Morphological evaluation of the risk of posterior communicating artery aneurysm rupture: a mirror aneurysm model

Wei-Dong XuDepartment of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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Ru-Dong ChenDepartment of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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Sheng-Qi HuDepartment of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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Yu-Yang HouDepartment of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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Jia-Sheng YuDepartment of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

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OBJECTIVE

The aim of this study was to use morphological parameters of mirror posterior communicating artery (PCoA) aneurysms to evaluate aneurysm rupture risk.

METHODS

The morphological parameters of 45 pairs of ruptured mirror PCoA aneurysms were analyzed. Conditional univariate and multivariate logistic regression of the following paired morphological parameters was performed: aneurysm with a daughter sac, aneurysm height, aneurysm width, neck width, internal carotid artery diameter, PCoA diameter, flow angle, PCoA angle, aspect ratio, bottleneck factor, size ratio, height/width ratio, fetal posterior cerebral artery, and aneurysm with height > width. A scoring system was established according to the odds ratios (ORs). The receiver operating characteristic was used to test the prediction accuracy of this scoring system in the authors’ database of 523 PCoA aneurysms and the threshold value was used to define higher risk.

RESULTS

Aneurysm width (OR 1.676, p = 0.014), aneurysm with daughter sac (OR 7.775, p = 0.016), and aneurysm with height > width (OR 9.067, p = 0.012) were independent risk factors for rupture. The scoring system consisted of aneurysm width (1 point per mm), aneurysm with a daughter sac (5 points), and aneurysm with height > width (5 points). The area under the curve (AUC) of the scoring system was 0.842, and its threshold value was 7.97. A score ≥ 8 points was defined as higher risk. The AUC using this definition was 0.802.

CONCLUSIONS

Aneurysm width, aneurysms with height > width, and aneurysms with a daughter sac were independent risk factors for PCoA aneurysm rupture. The scoring system devised in this study accurately predicts rupture risk.

ABBREVIATIONS

AR = aspect ratio; AUC = area under the curve; BNF = bottleneck factor; Dica = diameter of the ICA; Dpcoa = diameter of the PCoA; DSA = digital subtraction angiography; fPCA = fetal-type posterior cerebral artery; H/W = height/width; ICA = internal carotid artery; OR = odds ratio; PCA = posterior cerebral artery; PCoA = posterior communicating artery; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage; SR = size ratio.
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Figure from Ramos et al. (pp 95–103).

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