Infundibular dilations of the posterior communicating arteries: pathogenesis, anatomical variants, aneurysm formation, and subarachnoid hemorrhage

Chen, Ching-Jen; Moosa, Shayan; Ding, Dale; Raper, Daniel; Burke, Rebecca M.; Lee, Cheng‐Chia; Chivukula, Srinivas; Wang, Tony R.; Starke, Robert M.; Crowley, R. Webster; Liu, Kenneth C.

doi:10.1136/neurintsurg-2015-011827

Cited by 11 publications

(7 citation statements)

References 35 publications

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“…Yet recent many studies propose other parameters including LSAR, which RSS was not involved, could also suggest the abnormal characteristics ( Zhang et al, 2016a , b ). In line with recent studies, SR, NWSSa, and OSI, in which RSS is considered, cannot just reflect the possible area of vascular injury and impact effect to vascular wall ( Castro, 2013 ; Chen et al, 2016 ; Paliwal et al, 2017 ). In this study, by following up a group of unruptured patients, the unruptured ratio in low risk group was 100% stratified by the RRS but 95.5% stratified by the IARS.…”

Section: Discussionmentioning

confidence: 58%

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Jiang

et al. 2018

Front. Neurosci.

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Objective: The aim of the present study is to investigate the potential morphological and hemodynamic risk factors related to intracranial aneurysms (IAs) rupture and establish a system to stratify the risk of IAs rupture to help the clinical decision-making.Methods: Patients admitted to our hospital for single-IAs were selected from January 2012 and January 2018. A propensity score matching was conducted to match patients. The morphological parameters were obtained from high solution CTA images, and the hemodynamic parameters were obtained in accordance with the outcomes of computational fluid dynamics (CFDs) simulation. Differences in the morphologic and hemodynamic parameters were compared. The significant parameters were selected to establish a novel scoring system (Intracranial Aneurysm Rupture Score, IARS). The comparison was drawn between the discriminating accuracy of IARS and the Rupture Resemblance Score (RRS) system to verify the value of IARS. Then, a group of patients with unruptured IAs was stratified into the high risk and low risk groups by IARS and RRS system separately and was followed up for 18–27 months to verify the value of IARS. The outcome of different stratifications was compared.Results: The matching process yielded 167 patients in each group. Differences of statistical significance were found in aneurysm length (p = 0.001), perpendicular height (H) (p < 0.001), aspect ratio (AR) (p < 0.001), size ratio (SR) (p < 0.001), deviated angle (DA) (p < 0.001), normalized average wall shear stress (NWSSa) (p < 0.001), wall shear stress gradient (WSSG) (p < 0.001), low shear area ratio (LSAR) (p = 0.01), and oscillatory shear index (OSI) (p = 0.01). Logistic regression analysis further demonstrated that SR, DA, NWSSa, LSAR, and OSI were the independent risk factors of IAs rupture. SR, DA, LSAR, and OSI were finally selected to establish the IARS. Our present IARS showed a higher discriminating value (AUC 0.81 vs. 0.77) in comparison with the RRS (SR, NWSSa, and OSI). After follow-up, seven patients were subject to IAs rupture. 5/26 in high risk group stratified by IARS, yet 7/57 in high risk group stratified by RRS. The accuracy of IARS was further verified (19.2% vs. 12.3%, AUC for the IARS and the RRS was 0.723 and 0.673, respectively).Conclusion: SR, DA, NWSSa, LSAR, and OSI were considered the independent risk factors of IAs rupture. Our novel IARS showed higher accuracy in discriminating IA rupture in comparison with RRS.

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Section: Discussionmentioning

confidence: 58%

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Jiang

et al. 2018

Front. Neurosci.

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“…Although infundibular widening is considered as a benign anatomical variant resulting from incomplete regression of a fetal vessel, it can on rare occasions form a saccular aneurysm. Chen et al [ 1 ] performed a comprehensive literature search and reviewed 15 case reports, including 16 cases describing aneurysm formation from infundibular widening at the posterior communicating artery origin. Thirteen of these patients (81.3%) were female.…”

Section: Discussionmentioning

confidence: 99%

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm

Park

Kim

2023

J Korean Neurosurg Soc

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A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman.

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“…Arterial IDs are benign lesions commonly believed to be present in as many as one-quarter of cerebral angiograms ( 7 , 13 ). Although these findings are considered normal vascular variants, whether they should be considered aneurysmal precursors, and candidates for clinical surveillance and potential treatment, remains a matter of debate ( 8 , 17 ). We cannot fully determine whether this paradoxical understanding of IDs was initially derived from a divergence among published histological findings.…”

Section: Discussionmentioning

confidence: 99%

Flow Diversion for the Management of Ruptured Intracranial Arterial Infudibular Dilatation: Proof of Principle and Therapeutic Protocol

et al. 2022

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Thought to be benign anatomical variants, cerebral infundibular dilatations (ID) are most commonly encountered at the junction of the internal carotid artery (ICA) and the posterior communicating artery (PcomA). The true nature of this entity remains controversial, as some literature reports suggest they should be considered preaneurysmal lesions and a potential source of devastating subarachnoid hemorrhage. This report describes cases of presumably ruptured IDs and their therapeutic endovascular management. We retrospectively reviewed and analyzed patients with isolated subarachnoid hemorrhage (SAH) where the only potential cause was ruptured cerebral IDs, treated or not, between January 2012 and June 2021. Morphological and radiological features, treatment and procedural considerations, clinical and angiographic outcomes were also reviewed. Natural history of the ID is poorly understood, and its relation to SAH remains controversial. Ruptured cerebral IDs can be the suspected cause of bleeding if no other vascular lesion is present during multimodal examinations. Endovascular flow diversion stenting is safe and effective for the proper treatment of ruptured IDs. Pending further validations with longitudinal data are needed to legitimate the natural course of these mysterious lesions.

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Infundibular dilations of the posterior communicating arteries: pathogenesis, anatomical variants, aneurysm formation, and subarachnoid hemorrhage

Abstract: IDs can rarely progress to aneurysms or rupture. Young patients with type II or III IDs with coexisting aneurysms or hypertension may benefit from long-term imaging surveillance.

Cited by 11 publications

References 35 publications

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm

Flow Diversion for the Management of Ruptured Intracranial Arterial Infudibular Dilatation: Proof of Principle and Therapeutic Protocol

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