Sex Differences in Intracranial Aneurysms: A Matched Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
- Availability of clinical data, particularly the sex of the affected patient.
- Availability of 3D angiography allowing for semi-automatic reconstruction of the morphological characteristics of the IA, either of the ruptured IA or, in cases of multiple incidental IAs, the largest IA of the patient.
2.1. Data Acquisition
- Epidemiological data:
- Pre-existing conditions and risk factors:
- ○
- ○
- Diabetes mellitus: documented diagnosis of type 1 or 2 diabetes or intake of oral antidiabetics or insulin [17].
- ○
- Hyperlipidemia: documented diagnosis or intake of medication lowering lipid or cholesterol levels in the blood [17].
- ○
- Peripheral arterial disease: documented diagnosis or imaging finding [17].
- ○
- Heart disease: documented diagnosis of myocardial infarction, coronary artery disease, cardiac arrhythmia, or other heart diseases [17].
- ○
- Ischemic stroke: documented diagnosis or imaging finding on admission [17].
- ○
- Obesity: documented body mass index of >30 kg/m2 [17].
- ○
- ○
- Aneurysm-specific factors:
- Clinical scores:
- ○
- Hunt and Hess scale: assessment of the clinical severity of the SAH on admission based on clinical presentation, ranging from minimal symptoms to severe coma and decerebrate rigidity [20].
- ○
- Fisher grade: assessment of SAH severity based on CT findings, ranging from no visible blood to significant intracerebral or intraventricular clots [21].
- ○
- Modified Rankin scale at discharge: assessment of neurological and functional disability at discharge, ranging from no symptoms to death [22].
- Complications associated with aneurysm therapy/rupture:
- ○
- Hydrocephalus: symptomatic enlargement of the ventricles on CT [17].
- ○
- Hydrocephalus treatment: placement of an external ventricular drainage or ventriculoperitoneal shunt [17].
- ○
- Vasospasm: vasospasm detection via transcranial doppler or angiography [17].
- ○
- Vasospasm treatment: treatment of vasospasm via endovascular spasmolysis or other endovascular procedures [17].
- ○
- Follow-up examinations:
- ○
- Follow-up duration: measured in months starting from the first admission of the patient [17].
- ○
- Occlusion of the aneurysm: assessed by follow-up imaging [17].
- ○
- Modified Rankin scale at follow-up: assessment of neurological and functional disability at follow-up, ranging from no symptoms to death [22].
2.2. Morphological Analysis
- Wmax: Maximum width of the aneurysm perpendicular to Hmax [25].
- Wortho: Maximum width of the aneurysm perpendicular to Hortho [25].
- OA 1: Ostium Area 1; surface of the aneurysm ostium [25].
- OA 2: Ostium Area 2; surface of the aneurysm ostium; the neck curve projected onto a plane [25].
- Alpha: Angle at point B1 describing the angle from the baseline to the dome point [25].
- Beta: Angle at point B2 describing the angle from the baseline to the dome point [25].
- Gamma: Angle at the aneurysm dome [25].
2.3. Matching Criteria and Cohort Matching
3. Statistical Analysis
4. Results
4.1. Cohort Overview
4.2. Analysis of the Matched Cohort
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Whole Cohort (n = 283) | Matched Cohort (n = 180) | |||||
---|---|---|---|---|---|---|
Male (n = 95) | Female (n = 188) | Statistical Analysis | Male (n = 95) | Female (n = 195) | Statistical Analysis | |
Age (mean) | 55.1 years | 55.6 years | p > 0.999 ** | 55.1 years | 53.6 years | p > 0.999 *** |
Hypertension | 70 (24.7%) | 134 (47.4%) | p > 0.999 **** | 70 (73.7%) | 70 (73.7%) | p > 0.999 **** |
Diabetes mellitus | 14 (5.0%) | 16 (5.7%) | p > 0.999 **** | 14 (14.7%) | 10 (10.5%) | p > 0.999 **** |
Hyperlipidemia | 19 (6.7%) | 29 (10.3%) | p > 0.999 **** | 19 (20%) | 18 (19.0%) | p > 0.999 **** |
Peripheral arterial disease | 4 (1.4%) | 3 (1.1%) | p > 0.999 **** | 4 (4.2%) | 1 (1.1%) | p > 0.999 **** |
Heart disease | 15 (5.3%) | 25 (8.8%) | p > 0.999 ***** | 15 (15.8%) | 13 (13.7%) | p > 0.999 **** |
Ischemic stroke | 9 (3.2%) | 11 (3.9%) | p > 0.999 **** | 9 (9.5%) | 1 (1.1%) | p > 0.999 **** |
Obesity | 33 (11.7%) | 44 (15.6%) | p > 0.999 **** | 33 (34.7%) | 26 (27.4%) | p > 0.999 **** |
Nicotine abuse | 62 (21.9%) | 85 (30.0%) | p = 0.031 **** | 62 (65.3%) | 68 (71.6%) | p > 0.999 **** |
Alcohol abuse | 23 (8.1%) | 13 (4.6%) | p = 0.031 **** | 23 (24.2%) | 11 (11.6%) | p = 0.124 **** |
Hmax (mean) | 5.9 | 5.6 | p > 0.999 * | 5.9 | 5.7 | p > 0.999 ** |
Wmax (mean) | 5.7 | 5.7 | p > 0.999 * | 5.7 | 5.9 | p > 0.999 ** |
Dmax (mean) | 7.6 | 7.3 | p > 0.999 * | 7.6 | 7.4 | p > 0.999 ** |
Hortho (mean) | 5.0 | 4.9 | p > 0.999 * | 5.0 | 5.0 | p > 0.999 ** |
Wortho (mean) | 6.6 | 6.4 | p > 0.999 * | 6.6 | 6.5 | p > 0.999 ** |
Nmax (mean) | 4.7 | 4.7 | p > 0.999 * | 4.7 | 4.7 | p > 0.999 ** |
Navg (mean) | 4.1 | 4.0 | p > 0.999 * | 4.1 | 4.0 | p > 0.999 ** |
AR 1 (mean) | 1.1 | 1.1 | p > 0.999 * | 1.1 | 1.1 | p > 0.999 * |
AR 2 (mean) | 1.2 | 1.3 | p > 0.999 * | 1.2 | 1.3 | p > 0.999 * |
EI (mean) | 0.3 | 0.3 | p > 0.999 ** | 0.3 | 0.3 | p = 0.812 ** |
NSI (mean) | 0.2 | 0.2 | p > 0.999 * | 0.2 | 0.2 | p > 0.999 *** |
UI (mean) | 0.1 | 0.1 | p > 0.999 * | 0.1 | 0.1 | p = 0.36 ** |
AA (mean) | 101.4 | 102.3 | p > 0.999 * | 101.4 | 99.3 | p > 0.999 ** |
Ostium Area 1 (mean) | 15.7 | 15.9 | p > 0.999 * | 15.6 | 14.6 | p > 0.999 ** |
Ostium Area 2 (mean) | 13.8 | 13.8 | p > 0.999 * | 13.8 | 13.1 | p > 0.999 ** |
VA (mean) | 117.7 | 141.7 | p > 0.999 * | 117.7 | 115.8 | p > 0.999 ** |
V_CH (mean) | 133.2 | 158.6 | p > 0.999 * | 133.2 | 130.5 | p > 0.999 ** |
A_CH (mean) | 119.5 | 120.6 | p > 0.999 * | 119.5 | 117.4 | p > 0.999 ** |
Alpha (mean) | 76.9 | 76.4 | p > 0.999 * | 76.9 | 78.7 | p > 0.999 * |
Beta (mean) | 61.4 | 62.6 | p > 0.999 * | 61.4 | 59.3 | p > 0.999 * |
Gamma (mean) | 41.8 | 40.9 | p > 0.999 * | 41.8 | 42.0 | p > 0.999 ** |
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Swiatek, V.M.; Amini, A.; Marinescu, M.; Dumitru, C.A.; Spitz, L.; Stein, K.-P.; Saalfeld, S.; Rashidi, A.; Sandalcioglu, I.E.; Neyazi, B. Sex Differences in Intracranial Aneurysms: A Matched Cohort Study. J. Pers. Med. 2024, 14, 1038. https://doi.org/10.3390/jpm14101038
Swiatek VM, Amini A, Marinescu M, Dumitru CA, Spitz L, Stein K-P, Saalfeld S, Rashidi A, Sandalcioglu IE, Neyazi B. Sex Differences in Intracranial Aneurysms: A Matched Cohort Study. Journal of Personalized Medicine. 2024; 14(10):1038. https://doi.org/10.3390/jpm14101038
Chicago/Turabian StyleSwiatek, Vanessa M., Amir Amini, Michelle Marinescu, Claudia A. Dumitru, Lena Spitz, Klaus-Peter Stein, Sylvia Saalfeld, Ali Rashidi, I. Erol Sandalcioglu, and Belal Neyazi. 2024. "Sex Differences in Intracranial Aneurysms: A Matched Cohort Study" Journal of Personalized Medicine 14, no. 10: 1038. https://doi.org/10.3390/jpm14101038
APA StyleSwiatek, V. M., Amini, A., Marinescu, M., Dumitru, C. A., Spitz, L., Stein, K.-P., Saalfeld, S., Rashidi, A., Sandalcioglu, I. E., & Neyazi, B. (2024). Sex Differences in Intracranial Aneurysms: A Matched Cohort Study. Journal of Personalized Medicine, 14(10), 1038. https://doi.org/10.3390/jpm14101038