Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms

Wang, Guangxian; Lee, Jun; Chen, You-qiang; Li, Wen; Yang, Ming-guang; Gong, Mingfu; Zhang, Dong

doi:10.1136/neurintsurg-2017-013553

Cited by 19 publications

(19 citation statements)

References 18 publications

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“…Maryam et al reported the ruptured IAs had significantly larger SR (4.08 ± 0.54 mm) than the unruptured group (2.57 ± 0.24 mm, p <0.01) 16 . However, Wang et al reported that the threshold value of SR for predicting ruptured PcomA aneurysms was 1.21 17 . Therefore, it is still necessary to further accurately divide the SR threshold according to the site of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Size, Aspect Ratio and Anatomic Location of Ruptured Intracranial Aneurysms: Consecutive Series of 415 Patients from a Prospective, Multicenter, Observational Study

Zheng

Zhou

Wang³

et al. 2018

Cell Transplant

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To analyze the size and location distribution of ruptured intracranial aneurysms (IAs) helps to provide evidence for clinical treatment of unruptured IAs using this feature of aneurysms. In this study, 415 patients who presented with an acute subarachnoid hemorrhage caused by IAs were enrolled from eight tertiary referral centers between June 2016 and March 2018. The size, aspect ratio and anatomic location of ruptured IAs were defined and reported by patient sex. In the study cohort of 415 patients (60.5% women) with saccular ruptured IAs, the three most common locations of ruptured IAs were posterior communicating artery (32.0%), anterior communicating artery (28.7%), and middle cerebral artery (13.5%). The mean size of all ruptured IAs was 5.3±3.1 mm (range 1.1–28.5 mm), but the size varied considerably by location. For example, ruptured IAs of the posterior communicating artery had a mean size of 5.8±3.1 mm, whereas the mean size of ruptured anterior communicating artery aneurysms was 4.6±1.7 mm. The mean AR in all ruptured IAs was 1.66±0.76. Of those aneurysms, 243 (58.6%) had an AR smaller than 1.6 and 318 (76.6%) had an AR smaller than 2.0. Our results suggested that the size of the most ruptured IAs are smaller than 7 mm or even 5 mm. The size and AR varied by sex and location. With the knowledge of size, location and AR, multiplicity should be considered for treatment strategies of unruptured IAs.

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Section: Discussionmentioning

confidence: 99%

Size, Aspect Ratio and Anatomic Location of Ruptured Intracranial Aneurysms: Consecutive Series of 415 Patients from a Prospective, Multicenter, Observational Study

Zheng

Zhou

Wang³

et al. 2018

Cell Transplant

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“…These findings are important for making decisions about when to treat patients with mirror aneurysms; however, special attention should be given to recognized risk factors for rupture, including the size and location of the aneurysms, the presence of a high AR (aspect ratio, depth/neck width) and a high SR (size ratio, depth/parent vessel diameter), patient age and the presence of previous SAH, as was the case in our patient [6–9] .…”

Section: Discussionmentioning

confidence: 81%

Bilateral Third Nerve Palsy in Mirror Aneurysms of the Posterior Communicating Arteries

Gómez‐Figueroa

Cardenas-Saenz

Quiñones-Pesqueira

et al. 2018

European Journal of Case Reports in Internal Medicine

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BackgroundBilateral third cranial nerve palsy has only been reported in a handful of conditions including some with inflammatory, tumoural and vascular causes. An urgent imaging study is mandatory to rule out vascular aetiology, mainly aneurysmal subarachnoid haemorrhage (aSAH).Case presentationA 28-year-old Hispanic woman presented to the emergency department with a 21-day history of a sudden-onset and severe headache that on three occasions was accompanied by transient loss of awareness, the last episode occurring a week previously. The simple CT image showed minimal bleeding at the level of the perimesencephalic cisterns, with evidence of SAH. An angioCT revealed a 5×6 mm bilobed saccular aneurysm of the right posterior communicating artery and a 2×2 mm saccular aneurysm in the posterior left communicating artery.ConclusionsA mirror aneurysm is found in 2–25% of aSAH cases. To date there is no consensus about the optimal management of patients with these findings.LEARNING POINTSThe presence of third cranial nerve palsy should always raise the suspicion of an aneurysm.Subarachnoid haemorrhage is the most common cause of a thunderclap headache.Aneurysmal subarachnoid haemorrhage requires surgical management in all cases.

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“…However inter-individual factors (including smoking, blood pressure and gender) may influence these results. Previous studies suggested that patients with multiple aneurysms provide internal controls for these inter-individual factors 8–10 17. There was only one study focusing on the mirror MCA aneurysms with normalized variables and did not contain any multivariate result.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with bilateral aneurysms can be an ideal model for analyzing the morphological risk factors of rupture. Using paired analysis, patient-related factors (eg, age, gender, ethnicity, smoking, hypertension and collagen genetics) can be neutralized by the internal controls 8–10. To our knowledge, there has been only one study involving this topic; that study did not include a multivariate analysis 11.…”

Section: Introductionmentioning

confidence: 99%

Morphology parameters for rupture in middle cerebral artery mirror aneurysms

Wang

et al. 2020

J NeuroIntervent Surg

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ObjectiveTo identify the morphological parameters correlated with the rupture of middle cerebral artery (MCA) aneurysms.MethodsWe retrospectively analyzed the digital subtraction angiography (DSA) data of 48 patients with ruptured mirror MCA aneurysms. Morphological parameters included aneurysm with wall protrusion, maximum diameter (Dmax), height, neck width, aneurysm width, dome projection, parent artery average diameter (Dp), aspect ratio (AR), bottleneck factor (BNF), size ratio (SR), M1/M2 ratio, and height/width (H/W) ratio. These paired parameters were analyzed by conditional univariate and multivariate logistic regressions to screen out the independent risk factors. We established a score based on the independent risk factors. Receiver operating characteristics (ROC) were generated to estimate the prediction performance of the score in our large database of 763 aneurysms.ResultsIn the univariate regressions, Dmax, height, aneurysm width, neck width, AR, BNF, H/W ratio, SR, anterior dome projection and aneurysm with wall protrusion were significant risk factors. Aneurysm width (OR 3.296, p=0.015), AR (OR 11.594, p=0.014) and anterior dome projection (OR 9.385, p=0.016) were independent risk factors in multivariate regression. The area under the curve (AUC) value of the score based on the three independent risk factors was 0.829.ConclusionAneurysm width, AR and anterior dome projection were independent risks factors of rupture.

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Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms

Abstract: Mirror PComAAs are a useful model to investigate the rupture risk of PComAAs. AR (≥0.98) and SR (≥1.21) are better predictors of ruptured PComAAs.

Cited by 19 publications

References 18 publications

Size, Aspect Ratio and Anatomic Location of Ruptured Intracranial Aneurysms: Consecutive Series of 415 Patients from a Prospective, Multicenter, Observational Study

Size, Aspect Ratio and Anatomic Location of Ruptured Intracranial Aneurysms: Consecutive Series of 415 Patients from a Prospective, Multicenter, Observational Study

Bilateral Third Nerve Palsy in Mirror Aneurysms of the Posterior Communicating Arteries

Morphology parameters for rupture in middle cerebral artery mirror aneurysms

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