Abstract
Background and PurposeAbout 20.1% of intracranial aneurysms (IAs) carriers are multiple intracranial aneurysms (MIAs) patients with higher rupture risk and worse prognosis. A prediction model may bring some potential benefits. This study attempted to develop and externally validate a dynamic nomogram to assess the rupture risk of each IA among patients with MIA.MethodWe retrospectively analyzed the data of 262 patients with 611 IAs admitted to the Hunan Provincial People's Hospital between November 2015 and November 2021. Multivariable logistic regression (MLR) was applied to select the risk factors and derive a nomogram model for the assessment of IA rupture risk in MIA patients. To externally validate the nomogram, data of 35 patients with 78 IAs were collected from another independent center between December 2009 and May 2021. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultSize, location, irregular shape, diabetes history, and neck width were independently associated with IA rupture. The nomogram showed a good discriminative ability for ruptured and unruptured IAs in the derivation cohort (AUC = 0.81; 95% CI, 0.774–0.847) and was successfully generalized in the external validation cohort (AUC = 0.744; 95% CI, 0.627–0.862). The nomogram was calibrated well, and the decision curve analysis showed that it would generate more net benefit in identifying IA rupture than the “treat all” or “treat none” strategies at the threshold probabilities ranging from 10 to 60% both in the derivation and external validation set. The web-based dynamic nomogram calculator was accessible on https://wfs666.shinyapps.io/onlinecalculator/.ConclusionExternal validation has shown that the model was the potential to assist clinical identification of dangerous aneurysms after longitudinal data evaluation. Size, neck width, and location are the primary risk factors for ruptured IAs.
Highlights
The incidence of intracranial aneurysms (IAs) is approximately 3%, which can result in aneurysmal subarachnoid hemorrhage with a high mortality and disability rate [1, 2]
After obtaining the permission from the institutional ethics committee, we retrospectively analyzed the data of all consecutive patients with IA admitted to the Hunan Provincial People’s Hospital between 2015 and 2021 who met the criteria as follow: [1] no less than two aneurysms; [2] complete neuroradiological examination by DSA imaging; and [3] confirmed ruptured aneurysm by intraoperative findings or computed tomography scan imaging
The following clinical data were collected from medical records: age; sex; history of smoking, drinking, hypertension, diabetes mellitus (DM), hyperlipidemia (HLP), atrial fibrillation, coronary heart disease (CHD), and subarachnoid hemorrhage (SAH)
Summary
The incidence of intracranial aneurysms (IAs) is approximately 3%, which can result in aneurysmal subarachnoid hemorrhage with a high mortality and disability rate [1, 2]. Multiple intracranial aneurysms (MIAs), defined as coexisting ≥2 IAs, occur in about 20.1% of IAs carriers [3]. Among patients over 70 years old, a worse prognosis occurs in those with MIAs than those with a single IA [7]. Physicians usually need to consider the rupture risk of each IA when formulating treatment strategies for patients with MIA. It is of great clinical significance to identify the IAs with a high risk of rupture among patients with MIA. About 20.1% of intracranial aneurysms (IAs) carriers are multiple intracranial aneurysms (MIAs) patients with higher rupture risk and worse prognosis.
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