Wei Heng, Tian Qi, Yao Kun, Wang Jianfeng, He Peibang, Guo Yujia, Han Wenrui, Gao Wenhong, Li Mingchang
Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, China.
Front Neurol. 2022 Apr 25;13:868652. doi: 10.3389/fneur.2022.868652. eCollection 2022.
This study aimed to determine the ruptured rate and hemodynamic difference between wide-neck aneurysms (WNAs) and narrow-neck aneurysms (NNAs), as well as the hemodynamic parameters of risk factors for aneurysm rupture.
A total of 121 cases of intracranial aneurysms (IAs) were studied retrospectively between January 2019 and April 2021 at Renmin Hospital of Wuhan University. Intracranial aneurysms were classified into four types: ruptured wide-neck aneurysms (RWNAs), unruptured wide-neck aneurysms (UWNAs), ruptured narrow-neck aneurysms (RNNAs), and unruptured narrow-neck aneurysms (UNNAs). The Chi-square test was used to compare differences in rupture ratios. The clinical characteristics and hemodynamics were analyzed statistically to reveal the rupture risk factors. Moreover, significant parameters were subjected to binary logistic regression analysis to identify the independent predictive factors. The receiver operating characteristic (ROC) curve was performed to obtain cutoff values.
WNAs ruptured more frequently than NNAs ( = 0.033). Ruptured intracranial aneurysms (RIAs) were characterized by significantly higher intra-aneurysmal pressure (IAP), wall shear stress (WSS), wall shear stress gradient (WSSG), and lower normalized wall shear stress (NWSS) than unruptured intracranial aneurysms (UIAs). RWNAs had higher IAP, WSS, and lower NWSS than UWNAs ( < 0.05). RNNAs had higher IAP, Streamwise WSSG and lower NWSS compared to UNNAs ( < 0.05). Binary logistic regression revealed that IAP and WSS were independent predictive risk factors for WNAs rupture, with cut-off values of 405.5 and 6.66 Pa, respectively. Also, IAP was an independent predictive risk factor for NNA rupture, with a cut-off value of 255.3 Pa.
Wide-neck aneurysms and narrow-neck aneurysms have diverse hemodynamics, which prompts a higher rupture ratio for WNAs. IAP could characterize the rupture risk in both WNAs and NNAs independently, but WSS could only predict the rupture risk in WNAs. This research might assist neurosurgeons with fostering a more sensible strategy for the treatment of IAs.
本研究旨在确定宽颈动脉瘤（WNA）和窄颈动脉瘤（NNA）之间的破裂率和血流动力学差异，以及动脉瘤破裂危险因素的血流动力学参数。
回顾性研究2019年1月至2021年4月在武汉大学人民医院的121例颅内动脉瘤（IA）。颅内动脉瘤分为四种类型：破裂宽颈动脉瘤（RWNA）、未破裂宽颈动脉瘤（UWNA）、破裂窄颈动脉瘤（RNNA）和未破裂窄颈动脉瘤（UNNA）。采用卡方检验比较破裂率差异。对临床特征和血流动力学进行统计学分析以揭示破裂危险因素。此外，对显著参数进行二元逻辑回归分析以确定独立预测因素。绘制受试者工作特征（ROC）曲线以获得临界值。
WNA比NNA破裂更频繁（P = 0.033）。与未破裂颅内动脉瘤（UIA）相比，破裂颅内动脉瘤（RIA）的瘤内压力（IAP）、壁面切应力（WSS）、壁面切应力梯度（WSSG）显著更高，而标准化壁面切应力（NWSS）更低。RWNA的IAP、WSS比UWNA更高，NWSS更低（P < 0.05）。与UNNA相比，RNNA的IAP、流向WSSG更高，NWSS更低（P < 0.05）。二元逻辑回归显示，IAP和WSS是WNA破裂的独立预测危险因素，临界值分别为405.5和6.66 Pa。此外，IAP是NNA破裂的独立预测危险因素，临界值为255.3 Pa。
宽颈动脉瘤和窄颈动脉瘤具有不同的血流动力学，这导致WNA的破裂率更高。IAP可独立表征WNA和NNA的破裂风险，但WSS仅能预测WNA的破裂风险。本研究可能有助于神经外科医生制定更合理的IA治疗策略。
