Risk Factors for Asymptomatic Intracranial Small Aneurysm Rupture Determined by Electrocardiographic-Gated 4D Computed Tomographic (CT) Angiography

BackgroundIntracranial aneurysms (IAs) are common in the population and current imaging-based rupture risk assessment needs to be refined. We aimed to use four-dimensional CT angiography (4D-CTA) to investigate the associations of irregular pulsation of IAs with conventional risk factors and the estimated rupture risk.MethodsOne hundred and five patients with 117 asymptomatic IAs underwent 4D-CTA. Geometric and morphologic parameters were measured and the presence of irregular pulsation (defined as a temporary focal protuberance ≥1 mm on more than three successive frames) was identified on 4D-CTA movies. One- and 5 year aneurysm rupture risk were estimated using UCAS and PHASES calculators. Univariate and multivariate analyses were performed to investigate the conventional risk factors associated with irregular pulsation.ResultsIrregular pulsation was observed in 41.0% (48/117) of IAs. Aneurysm size (OR=1.380, 95% CI 1.165 to 1.634), irregular shape (OR=3.737, 95% CI 1.108 to 12.608), and internal carotid artery location (OR=0.151, 95% CI 0.056 to 0.403) were independently associated with irregular pulsation (P<0.05). Aneurysms with irregular pulsation had more than a 6-fold higher estimated rupture risk (1- and 5-year risk [95% CI], 1.56% [0.42%–3.91%], and 2.40% [1.30%–4.30%], respectively) than aneurysms without irregular pulsation (0.23% [0.14%–0.78%] and 0.40% [0.40%–1.30%], respectively) (P<0.001).ConclusionsIAs with irregular pulsation are associated with larger size, irregular-shape, and non-ICA origin, and have more than a 6-fold higher estimated 1- and 5-year rupture risk than aneurysms without irregular pulsation. Irregular pulsation should be validated in future longitudinal studies to determine its predictive value for aneurysm growth and rupture.

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High-Resolution Vessel Wall Magnetic Resonance Imaging of Small Unruptured Intracranial Aneurysms

Journal of Clinical Medicine ◽

10.3390/jcm10020225 ◽

2021 ◽

Vol 10 (2) ◽

pp. 225

Author(s):

Łukasz Zwarzany ◽

Ernest Tyburski ◽

Wojciech Poncyljusz

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Magnetic Resonance ◽

High Resolution ◽

Vessel Wall ◽

Intracranial Aneurysms ◽

Aneurysm Rupture ◽

Resonance Imaging ◽

Aneurysm Wall ◽

Conventional Risk Factors

Background: We decided to investigate whether aneurysm wall enhancement (AWE) on high-resolution vessel wall magnetic resonance imaging (HR VW-MRI) coexists with the conventional risk factors for aneurysm rupture. Methods: We performed HR VW-MRI in 46 patients with 64 unruptured small intracranial aneurysms. Patient demographics and clinical characteristics were recorded. The PHASES score was calculated for each aneurysm. Results: Of the 64 aneurysms, 15 (23.4%) showed wall enhancement on post-contrast HR VW-MRI. Aneurysms with wall enhancement had significantly larger size (p = 0.001), higher dome-to-neck ratio (p = 0.024), and a more irregular shape (p = 0.003) than aneurysms without wall enhancement. The proportion of aneurysms with wall enhancement was significantly higher in older patients (p = 0.011), and those with a history of prior aneurysmal SAH. The mean PHASES score was significantly higher in aneurysms with wall enhancement (p < 0.000). The multivariate logistic regression analysis revealed that aneurysm irregularity and the PHASES score are independently associated with the presence of AWE. Conclusions: Aneurysm wall enhancement on HR VW-MRI coexists with the conventional risk factors for aneurysm rupture.

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Risk Factors for Cerebral Aneurysm Rupture in Mongolia

Clinical Neuroradiology ◽

10.1007/s00062-021-01051-z ◽

2021 ◽

Author(s):

Matthias Bechstein ◽

Amarjargal Gansukh ◽

Boldbat Regzengombo ◽

Oyun Byambajav ◽

Lukas Meyer ◽

...

Keyword(s):

Risk Factors ◽

Medical History ◽

Cerebral Aneurysm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Imaging Modality ◽

Treatment Options ◽

Time Estimation ◽

Developed Countries ◽

Aneurysm Rupture ◽

Risk Of Rupture

Abstract Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

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TCT-102: Multiple Plaque Rupture, Erosion and Stability as Assessed by Optical Coherence Tomography (OCT), Angioscopy, Intravascular Ultrasound (IVUS) and Coronary Computed Tomographic Angiography (CT-angiography)

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2011.10.115 ◽

2011 ◽

Vol 58 (20) ◽

pp. B30

Keyword(s):

Optical Coherence Tomography ◽

Intravascular Ultrasound ◽

Ct Angiography ◽

Plaque Rupture ◽

Computed Tomographic Angiography ◽

Optical Coherence ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽

10.1161/str.51.suppl_1.82 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xinyi Leng ◽

Robert Hurford ◽

Xueyan Feng ◽

Ka Lung Chan ◽

Linxin Li ◽

...

Keyword(s):

Risk Factors ◽

Ct Angiography ◽

Interobserver Agreement ◽

Arterial Stenosis ◽

Minor Stroke ◽

Intracranial Arterial Stenosis ◽

Stroke Patients ◽

Stroke Registry ◽

The Difference ◽

Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

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Increased detection of coronary atherosclerosis on 320-slice computed tomographic angiography with burden of cardiovascular risk factors and complications in patients with type 2 diabetes

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2015.12.019 ◽

2016 ◽

Vol 30 (3) ◽

pp. 494-500 ◽

Cited By ~ 3

Author(s):

Jian Rong ◽

Shu-Rong Bai ◽

Yu-Lian Chen ◽

Ci He

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Coronary Atherosclerosis ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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5201Intra-cardiac thrombus in patients undergoing ventricular tachycardia ablation. a computed tomographic scan study

European Heart Journal ◽

10.1093/eurheartj/ehz746.0059 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F Sacher ◽

P Roumegou ◽

J Duchateau ◽

N Derval ◽

A Denis ◽

...

Keyword(s):

Risk Factors ◽

Right Ventricle ◽

Left Atrium ◽

Left Ventricular ◽

Embolic Event ◽

Computed Tomographic ◽

Cardiac Thrombus ◽

Vt Ablation ◽

The Right ◽

Lv Aneurysm

Abstract Background Embolic event is one of the complications of VT ablation. This may be due to the presence of intra-cardiac thrombus before ablation. However, there is no clear consensus on how to rule out thrombus before the procedure. Objective We sought to examine the prevalence and risk factors of intra-cardiac thrombus with cardiac computed tomographic (CT) scan in patients undergoing scar-related VT ablation. Methods In absence of contra-indication, all patients undergoing scar-related VT ablation at our institution underwent contrast-enhanced cardiac CT within one week before ablation. 324 consecutive patients (292 male, 59±16 yo) have been included in this study. The etiology was ischemic cardiomyopathy (CMP) (n=191), arrhythmogenic right ventricular CMP (ARVC) (n=37), congenital CMP (n=11) or other CMP (n=85). LVEF was <40% in 154 patients (48%). Results Intra-cardiac thrombus was diagnosed in 29 (9%) patients: in the left atrium (n=8), in the right atrium (n=1), in the left ventricle (n=15), in the right ventricle (n=3), in right and left atrium (n=1), and in left atrium and right ventricle (n=1). Moreover in 2, a bilateral pulmonary embolism was identified. The population with thrombus was older (65±12 vs 58±16 years, p=0,005), with more permanent atrial fibrillation (AF) (28% vs 8%; p=0.005). Patients with left ventricular (LV) aneurysm were at higher risk of thrombus 50% vs 3% (p<0.001). The average CHADSVASC score was similar for both groups (2,5 vs 2,1; p=0.179). After matching for age and sex, only ischemic CMP and LV aneurysm were risk factors for thrombus. Because of arrhythmic storm, ablation was performed by epicardial approach only, in 5 patients with intra-ventricular thrombus and by retroaortic approach only, in 2 patients with LAA thrombus. No embolic event occurred during these procedures. Conclusion CT scans help eliminating intra-cardiac thrombus before VT ablation procedure. A high proportion of thrombus (9%) was identified. Whereas LV thrombus should systematically be ruled out before scar related VT ablation, in patients with AF, a LAA thrombus should also be eliminated as well as RV thrombus in patients with ARVC. Acknowledgement/Funding ANR-10-IAHU-04

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