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Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms

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Abstract

In patients with aneurysmal subarachnoid hemorrhage (aSAH) and multiple aneurysms, there is a need to objectively identify the ruptured aneurysm. Additionally, studying the intra-individual rupture risk of multiple aneurysms eliminates extrinsic risk factors and allows a focus on anatomical factors, which could be extrapolated to patients with single aneurysms too. Retrospective bi-center study (Department of Neurosurgery of the University Hospital Duesseldorf and Bern) on patients with multiple aneurysms and subarachnoid hemorrhage caused by the rupture of one of them. Parameters investigated were height, width, neck, shape, inflow angle, diameter of the proximal and distal arteries, width/neck ratio, height/width ratio, height/neck ratio, and localization. Statistical analysis and logistic regressions were performed by the R program, version 3.4.3. N = 186 patients with aSAH and multiple aneurysms were treated in either department from 2008 to 2016 (Bern: 2008–2016, 725 patients and 100 multiple aneurysms, Duesseldorf: 2012–2016, 355 patients, 86 multiple aneurysms). The mean age was 57 years. N = 119 patients had 2 aneurysms, N = 52 patients had 3 aneurysms, N = 14 had 4 aneurysms and N = 1 had 5 aneurysms. Eighty-four percent of ruptured aneurysms were significantly larger than the largest unruptured. Multilobularity of ruptured aneurysms was significantly higher than in unruptured. Metric variables describing the geometry (height, width, etc.) and shape are the most predictive for rupture. One or two of them alone are already reliable predictors. Ratios are completely redundant in saccular aneurysms.

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References

  1. Baharoglu MI, Schirmer CM, Hoit DA, Gao BL, Malek AM (2010) Aneurysm inflow-angle as a discriminant for rupture in sidewall cerebral aneurysms: morphometric and computational fluid dynamic analysis. Stroke 41:1423–1430

    Article  PubMed  Google Scholar 

  2. Broderick JP, Brott TG, Duldner JE, Tomsick T, Leach A (1994) Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke 25:1342–1347

    Article  CAS  PubMed  Google Scholar 

  3. Clarke G, Mendelow AD, Mitchell P (2005) Predicting the risk of rupture of intracranial aneurysms based on anatomical location. Acta Neurochir 147:259–263

    Article  CAS  PubMed  Google Scholar 

  4. De Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372

    Article  PubMed  PubMed Central  Google Scholar 

  5. Forget TR Jr, Benitez R, Veznedaroglu E, Sharan A, Mitchell W, Silva M, Rosenwasser RH (2001) A review of size and location of ruptured intracranial aneurysms. Neurosurgery 49:1322–1325

    Article  PubMed  Google Scholar 

  6. Huhtakangas J, Lehecka M, Lehto H, Jahromi BR, Niemelä M, Kivisaari R (2017) CTA analysis and assessment of morphological factors related to rupture in 413 posterior communicating artery aneurysms. Acta Neurochir 159(9):1643–1652

    Article  PubMed  Google Scholar 

  7. Ie Roux AA, Wallace MC (2010) Outcome and cost of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 21:235–246

    Article  Google Scholar 

  8. Ingal T, Asplund K, Mahönen M, Bonita R (2000) A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONIKA stroke study. Stroke 31:1054–1061

    Article  Google Scholar 

  9. Jiang H, Shen J, Wenig YX, Pan JW, Yu JB, Wan ZA et al (2015) Morphology parameters for mirror posterior communicating artery aneurysm rupture risk assessment. Neurol Med Chir (Tokyo) 55:498–504

    Article  Google Scholar 

  10. Jing L, Fan J, Wang Y, Li H, Wang S, Yang X, Zhang Y (2015) Morphologic and hemodynamic analysis in the patients with multiple intracranial aneurysms: ruptured versus unruptured. PLoS One 10(7):e0132494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kim MC, Hwang SK (2017) The rupture risk of aneurysm in the anterior communicating artery: a single center study. J Cerebrovasc Endovasc Neurosurg 19:36–43

    Article  PubMed  PubMed Central  Google Scholar 

  12. Labovitz DL, Halim AX, Brent B, Boden-Albala B, Hauser WA, Sacco RL (2006) Subarachnoid hemorrhage incidence among whites, blacks and Caribbean Hispanics: the northern Manhattan study. Neuroepidemiology 26:147–150

    Article  CAS  PubMed  Google Scholar 

  13. Lv N, Feng Z, Wang C, Cao W, Fang Y, Karmonik C, Liu J, Huang Q (2016) Morphological risk factors for rupture of small (< 7 mm) posterior communicating artery aneurysms. World Neurosurg 87:311–315

    Article  PubMed  Google Scholar 

  14. Maslehaty H, Ngando H, Meila D, Brassler F, Scholz M, Petridis AK (2013) Estimated low risk of rupture of small-sized unruptured intracranial aneurysms (UIAs) in relation to intracranial aneurysms in patients with subarachnoid haemorrhage. Acta Neurochir 155:1095–1100

    Article  PubMed  Google Scholar 

  15. Maslehaty H, Capone C, Frantsev R, Fischer I, Jabbarli R, Cornelius JF et al (2017) Predictive anatomical factors for rupture in middle cerebral mirror bifurcation aneurysms. J Neurosurg 25:1–9

    Google Scholar 

  16. Nader-Sepah A, Casimiro M, Sen J, Kitchen ND (2004) Is aspect ratio a reliable predictor of intracranial aneurysm rupture? Neurosurgery 54:1343–1347

    Article  Google Scholar 

  17. Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:342–348

    Article  CAS  PubMed  Google Scholar 

  18. Piotin M, Daghman B, Mounayer C, Spelle L, Moret J (2006) Ellipsoid approximation versus 3D rotational angiograpy in the volumetric assessment of intracranial aneurysms. AJNR Am J Neuroradiol 27:839–842

    CAS  PubMed  Google Scholar 

  19. Rashad S, Sugiyama SJ, Niizuma K, Sato K, Endo H, Omodaka S et al (2018) Impact of bifurcation and angle and inflow coefficient on the rupture risk of bifurcation type basilar artery tip aneurysms. J Neurosurg 128:723–730

    Article  PubMed  Google Scholar 

  20. Schneiders JJ, Marquering HA, van den Berg R, VanBavel E, Velthuis B, Rinkel GJ et al (2014) Rupture-associated changes of cerebral aneurysm geometry: high-resolution 3D imaging before and after rupture. AJNR Am J Neuroradiol 35:1358–1362

    Article  CAS  PubMed  Google Scholar 

  21. Skodvin TØ, Johnsen LH, Gjertsen Ø, Isaksen JG, Sorteberg A (2017) Cerebral aneurysm morphology before and after rupture: nationwide case series of 29 aneurysms. Stroke 48:880–886

    Article  PubMed  Google Scholar 

  22. Taveras JM, Wood EH (1976) Diagnostic neuroradiology, 2nd edn. Williams and Wilkins, Baltimore, pp 932–935

    Google Scholar 

  23. UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S et al (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 336:2474–2482

    Article  Google Scholar 

  24. Ujiie H, Tachibana H, Hiramatsu O, Hazel O, Matsumoto T, Ogasawara Y et al (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45:119–129

    CAS  PubMed  Google Scholar 

  25. Wang GH, Yu JY, Wen L, Zhang L, Mou KJ, Zhang D (2016) Risk factors for the rupture of middle cerebral artery bifurcation aneurysms using CT angiography. PLoS One 11(12):e0166654

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wang GX, Wen L, Yang L, Zhang QC, Yin JB, Duan CM et al (2018) Risk factors for the rupture of intracranial aneurysms using computed tomography angiography. World Neurosurg 110:330–338

    Article  Google Scholar 

  27. Weir B, Amidei C, Kongable G, Findlay JM, Kassell NF, Kelly J, Dai L, Karrison TG (2003) The aspect ratio (dome/neck) of ruptured and unruptured aneurysms. J Neurosurg 99:447–451

    Article  PubMed  Google Scholar 

  28. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 363:103–110

    Article  Google Scholar 

  29. Ye J, Zheng P, Hassan M, Jiang S, Zheng J (2017) Relationship of the angle between the A1 and A2 segments of the anterior cerebral artery with formation and rupture of anterior communicating artery aneurysm. J Neurosurg Sci 375:170–174

    Google Scholar 

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Author notes

  1. Christian Fung, Evangelos Mavrakis and Andreas Filis contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland

    Christian Fung, Jürgen Beck & Andreas Raabe

  2. Department of Neurosurgery, Inselspital, University of Freiburg, Freiburg, Switzerland

    Christian Fung & Jürgen Beck

  3. Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany

    Evangelos Mavrakis, Marian Suresh, Angelo Tortora, Jan F. Cornelius, Richard Bostelmann, Hans Jakob Steiger & Athanasios K. Petridis

  4. Department of Neurosurgery, Imland Hospital Rendsburg, Rendsburg, Germany

    Andreas Filis

  5. Division of Informatics and Data Science, Department of Neurosurgery, University Hospital Duesseldorf, Duesseldorf, Germany

    Igor Fischer

  6. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland

    Jan Gralla

  7. Department of Pediatrics, Stanford University, Stanford, CA, USA

    Muhammad Owais Khan

Authors
  1. Christian Fung
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Corresponding author

Correspondence to Andreas Filis.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics committee (Nr.: 5817R).

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Informed consent (oral) was obtained from all individual participants included in the study. Patients who did not consent were not included.

Electronic supplementary material

Supplemental Figure 1

Localization of ruptured and unruptured aneurysms (PNG 65.8 kb)

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Fung, C., Mavrakis, E., Filis, A. et al. Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms. Neurosurg Rev 42, 539–547 (2019). https://doi.org/10.1007/s10143-018-0998-1

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  • DOI: https://doi.org/10.1007/s10143-018-0998-1

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