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Size of ruptured intracranial aneurysms: a systematic review and meta-analysis

  • Review Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

There is wide variation in the reported size of ruptured intracranial aneurysms and methods of size estimation. There is widespread belief that small aneurysms < 7 mm do not rupture. Therefore, we performed a systematic review and meta-analysis of the literature to determine the size of ruptured aneurysms according to aneurysm locations and methods of size estimation.

Methods

We searched PubMed, Cochrane, CINAHL, and EMBASE databases using a combination of Medical Subject Headings (MeSH) terms. We included articles that reported mean aneurysm size in consecutive series of ruptured intracranial. We excluded studies limited to a specific aneurysm location or type. The random-effects model was used to calculate overall mean size and location-specific mean size. We performed meta-regression to explain observed heterogeneity and variation in reported size.

Results

The systematic review included 36 studies and 12,609 ruptured intracranial aneurysms. Overall mean aneurysm size was 7.0 mm (95% confidence interval [CI 6.2–7.4]). Pooled mean size varied with location. Overall mean size of 2145 ruptured anterior circulation aneurysms was 6.0 mm (95% CI 5.6–6.4, residual I2 = 86%). Overall mean size of 743 ruptured posterior circulation aneurysms was 6.2 mm (95% CI 5.3–7.0, residual I2 = 93%). Meta-regression identified aneurysm location and definition of size (i.e., maximum dimension vs. aneurysm height) as significant determinants of aneurysm size reported in the studies.

Conclusions

The mean size of ruptured aneurysms in most studies was approximately 7 mm. The general wisdom that aneurysms of this size do not rupture is incorrect. Location and size definition were significant determinants of aneurysm size.

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Acknowledgments

The authors thank Paul H. Dressel BFA for formatting the illustrations and Debra J. Zimmer for editorial assistance.

Funding

No funding was received in conjunction with this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Muhammad Waqas, Felix Chin, Andrew D. Gong, Hamid H. Rai, Kunal Vakharia, Rimal H. Dossani, Kenneth V. Snyder, Jason M. Davies, Elad I Levy & Adnan H Siddiqui

  2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA

    Muhammad Waqas, Felix Chin, Andrew D. Gong, Hamid H. Rai, Kunal Vakharia, Rimal H. Dossani, Hui Meng, Kenneth V. Snyder, Jason M. Davies, Elad I Levy & Adnan H Siddiqui

  3. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA

    Hamidreza Rajabzadeh-Oghaz, Hui Meng, Kenneth V. Snyder, Jason M. Davies, Elad I Levy & Adnan H Siddiqui

  4. Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA

    Hamidreza Rajabzadeh-Oghaz & Hui Meng

  5. Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA

    Maxim Mokin

  6. Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Kenneth V. Snyder

  7. Jacobs Institute, Buffalo, NY, USA

    Kenneth V. Snyder, Jason M. Davies, Elad I Levy & Adnan H Siddiqui

  8. Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Jason M. Davies

  9. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Elad I Levy & Adnan H Siddiqui

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  1. Muhammad Waqas
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Contributions

Conception and design: MW, AHS; acquisition of data: ADG, FC, HHR, MW; analysis and interpretation of data: all authors; drafting the manuscript: MW; critically revising the manuscript: all authors; reviewed submitted version of manuscript: all authors.

Corresponding author

Correspondence to Adnan H Siddiqui.

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Conflict of interest

JMD: Research grant: National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. Consulting: Medtronic; Honoraria: Neurotrauma Science, LLC; shareholder/ownership interests: Cerebrotech, RIST Neurovascular.

EIL: Shareholder/Ownership interests: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical; National Principal Investigator/Steering Committees: Medtronic (merged with Covidien Neurovascular) SWIFT Prime and SWIFT Direct Trials; Honoraria: Medtronic (training and lectures); Consultant: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed; Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical; Site Principal Investigator: CONFIDENCE study (MicroVention), STRATIS Study—Sub I (Medtronic).

HM: Principal investigator of NIH grant 1R01NS091075, R03NS090193, and Canon Medical Systems Corporation grant [no grant number]. Co-founder, Neurovascular Diagnostics, Inc.

MM: Ownership/stock: Serenity medical, Synchron, VICIS; Consultant: Canon Medical, Medtronic; NIH grant support R21NS109575 (Principal Investigator).

AHS: Co-investigator of NIH/NINDS 1R01NS091075; Financial interest/investor/stock options/ownership: Adona Medical, Inc., Amnis Therapeutics, (Purchased by Boston Scientific October 2017), Blink TBI Inc., Buffalo Technology Partners Inc., Cerebrotech Medical Systems, Inc., Cognition Medical, Endostream Medical Ltd., Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc., Q’Apel Medical Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular Inc., Sense Diagnostics, Inc., Serenity Medical Inc., Silk Road Medical, Spinnaker Medical, Inc., StimMed, Synchron, Three Rivers Medical Inc., Vastrax, LLC, VICIS, Inc., Viseon Inc.; Consultant/advisory board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Imperative Care, Inc. Integra LifeSciences Corp., Medtronic, MicroVention, Minnetronix Neuro, Inc., Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical Inc., Rapid Medical, Rebound Therapeutics Corp.(Purchased by Integra LifeSciences Corp.), Serenity Medical Inc., Silk Road Medical, StimMed, Stryker, Three Rivers Medical, Inc., VasSol, W.L. Gore & Associates; Principal investigator/steering comment of the following trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, and INVEST.

KVS: Consulting and teaching for Canon Medical Systems Corporation, Penumbra Inc., Medtronic, and Jacobs Institute. Co-Founder: Neurovascular Diagnostics, Inc.

The remaining authors report no disclosures.

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Institutional review board approval was deemed unnecessary. This submission does not contain any studies with human participants performed by any of the authors.

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Previous Presentation

Oral Presentation, Congress of Neurological Surgeons Annual Meeting, San Francisco CA, October 19-23, 2019

This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Waqas, M., Chin, F., Rajabzadeh-Oghaz, H. et al. Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir 162, 1353–1362 (2020). https://doi.org/10.1007/s00701-020-04291-z

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