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Bing Zhao - One of the best experts on this subject based on the ideXlab platform.
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prediction of rupture risk in anterior communicating artery Aneurysms with a feed forward artificial neural network
European Radiology, 2018Co-Authors: Jinjin Liu, Boli Lin, Yunjun Yang, Bing Zhao, Weijian Chen, Yongchun Chen, Li Lan, Meihao Wang, Yuxia DuanAbstract:Anterior communicating artery (ACOM) Aneurysms are the most common intracranial Aneurysms, and predicting their rupture risk is challenging. We aimed to predict this risk using a two-layer feed-forward artificial neural network (ANN). 594 ACOM Aneurysms, 54 unruptured and 540 ruptured, were reviewed. A two-layer feed-forward ANN was designed for ACOM Aneurysm rupture-risk analysis. To improve ANN efficiency, an adaptive synthetic (ADASYN) sampling approach was applied to generate more synthetic data for unruptured Aneurysms. Seventeen parameters (13 morphological parameters of ACOM Aneurysm measured from these patients' CT angiography (CTA) images, two demographic factors, and hypertension and smoking histories) were adopted as ANN input. Age, vessel size, Aneurysm height, perpendicular height, Aneurysm neck size, aspect ratio, size ratio, Aneurysm angle, vessel angle, Aneurysm projection, A1 segment configuration, Aneurysm lobulations and hypertension were significantly different between the ruptured and unruptured groups. Areas under the ROC curve for training, validating, testing and overall data sets were 0.953, 0.937, 0.928 and 0.950, respectively. Overall prediction accuracy for raw 594 samples was 94.8 %. This ANN presents good performance and offers a valuable tool for prediction of rupture risk in ACOM Aneurysms, which may facilitate management of unruptured ACOM Aneurysms. • A feed-forward ANN was designed for the prediction of rupture risk in ACOM Aneurysms. • Two demographic parameters, 13 morphological Aneurysm parameters, and hypertension/smoking history were acquired. • An ADASYN sampling approach was used to improve ANN quality. • Overall prediction accuracy of 94.8 % for the raw samples was achieved.
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larger size ratio associated with the rupture of very small 3 mm anterior communicating artery Aneurysms
Journal of NeuroInterventional Surgery, 2017Co-Authors: Boli Lin, S L Liu, Xiaotong Shao, Nengzhi Xia, Yue Zhang, Yunjun Yang, Ming Zhong, Qichuan Zhuge, Bing ZhaoAbstract: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.
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correlation of Aneurysm height size ratio of blood vessel diameter and the risks of Aneurysm rupture
Chinese Journal of Neurosurgery, 2016Co-Authors: Yongchun Chen, Weijian Chen, Shangchao Chen, Xianzhong Guo, Bing ZhaoAbstract:Objective To investigate the relationship between the maximum height of anterior communicating artery(AComA)Aneurysm or the size ratio(SR)of mean diameter of peripheral blood vessels and Aneurysm rupture. Methods The morphological parameters of the Aneurysms in 594 patients with AComA Aneurysm admitted to the Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University from October 2010 to December 2014 were analyzed retrospectively. There were 529 patients with ruptured AcoA Aneurysms and 65 with unruptured AComA Aneurysms. The maximum height of Aneurysms and the mean diameter of the peripheral vessels were collected respectively, and the relationship between SR and AComA Aneurysm rupture in both of them were analyzed at the same time. Results Among the 594 patients with AComA Aneurysm, the mean value of the maximum height of the Aneurysms in the ruptured Aneurysms was 4.26±2.19 mm. It was obviously larger than 2.82±2.04 mm of the unruptured Aneurysms, and the mean diameter of the peripheral blood vessels of the ruptured Aneurysms was 1.91±0.54 mm, it was smaller than the mean diameter of 2.16±0.49 mm in the peripheral blood vessels of the unruptured Aneurysms. There was significant difference between both of them(all P 2 group was significantly higher than that in the SR ≤2 group(P<0.001). After the analysis of ROC curve, the area under the curve of the SR ≤2 value of AComA Aneurysms was 0.744, and the optimal cut-off value was 1.19. Conclusions The size of SR value is significantly associated with the rupture of AComA Aneurysms. When determining the treatment options for patients with AComA Aneurysm in clinical practice, the SR value can be considered as a reference factor. Key words: Intracranial Aneurysm; Anterior communicating artery; Rupture risk; Morphology
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the effect of anterior projection of Aneurysm dome on the rupture of anterior communicating artery Aneurysms compared with posterior projection
Clinical Neurology and Neurosurgery, 2016Co-Authors: Xiaotong Shao, Yunjun Yang, Bing Zhao, Hao Wang, Yan Wang, Yingbao Huang, Jincheng Wang, Weijian ChenAbstract:Abstract Objective Recent studies have shown that anterior projection Aneurysms are associated with increased risk of rupture of anterior communicating artery (ACoA) Aneurysms. We aimed to determine differences in patient characteristics and Aneurysm morphologies between the anterior projection and posterior projection Aneurysm groups and to determine morphological predictors of rupture of the anterior projection Aneurysms. Materials and methods December 2007 to February 2015, 503 consecutive patients with single ACoA Aneurysms were included in this report. The ACoA Aneurysms were dichotomized as the anterior and posterior projection groups. Multivariate regression models were used to determine differences in patient and Aneurysm characteristics between the 2 groups and to determine predictors of rupture in the anterior projection Aneurysms. Results 363 (72.2%) patients had anterior projection Aneurysms and 140 (27.8%) had posterior projection Aneurysms. In univariate analysis, the anterior projection Aneurysms were associated with a larger Aneurysm size, a higher Aneurysm height, a higher perpendicular height, a larger aspect ratio, and a larger size ratio. The multivariate analysis showed that the anterior projection Aneurysms were independently associated with a larger size ratio compared with the posterior projection Aneurysms. A larger size ratio and a smaller vessel size were independently associated with rupture status in the anterior projection Aneurysms. Conclusions Compared with posterior projection Aneurysms, the anterior projection Aneurysms have a higher risk of rupture probably because of significant differences in Aneurysm morphologies. A larger size ratio and a smaller vessel size may be helpful to predict the risk of rupture in the anterior projection Aneurysms.
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sex differences in Aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery Aneurysms a retrospective study
BMJ Open, 2016Co-Authors: Boli Lin, Ming Zhong, Qichuan Zhuge, Bing Zhao, Weijian Chen, Lei Ruan, Yongchun Chen, Liang Hao Fan, Yunjun YangAbstract:Objectives Ruptured anterior communicating artery (ACoA) Aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in Aneurysm morphologies and clinical outcomes in patients with ruptured ACoA Aneurysms. Setting A tertiary referral hospital. Participants A total of 574 consecutive patients with ACoA Aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA Aneurysms were included in the study. Main outcome measures Aneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge. Results The Aneurysm sizes (p=0.001), Aneurysm heights (p=0.011), size ratios (p Conclusions The men were independently associated with larger Aneurysm sizes, greater Aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA Aneurysms.
J Mocco - One of the best experts on this subject based on the ideXlab platform.
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Aneurysm morphology and prediction of rupture an international study of unruptured intracranial Aneurysms analysis
Neurosurgery, 2018Co-Authors: J Mocco, Robert D Brown, James C Torner, David G Piepgras, Irene Meissner, Ana W Capuano, Kyle M Fargen, Madhavan L Raghavan, John HustonAbstract: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.
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pipeline embolization device for small paraophthalmic artery Aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and Aneurysm
Journal of Neurosurgery, 2016Co-Authors: Christoph J Griessenauer, Christopher J Stapleton, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Aman B Patel, Lucy He, Matthew R Fusco, J MoccoAbstract:OBJECTIVE Contemporary treatment for paraophthalmic artery Aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and Aneurysm, especially in smaller Aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic Aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and Aneurysm, radiographic outcomes of Aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography. OA origin was classified as follows: Type 1, OA separate from the Aneurysm; Type 2, OA from the Aneurysm neck; and Type 3, OA from the Aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale, and visual deficits were categorized as transient or permanent. RESULTS The cumulative number of small paraophthalmic Aneurysms treated with PED between 2009 and 2015 at the 4 participating institutions was 69 in 52 patients (54.1 ± 13.7 years of age) with a male-to-female ratio of 1:12. The distribution of OA origin was 72.5% for Type 1, 17.4% for Type 2, and 10.1% for Type 3. Radiographic outcome at the last follow-up (median 11.5 months) was available for 54 Aneurysms (78.3%) with complete, near-complete, and incomplete occlusion rates of 81.5%, 5.6%, and 12.9%, respectively. Two Aneurysms (3%) resulted in transient visual deficits, and no patient experienced a permanent visual deficit. At the last follow-up, the OA was patent in 96.8% of treated Aneurysms. Type 3 OA origin was associated with a lower rate of complete Aneurysm occlusion (p = 0.0297), demonstrating a trend toward visual deficits (p = 0.0797) and a lower rate of OA patency (p = 0.0783). CONCLUSIONS Pipeline embolization treatment of small paraophthalmic Aneurysms is safe and effective. An Aneurysm where the OA arises from the Aneurysm dome may be associated with lower rates of Aneurysm occlusion, OA patency, and higher rates of transient visual deficits.
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pipeline embolization device for small paraophthalmic artery Aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and Aneurysm
Journal of Neurosurgery, 2016Co-Authors: Christoph J Griessenauer, Christopher J Stapleton, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Aman B Patel, Lucy He, Matthew R Fusco, J MoccoAbstract:OBJECTIVE Contemporary treatment for paraophthalmic artery Aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and Aneurysm, especially in smaller Aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic Aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and Aneurysm, radiographic outcomes of Aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography. OA origin was classified as follows: Type 1, OA separate from the Aneurysm; Type 2, OA from the Aneurysm neck; and Type 3, OA from the Aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale, and visual deficits were categorized as transient or permanent. RESULTS The cumulative number of small paraophthalmic Aneurysms treated with PED b...
Christopher J Stapleton - One of the best experts on this subject based on the ideXlab platform.
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decreased wall shear stress at high pressure areas predicts the rupture point in ruptured intracranial Aneurysms
Journal of Neurosurgery, 2020Co-Authors: Tomoaki Suzuki, Christopher J Stapleton, Matthew J Koch, Kazutoshi Tanaka, Soichiro Fujimura, Takashi Suzuki, Takeshi YanagisawaAbstract:OBJECTIVEDegenerative cerebral Aneurysm walls are associated with Aneurysm rupture and subarachnoid hemorrhage. Thin-walled regions (TWRs) represent fragile areas that may eventually lead to Aneurysm rupture. Previous computational fluid dynamics (CFD) studies reported the correlation of maximum pressure (Pmax) areas and TWRs; however, the correlation with Aneurysm rupture has not been established. This study aims to investigate this hemodynamic correlation.METHODSThe Aneurysmal wall surface at the Pmax areas was intraoperatively evaluated using a fluid flow formula under pulsatile blood flow conditions in 23 patients with 23 saccular middle cerebral artery (MCA) bifurcation Aneurysms (16 unruptured and 7 ruptured). The pressure difference (Pd) at the Pmax areas was calculated by subtracting the average pressure (Pave) from the Pmax and normalized by dividing this by the dynamic pressure at the Aneurysm inlet side. The wall shear stress (WSS) was also calculated at the Pmax areas, Aneurysm dome, and parent artery. These hemodynamic parameters were used to validate the correlation with TWRs in unruptured MCA Aneurysms. The characteristic hemodynamic parameters at the rupture points in ruptured MCA Aneurysms were then determined.RESULTSIn 13 of 16 unruptured Aneurysms (81.2%), Pmax areas were identified that corresponded to TWRs. In 5 of the 7 ruptured cerebral Aneurysms, the Pmax areas coincided with the rupture point. At these areas, the Pd values were not higher than those of the TWRs in unruptured cerebral Aneurysms; however, minimum WSS, time-averaged WSS, and normalized WSS at the rupture point were significantly lower than those of the TWRs in unruptured Aneurysms (p < 0.01).CONCLUSIONSAt the Pmax area of TWRs, decreased WSS appears to be the crucial hemodynamic parameter that indicates the risk of Aneurysm rupture.
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pipeline embolization device for small paraophthalmic artery Aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and Aneurysm
Journal of Neurosurgery, 2016Co-Authors: Christoph J Griessenauer, Christopher J Stapleton, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Aman B Patel, Lucy He, Matthew R Fusco, J MoccoAbstract:OBJECTIVE Contemporary treatment for paraophthalmic artery Aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and Aneurysm, especially in smaller Aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic Aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and Aneurysm, radiographic outcomes of Aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography. OA origin was classified as follows: Type 1, OA separate from the Aneurysm; Type 2, OA from the Aneurysm neck; and Type 3, OA from the Aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale, and visual deficits were categorized as transient or permanent. RESULTS The cumulative number of small paraophthalmic Aneurysms treated with PED between 2009 and 2015 at the 4 participating institutions was 69 in 52 patients (54.1 ± 13.7 years of age) with a male-to-female ratio of 1:12. The distribution of OA origin was 72.5% for Type 1, 17.4% for Type 2, and 10.1% for Type 3. Radiographic outcome at the last follow-up (median 11.5 months) was available for 54 Aneurysms (78.3%) with complete, near-complete, and incomplete occlusion rates of 81.5%, 5.6%, and 12.9%, respectively. Two Aneurysms (3%) resulted in transient visual deficits, and no patient experienced a permanent visual deficit. At the last follow-up, the OA was patent in 96.8% of treated Aneurysms. Type 3 OA origin was associated with a lower rate of complete Aneurysm occlusion (p = 0.0297), demonstrating a trend toward visual deficits (p = 0.0797) and a lower rate of OA patency (p = 0.0783). CONCLUSIONS Pipeline embolization treatment of small paraophthalmic Aneurysms is safe and effective. An Aneurysm where the OA arises from the Aneurysm dome may be associated with lower rates of Aneurysm occlusion, OA patency, and higher rates of transient visual deficits.
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pipeline embolization device for small paraophthalmic artery Aneurysms with an emphasis on the anatomical relationship of ophthalmic artery origin and Aneurysm
Journal of Neurosurgery, 2016Co-Authors: Christoph J Griessenauer, Christopher J Stapleton, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Aman B Patel, Lucy He, Matthew R Fusco, J MoccoAbstract:OBJECTIVE Contemporary treatment for paraophthalmic artery Aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and Aneurysm, especially in smaller Aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic Aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and Aneurysm, radiographic outcomes of Aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography. OA origin was classified as follows: Type 1, OA separate from the Aneurysm; Type 2, OA from the Aneurysm neck; and Type 3, OA from the Aneurysm dome. Clinical outcome was assessed using the modified Rankin Scale, and visual deficits were categorized as transient or permanent. RESULTS The cumulative number of small paraophthalmic Aneurysms treated with PED b...
Ashish Sonig - One of the best experts on this subject based on the ideXlab platform.
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neck remnants and the risk of Aneurysm rupture after endovascular treatment with coiling or stent assisted coiling much ado about nothing
Neurosurgery, 2019Co-Authors: Stephan A Munich, Marshall C Cress, Leonardo Rangelcastilla, Ashish SonigAbstract:BACKGROUND Neck remnants are not uncommon after endovascular treatment of cerebral Aneurysms. Critics of endovascular treatments for cerebral Aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of Aneurysm neck remnants following endovascular therapies. OBJECTIVE To assess the clinical significance of residual Aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral Aneurysms. METHODS We retrospectively reviewed the records of 1292 Aneurysm cases that underwent endovascular treatment at 4 institutions. Aneurysms treated by primary coiling or stent-assisted coiling were included in the study; those treated by flow diversion were excluded Aneurysms with residual filling (i.e., Raymond-Roy Occlusion Classification II, neck remnant; or III, residual Aneurysm filling) were assessed for their risk of subsequent rupture. RESULTS A total of 626 Aneurysms were identified as having residual filling immediately posttreatment. Of these, 13 Aneurysms (2.1%) ruptured during the follow-up period (mean 7.3 mo; range 1-84 mo). Eleven of the 13 (84.6%) were ruptured at presentation. Rupture at presentation, the size of the Aneurysm, and the increasing age of the patient were predictive of posttreatment rupture. CONCLUSION We found that unruptured Aneurysms with residual necks following endovascular treatment posed a very low risk of rupture (0.6%). However, patients presenting with ruptured Aneurysms had a higher risk of rerupture from a neck remnant (3.4%). These results highlight the importance of achieving complete angiographic occlusion of ruptured Aneurysms.
Yunjun Yang - One of the best experts on this subject based on the ideXlab platform.
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prediction of rupture risk in anterior communicating artery Aneurysms with a feed forward artificial neural network
European Radiology, 2018Co-Authors: Jinjin Liu, Boli Lin, Yunjun Yang, Bing Zhao, Weijian Chen, Yongchun Chen, Li Lan, Meihao Wang, Yuxia DuanAbstract:Anterior communicating artery (ACOM) Aneurysms are the most common intracranial Aneurysms, and predicting their rupture risk is challenging. We aimed to predict this risk using a two-layer feed-forward artificial neural network (ANN). 594 ACOM Aneurysms, 54 unruptured and 540 ruptured, were reviewed. A two-layer feed-forward ANN was designed for ACOM Aneurysm rupture-risk analysis. To improve ANN efficiency, an adaptive synthetic (ADASYN) sampling approach was applied to generate more synthetic data for unruptured Aneurysms. Seventeen parameters (13 morphological parameters of ACOM Aneurysm measured from these patients' CT angiography (CTA) images, two demographic factors, and hypertension and smoking histories) were adopted as ANN input. Age, vessel size, Aneurysm height, perpendicular height, Aneurysm neck size, aspect ratio, size ratio, Aneurysm angle, vessel angle, Aneurysm projection, A1 segment configuration, Aneurysm lobulations and hypertension were significantly different between the ruptured and unruptured groups. Areas under the ROC curve for training, validating, testing and overall data sets were 0.953, 0.937, 0.928 and 0.950, respectively. Overall prediction accuracy for raw 594 samples was 94.8 %. This ANN presents good performance and offers a valuable tool for prediction of rupture risk in ACOM Aneurysms, which may facilitate management of unruptured ACOM Aneurysms. • A feed-forward ANN was designed for the prediction of rupture risk in ACOM Aneurysms. • Two demographic parameters, 13 morphological Aneurysm parameters, and hypertension/smoking history were acquired. • An ADASYN sampling approach was used to improve ANN quality. • Overall prediction accuracy of 94.8 % for the raw samples was achieved.
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larger size ratio associated with the rupture of very small 3 mm anterior communicating artery Aneurysms
Journal of NeuroInterventional Surgery, 2017Co-Authors: Boli Lin, S L Liu, Xiaotong Shao, Nengzhi Xia, Yue Zhang, Yunjun Yang, Ming Zhong, Qichuan Zhuge, Bing ZhaoAbstract: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.
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the effect of anterior projection of Aneurysm dome on the rupture of anterior communicating artery Aneurysms compared with posterior projection
Clinical Neurology and Neurosurgery, 2016Co-Authors: Xiaotong Shao, Yunjun Yang, Bing Zhao, Hao Wang, Yan Wang, Yingbao Huang, Jincheng Wang, Weijian ChenAbstract:Abstract Objective Recent studies have shown that anterior projection Aneurysms are associated with increased risk of rupture of anterior communicating artery (ACoA) Aneurysms. We aimed to determine differences in patient characteristics and Aneurysm morphologies between the anterior projection and posterior projection Aneurysm groups and to determine morphological predictors of rupture of the anterior projection Aneurysms. Materials and methods December 2007 to February 2015, 503 consecutive patients with single ACoA Aneurysms were included in this report. The ACoA Aneurysms were dichotomized as the anterior and posterior projection groups. Multivariate regression models were used to determine differences in patient and Aneurysm characteristics between the 2 groups and to determine predictors of rupture in the anterior projection Aneurysms. Results 363 (72.2%) patients had anterior projection Aneurysms and 140 (27.8%) had posterior projection Aneurysms. In univariate analysis, the anterior projection Aneurysms were associated with a larger Aneurysm size, a higher Aneurysm height, a higher perpendicular height, a larger aspect ratio, and a larger size ratio. The multivariate analysis showed that the anterior projection Aneurysms were independently associated with a larger size ratio compared with the posterior projection Aneurysms. A larger size ratio and a smaller vessel size were independently associated with rupture status in the anterior projection Aneurysms. Conclusions Compared with posterior projection Aneurysms, the anterior projection Aneurysms have a higher risk of rupture probably because of significant differences in Aneurysm morphologies. A larger size ratio and a smaller vessel size may be helpful to predict the risk of rupture in the anterior projection Aneurysms.
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sex differences in Aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery Aneurysms a retrospective study
BMJ Open, 2016Co-Authors: Boli Lin, Ming Zhong, Qichuan Zhuge, Bing Zhao, Weijian Chen, Lei Ruan, Yongchun Chen, Liang Hao Fan, Yunjun YangAbstract:Objectives Ruptured anterior communicating artery (ACoA) Aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in Aneurysm morphologies and clinical outcomes in patients with ruptured ACoA Aneurysms. Setting A tertiary referral hospital. Participants A total of 574 consecutive patients with ACoA Aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA Aneurysms were included in the study. Main outcome measures Aneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge. Results The Aneurysm sizes (p=0.001), Aneurysm heights (p=0.011), size ratios (p Conclusions The men were independently associated with larger Aneurysm sizes, greater Aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA Aneurysms.
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smoking associated with increased Aneurysm size in patients with anterior communicating artery Aneurysms
World Neurosurgery, 2016Co-Authors: Nengzhi Xia, Yunjun Yang, Ming Zhong, Qichuan Zhuge, Bing Zhao, Weijian Chen, Liang Hao Fan, Yijun LiuAbstract: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.
