Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants

Russell, Stephen; Lin, Ke; Hahn, Sigrid A.; Jafar, Jafar J.

doi:10.3171/jns.2003.99.2.0248

Cited by 60 publications

(29 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though this may be somewhat counterintuitive, it is not unlikely. Previous studies have reported that very small aneurysms are associated with more extensive hemorrhage, 30,33,37,43 are more difficult to treat, are associated with a relatively higher risk of periprocedural complications, particularly when treated endovascularly, and have relatively higher morbidity and mortality. 1,27,36,40 Giant aneurysms may present similar challenges.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

Jaja

Lingsma

Schweizer

et al. 2016

JNS

View full text Add to dashboard Cite

N euroimagiNg characteristics at hospital admission play an important role in the accurate diagnosis of subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms.3 They help to identify the aneurysm causing bleeding and outline its anatomical configuration and that of adjoining structures to guide optimal choice of treatment modality for exclusion of the ruptured aneurysm from circulation. Neuroimaging parameters at hospital admission have been investigated for their value as predictors of outcome after SAH. Among these param- obJective Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. methods The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R 2 . results Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each of the studied predictors accounted for less than 1% of the explained variance in outcome. coNclusioNs This study, which is based on the largest cohort of patients so far analyzed, has more precisely determined the prognostic value of the studied neuroimaging factors. Treatment choice has strong influence on the prognostic effect of aneurysm size and location. These findings should guide the development of reliable prognostic models and inform the design and analysis of future prospective studies, including clinical...

show abstract

Section: Discussionmentioning

confidence: 99%

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

Jaja

Lingsma

Schweizer

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…Further, we determined the percentages of carotid and basilar bifurcation aneurysms in the group of unruptured aneurysms. Finally, we calculated the number of carotid bifurcation aneurysms versus basilar in the ruptured as well as unruptured group of aneurysms based on the data derived from all studies except the one that did not specify the number of aneurysms at both locations [8]. Since the subset of data used in this analysis exists only of basilar and carotid artery bifurcation aneurysms and the normal configuration of the circle of Willis holds 2 ICA bifurcations and only 1 BA bifurcation, the expected ratio of aneurysms between both locations (assuming that all other variables are similar at both locations) is 2:1 (or 67:33%) in favor of the carotid artery.…”

Section: Methodsmentioning

confidence: 99%

Risk of Aneurysm Rupture at Intracranial Arterial Bifurcations

Kolk¹,

Algra²,

Rinkel³

2010

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Aneurysms on the posterior circulation, most commonly located at the basilar top, have a higher risk of rupture than aneurysms on the anterior circulation. If hemodynamic shear stress, which has its maximum impact at the distal carina of bifurcations, explains the higher rupture rate of basilar top aneurysms, aneurysms at the top of the carotid artery should have similar rupture rates given their geometrical similarities. Aim: Our purpose was to compare rupture risks of carotid and basilar artery bifurcation aneurysms. Methods: We included studies from Medline and Embase searches and compared proportions of ruptured and unruptured aneurysms at the basilar and carotid bifurcation with the assumption that carotid aneurysms are twice as prevalent based on the presence of 2 carotid and 1 basilar artery bifurcation on the circle of Willis. Results: Of all unruptured aneurysms, 8.3% were located on the basilar and 6.0% on the carotid bifurcation; 8.0% of all ruptured aneurysms were located on the basilar and 4.3% on the carotid bifurcation. Subsequently the ratios of carotid versus basilar aneurysms were 0.72 for unruptured and 0.55 for ruptured aneurysms, instead of the expected 2.0. Conclusions: Aneurysms are less frequently located on the carotid than on the basilar artery bifurcation. The proportion of ruptured carotid aneurysms is smaller than that of unruptured carotid aneurysms, suggesting a lower rupture risk for aneurysms at the carotid artery bifurcation. The anatomical geometry of the bifurcations and concomitant hemodynamic stress are considered an unlikely explanation for the higher risk of posterior circulation aneurysms.

show abstract

“…In addition, several previous studies have shown that the decision to treat unruptured aneurysms should not be based on aneurysm size alone. 4,16,20,26,27 In view of these data, if the patient is Ͻ50 years of age, is hypertensive, and harbors multiple aneurysms with diameters of Ն4 mm, surgical or endovascular treatment can reasonably be considered for prevention of future aneurysm rupture. Also, based on our current results, if aneurysm enlargement is documented during follow-up, the aneurysm should be treated with a surgical or an endovascular procedure.…”

Section: Surgical Indications For Incidentally Found Small Unrupturedmentioning

confidence: 99%

Small Unruptured Intracranial Aneurysm Verification Study

Sonobe

Yamazaki

Yonekura

et al. 2010

Stroke

412

307

View full text Add to dashboard Cite

show abstract

Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants

Abstract: Smaller cerebral aneurysm size is associated with a larger volume of SAH. The pathophysiological basis for this correlation remains speculative.

Cited by 60 publications

References 18 publications

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

Risk of Aneurysm Rupture at Intracranial Arterial Bifurcations

Small Unruptured Intracranial Aneurysm Verification Study

Contact Info

Product

Resources

About