Larger size ratio associated with the rupture of very small (≤3 mm) anterior communicating artery aneurysms

2016 ◽  
Vol 9 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Ting Xu ◽  
Boli Lin ◽  
Shuailiang Liu ◽  
Xiaotong Shao ◽  
Nengzhi Xia ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Univariate Analysis ◽  
Maximum Size ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Aneurysm Size ◽  
Aneurysm Morphology ◽  
Small Aneurysms

BackgroundAnterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.MethodsWe conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.ResultsOf the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.ConclusionsAbout one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.

The influence of aneurysm morphology on the volume of hemorrhage after rupture

2021 ◽  
pp. 1-9
Author(s):  
Pablo M. Munarriz ◽  
Blanca Navarro-Main ◽  
Jose F. Alén ◽  
Luis Jiménez-Roldán ◽  
Ana M. Castaño-Leon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Univariate Analysis ◽  
Size Ratio ◽  
Computer Assisted ◽  
Data Set ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Morphological Variables ◽  
Hemorrhage Volume ◽  
The Impact

OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient’s age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient’s age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient’s age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.

Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

2017 ◽  
Vol 78 (06) ◽  
pp. 610-616 ◽  
Author(s):  
Helena Švihlová ◽  
Alena Sejkorová ◽  
Tomáš Radovnický ◽  
Daniel Adámek ◽  
Jaroslav Hron ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Anterior Communicating Artery Aneurysm ◽  
Computational Fluid Dynamics Cfd ◽  
Inflow Jet ◽  
Rupture Site

AbstractComputational fluid dynamics (CFD) has been studied as a tool for the stratification of aneurysm rupture risk. We performed CFD analysis in a patient operated on for a ruptured anterior communicating artery aneurysm. The point of rupture was identified during surgery. The aneurysm and blood vessels were segmented from computed tomography angiography to prepare a model for simulations. We found that the streamlines showed a concentrated inflow jet directed straight at the rupture point, and high wall shear stress was found at the point of rupture in the aneurysm sac. Thus specific local hemodynamics may be indicative of the aneurysm rupture site.

Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms

2013 ◽  
Vol 118 (5) ◽  
pp. 978-983 ◽  
Author(s):  
Hidetoshi Matsukawa ◽  
Akihiro Uemura ◽  
Motoharu Fujii ◽  
Minobu Kamo ◽  
Osamu Takahashi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Multivariate Logistic Regression Analysis ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
3D Ct Angiography ◽  
Anterior Direction

Object Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture. Methods Data from 140 consecutive patients with ACoA aneurysms managed at the authors' facility between July 2003 and November 2011 were retrospectively reviewed. Patients with (78) and without (62) aneurysm rupture were divided into groups, and morphological and clinical characteristics were compared. Morphological characteristics were evaluated based on 3D CT angiography and included aneurysm location, dominance of the A1 portion of the anterior cerebral artery, direction of the aneurysm dome around the ACoA, aneurysm bleb(s), size of the aneurysm and its neck, aneurysm–parent artery angle, and existence of other intracranial unruptured aneurysms. Results Patients with ruptured ACoA aneurysms were significantly younger (a higher proportion were younger than 60 years of age) than those with unruptured lesions, and a significantly smaller proportion had hypercholesterolemia. A significantly larger proportion of patients with ruptured aneurysms showed an anterior direction of the aneurysm dome around the ACoA, had a bleb(s), and/or had an aneurysm size ≥ 5 mm. Multivariate logistic regression analysis showed that an anterior direction of the aneurysm dome around the ACoA (OR 6.0, p = 0.0012), the presence of a bleb(s) (OR 22, p < 0.0001), and an aneurysm size ≥ 5 mm (OR 3.16, p = 0.035) were significantly associated with ACoA aneurysm rupture. Conclusions Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.

scholarly journals The role of anatomical anomalies in anterior communicating artery aneurysm rupture

2013 ◽  
Vol 19 (3) ◽  
pp. 147-153
Author(s):  
Cr.P Dimitriu ◽  
C. Ionescu ◽  
P. Bordei ◽  
I. Bulbuc
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Circle Of Willis ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Aneurysm Size ◽  
Proper Patient Selection

Abstract Background and purpose:limited data exist to guide proper patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with anomalies of arterial segments that are forming the brain arterial circle of Willis but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared. Material and methods: we have performed this study on a number of 312 cases, of which 87 were dissections, 22 dissection followed by plastic injection, 135 magnetic resonance angiography (MRA), 75 computer tomography angiography (CTA), 40 digital subtraction angiographies (DSA), 30 in vivo (intraoperatory) observation. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of anterior cerebral artery anomalies. Results: we divided the study group in 2 cohorts, one control group of 272 cases, in which we have study the anatomical variants occurrence and aneurysm occurrence in general population and another included 45 patients admitted thru emergency room for subarachnoid hemorrhage, of those 38 were ruptured aneurysm of anterior communicating artery (ACoA). Mean aneurysm size was 8.9 mm. An anterior cerebral artery anomaly was identified in 31 cases (81.5%). Multivariate analysis revealed a higher risk of aneurysm rupture when an anterior cerebral artery was present. Conclusions: this study shows that anterior cerebral artery anomalies are more commonly found in ruptured as opposed to unruptured ACoA aneurysms. The presence of an ACA anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.

scholarly journals Definitions of intracranial aneurysm size and morphology: A call for standardization

2021 ◽  
Vol 12 ◽  
pp. 506
Author(s):  
William C. Merritt ◽  
Holly F. Berns ◽  
Andrew F. Ducruet ◽  
Timothy Andrew Becker
Keyword(s):  
Quantitative Measurement ◽  
Treatment Options ◽  
Publication Date ◽  
Rupture Risk ◽  
Scholarly Journals ◽  
Aneurysm Morphology ◽  
Size And Morphology ◽  
Neck Diameter ◽  
Wide Neck ◽  
Small Aneurysms

Background: Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods: We queried the MEDLINE (EBSCO) database using the terms “unruptured IA” and (“small” or “medium” or “large”) and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results: A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion: It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.

2D and 3D Morphologic Metrics Associated Intracranial Aneurysm Rupture

2010 ◽  
Author(s):  
Ding Ma ◽  
Sabareesh K. Natarajan ◽  
Jianping Xiang ◽  
Adnan Siddiqui ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Image Segmentation ◽  
Intracranial Aneurysms ◽  
Vessel Diameter ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Patient Specific ◽  
3D Image ◽  
Parent Vessel ◽  
3D Image Segmentation ◽  
Aneurysm Size

Intracranial aneurysms (IAs) rupture results in severe morbidity and mortality. Therefore indentifying IA rupture risk is highly critical. Although it has been recognized that IA rupture is the result of a complex vascular degeneration process involving multiple mechanobiological factors, such information for each patient is not readily available in clinical setting. Alternatively, morphology and hemodynamic metrics can be derived from routine patient-specific imaging. In previous studies, a number of morphological metrics derived from analysis of reconstructed vascular 3D geometry have shown significance in discriminating ruptured from unruptued IAs, including in particular aneurysm size ratio, defined as IA size divided by the parent vessel diameter. However, these measures rely on 3D image segmentation and measurement, which makes them less practical in current angiographic rooms often equipped with only biplane angiogram capability and even when 3D rotational angiography is available, on-site 3D image segmentation and analyses are still not practical. Our foregoing study examined three parameters measured on 2D angiographs: aneurysm Size Ratio (SR), Aspect Ratio (AR) and Size. We found that SR had the strongest correlation with IA rupture. The current study further evaluates these geometric metrics, measured both from 3D and 2D images, with a larger cohort of saccular intracranial aneurysms.

Impact of bifurcation angle and inflow coefficient on the rupture risk of bifurcation type basilar artery tip aneurysms

2018 ◽  
Vol 128 (3) ◽  
pp. 723-730 ◽  
Author(s):  
Sherif Rashad ◽  
Shin-ichiro Sugiyama ◽  
Kuniyasu Niizuma ◽  
Kenichi Sato ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Shear Stress ◽  
Aspect Ratio ◽  
Wall Shear Stress ◽  
Univariate Analysis ◽  
Aneurysm Rupture ◽  
Parent Artery ◽  
Maximum Height ◽  
Rupture Risk ◽  
Bifurcation Angle ◽  
Wall Shear

OBJECTIVERisk factors for aneurysm rupture have been extensively studied, with several factors showing significant correlations with rupture status. Several studies have shown that aneurysm shape and hemodynamics change after rupture. In the present study the authors investigated a static factor, the bifurcation angle, which does not change after rupture, to understand its effect on aneurysm rupture risk and hemodynamics.METHODSA hospital database was retrospectively reviewed to identify patients with cerebral aneurysms treated surgically or endovascularly in the period between 2008 and 2015. After acquiring 3D rotational angiographic data, 3D stereolithography models were created and computational fluid dynamic analysis was performed using commercially available software. Patient data (age and sex), morphometric factors (aneurysm volume and maximum height, aspect ratio, bifurcation angle, bottleneck ratio, and neck/parent artery ratio), and hemodynamic factors (inflow coefficient and wall shear stress) were statistically compared between ruptured and unruptured groups.RESULTSSeventy-one basilar tip aneurysms were included in this study, 22 ruptured and 49 unruptured. Univariate analysis showed aspect ratio, bifurcation angle, bottleneck ratio, and inflow coefficient were significantly correlated with a ruptured status. Logistic regression analysis showed that aspect ratio and bifurcation angle were significant predictors of a ruptured status. Bifurcation angle was inversely correlated with inflow coefficient (p < 0.0005), which in turn correlated directly with mean (p = 0.028) and maximum (p = 0.014) wall shear stress (WSS) using Pearson's correlation coefficient, whereas aspect ratio was inversely correlated with mean (0.012) and minimum (p = 0.018) WSS.CONCLUSIONSBifurcation angle and aspect ratio are independent predictors for aneurysm rupture. Bifurcation angle, which does not change after rupture, is correlated with hemodynamic factors including inflow coefficient and WSS, as well as rupture status. Aneurysms with the hands-up bifurcation configuration are more prone to rupture than aneurysms with other bifurcation configurations.

Size ratio for clinical assessment of intracranial aneurysm rupture risk

2010 ◽  
Vol 32 (5) ◽  
pp. 482-486 ◽  
Author(s):  
Ding Ma ◽  
Markus Tremmel ◽  
Rocco A. Paluch ◽  
Elad Levy I. Levy ◽  
Hui Meng ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Assessment ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Rupture Risk

Abstract TP77: Simple Morphological Parameters Associated With The Rupture Risk Of Posterior Communicating Artery Aneurysms.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Allen Ho ◽  
Ning Lin ◽  
Mary Stanley ◽  
Nareerat Charoenvimolphan ◽  
Sarthak Misra ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Statistical Significance ◽  
Morphological Characteristics ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Morphological Parameters ◽  
Rupture Risk ◽  
Flow Angle ◽  
Aneurysm Neck ◽  
Neck Diameter

Introduction: The contribution of morphological characteristics to the treatment decision of unruptured aneurysms has not been established in a systematic and location specific manner. We present a large sample of posterior communicating (PComm) aneurysms that were assessed using a diverse array of morphological variables to determine the parameters associated with aneurysm rupture. Methods: Demographic and clinical risk factors of aneurysm rupture were obtained viachart review. Pre-operative CT angiograms (CTA) were evaluated with 3D Slicer© to generate 3-D models of the aneurysms and surrounding vascular architecture. Morphological parameters examined in each model included aneurysm volume, aspect ratio, size ratio, distance to bifurcation and origin points, aneurysm angle, vessel angles, flow angles, and parent-daughter angles. Univariate and multivariate analyses were performed to determine statistical significance. Results: From 2005-2011, 141 PComm aneurysms were treated in a single institution, and preoperative CTAs from 48 patients (32 ruptured, 16 unruptured) were analyzed. Those that underwent reoperation, were associated with arteriovenous malformations, or lacked a preoperative CTA were excluded. Ruptured aneurysms were associated with smaller volume, greater aspect ratio, greater size ratio, smaller internal carotid artery (ICA) to aneurysm neck angle, larger PComm flow angle, larger ICA to PComm angle, and smaller PComm to daughter vessel angle. Multivariate logistic regression revealed that a larger neck diameter, greater aspect ratio, greater size ratio, and shorter ICA bifurcation to aneurysm distance were the most strongly associated with rupture after adjusting for all other variables. Interestingly, volume of the aneurysm had a smaller effect size than most other variables and rupture risk was associated with smaller volumes. Conclusion: We found that larger neck diameter, greater aspect ratio, greater size ratio, and smaller ICA bifurcation to aneurysm distance to be highly associated with PComm aneurysm rupture. These are easily measured and physically intuitive parameters. They are more strongly associated with PComm aneurysm rupture than size alone and can be readily applied in clinical practice.

scholarly journals Rapid Documented Growth of Aneurysm Bleb Led to Rupture of an Incidental Intracranial Anterior Communicating Artery Aneurysm

2017 ◽  
Vol 78 (05) ◽  
pp. 521-524 ◽  
Author(s):  
Jorn Fierstra ◽  
Giuseppe Esposito ◽  
Gerasimos Baltsavias ◽  
Oliver Bozinov ◽  
Luca Regli ◽  
...  
Keyword(s):  
High Risk ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Short Term ◽  
Anterior Communicating Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is to identify criteria indicating a higher risk of future UIA rupture. We report a rare patient with documented short-term bleb growth of an UIA followed by a fatal aneurysm rupture supporting the high risk of rupture of short-term shape changes in UIAs. Case Description A 72-year-old man with an incidental unruptured anterior communicating artery aneurysm of 9 mm showed a bleb growth on the aneurysm sac at 6-week follow-up computed tomography angiography (CTA). Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points; rupture risk 4.3% in 5 years). The patient wanted to discuss the treatment plan with his family before making a final decision. Two days after the CTA showing bleb growth, he was admitted emergently with a severe subarachnoid hemorrhage (SAH) (World Federation of Neurologic Surgeons grade 5; Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurologic deficits and multiple organ failure. Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefited from emergent aneurysm occlusion. The interest of this report comes from the proof that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.

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