Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Clinical article

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  • 1 Departments of Neurosurgery,
  • 2 Radiology, and
  • 3 Neuroendovascular Therapy, and
  • 4 Division of General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
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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.

Abbreviations used in this paper:CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; MRA = MR angiography; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.

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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 October 25, 2013; DOI: 10.3171/2013.9.JNS13921.

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