Joel Björkman1, Juhana Frösen1, Olli Tähtinen1, Daan Backes1, Terhi Huttunen1, Jaakko Harju1, Jukka Huttunen1, Mitja I Kurki1, Mikael von Und Zu Fraunberg1, Timo Koivisto1, Hannu Manninen1, Juha E Jääskeläinen1, Antti E Lindgren2. 1. From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.). 2. From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.). antti.lindgren@kuh.fi.
Abstract
BACKGROUND AND PURPOSE: We investigated which aneurysm-related risk factors for rupture best discriminate ruptured versus unruptured saccular intracranial aneurysms (sIAs) in subarachnoid hemorrhage patients with multiple sIAs. METHODS: We included 264 subarachnoid hemorrhage patients with a ruptured sIA and at least one additional unruptured sIA, from the Kuopio Intracranial Aneurysm database from 2003 to 2015. These patients had 268 ruptured and 445 unruptured sIAs. Angiograms of the 713 sIAs were reevaluated for multiple variables describing aneurysm shape. Multivariate generalized linear mixed models were used to calculate odds ratios with corresponding 95% confidence intervals for the independent risk factors for aneurysm rupture. RESULTS: In the multivariate analysis, only sIA size (P<0.004) and irregular shape (P<0.000) independently associated with sIA rupture. As an independent risk factor, irregular shape showed the strongest association with rupture (odds ratio 90.3; 95% confidence interval, 47.0-173.5). The sIA location, flow angles, bottleneck factor, or aspect ratio were not significantly associated with rupture. CONCLUSIONS: Irregular shape may identify the ruptured sIA better than size in patients presenting with aSAH and multiple sIAs.
BACKGROUND AND PURPOSE: We investigated which aneurysm-related risk factors for rupture best discriminate ruptured versus unruptured saccular intracranial aneurysms (sIAs) in subarachnoid hemorrhagepatients with multiple sIAs. METHODS: We included 264 subarachnoid hemorrhagepatients with a ruptured sIA and at least one additional unruptured sIA, from the Kuopio Intracranial Aneurysm database from 2003 to 2015. These patients had 268 ruptured and 445 unruptured sIAs. Angiograms of the 713 sIAs were reevaluated for multiple variables describing aneurysm shape. Multivariate generalized linear mixed models were used to calculate odds ratios with corresponding 95% confidence intervals for the independent risk factors for aneurysm rupture. RESULTS: In the multivariate analysis, only sIA size (P<0.004) and irregular shape (P<0.000) independently associated with sIA rupture. As an independent risk factor, irregular shape showed the strongest association with rupture (odds ratio 90.3; 95% confidence interval, 47.0-173.5). The sIA location, flow angles, bottleneck factor, or aspect ratio were not significantly associated with rupture. CONCLUSIONS: Irregular shape may identify the ruptured sIA better than size in patients presenting with aSAH and multiple sIAs.
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