Morphological risk factors for the rupture of anterior communicating artery aneurysms: the significance of fenestration.
BACKGROUND
The purpose of this study was to evaluate morphological factors associated with rupture in anterior communicating artery (AcomA) aneurysms and to investigate the significance of AcomA fenestration as a risk factor for aneurysm rupture.


METHODS
The clinical and radiologic findings of 255 patients with AcomA aneurysms treated with coil embolization between January 2005 and March 2014 were retrospectively reviewed. We performed univariate and multivariate analyses to evaluate the associations between morphological variables and rupture status.


RESULTS
The number of patients with AcomA fenestration was 17 out of 255 (6.6 %). There were no statistically significant differences between the fenestration group and non-fenestration group in clinical and morphological characteristics. Multivariate logistic regression tests showed that superior direction of aneurysm dome (OR 2.802, p = 0.023), presence of a bleb (OR 5.998, p < 0.001), high aspect ratio (OR 3.138, p = 0.009), size greater than 7 mm (OR 3.356, p = 0.013), and AcomA fenestration (OR 4.135, p = 0.026) were significantly associated with AcomA aneurysm rupture.


CONCLUSIONS
The results of this study demonstrated that a fenestrated AcomA is associated with risk of aneurysm rupture. Therefore, AcomA fenestration can be considered as an important morphological risk factor for rupture, along with other known risk factors such as the direction of aneurysm dome, a bleb, high aspect ratio, and size.
Department of Neurosurgery, Bundang Jesaeng Hospital, Sungnam, Korea.
Jai Ho
JH
Choi
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Kyung Il
KI
Jo
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. somatom.kim@samsung.com.|Department of Interventional Neuroradiology, Samsung Medical Center, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea. somatom.kim@samsung.com.
Keon Ha
KH
Kim
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Pyoung
P
Jeon
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Je Young
JY
Yeon
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jong Soo
JS
Kim
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Seung Chyul
SC
Hong
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D015901:Angiography, Digital Subtraction / Q000706:statistics & numerical data*; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity
Anterior communicating artery; Fenestration; Intracranial aneurysm; Subarachnoid hemorrhage