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Hemorrhagic stroke
Original research
Shape related features of intracranial aneurysm are associated with rupture status in a large Chinese cohort
  1. Yuting Wang1,
  2. Meixiong Cheng2,
  3. Sijie Liu1,
  4. Guanglan Xie1,
  5. Ling Liu2,
  6. Xiao Wu3,
  7. Ajay Malhotra4,
  8. Mahmud Mossa-Basha5,
  9. Chengcheng Zhu5
  1. 1 Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
  2. 2 Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
  3. 3 Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  4. 4 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  5. 5 Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr Meixiong Cheng, Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China. Address: No. 32, Section 2, 1st Ring Road (West), Chengdu, 610072, China, Chengdu, China; chengmeixiong{at}med.uestc.edu.cn

Abstract

Background To investigate the prevalence of small ruptured saccular intracranial aneurysms (sIA) in a Chinese cohort and to identify factors associated with rupture status of sIAs.

Methods Consecutive patients with confirmed sIAs by DSA from January 2015 to July 2019 were included. Demographic and aneurysmal features, including maximal diameter, location, irregularity (lobulated or with blebs), and aspect ratio (AR, defined as height divided by neck width) were recorded and analyzed. Mixed effect logistic regression was used in multivariate analysis.

Results We analyzed 1514 sIAs in a Chinese cohort of 1216 patients, including 651 ruptured and 863 unruptured sIAs. Median aneurysm size was 5.7 mm for ruptured aneurysms, with 66.1% <7 mm in maximal diameter, and 40.2% measuring <5 mm. The median PHASES score of ruptured sIAs was 5. In multivariate analysis, male sex, hypertension, locations other than the internal carotid artery, irregularity (lobulated or with blebs), and higher AR were independently associated with rupture status (OR for irregularity, 2.88, 95% CI 2.20 to 3.77, p<0.001; OR for AR, 1.12, 95% CI 1.01 to 1.24, p=0.036). However, maximal diameter was not significantly associated with rupture status (p=0.72).

Conclusions In this cohort, ruptured sIAs were frequently smaller than 7 mm. Shape related features, such as irregularity and higher AR, were associated with the ruptured status of sIAs, irrespective of diameter. PHASES seems to be inadequate in sIA risk stratification. Shape related parameters may be further investigated in prospective studies.

  • brain
  • aneurysm
  • angiography
  • subarachnoid
  • hemorrhage

Data availability statement

All data relevant to the study are included in the article and the raw data are uploaded as supplementary file. The deidentified participant data that support the findings of this study are available from the first and corresponding authors upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017452

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    Data availability statement

    All data relevant to the study are included in the article and the raw data are uploaded as supplementary file. The deidentified participant data that support the findings of this study are available from the first and corresponding authors upon reasonable request.

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    Footnotes

    • Twitter @AjayMalhotraRad

    • Contributors All authors have contributed substantially to the manuscript and approved the submission.

    • Funding This work was supported by the Scientific Research Fund of Sichuan Provincial People’s Hospital, 2020LY05.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.