Background and purpose Approximately 15%–45%of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms(MIAs).Determining which one is most likely to rupture is extremely important for tre...Background and purpose Approximately 15%–45%of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms(MIAs).Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients.This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients.Methods A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets.Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set.The discriminative accuracy,calibration performance and clinical usefulness of this nomogram were assessed.We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage(SAH)patients and compared its performance with the nomogram model.Results Multivariate analyses identified seven variables that were significantly associated with IA rupture(history of SAH,alcohol consumption,female sex,aspect ratio>1.5,posterior circulation,irregular shape and bifurcation location).The clinical and morphological-based MIAs(CMB-MIAs)nomogram model showed good calibration and discrimination(derivation set:area under the curve(AUC)=0.740 validation set:AUC=0.772).Decision curve analysis demonstrated that the nomogram was clinically useful.Compared with the nomogram model,the AUC of multivariate model developed from SAH patients had lower value of 0.730.Conclusions This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort.This nomogram could be used in decision-making and risk stratification in MIAs patients.展开更多
Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PA...Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods:From June 2006 to July 2013,26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution.Fourteen patients had ruptured aneurysms,and twelve patients had unruptured aneurysms.The endovascular modalities were the following:1) PAO (n =19),2) palliative embolization (n =5),and 3) proximal PAO (n =2).Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results:The procedure was technically successful in all cases.In the PAO and proximal PAO group,all of the immediate angiography showed occlusion of the parent vessel,and follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure,and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred.Five procedure related complications occurred totally:rebleeding (n =1),hemiparesis (n =2),and hemianopsia (n =2).Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted.Sacrificing the parent artery appears to be well tolerated for distal segment of PCA.We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location.However,palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.展开更多
基金supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2019TX320002)the Natural Science Foundation of China(No.81771233).
文摘Background and purpose Approximately 15%–45%of patients with unruptured intracranial aneurysms have multiple intracranial aneurysms(MIAs).Determining which one is most likely to rupture is extremely important for treatment decision making for MIAs patients.This study aimed to develop and validate a nomogram to evaluate the per-aneurysm rupture risk of MIAs patients.Methods A total of 1671 IAs from 700 patients with MIAs were randomly dichotomised into derivation and validation sets.Multivariate logistic regression analysis was used to select predictors and construct a nomogram model for aneurysm rupture risk assessment in the derivation set.The discriminative accuracy,calibration performance and clinical usefulness of this nomogram were assessed.We also developed a multivariate model for a subgroup of 158 subarachnoid haemorrhage(SAH)patients and compared its performance with the nomogram model.Results Multivariate analyses identified seven variables that were significantly associated with IA rupture(history of SAH,alcohol consumption,female sex,aspect ratio>1.5,posterior circulation,irregular shape and bifurcation location).The clinical and morphological-based MIAs(CMB-MIAs)nomogram model showed good calibration and discrimination(derivation set:area under the curve(AUC)=0.740 validation set:AUC=0.772).Decision curve analysis demonstrated that the nomogram was clinically useful.Compared with the nomogram model,the AUC of multivariate model developed from SAH patients had lower value of 0.730.Conclusions This CMB-MIAs nomogram for MIAs rupture risk is the first to be developed and validated in a large multi-institutional cohort.This nomogram could be used in decision-making and risk stratification in MIAs patients.
基金This research was supported by the Natural Science Foundation of Beijing,China,Specific Research Projects for Capital Health Development
文摘Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods:From June 2006 to July 2013,26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution.Fourteen patients had ruptured aneurysms,and twelve patients had unruptured aneurysms.The endovascular modalities were the following:1) PAO (n =19),2) palliative embolization (n =5),and 3) proximal PAO (n =2).Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results:The procedure was technically successful in all cases.In the PAO and proximal PAO group,all of the immediate angiography showed occlusion of the parent vessel,and follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure,and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred.Five procedure related complications occurred totally:rebleeding (n =1),hemiparesis (n =2),and hemianopsia (n =2).Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted.Sacrificing the parent artery appears to be well tolerated for distal segment of PCA.We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location.However,palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.