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Bing Zhao - One of the best experts on this subject based on the ideXlab platform.

  • larger Size ratio associated with the rupture of very small 3 mm anterior communicating artery Aneurysms
    Journal of NeuroInterventional Surgery, 2017
    Co-Authors: Boli Lin, S L Liu, Xiaotong Shao, Nengzhi Xia, Yue Zhang, Yunjun Yang, Ming Zhong, Qichuan Zhuge, Bing Zhao
    Abstract:

    Background Anterior communicating artery (AcoA) Aneurysms have a high rupture risk, and ruptured AcoA Aneurysms tend to be smaller than other intracranial Aneurysms. We aimed to determine the incidence and morphologic predictors of Aneurysm rupture of very small AcoA Aneurysms. Methods We conducted a retrospective analysis of 519 consecutive patients with single AcoA Aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small Aneurysms were defined as those with a maximum Size ≤3 mm, and small Aneurysms were defined as those with a maximum Size ≤5 mm. Multivariate regression analyses were used to determine the association between Aneurysm morphology and Aneurysm rupture status. Results Of the 474 ruptured AcoA Aneurysms, 134 (28.3%) Aneurysms were very small and 278 (58.6%) Aneurysms were small. In the univariate analysis for very small Aneurysms, larger Aneurysm Size (p=0.037), larger Size ratio (p=0.002), higher Aneurysm height (p=0.038), smaller vessel Size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with Aneurysm rupture. Multivariate analysis revealed that a larger Size ratio was independently associated with the rupture status of the very small Aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger Aneurysm Size, larger Size ratio, and dominant A1 segment configuration were associated with the rupture of small Aneurysms. Conclusions About one-third of ruptured AcoA Aneurysms were very small. A larger Size ratio, rather than other Aneurysm morphologies, was independently associated with the rupture of very small AcoA Aneurysms.

  • smoking associated with increased Aneurysm Size in patients with anterior communicating artery Aneurysms
    World Neurosurgery, 2016
    Co-Authors: Nengzhi Xia, Yunjun Yang, Ming Zhong, Qichuan Zhuge, Bing Zhao, Weijian Chen, Liang Hao Fan, Yijun Liu
    Abstract:

    Background Hypertension and smoking are risk factors for Aneurysm formation or rupture. We aimed to identify differences in Aneurysm morphologies associated with hypertension or smoking in patients with anterior communicating artery (AcoA) Aneurysms. Methods Between December 2007 and February 2015, 574 consecutive patients with AcoA Aneurysms were identified from the Electronic Medical Record System. We extracted data on histories of hypertension alone, smoking alone, nonhypertension and nonsmoking, and both hypertension and smoking. The morphologic parameters of Aneurysms were remeasured via computed tomography angiography image reconstruction. Multivariate logistic regression analyses were used to determine the differences in morphologies in patients with hypertension or who smoked. Results In the study, 495 patients with single AcoA Aneurysm were included. Age, sex, vessel Size, Aneurysm Size and height, Size ratio, A1 segment configuration, and Aneurysm shape were significantly different among the groups. A larger Aneurysm occurred more often in patients who only smoked compared with those without hypertension who did not smoke (adjusted odds ratio, 1.19; 95% confidence interval, 1.04–1.36; P  = 0.012). Patients with hypertension who also smoked more commonly had a larger Aneurysm Size than those with hypertension alone (adjusted odds ratio, 0.89; 95% confidence interval, 0.79–0.99; P = 0.040). There were significant differences in age, sex, and Aneurysm morphology between the smoking patients and those with hypertension alone. Conclusions Aneurysm Size was an independent morphologic parameter associated with smoking in patients with ACoA Aneurysms compared with other Aneurysm morphologies. Smoking may be associated independently with increased Aneurysm Size and should be given up in patients with AcoA Aneurysms.

David Saloner - One of the best experts on this subject based on the ideXlab platform.

  • wall enhancement on black blood mri is independently associated with symptomatic status of unruptured intracranial saccular Aneurysm
    European Radiology, 2020
    Co-Authors: Chengcheng Zhu, Xinrui Wang, Andrew J Degnan, Zhang Shi, Bing Tian, Qi Liu, Christopher P Hess, Laura Eisenmenger, David Saloner
    Abstract:

    This study aims to investigate whether Aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial Aneurysms (UIAs). One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to Aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and Aneurysm Size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for Aneurysms Size < 10 mm. Symptomatic UIAs had significantly larger Aneurysm Size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to Aneurysm Size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of Aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms. Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes. • Symptomatic intracranial Aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic Aneurysms. • Larger wall enhancement area is independently associated with symptomatic intracranial Aneurysm.

  • wall enhancement on black blood mri is independently associated with symptomatic status of unruptured intracranial saccular Aneurysm
    European Radiology, 2020
    Co-Authors: Xinrui Wang, Andrew J Degnan, Bing Tian, Christopher P Hess, David Saloner, Laura Eisenmenger, Jianping Lu
    Abstract:

    OBJECTIVE This study aims to investigate whether Aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial Aneurysms (UIAs). METHODS One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to Aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and Aneurysm Size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for Aneurysms Size < 10 mm. RESULTS Symptomatic UIAs had significantly larger Aneurysm Size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to Aneurysm Size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of Aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms. CONCLUSIONS Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes. KEY POINTS • Symptomatic intracranial Aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic Aneurysms. • Larger wall enhancement area is independently associated with symptomatic intracranial Aneurysm.

  • wall stress analyses in patients with 5 cm versus 5 cm ascending thoracic aortic Aneurysm
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Zhongjie Wang, Yue Xuan, Michael D Hope, Julius M Guccione, David Saloner, Andrew D Wisneski, Nick Flores, Matthew Y Lum, Justin Inman, Elaine E Tseng
    Abstract:

    Abstract Objective Current guidelines for elective surgery of ascending thoracic aortic Aneurysms (aTAAs) use Aneurysm Size as primary determinant for risk stratification of adverse events. Biomechanically, dissection may occur when wall stress exceeds wall strength. Determining patient-specific aTAA wall stresses by finite element analysis can potentially predict patient-specific risk of dissection. This study compared peak wall stresses in patients with ≥5.0 cm versus Methods Patients with aTAA ≥5.0 cm (n = 47) and Results Peak circumferential stresses at systolic pressure were 530 ± 83 kPa for aTAA ≥5.0 cm versus 486 ± 87 kPa for aTAA Conclusions Peak patient-specific aTAA wall stresses overall were larger for ≥5.0 cm than aTAA

  • wall enhancement of intracranial unruptured Aneurysm is associated with increased rupture risk and traditional risk factors
    European Radiology, 2018
    Co-Authors: Chengcheng Zhu, Xinrui Wang, Andrew J Degnan, Zhang Shi, Bing Tian, Qi Liu, Christopher P Hess, David Saloner
    Abstract:

    Aneurysm wall enhancement (AWE) on MRI has been considered an imaging marker to indicate active Aneurysm inflammation, but no prospective studies have assessed the ability of AWE to predict rupture risk or growth. We aim to study the association of AWE with traditional risk factors and the estimated rupture risk. Seventy-seven patients (mean age, 58.4 ± 10.8 years; 57% female) with 88 asymptomatic intracranial saccular Aneurysms underwent both 3-T high-resolution MRI and three-dimensional (3D) rotational digital subtraction angiography (DSA). Geometric and morphologic parameters were measured on DSA, and the degree of AWE on MRI was graded. One- and 5-year rupture risks of Aneurysms were estimated using the UCAS and PHASES calculator. Parameters associated with AWE were analyzed using uni- and multivariate logistic regression. Non-internal carotid artery location (OR 3.4, 95% CI 1.6-7.1) and Aneurysm Size (OR 1.9, 95% CI 1.3-2.7) were independently associated with AWE (p < 0.05). Aneurysms with AWE had significantly higher estimated rupture risk (1 and 5 year, 1.9% and 5.8%) than Aneurysms without AWE (0.5% and 2.1%) (p < 0.001). Stronger and larger areas of AWE were correlated with the Aneurysm Size, Size ratio and estimated rupture risk (R2 ≥ 0.30) (p < 0.01). Prospective assessment of asymptomatic intracranial Aneurysms with MRI suggests that AWE is associated with traditional risk factors and estimated short- and medium-term rupture risk. • AWE independently associates with Aneurysm location and Size. • Aneurysms with AWE have higher rupture risk than Aneurysms without AWE. • Stronger and larger areas of AWE correlated with the Aneurysm Size, Size ratio and rupture risk.

Christopher S Ogilvy - One of the best experts on this subject based on the ideXlab platform.

  • combined outcomes of endovascular or surgical treatment of unruptured anterior communicating artery Aneurysms is a more aggressive management strategy warranted
    World Neurosurgery, 2018
    Co-Authors: Philip G R Schmalz, Alejandro Enriquezmarulanda, Abdulrahman Y Alturki, Christopher J Stapleton, Ajith J Thomas, Christopher S Ogilvy
    Abstract:

    Background Updated natural history studies that suggest anterior communicating artery Aneurysms have a higher risk of rupture than formerly appreciated. As endovascular and open techniques advance, morbidity may fall to levels that suggest the feasibility of intervention even for small Aneurysms. This study was conducted to assess the risk associated with treating smaller, unruptured anterior communicating artery Aneurysms. Methods A cross-sectional study of 149 patients with unruptured anterior communicating Aneurysms treated over a 6-year period was performed. Treatment was based on an estimate of the highest efficacy/lowest risk for each patient. Outcomes were recorded at 3 months and 1 year after treatment. The primary outcome measure was a modified Rankin scale score of >2 at 1 year, or persistent cognitive impairment confirmed by a neurologist. Results The average patient age was 61 years (range, 34–84 years), and the median Aneurysm Size was 5.5 mm (interquartile range, 4–7 mm). Clipping was performed in 98 patients (65.8%). Poor outcome was observed in 12 patients (8%). Neither Aneurysm Size nor treatment method was predictive of poor outcome. Both a history of coronary artery disease/myocardial infarction and age were most significantly associated with poor outcome (coronary artery disease/myocardial infarction: odds ratio [OR], 8.11; 95% confidence interval [CI], 2.20–29.86; P = 0.002; age: OR, 1.09; 95% CI, 1.019–1.17; P = 0.013). Dichotomized for age >65 years, the odds of poor outcome increased nearly 11-fold (OR, 10.93; 95% CI, 2.29–52.03; P = 0.003). Conclusions The risk associated with treating unruptured anterior communicating artery Aneurysms in patients age

  • combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide necked intracranial Aneurysms that are unsuitable for clipping or coil embolization
    Journal of Neurosurgery, 2001
    Co-Authors: Brian L Hoh, Christopher M Putman, Ronald F Budzik, Bob S Carter, Christopher S Ogilvy
    Abstract:

    Object. Certain intracranial Aneurysms, because of their fusiform or complex wide-necked structure, giant Size, or involvement with critical perforating or branch vessels, are unamenable to direct surgical clipping or endovascular coil treatment. Management of such lesions requires alternative or novel treatment strategies. Proximal and distal occlusion (trapping) is the most effective strategy. In lesions that cannot be trapped, alteration in blood flow to the “inflow zone,” the site most vulnerable to Aneurysm growth and rupture, is used. Methods. From 1991 to 1999 the combined neurosurgical—neuroendovascular team at the Massachusetts General Hospital (MGH) managed 48 intracranial Aneurysms that could not be clipped or occluded. Intracavernous internal carotid artery Aneurysms were excluded from this analysis. By applying a previously described Aneurysm rupture risk classification system (MGH Grades 0–5) based on the age of the patient, Aneurysm Size, Hunt and Hess grade, Fisher grade, and whether the a...

Robert F Spetzler - One of the best experts on this subject based on the ideXlab platform.

  • analysis of overlapping surgery in patients undergoing microsurgical Aneurysm clipping acute and long term outcomes from the barrow ruptured Aneurysm trial
    Journal of Neurosurgery, 2017
    Co-Authors: Michael A Mooney, Scott Brigeman, Michael A Bohl, Elias D Simon, John P Sheehy, Steve W Chang, Robert F Spetzler
    Abstract:

    OBJECTIVEOverlapping surgery is a controversial subject in medicine today; however, few studies have examined the outcomes of this practice. The authors analyzed outcomes of patients with acutely ruptured saccular Aneurysms who were treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial. Acute and long-term outcomes for overlapping versus nonoverlapping cases were compared.METHODSDuring the study period, 241 patients with ruptured saccular Aneurysms underwent microsurgical clipping. Patients were separated into overlapping (n = 123) and nonoverlapping (n = 118) groups based on surgical start/stop times. Outcomes at discharge and at 6 months, 1 year, 3 years, and 6 years after surgery were analyzed.RESULTSPatient variables (e.g., age, smoking status, cardiovascular history, Hunt and Hess grade, Fisher grade, and Aneurysm Size) were similar between the 2 groups. Aneurysm locations were similar, with the exception of the overlapping group having more...

  • treatment of ruptured anterior communicating artery Aneurysms equipoise in the endovascular era
    Neurosurgery, 2015
    Co-Authors: Karam Moon, Michael R Levitt, Rami O Almefty, Peter Nakaji, Felipe C Albuquerque, Joseph M Zabramski, Cameron G Mcdougall, Robert F Spetzler
    Abstract:

    Background Ruptured anterior communicating artery (ACoA) Aneurysms are heterogeneous intracranial Aneurysms whose diverse morphological features influence treatment modality. Objective To compare clinical outcomes and complications of all ruptured ACoA Aneurysms treated by clipping or coiling in a modern institutional trial. Methods All patients with ruptured ACoA Aneurysms in the Barrow Ruptured Aneurysm Trial were included. Clinical follow-up at 1 and 3 years was analyzed; charts were reviewed for patient demographics, Aneurysm characteristics, and in-hospital complications. Results This cohort included 130 patients (mean age, 52.5 years). Mean Aneurysm Size was 5.8 mm. Most Aneurysm domes projected anteriorly (n = 52). After randomization and crossover, 91 ACoA Aneurysms (70%) were clipped and 39 (30%) were coiled. Twenty-two patients (16.9%) initially randomized to coiling crossed over to clipping after evaluation. No patients crossed over from clipping to coiling. Characteristics precluding Aneurysms from coiling included unfavorable dome-to-neck ratio, lesions difficult to access by catheter, and branch vessel involvement. Aneurysm Size and dome projection were not significantly associated with treatment group, clinical outcome, or retreatment. No significant difference existed in clinical outcome (modified Rankin Scale scores) between groups at discharge or at 1-year or 3-year follow-up using as-treated and intention-to-treat analyses. Retreatment was performed in 3 clipped patients (2.3%) and 3 coiled patients (2.3%). Conclusion Ruptured ACoA Aneurysms, regardless of Size and projection, were safely treated by both treatment modalities in a large-scale randomized clinical trial. Clinical outcomes and stroke rates did not differ significantly in as-treated or intention-to-treat analyses.

Philip G R Schmalz - One of the best experts on this subject based on the ideXlab platform.

  • combined outcomes of endovascular or surgical treatment of unruptured anterior communicating artery Aneurysms is a more aggressive management strategy warranted
    World Neurosurgery, 2018
    Co-Authors: Philip G R Schmalz, Alejandro Enriquezmarulanda, Abdulrahman Y Alturki, Christopher J Stapleton, Ajith J Thomas, Christopher S Ogilvy
    Abstract:

    Background Updated natural history studies that suggest anterior communicating artery Aneurysms have a higher risk of rupture than formerly appreciated. As endovascular and open techniques advance, morbidity may fall to levels that suggest the feasibility of intervention even for small Aneurysms. This study was conducted to assess the risk associated with treating smaller, unruptured anterior communicating artery Aneurysms. Methods A cross-sectional study of 149 patients with unruptured anterior communicating Aneurysms treated over a 6-year period was performed. Treatment was based on an estimate of the highest efficacy/lowest risk for each patient. Outcomes were recorded at 3 months and 1 year after treatment. The primary outcome measure was a modified Rankin scale score of >2 at 1 year, or persistent cognitive impairment confirmed by a neurologist. Results The average patient age was 61 years (range, 34–84 years), and the median Aneurysm Size was 5.5 mm (interquartile range, 4–7 mm). Clipping was performed in 98 patients (65.8%). Poor outcome was observed in 12 patients (8%). Neither Aneurysm Size nor treatment method was predictive of poor outcome. Both a history of coronary artery disease/myocardial infarction and age were most significantly associated with poor outcome (coronary artery disease/myocardial infarction: odds ratio [OR], 8.11; 95% confidence interval [CI], 2.20–29.86; P = 0.002; age: OR, 1.09; 95% CI, 1.019–1.17; P = 0.013). Dichotomized for age >65 years, the odds of poor outcome increased nearly 11-fold (OR, 10.93; 95% CI, 2.29–52.03; P = 0.003). Conclusions The risk associated with treating unruptured anterior communicating artery Aneurysms in patients age