Abstract
In contrast to size, the association of morphological characteristics of intracranial aneurysms with rupture has not been established in a systematic manner. We present an analysis of the morphological variables that are associated with rupture in anterior communicating artery aneurysms to determine site-specific risk variables. One hundred and twenty-four anterior communicating artery aneurysms were treated in a single institution from 2005 to 2010, and CT angiograms (CTAs) or rotational angiography from 79 patients (42 ruptured, 37 unruptured) were analyzed. Vascular imaging was evaluated with 3D Slicer© to generate models of the aneurysms and surrounding vasculature. Morphological parameters were examined using univariate and multivariate analysis and included aneurysm volume, aspect ratio, size ratio, distance to bifurcation, aneurysm angle, vessel angle, flow angle, and parent-daughter angle. Multivariate logistic regression revealed that size ratio, flow angle, and parent-daughter angle were associated with aneurysm rupture after adjustment for age, sex, smoking history, and other clinical risk factors. Simple morphological parameters such as size ratio, flow angle, and parent-daughter angle may thus aid in the evaluation of rupture risk of anterior communicating artery aneurysms.
Highlights
The prevalence of cerebral aneurysms is estimated to be 1–3% [1,2,3] and unruptured aneurysms appear to be identified with increasing frequency [3,4]
Patients with ruptured aneurysms were more likely to have a history of smoking than those with unruptured aneurysms (57.1% vs. 29.7%), whereas those with unruptured anterior communicating artery (AcoA) aneurysms were more likely to harbor multiple aneurysms (Table 1)
Ruptured aneurysms were associated with larger aneurysm angle (95.5 vs. 84.4, p = 0.05) and flow angle (125.7 vs. 112.6, p = 0.05), smaller parent-daughter angle (68.2 vs. 80.3, p = 0.04), as well as higher size ratio (3.22 vs. 2.34, p = 0.03) and aspect ratio
Summary
The prevalence of cerebral aneurysms is estimated to be 1–3% [1,2,3] and unruptured aneurysms appear to be identified with increasing frequency [3,4]. A number of geometric parameters, including aspect ratio [10,11], size ratio [12,13], aneurysm inflow angle [14], and volume-to-ostium ratio [15], have been shown to have greater association with aneurysm rupture status than size alone. Such studies grouped together all aneurysm types, which may confound characteristics that are specific to the vascular anatomy associated with a specific location. We present a large sample of anterior communicating artery (ACoA) aneurysms that were assessed using a diverse array of morphological variables to determine the parameters associated with aneurysm rupture at this specific location
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