Abstract
This article assesses the association between anterior circulation morphometry and
the presence of intracranial aneurysm using three-dimensional rotational angiography
(3DRA). A retrospective analysis at a Peruvian academic medical center between December
2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms
and matched controls who underwent 3DRA. Angiographic images were obtained per standard
of care, and measurements of the vasculature were performed using 3DRA vascular automated
software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women
represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2).
In multivariate analysis, five specific features were found to be statistically significant
predictors for presence of an anterior circulation aneurysm: female sex (odds ratio
[OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the
ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior
reports by demonstrating five specific patient and imaging features associated with
anterior circulation aneurysms. While 3DRA is the standard of care in many settings,
medical centers with resource limitations may not have access to this technique. The
demographic and morphological features identified in our study may have correlates
that if detected on contrast computed tomography or magnetic resonance imaging studies,
may be used to help screen for a higher level of care in select patients.
Keywords
intracranial aneurysm - 3DRA - angiography - anterior circulation - ethnicity
