Cerebral Aneurysm Size before and after Rupture: Case Series and Literature Review

Yi, Julia; Zielinski, Danielle; Chen, Michael

doi:10.1016/j.jstrokecerebrovasdis.2016.01.031

Cited by 22 publications

(11 citation statements)

References 12 publications

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“…[ 65 ] However, data from several small studies suggest that this assumption may not be accurate. [ 28 43 48 64 ] A recent nationwide retrospective review from Norway sought to further investigate this phenomenon. [ 49 ] In this study, Skodvin et al .…”

Section: Discussionmentioning

confidence: 99%

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Bhogal¹,

AlMatter²,

Hellstern³

et al. 2018

Surg Neurol Int

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Background:The risk of aneurysmal rupture is dependent upon numerous factors, however, there are inconsistencies in the results between studies, which may be due to confounding factors. This can be avoided by comparing the characteristics of ruptured and unruptured aneurysms within the same patient. We sought to analyze the aneurysm characteristics of patients with acute aneurysmal subarachnoid hemorrhage (SAH) and multiple intracranial aneurysms.Methods:We reviewed our prospectively maintained institutional database, between 01/10/2007 and 01/01/2017, for all patients with confirmed SAH and >1 aneurysm. We recorded the size, location, and morphology and calculated secondary geometric indices such as bottleneck factor and aspect ratio.Results:During the study period, a total of 694 patients with aneurysmal SAH were admitted to our institution. We identified 113 patients (74.3% female, average age 51.7 ± 12.3). The majority of patients had only one associate unruptured aneurysm (79.6%). The average unruptured aneurysm was 3.1 ± 1.5 mm and the average ruptured aneurysm was 5.7 ± 2.7 mm (P < 0.001). In the multivariate analysis, aneurysm location, aneurysm morphology, and size were independently associated with rupture. A complex aneurysm morphology was the strongest risk factor for rupture (OR, 29.27; 95% CI 14.33–59.78; P < 0.001) with size >7 mm (OR, 17.74; 95% CI 4.07–77.35; P < 0.001), and AcomA location also showing a strong independent association.Conclusion:Size plays an important part in determining rupture risk, however, other factors such as location and in particular morphology must also be considered. We believe that the introduction of vessel wall imaging will help to risk stratify aneurysms.

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Section: Discussionmentioning

confidence: 99%

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Bhogal¹,

AlMatter²,

Hellstern³

et al. 2018

Surg Neurol Int

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“…is has, however, been contradicted by two previous studies. [17,27] erefore, we believe that the measured size postrupture reflects the prerupture size of the aneurysm.…”

Section: Discussionmentioning

confidence: 89%

“…This has, however, been contradicted by two previous studies. [ 17 , 27 ] Therefore, we believe that the measured size postrupture reflects the prerupture size of the aneurysm. The reason why AcomA and PcomA aneurysms are more prone to rupture at a smaller size is unknown.…”

Section: Discussionmentioning

confidence: 99%

Small ruptured intracranial aneurysms are overrepresented at the anterior and posterior communicating artery: Results of a multiple regression analysis

Naamansen

Larsen

Johannsson

et al. 2022

Surgical Neurology International

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Background: Anterior communicating artery (AcomA) represents the most common location for ruptured intracranial aneurysms (rIAs). Approximately 50% of all rIAs are smaller than 7 mm, but factors that lead to rupture are multifactorial. The study investigates whether AcomA location represents an independent risk factor for small size at time of rupture (<7 mm) in a cohort of aneurysmal subarachnoid hemorrhage (aSAH) when controlling for known risk factors. Methods: The aSAH cohort was retrospectively searched from our institution charts. The cohort was dichotomized into small aneurysms (<7 mm) or large aneurysms (≥7 mm). Risk factors for rupture were identified according to the unruptured intracranial aneurysm treatment score (UIATS). These were sex, age, location, smoking, hypertension, alcohol abuse, aneurysm morphology, multiplicity, previous SAH, and family history. With size as independent variable, a multiple regression analysis was performed including UIATS risk factors. Results: One-hundred and seventy-six patients were included in the study. About 49.4% of the aneurysms were <7 mm. Multiple regression analysis demonstrated that aneurysms located at AcomA and posterior communicating artery (PcomA) was significantly more frequent smaller than 7 mm, compared to middle cerebral artery (P = 0.006), internal carotid artery (other than PcomA) (P = 0.013), and posterior circulation (P = 0.017), when controlling for risk factors. Conclusion: Ruptured AcomA and PcomA aneurysms are more frequent smaller than 7 mm compared to other locations. Patients with unruptured UIA at either AcomA or PcomA may be at increased risk of rupture even if the size of the aneurysm is small. Further studies are needed to confirm this finding.

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“…First, this is a retrospective analysis of patients with a small sample size of ACoAAs from one hospital, and patients' confounding clinical characteristics may lead to statistical bias. Second, the ACoAAs were not monitored in real time, and the shape or size of the ruptured ACoAAs might have changed due to the rupture, and the results may be biased, even though previous studies reported that aneurysms do not shrink in size after rupture (27, 28). Third, the unruptured ACoAAs may rupture in the future.…”

Section: Limitationsmentioning

confidence: 99%

A Simple Scoring Model for Prediction of Rupture Risk of Anterior Communicating Artery Aneurysms

Wang¹,

Wang²,

Liu³

et al. 2019

Front. Neurol.

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Background: The rupture risk of anterior communicating artery aneurysms (ACoAAs) has been known to be higher than that of aneurysms at other locations. Thus, the aim of this study is to investigate the clinical and morphological characteristics associated with risk factors for the rupture of ACoAAs. Methods: In total, 361 consecutive patients with 361 ACoAAs between August 2011 and December 2017 were retrospectively reviewed. Patients and ACoAAs were divided into ruptured and unruptured groups. In addition to clinical characteristics, ACoAA characteristics were evaluated by CT angiography (CTA). A multiple logistic regression analysis was used to identify the independent risk factors associated with ACoAA rupture. The assignment score of these variables depends on the β coefficient. A receiver operating characteristic (ROC) curve analysis was used to calculate the optimal thresholds. Results: The multiple logistic regression model revealed that A1 dominance [odds ratio (OR) 3.034], an irregular shape (OR 3.358), and an aspect ratio ≥1.19 (AR; OR 3.163) increased the risk of rupture, while cerebral atherosclerosis (OR 0.080), and mean diameters ≥2.48 mm (OR 0.474) were negatively correlated with ACoAA rupture. Incorporating these five factors, the ROC analysis revealed that the threshold value of the multifactors was one, the sensitivity was 88.3%, and the specificity was 66.0%. Conclusions: The scoring model is a simple method that is based on A1 dominance, irregular shape, aspect ratio, cerebral atherosclerosis, and mean diameters from CTA and is of great value in the prediction of the rupture risk of ACoAAs.

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Cerebral Aneurysm Size before and after Rupture: Case Series and Literature Review

Cited by 22 publications

References 12 publications

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms

Small ruptured intracranial aneurysms are overrepresented at the anterior and posterior communicating artery: Results of a multiple regression analysis

A Simple Scoring Model for Prediction of Rupture Risk of Anterior Communicating Artery Aneurysms

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