Ruptured Risk Assessment And Clinical Study Of Internal Carotid Arterial-posterior Communicating Aneurysm

Part I: Rupture risk assessment and prediction model of internal carotid arterialposterior communicating aneurysm.Objective: The general clinical data and morphological characteristics of patients with ruptured and unruptured posterior communicating aneurysms were retrospectively analyzed.The independent risk factors of ruptured posterior communicating aneurysms were analyzed by logistic regression and decision tree in machine learning methods,and a model was built to predict the risk of ruptured posterior communicating aneurysms,providing reference for clinical treatment of posterior communicating aneurysms.Methods: Collect patients with posterior communicating artery aneurysm diagnosed by the affiliated hospital of Qingdao University from December 2015 to December 2022.According to the inclusion and exclusion criteria,340 patients with posterior communicating artery aneurysms were screened,and clinical and morphological data were collected.SPSS26.0 software was used to statistically analyze the data collected from patients with posterior communicating artery aneurysms.Logistic regression analysis and decision tree in machine learning were used to construct the prediction model of posterior traffic aneurysms,and the area under the receiver operating characteristic curve(ROC)area under the cure(AUC)was used to evaluate the effectiveness of the model.Results: The patients in this study were divided into rupture group and nonrupture group.There was no statistically significant difference in sex,smoking history,tumor neck width and aneurysm width between the ruptured group and the unruptured group.The history of hypertension,the presence of embryonic posterior cerebral artery,the regularity of morphology,age,the height of aneurysm,the ratio of tumor height to width,and the incidence angle were statistically significant.Logistic regression showed that the combination of embryonic posterior cerebral artery,aneurysm height,tumor height to width ratio,incidence angle and irregular shape were independent risk factors for posterior communicating artery aneurysm rupture.The area under the ROC curve(ACU)is 0.83(95% CI: 0.74-093)after the application test of the prediction model built by logistic regression.When the cutoff value is 0.648,the model has the best efficiency,with sensitivity of 83.3% and specificity of 76.9%.The prediction model is constructed by the decision tree in machine learning.After applying the test set to the model,the area under the ROC curve(AUC)is 0.81,(95CI%: 0.72-0.90).When 0.67 is the best cutoff value,the accuracy is 0.83%,the sensitivity is 0.87,and the specificity is 0.63.Conclusion: The patients with fetal posterior cerebral artery,the height of aneurysm,the ratio of height to width of aneurysm,the inflow angle and the irregular shape are independent risk factors for the rupture of posterior communicating artery aneurysm.Logistic regression is used to build the prediction model,and the area under the ROC curve(AUC)is used to verify that the model has good efficiency.The prediction model of decision tree construction in machine learning also has good effectiveness.The effectiveness of Logistic regression model is similar to that of decision tree classification model in machine learning.This study can provide reference for the risk prediction of posterior communicating artery aneurysm rupture.Part Ⅱ: Classification and endovascular treatment of posterior communicating aneurysms combined fetal posterior cerebral artery.Objective: As an independent risk factor for rupture of posterior communicating aneurysms combined fetal posterior cerebral artery was divided into lateral wall type and bifurcated type to explore the safety and effectiveness of different types of endovascular interventional therapy and different treatment methods.Methods: The clinical data of 63 patients with posterior communicating aneurysms combined fetal posterior cerebral artery who underwent endovascular intervention were retrospectively analyzed.The patients were staged according to the vascular condition on cerebral angiography or computed tomography angiography(CTA),and the Hunt-Hess grading scale was applied to assess the clinical condition before treatment,the modified Raymond-Roy classification was used to assess the immediate treatment of aneurysms and follow-up outcomes,and the modified Rankin Scale(m RS)score was used to assess the prognosis of patients.Results: Of 63 patients with posterior communicating aneurysms combined fetal posterior cerebral artery.There were 57 cases of Hunt-Hess(grade 0-II)and 6 cases of Hunt-Hess(grade III-IV),and immediate postoperative angiography showed adequate embolization in 54cases(19 cases of Raymond grade I and 35 cases of grade II)and incomplete embolization in 9 cases(Raymond grade III).The prognosis of the patients(m RS score0 in 49 cases,1 in 9 cases,3 in 2 cases,5 in 1 case,and 6 in 2 cases).There were 14 cases of sidewall type and 49 cases of bifurcation type.There was no significant difference in the recurrence of aneurysm after treatment with different types(P<0.542).Conclusion: Endovascular intervention for posterior communicating aneurysms combined fetal posterior cerebral artery is safe and effective,and appropriate treatment modalities should be selected according to different staging,and close long-term follow-up is required.