scholarly journals Definition and extraction of 2D shape indices of intracranial aneurysm necks for rupture risk assessment

2021 ◽  
Author(s):  
Sarah Mittenentzwei ◽  
Oliver Beuing ◽  
Belal Neyazi ◽  
I. Erol Sandalcioglu ◽  
Naomi Larsen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Intracranial Aneurysms ◽  
Treatment Decision ◽  
3D Models ◽  
Subsequent Treatment ◽  
Rupture Risk ◽  
Parent Vessel ◽  
Brain Vessels ◽  
Ruptured Aneurysms ◽  
Shape Indices

Abstract Purpose Intracranial aneurysms are local dilations of brain vessels. Their rupture, as well as their treatment, is associated with high risk of morbidity and mortality. In this work, we propose shape indices for aneurysm ostia for the rupture risk assessment of intracranial aneurysms. Methods We analyzed 84 middle cerebral artery bifurcation aneurysms (27 ruptured and 57 unruptured) and their ostia, with respect to their size and shape. We extracted 3D models of the aneurysms and vascular trees. A semi-automatic approach was used to separate the aneurysm from its parent vessel and to reconstruct the ostium. We used known indices to quantitatively describe the aneurysms. For the ostium, we present new shape indices: the 2D Undulation Index (UI$$_\mathrm{2D}$$ 2 D ), the 2D Ellipticity Index (EI$$_\mathrm{2D}$$ 2 D ) and the 2D Noncircularity Index (NCI$$_\mathrm{2D}$$ 2 D ). Results were analyzed using the Student t test, the Mann–Whitney U test and a correlation analysis between indices of the aneurysms and their ostia. Results Of the indices, none was significantly associated with rupture status. Most aneurysms have an NCI$$_\mathrm{2D}$$ 2 D below 0.2. Of the aneurysms that have an NCI$$_\mathrm{2D}$$ 2 D above 0.5, only one is ruptured, which indicates that ruptured aneurysms often have a circular-shaped ostium. Furthermore, the ostia of ruptured aneurysms tend to have a smaller area, which is also correlated with the aneurysm’s size. While also other variables were significantly correlated, strong linear correlations can only be seen between the area of the ostium with the aneurysm’s volume and surface. Conclusion The proposed shape indices open up new possibilities to quantitatively describe and compare ostia, which can be beneficial for rupture risk assessment and subsequent treatment decision. Additionally, this work shows that the ostium area and the size of the aneurysm are correlated. Further longitudinal studies are necessary to analyze whether stable and unstable aneurysms can be distinguished by their ostia.

scholarly journals Clinical application of 3D virtual and printed models for cerebrovascular diseases

2021 ◽  
Author(s):  
Jin Woo Bae ◽  
Da Yeong Lee ◽  
Chang Hwan Pang ◽  
Jeong Eun Kim ◽  
Chul-Kee Park ◽  
...  
Keyword(s):  
3D Printing ◽  
Intracranial Aneurysms ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
3D Models ◽  
Cerebrovascular Diseases ◽  
Brain Vessels ◽  
Cavernous Malformations ◽  
Small Vessels ◽  
Virtual Models

Abstract Three-dimensional (3D) printing techniques are rapidly advancing in the medical industry and in clinical practice. We aimed to evaluate the usefulness of 3D virtual and printed models of 12 representative cerebrovascular diseases, consisting of 9 intracranial aneurysms, 2 cavernous malformations and 1 arteriovenous malformation. Using the software we developed, segmentation of raw data and rendering and modification for 3D virtual models were processed mostly automatically. Among the 12 virtual models, 9 (excluding 3 intracranial aneurysms) were printed with a commercial 3D printing system and materials. Most intracranial structures were satisfactorily made, including the skull, brain, vessels, thrombus, tentorium and major cranial nerves. The 3D models were thought to be very helpful in experiencing the operative views from various directions in advance and in selecting an appropriate surgical approach. However, it was still difficult to discriminate small vessels and cranial nerves, to feel a realistic tactile sense and to directly perform presurgical simulations, such as dissection, removal, clipping and microanastomosis. With advancements in radiological resolution, processing techniques and material properties, 3D modeling is expected to simulate real brain tissues more closely.

Rescue mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms

2016 ◽  
Vol 9 (3) ◽  
pp. 244-249 ◽  
Author(s):  
Jun Hyong Ahn ◽  
Hyo Sub Jun ◽  
Joon Ho Song ◽  
Byung Moon Cho ◽  
Ho Kook Lee ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Mechanical Thrombectomy ◽  
Thromboembolic Complications ◽  
Parent Vessel ◽  
Safety And Efficacy ◽  
Ruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Ruptured Intracranial Aneurysms ◽  
Retrievable Stent

ObjectiveTo examine the safety and efficacy of mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.MethodsBetween June 2011 and June 2015, 631 consecutive patients with ruptured intracranial aneurysms underwent coil embolization at 6 hospitals. Among 53 patients who had thromboembolic complications, 15 patients harboring 15 aneurysms underwent rescue mechanical thrombectomy with a retrievable stent for the treatment of thromboembolic occlusion during the coiling of ruptured aneurysms. The patients' clinical and radiologic outcomes were retrospectively reviewed.ResultsOf the 15 aneurysms, coiling alone was used for 13 (86.7%), and stent-assisted coiling was performed for 2 (13.3%). Thromboembolic occlusion most frequently occurred distal to the aneurysm (n=10, 66.7%), followed by proximal to the aneurysm (n=3, 20%), and at the coil−parent vessel interface (n=2, 13.3%). All patients underwent mechanical thrombectomy with a retrievable stent, including 5 patients who were initially treated with an IA tirofiban infusion. Complete recanalization (Thrombolysis in Cerebral Infarction (TICI) 3) was obtained in 13 (86.7%) and partial recanalization (TICI 2b) in 2 (13.3%). Two patients who had received IA tirofiban before mechanical thrombectomy had hemorrhagic complications. At 6 months after discharge, 9 patients had a modified Rankin Scale (mRS) score of 1, 3 patients were mRS 2, 1 patient was mRS 3, 1 patient was mRS 4, and 1 patient was mRS 6.ConclusionsRescue mechanical thrombectomy using a retrievable stent can be a useful treatment for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.

scholarly journals Survey of European neurosurgeons’ management of unruptured intracranial aneurysms: inconsistent practice and organization

2020 ◽  
Vol 163 (1) ◽  
pp. 113-121
Author(s):  
Torbjørn Øygard Skodvin ◽  
Roar Kloster ◽  
Wilhelm Sorteberg ◽  
Jørgen Gjernes Isaksen
Keyword(s):  
Risk Assessment ◽  
Intracranial Aneurysms ◽  
Treatment Decision ◽  
Gdp Per Capita ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Unruptured Aneurysms ◽  
Additional Information ◽  
Unruptured Intracranial Aneurysms ◽  
Per Capita

Abstract Background The discovery of an unruptured intracranial aneurysm creates a dilemma between observation and treatment. Neurosurgeons’ routines for risk assessment and treatment decision-making are unknown. The position of evidence-based medicine in European neurosurgery is considered to be weak, high-grade guidelines do not exist and variations between institutions are probable. We aimed to explore European neurosurgeons’ management routines for newly discovered unruptured intracranial aneurysms. Methods In cooperation with the European Association of Neurosurgical Societies (EANS), we conducted an online, cross-sectional survey of 420 European neurosurgeons during Spring/Summer 2016 (1533 non-Norwegians invited through the EANS, and 16 Norwegians invited through heads of departments because of the need for additional information for a separate study). We asked about demographic variables, routines for management and risk assessment of newly discovered unruptured intracranial aneurysms and presented a case. We collected information about gross domestic product (GDP) per capita from the International Monetary Fund. Results The response rate to the invite from the EANS was 26%, with respondents from 47 countries. More than half of the respondents (n = 226 [54%]) reported that their department treated less than 25 unruptured aneurysms yearly. Forty percent said their department used aneurysm size cut-off to guide treatment decisions, with a mean size of 6 mm. Presented with a case, respondents from countries with a lower GDP per capita recommended intervention more often than respondents from higher-income countries. Vascular neurosurgeons more commonly recommended observation. Conclusion The answers to this self-reported survey indicate that many centers have a treatment volume lower than recommended by international guidelines, and that there are socioeconomic differences in care. Better documentation of treatment and outcome, for example with clinical quality registries, is needed to drive improvements of care.

scholarly journals Combining visual analytics and case-based reasoning for rupture risk assessment of intracranial aneurysms

2020 ◽  
Vol 15 (9) ◽  
pp. 1525-1535
Author(s):  
Lena Spitz ◽  
Uli Niemann ◽  
Oliver Beuing ◽  
Belal Neyazi ◽  
I. Erol Sandalcioglu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Visual Analytics ◽  
Intracranial Aneurysms ◽  
Case Based Reasoning ◽  
Rupture Risk ◽  
Case Based

scholarly journals Hemodynamics in aneurysm blebs with different wall characteristics

2020 ◽  
pp. neurintsurg-2020-016601
Author(s):  
Seyedeh Fatemeh Salimi Ashkezari ◽  
Fernando Mut ◽  
Bong Jae Chung ◽  
Alexander K Yu ◽  
Christopher J Stapleton ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Shear Stress ◽  
Intracranial Aneurysms ◽  
Wall Stress ◽  
Shear Strain Rate ◽  
Rupture Risk ◽  
Ruptured Aneurysms ◽  
The Relationship ◽  
Development And Evolution

BackgroundBlebs are important secondary structures of intracranial aneurysms associated with increased rupture risk and can affect local wall stress and hemodynamics. Mechanisms of bleb development and evolution are not clearly understood. We investigate the relationship between blebs with different wall characteristics and local hemodynamics and rupture sites.MethodsBlebs with different wall appearances in intra-operative videos were analyzed with image-based computational fluid dynamics. Thin red blebs were compared against thick atherosclerotic/hyperplastic white/yellow blebs. Rupture points were identified in videos of ruptured aneurysms harboring blebs.ResultsThin blebs tended to be closer to the inflow than atherosclerotic blebs of the same aneurysm (P=0.0234). Blebs near the inflow had higher velocity (P=0.0213), vorticity (P=0.0057), shear strain rate (P=0.0084), wall shear stress (WSS) (P=0.0085), and WSS gradient (P=0.0151) than blebs far from the inflow. In a subset of 12 ruptured aneurysms harboring blebs, rupture points were associated with thin blebs in 42% of aneurysms, atherosclerotic blebs in 25%, and were away from blebs in the remaining 33%.ConclusionsNot all blebs are equal; some have thin translucent walls while others have thick atherosclerotic walls. Thin blebs tend to be located closer to the inflow than atherosclerotic blebs. Blebs near the inflow are exposed to stronger flows with higher and spatially variable WSS than blebs far from the inflow which tend to have uniformly lower WSS. Aneurysms can rupture at thin blebs, atherosclerotic blebs, and even away from blebs. Further study of wall failure in aneurysms with different bleb types is needed.

AView: A Clinical Tool for Hemodynamic and Morphological Analysis of Intracranial Aneurysms

2013 ◽  
Author(s):  
Jianping Xiang ◽  
Nicole Varble ◽  
Adnan Siddiqui ◽  
Luca Antiga ◽  
Hui Meng
Keyword(s):  
Risk Assessment ◽  
Intracranial Aneurysms ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
Analysis Tool ◽  
Rupture Risk ◽  
Clinical Workflow ◽  
Clinical Tool ◽  
Workflow System ◽  
Unruptured Intracranial Aneurysms

Neurointerventionists are routinely faced with the dilemma whether or not to treat unruptured intracranial aneurysms. Hemodynamic and morphological characteristics have become important considerations for aneurysm rupture-risk assessment [1]. Clinicians require an integrated tool that analyzes these parameters to help make treatment decisions in clinical workflow, however such a tool does not exist. To this end, Toshiba Stroke and Vascular Research Center (TSVRC) at University at Buffalo and Orobix Srl (Italy) have developed a prototype of a computational workflow system. Termed AView, it is an integrated, image-based vascular analysis tool for rapid assessment of aneurysmal hemodynamics, morphometrics, rupture risk assessment, and treatment planning.

scholarly journals Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study

2021 ◽  
pp. svn-2020-000480
Author(s):  
Xin Feng ◽  
Xin Tong ◽  
Fei Peng ◽  
Hao Niu ◽  
Peng Qi ◽  
...  
Keyword(s):  
Decision Making ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Treatment Decision ◽  
Aneurysm Rupture ◽  
Multivariate Model ◽  
Rupture Risk ◽  
Multiple Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms

Background and purposeApproximately 15%–45% of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms (MIAs). Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients. This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients.MethodsA total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets. Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set. The discriminative accuracy, calibration performance and clinical usefulness of this nomogram were assessed. We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage (SAH) patients and compared its performance with the nomogram model.ResultsMultivariate analyses identified seven variables that were significantly associated with IA rupture (history of SAH, alcohol consumption, female sex, aspect ratio >1.5, posterior circulation, irregular shape and bifurcation location). The clinical and morphological-based MIAs (CMB-MIAs) nomogram model showed good calibration and discrimination (derivation set: area under the curve (AUC)=0.740 validation set: AUC=0.772). Decision curve analysis demonstrated that the nomogram was clinically useful. Compared with the nomogram model, the AUC of multivariate model developed from SAH patients had lower value of 0.730.ConclusionsThis CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort. This nomogram could be used in decision-making and risk stratification in MIAs patients.

scholarly journals Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 491-496 ◽  
Author(s):  
J Mocco ◽  
Robert D Brown ◽  
James C Torner ◽  
Ana W Capuano ◽  
Kyle M Fargen ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Morphological Characteristics ◽  
International Study ◽  
Vessel Diameter ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Unruptured Intracranial Aneurysm ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms

Abstract BACKGROUND There are conflicting data between natural history studies suggesting a very low risk of rupture for small, unruptured intracranial aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured aneurysms than expected. OBJECTIVE To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS A case-control design was used to analyze morphological characteristics associated with aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured aneurysms during follow-up were matched (by size and location) with 198 patients with unruptured intracranial aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, aneurysm angle, neck diameter, parent vessel diameter, and calculated aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). CONCLUSION This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence unruptured intracranial aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.

scholarly journals Comparison of Unruptured Intracranial Aneurysm Treatment Score and PHASES Score in Subarachnoid Hemorrhage Patients With Multiple Intracranial Aneurysms

2021 ◽  
Vol 12 ◽  
Author(s):  
Axel Neulen ◽  
Tobias Pantel ◽  
Jochem König ◽  
Marc A. Brockmann ◽  
Florian Ringel ◽  
...  
Keyword(s):  
Decision Making ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Conservative Management ◽  
Intracranial Aneurysms ◽  
Significant Proportion ◽  
Rupture Risk ◽  
Unruptured Intracranial Aneurysm ◽  
Multiple Intracranial Aneurysms ◽  
Ruptured Aneurysms

Objective: Unruptured Intracranial Aneurysm (UIA) Treatment Score (UIATS) and PHASES score are used to inform treatment decision making for UIAs (treatment or observation). We assessed the ability of the scoring systems to discriminate between ruptured aneurysms and UIAs in a subarachnoid hemorrhage (SAH) cohort with multiple aneurysms.Methods: We retrospectively applied PHASES and UIATS scoring to the aneurysms of 40 consecutive patients with SAH and multiple intracranial aneurysms.Results: PHASES score discriminated better between ruptured aneurysms and UIAs than UIATS. PHASES scores and the difference between the UIATS subscores were higher for ruptured aneurysms compared with UIAs, which reached significance for the PHASES score. PHASES score estimated a low 5-year rupture risk in a larger proportion of the UIAs (≤0.7% in 62.3%, ≤1.7% in 98.4%) than of the ruptured aneurysms (≤0.7% in 22.5%, ≤1.7% in 82.5%). In the 40 ruptured aneurysms, UIATS provided recommendation for treatment in 11 (27.5%), conservative management in 14 (35.0%), and was inconclusive in 15 cases (37.5%). In the 61 UIAs, UIATS recommended treatment in 16 (26.2%), conservative management in 29 (47.5%), and was inconclusive in 16 (26.2%) cases.Conclusion: Similar to previous SAH cohorts, a significant proportion of the ruptured aneurysms exhibited a low-rupture risk. Nevertheless, PHASES score discriminated between ruptured aneurysms and UIAs in our cohort; the lower discriminatory power of UIATS was due to high weights of aneurysm-independent factors. We recommend careful integration of the scores for individual decision making. Large-scale prospective trials are required to establish score-based treatment strategies for UIAs.

scholarly journals Rupture risk assessment for multiple intracranial aneurysms: why there is no need for dozens of clinical, morphological and hemodynamic parameters

2020 ◽  
Vol 13 ◽  
pp. 175628642096615
Author(s):  
Belal Neyazi ◽  
Vanessa M. Swiatek ◽  
Martin Skalej ◽  
Oliver Beuing ◽  
Klaus-Peter Stein ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Residence Time ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Rupture Risk ◽  
Multiple Intracranial Aneurysms ◽  
Unruptured Aneurysms ◽  
Relative Residence Time ◽  
Two Parameters

Introduction: A multitude of approaches have been postulated for assessing the risk of intracranial aneurysm rupture. However, the amount of potential predictive factors is not applicable in clinical practice and they are rejected in favor of the more practical PHASES score. For the subgroup of multiple intracranial aneurysms (MIAs), the PHASES score might severely underestimate the rupture risk, as only the aneurysm with the largest diameter is considered for risk evaluation. Methods: In this study, we investigated 38 patients harboring a total number of 87 MIAs with respect to their morphological and hemodynamical characteristics. For the determination of the best suited parameters regarding their predictive power for aneurysm rupture, we conducted three phases of statistical evaluation. The statistical analysis aimed to identify parameters that differ significantly between ruptured and unruptured aneurysms, show smallest possible correlations among each other and have a high impact on rupture risk prediction. Results: Significant differences between ruptured and unruptured aneurysms were found in 16 out of 49 parameters. The lowest correlation were found for gamma, aspect ratio (AR1), aneurysm maximal relative residence time (Aneurysm_RRT_max) and aneurysm mean relative residence time. The data-driven parameter selection yielded a significant correlation of only two parameters (AR1 and the Aneurysm_RRT_max) with rupture state (area under curve = 0.75). Conclusion: A high number of established morphological and hemodynamical parameters seem to have no or only low effect on prediction of aneurysm rupture in patients with MIAs. For best possible rupture risk assessment of patients with MIAs, only the morphological parameter AR1 and the hemodynamical parameter Aneurysm_RRT_max need to be included in the prediction model.

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