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A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

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机构: [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, [2]China National Clinical Research Center for Neurological Diseases, Beijing, China, [3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China, [4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China, [5]Department of Bioengineering, School of Life Sciences, Beijing University of Technology, Beijing, China
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关键词: intracranial aneurysm rupture hemodynamic morphological computational fluid dynamics

摘要:
Objective: The aim of the present study is to investigate the potential morphological and hemodynamic risk factors related to intracranial aneurysms (IAs) rupture and establish a system to stratify the risk of IAs rupture to help the clinical decision-making. Methods: Patients admitted to our hospital for single-IAs were selected from January 2012 and January 2018. A propensity score matching was conducted to match patients. The morphological parameters were obtained from high solution CTA images, and the hemodynamic parameters were obtained in accordance with the outcomes of computational fluid dynamics (CFDs) simulation. Differences in the morphologic and hemodynamic parameters were compared. The significant parameters were selected to establish a novel scoring system (Intracranial Aneurysm Rupture Score, IARS). The comparison was drawn between the discriminating accuracy of IARS and the Rupture Resemblance Score (RRS) system to verify the value of IARS. Then, a group of patients with unruptured IAs was stratified into the high risk and low risk groups by IARS and RRS system separately and was followed up for 18-27 months to verify the value of IARS. The outcome of different stratifications was compared. Results: The matching process yielded 167 patients in each group. Differences of statistical significance were found in aneurysm length (p = 0.001), perpendicular height (H) (p < 0.001), aspect ratio (AR) (p < 0.001), size ratio (SR) (p < 0.001), deviated angle (DA) (p < 0.001), normalized average wall shear stress (NWSSa) (p < 0.001), wall shear stress gradient (WSSG) (p < 0.001), low shear area ratio (LSAR) (p = 0.01), and oscillatory shear index (OSI) (p = 0.01). Logistic regression analysis further demonstrated that SR, DA, NWSSa, LSAR, and OSI were the independent risk factors of IAs rupture. SR, DA, LSAR, and OSI were finally selected to establish the IARS. Our present IARS showed a higher discriminating value (AUC 0.81 vs. 0.77) in comparison with the RRS (SR, NWSSa, and OSI). After follow-up, seven patients were subject to IAs rupture. 5/26 in high risk group stratified by IARS, yet 7/57 in high risk group stratified by RRS. The accuracy of IARS was further verified (19.2% vs. 12.3%, AUC for the IARS and the RRS was 0.723 and 0.673, respectively). Conclusion: SR DA, NWSSa, LSAR, and OSI were considered the independent risk factors of IAs rupture. Our novel IARS showed higher accuracy in discriminating IA rupture in comparison with RRS.

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出版当年[2017]版:
大类 | 2 区 医学
小类 | 3 区 神经科学
最新[2025]版:
大类 | 3 区 医学
小类 | 3 区 神经科学
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出版当年[2016]版:
Q2 NEUROSCIENCES
最新[2023]版:
Q2 NEUROSCIENCES

影响因子: 最新[2023版] 最新五年平均 出版当年[2016版] 出版当年五年平均 出版前一年[2015版] 出版后一年[2017版]

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第一作者机构: [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, [2]China National Clinical Research Center for Neurological Diseases, Beijing, China, [3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China,
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通讯作者:
通讯机构: [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, [2]China National Clinical Research Center for Neurological Diseases, Beijing, China, [3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China,
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