CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 335-339
DOI: 10.4103/ajns.AJNS_495_20
Original Article

Clinical and morphological characteristics of ruptured small (<5 mm) posterior communicating artery aneurysms

Aoto Shibata
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Tomoya Kamide
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Shunsuke Ikeda
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Shinichiro Yoshikawa
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Eisuke Tsukagoshi
1   Department of Neuro Endovascular Therapy, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Azusa Yonezawa
1   Department of Neuro Endovascular Therapy, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Ririko Takeda
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Yuichiro Kikkawa
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Shinya Kohyama
1   Department of Neuro Endovascular Therapy, International Medical Center, Saitama Medical University, Hidaka, Saitama
,
Hiroki Kurita
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
› Author Affiliations

Context: Small intracranial aneurysms (IAs) are considered to have a low risk of rupture; however, in clinical practice, we often encounter patients with subarachnoid hemorrhage (SAH) due to rupture of small IAs. Aims: This study aims to clarify the clinical and morphological characteristics of ruptured small IA, focusing on posterior communicating artery (PCoA) aneurysms as a prone site. Settings and Design: We retrospectively reviewed 102 consecutive patients with SAH due to ruptured PCoA aneurysm who underwent microsurgical or endovascular aneurysm repair between April 2013 and March 2018. Subjects and Methods: All PCoA aneurysms were diagnosed using three-dimensional rotation angiography or three-dimensional computed tomography angiography. Information regarding the following clinical characteristics was collected: age, sex, past medical history, current smoking, antithrombotic therapy, multiplicity, hydrocephalus, intracerebral hemorrhage, intraventricular hemorrhage, and World Federation of Neurosurgical Societies (WFNS) Grade on admission. Statistical Analysis Used: We analyzed factors of ruptured small IA, focusing on PCoA aneurysms using univariate and multivariate regression analyses. Results: Univariate and multivariate analyses revealed that low aspect ratio (AR) (odds ratio [OR] = 0.33, P = 0.01) and nonfetal type of PCoA (OR = 0.31, P = 0.02) might be independent characteristics of ruptured small PCoA aneurysms. However, age, sex, past medical history, WFNS grade, and treatment outcome were not different between the small and nonsmall PCoA aneurysms. The aneurysm size was not associated to the selection of treatment, proportion of complications, and treatment outcome. Conclusions: In cases of ruptured PCoA aneurysms, low AR and nonfetal type of PCoA might be associated with rupture of small aneurysms.

Financial support and sponsorship

Nil.




Publication History

Received: 19 November 2020

Accepted: 30 January 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet (London, England) 2007;369;306-18.
  • 2 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet (London, England) 2003;362;103-10.
  • 3 Juvela S, Poussa K, Lehto H, Porras M. Natural history of unruptured intracranial aneurysms: A long-term follow-up study. Stroke 2013;44:2414-21.
  • 4 Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain 2000;123(Pt 2):205-21.
  • 5 Weir B, Disney L, Karrison T. Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 2002;96:64-70.
  • 6 Winn HR, Jane JA Sr., Taylor J, Kaiser D, Britz GW. Prevalence of asymptomatic incidental aneurysms: Review of 4568 arteriograms. J Neurosurg 2002;96;43-9.
  • 7 Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 2010;41:1969-77.
  • 8 Forget TR Jr., Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, et al. A review of size and location of ruptured intracranial aneurysms. Neurosurgery 2001;49;1322-5.
  • 9 Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke 1994;25:1342-7.
  • 10 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: Probability and risk factors for aneurysm rupture. Neurosurg Focus 2000;8: Preview 1.
  • 11 Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, et al. Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study. Stroke 1999;30:1390-5.
  • 12 Sato K, Yoshimoto Y. Risk profile of intracranial aneurysms: Rupture rate is not constant after formation. Stroke 2011;42;3376-81.
  • 13 Nader-Sepahi A, Casimiro M, Sen J, Kitchen ND. Is aspect ratio a reliable predictor of intracranial aneurysm rupture? Neurosurgery 2004;54:1343-7.
  • 14 Tateshima S, Chien A, Sayre J, Cebral J, Viñuela F. The effect of aneurysm geometry on the intra-aneurysmal flow condition. Neuroradiology 2010;52:1135-41.
  • 15 Meng H, Tutino VM, Xiang J, Siddiqui A. High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: Toward a unifying hypothesis. AJNR Am J Neuroradiol 2014;35:1254-62.
  • 16 Qiu T, Jin G, Bao W, Lu H. Intercorrelations of morphology with hemodynamics in intracranial aneurysms in computational fluid dynamics. Neurosciences (Riyadh) 2017;22:205-12.
  • 17 Baharoglu MI, Schirmer CM, Hoit DA, Gao BL, Malek AM. Aneurysm inflow-angle as a discriminant for rupture in sidewall cerebral aneurysms: Morphometric and computational fluid dynamic analysis. Stroke 2010;41:1423-30.
  • 18 Kaneko N, Mashiko T, Namba K, Tateshima S, Watanabe E, Kawai K. A patient-specific intracranial aneurysm model with endothelial lining: A novel in vitro approach to bridge the gap between biology and flow dynamics. J Neurointerv Surg 2018;10:306-9.
  • 19 Meng H, Wang Z, Kim M, Ecker RD, Hopkins LN. Saccular aneurysms on straight and curved vessels are subject to different hemodynamics: Implications of intravascular stenting. AJNR Am J Neuroradiol 2006;27:1861-5.
  • 20 Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, Choque-Velasquez J, et al. Microneurosurgical management of posterior communicating artery aneurysm: A contemporary series from Helsinki. World Neurosurg 2017;101:379-88.
  • 21 Ujiie H, Tamano Y, Sasaki K, Hori T. Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 2001;48:495-502.
  • 22 Cebral JR, Mut F, Weir J, Putman CM. Association of hemodynamic characteristics and cerebral aneurysm rupture. AJNR Am J Neuroradiol 2011;32:264-70.
  • 23 Yu M, Huang Q, Hong B, Qiao F, Liu J. Morphological differences between the aneurysmal and normal artery in patients with internal carotid-posterior communicating artery aneurysm. J Clin Neurosci 2010;17:1395-8.
  • 24 He Z, Wan Y. Is fetal-type posterior cerebral artery a risk factor for intracranial aneurysm as analyzed by multislice CT angiography? Exp Ther Med 2018;15:838-46.
  • 25 Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 2005;26:2550-9.
  • 26 Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, et al. Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 2011;42:144-52.
  • 27 Shojima M, Oshima M, Takagi K, Torii R, Hayakawa M, Katada K, et al. Magnitude and role of wall shear stress on cerebral aneurysm: Computational fluid dynamic study of 20 middle cerebral artery aneurysms. Stroke 2004;35:2500-5.
  • 28 Tremmel M, Dhar S, Levy EI, Mocco J, Meng H. Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: Results from a virtual experimental study. Neurosurgery 2009;64:622-30.