title: Morphological parameters associated with ruptured posterior communicating aneurysms.
abstract: The rupture risk of unruptured intracranial aneurysms is known to be dependent on the size of the aneurysm. However, the association of morphological characteristics with ruptured aneurysms has not been established in a systematic and location specific manner for the most common aneurysm locations. We evaluated posterior communicating artery (PCoA) aneurysms for morphological parameters associated with aneurysm rupture in that location. CT angiograms were evaluated to generate 3-D models of the aneurysms and surrounding vasculature. Univariate and multivariate analyses were performed to evaluate morphological parameters including aneurysm volume, aspect ratio, size ratio, distance to ICA bifurcation, aneurysm angle, vessel angles, flow angles, and vessel-to-vessel angles. From 2005-2012, 148 PCoA aneurysms were treated in a single institution. Preoperative CTAs from 63 patients (40 ruptured, 23 unruptured) were available and analyzed. Multivariate logistic regression revealed that smaller volume (p = 0.011), larger aneurysm neck diameter (0.048), and shorter ICA bifurcation to aneurysm distance (p = 0.005) were the most strongly associated with aneurysm rupture after adjusting for all other clinical and morphological variables. Multivariate subgroup analysis for patients with visualized PCoA demonstrated that larger neck diameter (p = 0.018) and shorter ICA bifurcation to aneurysm distance (p = 0.011) were significantly associated with rupture. Intracerebral hemorrhage was associated with smaller volume, larger maximum height, and smaller aneurysm angle, in addition to lateral projection, male sex, and lack of hypertension. We found that shorter ICA bifurcation to aneurysm distance is significantly associated with PCoA aneurysm rupture. This is a new physically intuitive parameter that can be measured easily and therefore be readily applied in clinical practice to aid in the evaluation of patients with PCoA aneurysms.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Allen
authors.initials: A
authors.lastname: Ho
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Nareerat
authors.initials: N
authors.lastname: Charoenvimolphan
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Mary
authors.initials: M
authors.lastname: Stanley
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.affiliation: Department of Neurosurgery, University of Texas Medical School at Houston, Houston, Texas, United States of America.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Day
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D017542:Aneurysm, Ruptured / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000473:pathology; D003710:Demography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis
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