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Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms

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Abstract

Purpose

Neurosurgeons can manage unruptured intracranial aneurysms (UIAs). However, the stability of UIAs under follow-up remains uncertain. This study aimed to examine the risk factors associated with the instability (rupture or growth) of UIAs during follow-up.

Methods

We obtained information on patients with UIA who underwent ≥ 6 months of the time of flight-magnetic resonance angiography (TOF-MRA) imaging follow-up in two centers. Computer-assisted semi-automated measurement (CASAM) techniques were used for recording morphological parameters and determining the growth of these aneurysms. We also recorded hemodynamic parameters at the beginning of the follow-up. The univariate and multivariate Cox regression analyses were performed to calculate hazard ratios with corresponding 95% confidence intervals for the clinical, morphological, and hemodynamic risk factors for aneurysm instability.

Results

A total of 304 aneurysms from 263 patients (80.4%) were included for analysis. The annual aneurysm growth rate was 4.7%. Significant predictive factors for aneurysm instability in the multivariate analysis were as follows: poorly controlled hypertension (hazard ratio (HR), 2.97 (95% CI, 1.27–6.98), P = 0.012); aneurysms located on posterior circulation (HR, 7.81 (95% CI, 2.28–26.73), P = 0.001), posterior communication artery (HR, 3.01 (95% CI, 1.07–8.46), P = 0.036), and cavernous carotid artery (HR, 3.78 (95% CI, 1.18–12.17), P = 0.026); and size ratio ≥ 0.87 (HR, 2.54 (95% CI, 1.14–5.68), P = 0.023).

Conclusions

The management of UIAs should focus on the control of hypertension during the follow-up. Aneurysms on the posterior communicating artery, posterior circulation, and cavernous carotid arteries require intensive surveillance or timely treatment.

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Acknowledgements

We are grateful to Zhaoyang Lin for their assistance with professional language editing.

Funding

This study was supported by the ‘National Key R&D program of China (grant nos. 2016YFC1300800)’ and the ‘Beijing Municipal Administration of Hospitals’ Ascent Plan (grant nos. DFL20180801)’ and the ’Beijing Scientific and Technologic Project (grant nos. Z201100005520021)’.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, 100053, Beijing, China

    Jiewen Geng, Simin Wang, Peng Hu, Chuan He & Hongqi Zhang

  2. China International Neuroscience Institute, Beijing, China

    Jiewen Geng, Simin Wang, Peng Hu, Chuan He & Hongqi Zhang

  3. Department of Neurosurgery, Weihai Municipal Hospital, Weihai, China

    Yadong Wang

  4. Department of R&D, UnionStrong (Beijing) Technology Co. Ltd, Beijing, China

    Wenzhi Wang, Gang Fang & Guangming Yang

  5. Department of Neurosurgery, Xi’an NO. 3 Hospital the Affiliated Hospital of Northwest University, Xi’an, China

    Xinxin Fan

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  1. Jiewen Geng
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Contributions

J. Geng: conceived and designed the research, performed statistical analysis and wrote the original version of the manuscript, collected the data; H. Zhang: conceived and designed the research, handled funding and supervision; S. Wang drafted the final submitted version, collected the data; W. Wang: designed the algorithm, responsible for measurement data; G. Fang: designed the algorithm, responsible for measurement data; G. Yang: designed the algorithm, responsible for measurement data; Y. Wang: collected the data; X. Fan: collected the data; P. Hu: handled funding and supvervision; C. He: handled funding and supervision. All authors made critical revisions of the manuscript.

Corresponding author

Correspondence to Hongqi Zhang.

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Conflict of interest

J. Geng, S. Wang,Y. Wang, W. Wang, G. Fang, G. Yang, X. Fan, P. Hu, C. He and H. Zhang declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our institutional ethics committee (N0.2017024 and No.2017082). Informed consent was obtained from all individual participants included in the study.

Additional information

The authors Jiewen Geng and Simin Wang contributed equally to this article.

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Geng, J., Wang, S., Wang, Y. et al. Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms. Clin Neuroradiol 33, 1133–1142 (2023). https://doi.org/10.1007/s00062-023-01324-9

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