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The current study investigated the prevalence and risk factors of somatization, depression, and anxiety among 374 frontline nurses in less severely affected areas during the initial period of the coronavirus disease 2019 (COVID-19) outbreak. The prevalence of somatization, depression, and anxiety among frontline nurses was 41.4%, 40.1%, and 37.4%, respectively. Nurses from provincial-level hospitals were less likely to report somatization (odds ratio [OR] = 0.50; p = 0.018), depression (OR = 0.52; p = 0.024), and anxiety (OR = 0.35; p < 0.001) than those from county-level hospitals. Longer service duration was significantly associated with a higher likelihood of reporting somatization (OR = 1.06; p = 0.008) and depression (OR = 1.06; p = 0.006). Psychological distress exists in frontline nurses in less severely affected areas, and hospital levels and service duration are independent risk factors for psychological stress in these nurses. Maintaining nurses' mental health is an important issue in addressing the COVID-19 pandemic in addition to sufficient distribution of medical resources between hospitals at different levels. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (4), 37–44.]

To investigate the effect and safety of recanalization surgery for non-acute occlusion of large intracranial arteries and factors affecting clincial outcomes. Patients with non-acute occlusion of internal carotid artery (ICA), middle cerebral artery (MCA), and vertebrobasilar artery (VBA) treated with recanalization were retrospectively enrolled. The clinical and angiographic data were analyzed. 177 patients were enrolled, including 67 patients with intracranial ICA occlusion, 52 with MCA occlusion, and 58 with VBA occlusion. Successful recanalization was achieved in 152 (85.9%) patients. Complications occurred in 15 patients (8.5%). Followed up for 3–7 months, the 90 day mRS was significantly improved compared with that before the procedure. Among 152 patients with successful recanalization, eight patients experienced reocclusion (5.3%), and 11 patients experienced restenosis (7.2%). Successful recanalization was significantly (P

ObjectiveTo investigate the value of the MRI arterial spin labeling (ASL) in evaluating the blood-brain barrier permeability of anterior circulation ischemic lesions in subacute ischemic stroke (SIS) and the risk of hemorrhage transformation (HT) after endovascular recanalization.Materials and methodsPatients with anterior circulation SIS treated with endovascular recanalization were prospectively enrolled. The imaging presentations in the MRI ASL sequences, dynamic contrast-enhanced (DCE) sequence, and Xper CT were studied. The relative cerebral blood flow (rCBF), volume transfer constant (Ktrans), and the weighted Kappa coefficient (rKtrans) were analyzed.ResultsAmong 27 eligible patients, HT occurred in 7 patients (25.92%). Patients with HT had significantly higher rCBF value (1.56 ± 0.16 vs. 1.16 ± 0.16), Ktrans, (0.08 ± 0.03 min vs. 0.03 ± 0.01 min) and rKtrans (3.02 ± 0.89 vs. 1.89 ± 0.56). The ASL imaging sequence had a high consistency with the DCE sequence and Xper CT with a high weighted Kappa coefficient of 0.91 for the DCE sequence and 0.70 for the Xper CT imaging. The DCE sequence was also highly consistent with the Xper CT in imaging classification with a high weighted Kappa coefficient of 0.78. The rCBF value in the 21 patients with the subcortical and basal ganglia infarction was significantly lower than that in the other 6 patients with the cortical infarction (1.222 ± 0.221 vs. 1.413 ± 0.259, t = 1.795, P = 0.004).ConclusionThe MRI ASL sequence has an important role in evaluating the blood-brain barrier permeability and the risk of hemorrhagic transformation of anterior circulation SIS following endovascular recanalization.

Background Circular RNAs (circRNAs) can act as microRNA (miRNA) sponges, thus regulating gene expression. The role of circRNAs in the process of oxygen-glucose deprivation/reoxygenation (OGD/R) is unclear. Here, we explored the mechanism underlying Circ VRK1 in human brain microvascular endothelial cells (HBMVECs) injury induced by OGD/R. Methods The OGD/R cell model was established in HBMVECs. The microarray was applied to detect differentially expressed circRNAs, followed by subcellular fractionation assay. Colony formation assay, flow cytometry, ELISA, tube formation, Transwell and western blot assays were performed for loss-of-function assay. HE staining, TTC staining, immunohistochemistry and western blot were performed in an established mouse model. The relationships between Circ VRK1 and miR-17, and between miR-17 and PTEN were detected by bioinformatics and dual-luciferase assays. Rescue experiments were conducted in vitro and in vivo, and PI3K/AKT activity was detected by Western Blot. Results Circ VRK1, predominantly present in the cytoplasm of cells, was upregulated in the HBMVECs exposed to OGD/R. Circ VRK1 downregulation decreased proliferation, migration, tube formation, inflammatory factors and oxidative stress, while increased apoptosis in HBMVECs. Moreover, Circ VRK1 silencing reduced neurological damage, cerebral infarct size, CD34-positive cell counts and VEGF expression in mice. Circ VRK1 mediated PTEN expression and the PI3K/AKT pathway by targeting miR-17. Deletion of miR-17 inhibited the effects of Circ VRK1 siRNA, and silencing of PTEN suppressed the effects of miR-17 inhibitor. Conclusion Circ VRK1 was upregulated during OGD/R. Circ VRK1 downregulation regulates PTEN expression by targeting miR-17, thereby promoting PI3K/AKT pathway activity to alleviate OGD/R injury.

The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF).Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed.A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome.CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.

Purpose To retrospectively investigate the epicardial fat volume with multidetector computed tomography (MDCT) and other risk factors for the prevalence of three-vessel coronary lesion. Materials and methods MDCT was performed on 424 subjects with or without three-vessel coronary lesion. Blood was tested for triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lipoprotein a, and fasting blood glucose. Results Among all the subjects, a significant (P P P = 0.001) greater in the patients than in the control group, whereas HDL and Apo A were both significantly (P P Conclusion Three-vessel coronary lesions are more prevalent in subjects with greater volume of epicardial fat and in male gender.

Benign scarring central airway stenosis can be managed by high-pressure balloon dilatation, laser, surgery and stent implantation. The stenosis may have a high recurrence rate that necessitates repeated treatment. Pirfenidone (PFD) has anti-fibrosis effects and has been used in a variety of fibrosis diseases. Animal experiments suggested that PFD can prevent tracheal stenosis.Patients with scarring central airway stenosis usually have chest tightness, cough and dyspnea.Computed tomography scanning showed stenosis of the trachea and/or bronchus. Bronchoscopy revealed occlusion or stenosis of the trachea or bronchus.The use of PFD in combination with other interventional management was reported to treat 2 cases of tracheobronchial stenosis after injury in this study. In the combined use of PFD and interventional management, PFD could help to alleviate tracheobronchial stenosis, prolong the time interval of bronchoscopic interventional treatment, and reduce medical costs.The stenosis in the trachea and/or bronchus is relieved and the patients do not have any relevant symptoms.

The effects of repeated controlled ovarian stimulation (COS) on the female reproductive system are still controversial. This study investigated the effects of repeated COS on the ovaries and uterus of mice and its possible mechanism. Female ICR (Institute of Cancer Research) mice were subjected to the COS using pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) for 1, 3, 5, and 7 cycles. Serum hormone levels, reactive oxidative stress (ROS), 8-hydroxy-2'-deoxyguanosine (8-OHdG), total antioxidant capacity (T-AOC), and superoxide dismutase (SOD) in the mouse ovary and uterus were analyzed by ELISA. The morphology of the ovary and endometrium, ovarian apoptosis, and expressions of the vascular endothelial growth factor (VEGF), leukemia inhibitory factor (LIF), PI3K, AKT, Bax, and Bcl-2 in the ovarian and uterine tissues were tested by hematoxylin-eosin (HE) staining, immunohistochemistry, and western blot. The results showed that repeated COS significantly decreased the hormone level (estradiol, progesterone and anti-Müllerian hormone), high-quality of the MII oocyte ratio, oocyte and embryo number, antioxidant capacity (T-AOC, SOD activity), and the protein level of Bcl-2, LIF, and VEGF, but increased the oxidative damage (ROS, 8-OHdG content), embryo fragment ratio, and expression of pro-apoptotic protein Bax. In addition, the expressions of p-PI3K and p-AKT also decreased with the increase of COS cycle. In conclusion, repeated COS causes ovarian and uterus damage possibly through the PI3K/AKT signaling pathway, and this finding may provide some experimental basis for guiding clinical treatment.

To investigate the association of middle cerebral artery (MCA) bifurcation aneurysms with bifurcation morphology.205 patients were enrolled, including 61 patients with MCA bifurcation aneurysms and 144 non-aneurysmal subjects. Aneurysmal cases were divided into types C (aneurysm neck on extension of the parent artery centerline) and D (deviating neck). The radius of the parent artery M1 (RIn aneurysmal MCA bifurcations, bifurcating angle, TBifurcation angle and arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery have a higher value in distinguishing MCA aneurysmal from non-aneurysmal ones, and the tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.

This study was to analyze the in vivo distribution of wall shear stress (WSS), velocity and in-plane pressure difference in normal carotid artery by using computational fluid dynamics (CFD) based on contrast-enhanced MRA (CE-MRA) data and to determine whether there were differences in these hemodynamic parameters between atherosclerosis-free and atherosclerosis-prone areas. CE-MRA was performed on 16 normal carotid arteries to obtain carotid three-dimensional surface data. CFD analysis was then performed to estimate those parameters in atherosclerosis-free (distal common carotid artery and distal internal carotid artery) and atherosclerosis-prone (carotid bifurcation) areas. One-way analysis of variance (ANOVA) was conducted to analyze differences among these three areas. CFD analysis revealed that WSS and velocity were significantly lower in carotid bifurcation compared to distal common carotid artery (CCA) (P =0.011, P

Object Arterial bifurcations represent preferred locations for aneurysm formation, especially when they are associated with variations in divider geometry. The authors hypothesized a link between basilar apex aneurysms and basilar bifurcation (α) and vertebrobasilar junction (VBJ) angles. Methods The α and VBJ angles were measured in 3D MR and rotational angiographic volumes using a coplanar 3-point technique. Angle α was compared between age-matched cohorts in 45 patients with basilar artery (BA) aneurysms, 65 patients with aneurysms in other locations (non-BA), and 103 nonaneurysmal controls. Additional analysis was performed in 273 nonaneurysmal controls. Computational fluid dynamics (CFD) simulations were performed on parametric BA models with increasing angles. Results Angle α was significantly wider in patients with BA aneurysms (146.7° ± 20.5°) than in those with non-BA aneurysms (111.7° ± 18°) and in controls (103° ± 20.6°) (p < 0.0001), whereas no difference was observed for the VBJ angle. A wider angle α correlated with BA aneurysm neck width but not dome size, which is consistent with CFD results showing a widening of the impingement zone at the bifurcation apex. BA bifurcations hosting even small aneurysms (< 5 mm) had a significantly larger α angle compared with matched controls (p < 0.0001). In nonaneurysmal controls, α increased with age (p < 0.0001), with a threshold effect above 35 years of age and a steeper dependence in females (p = 0.002) than males (p = 0.04). Conclusions The α angle widens with age during adulthood, especially in females. This angular widening is associated with basilar bifurcation aneurysms and may predispose individuals to aneurysm initiation by diffusing the flow impingement zone away from the protective medial band region of the flow divider.

Object Prediction of aneurysm rupture likelihood is clinically valuable, given that more unruptured aneurysms are being discovered incidentally with the increased use of imaging. The authors set out to evaluate the relative performance of morphological features for rupture status discrimination in the context of the divergent geometrical and hemodynamic characteristics of sidewall- and bifurcation-type aneurysms. Methods Catheter 3D rotational angiographic images of 271 consecutive aneurysms (101 ruptured, 135 bifurcation type) were used to assess the following parameters in 3D: maximum diameter (Dmax), height, height/width ratio, aspect ratio, size ratio, nonsphericity index, and inflow angle. Univariate statistics applied to the bifurcation, sidewall, and combined (bifurcation + sidewall) sets identified significant features for inclusion in multivariate analysis yielding area under the curve (AUC) and optimal thresholds in the receiver-operating characteristic. Furthermore, a computational fluid dynamics analysis was performed to evaluate the flow and wall shear stress conditions inside sidewall and bifurcation aneurysms at different inflow angles. Results The mean Dmax, height, and inflow angle were significantly greater in ruptured sidewall aneurysms than in unruptured sidewall aneurysms, but showed no difference between ruptured and unruptured bifurcation lesions. There was a statistically significant difference between ruptured and unruptured aneurysms for all measured features in the combined set. Multivariate analysis identified the following: 1) nonsphericity index as the only rupture status discriminator in bifurcation lesions (AUC = 0.67); 2) height/width ratio, size ratio, and inflow angle as strong discriminators in sidewall lesions (AUC = 0.87); and 3) height/width ratio, inflow angle, and size ratio as intermediate discriminators in the combined group (AUC = 0.76). Computational fluid dynamics analysis showed that although increasing inflow angle in a sidewall model led to deeper penetration of flow, higher velocities, and higher wall shear stress inside the aneurysm dome, it produced the exact opposite results in a bifurcation model. Conclusions Retrospective morphological and hemodynamic analysis point to a dichotomy between sidewall and bifurcation aneurysms with respect to performance of shape and size parameters in identifying rupture status, suggesting the need for aneurysm type–based analyses in future studies. The current most commonly used clinical risk assessment metric, Dmax, was found to be of no value in differentiating between ruptured and unruptured bifurcation aneurysms.

Arterial bifurcations represent preferred locations for aneurysm formation, especially when they are associated with variations in divider geometry. The authors hypothesized a link between basilar apex aneurysms and basilar bifurcation (α) and vertebrobasilar junction (VBJ) angles.The α and VBJ angles were measured in 3D MR and rotational angiographic volumes using a coplanar 3-point technique. Angle α was compared between age-matched cohorts in 45 patients with basilar artery (BA) aneurysms, 65 patients with aneurysms in other locations (non-BA), and 103 nonaneurysmal controls. Additional analysis was performed in 273 nonaneurysmal controls. Computational fluid dynamics (CFD) simulations were performed on parametric BA models with increasing angles.Angle α was significantly wider in patients with BA aneurysms (146.7° ± 20.5°) than in those with non-BA aneurysms (111.7° ± 18°) and in controls (103° ± 20.6°) (p0.0001), whereas no difference was observed for the VBJ angle. A wider angle α correlated with BA aneurysm neck width but not dome size, which is consistent with CFD results showing a widening of the impingement zone at the bifurcation apex. BA bifurcations hosting even small aneurysms (5 mm) had a significantly larger α angle compared with matched controls (p0.0001). In nonaneurysmal controls, α increased with age (p0.0001), with a threshold effect above 35 years of age and a steeper dependence in females (p = 0.002) than males (p = 0.04).The α angle widens with age during adulthood, especially in females. This angular widening is associated with basilar bifurcation aneurysms and may predispose individuals to aneurysm initiation by diffusing the flow impingement zone away from the protective medial band region of the flow divider.

Background Although intracranial stenting has been associated with in-stent stenosis, the vascular response of cerebral vessels to the deployment of the Enterprise vascular reconstruction device is poorly defined. Objective To evaluate the change in parent vessel caliber that ensues after Enterprise stent placement. Methods Seventy-seven patients with 88 aneurysms were treated using Enterprise stent-assisted coil embolization and underwent high-resolution three-dimensional rotational angiography followed by three-dimensional edge-detection filtering to remove windowing-dependence measurement artifact. Orthogonal diameters and cross-sectional areas (CSAs) were measured proximal and distal on either side of the leading stent edge (points A, B), trailing stent edge (points D, E), and at mid-stent (point C). Results Enterprise stent deployment caused an instant increase in the parent artery CSA by 8.98% at D, which was followed 4–6 months later by significant in-stent stenosis (15.78% at A, 27.24% at B, 10.68% at C, 32.12% at D, and 28.28% at E) in the stented artery. This time-dependent phenomenon showed resolution which was complete by 12–24 months after treatment. This target vessel stenosis showed significant age dependence with greater response in the young. No flow-limiting stenosis requiring treatment was observed in this series. Conclusions Use of the Enterprise stent is associated with a significant dynamic and spontaneously resolvable age-dependent in-stent stenosis. Further study is warranted on the clinical impact, if any, of this occurrence.

Although advances in endovascular techniques have permitted reconstruction of intimal dissections and related pseudoaneurysms of the extracranial cervical internal carotid artery, highly tortuous tonsillar loop anatomic variants still pose an obstacle to conventional extracranial self-expanding carotid stents. During a 12 year period, nine of 48 cases with cervical carotid dissections were associated with a tonsillar loop. Five patients required endovascular treatment, which was performed using a microcatheter-based technique with the low-profile Enterprise vascular reconstruction device (Codman Neurovascular, Raynham, MA, USA). Technical, radiographic, and clinical outcomes were analyzed for each patient. Dissection etiology was spontaneous in three patients, iatrogenic in one, and traumatic in one. Four near-occlusive tonsillar loop dissections were successfully recanalized during the acute phase. Dissection-related stenosis improved from 90 ± 22% to 31 ± 13%, with tandem stents needed in three instances to seal the inflow zone. There were no procedure-related transient ischemic attacks (TIA), minor/major strokes, or deaths. Angiographic follow-up for a mean of 28.0 ± 21.6 months showed all stents were patent, with average stenosis of 25.2 ± 12.2%. Focal ovalization and kinking of the closed-cell design was noted at the sharpest curve in one patient. Clinical outcome (follow-up of 28.1 ± 21.5 months) demonstrated overall improvement with no clinical worsening, new TIA, or stroke. Tonsillar loop-associated carotid dissections can be successfully and durably recanalized using the low-profile Enterprise stent with an excellent long-term patency rate and low procedural risk. The possibility of stent kinking and low radial force should be considered when planning reconstruction with this device.

BACKGROUND Self-expanding intracranial stent-assisted coiling of bifurcation aneurysms has recently been shown to straighten target cerebral vessels, a phenomenon with unknown hemodynamic effect. OBJECTIVE To investigate the impact of angular remodeling in aneurysms treated with single stent-assisted coiling with the use of computational fluid dynamic techniques. METHODS Fourteen patients (7 women, mean age 55) who underwent stent coiling of 14 wide-necked bifurcation aneurysms were included based on the availability of high-resolution 3-dimensional rotational angiography. Pretreatment data sets underwent virtual aneurysm removal to isolate the effect of stenting. Wall shear stress and pressure profiles obtained from constant flow input computational fluid dynamic analysis were analyzed for apical hemodynamic changes. RESULTS Stenting increased the bifurcation angle with significant straightening immediately after treatment and at follow-up (107.3° vs. 144.9°, P < .001). The increased stented angle at follow-up led to decreased pressure drop at the bifurcation apex (12.2 vs. 9.9 Pa, P < .003) and migration of the flow impingement zone (FIZ) toward the contralateral nonstented daughter branch by a mean of 1.48 ± 0.2 mm. Stent-induced angular remodeling decreased FIZ width separating peak apical wall shear stress (3.4 vs. 2.5 mm, P < .004). Analysis of FIZ distance measured from the parent vessel centerline showed it to be linearly (r = .58, P < .002) and FIZ width inversely correlated (r = .46, P < .02) to vessel bifurcation angle. CONCLUSION Stent-induced angular remodeling significantly altered bifurcation apex hemodynamics in a favorable direction by blunting apical pressure and inducing the narrowing and migration of the FIZ, a novel response to intracranial stenting that should be added to intimal hyperplasia and flow diversion.

BACKGROUND Although wide-necked basilar bifurcation aneurysms are treated with Y-stent coiling, the effect of this intervention on vessel configuration and hemodynamics is unknown. OBJECTIVE To investigate the immediate and delayed effects of Y-stenting using self-expanding microstents on basilar bifurcation architecture and hemodynamics. METHODS Fifteen patients underwent basilar Y-stent coiling and imaging with rotational angiography. Vascular angles were measured between proximal P1 segments of the posterior cerebral arteries (α) and between the basilar artery and each P1 segment (β(1,2)) in the anteroposterior and γ(1,2) sagittal planes. Patient-specific computational fluid dynamic analysis was used to estimate wall shear stress (WSS) changes with treatment. RESULTS In the anteroposterior plane, Y-stenting significantly decreased angle α and increased β angles immediately after stent coiling (P < .05 and P < .01, respectively) in a continued dynamic remodeling that progressed further in later months; sagittal γ angles also decreased (P < .0001). This novel stent-induced geometric progressive remodeling resulted in effective straightening and narrowing of the basilar bifurcation angle α (150.0 degrees vs 113 degrees, P < .0001) with significant correlation (r = 0.39, P < .05) between pretreatment proximal P1 angles and maximal angular change. Computational fluid dynamic analysis showed the angular remodeling led to significant narrowing of the WSS interpeak at the apex, redirecting high WSS away from the neck transition zone with native vessel toward the inert coil mass. CONCLUSION Y-configuration stent coiling induced immediate and, more significantly, a previously undefined delayed cerebrovascular remodeling. This progressive stent-induced angular remodeling alters perianeurysmal hemodynamics, independent of the flow-diverting properties of stent struts, thus shifting the balance of hemodynamic forces affecting aneurysm development and evolution.

BACKGROUND AND PURPOSE: Wide-neck bifurcating aneurysms are increasingly treated with intracranial stent-assisted coiling by using shape-memory alloy microstents. We sought to investigate the short- and long-term effects of intracranial stent implantation on the geometry and angular conformation of the stent-coiled vascular bifurcation. MATERIALS AND METHODS: Thirty patients underwent stent-mediated coiling for 31 bifurcation aneurysms by using 31 self-expanding Neuroform (n = 14) and Enterprise (n = 17) stents (17 women; mean age, 56 years). The angle (δ) between the stented mother and daughter vessels at the bifurcation was measured by using multiplanar imaging of reconstructed rotational conventional angiography volumes and was compared by using matched-pair statistics. Neuroform and Enterprise longitudinal stent stiffness was measured in vitro at an increasing bending angle θ (θ = 180°− δ). RESULTS: Stent deployment increased the bifurcation angle δ from 101.5° to 119.8° postprocedurally and to 137.3° (P < .0001) at latest follow-up, resulting in effective straightening; the angular remodeling was greater in distal-versus-proximal arteries (anterior cerebral > MCA > BA > ICA), inversely proportional to mother-vessel diameter and proportional to pretreatment bending angle θ. At follow-up, angle δ continued to significantly expand, with remodeling being greater in the early period (1–6 versus >7 months) and more pronounced with the longitudinally stiffer closed-cell Enterprise compared with the open-cell Neuroform stent. CONCLUSIONS: Stent placement across bifurcation aneurysms leads to a significant biphasic angular remodeling related to stent type and vessel caliber, altering morphology to mimic sidewall lesions, a phenomenon needing consideration during procedural planning. Future work is needed to uncover the hemodynamic implications of this structural change and any possible effect on aneurysm-recurrence rates.

BACKGROUND Aneurysm size ratio (SR), variably defined as the ratio of dome height (H) or maximal dimension (D(max)) over average parent vessel diameter (PV) diameter, has been proposed as a promising aneurysm rupture status predictor. OBJECTIVE To evaluate the incremental contribution of SR to retrospective rupture status determination in a large high-resolution aneurysm database. METHODS Measurements were performed on catheter 3D-rotational angiographic volumetric datasets for 267 aneurysms (98 ruptured). SR was computed both as H/PV (SR1) and as D(max)/PV (SR2), and its discriminant performance was evaluated on the whole dataset, on aneurysm-type subsets (bifurcation [BIF] vs sidewall [SW]), and at specific aneurysm locations. Univariate and multivariate statistical analyses were performed by the use of area under the curve (AUC) of the receiver-operating characteristics. RESULTS Neither SR1 nor SR2 were statistically correlated to rupture status in the BIF group, where only PV (AUC = 0.61) achieved significance. All parameters were statistically significant in the combined group, but with modest performance (AUC range, 0.62-0.74). SR1 (AUC = 0.84) and SR2 (AUC = 0.78) were strong predictors in the SW group, similar to H (AUC = 0.83) and D(max) (AUC = 0.77). Multivariate statistics failed to support SR as an incremental independent parameter from PV, D(max), and H. CONCLUSION SR provides an uneven performance that depends strongly on the BIF/SW distribution of the data and is not useful for bifurcation lesions. In the SW subset, the incremental contribution of the SR over its H or D(max) individual component measurements could not be validated, suggesting prior findings of its utility to be the result of aneurysm-type selection bias.

Background and Purpose— The ability to discriminate between ruptured and unruptured cerebral aneurysms on a morphological basis may be useful in clinical risk stratification. The objective was to evaluate the importance of inflow-angle (IA), the angle separating parent vessel and aneurysm dome main axes. Methods— IA, maximal dimension, height–width ratio, and dome–neck aspect ratio were evaluated in sidewall-type aneurysms with respect to rupture status in a cohort of 116 aneurysms in 102 patients. Computational fluid dynamic analysis was performed in an idealized model with variational analysis of the effect of IA on intra-aneurysmal hemodynamics. Results— Univariate analysis identified IA as significantly more obtuse in the ruptured subset (124.9°±26.5° versus 105.8°±18.5°, P =0.0001); similarly, maximal dimension, height–width ratio, and dome–neck aspect ratio were significantly greater in the ruptured subset; multivariate logistic regression identified only IA ( P =0.0158) and height–width ratio ( P =0.0017), but not maximal dimension or dome–neck aspect ratio, as independent discriminants of rupture status. Computational fluid dynamic analysis showed increasing IA leading to deeper migration of the flow recirculation zone into the aneurysm with higher peak flow velocities and a greater transmission of kinetic energy into the distal portion of the dome. Increasing IA resulted in higher inflow velocity and greater wall shear stress magnitude and spatial gradients in both the inflow zone and dome. Conclusions— Inflow-angle is a significant discriminant of rupture status in sidewall-type aneurysms and is associated with higher energy transmission to the dome. These results support inclusion of IA in future prospective aneurysm rupture risk assessment trials.