scholarly journals Galvos smegenų arterijų aneurizmų maišo ir kaklo santykio klinikinė reikšmė

2007 ◽  
Vol 5 (1) ◽  
pp. 0-0
Author(s):  
Gytis Šustickas ◽  
Jurgita Ušinskienė ◽  
Gintaras Migauskas ◽  
Ugnius Kšanas ◽  
Robertas Kvaščevičius ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Aneurysm Rupture ◽  
Unruptured Aneurysm ◽  
Ruptured Aneurysm ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Emergency Hospital ◽  
Aneurysm Size ◽  
Patient Groups ◽  
Vilnius University

Gytis Šustickas1, Jurgita Ušinskienė2, Gintaras Migauskas1, Ugnius Kšanas1, Robertas Kvaščevičius1, Saulius Širšinaitis1, Jolita Gaidelienė3, Virginija Gaigalaitė11 Vilniaus universiteto Neurologijos ir neurochirurgijos klinikaŠiltnamių g. 29, LT-04130 Vilnius2 Vilniaus universiteto Pulmonologijos ir radiologijos klinika,Santariškių g. 12, LT-08661 Vilnius3 VšĮ Vilniaus greitosios pagalbos universitetinės ligoninės Anesteziologijos skyrius,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslas Sparčiai tobulėjančios kompiuterinės technologijos, gerėjanti galvos smegenų kraujagyslių diagnostika iškėlė naują problemą gydytojams: kaip elgtis su neplyšusia galvos smegenų arterijos aneurizma (GSAA). Jos plyšimo rizikos įvertinimas, prognozinių veiksnių paieška sukėlė naują bangą pasaulinėje neurochirurgijoje ir neuroradiologijoje. Greitai ateis diena, kai kas dvidešimtam pasaulio gyventojui turėsime paaiškinti, koks optimalus jam diagnozuotos galvos smegenų arterijos aneurizmos gydymas. Pagrindinis mūsų tyrimo tikslas – įvertinti aneurizmos maišo ir kaklo santykio klinikinę reikšmę prognozuojant galimą aneurizmos plyšimą. Ligoniai ir metodai Prospektyviai ištirti visi 265 pacientai, 2000–2006 metais VšĮ Vilniaus greitosios pagalbos universitetinės ligoninės Neurochirurgijos ir Reanimacijos skyriuose gydyti nuo galvos smegenų arterijos maišelinės aneurizmos. 23 pacientams diagnozuota neplyšusi, 242 pacientams – plyšusi aneurizma. Šioje grupėje 36 pacientams aneurizma plyšo pakartotinai. Pacientai suskirstyti į tris grupes: neplyšusių (n = 23), plyšusių pirmą kartą (n = 206) ir plyšusių pakartotinai (n = 36) aneurizmų. Atlikti visų maišelinių aneurizmų maišo ir kaklo matavimai, įvertinta aneurizmos lokalizacija, paciento amžius, atlikta statistinė analizė. Verpstinės ir gigantinės aneurizmos į tyrimą neįtrauktos. Rezultatai Galvos smegenų arterijos maišelinės aneurizmos maišo ir kaklo santykis (MKS) statistiškai reikšmingai skyrėsi visose trijose pacientų grupėse: neplyšusių MKS 1,83 ± 0,2 (p < 0,01), plyšusių pirmą kartą – 2,36 ± 0,05 (p < 0,01) ir plyšusių pakartotinai – 3,1 ± 0,08 (p < 0,01). Didėjant MKS, labai daugėjo plyšusių aneurizmų, kad ir kokia būtų aneurizmos lokalizacija. Pats aneurizmos maišo dydis nebuvo toks reikšmingas tirtiems pacientams. Aneurizmos kaklas didesnis greitos kraujotakos arterijose (3,45 ± 0,17 mm), palyginti su lėtos kraujotakos jungiančiosiose arterijose (3,01 ± 0,07 mm; p < 0,05). Išvados Gauti statistiškai reikšmingi MKS duomenys į klinikinę praktiką mums leidžia įtraukti dar vieną labai svarbų GSAA parametrą, kuris gali būti papildomas veiksnys sprendžiant dėl neplyšusios besimptomės aneurizmos gydymo taktikos. Taip pat šis parametras gali būti naudingas numatant plyšusios GSAA aktyvaus gydymo terminus. Pagrindiniai žodžiai: maišo ir kaklo santykis, aneurizmos plyšimo rizika, neplyšusi aneurizma, plyšusi aneurizma, subarachnoidinė hemoragija Clinical significance of cerebral arterial aneurysm dome / neck ratio Gytis Šustickas1, Jurgita Ušinskienė2, Gintaras Migauskas1, Ugnius Kšanas1, Robertas Kvaščevičius1, Saulius Širšinaitis1, Jolita Gaidelienė3, Virginija Gaigalaitė11 Vilnius University, Clinic of Neurology and Neurosurgery,Šiltnamių 29, LT-04130 Vilnius, Lithuania2 Vilnius University, Clinic of Pulmonology and Radiology3 Vilnius University Emergency Hospital, Department of Anaesthesiology,Šiltnamių 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / objective The present prospective study was undertaken to assess the reliability of the aspect ratio (i.e. aneurysm deph to aneurysm neck width) for predicting aneurysm rupture. Unruptured aneurysm, ruptured aneurysm and rebleeded aneurysm patient groups are compared. Aneurysm size, site, patient age and gender also are taken into account. Patients and methods Intraoperative measurements were made of consecutive patients with 265 aneurysms in three patient groups admitted between 2000 and 2006 to Department of Neurosurgery, Vilnius University Emergency Hospital. 23 unruptured aneurysms, 206 ruptured and 36 which rebled where included into the study. Giant and fusiform aneurysms were excuded from the study. Results Aspect ratio was 1.83 ± 0.2 (p < 0.01) for unruptured aneurysms, 2.36 ± 0.05 (p < 0.01) for ruptured and 3.1 ± 0.08 (p < 0.01) which rebled. Aneurysm size has not to be found significant factor for aneurysm rupture in our study. Aneurysm neck was wider on high flow arteries (i.g., MCA and ICA) to compare with low flow arteries (i.g., ACom and PCom) respectively 3.45 ± 0.17 mm and 3.01 ± 0.07 mm (p < 0.05). Conclusion The aspect ratio was found to be a statistically significant important index to calculate for predicting aneurysm rupture. Key words: aspect ratio, dome/neck ratio, aneurysm size, risk of aneurysm rupture, unruptured aneurysm, ruptured aneurysm, subarachnoid hemorrhage

Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms

2013 ◽  
Vol 118 (5) ◽  
pp. 978-983 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Akihiro Uemura ◽  
Motoharu Fujii ◽  
Minobu Kamo ◽  
Osamu Takahashi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Multivariate Logistic Regression Analysis ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
3D Ct Angiography ◽  
Anterior Direction

Object Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture. Methods Data from 140 consecutive patients with ACoA aneurysms managed at the authors' facility between July 2003 and November 2011 were retrospectively reviewed. Patients with (78) and without (62) aneurysm rupture were divided into groups, and morphological and clinical characteristics were compared. Morphological characteristics were evaluated based on 3D CT angiography and included aneurysm location, dominance of the A1 portion of the anterior cerebral artery, direction of the aneurysm dome around the ACoA, aneurysm bleb(s), size of the aneurysm and its neck, aneurysm–parent artery angle, and existence of other intracranial unruptured aneurysms. Results Patients with ruptured ACoA aneurysms were significantly younger (a higher proportion were younger than 60 years of age) than those with unruptured lesions, and a significantly smaller proportion had hypercholesterolemia. A significantly larger proportion of patients with ruptured aneurysms showed an anterior direction of the aneurysm dome around the ACoA, had a bleb(s), and/or had an aneurysm size ≥ 5 mm. Multivariate logistic regression analysis showed that an anterior direction of the aneurysm dome around the ACoA (OR 6.0, p = 0.0012), the presence of a bleb(s) (OR 22, p < 0.0001), and an aneurysm size ≥ 5 mm (OR 3.16, p = 0.035) were significantly associated with ACoA aneurysm rupture. Conclusions Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.

Abstract W MP46: Novel In Vivo Assessment of Unruptured Intracranial Aneurysm Inflammatory Factors: Prospective Analysis of Intra-Aneurysmal Serum Inflammatory Markers in a University Hospital

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Steve M Cordina ◽  
William Gerthoffer ◽  
Anthony Martino ◽  
Russell Wilson ◽  
Dean K Naritoku
Keyword(s):  
Intracranial Aneurysm ◽  
Coil Embolization ◽  
Inflammatory Markers ◽  
Unruptured Aneurysm ◽  
University Hospital ◽  
Complement C3 ◽  
Inflammatory Factors ◽  
Parent Vessel ◽  
Unruptured Aneurysms ◽  
Aneurysm Size

Background: There are known correlations between intracranial aneurysm size as well as underlying demographic risk factors that lead to aneurysm rupture. The treatment of unruptured aneurysms is predicated on this, however selecting which unruptured aneurysms should be treated can be difficult. It is thought that formation, growth and eventual rupture of aneurysms is due to an underlying inflammatory process, which has been shown in pathological studies to exist within aneurysmal walls. The inflammatory milieu within a live aneurysmal sac and its implications for aneurysmal rupture is not currently known. Objective: To determine the presence of inflammatory markers within unruptured aneurysm sacs. Methods: We analyzed prospectively collected data from a database of patients who presented for unruptured aneurysm coil embolization over the span of 25 months to a University Hospital. These patients had blood samples withdrawn from the aneurysm sac immediately prior to coil embolization. This blood was sent for testing, with controls provided by blood sampled from the aneurysm parent vessel. Complement C3 and C4 levels from the aneurysm and parent vessel were then compared using column tables with paired t-test analysis. Results: A total of 8 patients were enrolled. The mean age (± SD) of treated patients was 68 (±15.3) years and 7 (87.5%) were women. 5 aneurysms (62.5%) were in the anterior circulation. Aneurysm size ranged from 5mm to 14mm, mean size 8.9mm (± 3.1mm). 5 patients (62.5%) were white while 7 patients (87.5%) had history of hypertension. C3 and C4 analysis showed a consistent decrease of complement values within the aneurysm as compared to the parent vessel. (For C3, mean of differences [MD] was 9.375, 95% confidence interval [CI] 5.56-13.19. For C4, MD was 1.500, 95% CI 0.50-2.50.) Conclusion: There is an observed decrease in complement values within unruptured aneurysms, suggestive of ongoing classic complement pathway activation. This supports the aneurysm inflammation model, which shows complement deposition in aneurysm walls. Our data suggests that this process is ongoing in live unruptured aneurysms and could be possibly targeted in future aneurysm trials. Further investigation is needed.

Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms

2012 ◽  
Vol 117 (5) ◽  
pp. 913-919 ◽  
Author(s):  
Ning Lin ◽  
Allen Ho ◽  
Bradley A. Gross ◽  
Steven Pieper ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Aneurysm Rupture ◽  
Morphological Parameters ◽  
Flow Angle ◽  
Ruptured Aneurysms ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
Morphological Variables

Object Management of unruptured intracranial aneurysms remains controversial in neurosurgery. The contribution of morphological parameters has not been included in the treatment paradigm in a systematic manner or for any particular aneurysm location. The authors present a large sample of middle cerebral artery (MCA) aneurysms that were assessed using morphological variables to determine the parameters associated with aneurysm rupture. Methods Preoperative CT angiography (CTA) studies were evaluated using Slicer software to generate 3D models of the aneurysms and their surrounding vascular architecture. Morphological parameters examined in each model included 5 variables already defined in the literature (aneurysm size, aspect ratio, aneurysm angle, vessel angle, and size ratio) and 3 novel variables (flow angle, distance to the genu, and parent-daughter angle). Univariate and multivariate statistical analyses were performed to determine statistical significance. Results Between 2005 and 2008, 132 MCA aneurysms were treated at a single institution, and CTA studies of 79 aneurysms (40 ruptured and 39 unruptured) were analyzed. Fifty-three aneurysms were excluded because of reoperation (4), associated AVM (2), or lack of preoperative CTA studies (47). Ruptured aneurysms were associated with larger size, greater aspect ratio, larger aneurysm and flow angles, and smaller parent-daughter angle. Multivariate logistic regression revealed that aspect ratio, flow angle, and parent-daughter angle were the strongest factors associated with ruptured aneurysms. Conclusions Aspect ratio, flow angle, and parent-daughter angle are more strongly associated with ruptured MCA aneurysms than size. The association of parameters independent of aneurysm morphology with ruptured aneurysms suggests that these parameters may be associated with an increased risk of aneurysm rupture. These factors are readily applied in clinical practice and should be considered in addition to aneurysm size when assessing the risk of aneurysm rupture specific to the MCA location.

scholarly journals Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

2016 ◽  
Vol 125 (3) ◽  
pp. 720-729 ◽  
Author(s):  
Sam Safavi-Abbasi ◽  
Felix Moron ◽  
Hai Sun ◽  
Mark E. Oppenlander ◽  
M. Yashar S. Kalani ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Recurrence Rate ◽  
Aneurysm Rupture ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Augmentation Strategies ◽  
Augmentation Techniques ◽  
The Mean ◽  
Clipping Technique

OBJECTIVE To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping (“cotton-clipping” technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton (“cotton-augmentation” technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. METHODS The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. RESULTS The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24–72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10–126 months), the mean GOS score at last follow-up was 4.8. The total number of patient follow-up years was 289.4. During the follow-up period, none of the cotton-clipped aneurysms increased in size, changed in configuration, or rebled. None of the patients experienced early rebleeding. The annual hemorrhage rate for aneurysms treated with cotton-augmentation was 0.52% and the recurrence rate was 1.03% per year. For all patients in the study, the overall risk of hemorrhage was 0.35% per year and the annual recurrence rate was 0.69%. CONCLUSIONS Cotton-clipping is an effective and durable treatment strategy for intraoperative aneurysm rupture and for management of broad-based aneurysms. Cotton-augmentation can be safely used to manage unclippable or partially clipped intracranial aneurysms and affords protection from early aneurysm re-rupture and a relatively low rate of late rehemorrhage.

Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i69-i76 ◽  
Author(s):  
Ning Lin ◽  
Kevin S Cahill ◽  
Kai U Frerichs ◽  
Robert M Friedlander ◽  
Elizabeth B Claus
Keyword(s):  
Hospital Mortality ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysm ◽  
Ruptured Aneurysm ◽  
Teaching Hospitals ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
The Usa ◽  
Over Time

BackgroundIntegration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm.ObjectiveTo describe patterns of use and in-hospital mortality associated with surgical and endovascular treatments of cerebral aneurysms over the past decade.Materials and methodsThe data are 34 899 hospital discharges with a diagnosis of ruptured or unruptured cerebral aneurysm from 1998 to 2007 identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular coiling and surgical clipping and in-hospital mortality among patients with an aneurysm are examined over a decade by hospital and patient demographic characteristics.ResultsFrom 1998 to 2007, 20 134 discharges with a ruptured aneurysm and 14 765 discharges with an unruptured aneurysm were identified. Over this decade, the number of patients discharged with a ruptured aneurysm was stable while the number discharged with an unruptured aneurysm increased significantly. The use of endovascular coiling increased at least twofold for both groups of patient (p<0.001) with the majority of unruptured aneurysms treated with coiling by 2007. Although whites were more likely than non-whites to undergo coiling versus clipping for a ruptured aneurysm (OR=1.30; 95% CI 1.13 to 1.48) and men with unruptured aneurysms were more likely than women to undergo coiling (OR=1.26; 95% CI 1.13 to 1.40), by 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant. Over time the use of coiling spread from primarily large, teaching hospitals to smaller, non-teaching hospitals.ConclusionsThe majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.

Is the Aspect Ratio a Reliable Index for Predicting the Rupture of a Saccular Aneurysm?

Neurosurgery ◽  
2001 ◽  
Vol 48 (3) ◽  
pp. 495-503 ◽  
Author(s):  
Hiroshi Ujiie ◽  
Yoshinori Tamano ◽  
Kuri Sasaki ◽  
Tomokatsu Hori
Keyword(s):  
Aspect Ratio ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Group Versus ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Aspect Ratios ◽  
Aneurysm Size ◽  
The Mean

Abstract OBJECTIVE The present retrospective study was undertaken to prove the reliability of the aspect ratio (aneurysm depth to aneurysm neck width) for predicting an aneurysmal rupture. The aspect ratio is considered a better geometric index than aneurysm size for determining the intra-aneurysmal blood flow. METHODS We measured the aspect ratios and the sizes of aneurysms, as determined by examining angiographic films magnified 1.4×, in 129 patients with ruptured aneurysms and in 72 patients with 78 unruptured aneurysms. After categorizing the aneurysms into four groups on the basis of their locations (aneurysms of the anterior communicating artery, middle cerebral artery, internal carotid artery-posterior communicating artery [ICA-PComA], and other aneurysms), a statistical analysis of ruptured and unruptured aneurysms was performed. RESULTS The mean aneurysm size was found to be statistically significant in the aneurysms at the ICA-PComA and in locations excluding the anterior communicating artery, the middle cerebral artery, and the ICA-PComA. However, the mean aspect ratio was statistically significant at all four locations. In patients with ruptured aneurysms, no ruptured aneurysms with an aspect ratio of less than 1.0 were found. The distribution of the ruptured group versus the unruptured group with an aspect ratio of less than 1.6 at each location was 13 versus 79%, respectively, at the anterior communicating artery, 11 versus 58% at the middle cerebral artery, 11% versus 85% at the ICA-PComA, and 7 versus 81% at other locations. CONCLUSION The aspect ratio between ruptured aneurysms and unruptured aneurysms was found to be statistically significant, and almost 80% of the ruptured aneurysms showed an aspect ratio of more than 1.6, whereas almost 90% of the unruptured aneurysms showed an aspect ratio of less than 1.6. This study therefore suggests that the aspect ratio may be useful in predicting imminent aneurysmal ruptures.

Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms

1981 ◽  
Vol 55 (4) ◽  
pp. 524-526 ◽  
Author(s):  
Olli Heiskanen
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Unruptured Aneurysm ◽  
Ruptured Aneurysm ◽  
Surgical Mortality ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Risk Of Bleeding ◽  
Fatal Bleeding

✓ The author presents a follow-up review of 61 patients with subarachnoid hemorrhage (SAH) and at least two intracranial artery aneurysms, in whom only the ruptured aneurysm had been clipped. During a 10-year follow-up period, seven patients bled from a previously unruptured aneurysm; four of the hemorrhages were fatal. Three additional patients suffered fatal bleeding more than 10 years after the first SAH. The surgical mortality rate when operating on a ruptured aneurysm at this clinic was 4.2% in 1979. Considering that the mortality rate after rebleeding during an average follow-up period of 16 years was 11.5%, operation for unruptured aneurysms seems to have a slight edge over conservative treatment.

Abstract TP77: Simple Morphological Parameters Associated With The Rupture Risk Of Posterior Communicating Artery Aneurysms.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Allen Ho ◽  
Ning Lin ◽  
Mary Stanley ◽  
Nareerat Charoenvimolphan ◽  
Sarthak Misra ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Statistical Significance ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Morphological Parameters ◽  
Rupture Risk ◽  
Flow Angle ◽  
Aneurysm Neck ◽  
Neck Diameter

Introduction: The contribution of morphological characteristics to the treatment decision of unruptured aneurysms has not been established in a systematic and location specific manner. We present a large sample of posterior communicating (PComm) aneurysms that were assessed using a diverse array of morphological variables to determine the parameters associated with aneurysm rupture. Methods: Demographic and clinical risk factors of aneurysm rupture were obtained viachart review. Pre-operative CT angiograms (CTA) were evaluated with 3D Slicer© to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, distance to bifurcation and origin points, aneurysm angle, vessel angles, flow angles, and parent-daughter angles. Univariate and multivariate analyses were performed to determine statistical significance. Results: From 2005-2011, 141 PComm aneurysms were treated in a single institution, and preoperative CTAs from 48 patients (32 ruptured, 16 unruptured) were analyzed. Those that underwent reoperation, were associated with arteriovenous malformations, or lacked a preoperative CTA were excluded. Ruptured aneurysms were associated with smaller volume, greater aspect ratio, greater size ratio, smaller internal carotid artery (ICA) to aneurysm neck angle, larger PComm flow angle, larger ICA to PComm angle, and smaller PComm to daughter vessel angle. Multivariate logistic regression revealed that a larger neck diameter, greater aspect ratio, greater size ratio, and shorter ICA bifurcation to aneurysm distance were the most strongly associated with rupture after adjusting for all other variables. Interestingly, volume of the aneurysm had a smaller effect size than most other variables and rupture risk was associated with smaller volumes. Conclusion: We found that larger neck diameter, greater aspect ratio, greater size ratio, and smaller ICA bifurcation to aneurysm distance to be highly associated with PComm aneurysm rupture. These are easily measured and physically intuitive parameters. They are more strongly associated with PComm aneurysm rupture than size alone and can be readily applied in clinical practice.

168 Wall Enhancement in Unruptured Aneurysms is Associated with Symptomatic Presentation and Size

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 243-243
Author(s):  
Branden John Cord ◽  
Samuel Aramis Cornelio Sommaruga ◽  
Ryan Matthew Hebert ◽  
Ajay Malhotra ◽  
Michelle H Johnson ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Vessel Wall ◽  
Nerve Palsy ◽  
Aneurysm Rupture ◽  
Multivariate Logistic Regression Model ◽  
Rupture Risk ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Aneurysm Wall

Abstract INTRODUCTION Current rupture risk models are based largely on aneurysm size and location. These models are imperfect as reflected in the aneurysm paradox the observation that most ruptured aneurysms are small, but that small, incidentally discovered, unruptured aneurysms harbor the lowest rupture risk. It is difficult to determine which incidentally found aneurysms warrant elective treatment to prevent future rupture. Newer imaging strategies, including high-resolution magnetic resonance vessel wall imaging (MR-VWI) for the first time give us an indirect view of the vessel wall in our aneurysm patients. MR-VWI has already proven to be a potent biomarker of aneurysm rupture, and may also be useful in subcategorizing unruptured aneurysms for further risk stratification. METHODS A prospectively maintained database of unruptured aneurysms imaged with MR-VWI was retrospectively reviewed. Demographic information, medical comorbidities, and aneurysm properties were obtained. Two expert, blinded reviewers scored aneurysms for degree of wall enhancement (none or thin vs thick). A multivariate logistic regression model was built to assess factors that predicted aneurysm wall enhancement. RESULTS >Of the 94 unruptured aneurysms included in the final analysis, 64% had none or thin enhancement, and 36% had thick enhancement (inter-rater kappa 0.86, 95% CI = 0.76-0.96). Symptomatic presentation (both suspicious headache and cranial nerve palsy) was strongly associated with thick aneurysm wall enhancement (suspicious headache OR = 8.6, 95% CI = 1.9-45.7; cranial nerve palsy OR = 219, 95% CI = 13.6-13764). Larger aneurysm size was also independently associated with aneurysm wall enhancement (OR = 1.26/mm, 95% CI = 1.1-1.5). CONCLUSION Symptomatic presentation (suspicious headache, or cranial nerve palsy) and larger aneurysm size were independent predictors for thick aneurysm wall enhancement. This is the first study to determine a relationship between suspicious headache without evidence of overt SAH and aneurysm wall enhancement. This finding provides further evidence that aneurysm wall enhancement may be a useful biomarker to further risk stratify unruptured saccular intracranial aneurysms.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

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