True posterior communicating artery aneurysms: are they more prone to rupture? A biomorphometric analysis

He, Wenzhuan; Hauptman, Jason S.; Pasupuleti, Latha; Setton, Avi; Farrow, Maria G.; Kasper, L; Karimi, Reza; Gandhi, Chirag D.; Catrambone, Jeffrey; Prestigiacomo, Charles J.

doi:10.3171/2009.8.jns08731

Cited by 37 publications

(37 citation statements)

References 35 publications

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“…However, follow-up studies have found that the majority of PCoA aneurysms rupture at smaller sizes than would be expected based on ISUIA [6], [14], [23]. This may represent the fact that flow induced hemodynamic stress involved at aneurysm site is important for rupture, independent of the size of the aneurysm itself [24]–[28].…”

Section: Discussionmentioning

confidence: 97%

Morphological Parameters Associated with Ruptured Posterior Communicating Aneurysms

Lin

Charoenvimolphan

et al. 2014

PLoS ONE

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The rupture risk of unruptured intracranial aneurysms is known to be dependent on the size of the aneurysm. However, the association of morphological characteristics with ruptured aneurysms has not been established in a systematic and location specific manner for the most common aneurysm locations. We evaluated posterior communicating artery (PCoA) aneurysms for morphological parameters associated with aneurysm rupture in that location. CT angiograms were evaluated to generate 3-D models of the aneurysms and surrounding vasculature. Univariate and multivariate analyses were performed to evaluate morphological parameters including aneurysm volume, aspect ratio, size ratio, distance to ICA bifurcation, aneurysm angle, vessel angles, flow angles, and vessel-to-vessel angles. From 2005–2012, 148 PCoA aneurysms were treated in a single institution. Preoperative CTAs from 63 patients (40 ruptured, 23 unruptured) were available and analyzed. Multivariate logistic regression revealed that smaller volume (p = 0.011), larger aneurysm neck diameter (0.048), and shorter ICA bifurcation to aneurysm distance (p = 0.005) were the most strongly associated with aneurysm rupture after adjusting for all other clinical and morphological variables. Multivariate subgroup analysis for patients with visualized PCoA demonstrated that larger neck diameter (p = 0.018) and shorter ICA bifurcation to aneurysm distance (p = 0.011) were significantly associated with rupture. Intracerebral hemorrhage was associated with smaller volume, larger maximum height, and smaller aneurysm angle, in addition to lateral projection, male sex, and lack of hypertension. We found that shorter ICA bifurcation to aneurysm distance is significantly associated with PCoA aneurysm rupture. This is a new physically intuitive parameter that can be measured easily and therefore be readily applied in clinical practice to aid in the evaluation of patients with PCoA aneurysms.

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Section: Discussionmentioning

confidence: 97%

Morphological Parameters Associated with Ruptured Posterior Communicating Aneurysms

Lin

Charoenvimolphan

et al. 2014

PLoS ONE

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“…Because fetal PCOM arteries are the only supply to the PCA, care must be taken not to compromise flow to this artery during clipping or coiling of PCOM artery aneurysms [8]. The aneurysm neck originates from the PCOM artery in 0.1–2.8% of all aneurysms and 4.6–13% of PCOM artery aneurysms [8, 9]. These aneurysms are encountered mostly with large or fetal PCOM arteries and pose a challenge to coiling and clipping due to the carefulness required to maintain the flow through the PCOM [9].…”

Section: Discussionmentioning

confidence: 99%

“…The aneurysm neck originates from the PCOM artery in 0.1–2.8% of all aneurysms and 4.6–13% of PCOM artery aneurysms [8, 9]. These aneurysms are encountered mostly with large or fetal PCOM arteries and pose a challenge to coiling and clipping due to the carefulness required to maintain the flow through the PCOM [9]. With fetal PCA, it is necessary to have an optimal dome to neck ratio for safe coiling.…”

Section: Discussionmentioning

confidence: 99%

Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery

Zanaty

Chalouhi

Starke

et al. 2016

Case Reports in Vascular Medicine

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The pipeline embolization device has emerged as an important endovascular option. This is in part due to safety, efficacy, and possibly the ability to shorten the operative time considerably. With this new technology, some limitations are emerging as experience accumulates. We report three cases of posterior communicating (PCOM) artery aneurysms associated with fetal posterior cerebral artery where pipeline embolization was unsuccessful in obliterating the aneurysms. PCOM artery aneurysms associated with a fetal PCA should be managed either by microsurgical clipping or coiling when feasible.

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“…11,15 A recent study on the natural course of unruptured cerebral aneurysms conducted in a Japanese cohort (Unruptured Cerebral Aneurysm Study [UCAS]) showed that a PCoA aneurysm is more likely to rupture. 28 Thus, knowledge of risk factors for rupture is thought to be crucial for managing patients with PCoA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Matsukawa¹,

Fujii²,

Akaike

et al. 2014

JNS

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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.

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True posterior communicating artery aneurysms: are they more prone to rupture? A biomorphometric analysis

Cited by 37 publications

References 35 publications

Morphological Parameters Associated with Ruptured Posterior Communicating Aneurysms

Morphological Parameters Associated with Ruptured Posterior Communicating Aneurysms

Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

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