Intraoperative Aneurysm Rupture Research Articles

Risk and Prognostic Factors for Rupture of Intracranial Aneurysms During Endovascular Embolization

Intraoperative aneurysm rupture (IPR) always results in a poor prognosis for the patient. However, the risk factors of IPR are unclear. In this article, the risk factors are explored, a nomogram model for predicting IPR is established, and the prognostic factors for patients with IPR are analyzed. A total of 549 patients with aneurysm, which were embolized from September 2011 to September 2015, were enrolled for analysis. Univariate and multivariate logistic regression were performed to explore the risk factors for IPR, and a nomogram was established. A nonparametric Mann-Whitney U test was performed to analyze prognostic factors for patients with IPR. Twenty-one patients (4.4%) experienced IPR. In univariate analysis, Hunt-Hess grade (P= 0.002), time from hospitalization to treatment (P= 0.08) and subarachnoid hemorrhage (SAH) to treatment (P= 0.08), aneurysm neck (P= 0.08), assistive technique (P= 0.03), and intraoperative cerebral vasospasm (P < 0.001) were significantly associated with IPR. In multivariate analysis, Hunt-Hess grade (odds ratio [OR], 8.177; 95% confidence interval [CI], 1.714-39.012; P= 0.008), aneurysm neck (OR, 5.629; 95% CI, 1.149-27.575; P= 0.033), assistive technique (OR, 1.393; 95% CI, 0.961-2.018; P= 0.080), and intraoperative cerebral vasospasm (OR, 4.280; 95% CI, 1.081-16.947; P= 0.038) were independent risk factors for IPR. Hydrocephalus (P= 0.069), history of SAH (P= 0.10), ≥2 SAH (P= 0.051), location of aneurysm (P= 0.09), and number of aneurysms (P= 0.025) were associated with the bad outcome. Hunt-Hess grading, aneurysm neck, intraoperative assistive technology, and vasospasm were independent risk factors for IPR. Hydrocephalus requiring surgical intervention, times of rupture, location of aneurysm, and the number of aneurysms were relevant to the prognosis of patients.

Atrial fibrillation with hemodynamic instability after the use of the third dose of adenosine during surgery for 7 intracranial aneurysms

Adenosine-induced asystole is a technique that prevents and controls the intraoperative rupture of cerebral aneurysm, facilitating temporary, and/or definitive clipping of the aneurysm. This is the case of a 58-year-old woman who underwent clipping of 7 intracranial aneurysms, who was induced asystole with adeno-sine 3 times and developed atrial fibrillation with hemodynamic instability after the last dose. Adenosine has been shown to be useful and safe, however, its use should be planned and possible cardiological complications should be considered.

The role of morphological and hemodynamic factors in predicting intraoperative aneurysm rupture during aneurysm clipping

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

Balloon-assisted coiling of cerebral aneurysms with the dual-lumen Scepter XC balloon catheter: Experience at two high-volume centers.

The Scepter XC is a dual-lumen balloon catheter that accommodates a 0.014-inch microwire and can be used for balloon-assisted coiling of cerebral aneurysms. We describe our experience with the use of this device. Two high-volume institution neurointerventional databases were retrospectively reviewed for cerebral aneurysms treated with balloon-assisted coiling using the Scepter XC balloon catheter. Patient demographics, aneurysm characteristics, and procedural details were recorded. Major procedure-related neurologic complications were defined as events that caused an increase in modified Rankin Scale that persisted for more than 1 week after the procedure. Follow-up aneurysm occlusion was assessed using the Raymond-Roy classification. During the study period, 231 aneurysms were treated in 219 patients (152 women, 67 men) with a mean age of 58.4 ± 12.2 years. Mean aneurysm size was 6.1 ± 3.1 mm, with a mean neck diameter of 3.1 ± 1.3 mm. In total, 77.5% of aneurysms were wide necked, and 39.8% were treated in the setting of subarachnoid hemorrhage. The major complication rate was 0.9% (2/231) per treated aneurysm, including one stroke and one death related to intraoperative aneurysm rupture. Excluding patients who died, angiographic follow up was available for 85.3% (191/224) of aneurysms. During a mean follow up of 17.4 ± 13.0 months (range, 1.7-66.5 months), Raymond-Roy 1 and 2 occlusion rates were 56.5% (108/191) and 35.6% (68/191), respectively. The retreatment rate was 12.6% (24/191). Our experience using the coaxial dual-lumen Scepter XC for balloon-assisted coiling demonstrates acceptable aneurysm occlusion and complication rates.

The Morphological and Hemodynamic Characteristics of the Intraoperative Ruptured Aneurysm.

Background and ObjectivesIntraoperative aneurysm rupture (IOR) is a difficult event during the clipping process for intracranial aneurysms, and could result in a bad prognosis. Preoperative discrimination of aneurysms with high risk of IOR is vital for operators. The aim of this study was to explore the hemodynamic-morphological risk factors for the IOR.MethodsIn the present study, patients admitted for unruptured IA from January 2012 to April 2018 were retrospectively reviewed. A propensity score matching was performed to match patients. The morphological features and the hemodynamic features were extracted. Differences in the morphologic and hemodynamic parameters were compared. Risk factors associated with IOR were explored. Subsequently, the hemodynamic characteristics in different rupture stages and different regions in IOR aneurysm were compared.Results96 cases of patients with aneurysms, were found by the matching process in each group. The statistically significant difference was found in the maximum length (L) (p = 0.041), maximum diameter of body (D) (p = 0.032), aspect ratio (AR) (p < 0.001), non-sphericity index (NSI) (p < 0.001), normalized wall shear stress maximum (NWSSm) (p < 0.001) and oscillatory shear index (OSI) (p < 0.001). A regression analysis demonstrated AR (OR = 7.03, p < 0.001), NWSSm (OR = 15.55, p = 0.014) and OSI (OR = 28.30, p < 0.001) as the independent risk factors for IOR. AR was much larger, and NWSSm and NWSSa were much lower for IAs that ruptured in early or pre-dissection stage than those for IAs that ruptured in dissection stage or clip application stage. NWSSa and NWSSm in rupture area were both lower than those in adjacent area.ConclusionAR, NWSSm, and OSI are considered three independent risk factors for intraoperative aneurysm rupture, which could serve as predictors. A selection of intervention methods for aneurysms with high AR, low NWSSm, and high OSI should carefully be considered.

Microsurgical clipping of an unruptured superiorly projecting ACoM aneurysm in a rotated ACoM complex.

Key Clinical MessageThis case illustrates surgical technique for wide neck aneurysm clipping in a rotated complex and how to manage intraoperative aneurysm rupture while maintaining hemostasis (Cai et al., Anterior communicating artery aneurysm morphology and the risk of rupture. World Neurosurg. 2018;109:119 and Dehdashti et al., The implication of anterior communicating complex rotation and 3‐dimensional computerized tomography angiography findings in surgical approach to anterior communicating artery aneurysms. World Neurosurg. 2016;91:34).

Neurogenic stressor cardiomyopathy caused by aneurysmal subarachnoid hemorrhage

Clinical demonstration of the development of acute non-coronarogenic myocardial lesion in a patient with intraoperative rupture of the arterial aneurysm of the basilar artery. Neurogenic cardiomyopathy should be considered in the differential diagnostics of acute heart failure in patients with acute cerebral lesion.

Surgical Training for the Management of Intraoperative Aneurysm Rupture Using a Three-Dimensional Artificial Model.

Background:Intraoperative aneurysm rupture (IAR) is one of the most dreaded complications of microsurgical cerebral aneurysm clipping. The surgical result is directly affected by whether an operator can control IAR. However, the development of endovascular treatment has decreased the probability of exposure to this situation for neurosurgical residents. Therefore, neurovascular surgeons must develop the skills and mental attitude to deal with IAR through off-the-job training, without conducting actual operations.Materials and Methods:We have developed a tabletop training system using three-dimensional artificial modeling that can be used for daily clinical practice.Results and Conclusions:Our model is useful for training because of its low cost, reusability, and ease of preparation and practice.

Microsurgery for Upper Basilar Tip Aneurysm With Intraoperative Rupture: 3-Dimensional Operative Video.

In the last years, a shift from the microsurgical treatment to an endovascular therapy in patients with basilar apex aneurysm has been settled, part of this phenomenon is related to the significant tendency of vital perforators to be involved in the aneurysm dissection and clipping, which can implicate unfavorable outcomes. Nevertheless, microsurgical treatment remains the treatment that can provide the superior rates of stable and durable aneurysm occlusion, which is most important to young patients.In this video, we present the case of a 45-yr-old female patient who complained of a sudden and severe headache and presented with progressive lethargy during the following 3 d.At admission, computed tomography did not show abnormal findings. However, cerebrospinal fluid analysis showed erythrocytes and corroborated the clinical suspicion of spontaneous subarachnoid hemorrhage. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.Angiography and magnetic resonance imaging revealed a saccular basilar apex aneurysm. It showed a wide neck as well as a lobulated dome with upward and slightly left projection. The aneurysm did not involve angiographically visible thalamoperforator arteries, which allowed the microsurgical treatment by the fronto-orbitozygomatic approach. However, during the interpeduncular cistern dissection, an intraoperative rupture of the aneurysm occurred. This video exemplifies the steps required to manage an intraoperative rupture of a basilar apex aneurysm.

Single-Center Case Series of Temporary Stent Assistance for Coiling of Acutely Ruptured Aneurysms

Wide-necked intracranial aneurysms continue to pose a challenge for endovascular surgeons. Flow diversion and stent-assisted coiling are 2 techniques that have improved the ability to manage these lesions, but these require the use of dual antiplatelet therapy. In patients with aneurysmal subarachnoid hemorrhage, dual antiplatelet therapy is relatively contraindicated, and many surgeons prefer to use open techniques or balloon assistance for coiling, although at times the latter is not feasible. We describe temporary stent assistance using retrievable stents for coiling of ruptured intracranial aneurysms as an endovascular management option. Surgeon case logs were retrospectively reviewed for cases of temporary stent assistance for aneurysm coiling. Cases were identified and compiled into a case series. Seven cases were identified, including 6 using the Solitaire FR device in an off-label manner as a temporary stent for assistance with coiling of wide-necked aneurysms. One patient experienced intraoperative aneurysm rupture (planned stent coiling; stent placement aborted after rupture), but otherwise no hemorrhagic complications were noted. Two patients experienced radiographic thromboembolic complications, with 1 patient requiring intervention during the index operation, but neither patient experienced demonstrable neurologic deficits postoperatively. After mean follow-up of 9 months, the average Glasgow Coma Scale score was 14, and the average modified Rankin Scale score was 1.2. Stents and stent retrievers can be temporarily used for technically challenging aneurysms as an alternative to balloon assistance for treatment of ruptured intracranial aneurysms without needing to use dual antiplatelet therapy.

Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

Intraoperative aneurysmal rupture (IAR) is one of the most dramatic complications of intracranial intervention. Its frequency, depending on the aneurysm’s localization and anatomical features, may reach 50%. IAR leads to the increase of unfavorable outcomes by 1.5–3 times. There exists a variety of techniques aimed to reduce the frequency of this complication, however, all of them have essential limitations.&#x0D; The review presents analyses of the basic risk factors for IAR and techniques of its prevention, as well as modern approaches directed at the alleviation of this complication’s consequences.

Stent-assisted coil embolization of anterior communicating artery aneurysms using the LVIS Jr stent.

This retrospective study evaluates the safety and mid-term and long-term effectiveness of stent-assisted coil embolization of anterior communicating artery (Acomm) aneurysms treated with the LVIS Jr stent. All patients treated with the LVIS Jr stent for Acomm aneurysms between June 2015 and March 2018 were included in the analysis. Details of the procedure's periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up assessment were collected. A total of 25 patients with 25 aneurysms were included. Eighteen aneurysms were found incidentally. Seven patients presented with seven ruptured aneurysms: Six were remotely ruptured and one acutely ruptured. Twenty-four patients were treated successfully and one technical failure is reported. The parent arteries measured 1.4 mm to 2.9 mm in diameter (mean, 2.3 mm). Intraprocedural thromboembolic complications occurred in two patients (8%) and an intraoperative aneurysm rupture in one patient (4%). Immediate complete aneurysm occlusion was noted in 18 out of 25 patients (72%). Clinical follow-up ranged from three months to 36 months (mean, 15.8 months) and the imaging follow-up ranged from two to 35 months (mean, 14.2 months). Complete aneurysm occlusion was achieved in 14 out of 20 patients (70%) at last angiographic follow-up. Of the two patients with in-stent thrombosis, one patient had an acutely ruptured aneurysm and the other patient was treated with an LVIS Jr stent in a Y configuration. Neurological morbidity and mortality rate were 0%. Complex, wide-necked Acomm aneurysms can be effectively treated with stent-assisted embolization using LVIS Jr stents.

Unruptured Intracranial Aneurysms.

Unruptured Intracranial Aneurysms.

Intraoperative Aneurysm Rupture During Microsurgical Clipping: Risk Re-evaluation in the Post–International Subarachnoid Aneurysm Trial Era

Intraoperative aneurysm rupture (IOAR) is a common complication during intracranial aneurysm (IA) surgery. In light of the paradigm shift regarding IA selected for clipping in the post-International Subarachnoid Aneurysm Trial (ISAT) era, we aimed to evaluate the risk factors and effects of IOAR in an institutional series of clipped ruptured IA (RIA) and unruptured IA (UIA). All IAs treated with microsurgical clipping at our institution between 2003 and 2016 were eligible for this study. Demographic, clinical, and radiographic factors were correlated with occurrence of IOAR in univariate and multivariate analyses. The effect on outcome was analyzed for RIA and UIA separately. Nine hundred and three clipped IAs were included in the final analysis (538 UIA and 365 RIA). IOAR occurred in 163 cases (18.1%), mostly during clipping of RIA (37.5% vs. 4.8%) In multivariate analysis, ruptured status (adjusted odds ratio [aOR], 10.46; P < 0.001), sack size (aOR, 1.05 per mm increase; P= 0.038) and IA location in the anterior communicating artery (aOR, 2.31; P < 0.001) independently predicted IOAR. For RIA cases, IOAR was also independently predicted by rebleeding before therapy (aOR, 3.11; P= 0.033) and clinical severity of subarachnoid hemorrhage (aOR, 1.18 per WFNS grade increase; P= 0.049). IOAR independently predicted poor outcome (aOR, 1.83; P= 0.042) after RIA surgery. In turn, IOAR affected only the risk for cerebral infarct (OR, 3.75; P= 0.003) and incomplete IA occlusion (OR, 3.45; P= 0.003) for UIA cases, but not the outcome (P= 0.263). IOAR was independently predicted by the ruptured status, location, and size of IA and by initial severity of aneurysmal bleeding and pretreatment rebleeding. The influence of IOAR differed between RIA and UIA cases.

Rapid Ventricular Pacing for Neurovascular Surgery: A Study on Cardiac and Cerebral Effects

Intraoperative rupture of a cerebral aneurysm during neurosurgery can be a devastating event that increases perioperative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique to obtain flow arrest for short periods of time during dissection or rupture of the aneurysm. The objective of this study was to evaluate the neurological and cardiac effects of repetitive periods of RVP during cerebrovascular surgery. Data from patients who underwent repetitive RVP during craniotomy for cerebrovascular disorders were retrospectively analyzed from a single-center medical records database (Cegeka Medical Health Care Systems). We compared preoperative and postoperative troponin levels (cTnI) to assess cardiac ischemia. Preoperative and postoperative magnetic resonance imaging (MRI) results were screened for RVP-induced infarcts by evaluating diffusion restriction in the hemisphere contralateral to the operated side and the fossa posterior. A total of 37 patients were analyzed. An immediate decrease of systolic arterial blood pressure (<60 mm Hg) was achieved after initiation of RVP. Postoperative MRI did not reveal areas of diffusion restriction. RVP tended to be a predictor of postoperative cTnI increase. Preoperative and postoperative cTnI levels were higher in patients with a subarachnoid hemorrhage compared to patients without one. After 24 hours cTnI jevels normalized to preoperative values. Systolic arterial blood pressure decreased after RVP but normalized immediately when pacing stopped. MRI of the brain did not show RVP-related ischemia and the limited cTnI level increase normalized to preoperative values. Therefore, RVP during short periods of time seems to be a safe blood pressure-lowering technique for the brain and heart.

Editor's Choice – Open Thoracic and Thoraco-abdominal Aortic Repair After Prior Endovascular Therapy

The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n=38; 86%), EVAR (n=3; 7%), fenestrated EVAR (n=1; 2%) and TEVAR plus EVAR (n=1; 2%). Eleven patients (25%) had had previous open aortic surgery at the secondary surgery site. Indications for TAA(A) repair were Type I endoleak (n=10; 23%), post-dissection aneurysm progression due to persisting false lumen perfusion (n=8; 18%), proximal/distal disease progression (n=16; 36%), device fracture/dislocation (n=4; 9%), infection (n=5; 11%), and initial endograft misplacement (n=1; 2%). The operations included descending thoracic aortic repair (n=13, 29%), TAAA Type I (n=4; 9%), Type II (n=5; 11%), Type III (n=13; 29%), Type IV (n=7; 16%), and Type V repair (n=3; 7%) with simultaneous arch repair in 18% (n=8). The median time to secondary surgery was 36 (2-168) months. The median follow up was 39 (3-118) months. In hospital mortality was 20% (n=9) due to intra-operative aneurysm rupture, pneumonia induced sepsis, hemorrhagic cerebellar infarction, mesenteric ischaemia, broncho-esophageal fistula, and multiorgan failure (1/9) as well as haemorrhage (3/9). Estimated survival was 73% at 1 year and 71% overall. The most frequent complications were pneumonia (n=19; 43%), bleeding requiring revision (n=11; 25%) and sepsis (n=14; 32%). Transient dialysis was required in 32% (n=14), permanent dialysis in 6% (n=2). Permanent spinal cord deficit (paraparesis) occurred in 6% (n=2). Estimated freedom from aortic re-intervention was 86%. Open TAA(A) repair as a secondary procedure after previous endovascular aortic therapy is an important treatment option even in the endovascular era. It represents a durable treatment that can produce respectable outcomes. Yet the peri-operative morbidity and mortality are relevant and a specialised team and infrastructure are mandatory for these complex procedures. Therefore, centralisation is required.

Use of temporary arterial occlusion during anterior cerebral artery aneurysm repair

Introduction: This study was undertaken to determine variables that could predict, in the perioperative period of anterior communicating artery (ACom) aneurysms surgeries, the likelihood of postoperative sequelae and complications, after temporary arterial occlusion. Patients and Methods: In a universe of 92 patients submitted to ACom aneurysm clipping between 2000 and 2013, 32 were operated in the last seven years. Among these patients, 21 needed temporary arterial occlusion during surgical aneurysm repair, and had their data examined retrospectively. Results: Aneurysms larger than 7mm were more likely to be treated with longer temporary clipping time than small aneurysms, &lt;7mm (22±5.7 vs 11.3±4.1, t-Test, p &lt;0.0001). There was no statistical correlation between time of occlusion and outcome (r=0.92, Pearson, p&gt;0.08). Age, Glasgow Coma Scale (GCS) at initial evaluation, and Fisher scale at 1st CT scanning were independent factors of unfavorable outcome (Glasgow Outcome Scale ≤ 3) (cox-regression, p&lt;0.001). Among variable factors, patients older than 50 years, an initial GCS under 13, and a Fisher grade III or IV resulted in worse outcome. Meanwhile gender, tobacco or alcohol addiction, obesity, arterial hypertension, dyslipidemia, location of temporary occlusion (A1 or A2), intraoperative rupture and the aneurysm size were not identified as independent prognostic factors. During follow-up period, two thirds of the patients had a favorable outcome (GOS ≥ 4), accomplishing normal daily life activities without major complications. Fifty-two percent of patients evolved with hydrocephalus, despite of routine fenestration of the lamina terminalis, performed in 71.4% of procedures. Most patients also developed clinical vasospasm (66.6%), with 19% of the patients presenting with a severe disease. Delayed ischemic neurological deficit was observed in 28.5%, secondary to severe vasospasm, and without any statistical correlation to time of temporary occlusion or intraoperative aneurysm rupture. Conclusion: Temporary clipping during ACom aneurysm repair does not seem to add more morbidities to the procedure, and is not an independent prognostic factor. However, age, initial GCS and Fisher grade are associated to unfavorable outcome.

Letter to the Editor. Intraoperative aneurysm rupture during awake clipping of cerebral aneurysms.

Letter to the Editor. Intraoperative aneurysm rupture during awake clipping of cerebral aneurysms.

Protocol to the induction of loco-regional mild hypothermia for temporay clipping in the surgery of the middle cerebral artery aneurysm

Introduction: Less than 30% of Middle Cerebral Artery (MCA) aneurysms are amenable for endovascular coiling. Microvascular surgery still carries a large number of complications, since many perforators arteries arise near to the neck of the aneurysm and, in many cases, one or more branches of bifurcation or trifurcation of the MCA originate in the aneurysm wall. Temporary clipping of the proximal MCA avoids the aneurysmal rupture, facilitates the aneurysm dissection and clip placement but long term temporary clipping carries a great risk of ischemic complications. Objective: We developed a protocol of brain protection based on the neuroprotective properties of mild hypothermia which would intend to permit a more extended time of temporary clipping. Methods: Sixty-eight cases of MCA incidental aneurysms or after the 12nd day of hemorrhage were operated on. Brain temperature was dropped at levels that varied from 29.5ºC at 15mm parenchymal depth to 32.5ºC at ventricular level. There was no change in the patient’s body temperature. Temporary MCA clipping varied from 8 to 28 minutes. Results: There was no intraoperative aneurysm rupture. All 68 patients were alive and neurologically unchanged at the 90th and 180th follow-up days. Conclusion: Loco-regional mild hypothermia may be effective in protecting cerebral parenchyma in cases of temporary clipping over 8 minutes up to 28 minutes in MCA aneurysms surgery.

Monitoring Dynamic Morphological Changes With Electrocardiography-Gated Dynamic 4-Dimensional Computed Tomography Angiography to Predict Intraoperative Rupture of Intracranial Aneurysms.

This study aims to evaluate dynamic morphological changes of intracranial aneurysms to predict intraoperative aneurysm rupture (IAR) during clipping. Included in this study were 153 patients, who had ruptured and microsurgical-clipped aneurysms. All patients underwent dual-source computed tomography examination of electrocardiography-gated dynamic 4-dimensional computed tomography angiography before clipping. Original scanning data were reconstructed to produce 20 data sets of cardiac cycles with 5% time intervals. The aneurysm neck, transverse and longitudinal diameters, and volume from the 20 groups of images were measured to calculate their respective change rates. In addition, other data and clinical characteristics were recorded. Data were analyzed by logistic regression to identify factors associated with IAR. Of the 153 patients, 24 patients experienced IAR. Multivariable analysis revealed that the aneurysm neck change rate (P = 0.0001; odds ratio, 1.276) and aspect ratio (height/neck ratio, P = 0.025; odds ratio, 2.387) are predictors for IAR. When the change rate was greater than or equal to 60%, and the sensitivity and specificity were 91.7% and 76.7%, respectively. Aneurysm neck change rate is independent predictor of IAR.