Aneurysm Patients Research Articles

Arch replacement with collared elephant trunks: The Siena approach.

ObjectiveTo illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported.MethodsAll aortic arch–replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes.ResultsOf 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n = 16); 5.4% stroke (n = 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n = 97 endovascular [66.4%], n = 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median follow-up was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P = .22) between dissection and aneurysm groups.ConclusionsSiena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery.

Artificial intelligence assistance improves reporting efficiency of thoracic aortic aneurysm CT follow-up

ObjectiveFollow-up of aortic aneurysms by computed tomography (CT) is crucial to balance the risks of treatment and rupture. Artificial intelligence (AI)-assisted radiology reporting promises time savings and reduced inter-reader variabilities. MethodsThe influence of AI assistance on the efficiency and accuracy of aortic aneurysm reporting according to the AHA / ESC guidelines was quantified based on 324 AI measurements and 1944 radiological measurements: 18 aortic aneurysm patients, each with two CT scans (arterial contrast phase, electrocardiogram-gated) with an interval of at least six months have been included. One board-certified radiologist and two residents (8/4/2 years of experience in vascular imaging) independently assessed aortic diameters at nine landmark positions. Aneurysm extensions were compared with original CT reports. After three weeks washout period, CTs were re-assessed, based on graphically illustrated AI measurements. ResultsTime-consuming guideline-compliant aortic measurements revealed additional affections of the root / arch for 80 % of aneurysms that had initially been reported to be limited to the ascending aorta. AI assistance reduced mean reporting time by 63 % from 13:01 to 04:46 min including manual corrections of AI measurements (performed for 33.6 % of all measurements with predominance at the sinuses of Vasalva). AI assistance reduced total diameter inter-reader variability by 42.5 % (0.42 / 1.16 mm with / without AI assistance, mean of all patients and landmark positions, significant reduction for 6 out of 9 measuring positions). Conventional and AI-assisted quantification aneurysm progress varied to small extent (mean of 0.75 mm over all patients / landmark positions) not significantly exceeding radiologist’s inter-reader variabilities. ConclusionsGuideline-compliant aorta measurement is crucial to report detailed aneurysm extension which might affect the strategy of interventional repair. AI assistance promises improved reporting efficiency and has high potential to reduce radiologist’s inter-reader variabilities that can hamper diagnostic follow-up accuracy. Key pointThe time-consuming guideline-compliant aorta aneurysm assessment is crucial to report aneurysm extension in detail; AI-assisted measurement reduces reporting time, improves extension evaluation and reduces inter-reader variability.

Inflammation-based Scores are Associated with the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage After Neuro-intervention.

Prognostic significance of inflammatory response has been reported in various diseases. The objective of this study was to analyze the association between inflammation- based scores and the prognosis of patients who underwent neuro-intervention for aneurysmal subarachnoid hemorrhage (SAH). Inflammation-based scores such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) were analyzed for aneurysmal SAH patients who underwent endovascular intervention. Unfavorable functional outcome was defined as a modified Rankin Scale (mRS) score of 3-6. Receiver operating characteristic (ROC) curve analysis was performed to identify cut-off values of inflammation- based scores for predicting unfavorable functional outcome. Logistic regression analyses were performed to explore the relationship between inflammation-based scores and the prognosis of patients. A total of 498 patients were enrolled. Optimal cutoff values of inflammation-based scores of NLR, LMR, and MHR for unfavorable functional outcome were 5.7, 4.2, and 1.5, respectively (p < 0.001, < 0.001, and 0.004, respectively). In multivariate analysis, NLR value ≥ 5.7 (odds ratio [OR] 1.92, 95% CI 1.42-3.42; P = 0.008), LMR value < 4.2 (OR 1.74, 95% CI 1.48-2.98; P = 0.018), and MHR value ≥ 1.5 (OR 1.44, 95% CI 1.22-2.82; P = 0.040) were independently associated with unfavorable functional outcome. Inflammation based scores were associated with functional outcome after endovascular intervention for aneurysmal SAH. Higher NLR and MHR with lower LMR could predict unfavorable outcomes of aneurysmal SAH patients who underwent endovascular intervention.

Abstract 15839: Patients With Abdominal Aortic Aneurysms Have Reduced Levels of MicroRNA 122-5p in Circulating Exosomes

Introduction: There are currently no specific biomarkers to screen and monitor disease progression in abdominal aortic aneurysms (AAA), which are the 15 th leading cause of death in the United States. Circulating exosomes contain microRNAs (miRNA) that are potential biomarkers of disease. This study aimed to characterize the exosomal miRNA expression profile of patients with AAA in order to identify novel markers of disease. Methods: A total of 109 patients scheduled to undergo a duplex ultrasound (US) for screening or surveillance of AAA were screened to participate in the study. Eleven patients with AAA (max aortic diameter &gt;3cm) and 15 non-aneurysmal controls (max aortic diameter &lt;3cm on screening US) were enrolled. Circulating plasma exosomes were isolated using Cushioned-Density Gradient Ultracentrifugation and total RNA was extracted. Next Generation Sequencing was performed on the Illumina HiSeq4000 SE50 after NEBNext Multiplex Small RNA Library Prep. Differential miRNA expression analysis was performed using DESeq2 software with a Benjamini-Hochberg correction. MicroRNA expression profiles were validated by Quantitative Real-Time PCR. Results: Aortic diameter, as measured by US, was significantly larger in the AAA group (mean maximum diameter 5.2 vs 2.3 cm, p =2.84x10 -6 ). Aneurysm patients were more likely to suffer from CAD (5/11 vs 1/15, p = 0.05) but had similar levels of PAD (4/11 vs 2/15, p =0.35) and COPD (4/11 vs 4/15, p =0.68) compared to controls. A total of 40 miRNAs were differentially expressed ( p &lt;0.05). Of these, 18 miRNAs were up-regulated and 22 were down-regulated in controls compared to AAA. After false discovery rate (FDR) adjustment, only miR-122-5p was expressed at significantly different levels in AAA compared to controls (fold change = 5.03 controls vs AAA; raw p = 1.8x10 -5 ; FDR p =0.02). Conclusions: Plasma exosomes from AAA patients have significantly reduced levels of miRNA-122-5p compared to controls.

Comparison Outcomes of Anesthesia and Hospitalization of Endovascular Treatment versus Open Surgery for Infra Renal Abdominal Aortic Aneurysm at Sina Hospital from 2011 to 2019

Background: Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm surgery, and endovascular aneurysm repair (EVAR). The purpose of this article is to investigate and compare the outcomes of all cases of open surgery versus EVAR conducted from2011 to 2019 at Sina Medical Research and Training Hospital, the first EVAR was conducted at Sina Hospital in 2011. Methods: This research is a retrospective cross-sectional study. The study population consisted of all abdominal aortic aneurysm patients who were treated at Sina Hospital in Tehran from September 2011 to December 2019. All patients who met the inclusion criteria participated in the study. A checklist of required data was prepared and used to extract data from patients' medical case files. Patients' information was completed via telephone contact with patients or their families. Analyses were performed using SPSS software with a 5-percent error rate. Results: The sample consisted of 194 patients who were divided into two groups. 73 patients (37.6%) underwent open surgery and 121 patients (62.4%) underwent EVAR. All patients (100%) who underwent open surgery received general anesthesia, while only 15 patients (12.8%) who underwent EVAR received general anesthesia, and 102 patients (87.2%) who underwent EVAR received spinal anesthesia. Rates of blood loss and blood transfusion, length of stay in the intensive care unit (ICU), the total length of postoperative hospitalization for patients who underwent open surgery were significantly higher than for those who underwent EVAR (P-value &lt;0.001). The mortality probability of patients with a history of CVA and smoking was3.47 and 2.66 times higher than those with a negative history of these cases, respectively. Although average EF was higher in living patients compared to deceased ones, this difference was not statistically significant (P-value= 0.161). Conclusion: Surgery duration, length of stay in ICU, length of hospital stay, and rate of blood transfusion of patients undergoing EVAR was reduced in comparison with those undergoing open surgery.

Easily created prediction model using deep learning software (Prediction One, Sony Network Communications Inc.) for subarachnoid hemorrhage outcomes from small dataset at admission.

Background: Reliable prediction models of subarachnoid hemorrhage (SAH) outcomes are needed for decision-making of the treatment. SAFIRE score using only four variables is a good prediction scoring system. However, making such prediction models needs a large number of samples and time-consuming statistical analysis. Deep learning (DL), one of the artificial intelligence, is attractive, but there were no reports on prediction models for SAH outcomes using DL. We herein made a prediction model using DL software, Prediction One (Sony Network Communications Inc., Tokyo, Japan) and compared it to SAFIRE score.Methods: We used 153 consecutive aneurysmal SAH patients data in our hospital between 2012 and 2019. Modified Rankin Scale (mRS) 0–3 at 6 months was defined as a favorable outcome. We randomly divided them into 102 patients training dataset and 51 patients external validation dataset. Prediction one made the prediction model using the training dataset with internal cross-validation. We used both the created model and SAFIRE score to predict the outcomes using the external validation set. The areas under the curve (AUCs) were compared.Results: The model made by Prediction One using 28 variables had AUC of 0.848, and its AUC for the validation dataset was 0.953 (95%CI 0.900–1.000). AUCs calculated using SAFIRE score were 0.875 for the training dataset and 0.960 for the validation dataset, respectively.Conclusion: We easily and quickly made prediction models using Prediction One, even with a small single-center dataset. The accuracy of the model was not so inferior to those of previous statistically calculated prediction models.

An update on the improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms

ABSTRACT Purpose Endovascular aneurysm repair (EVAR), performed within device instructions for use (IFU), offers improved outcomes. New endograft designs attempt to increase eligibility rates of abdominal aortic aneurysm (AAA) patients treated within device IFU. We aim to examine the anatomic suitability of the Ovation endograft in our AAA patients and compare it with the other contemporary devices. Research design and methods Three-hundred and seven consecutive elective AAA patients treated during a 5-year period were included. Patient-specific anatomic characteristics were based on endograft IFUs to determine eligibility rates of each system. Results Two-hundred-twenty-five patients underwent EVAR and 82 open surgery. Ineligibility for device implantation was significantly lower for the Ovation iX system (32%) compared to other devices (AFX-2:49%, Altura:49%, Anaconda:54%, Endurant II:46%, Excluder:52%, Excluder Conformable:39%, Incraft:43%, E-Tegra:52%, Zenith-Alpha:52%; P-Value<0.001). The Alto system (next-generation Ovation) achieved an even lower ineligibility rate of 30% (P = 0.008). Short proximal aortic neck length followed by access vessel inadequacy were the primary reasons for ineligibility. Conclusion The Ovation-iX included more patients with anatomic characteristics within device IFUs resulting in improved eligibility rates compared with the rest of contemporary devices. Its evolution, the Alto system, further improves patient eligibility due to the inclusion of shorter aortic necks. Expert Opinion The Ovation iX system presented a significantly better performance and was eligible for use in a greater number of patients in our series of elective AAA repairs, accommodating patient-specific aortic anatomies. Of course, performing EVAR within the endograft’s IFU is important to achieve optimal and durable outcomes. The proximal neck length followed by the size of the access vessels are the two more common factors resulting in loss of eligibility. Except for overall eligibility rates, a case by case decision must be made on which is the most suitable device for each patient, based on the specific characteristics of its unique anatomy.

Analysis of prognosis factors for reintervention after endovascular aneurysm repair in patients with abdominal aortic aneurysm

Objectives: To examine the prognosis factors for readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients in the Chinese population. Methods: A total of 1 129 AAA patients who underwent EVAR at Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2010 to December 2017 were enrolled. There were 948 males and 181 females, with an age of (71.2±9.6) years (range: 18 to 93 years). Comorbidities included primary hypertension found in 630 patients, diabetes mellitus in 129 patients and coronary heart disease in 163 patients. A total of 214 patients had a history of smoking, and 11 patients had a history of previous aortic intervention.Clinical data including baseline information, laboratory examinations and follow-up data before December 31, 2019 were retrospectively collected. The primary end point was readmission. Cox regression analysis was used to analyze the prognosis factors for the end point. Results: All patients completed at least one follow-up with a follow-up time of 22.7(42.6) months (range: 1 to 120 months). The readmission rate of 1 year post-operation was 4.52% (51/1 129). The overall readmission rate was 11.34% (128/1 129) during the whole follow-up duration. The main reasons of readmission included endoleak in 60 patients with readmission, iliac limb occlusion in 25 patients and distal iliac aneurysm in 12 patients. Age (HR=0.972, 95%CI: 0.956 to 0.987, P<0.01) and elevated pre-operative fibrinogen level (HR=2.213, 95%CI: 1.185 to 4.134, P=0.013) were found to be the prognosis factors for the survival time free from aortic-related readmission in univariate Cox regression analysis. Elevated pre-operative fibrinogen level (HR=2.542, 95%CI: 1.353 to 4.776, P=0.004) was found to be the prognosis factor for the survival time free from aortic-related readmission in multivariate Cox regression analysis. Conclusions: The most common reason for readmission was endoleak, followed by iliac limb occlusion and distal iliac aneurysm. Elevated pre-operative fibri nogen level was the risk factor for the survival time free from aortic-related readmission, though further researches were warranted for exploring the underlying mechanism.

Treatment strategies of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysm

It is more than 20 years since the first endovascular repair of thoracoabdominal aortic aneurysm was performed. Significantly reducing risk of morbidity and mortality compared with open aortic repair, the advent of endovascular repair has revolutionized the treatment of complex aortic disease. It is now the first-line treatment for most thoracoabdominal aortic aneurysm patients. However, spinal cord ischemia (SCI) remains one of the most threatening complications after the procedure, and significantly reduces overall survival. The pathophysiology of spinal cord ischemia remains unclear but may well be multifactorial. Risk factors for SCI include excessive aortic coverage, detriment to the collateral network through occlusion of the left subclavian or internal iliac arteries, perioperative hypotension and chronic renal failure. SCI could be predicted, prevented and ameliorated through the application of motor evoked potential, permissive perioperative hypertension, cerebrospinal fluid drainage (CSFD), preoperative or concomitant left subclavian artery (LSA) revascularization and some drugs. However, there are certain complications and contraindications for CSFD and arterial revascularization. As a result, we must balance the pros and cons of these invasive measures. So we summarize our clinical experience and propose the employment of LSA revascularization and CSFD in certain kinds of high-risk patients respectively. With the development of technology and preventive measures, we believe that SCI could be minimized in the forseeable future.

Association between inflammatory response and outcome after subarachnoid haemorrhage.

ObjectivesRecent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1‐year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI).Materials and methodsThis prospective observational pilot study included patients with an aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, between May 2015 and October 2016. The patients were stratified according to the extended Glasgow Outcome Scale (GOSE) as having an unfavourable (score: 1–4) or favourable outcome (score: 5–8). Furthermore, patients were stratified depending on development of DCI or not. Patient data and blood samples were collected and analysed at admission and after 10 days.ResultsElevated serum concentrations of inflammatory markers such as tumour necrosis factor‐α and interleukin (IL)‐6, IL‐1Ra, C‐reactive protein and intercellular adhesion molecule‐1 were detected in patients with unfavourable outcome. When adjustments for Glasgow coma scale were made, only IL‐1Ra remained significantly associated with poor outcome (p = 0.012). The inflammatory response after aSAH was not predictive of the development of DCI.ConclusionElevated serum concentrations of inflammatory markers were associated with poor neurological outcome 1‐year after aSAH. However, inflammatory markers are affected by many clinical events, and when adjustments were made, only IL‐1Ra remained significantly associated with poor outcome. The robustness of these results needs to be tested in a larger trial.

Cortical Blood Flow Insufficiency Scores with Computed Tomography Perfusion can Predict Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients: A Cohort Study.

The World Federation of Neurosurgical Societies (WFNS) scale is widely accepted for predicting outcomes for subarachnoid hemorrhage (SAH) patients. However, it is difficult to definitely predict outcomes for the most poor grade, WFNS grade 5. The present study aimed to investigate the prognostic ability of a novel classification using computed tomography perfusion (CTP) findings, called the cortical blood flow insufficiency (CBFI) scores. CTP was performed on admission for aneurysmal SAH followed by radical treatments within 72 hours of onset. Twenty-four cerebral cortex regions of interest (ROIs) were defined. CBFI was defined as Tmax > 4s in each ROI, and CBFI scores were calculated based on the total number of ROIs with CBFI. Using the optimal cutoff value based on receiver operating characteristics (ROC) analysis to predict patient functional outcomes, CBFI scores were divided into "high" or "low" CBFI scores. Patient functional outcomes at 90days were categorized based on modified Rankin Scale scores (0-3, favorable group; 4-6 unfavorable group) (0-4, non-catastrophic group; 5-6, catastrophic group). Fifty-seven patients were included in this study, of whom 21 (36.8%) and 13 (22.8%) were in the unfavorable and the catastrophic groups, respectively. A factor predicting unfavorable and catastrophic outcomes was CBFI score cutoff value of 7 points (area under the curve, 0.73 and 0.81, respectively). In multivariable logistic regression analysis for unfavorable outcome, high CBFI scores (odds ratio (OR), 8.6; 95% confidence interval (CI), 1.1-65.4; P = 0.04) and WFNS grade 5 (OR, 30.0; 95% CI, 4.5-201.0; P < 0.001) remained as independent predictors, while for catastrophic outcome, high CBFI scores (OR, 25.3; 95% CI, 3.3-194.0; P = 0.002) and age (OR, 1.1; 95% CI, 1.0-1.2; P = 0.02) remained as independent predictors. Conversely, WFNS grade 5 was not an independent predictor of catastrophic outcomes (OR, 3.8; 95% CI, 0.6-24.0; P = 0.15). In high CBFI scores, the OR of the delayed cerebral ischemia (DCI) occurrence was 9.6 (95% CI, 1.5-61.4; P = 0.02) after adjusting for age. High CBFI scores could predict unfavorable and catastrophic outcomes for aneurysmal SAH patients and DCI occurrence.

Exploring the association of long noncoding RNA expression profiles with intracranial aneurysms, based on sequencing and related bioinformatics analysis

BackgroundThe present study aims to investigate the complete long non-coding RNA (lncRNA) and messenger RNA (mRNA) expression profiles in Intracranial aneurysm (IA) patients and controls by RNA sequencing, which reveals the lncRNA with predictive value for IA risk.MethodsThe comprehensive lncRNA and mRNA expression profiles were detected by RNA-Seq in human IA walls and superficial temporal arteries (STAs), followed by bioinformatics analyses, such as GO analysis, KEGG pathway analysis, and CNC network construction. Subsequently, qRT-PCR was used to profile the expression levels of selected lncRNA (lncRNA ENST000000576153, lncRNA ENST00000607042, lncRNA ENST00000471220, lncRNA ENST00000478738, lncRNA MALAT1, lncRNA ENST00000508090 and lncRNA ENST00000579688) in 30 (small) or 130 (large) peripheral blood leukocytes, respectively. Multivariate logistic regression was utilized to analyze the effects of lncRNA on IA. Receiver operating characteristic (ROC) curve was further drawn to explore the value of lncRNA in predicting IA.ResultsTotally 900 up-regulated and 293 down-regulated lncRNAs, as well as 1297 up-regulated and 831 down-regulated mRNAs were discovered in sequencing. Enrichment analyses revealed that they were actively involved in immune/inflammatory response and cell adhesion/extracellular matrix. Co-expression analysis and further enrichment analyses showed that five candidate lncRNAs might participate in IA’s inflammatory response. Besides, after controlling other conventional risk factors, multivariate logistic regression analysis disclosed that low expression of lncRNA ENST00000607042, lncRNA ENST00000471220, lncRNA ENST00000478738, lncRNA MALAT1 in peripheral blood leukocytes were independent risk factors for IA. LncRNA ENST00000607042 has superior diagnostic value for IA.ConclusionsThis study reveals the complete lncRNAs expression profiles in IA. The inflammatory response was closely related to IA. Besides, lncRNA ENST00000607042 might be a novel biomarker for IA risk.

4D Digital Subtraction Angiography for the Temporal Flow Visualization of Intracranial Aneurysms and Vascular Malformations

PurposeTo assess the benefit and radiation dose of four-dimensional (4D) digital subtraction angiography (DSA) - a time resolved three-dimensional (3D) DSA application - to evaluate the flow and architecture of aneurysms and vascular malformations. MethodsAll patients with cerebrovascular disease were considered who underwent 4D-DSA at our institution between January 2015 and February 2016. For the aneurysm patients, we evaluated the image quality in terms of the visualization of contrast flow in the aneurysm on a 3-point scale (excellent, fair and poor). Interrater agreement between two raters was estimated using Cohen's Kappa statistics. For the shunt disease patients, the additional information obtained from the 4D-DSA was described for each disease. The median radiation dose and volume of contrast medium required for the acquisitions were estimated. ResultsA total of 173 patients underwent 4D-DSA; 126 intracranial aneurysms, 10 arteriovenous malformations (AVM), 15 dural arteriovenous fistula (dAVF) and 22 other diseases. For aneurysm patients, excellent and fair visualization of the intra-aneurysmal flow was observed in 27.7%, 72.3%, and excellent (κ = 0.9) agreement between the raters was found. For AVM and dAVF patients, 4D-DSA clarified the complex vasculature by viewing the discrete time phase of contrast filling. Median radiation dose for intracranial lesions was 79.6 mGy for 6s 4D-DSA, and 175 mGy for 12s 4D-DSA. The median amount of contrast medium used was 18.0 ml for 6s 4D-DSA and 21.0 ml for 12s 4D-DSA. Conclusions4D-DSA provided additional information regarding intra-aneurysmal flow and contributed to detect different component of nidus or shunt points.

Black-blood vessel wall magnetic resonance imaging – A new imaging biomarker for regrowth of coiled saccular aneurysms?

BackgroundVessel wall imaging (VWI) of cerebral aneurysms is a new tool to risk stratify unruptured aneurysms. We hypothesized that the degree and pattern of aneurysm wall enhancement may predict the regrowth of these aneurysms. The aim of this study was to identify patient risk factors and VWI parameters associated with aneurysm regrowth. MethodsWe retrospectively reviewed 71 saccular aneurysms and 75 follow-up VWI studies in patients who underwent the coil embolization procedure for unruptured saccular aneurysm. The relationship between VWI enhancement and aneurysm regrowth was analyzed by Pearson’s chi-square test. Diagnostic performance of VWI enhancement in the diagnosis of regrowth aneurysm was determined to compare with digital subtraction angiography (DSA), and contrast-enhanced magnetic resonance angiography (CE-MRA) or time-of-flight MRA (TOF-MRA). Inter-rater agreement was measured by Cohen’s kappa coefficient. ResultsFourteen of 71 aneurysms (19.71%) were categorized into the aneurysm regrowth group, while aneurysm wall enhancement was found in 55 studies (73.33%). All wall enhancements were found in the aneurysm regrowth group, and no significant association was found between aneurysm regrowth and patient risk factors or VWI parameters. The diagnostic performance parameters of VWI relative to the DSA, and CE-MRA or TOF-MRA results were 100% sensitivity, 38.5% specificity, 30.4% positive predictive value, 100% negative predictive value, and 52% accuracy. ConclusionsWall enhancement of post-coil embolization of saccular aneurysm on VWI may be used as a screening imaging test to predict aneurysm regrowth, and may help to identify an unstable aneurysm, if the degree of enhancement increase or change of the pattern.

Relationship between total plasma homocysteine and the risk of aneurysms - a meta-analysis.

Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.

Aortic Aneurysm Natural Progression is Not Influenced by Concomitant Malignancy and Chemotherapy

Aortic aneurysms occur concomitantly with malignancy in approximately 1.0-17.0% of patients. There is little published information regarding the effects of subsequent oncological therapies on aortic aneurysm growth. The aim of this study was to determine the effects of chemoradiation therapies on the natural progression of small abdominal aortic aneurysm (AAA), thoracic aortic aneurysm, and thoracoabdominal aortic aneurysm. Patients with aortic aneurysms with and without malignancy between 2005 and 2017 were identified within institutional databases using Current Procedural Terminology and International Classification of Disease codes. Inclusion criteria included complete chemotherapy documentation, a minimum of 3 multiplanar axial/coronal imaging or ultrasonography before, during, and after receiving therapy or 2 studies for patients without malignancy. Propensity matching, Cox and linear regression, and Kaplan-Meier survival analyses were performed. A total of 159 (172 aneurysms) patients with malignancy and 127 (149 aneurysms) patients without malignancy were included. Average patient demographics were 74.4±9.8-years-old, Caucasian (66.8%), male (70.3%), with hypertension (71.1%), current smoking (24.5%), coronary atherosclerotic disease (26.2%), and AAA (71.0%). The most common malignancy was lung cancer (48.4%) with most chemotherapy regimens including a platinum-based alkylating agent and concurrent antimetabolite (56.0%). The overall median follow-up time was 28.2 (range 3.1-174.4) months. Aortic aneurysms in patients without malignancy grew to larger sizes (4.43±0.96 vs. 4.14±1.00, P=0.008) with similar median growth rates (0.12 vs. 0.12cm/year, P=0.090), had more atypical morphologic features (14.1% vs. 0.6%, P<0.001), more frequently underwent repair (22.1% vs. 8.7%, P=0.001), and more frequently required emergency repair for rupture (5.4% vs. 0.0%, P=0.087). Cox regression identified initial aortic size ≥4.0cm (hazard ratio [HR] 3.028), AAA (HR 2.146), chronic aortic findings (3.589), and the use of topoisomerase inhibitors (HR 2.694). Linear regression demonstrated increased growth rates predicted by antimetabolite chemotherapy (β 0.170), initial aortic size (β 0.086), and abdominal aortic location (β 0.139, all P<0.002). Small aortic aneurysms with concomitant malignancies are discovered at smaller initial sizes, grow at similar rates, require fewer interventions, and have fewer ruptures and acute dissections than patients without malignancy. Antimetabolite therapies modestly accelerate aneurysmal growth, and patients receiving topoisomerase inhibitors may require earlier repair. Patients with concomitant disease can be confidently treated according to standard institutional aneurysm surveillance protocols. Overall, we recommend treatment of the malignancy before small aortic aneurysm repair as these aneurysms behave similarly to those in patients without malignancy.

Apical hypertrophic cardiomyopathy with left ventricular apical aneurysm: prevalence, cardiac magnetic resonance characteristics, and prognosis

Hypertrophic cardiomyopathy (HCM) with left ventricular apical aneurysm (LVAA) is associated with an increased risk of adverse cardiovascular events. However, the clinical significance of LVAA in apical HCM (ApHCM) has not been reported. This study aimed to investigate the prevalence, cardiac magnetic resonance (CMR) characteristics, and prognosis of LVAA in ApHCM patients. A total of 1332 consecutive ApHCM patients confirmed by CMR in our hospital were retrospectively analysed. LVAAs were identified in 31 patients of all ApHCM patients (2.3%, 31/1332). Besides, 31 age- and gender-matched ApHCM patients without LVAA were used for comparison. Of the 31 aneurysm patients (mean age, 53.8 ± 15.1 years old), 28 (90.3%) had clinical symptoms, and 3 (9.7%) had a family history of HCM. The rate of missed diagnosis of echocardiography for detecting LVAA was 64.5% (20/31), most (90%, 18/20) of unidentified LVAAs by echocardiography were small aneurysms (<20 mm). Compared with ApHCM patients without LVAA, the proportion of systolic mid-cavity obstruction and late gadolinium enhancement (LGE) presence, and the LGE extent in ApHCM patients with LVAA were significantly higher (all P<0.05). The Kaplan-Meier curves showed that the event-free survival rate in ApHCM patients with LVAA was significantly lower than that in ApHCM patients without LVAA (log rank, P = 0.010). ApHCM with LVAA is a very rare condition, which is often missed by echocardiography and could be reliably detected with CMR and is associated with a higher risk of adverse cardiovascular events compared with ApHCM without LVAA.

A Novel Anisotropic Failure Criterion With Dispersed Fiber Orientations for Aortic Tissues.

Accurate failure criteria play a fundamental role in biomechanical analyses of aortic wall rupture and dissection. Experimental investigations have demonstrated a significant difference of aortic wall strengths in the circumferential and axial directions. Therefore, the isotropic von Mises stress and maximum principal stress, commonly used in computational analysis of the aortic wall, are inadequate for modeling of anisotropic failure properties. In this study, we propose a novel stress-based anisotropic failure criterion with dispersed fiber orientations. In the new failure criterion, the overall failure metric is computed by using angular integration (AI) of failure metrics in all directions. Affine rotations of fiber orientations due to finite deformation are taken into account in an anisotropic hyperelastic constitutive model. To examine fitting capability of the failure criterion, a set of off-axis uniaxial tension tests were performed on aortic tissues of four porcine individuals and 18 human ascending thoracic aortic aneurysm (ATAA) patients. The dispersed fiber failure criterion demonstrates a good fitting capability with the off-axis testing data. Under simulated biaxial stress conditions, the dispersed fiber failure criterion predicts a smaller failure envelope comparing to those predicted by the traditional anisotropic criteria without fiber dispersion, which highlights the potentially important role of fiber dispersion in the failure of the aortic wall. Our results suggest that the deformation-dependent fiber orientations need to be considered when wall strength determined from uniaxial tests are used for in vivo biomechanical analysis. More investigations are needed to determine biaxial failure properties of the aortic wall.

Prevalence of and risk factors for anxiety and depression in Chinese patients with unruptured intracranial aneurysms treated by endovascular intervention

BackgroundStudies on anxiety and depression in unruptured intracranial aneurysm (UIA) patients after treatment via endovascular intervention are rare and controversial. We aimed to explore the prevalence of anxiety and depression among Chinese patients with UIAs treated by endovascular intervention and to identify which factors contribute to the development of these symptoms.MethodsWe performed a cross-sectional study on anxiety and depression in patients who underwent endovascular treatment for UIAs using the Hospital Anxiety and Depression Scale (HADS). The demographic, clinical and radiological data for all patients were retrospectively collected from the aneurysm database and medical records. Moreover, we utilized data from a large sample of 200 UIA patients and multivariate logistic regression analysis to investigate the risk factors for anxiety and depression in these patients. Candidate variables with P values less than 0.20 in univariate analysis were included in the multivariate logistic regression analysis.ResultsTwo hundred patients returned completed questionnaires in this study. Of these 200 patients, 34 (17.0%) suffered from anxiety and 31 (15.5%) suffered from depression 30.67 ± 8.6 months after being discharged. The multivariate analysis results indicated that shorter sleep times were statistically significantly associated with depression (OR = 1.62, 95% CI: 1.14 ~ 2.29, P = 0.007, Adjusted P = 0.02). .ConclusionThe prevalences of anxiety and depression in UIA patients treated by endovascular intervention were 17.0 and 15.5%, respectively. Shorter sleep times were significantly associated with depression. Our findings provide evidence for the clinical and psychological management of these patients.

Institutional Experience of Microsurgical Management in Posterior Circulation Aneurysm.

Introduction:Posterior circulation aneurysm constitutes 15%–20% of all intracerebral aneurysms. With the advancement of endovascular techniques, the microsurgery for posterior circulation aneurysms has been pushed back a little. Even the International Subarachnoid Aneurysmal Trial gave support to the concepts of endovascular procedures, but microsurgical modality should not be discouraged. We present our institutional experience of microsurgical techniques on posterior circulation aneurysms.Materials and Methods:We performed a retrospective analysis of 37 patients of posterior circulation aneurysm from 2015 to 2019, referred to Bantane Hospital, Japan. We included all posterior circulation aneurysms such as basilar tip, basilar trunk, and vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysms, admitted and treated with clipping or bypass and trapping. We assessed the outcome as measured by modified Rankin Score (mRS), complications, and mortality.Results:Out of 37 patients, 10 cases were a basilar tip, one case was the basilar trunk, and 26 cases were VA-PICA aneurysm. Intraoperatively, neuromonitoring, indocyanine green dye, dual-image videoangiography (DIVA), and neuro endoscope were used. Two patients of basilar tip aneurysm developed third cranial nerve paresis and six patients of VA-PICA aneurysm developed lower cranial nerve paresis which resolved spontaneously. All the patients were discharged with mRS of 0 or 1. No mortality was recorded in our study.Conclusion:Microsurgical clipping of posterior circulation aneurysm is safe in unruptured aneurysm with a very low risk of mortality and morbidity under experienced hands. All postoperative complications in our study were transient and resolved with time with no residual deficits. Preoperative simulation, intraoperative neuromonitoring, DIVA, and neuro endoscope help achieve complete obliteration of aneurysmal sac and avoid complications.