Vu Dang Luu, Nguyen Van Hoang, Nguyen Huu An, Nguyen Quang Anh, Tran Anh Tuan, Le Hoang Kien, Nguyen Tat Thien, Nguyen Thu Trang, Tran Cuong, Tran Xuan Bach, Le Chi Cong, Pierot Laurent
From the Radiology Center (D.L.V., V.H.N., H.A.N., Q.A.N, A.T.T., H.K.L., Tat T.N., Thu T.N., C.T., X.B.T., C.C.L.), Bach Mai Hospital, Hanoi, Vietnam.
Department of Radiology (D.L.V., Q.A.N.), Hanoi Medical University, Hanoi, Vietnam.
AJNR Am J Neuroradiol. 2025 Jan 8;46(1):75-83. doi: 10.3174/ajnr.A8444.
Hemodynamic factors significantly influence the onset, progression, and rupture of intracranial aneurysms (IAs). Current rupture risk prediction scores focus primarily on the clinical, anatomic, and morphologic aspects. This study aimed to investigate the hemodynamic characteristics differences between ruptured and unruptured IAs.
Conducted from July 2021 to July 2022, this prospective cohort study involved patients with ruptured and unruptured IAs undergoing DSA. Hemodynamic characteristics were assessed by using the AneurysmFlow tool. Hemodynamic, clinical, anatomic, and morphologic parameters were compared between ruptured and unruptured IA groups.
The study included 127 patients with 135 aneurysms (67 ruptured, 68 unruptured). Complex flow patterns (type 3 and 4) were observed more frequently in ruptured aneurysms compared with unruptured aneurysms (OR, 5.57; 95% CI, 2.49-12.45; < .001) in univariate analysis, and were also more common in unruptured aneurysms associated with daughter sac features ( = .015). The mean aneurysm flow amplitude (MAFA) was lower in ruptured aneurysms, and associated with lower flow velocity in the parent artery related to vasospasm. MAFA in the aneurysmal dome or any additional daughter sacs was lowest compared with other regions inside the aneurysms. The technical failure rate of AneurysmFlow measurements was 8.5% (12 of 139 patients). Additionally, hypertension (OR, 0.42; 95% CI, 0.30-0.54; < .001), bifurcation location (anterior communicating artery/anterior cerebral artery/MCA/posterior communicating artery/posterior circulation) (OR, 0.17; 95% CI, 0.05-0.29; = .005), and irregular shape (OR, 0.19; 95% CI, 0.05-0.35; = .012) were identified as independently associated with rupture.
Complex flow patterns identified on the AneurysmFlow tool are significantly more common in ruptured and unruptured aneurysms associated with daughter sac features. The lowest MAFA in the aneurysmal dome and daughter sacs likely indicates specific pathophysiologic changes within the aneurysm wall associated with rupture incidence. Hypertension, bifurcation location, and an irregular shape are independently associated with the risk of rupture. Further multicenter studies with larger sample sizes are needed to validate these findings.
血流动力学因素对颅内动脉瘤（IA）的发生、发展及破裂有显著影响。目前的破裂风险预测评分主要集中在临床、解剖和形态学方面。本研究旨在探讨破裂与未破裂IA的血流动力学特征差异。
本前瞻性队列研究于2021年7月至2022年7月进行，纳入接受数字减影血管造影（DSA）的破裂与未破裂IA患者。使用AneurysmFlow工具评估血流动力学特征。比较破裂与未破裂IA组之间的血流动力学、临床、解剖和形态学参数。
该研究纳入127例患者，共135个动脉瘤（67个破裂，68个未破裂）。在单因素分析中，与未破裂动脉瘤相比，破裂动脉瘤更常观察到复杂血流模式（3型和4型）（比值比[OR]，5.57；95%置信区间[CI]，2.49 - 12.45；P <.001），在伴有子囊特征的未破裂动脉瘤中也更常见（P =.015）。破裂动脉瘤的平均动脉瘤血流幅度（MAFA）较低，且与因血管痉挛导致的载瘤动脉血流速度降低有关。与动脉瘤内其他区域相比，动脉瘤瘤顶或任何额外子囊处的MAFA最低。AneurysmFlow测量的技术失败率为8.5%（139例患者中的12例）。此外，高血压（OR，0.42；95% CI，0.30 - 0.54；P <.001）、分叉位置（前交通动脉/大脑前动脉/大脑中动脉/后交通动脉/后循环）（OR，0.17；95% CI，0.05 - 0.29；P =.005）和不规则形状（OR，0.19；95% CI，0.05 - 0.35；P =.012）被确定为与破裂独立相关。
AneurysmFlow工具识别出的复杂血流模式在伴有子囊特征的破裂与未破裂动脉瘤中显著更常见。动脉瘤瘤顶和子囊处最低的MAFA可能表明与破裂发生率相关的动脉瘤壁内特定病理生理变化。高血压、分叉位置和不规则形状与破裂风险独立相关。需要进一步开展更大样本量的多中心研究来验证这些发现。
