title: Morphological, hemodynamic, and clinical independent risk factors for anterior communicating artery aneurysms.
abstract: OBJECTIVE
  The pathogenesis of cerebral aneurysms still raises some controversies. The aim of this study was to identify morphological, hemodynamic, and clinical independent risk factors for anterior communicating artery (ACoA) aneurysm development.
  
  
  METHODS
  Computed tomography angiography and transcranial color-coded sonography were performed in 77 patients with a nonbleeding ACoA aneurysm and in 73 controls. Symmetry of A1 segments of the anterior cerebral arteries, angles between A1 and A2 segments, tortuosity, diameter, mean velocity (Vm), pulsatility index, and volume flow rate in both A1 segments were determined. Moreover, all study participants completed a survey on their medical history. Multivariate backward stepwise logistic regression analysis was performed to identify independent risk factors for ACoA aneurysm development.
  
  
  RESULTS
  Smoking, hypertension, asymmetry of A1 segments, the angle between A1 and A2 segments, A1 segment diameter, Vm, pulsatility index, and volume flow rate turned out to be associated with the occurrence of ACoA aneurysms on univariate analysis. Multivariate analysis identified smoking (odds ratio, 2.036; 95% confidence interval, 1.277-3.245), asymmetry of A1 segments>40% (odds ratio, 2.524; 95% confidence interval, 1.275-4.996), pulsatility index (odds ratio, 0.004; 95% confidence interval, 0.000-0.124), and the angle between A1 and A2 segments≤100° (odds ratio, 4.665; 95% confidence interval, 2.247-9.687) as independent strong risk factors for ACoA aneurysm development.
  
  
  CONCLUSIONS
  The risk of ACoA aneurysm formation is determined by several independent clinical, morphological, and hemodynamic factors. The strongest independent risk factors include smoking, asymmetry of A1 segments>40%, low blood flow pulsatility, and the angle between A1 and A2 segments≤100°.
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.). wkaspera@wp.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kaspera
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Piotr
authors.initials: P
authors.lastname: Ładziński
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Patrycja
authors.initials: P
authors.lastname: Larysz
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Anna
authors.initials: A
authors.lastname: Hebda
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Ptaszkiewicz
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Marek
authors.initials: M
authors.lastname: Kopera
authors.affiliation: From the Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland (W.K., P.Ł., P.L., M.K.); Radiodiagnostic Department (A.H.) and Department of Radiotherapy (D.L.), Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice, Poland; and Radiodiagnostic Department, Specialist Hospital, Jaworzno, Poland (K.P.).
authors.forename: Dawid
authors.initials: D
authors.lastname: Larysz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002533:Cerebral Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D017585:Ultrasonography, Doppler, Transcranial
keywords: anterior cerebral artery; hemodynamics; intracranial aneurysm; multidetector computed tomography; risk factors; ultrasonography, doppler, transcranial