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Risk factors of unruptured intracranial aneurysms instability in the elderly

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Abstract

Background

Presently, a consistent strategy for determining the stability of unruptured intracranial aneurysms (UIAs) in elderly patients is lacking, primarily due to the unique characteristics of this demographic. Our objective was to assess the risk factors contributing to aneurysm instability (growth or rupture) within the elderly population.

Methods

In this study, we compiled data from follow-up patients with UIAs spanning from November 2016 to August 2021. We specifically focused on patients aged ≥ 60 years. Clinical histories were gathered, and morphological parameters of aneurysms were measured. The growth of aneurysms was determined using the computer-assisted semi-automated measurement (CASAM). Growth and rupture rates of UIAs were calculated, and both univariate and multivariate Cox regression analyses were conducted. Additionally, Kaplan–Meier survival curves were plotted.

Results

A total of 184 patients with 210 aneurysms were enrolled in the study. The follow-up period encompasses 506.6 aneurysm-years and 401.4 patient-years. Among all the aneurysms, 23 aneurysms exhibited growth, with an annual aneurysm growth rate of 11.0%, and 1 (4.5%) experienced rupture, resulting in an annual aneurysm rupture rate of 0.21%. Multivariate Cox analysis identified poorly controlled hypertension (P = 0.011) and high-risk aneurysms (including anterior cerebral artery (ACA), anterior communicating artery (AcoA), posterior communicating artery aneurysm (PcoA), posterior circulation (PC) > 4 mm or distal internal carotid artery (ICAd), middle cerebral artery (MCA), and PC > 7 mm) (P = 0.006) as independent risk factors for the development of unstable aneurysms.

Conclusions

In the elderly, poorly controlled hypertension and high-risk aneurysms emerge as significant risk factors for aneurysm instability. This underscores the importance of rigorous surveillance or timely intervention in patients presenting with these risk factors.

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Data availability

Data can be obtained by contacting the corresponding author via email under reasonable requirements.

Code availability

Not applicable.

Abbreviations

UIA:

Unruptured intracranial aneurysm

CASAM:

Computer-assisted semi-automated measurement

SAH:

Subarachnoid hemorrhage

TOF-MRA:

Time of flight magnetic resonance angiogram

PCoA:

Posterior communicating artery

ACoA:

Anterior communicating artery

MCA:

Middle cerebral artery

CCA:

Cavernous carotid artery

ACA:

Anterior cerebral artery

ICAp:

Proximal internal carotid artery

ICAd:

Distal internal carotid artery

PC:

Posterior circulation

D:

Diameter

W:

Width

H:

Height

V:

Volume

AA:

Aneurysm angle

N:

Neck width

V:

Volume

FA:

Flow angle

NS:

Neck surface

UI:

Undulation index

NSI:

Nonsphericity index

AR:

Aspect ratio

SR:

Size ratio

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Funding

This work received support from the National Key Research Development Program (grant number 2016YFC1300800) and the Bei**g Scientific and Technologic Project (grant number Z201100005520021).

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Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, **cheng District, Bei**g, 10053, China

    Simin Wang, Jiewen Geng, Yadong Wang, Wenzhi Wang, Peng Hu, Chuan He & Hongqi Zhang

  2. Department of Neurosurgery, Weihai Municipal Hospital, Weihai, Shandong, China

    Yadong Wang

  3. Department of R&D, UnionStrong (Bei**g) Technology Co. Ltd, Bei**g, China

    Wenzhi Wang

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Contributions

SM-W and HQ-Z conceived and designed the research. SM-W, JW-G, and WZ-W developed the algorithm and conducted the CASAM and hemodynamic analysis. SM-W assessed aneurysm growth. SM-W, JW-G, and YD-W collected and reviewed the data. SM-W analyzed the data and performed statistical analysis. PH, CH, and HQ-Z managed funding and supervision. SM-W drafted the manuscript. All authors made critical revisions to the manuscript and reviewed the final version.

Corresponding author

Correspondence to Hongqi Zhang.

Ethics declarations

Ethics approval

The study received approval from the research institute's committee on human research, and informed consent was obtained from all individual participants (Xuanwu Hospital; No. 2017082).

Informed consent

Informed consent was obtained from the parents or legal guardians of all individual participants included in the study.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Comments

The elderly present a distinct cohort of patients concerning aneurysms. In our assessment of risk factors contributing to the unstable growth of aneurysms in this demographic, we considered clinical information, morphological parameters. The Computer-Assisted Semi-Automatic Measurement (CASAM) method was employed to evaluate the three-dimensional morphological aspects of aneurysms. Utilizing these methodologies, we scrutinized 210 cases of unruptured aneurysms, aiming to discern the risk factors associated with aneurysm instability. Our objective was to assess the risk factors contributing to aneurysm instability (growth or rupture) within the elderly population. As dedicated readers of Acta Neurochirurgica, we hold confidence in the journal's ability to disseminate cutting-edge technologies and ideas to the broader community of neurosurgeons and neurointerventional physicians. We sincerely hope that our manuscript aligns with the publication standards of your esteemed journal.

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Wang, S., Geng, J., Wang, Y. et al. Risk factors of unruptured intracranial aneurysms instability in the elderly. Acta Neurochir 166, 35 (2024). https://doi.org/10.1007/s00701-024-05901-w

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