Abstract
ObjectiveLately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms.MethodsData from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries.ResultsPatients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms.ConclusionWe observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.
Highlights
IntroductionThe aim is to find the path of the lowest total risk for the patient, while comparing the individual risk of aneurysm rupture over time against the risk of the intervention
This risk assessment of the likelihood of rupture has mainly been based on metric variables such as the height as well as the morphology of the aneurysms. [9, 11, 12, 25] Lately, studies revealed the need to assess aneurysms in a location-specific manner; the known morphological parameters appear to be specific for different locations. [2, 16, 20] For example, recent studies indicated that the aneurysm size is not an adequate indicator for the probability of rupture in aneurysms of the arteria communicans anterior (ACOM). [2, 16] As a result, localization-specific factors that
In basilar tip aneurysms (BTAs), an increased posterior cerebral artery (PCA) angle has been reported to be associated with the risk of aneurysm rupture. [3, 8] In general, there is no consensus in the literature regarding the flow dynamics around the vessels directly distal to the aneurysm, known as daughter arteries
Summary
The aim is to find the path of the lowest total risk for the patient, while comparing the individual risk of aneurysm rupture over time against the risk of the intervention. In recent years, this risk assessment of the likelihood of rupture has mainly been based on metric variables such as the height as well as the morphology of the aneurysms. [3, 23] Recent studies revealed a wider bifurcation angle, including the medial cerebral artery (MCA) [1], the anterior cerebral artery (ACA) [28], and the basilar artery (BA) [29], can alternate the flow dynamics and promote the formation of local aneurysms. There are several publications that identify vessel diameters of daughter vessels as well as asymmetry in bifurcations as a risk factor for aneurysm rupture. [28, 30] In contrast, other studies could not confirm this correlation between the distal vascular diameter or asymmetries and the risk of rupture. [6, 13]
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