The effect of clinical, bifurcation, and aneurysm morphological characteristics on the risk of rupture in internal carotid artery bifurcation aneurysms.

Rıfat Akdağ, İdris Gürpınar
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Abstract

Background: This study aimed to examine the clinical and morphological characteristics associated with the risk of rupture of internal carotid artery (ICA) bifurcation aneurysms (ICAbifAn) by comparing ruptured and unruptured aneurysms.

Methods: The two-center observational study included 66 patients with ICAbifAn (4.3%) identified from a database of 1,512 patients with intracranial aneurysms. The following data were collected and evaluated for their association with rupture risk: demo-graphic data, medical history, aneurysm neck and dome size, bottleneck factor, aspect ratio (AR), size ratio, dome projection and localization, ICA (D1), M1, and A1 diameters, and ICA-M1 (β), ICA-A1 (γ), and M1-A1 (α) angles.

Results: Sixty ICAbifAn cases were included in the study. Of these, 26 (43.3%) were ruptured aneurysms, and 34 (56.7%) were un-ruptured aneurysms. Patients in the ruptured group were younger than those in the unruptured group (p=0.017). The ruptured group had a smaller α angle (p=0.018) and significantly narrower A1 (p=0.004) and M1 (p=0.005) vessel diameters compared to the unruptured group. Irregular shape (p=0.001), AR>1.7, and a narrow neck (p=0.007) were significant predictors of rupture. Logistic regression analysis revealed that AR, α angle, and M1 and A1 diameters were significant predictors of aneurysm rupture. In receiver operating characteristic (ROC) analysis, an α angle cutoff of 126.2° exhibited a sensitivity of 61.5% and a specificity of 67.7% (area under the curve [AUC]=0.67). A cutoff M1 diameter of 2 mm exhibited a sensitivity and specificity of 61.5% and 76.4%, respectively (AUC=0.71). Additionally, a cutoff A1 diameter of 1.5 mm exhibited a sensitivity and specificity of 73.1% and 71.1%, respectively (AUC=0.75).

Conclusion: This study provided insights into the impact of aneurysm and bifurcation geometry on the risk of ICAbifAn rupture, which may also be applicable to more common bifurcation site aneurysms. Simple morphological measurements at the bifurcation region, where instability prevails, may serve as useful indicators for clinicians evaluating the likelihood of ICAbifAn rupture.

临床、分岔及动脉瘤形态特征对颈内动脉分岔动脉瘤破裂风险的影响。
背景:本研究旨在通过比较破裂和未破裂的颈内动脉(ICA)分支动脉瘤(ICAbifAn)的临床和形态学特征,探讨与破裂风险相关的临床和形态学特征。方法:双中心观察性研究纳入了从1512例颅内动脉瘤患者数据库中筛选的66例使用ICAbifAn的患者(4.3%)。收集以下数据并评估其与破裂风险的关系:人口统计学数据、病史、动脉瘤颈部和穹窿大小、瓶颈因素、宽高比(AR)、尺寸比、穹窿投影和定位、ICA (D1)、M1和A1直径、ICA-M1 (β)、ICA-A1 (γ)和M1-A1 (α)角度。结果:60例ICAbifAn纳入研究。其中破裂动脉瘤26例(43.3%),未破裂动脉瘤34例(56.7%)。破裂组患者年龄明显小于未破裂组(p=0.017)。与未破裂组相比,破裂组α角较小(p=0.018), A1 (p=0.004)和M1 (p=0.005)血管直径明显变窄。不规则形状(p=0.001)、AR bbb1.7和颈部狭窄(p=0.007)是破裂的重要预测因素。Logistic回归分析显示,AR、α角、M1和A1直径是动脉瘤破裂的显著预测因子。在受试者工作特征(ROC)分析中,α角截断为126.2°,灵敏度为61.5%,特异性为67.7%(曲线下面积[AUC]=0.67)。截断M1直径为2 mm,灵敏度和特异性分别为61.5%和76.4% (AUC=0.71)。截断A1直径为1.5 mm,灵敏度和特异性分别为73.1%和71.1% (AUC=0.75)。结论:本研究揭示了动脉瘤和分岔几何形状对ICAbifAn破裂风险的影响,这也可能适用于更常见的分岔部位动脉瘤。在分叉区,不稳定性普遍存在,简单的形态学测量可以作为临床医生评估ICAbifAn破裂可能性的有用指标。
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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