Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 201...Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 2015.Patients were grouped based on their history of aneurysmal subarachnoid hemorrhage(aSAH)into ruptured and unruptured categories.In the ruptured group,aneurysms were further classified as ruptured MIAs(R-MIAs)and unruptured MIAs(U-MIAs).Patient-and aneurysm-related factors were analyzed using univariate analysis to determine their significance in rupture risk.Receiver operating characteristic(ROC)analysis was employed to calculate the area under the curve(AUC)and identify optimal thresholds for five morphological parameters distinguishing R-MIAs from U-MIAs.Results:Of 368 enrolled patients,327(86 with ruptured aneurysms and 241 unruptured)were included in the analysis.Among the ruptured group,66 patients had R-MIAs and 96 had U-MIAs.Univariate analysis identified statistically significant factors associated with rupture,including BMI,irregular aneurysm shape,size,aspect ratio,size ratio,and bottleneck(P<0.05).Size,size ratio,and bottleneck exhibited high AUC values(AUC>0.7).ROC analysis determined an optimal threshold of 4.6 mm for MIA rupture size.Conclusions:Lower BMI,irregular aneurysm shape,larger size,larger size ratio,and bottleneck are associated with an increased risk of MIA rupture.Notably,MIAs may rupture at smaller sizes compared to single intracranial aneurysms.展开更多
Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hem...Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.展开更多
<span style="font-family:Verdana;">Multiple visceral artery aneurysms are relatively rare;the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depend...<span style="font-family:Verdana;">Multiple visceral artery aneurysms are relatively rare;the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depends on the size and site of the aneurysm. We report the case of a 33-year-old man with recurrent episodes of obstructive jaundice and weight loss. Computed tomography with contrast revealed scattered hepatic arterial aneurysms with two other aneurysms along the course of the left gastro-duo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">denal and superior mesenteric artery. Investigations to determine the etiology were negative, but the patient had a history of smoking and substance abuse. </span><span style="font-family:Verdana;">Angiography revealed an occluded feeding artery. The patient developed</span><span style="font-family:Verdana;"> multiorgan failure, leading to cardiac arrest and died. Diagnosing multiple visceral artery aneurysms needs a high index of suspicion;early diagnosis enables early intervention, which can reduce the high mortality of this condition.</span></span>展开更多
Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations betwee...Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.展开更多
Background Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple ...Background Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states. Methods We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms. Results The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm. Conclusions Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.展开更多
文摘Objective:To identify risk factors associated with multiple intracranial aneurysm(MIA)rupture.Methods:This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 2015.Patients were grouped based on their history of aneurysmal subarachnoid hemorrhage(aSAH)into ruptured and unruptured categories.In the ruptured group,aneurysms were further classified as ruptured MIAs(R-MIAs)and unruptured MIAs(U-MIAs).Patient-and aneurysm-related factors were analyzed using univariate analysis to determine their significance in rupture risk.Receiver operating characteristic(ROC)analysis was employed to calculate the area under the curve(AUC)and identify optimal thresholds for five morphological parameters distinguishing R-MIAs from U-MIAs.Results:Of 368 enrolled patients,327(86 with ruptured aneurysms and 241 unruptured)were included in the analysis.Among the ruptured group,66 patients had R-MIAs and 96 had U-MIAs.Univariate analysis identified statistically significant factors associated with rupture,including BMI,irregular aneurysm shape,size,aspect ratio,size ratio,and bottleneck(P<0.05).Size,size ratio,and bottleneck exhibited high AUC values(AUC>0.7).ROC analysis determined an optimal threshold of 4.6 mm for MIA rupture size.Conclusions:Lower BMI,irregular aneurysm shape,larger size,larger size ratio,and bottleneck are associated with an increased risk of MIA rupture.Notably,MIAs may rupture at smaller sizes compared to single intracranial aneurysms.
基金supported by Research Project of Third Military Medical University(2016YLC22)
文摘Objective: To identify the morphological parameters that are related to intracranial aneurysms(IAs) rupture using a case-control model.Methods: A total of 107 patients with multiple IAs and aneurysmal subarachnoid hemorrhage between August 2011 and February 2017 were enrolled in this study.Characteristics of IAs location, shape, neck width, perpendicular height, depth, maximum size, flow angle, parent vessel diameter(PVD), aspect ratio(AR) and size ratio(SR) were evaluated using CT angiography.Multiple logistic regression analysis was used to identify the independent risk factors associated with IAs rupture.Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained.Results: IAs located in the internal carotid artery(ICA) was associated with a negative risk of rupture, whereas AR, SR1(height/PVD) and SR2(depth/PVD) were associated with increased risk of rupture.When SR was calculated differently, the odds ratio values of these factors were also different.The receiver operating characteristic curve showed that AR, SR1 and SR2 had cut-off values of 1.01, 1.48 and 1.40, respectively.SR3(maximum size/PVD) was not associated with IAs rupture.Conclusions: IAs located in the ICA are associated with a negative risk of rupture, while high AR(>1.01), SR1(>1.48) or SR2(>1.40) are risk factors for multiple IAs rupture.
文摘<span style="font-family:Verdana;">Multiple visceral artery aneurysms are relatively rare;the rarest are superior mesenteric artery and gastroduodenal artery aneurysms. The clinical presentation depends on the size and site of the aneurysm. We report the case of a 33-year-old man with recurrent episodes of obstructive jaundice and weight loss. Computed tomography with contrast revealed scattered hepatic arterial aneurysms with two other aneurysms along the course of the left gastro-duo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">denal and superior mesenteric artery. Investigations to determine the etiology were negative, but the patient had a history of smoking and substance abuse. </span><span style="font-family:Verdana;">Angiography revealed an occluded feeding artery. The patient developed</span><span style="font-family:Verdana;"> multiorgan failure, leading to cardiac arrest and died. Diagnosing multiple visceral artery aneurysms needs a high index of suspicion;early diagnosis enables early intervention, which can reduce the high mortality of this condition.</span></span>
基金supported by the National Natural Science Foundation of China, No. 81171109
文摘Hemodynamic parameters play an important role in aneurysm formation and growth. However, it is difficult to directly observe a rapidly growing de novo aneurysm in a patient. To investigate possible associations between hemodynamic parameters and the formation and growth of intracranial aneurysms, the present study constructed a computational model of a case with an internal carotid artery aneurysm and an anterior communicating artery aneurysm, based on the CT angiography findings of a patient. To simulate the formation of the anterior communicating artery aneurysm and the growth of the internal carotid artery aneurysm, we then constructed a model that virtually removed the anterior communicating artery aneurysm, and a further two models that also progressively decreased the size of the internal carotid artery aneurysm. Computational simulations of the fluid dynamics of the four models were performed under pulsatile flow conditions, and wall shear stress was compared among the different models. In the three aneurysm growth models, increasing size of the aneurysm was associated with an increased area of low wall shear stress, a significant decrease in wall shear stress at the dome of the aneurysm, and a significant change in the wall shear stress of the parent artery. The wall shear stress of the anterior communicating artery remained low, and was significantly lower than the wall shear stress at the bifurcation of the internal carotid artery or the bifurcation of the middle cerebral artery. After formation of the anterior communicating artery aneurysm, the wall shear stress at the dome of the internal carotid artery aneurysm increased significantly, and the wall shear stress in the upstream arteries also changed significantly. These findings indicate that low wall shear stress may be associated with the initiation and growth of aneurysms, and that aneurysm formation and growth may influence hemodynamic parameters in the local and adjacent arteries.
基金supported by National Natural Science Foundation of China(grant numbers:82201435,82272092,81220108007,81801156,81801158,81471167,81671139 and 81960330)Henan Province Medical Science and Technology Research and Joint Construction Project(grant number:LHGJ20220337)+2 种基金China Postdoctoral Science Foundation(grant number:2022M712893)Scientific Research Cultivation Plan of Beijing Municipal Hospitals(grant number:PX2022022)Beijing Neurosurgical Institute Youth Innovation Fund(grant number:BNI-2024005).
文摘Background Hemodynamic factors play an important role in aneurysm initiation, growth, rupture, and recurrence, while the mechanism of the hemodynamic characteristics is still controversial. A unique model of multiple aneurysms (initiation, growth, rupture, and recurrence) is helpful to avoids the confounders and further explore the possible hemodynamic mechanisms of aneurysm in different states. Methods We present a model with multiple aneurysms, and including the states of initiation, growth, rupture, and recurrence, discuss the proposed mechanisms, and describe computational fluid dynamic model that was used to evaluate the likely hemodynamic effect of different states of the aneurysms. Results The hemodynamic analysis suggests that high flow impingement and high WSS distribution at normal parent artery was found before aneurysmal initiation. The WSS distribution and flow velocity were decreased in the new sac after aneurysmal growth. Low WSS was the risk hemodynamic factor for aneurysmal rupture. High flow concentration region on the neck plane after coil embolization still marked in recanalized aneurysm. Conclusions Associations have been identified between high flow impingement and aneurysm recanalization, while low WSS is linked to the rupture of aneurysms. High flow concentration and high WSS distribution at normal artery associated with aneurysm initiation and growth, while after growth, the high-risk hemodynamics of aneurysm rupture was occurred, which is low WSS at aneurysm dome.
