title: Larger size ratio associated with the rupture of very small (≤3 mm) anterior communicating artery aneurysms.
abstract: BACKGROUND
  Anterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.
  
  
  METHODS
  We conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.
  
  
  RESULTS
  Of the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.
  
  
  CONCLUSIONS
  About one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ting
authors.identifier: http://orcid.org/0000-0002-3464-896X
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Boli
authors.identifier: http://orcid.org/0000-0002-3282-3445
authors.initials: B
authors.lastname: Lin
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Shuailiang
authors.identifier: http://orcid.org/0000-0003-2884-7556
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xiaotong
authors.initials: X
authors.lastname: Shao
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Nengzhi
authors.initials: N
authors.lastname: Xia
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Haoli
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yunjun
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhong
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Qichuan
authors.initials: Q
authors.lastname: Zhuge
authors.affiliation: Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.|Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Weijian
authors.initials: W
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Aneurysm; CT Angiography