Abstract
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters.Three-dimensional morphological parameters in 409 patients with 432 PCoA aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 who had available CT angiography (CTA) or digital subtraction angiography (DSA) were evaluated. Morphological parameters examined included aneurysm wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal PCoA, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological parameters with rupture of PCoA aneurysms. Additional analyses were performed to determine the association of patient factors with the morphological parameters. Irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with ruptured PCoA aneurysms, whereas perpendicular height was inversely associated with rupture in a multivariable model. Older age was associated with lower aspect ratio, with a trend towards lower height/width ratio and smaller flow angle, features that are associated with a lower rupture risk. Morphological parameters are easy to assess and could help in risk stratification in patients with unruptured PCoA aneurysms. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk.
Highlights
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner
Ruptured aneurysms had a higher rate of irregularity (69% vs 22%), daughter dome (80% vs 23%), greater perpendicular height (6.0 vs 5.0 mm), maximum height (6.7 vs 5.5 mm), aspect ratio (1.9 vs 1.4), height/width ratio (1.3 vs 1.1), size ratio (0.95 vs 0.74), and flow angle (119 vs 108 degrees), non-hypoplastic posterior communicating artery (PCoA) (63% vs 51%), and smaller distal ICA diameter (3.2 vs 3.4 mm), proximal ICA diameter (3.0 vs 3.2 mm), and diameter size ratio (0.71 vs 0.75)
We demonstrated that irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with rupture, whereas perpendicular height was inversely associated with rupture in a multivariable model
Summary
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk. While general features such as size is known to affect the rupture risk of an aneurysm, the effects of more specific morphological features, as well as acquired risk factors such as smoking and hypertension, in a site specific manner remains to be e lucidated[1,2]. Investigating the effects of morphological parameters of the aneurysm and surrounding vascular tree that affect these hemodynamic factors in a location specific manner would be important in understanding the rupture risk of an aneurysm. Which are not intrinsic to aneurysm morphology, and the evaluation of clinical factors that may be associated with particular morphologies
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