The prognostic effects of hemodynamic parameters on rupture of intracranial aneurysm: A systematic review and meta-analysis

Han, Peng; Jin, Dianshi; Wei, Wei; Leng, Xiaolei; Liu, Le; Yu, Jun; Li, Xuqin

doi:10.1016/j.ijsu.2020.12.012

Cited by 30 publications

(21 citation statements)

References 39 publications

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“…Blood flow is characterized by laminar flow, eddy currents, and turbulence. Eddy currents are created by slower laminar flow along the vessel wall and faster flow near the center [ 16 ]. Blood flow to large aneurysms is increased, and combined with the larger cavity, it enhances the formation of eddy current, which can damage the vessel walls and increase platelet aggregation and thrombi formation [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Magnetic Resonance Imaging (HR-MRI) Evaluation of the Distribution and Characteristics of Intra-Aneurysm Thrombosis to Improve Clinical Diagnosis of Thrombotic Intracranial Aneurysm

Chen

et al. 2022

Med Sci Monit

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Background We aimed to analyze the related factors of intracranial anterior circulation saccular artery thrombosis and its characteristics on high-resolution magnetic resonance imaging (HR-MRI) images to provide a basis for neurosurgeons to select the precise treatment strategy for thrombotic intracranial aneurysms (TIA). Material/Methods This retrospective analysis included 136 patients with unruptured intracranial anterior circulation artery aneurysms who underwent HR-MRI. The 136 aneurysms were divided into thrombus (41) and non-thrombus (95) groups. Single factor analysis of morphological and clinical indicators were conducted to select meaningful indicators for logistic regression analysis; the optimal diagnostic threshold was calculated through ROC curve analysis. The location and signal characteristics of thrombi were analyzed to inform clinical treatment. Results Single factor analysis revealed significant differences in patient age, aneurysm size, aneurysm neck, aspect ratio, size ratio, and hyperlipidemia between the 2 groups ( P <0.05). Multi-factor regression analysis demonstrated that aneurysm size (OR=2.180) and aspect ratio value (OR=7.495) were correlated with intracranial thrombosis. ROC curve analysis showed that for aneurysms larger than 8 mm, the sensitivity and specificity of TIA prediction were 83% and 93%, respectively. For aneurysms with aspect ratio values greater than 2.5, sensitivity and specificity of TIA predication were 75% and 95%, respectively. The proportion of aneurysm wall enhancement and clinical symptoms in the thrombus group was significantly higher than that in the non-thrombus group. Conclusions Intracranial unruptured aneurysms with the size larger than 8 mm or with aspect ratio values higher than 2.5 indicated the possible formation of thrombosis in the aneurysm.

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Section: Discussionmentioning

confidence: 99%

High-Resolution Magnetic Resonance Imaging (HR-MRI) Evaluation of the Distribution and Characteristics of Intra-Aneurysm Thrombosis to Improve Clinical Diagnosis of Thrombotic Intracranial Aneurysm

Chen

et al. 2022

Med Sci Monit

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“…In the process of patients with intracranial aneurysm undergoing craniotomy, the blood-brain barrier is vulnerable to severe damage, which greatly increases the risk of intracranial infection. [ 13 ] Intracranial infection is one of the most serious clinical diseases of the central nervous system, and most common intracranial infections are bacterial infections. [ 14 , 15 ] Intracranial infections are more complicated and difficult to treat.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of intracranial infection in patients after intracranial aneurysm surgery

Guo¹,

Fang²,

Wu³

2021

Medicine

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Postoperative intracranial infection after intracranial aneurysm is relatively common in clinical setting; it is necessary to analyze the clinical risk factors of postoperative intracranial infection, to provide reliable evidence to the management of aneurysm. Patients with intracranial aneurysm admitted from January 1, 2016, to November 30, 2020, are included. We collected the patient's personal and treatment data, and analyzed the risk factors of intracranial infection by multivariate logistic regression analysis. We compared the cerebrospinal fluid (CSF) indicators and serological indicators and analyzed their correlation with intracranial infection by spearman analysis. A total of 236 patients with intracranial aneurysm were included; the incidence of postoperative intracranial infection was 12.71%. There were significant differences in the diabetes, intraoperative aneurysm rupture, intraoperative CSF leakage, duration of surgery, and estimated blood loss between infection and non-infection group. Logistic regression indicated that diabetes [odds ratio (OR) 2.053, 95% confidence interval (95% CI) 1.092∼3.385], intraoperative aneurysm rupture (OR 2.239, 95% CI 1.173∼4.312), intraoperative CSF leakage (OR 2.168, 95% CI 1.033∼3.451), duration of surgery ≥360 minutes (OR 1.926, 95% CI 1.108∼2.655), and estimated blood loss ≥125 mL (OR 2.459, 95% CI 1.854∼3.447) were the independent risk factors of postoperative intracranial infection in patients with aneurysm surgery (all P < .05). Klebsiella pneumoniae , Escherichia coli , and Staphylococcus epidermidis were the top 3 commonly seen pathogens. Spearman analyses indicated that PCT, CRP, LA, LDH were all correlated with intracranial infection (all P < .05). There are multiple factors for the postoperative intracranial infection in patients with aneurysm. Coping strategies should be formulated targeted on those risks to improve the prognosis of patients.

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“…The hemodynamic parameters of interest in this work are the local fluid pressure (P), Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), and Directional Wall Shear Stress Gradient (WSSGdir). OSI measures the oscillation of WSS by dividing the magnitude of the time average of the WSS vector with the time average of the magnitude of WSS and has been shown to correlate directly with aneurysm instability and rupture [65].…”

Section: Methodsmentioning

confidence: 99%

“…OSI measures the oscillation of WSS by dividing the magnitude of the time average of the WSS vector with the time average of the magnitude of WSS and has been shown to correlate directly with aneurysm instability and rupture [65].…”

Section: Cfd Analysismentioning

confidence: 99%

Intracranial Aneurysm Wall Displacement Predicts Instability

Pionteck

Abderezaei

Fillingham

et al. 2022

Preprint

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Ruptured intracranial aneurysms (IAs) are catastrophic events associated with a high mortality rate. An estimation of 6 million people in the United States have reported IAs, raising a pressing need for diagnostic tools to assess IAs rupture risks. Current population-based guidelines are imperfect, hence the need for new quantifiable variables and imaging markers. Aneurysm wall motion has been identified as a potential marker of high risk aneurysms, but conventional imaging techniques are challenged by small IAs sizes and limited spatial resolution. Recently, amplified Flow (aFlow) has been introduced as an algorithm which allows visualization and quantification of aneurysm wall motion based on amplification of 4D flow MRI data. In this work, we used aFlow to assess IAs wall motion in patients with growing aneurysms. The results were compared with a patient cohort with stable aneurysms. Among 118 patients with unruptured IAs who underwent sequential surveillance imaging, 10 patients with growing IAs who had baseline 3D TOF-MRA and 4D flow MR imaging were identified and matched with another cohort of patients with stable IAs based on IAs size and location. aFlow was then applied to the 4D flow MR data to amplify the aneurysm wall displacement. Voxel-based values of displacement were extracted for each aneurysm and normalized with respect to the reference parent artery. Following histogram analysis, the highest and lowest IAs displacements were calculated, together with their standard deviation and interquartile ranges. A paired-wise analysis was adopted to assess the differences among clinical variables, demographic data, morphological features, and aFlow parameters between patients with stable versus growing aneurysm. Results demonstrated higher wall motion and higher variability of deformation for the growing aneurysms, possibly due to inhomogeneities of the mechanical characteristics of the vessels walls or to underlying hemodynamics. Computational Fluid Dynamic simulation was also conducted for a subset of 6 stable and 6 growing aneurysms to examine the correlation between hemodynamic parameters, wall motion, and aneurysm stability. The magnitude and variance of directional wall shear stress gradient, in addition to area of colocation of elevated oscillatory shear stress and high variance in pressure, were highly correlated with both wall motion and aneurysm stability. We demonstrated here that the measurement and amplification of the aneurysm wall motion achieved with our method has the potential to differentiate stable from growing aneurysms, and potentially act as a substitute for in depth computational fluid dynamic analysis.

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The prognostic effects of hemodynamic parameters on rupture of intracranial aneurysm: A systematic review and meta-analysis

Cited by 30 publications

References 39 publications

High-Resolution Magnetic Resonance Imaging (HR-MRI) Evaluation of the Distribution and Characteristics of Intra-Aneurysm Thrombosis to Improve Clinical Diagnosis of Thrombotic Intracranial Aneurysm

High-Resolution Magnetic Resonance Imaging (HR-MRI) Evaluation of the Distribution and Characteristics of Intra-Aneurysm Thrombosis to Improve Clinical Diagnosis of Thrombotic Intracranial Aneurysm

Risk factors of intracranial infection in patients after intracranial aneurysm surgery

Intracranial Aneurysm Wall Displacement Predicts Instability

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