Risk Of Rupture In Patients Research Articles

A nomoscore of four genes for predicting the rupture risk in abdominal aortic aneurysm patients with osteoarthritis

BackgroundAbdominal aortic aneurysm (AAA) represents one of the most life-threatening cardiovascular diseases and is increasingly becoming a significant global public health concern. The aneurysms-osteoarthritis syndrome (AOS) has gained recognition, as patients with this syndrome often exhibit early-stage osteoarthritis (OA) and have a substantially increased risk of rupture, even with mild dilation of the aneurysm. The aim of this study was to discover potential biomarkers that can predict the occurrence of AAA rupture in patients with OA. MethodsTwo gene expression profile datasets (GSE98278, GSE51588) and two single-cell RNA-seq datasets (GSE164678, GSE152583) were obtained from the GEO database. Functional enrichment analysis, PPI network construction, and machine learning algorithms, including LASSO, Random Forest, and SVM-RFE, were utilized to identify hub genes. In addition, a nomogram and ROC curves were generated to predict the risk of rupture in patients with AAA. Moreover, we analyzed the immune cell infiltration in the AAA tissue microenvironment by CIBERSORT and validated key gene expression in different macrophage subtypes through single-cell analysis. ResultsA total of 105 intersecting DEGs that showed consistent changes between rAAA and OA dataset were identified. From these DEGs, four hub genes (PAK1, FCGR1B, LOX and PDPN) were selected by machine learning. High predictive performance was observed for the nomogram based on these hub genes, with an AUC of 0.975 (95 % CI: 0.942–1.000). Abnormal immune cell infiltration was detected in rAAA and correlated significantly with the hub genes. Ruptured AAA cases exhibited higher nomoscore values and lower M2 macrophage infiltration compared to stable AAA. Validation in animal models (PPE+BAPN-induced rAAA) confirmed the significant role of these biomarkers in AAA pathology. ConclusionThe present study successfully identified four potential hub genes (PAK1, FCGR1B, LOX and PDPN) and developed a robust predictive nomogram to assess the risk of AAA rupture. The findings also shed light on the connection between hub genes and immune cell components in the microenvironment of rAAA. These findings support future research on key genes in AAA patients with OA, providing insights for novel management strategies for AAA.

Prevalence and Related Factors of Rupture among Cases with Ectopic Pregnancy; a Systematic Review and Meta-Analysis.

In the absence of timely treatment, the risk of rupture in patients with ectopic pregnancy (EP) increases, which is associated with extensive bleeding, complicated surgery, and maternal death. This study aimed to investigate the prevalence of rupture and its related factors among EP cases. A comprehensive, systematic search was conducted in electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Ectopic pregnancies", "Extrauterine pregnancies", and "Ruptured ectopic pregnancy" from the earliest to the 13th of December 2022. The CMA program, version 3, was utilized for analysis. The overall effect size was calculated using the sample size and the frequency of rupturein each of the studies. Heterogeneity was measured using the I2 statistics. A total of 5,269 women with EP participated in 17 studies. The pooled prevalence of rupture was 56.4% (95%CI: 44.9% to 67.2%; I2=98.09%; P<0.001). Factors such as number of parties, amount of β-hCG, age, history of ectopic pregnancy, cornual and isthmic pregnancies, gestational age, number of gravidities, history of tubal ligation, tubal diameters, periods of infertility, history of infertility, pregnancy by ovulation induction, extensive hemoperitoneum, ampullar and isthmic pregnancies, ampullar pregnancies, preoperative heart rate (HR), triage, triage shock index (SI), abdominal pain, single marital status, preoperative hemoglobin levels, preoperative hematocrit levels, history of pelvic inflammatory disease (PID), and use of contraceptives were associated with the prevalence of rupture in EP cases. Based on the findings, 56.4% of EP cases experienced rupture and various factors influence its prevalence. As a result, health managers and policymakers can address and mitigate modifiable factors contributing to rupture in EP cases by implementing regular consultations and screenings.

The rupture risk factors of mirror intracranial aneurysms: A systematic review and meta-analysis based on morphological and hemodynamic parameters.

Intracranial aneurysms (IAs) are a prevalent form of vascular disease that can lead to fatal outcomes upon rupture. Mirror intracranial aneurysms (MIAs) are a specific type of multiple aneurysms situated symmetrically on both sides of the parent arteries. The factors contributing to the risk of MIA rupture, based on morphological and hemodynamic parameters, are currently controversial. Thus, we conducted a systematic review and meta-analysis to investigate the risk factors for MIA rupture. The study performed an electronic search of Chinese and English databases, including China national Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases, and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The morphological parameters (IA size, aspect ratio [AR], size ratio [SR], bottleneck factor [BNF], height-width ratio [HWR], irregular shape) and hemodynamic parameters (wall shear stress [WSS], low WSS area [LSA], oscillatory shear index [OSI]) were analyzed for their significance in determining the risk of MIA rupture. The analysis comprised 18 retrospective studies involving 647 patients, with a total of 1294 IAs detected, including 605 ruptured and 689 unruptured. The meta-analysis revealed that IA size, AR, SR, and irregular shape exhibited significant differences between the ruptured and unruptured groups, but HWR did not. In terms of hemodynamic parameters, WSS, OSI, and LSA were found to have significant differences between the two groups. Our results demonstrate that larger IAs, higher AR, SR, and BNF are associated with a higher risk of rupture in patients with MIAs, regardless of their location. there is no significant difference in HWR between the ruptured and unruptured groups. These preliminary findings offer valuable insights for clinical decision-making and a more comprehensive comprehension of the current MIA status. Nevertheless, larger and multi-center studies are indispensable for corroborating these findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/ identifier: CRD42022345587.

Risk Factors for Intracranial Aneurysm Rupture: A Clinical Case Series and Systematic Review of the Literature.

To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm. We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases. Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p=0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p=0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p=0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis. Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.

Association Between Aneurysmal Hemodynamics and Rupture Risk of Unruptured Intracranial Aneurysms.

BackgroundAssessing rupture risk in patients with unruptured intracranial aneurysms (UIAs) remains challenging. Hemodynamics plays an important role in the natural history of intracranial aneurysms. This study aimed to compare aneurysmal hemodynamic features between patients with different rupture risk as determined by PHASES score.MethodsWe retrospectively examined 238 patients who harbored a solitary saccular UIA. Patients were stratified by rupture risk into low-, intermediate-, and high-risk groups according to PHASES score. Flow simulations were performed to compare differences in hemodynamics among the groups.ResultsAneurysmal time-averaged wall shear stress (WSSa) and normalized WSS (WSSn) decreased progressively as PHASES score increased. WSSa and WSSn significantly differed among the low-, intermediate-, and high-risk groups (p < 0.001). WSSa was significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.004). WSSn was also significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.001).ConclusionsLow WSS was significantly associated with higher risk of intracranial aneurysm rupture as determined by PHASES score, indicating that hemodynamics may play an important role in aneurysmal rupture. In the future, a multidimensional rupture risk prediction model that includes hemodynamic parameters should be investigated.

Morphological characteristics associated with ruptured intracranial vertebral artery dissecting aneurysms

ObjectiveMorphological risk factors for the rupture of intracranial vertebral artery dissecting aneurysms (IVADAs) have not been well characterized. In this study, we aim to identify morphological characteristics associated with IVADA...

Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis.

Surveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare. We performed meta-analysis to examine long-term rupture risk over ≥1-year follow-up duration in patients with unruptured intracranial aneurysm who underwent endovascular therapy. Multiple databases were searched for relevant publications between 1995 and 2018. Studies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included. Random effects meta-analysis was used, and results were expressed as long-term rupture rate per 100 patient-year with respective 95% CIs. For ruptured aneurysms during follow-up, data were collected on size and completeness of initial Treatment. Twenty-four studies were identified. Among 4842 patients with a mean follow-up duration of 3.2 years, a total of 12 patients (0.25%) experienced rupture of previous unruptured intracranial aneurysms after endovascular treatment. Nine of these 12 patients harbored aneurysms that were large, incompletely treated, or both. A total of 2 anterior circulation, small, completely coiled aneurysms subsequently ruptured. The long-term rupture rate per 100 patient-year for unruptured intracranial aneurysms treated with endovascular therapy was 0.48 (95% CI, 0.45-0.51). Retreatment was carried out in 236 (4.9%) of these 4842 patients. A limitation of the study is that a lack of systematic nature of follow-up and mean follow-up duration of 3.2 years are not sufficient to make general recommendations about aneurysm followup paradigms. Given a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium-sized, well-treated aneurysms is exceedingly rare.

VESS23. Risk of Developing an Abdominal Aortic Aneurysm After Ectatic Aorta Detection After Initial Screening

Current abdominal aortic aneurysm (AAA) surveillance guidelines recommend no further follow-up after initial abdominal aortic screening of greater than 3.0 cm in aortic diameter. However, recent reports have demonstrated patients with late AAA formation and late ruptures after initial ultrasound screening detection of patients with an aortic diameter of 2.5 to 2.9 cm (ectatic aorta). The purpose of this study is to determine AAA development and rupture risk in patients with detected ectatic aortas identified from an initial AAA screening. A retrospective chart review of all patients screened for AAA from January 1, 2007, to December 31, 2016, within a regional healthcare system was conducted. Screening criteria were men 65 to 75 years of age who smoked a minimum of 100 cigarettes in their lifetime. An ectatic aorta was defined as a maximum aortic diameter from 2.5 to 2.9 cm. An AAA was defined as an aortic diameter of 3 cm or greater. Patients screened with ectatic aortas that had subsequent follow-up imaging of the aorta from either a computed tomography scan or ultrasound examination were analyzed for associated clinical and cardiovascular risk factors. Univariate and χ2 analyses were performed to identify risks associated with the development of AAA from an initially diagnosed ectatic aorta. A total of 3205 patients (mean ± standard deviation of 72.1 ± 5.3 years of age) with ectatic aortas were detected from January 1, 2007, to December 31, 2016. The average ectatic aortic diameter from screening was 2.6 ± 0.1 cm. A total of 852 of 3205 patients (26.6%) had received subsequent imaging for other clinical indications, with an average time between scans of 5.4 ± 2.9 years. There were 90 of the 852 patients (10.6%) with ectatic aortas who developed into an AAA from the last follow-up scan. Two patients had aortic growth to 5.5 cm or greater (0.2%). Older age, longer time interval between scans, larger initial screening diameter, active smoking status, chronic obstructive pulmonary disease, and a low body mass index were associated with AAA development (Table). Of all patients with detected ectatic aortas who had a subsequent imaging for other clinical indications, 10.6% developed a subsequent AAA and 0.2% developed an AAA of 5.5 cm or greater. Given that only 26.6% of patients with an ectatic aorta had a subsequent imaging study, these numbers may underestimate the true conversion to AAA. Consideration for follow-up imaging studies at 5 years should be targeted in patients with ectatic aortas who are active smokers and have chronic obstructive pulmonary disease.TableClinical and Risk Factor DataClinical dataTotal (n = 3205)Normal aorta (n = 762)AAA (n = 90)P valueAge, years72.1 ± 5.372.6 ± 5.574.2 ± 6.6.01Follow-up, years5.4 ± 2.95.9 ± 2.97.2 ± 2.9<.01Initial aortic screening diameter, cm2.6 ± 0.12.6 ± 0.12.7 ± 0.1<.01Body mass index, kg/m229.7 ± 6.029.1 ± 6.327.5 ± 5.1.02Total cholesterol, mg/dL163.6 ± 40.0159.8 ± 40.7155.2 ± 37.9.31Hemoglobin A1c, %6.5 ± 11.46.3 ± 2.56.1 ± 0.9.45Active smoking status671 (20.9)142 (18.6)25 (27.8).04Chronic obstructive pulmonary disease639 (20.0)164 (21.5)40 (44.4)<.01Hypertension2417 (75.4)606 (79.5)76 (84.4).27Diabetes1159 (36.1)296 (38.8)28 (31.1).15Statin use1482 (46.2)385 (50.5)48 (53.3).62Living status2716 (84.7)617 (81.0)73 (81.1).97Values are mean ± standard deviation or number (%). Open table in a new tab

Estimation of Abdominal Aortic Aneurysm Rupture Risk with Biomechanical Imaging Markers

PurposeTo evaluate whether the biomechanical marker known as rupture risk equivalent diameter (RRED) was superior to the actual abdominal aortic aneurysm (AAA) diameter in estimating future rupture risk in patients who had undergone pre-rupture computed tomography (CT) angiography. Materials and MethodsA retrospective study was conducted in 13 patients with ruptured AAAs who had undergone CT angiography before and after rupture between 2001 and 2015. The median time between the 2 scans was 731 days. Biomechanical and geometrical markers such as maximal AAA diameter, peak wall stress (PWS), and RRED were calculated with AAA-dedicated software. The main analyses determined whether RRED was higher than the actual diameter and the threshold diameter for elective surgery (55 mm for men, 50 mm for women) in AAAs before and after rupture. Differences between diameter and biomechanical markers before and after rupture were tested with appropriate statistical tests. ResultsRRED before and after rupture was smaller than the actual diameter in 7 of 13 cases. Post-rupture RRED was estimated to be smaller than the threshold diameter for elective repair in 4 cases, again suggesting a low rupture risk. The median PWS before and after rupture was 181.7 kPa (interquartile range [IQR], 152.1–244.2 kPa) and 274.1 kPa (IQR, 172.2–377.2 kPa), respectively. ConclusionsRRED was smaller than the actual diameter in more than half of pre-rupture AAAs, suggesting a lower rupture risk than estimated with the actual diameter. The results suggest that the currently available biomechanical imaging markers might not be ready for use in clinical practice.

Stress in Patients With (Un)ruptured Intracranial Aneurysms vs Population-Based Controls

Stress is associated with increased risk of stroke and might predispose to presence and rupture of intracranial aneurysms. To study the association of recent and lifelong stress with unruptured intracranial aneurysm (UIA) and aneurysmal subarachnoid hemorrhage (ASAH). In 227 UIA patients (mean age 61±11 yr), 490 ASAH patients (59±11 yr), and 775 controls (51±15 yr) who were randomly retrieved from the general population, we assessed occurrence of major life events and perceived stress during the preceding 12 mo and the entire life. With multivariable logistic regression analysis, we calculated odds ratios (ORs) with 95% confidence intervals (95% CIs) for 4 categories of life events (financial-related, work-related, children-related, and death of family members) and for periods of perceived stress at home and at work (never vs sometimes, often, or always). We adjusted for sex, age, alcohol consumption, smoking, and hypertension. The 4 categories of life events and perceived stress at work had ORs ranging from 0.4 to 1.7, of which financial stress for UIA was statistically significant (95% CI: 1.1-2.5). ORs for chronic perceived stress at home in the previous year were 4.3 (95% CI: 1.8-10.3) for UIA and 2.5 (1.2-5.5) for ASAH, and for lifelong exposure 5.7 (2.2-14.5) for UIA and 3.0 (1.3-7.0) for ASAH. For some components of stress, there may be a relation with UIA and ASAH. The mechanisms underlying this relation should be unraveled; strategies to improve coping with stress may reduce the risk of rupture in patients with unruptured aneurysms.

Finite element analysis in symptomatic and asymptomatic abdominal aortic aneurysms for aortic disease risk stratification.

Advanced biomechanical models can provide additional information concerning rupture risk in abdominal aortic aneurysms (AAA). Here we evaluated the predictive value of finite element analysis (FEA) to assess AAA rupture risk. In a case-control study, we compared FEA parameters in a group of symptomatic AAA (sAAA) patients, considered as a high risk of rupture group, with FEA parameters in asymptomatic AAA patients (aAAA). We included 15 sAAA and 28 aAAA patients matched for age- and maximum diameter diagnosed with infrarenal non-ruptured AAA at our center between 2009 and 2013. Mean age was 75±69 years and mean maximum diameter was 77±17 mm. Peak wall stress (PWS) was significantly higher in sAAA patients than in aAAA patients (354.3±139.6 kPa vs. 248.6±81.9 kPa; P=0.001). The C statistic for the ROC curve based on PWS was 0.748 (95% CI: 0.592-0.903; P=0.008). CART analysis classified patients into high and low PWS groups. The high-PWS group (>305.15 kPa; N.=15) had a higher incidence of sAAA (33.3% aAAA, 66.7% sAAA) than the low-PWS-group (≤305.15 kPa; N.=28. 82.1% aAAA, 17.9% sAAA). In conclusion, PWS was significantly higher in sAAA patients. Measuring PWS may help estimate the individual rupture risk in patients with AAA, but larger studies are needed to confirm our results.

Unruptured Intracranial Aneurysms.

Unruptured Intracranial Aneurysms.

Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms.

In patients with aneurysmal subarachnoid hemorrhage (aSAH) and multiple aneurysms, there is a need to objectively identify the ruptured aneurysm. Additionally, studying the intra-individual rupture risk of multiple aneurysms eliminates extrinsic risk factors and allows a focus on anatomical factors, which could be extrapolated to patients with single aneurysms too. Retrospective bi-center study (Department of Neurosurgery of the University Hospital Duesseldorf and Bern) on patients with multiple aneurysms and subarachnoid hemorrhage caused by the rupture of one of them. Parameters investigated were height, width, neck, shape, inflow angle, diameter of the proximal and distal arteries, width/neck ratio, height/width ratio, height/neck ratio, and localization. Statistical analysis and logistic regressions were performed by the R program, version 3.4.3. N = 186 patients with aSAH and multiple aneurysms were treated in either department from 2008 to 2016 (Bern: 2008-2016, 725 patients and 100 multiple aneurysms, Duesseldorf: 2012-2016, 355 patients, 86 multiple aneurysms). The mean age was 57years. N = 119 patients had 2 aneurysms, N = 52 patients had 3 aneurysms, N = 14 had 4 aneurysms and N = 1 had 5 aneurysms. Eighty-four percent of ruptured aneurysms were significantly larger than the largest unruptured. Multilobularity of ruptured aneurysms was significantly higher than in unruptured. Metric variables describing the geometry (height, width, etc.) and shape are the most predictive for rupture. One or two of them alone are already reliable predictors. Ratios are completely redundant in saccular aneurysms.

Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms

Characterization of the rupture risk factors for small intracranial aneurysms (SIAs, ≤5 mm) is clinically valuable. The present study aims to identify image-based morphological parameters and anatomical locations associated with the rupture status of SIAs. Two hundred and sixty-three patients with single SIAs (128 ruptured, 135 unruptured) were included, and six morphological parameters, including size, aspect ratio (AR), size ratio (SR), height–width ratio (H/W), flow angle (FA) and aneurysm width–parent artery diameter ratio, and the aneurysm locations were evaluated using three-dimensional geometry, and were used to identify a correlation with aneurysm rupture. Statistically significant differences were observed between ruptured and unruptured groups for AR, SR, H/W, FA, and aneurysm locations, from univariate analyses. Logistic regression analysis further revealed that AR (p = 0.034), SR (p = 0.004), H/W (p = 0.003), and FA (p < 0.001) had the strongest independent correlation with ruptured SIAs after adjustment for age, gender and other clinical risk factors. A future study on a larger SIA cohort need to establish to what extent the AR, SR, H/W and FA increase the risk of rupture in patients with unruptured SIAs in terms of absolute risks.

Heroin Use Is Associated with Ruptured Saccular Aneurysms.

While cocaine use is thought to be associated with aneurysmal rupture, it is not known whether heroin use increases the risk of rupture in patients with non-mycotic saccular aneurysms. Our goal was to investigate the association between heroin and cocaine use and the rupture of saccular non-mycotic aneurysms. The medical records of 4701 patients with 6411 intracranial aneurysms, including 1201 prospective patients, diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the association between heroin, cocaine, and methadone use and the presence of ruptured intracranial aneurysms. In multivariable analysis, current heroin use was significantly associated with rupture status (OR 3.23, 95% CI 1.33-7.83) whereas former heroin use (with and without methadone replacement therapy), and current and former cocaine use were not significantly associated with intracranial aneurysm rupture. In the present study, heroin rather than cocaine use is significantly associated with intracranial aneurysm rupture in patients with non-mycotic saccular cerebral aneurysms, emphasizing the possible role of heroin in the pathophysiology of aneurysm rupture and the importance of heroin cessation in patients harboring unruptured intracranial aneurysms.

Biomechanical Simulation to Compare the Blood Hemodynamics and Cerebral Aneurysm Rupture Risk in Patients with Different Aneurysm Necks

In this study, one normal subject and two patients suffering from a cerebral aneurysm with circular and elliptical necks are analyzed by using the fluid-structure interaction (FSI) method. Although the blood hemodynamics parameters increase after the occurrence of the disease, the largest increase is in the wall shear stress (by a factor of 4.1–6.5) as compared to the normal subject. The increase in these parameters for patients with a circular neck is more pronounced than that with an elliptical neck. The blood flow becomes slightly more turbulent after the occurrence of the cerebral aneurysm, though it still remains in the range of the laminar flow and the pulsatility of the blood flow in patients is 28–45% greater than that of the normal subject. Finally, the results show that the risk of vessel rupture in the cerebral aneurysm with a circular neck is 40.8% higher than that in the case of the cerebral aneurysm with an elliptical neck.

A proposed classification for assessing rupture risk in patients with intracranial arteriovenous malformations.

Background:Whether cerebral arteriovenous malformations (AVMs) should be treated remains an ongoing debate. Nevertheless, there is a need for predictive factors that assist in labelling lesions as low or high risk for future rupture. Our aim was to design a new classification that would consider hemodynamic and anatomic factors in the rapid assessment of rupture risk in patients with AVMs.Methods:This was a retrospective study that included 639 patients with ruptured and unruptured AVMs. We proposed a new classification score (1–4 points) for AVM rupture risk using three factors: feeding artery mean velocity (Vm), nidus size, and type of venous drainage. We employed descriptive statistics and logistic regression analysis.Results:A total of 639 patients with cerebral AVMs, 388 (60%) had unruptured AVMs and 251 (40%) had ruptured AVMs. Logistic regression analysis revealed a significant effect of Vm, nidus size, and venous drainage type in accounting for the variability of rupture odds (P = 0.0001, R2 = 0.437) for patients with AVMs. Based in the odds ratios, grades 1 and 2 of the proposed classification were corresponded to low risk of hemorrhage, while grades 3 and 4 were associated with hemorrhage: 1 point OR = (0.107 95% CI; 0.061–0.188), 2 point OR = (0.227 95% CI; 0.153–0.338), 3 point OR = (3.292 95% CI; 2.325–4.661), and 4 point OR = (23.304 95% CI; 11.077–49.027).Conclusion:This classification is useful and easy to use, and it may allow for the individualisation of each cerebral AVM and the assessment of rupture risk based on a model of categorisation.

Biomechanical Simulation to Compare the Blood Hemodynamics and Cerebral Aneurysm Rupture Risk in patients with Different Aneurysm Necks

Biomechanical Simulation to Compare the Blood Hemodynamics and Cerebral Aneurysm Rupture Risk in patients with Different Aneurysm Necks

Optimal Management of Renal Artery Aneurysms: Observation Versus Intervention

This study evaluated outcomes of treated renal artery aneurysms (RAAs) and the natural history of observed RAAs. A total of 114 patients with RAA managed from 1994 to 2014 were retrospectively reviewed. Primary outcomes included morbidity and mortality of RAAs treated operatively (OP) with open and endovascular procedures and aneurysm growth rate and risk of rupture in patients managed nonoperatively (NOP). Secondary outcomes included renal artery patency and need for reintervention in the OP group and kidney function in the OP and NOP groups. There were 49 OP patients (34 females) and 66 NOP (31 females). Three RAAs ruptured (sizes: 34, 36, and 41 mm). Mean aneurysm size was 26.8 ± 8.9 mm (OP) and 13.6 ± 5.2 mm (NOP; P < .001). A total of 57% of patients in OP were symptomatic, with flank pain (24%), hematuria (18%), and severe hypertension (18%). Nine (19%) and 29 (60%) of OP patients had a RAA <20 and <30 mm, respectively. RAA location in the OP included the primary bifurcation in 28, main renal artery in 8, upper and lower segmental pole branches in 5 each, and middle segmental pole branch in 2. Operative management included RAA resection and saphenous vein graft (SVG) in 15, vein patch in 11, primary repair in 7, ex vivo reconstruction in 7, Dacron graft in 2, internal iliac artery patch in 1, and endovascular coil embolization in 3. Mean renal ischemia time was 56 ± 48 minutes (ex vivo: 151 ± 27 minutes; not ex vivo: 40 ± 27 minutes). The 30-day mortality was 0%. One patient had a nephrectomy at the time of repair due to venous injury, and a second one occurred at 3.7 months due to SVG occlusion. One patient underwent concomitant splenectomy. One patient's operation was aborted due inflammation from a previously ruptured and coiled RAA, who subsequently underwent definitive embolization. Complications included pancreatitis (n = 1) and reexploration for small bowel obstruction (n = 1) and bleeding (n = 1). RAA reintervention was 0%. NOP RAAs were followed up for 76.8 ± 54.4 months and had a growth rate of 0.3 ± 0.9 mm/y. There were no ruptures and no conversions to OP. Kidney function in NOP remained stable (Δ glomerular filtration rate, 5.4 ± 21.1 mL/min) but worsened in OP (Δ glomerular filtration rate, 5.9 ± 23.5 mL/min; P = .008). No RAA <34 mm ruptured. Because the rate of growth is slow and kidney function remains stable without repair, RAA <30 mm should be observed unless symptoms occur.

Size and anatomic location of ruptured intracranial aneurysms in patients with single and multiple aneurysms: a retrospective study from a single center

Background and purposeThe difference in the relationship between the size of intracranial aneurysms (IAs) and their risk of rupture in patients with singe IAs versus those with multiple IAs is...