Deans' stroke musings: Focal Aneurysm Wall Enhancement in Vessel Wall Imaging as a Surrogate Marker for Predicting Aneurysm Instability

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, December 12, 2023

Focal Aneurysm Wall Enhancement in Vessel Wall Imaging as a Surrogate Marker for Predicting Aneurysm Instability

If you have an aneurysm you might want your doctor to be competent in this imaging.

Focal Aneurysm Wall Enhancement in Vessel Wall Imaging as a Surrogate Marker for Predicting Aneurysm Instability

Yukishige Hashimoto,

Toshinori Matsushige,

Chiaki Ono and

Originally published25 Sep 2023https://doi.org/10.1161/SVIN.123.001029Stroke: Vascular and Interventional Neurology. 2023;3:e001029

Other version(s) of this article

Abstract

Background

The establishment of a risk stratification method for unruptured intracranial aneurysms (UIAs) remains an interdisciplinary challenge. The present study attempted to identify unstable UIAs using magnetic resonance vessel wall imaging in prospective data sets. Hemodynamic parameters in unstable UIAs were also examined to clarify the mechanisms by which segmented aneurysm wall enhancement (AWE) affects longitudinal morphological changes.

Methods

Patients with UIAs who underwent contrast‐enhanced vessel wall imaging between 2017 and 2022 and were followed up for more than 6 months were included. Two readers independently rated AWE patterns (no, focal, and circumferential AWE) on vessel wall imaging and morphological changes on time‐of‐flight magnetic resonance angiography. Computational fluid dynamics studies were performed on unstable UIAs to evaluate the hemodynamic features of evolved or ruptured points in aneurysm walls.

Results

Aneurysm growth was observed in 13 of 114 UIAs in the present study during a median follow‐up of 34 months. Of the 13 growing UIAs, their AWE patterns were as follows: no AWE in 6 and focal AWE (FAWE) in 7 UIAs. Univariable Cox regression analysis showed that aneurysm size and FAWE were associated with aneurysm growth. On multivariable Cox regression analysis, FAWE (hazard ratio, 4.59 [95% CI, 1.29–16.3]; P=0.019) was independently associated with aneurysm growth. Kaplan–Meier curve revealed significant differences between AWE patterns and UIA growth (P<0.001). Aneurysms ruptured in the 4 UIAs with FAWE during the follow‐up and all rupture points corresponded to nonenhanced lesions in aneurysm walls. Nonenhanced areas had higher wall shear stress than enhanced areas (1.59±1.02 versus 0.53±0.32; P=0.022).

Conclusion

FAWE may be associated with aneurysm growth and rupture during follow‐up. A comprehensive analysis of nonenhanced areas of UIAs with FAWE using vessel wall imaging and computational fluid dynamics provides insights into the mechanisms underlying aneurysm instability.