Multivariate predictors of intracranial aneurysm rupture and hemorrhage by regression analysis with emphasis on aneurysm angle / 中华神经医学杂志

ABSTRACT

Objective To evaluate the influence of aneurismal inclination angle in the intracranial aneurysm rupture and hemorrhage. Methods A total of 2064 patients with intracranial aneurysms (1086 without rupture and hemorrhage, and 978 with rupture and hemorrhage), admitted to our hospital from January 2010 to April 2018, were chosen in our study. DSA examination and three-dimensional reconstruction were used for morphological evaluation of aneurysms, including aneurysm size, location, morphous feature, aneurismal inclination angle, vessel angle, aspect ratio (AR) and size ratio (SR). Risk factors of intracranial aneurysm rupture were analyzed by univariate and multivariate regression models; two-piecewise linear regression model and smooth curve fitting were used to analyze the saturation threshold effect of aneurismal inclination angle on aneurysm rupture and hemorrhage to evaluate the correlation between aneurismal inclination angle and aneurysm rupture and hemorrhage. Stratified analysis was conducted to clarify the influence of aneurismal inclination angle changes in risk of aneurysm rupture and hemorrhage in presence of various stratified factors (cerebral microbleeds [CMBs], diabetes, and hyperlipidemia). Results Aneurysm inclination angle was an independent risk factor for aneurysm rupture and hemorrhage (HR=1.02, 95％CI 1.01-1.03, P=0.000). Risk of aneurysm rupture and hemorrhage increased when aneurismal inclination angle was more than 106.3 degrees for each additional degree; each degree of increase in aneurysm inclination increased the risk of aneurysm rupture and hemorrhage by 3％. As compared with patients without CMBs, risk of aneurysm rupture and hemorrhage increased extra 7％in patients with CMBs for each additional degree of aneurismal inclination angle;as compared with patients without diabetes mellitus MD, for each additional degree of aneurismal inclination angle, risk of aneurysm rupture and hemorrhage increased extra 2％in diabetes patients with fasting blood-glucose (FBG)≤ 6.0 mmol/L, and increased extra 4％in diabetes patients with FBS>6.0 mmol/L, respectively; as compared with patients without hyperlipemia, risk of aneurysm rupture and hemorrhage increased extra 3％in patients with hyperlipemia for each additional degree of aneurismal inclination angle. Conclusion The aneurismal inclination angle is closely related to intracranial aneurysm rupture and hemorrhage, and accurate measurement of aneurismal inclination angle has important clinical significance in assessing the risk of aneurysm rupture and hemorrhage.