Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms

Clinical article

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Object

Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture.

Methods

Data from 140 consecutive patients with ACoA aneurysms managed at the authors' facility between July 2003 and November 2011 were retrospectively reviewed. Patients with (78) and without (62) aneurysm rupture were divided into groups, and morphological and clinical characteristics were compared. Morphological characteristics were evaluated based on 3D CT angiography and included aneurysm location, dominance of the A1 portion of the anterior cerebral artery, direction of the aneurysm dome around the ACoA, aneurysm bleb(s), size of the aneurysm and its neck, aneurysm–parent artery angle, and existence of other intracranial unruptured aneurysms.

Results

Patients with ruptured ACoA aneurysms were significantly younger (a higher proportion were younger than 60 years of age) than those with unruptured lesions, and a significantly smaller proportion had hypercholesterolemia. A significantly larger proportion of patients with ruptured aneurysms showed an anterior direction of the aneurysm dome around the ACoA, had a bleb(s), and/or had an aneurysm size ≥ 5 mm. Multivariate logistic regression analysis showed that an anterior direction of the aneurysm dome around the ACoA (OR 6.0, p = 0.0012), the presence of a bleb(s) (OR 22, p < 0.0001), and an aneurysm size ≥ 5 mm (OR 3.16, p = 0.035) were significantly associated with ACoA aneurysm rupture.

Conclusions

Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.

Abbreviations used in this paper:ACA = anterior cerebral artery; ACoA = anterior communicating artery; CTA = CT angiography; DSA = digital subtraction angiography; IQR = interquartile range; MRA = MR angiography; SAH = subarachnoid hemorrhage.
Article Information

Contributor Notes

Address correspondence to: Hidetoshi Matsukawa, M.D., Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan. email: mahide@luke.or.jp.Please include this information when citing this paper: published online December 14, 2012; DOI: 10.3171/2012.11.JNS121210.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Agrawal AKato YChen LKaragiozov KYoneda MImizu S: Anterior communicating artery aneurysms: an overview. Minim Invasive Neurosurg 51:1311352008

    • Search Google Scholar
    • Export Citation
  • 2

    Asari SOhmoto T: Natural history and risk factors of unruptured cerebral aneurysms. Clin Neurol Neurosurg 95:2052141993

  • 3

    Cebral JRCastro MAAppanaboyina SPutman CMMillan DFrangi AF: Efficient pipeline for image-based patient-specific analysis of cerebral aneurysm hemodynamics: technique and sensitivity. IEEE Trans Med Imaging 24:4574672005

    • Search Google Scholar
    • Export Citation
  • 4

    Cebral JRSheridan MPutman CM: Hemodynamics and bleb formation in intracranial aneurysms. AJNR Am J Neuroradiol 31:3043102010

  • 5

    Fisher CMKistler JPDavis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:191980

    • Search Google Scholar
    • Export Citation
  • 6

    Hassan THassan AAAhmed YM: Influence of parent vessel dominancy on fluid dynamics of anterior communicating artery aneurysms. Acta Neurochir (Wien) 153:3053102011

    • Search Google Scholar
    • Export Citation
  • 7

    Hassan TTimofeev EVSaito TShimizu HEzura MMatsumoto Y: A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture. J Neurosurg 103:6626802005

    • Search Google Scholar
    • Export Citation
  • 8

    Inagawa T: Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106:1191261990

  • 9

    Inagawa T: Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan. World Neurosurg 73:1551642010

    • Search Google Scholar
    • Export Citation
  • 10

    Inagawa T: Site of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. Cerebrovasc Dis 30:72842010

  • 11

    Inagawa T: Trends in incidence and case fatality rates of aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Stroke 32:149915072001

    • Search Google Scholar
    • Export Citation
  • 12

    Inagawa THada HKatoh Y: Unruptured intracranial aneurysms in elderly patients. Surg Neurol 38:3643701992

  • 13

    International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:172517331998. (Erratum in N Engl J Med 340:744 1999)

    • Search Google Scholar
    • Export Citation
  • 14

    Iwamoto HKiyohara YFujishima MKato INakayama KSueishi K: Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study. Stroke 30:139013951999

    • Search Google Scholar
    • Export Citation
  • 15

    Juvela SHernesniemi J: Clinical manifestations and survival rates among patients with saccular intracranial aneurysms: population-based study in Olmsted County, Minnesota, 1965 to 1995. Neurosurgery 50:116711692002. (Letter)

    • Search Google Scholar
    • Export Citation
  • 16

    Karmonik CYen CGrossman RGKlucznik RBenndorf G: Intra-aneurysmal flow patterns and wall shear stresses calculated with computational flow dynamics in an anterior communicating artery aneurysm depend on knowledge of patient-specific inflow rates. Acta Neurochir (Wien) 151:4794852009

    • Search Google Scholar
    • Export Citation
  • 17

    Koffijberg HBuskens EGranath FAdami JEkbom ARinkel GJ: Subarachnoid haemorrhage in Sweden 1987–2002: regional incidence and case fatality rates. J Neurol Neurosurg Psychiatry 79:2942992008

    • Search Google Scholar
    • Export Citation
  • 18

    Lindekleiv HSandvei MSNjølstad ILøchen MLRomundstad PRVatten L: Sex differences in risk factors for aneurysmal subarachnoid hemorrhage: a cohort study. Neurology 76:6376432011

    • Search Google Scholar
    • Export Citation
  • 19

    Mavaddat NKirkpatrick PJRogers RDSahakian BJ: Deficits in decision-making in patients with aneurysms of the anterior communicating artery. Brain 123:210921172000

    • Search Google Scholar
    • Export Citation
  • 20

    Morita AKirino THashi KAoki NFukuhara SHashimoto N: The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:247424822012

    • Search Google Scholar
    • Export Citation
  • 21

    Richardson AEJane JAPayne PM: Assessment of the natural history of anterior communicating aneurysms. J Neurosurg 21:2662741964

  • 22

    Sakaki SOhta SOhue SKohno KMatsuoka K: Outcome in elderly patients with ruptured intracranial aneurysm. Clin Neurol Neurosurg 91:21271989

    • Search Google Scholar
    • Export Citation
  • 23

    Satoh TOmi MOhsako CKatsumata AYoshimoto YTsuchimoto S: Influence of perianeurysmal environment on the deformation and bleb formation of the unruptured cerebral aneurysm: assessment with fusion imaging of 3D MR cisternography and 3D MR angiography. AJNR Am J Neuroradiol 26:201020182005

    • Search Google Scholar
    • Export Citation
  • 24

    Satoh TOmi MOhsako CKatsumata AYoshimoto YTsuchimoto S: Visualization of aneurysmal contours and perianeurysmal environment with conventional and transparent 3D MR cisternography. AJNR Am J Neuroradiol 26:3133182005

    • Search Google Scholar
    • Export Citation
  • 25

    Säveland HLjunggren BBrandt LMesseter K: Delayed ischemic deterioration in patients with early aneurysm operation and intravenous nimodipine. Neurosurgery 18:1461501986

    • Search Google Scholar
    • Export Citation
  • 26

    Schievink WIWijdicks EFMPiepgras DGChu CPO'Fallon WMWhisnant JP: The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg 82:7917951995

    • Search Google Scholar
    • Export Citation
  • 27

    Shallice TBurgess PW: Deficits in strategy application following frontal lobe damage in man. Brain 114:7277411991

  • 28

    Shojima MOshima MTakagi KTorii RNagata KShirouzu I: Role of the bloodstream impacting force and the local pressure elevation in the rupture of cerebral aneurysms. Stroke 36:193319382005

    • Search Google Scholar
    • Export Citation
  • 29

    Steinman DAMilner JSNorley CJLownie SPHoldsworth DW: Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. AJNR Am J Neuroradiol 24:5595662003

    • Search Google Scholar
    • Export Citation
  • 30

    Tateshima SMurayama YVillablanca JPMorino TTakahashi HYamauchi T: Intraaneurysmal flow dynamics study featuring an acrylic aneurysm model manufactured using a computerized tomography angiogram as a mold. J Neurosurg 95:102010272001

    • Search Google Scholar
    • Export Citation
  • 31

    Velthuis BKvan Leeuwen MSWitkamp TDRamos LMPBerkelbach van der Sprenkel JWRinkel GJE: Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography. J Neurosurg 95:2062122001

    • Search Google Scholar
    • Export Citation
  • 32

    Wang SSZheng HPZhang FHWang RM: The microanatomical structure of the cistern of the lamina terminalis. J Clin Neurosci 18:2532592011

    • Search Google Scholar
    • Export Citation
  • 33

    Wermer MJHvan der Schaaf ICAlgra ARinkel GJE: Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke 38:140414102007

    • Search Google Scholar
    • Export Citation
  • 34

    Wilson GRiggs HERupp C: The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 11:1281341954

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