Journal
CLINICAL NEUROLOGY AND NEUROSURGERY
Volume 208, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.clineuro.2021.106877
Keywords
Intracranial aneurysm; Elderly patients; Rupture; Risk factor; 4D-CT angiography
Categories
Funding
- Shanghai Science and Technology Project [18411962700]
- Shanghai Jiaotong University School of Medicine Research Project [DLY201821]
- SJTU Medical Engineering Cross-cutting Research Foundation [ZH2018ZDA07]
- National Key Research and Development Program [2016YFC1300800]
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This study investigated the morphological predictors of irregular pulsation of aneurysms in elderly patients using 4D-CTA. The findings suggest that a large size ratio, posterior circulation aneurysms, the presence of a daughter dome, and aneurysm rupture are independent predictors of irregular pulsation, providing insight into the risk of aneurysm rupture.
Objective: The natural history of unruptured intracranial aneurysms (UIAs) in elderly patients remains poorly understood, and the treatment of UIAs is controversial. The presence of irregular pulsation detected by fourdimensional CT angiography (4D-CTA) is associated with ruptured aneurysms. We aimed to investigate the morphological predictors of irregular pulsation of aneurysms in elderly patients. Patients and methods: We performed a prospective study of intracranial aneurysms detected by 4D-CTA. Elderly patients were defined as those more than 60 years of age. The irregular pulsation was defined as a focal protuberance during a cardiac cycle. We performed multivariate analyses to determine the associations of clinical characteristics and aneurysm morphologies with the irregular pulsation of aneurysms. Results: A total of 128 elderly patients with 166 intracranial aneurysms was included. The irregular pulsation occurred in 71 (42.8%) aneurysms. The multivariate analysis showed that a large size ratio (p = 0.006), posterior circulation aneurysms (p = 0.033), the presence of a daughter dome (p = 0.006), and aneurysm rupture (p = 0.032) were independently associated with the irregular pulsation. The multivariate analysis of predictors of irregular pulsation of unruptured aneurysms showed that size ratio (p = 0.01) and the presence of a daughter dome (p = 0.016) were independent predictors of irregular pulsation. Conclusion: A large size ratio, posterior circulation aneurysms, the presence of a daughter dome, and aneurysm rupture were independent predictors of the irregular pulsation of aneurysms in elderly patients. The morphological characteristics detected by 4D-CTA may be helpful to evaluate the risk of rupture of aneurysms.
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