open access
Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm ( < 5 mm)
, 1, 1, 1, 1, 1, 1, 1
Affiliations- Department of Neurosurgery in Beijing Luhe Hospital, Capital Medical University, No. 82, Xinhua South Road, Tongzhou District, Beijing, 100076 beijing, China
open access
Abstract
Aim. To identify the risk factors for clinical and radiographic grades of subarachnoid haemorrhage (SAH) in small (< 5 mm) intracranial aneurysms (SIAs).
Material and methods. We retrospectively analysed patients with SIAs treated in our centre between February 2009 and June 2018. The clinical status was graded using the Hunt and Hess (H&H) score and the radiological severity of SAH was graded by Fisher grades (FG). The risk factors were determined using multivariate logistic regression analysis.
Results. A total of 160 patients with ruptured SIAs (< 5 mm) were included. In univariate analysis, smoking (P = 0.007), alcohol use (P = 0.048), aspirin use (P = 0.001), and higher size ratio (SR) (P = 0.001) were significantly associated with a higher H&H grade (3–5) in SIAs; and smoking (P = 0.019), aspirin use (P = 0.031), inflow angle < 90 degrees (P = 0.011), and aneurysm size (P = 0.039) were significantly associated with a higher FG score (3–4). In the adjusted multivariate analysis, previous SAH (OR, 12.245, 95% CI, 2.261–66.334, P = 0.004), aspirin use (OR, 4.677, 95% CI, 1.392–15.718, P = 0.013), alcohol use (OR, 3.392, 95% CI, 1.146–10.045, P = 0.027), inflow angle < 90 (OR, 3.881, 95% CI, 1.273–11.831, P = 0.017), and higher SR (OR, 6.611, 95% CI, 2.235–19.560, P = 0.001) were independent risk factors for a higher H&H grade in ruptured SIAs; smoking (OR, 2.157, 95% CI, 1.061–4.384, P = 0.034), and inflow angle < 90 degrees (OR, 2.603, 95% CI, 1.324–5.115, P = 0.006) were independent risk factors for a higher FG (3–4).
Conclusions. This study revealed that inflow angle < 90 degrees and size ratio, but not absolute size, may highly predict poorer grade of SAH in SRA. Aspirin use, previous SAH, and alcohol use were significantly associated with a higher H&H grade in ruptured SIAs, and smoking was a significant predictor of poorer FG.
Abstract
Aim. To identify the risk factors for clinical and radiographic grades of subarachnoid haemorrhage (SAH) in small (< 5 mm) intracranial aneurysms (SIAs).
Material and methods. We retrospectively analysed patients with SIAs treated in our centre between February 2009 and June 2018. The clinical status was graded using the Hunt and Hess (H&H) score and the radiological severity of SAH was graded by Fisher grades (FG). The risk factors were determined using multivariate logistic regression analysis.
Results. A total of 160 patients with ruptured SIAs (< 5 mm) were included. In univariate analysis, smoking (P = 0.007), alcohol use (P = 0.048), aspirin use (P = 0.001), and higher size ratio (SR) (P = 0.001) were significantly associated with a higher H&H grade (3–5) in SIAs; and smoking (P = 0.019), aspirin use (P = 0.031), inflow angle < 90 degrees (P = 0.011), and aneurysm size (P = 0.039) were significantly associated with a higher FG score (3–4). In the adjusted multivariate analysis, previous SAH (OR, 12.245, 95% CI, 2.261–66.334, P = 0.004), aspirin use (OR, 4.677, 95% CI, 1.392–15.718, P = 0.013), alcohol use (OR, 3.392, 95% CI, 1.146–10.045, P = 0.027), inflow angle < 90 (OR, 3.881, 95% CI, 1.273–11.831, P = 0.017), and higher SR (OR, 6.611, 95% CI, 2.235–19.560, P = 0.001) were independent risk factors for a higher H&H grade in ruptured SIAs; smoking (OR, 2.157, 95% CI, 1.061–4.384, P = 0.034), and inflow angle < 90 degrees (OR, 2.603, 95% CI, 1.324–5.115, P = 0.006) were independent risk factors for a higher FG (3–4).
Conclusions. This study revealed that inflow angle < 90 degrees and size ratio, but not absolute size, may highly predict poorer grade of SAH in SRA. Aspirin use, previous SAH, and alcohol use were significantly associated with a higher H&H grade in ruptured SIAs, and smoking was a significant predictor of poorer FG.
Keywords
intracranial aneurysm, small, rupture, aspirin use, Hunt and Hess score, Fisher grade
About this articleTitle
Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
296-303
Published online
2019-07-29
Page views
1716
Article views/downloads
1083
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2019;53(4):296-303.
Keywords
intracranial aneurysm
small
rupture
aspirin use
Hunt and Hess score
Fisher grade
Authors
Junli Tai
Jianxin Liu
Jianhua Lv
Kang Huibin
Zhe Hou
Jun Yang
Hongbing Zhang
Qing Huang
References (38)- Amigo N, Valencia Á. Determining significant morphological and hemodynamic parameters to assess the rupture risk of cerebral aneurysms. Journal of Medical and Biological Engineering. 2018; 39(3): 329–335.
- Baharoglu MI, Schirmer CM, Hoit DA, et al. Aneurysm inflow-angle as a discriminant for rupture in sidewall cerebral aneurysms: morphometric and computational fluid dynamic analysis. Stroke. 2010; 41(7): 1423–1430.
- Bender MT, Wendt H, Monarch T, et al. Small aneurysms account for the majority and increasing percentage of aneurysmal subarachnoid hemorrhage: a 25-year, single institution study. Neurosurgery. 2018; 83(4): 692–699.
- Brown R, Broderick J. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. The Lancet Neurology. 2014; 13(4): 393–404.
- Chiu JJ, Usami S, Chien S. Vascular endothelial responses to disturbed flow: pathologic implications for atherosclerosis. Bioengineering in Cell and Tissue Research. : 469–496.
- Darwazeh R, Wei M, Zhong J, et al. Significant injury of the mammillothalamic tract without injury of the corticospinal tract after aneurysmal subarachnoid hemorrhage: a retrospective diffusion tensor imaging study. World Neurosurg. 2018; 114: e624–e630.
- Dhar S, Tremmel M, Mocco J, et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery. 2008; 63(2): 185–96; discussion 196.
- Duan Z, Li Y, Guan S, et al. Morphological parameters and anatomical locations associated with rupture status of small intracranial aneurysms. Sci Rep. 2018; 8(1): 6440.
- Feng X, Zhang B, Guo E, et al. Bifurcation location and growth of aneurysm size are significantly associated with an irregular shape of unruptured intracranial aneurysms. World Neurosurg. 2017; 107: 255–262.
- Hasan DM, Mahaney KB, Brown RD, et al. Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture. Stroke. 2011; 42(11): 3156–3162.
- Huttunen J, Lindgren A, Kurki MI, et al. Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage. Neurology. 2017; 89(3): 263–268.
- Ji W, Liu A, Lv X, et al. Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment. Interv Neuroradiol. 2016; 22(4): 383–388.
- Kashiwazaki D, Kuroda S. Sapporo SAH Study Group. Size ratio can highly predict rupture risk in intracranial small (<5 mm) aneurysms. Stroke. 2013; 44(8): 2169–2173.
- Korja M, Kivisaari R, Rezai Jahromi B, et al. Size and location of ruptured intracranial aneurysms: consecutive series of 1993 hospital-admitted patients. J Neurosurg. 2017; 127(4): 748–753.
- Koyanagi M, Fukuda H, Lo B, et al. Effect of intrathecal milrinone injection via lumbar catheter on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2017; 12: 1–6.
- International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms — risk of rupture and risks of surgical intervention. N Engl J Med. 1998; 339(24): 1725–1733.
- Lv N, Feng Z, Wang C, et al. Morphological risk factors for rupture of small (< 7 mm) posterior communicating artery aneurysms. World Neurosurg. 2016; 87: 311–315.
- Meng H, Tutino VM, Xiang J, et al. High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR Am J Neuroradiol. 2014; 35(7): 1254–1262.
- Mocco J, Brown RD, Torner JC, et al. International Study of Unruptured Intracranial Aneurysms Investigators. Aneurysm morphology and prediction of rupture: an international study of unruptured intracranial aneurysms analysis. Neurosurgery. 2018; 82(4): 491–496.
- Nahed BV, DiLuna ML, Morgan T, et al. Hypertension, age, and location predict rupture of small intracranial aneurysms. Neurosurgery. 2005; 57(4): 676–83; discussion 676.
- Passerini AG, Polacek DC, Shi C, et al. Coexisting proinflammatory and antioxidative endothelial transcription profiles in a disturbed flow region of the adult porcine aorta. Proc Natl Acad Sci U S A. 2004; 101(8): 2482–2487.
- Phan K, Moore JM, Griessenauer CJ, et al. Aspirin and risk of subarachnoid hemorrhage: systematic review and meta-analysis. Stroke. 2017; 48(5): 1210–1217.
- Poblete R, Cen S, Zheng L, et al. Serum lactic acid following aneurysmal subarachnoid hemorrhage is a marker of disease severity but is not associated with hospital outcomes. Frontiers in Neurology. 2018; 9.
- Pottegård A, García Rodríguez LA, Poulsen FR, et al. Antithrombotic drugs and subarachnoid haemorrhage risk. A nationwide case-control study in Denmark. Thromb Haemost. 2015; 114(5): 1064–1075.
- Rahman M, Smietana J, Hauck E, et al. Size ratio correlates with intracranial aneurysm rupture status: a prospective study. Stroke. 2010; 41(5): 916–920.
- Savarraj JPJ, Parsha K, Hergenroeder GW, et al. Systematic model of peripheral inflammation after subarachnoid hemorrhage. Neurology. 2017; 88(16): 1535–1545.
- Starke RM, Chalouhi N, Ding D, et al. Potential role of aspirin in the prevention of aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis. 2015; 39(5-6): 332–342.
- Tykocki T, Nauman P, Dow Enko A. Morphometric predictors of posterior circulation aneurysms risk rupture. Neurol Res. 2014; 36(8): 733–738.
- Tykocki T, Kostkiewicz B. Correlation between the aneurysm morphometry and severity of subarachnoid hemorrhage in the posterior cerebral circulation. World Neurosurg. 2014; 82(6): 1100–1105.
- Ujiie H, Tamano Y, Sasaki K, et al. Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery. 2001; 48(3): 495–502; discussion 502.
- Wang AC, Heros RC. Editorial: Subarachnoid hemorrhage grading scales. J Neurosurg. 2016; 124(2): 296–298.
- White PM, Wardlaw JM. Unruptured intracranial aneurysms. J Neuroradiol. 2003; 30(5): 336–350.
- Chalouhi N, Atallah E, Jabbour P, et al. Aspirin for the prevention of intracranial aneurysm rupture. Neurosurgery. 2017; 64(CN_suppl_1): 114–118.
- Malik AN, Gross BA, Rosalind Lai PM, et al. Aspirin and aneurysmal subarachnoid hemorrhage. World Neurosurg. 2014; 82(6): 1127–1130.
- Hasan DM, Mahaney KB, Brown RD, et al. Aspirin as a promising agent for decreasing incidence of cerebral aneurysm rupture. Stroke. 2011; 42(11): 3156–3162.
- García-Rodríguez LA, Gaist D, Morton J, et al. Antithrombotic drugs and risk of hemorrhagic stroke in the general population. Neurology. 2013; 81(6): 566–574.
- Zheng Y, Zhou B, Wang X, et al. Size, aspect ratio and anatomic location of ruptured intracranial aneurysms: consecutive series of 415 patients from a prospective, multicenter, observational study. Cell Transplant. 2018 [Epub ahead of print]: 963689718817227.
- Tremmel M, Dhar S, Levy EI, et al. Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study. Neurosurgery. 2009; 64(4): 622–30; discussion 630.
