You are here

  • Home
  • Online First
  • Risk of unruptured aneurysms in subarachnoid hemorrhage patients with multiple intracranial aneurysms: a multicenter, longitudinal, comparative study from China

Article Text

Article menu
Download PDFPDF
Hemorrhagic stroke
Original research
Risk of unruptured aneurysms in subarachnoid hemorrhage patients with multiple intracranial aneurysms: a multicenter, longitudinal, comparative study from China
  1. Jian Liu1,2,
  2. Yiping Zhang1,2,
  3. Michael R Levitt3,
  4. Mahmud Mossa-Basha4,
  5. Chao Wang1,2,
  6. Mirzat Turhon1,2,
  7. Ying Zhang1,2,
  8. Yisen Zhang1,2,
  9. Kun Wang1,2,
  10. Chengcheng Zhu4,
  11. Xinjian Yang1,2
  1. 1Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
  4. 4Department of Radiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Xinjian Yang, Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; yangxinjian{at}voiceoftiantan.org; Dr Chengcheng Zhu, Department of Radiology, University of Washington, 325 9th Avenue Seattle, Washington 98104, USA; zhucheng{at}uw.edu

Abstract

Background In aneurysmal subarachnoid hemorrhage patients with multiple intracranial aneurysms (aSAH-MIA patients), the risk of secondary unruptured intracranial aneurysms is inconsistent. This study aimed to explore the risk of unruptured aneurysms in Chinese aSAH-MIA patients.

Methods The medical records and angiographic images of aSAH-MIA patients from eight cerebrovascular centers in China were retrospectively reviewed and analyzed. Patients with a single unruptured intracranial aneurysm (UIA) and no prior aSAH were used as controls. Propensity score matching (PSM) was employed to balance the differences in age, gender, aneurysm size, aneurysm site, and follow-up duration between the two groups.

Results The study included 267 unruptured aneurysms from 204 aSAH-MIA patients and 769 single UIA. After PSM, 201 aneurysms were enrolled in the aSAH-MIA group and 201 aneurysms in the control group. The mean follow-up was 2.2 years. Thirty-four aneurysm instability events (28 growth and 6 rupture, 16.9%) occurred during follow-up in the aSAH-MIA group and 16 instability events (13 growth and 3 rupture, 8%) occurred in the control group. Risk factors for aneurysmal instability were aneurysm irregularity (OR 2.53; 95% CI 1.18 to 4.31), higher size ratio (OR 1.23; 95% CI 1.37 to 4.39), and middle cerebral artery location (OR 1.86; 95% CI 1.03 to 3.17). The risk of aneurysmal instability was substantially elevated in the aSAH-MIA group (HR 2.07; 95% CI 1.12 to 3.02).

Conclusions Unruptured aneurysms in Chinese aSAH-MIA patients exhibited higher risks of growth and rupture than in patients with a single UIA. Middle cerebral artery location, higher size ratio and irregular shape were associated with higher risk of growth or rupture.

  • Aneurysm
  • Hemorrhage

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-021113

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    View Full Text

    Footnotes

    • Twitter @DrMichaelLevitt, @Ying Zhang

    • JL and YZ contributed equally.

    • Contributors XY and CZ contributed to the study conception, design and supervision, and were joint last authors. The first draft of the manuscript was written by JL and YZ, and these authors contributed equally to this work. Acquisition, analysis, or interpretation of data: all authors. Critical revision of the manuscript for important intellectual content: all authors. Data analysis was performed by YZ and CW. All authors read and approved the final manuscript.

    • Funding This study was supported by the National Natural Science Foundation of China (Grant Nos 82272092, 82072036, 82372058) and Beijing Hospitals Authority Research and Cultivation Programme (Grant No. PX2022022). Chengcheng Zhu is supported by United States National Institute of Health (NIH) grants R01HL162743 and R00HL136883.

    • 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.