Abstract
Objective To investigate morphological and hemodynamic risk factors associated with intraoperative aneurysm rupture (IOR) during clipping to provide evidence for predicting the risk of intraoperative aneurysm rupture. Methods This study retrospectively reviewed 84 patients who underwent aneurysm clipping at Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from January 2014 to April 2018. This cohort included 28 patients with IOR aneurysms and 56 patients with non-IOR aneurysms. Models were constructed based on presurgical CT angiogram. Morphological parameters were measured and hemodynamic parameters were obtained using computational fluid dynamics. The differences between IOR aneurysms and non-IOR aneurysms were analyzed, and independent risk factors were investigated using multivariate logistic analysis. Receiver operating characteristic (ROC) curve analysis was performed to test the predicting value. Results The statistically significant difference was found in length (12.93±8.12 mm vs. 10.43±5.65 mm), aspect ratio (AR) (1.71±0.59 vs. 1.25±0.45), normalized wall shear stress maximum (NWSSM) [0.56 (0.07-1.03) vs. 0.73 (0.21-1.69)], wall shear stress gradient average (14.31±7.19 vs. 11.61±6.52), oscillatory shear index (OSI) [0.006 8 (0.001 1-0.014 4) vs. 0.002 4 (0.000 8-0.007 3)] and low stress area ratio (LSAR)[(0.39 (0.19-0.73) vs. 0.28 (0.12-0.66)](all P<0.05). Multivariate logistic analysis demonstrated AR (OR=3.92, 95%CI: 1.18-12.99, P=0.030), NWSSM (OR=0.44, 95%CI: 0.31-0.63, P=0.001) and OSI (OR=14.84, 95%CI: 11.20-18.90, P=0.001) as independent risk factors for IOR. ROC analysis revealed that the areas under curve of AR, NWSSM and OSI were 0.746, 0.793 and 0.729, respectively (P<0.01). Conclusion AR, NWSSM and OSI are independent risk factors for IOR during clipping with good predicting values. Key words: Intracranial aneurysm; Aneurysm, ruptured; Neurosurgical procedures; Hemodynamics; Morphological
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