Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Abstract

Object Recent studies have shown that posterior circulation aneurysms, specifically posterior communicating artery (PCoA) aneurysms, are more likely to rupture than other aneurysms. To date, few studies have investigated the factors contributing to PCoA aneurysm rupture. The authors aimed to identify morphological and clinical characteristics predisposing to PCoA aneurysm rupture. Methods The authors retrospectively reviewed 134 consecutive patients with PCoA aneurysms managed at their facility between July 2003 and December 2012. The authors divided patients into groups of those with aneurysmal rupture (n = 39) and without aneurysmal rupture (n = 95) and compared morphological and clinical characteristics. Morphological characteristics were mainly evaluated by 3D CT angiography and included diameter of arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery), size of the aneurysm, dome-to-neck ratio, neck direction of the aneurysmal dome around the PCoA (medial, lateral, superior, inferior, and posterior), aneurysm bleb formation, whether the PCoA was fetal type, and the existence of other intracranial unruptured aneurysm(s). Results Patients with ruptured PCoA aneurysms were significantly younger (a higher proportion were < 60 years of age) and a significantly higher proportion of patients with ruptured PCoA aneurysms showed a lateral direction of the aneurysmal dome around the PCoA, had bleb formation, and the aneurysm was > 7 mm in diameter and/or the dome-to-neck ratio was > 2.0. Multivariate logistic regression analysis showed age < 60 years (OR 4.3, p = 0.011), history of hypertension (OR 5.1, p = 0.008), lateral direction of the aneurysmal dome around the PCoA (OR 6.7, p = 0.0001), and bleb formation (OR 11, p < 0.0001) to be significantly associated with PCoA aneurysm rupture. Conclusions The present results demonstrated that lateral projection of a PCoA aneurysm may be related to rupture.

Morphological Parameters Associated with Ruptured Posterior Communicating Aneurysms

“…The most important configurations in modern practice relate to the lateral versus inferior projection of the aneurysm dome since inferiorly projecting aneurysms commonly compress the oculomotor nerve while laterally projecting aneurysms can be tightly adherent to the temporal lobe and are sources of temporal lobe hemorrhage when ruptured. Recent investigation has also shown that ruptured aneurysms are associated with lateral projection of the aneurysm dome [37]. This relationship held true within our sample, where ruptured aneurysms (55%) were more associated with lateral projection than unruptured aneurysms (30%).…”

Morphological and hemodynamic analysis of posterior communicating artery aneurysms prone to rupture: a matched case–control study

“…The strongest independent risk factors include smoking, asymmetry of A1 segments >40%, low blood flow pulsatility, and angle between A1 and A2 segments ≤100°. Matsukawa et al 16 retrospectively reviewed 134 consecutive patients with PcomA aneurysms (39 ruptured) and compared the morphological and clinical characteristics. The results showed that age <60 years, history of hypertension, lateral direction of the aneurysmal dome, and bleb formation were significantly associated with aneurysm rupture.…”

Clipping treatment of posterior communicating artery aneurysms associated with arteriosclerosis and calcification: A single center study of 136�cases

“…The arteriosclerosis and calcification of the parent artery in type II and III cases easily led to intraoperative rupture during aneurysm clipping, with type III aneurysms having a greater risk of intraoperative rupture than type II because the aneurysm neck and parent artery exhibited arteriosclerosis or calcification. There are many techniques for clipping PCoA aneurysms, with >100 types of intracranial aneurysm clips available (25). Among them, fenestrated clips for PCoA aneurysm clipping are occasionally used (26).…”