect ratio (AR, OR 2.430) were correlated with progression. Based on these three factors, the threshold value of our predictive score was 0.5, and the area under the curve (AUC), sensitivity and specificity were 0.756, 93.1% and 40.6%, respectively, while the AUC, sensitivity and specificity of the ELAPSS score were 0.711, 55.6%, and 75.2%, respectively. Conclusions: IAs located at the bifurcation, with an irregular shape and with an elevated AR are risk factors for UIA progression in the Chinese population. Our predictive score is of great value in predicting the risk of UIA progression.

Increased Levels of Serum IL-15 and TNF-β Indicate the Progression of Human Intracranial Aneurysm

“…Although we have adjusted the imbalances in recorded comorbidities and drugs through PSM, our results may still be influenced by this limitation. Second, as a prediction model for aneurysm growth, the accuracy of ELAPSS score has been confirmed (Feghali et al, 2021;Wang et al, 2021). However, this study lacked follow-up data, and we could not compare the real IA progression rate of our cohort with that estimated by the ELAPSS score, in other words, our results may not represent the real clinical situations.…”

Compare deep learning model and conventional logistic regression model for the identification of unstable saccular intracranial aneurysms in computed tomography angiography

“…All IAs that met the above inclusion criteria were ultimately divided into two groups: stable IAs and unstable IAs. Following previous studies ( 6 , 7 , 21 - 23 ), the IAs were diagnosed as unstable IAs if they met the following criteria: (I) history of SAH due to ruptured but untreated, (II) rupture or growth (the increase in any size to ≥1 mm) or shape change (e.g., formation of blebs and lobes) during follow-up, and (III) neurological symptoms associated with the IA (e.g., sudden headache, blepharoptosis). Of note, ruptured IAs were collected and defined as the unstable group because such IAs are more prone to rebleed.…”

“…The acquired images were transferred to the GE Advantage workstation (Advantage Windows 4.5), where 3D volume renderings (VRs) and maximum-intensity projections (MIPs) were generated. According to published definitions, morphological parameters were measured directly from 3D CTA images ( 6 , 22 ). All images were reviewed independently by two neuroradiologists with 10 and 20 years of experience.…”

“…At present, the management of unruptured IAs is still controversial. The progression of IAs is correlated with hypertension, age, earlier SAH, size, location, and shape (PHAESE score) ( 6 - 8 ) and results in a higher risk of rupture, in which case the IA is defined as an unstable IA ( 9 ). Thus, it is crucial to distinguish unstable from stable IAs as early as possible to derive optimal clinical decision-making for further treatment or follow-up.…”

Low-profile visualized intraluminal support-within-Enterprise overlapping-stent technique versus flow diversion in the treatment of intracranial vertebrobasilar trunk dissecting aneurysms

“…An intracranial vertebrobasilar trunk dissecting aneurysm (VBTDA) is defined as an aneurysm originating from the arterial segment from the intradural segment of the vertebral artery (VA) up to the origin of the superior cerebellar artery (1). A VBTDA is a rare condition that has high risks of mortality and disability compared to an anterior circulation aneurysm due to its specific location, pathological features, and relationship to the perforating branches (1)(2)(3)(4)(5). Furthermore, due to the limited surgical accessibility and the relationship to the perforating branches, open surgical options are not recommended and are often associated with high morbidity and mortality rates (6,7).…”