A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

Q1 Medicine

World Neurosurgery: X Pub Date : 2024-03-25 DOI:10.1016/j.wnsx.2024.100370

Tomofumi Takenaka , Hajime Nakamura , Shuhei Yamada , Tomoki Kidani , Akihiro Tateishi , Shingo Toyota , Toshiyuki Fujinaka , Takuyu Taki , Akatsuki Wakayama , Haruhiko Kishima

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Abstract

Objective

The risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms.

Methods

We retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021. We defined the NBA as the angle formed by the MCA aneurysm neck and M2 superior or inferior branch vessel line. The superior and inferior NBA were measured on admission via three-dimensional computed tomography angiography on admission. We divided the patients into clipping (106 patients) and coiling (22 patients) groups according to the treatment. Risk factors associated with procedural CI were analyzed in each group.

Results

Both groups showed that an enlarged superior NBA was a significant risk factor for procedural CI (clipping, P < 0.0005; coiling group, P = 0.007). The receiver operating characteristic curve showed the closed thresholds of the superior NBA with procedural CI in both groups (clipping group, 128.5°, sensitivity and specificity of 0.667 and 0.848, respectively; coiling group, 130.9°, sensitivity and specificity of 1 and 0.889, respectively).

Conclusion

The NBA can estimate the procedural risk of ruptured MCA aneurysms. In addition, an enlarged superior NBA is a risk factor for procedural CI in both clipping and coiling techniques.

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治疗大脑中动脉瘤破裂过程中缺血性并发症的新预测指标颈支角

目的大脑中动脉（MCA）动脉瘤破裂导致术中脑缺血（CI）的风险因素尚不明确。本研究提出了动脉瘤颈和分支血管的简单定量指标--颈支角（NBA），并分析了其作为预测破裂 MCA 动脉瘤术中 CI 的有用性。我们将 NBA 定义为 MCA 动脉瘤颈与 M2 上支或下支血管线形成的角度。入院时通过三维计算机断层扫描血管造影测量上、下NBA。我们根据治疗方法将患者分为夹闭组（106 例）和卷绕组（22 例）。结果两组均显示，上NBA扩大是手术CI的重要危险因素（夹闭组，P < 0.0005；卷绕组，P = 0.007）。接收器操作特征曲线显示了上NBA与两组手术CI的闭合阈值（剪切组，128.5°，敏感性和特异性分别为0.667和0.848；卷绕组，130.9°，敏感性和特异性分别为1和0.889）。此外，在剪切和旋切技术中，上NBA增大是手术CI的风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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