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Published in: Acta Neurochirurgica 9/2014

Open Access 01-09-2014 | Clinical Article - Vascular

Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features

Authors: Tomasz Tykocki, Bogusław Kostkiewicz

Published in: Acta Neurochirurgica | Issue 9/2014

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Abstract

Background

Intracranial aneurysms (IAs) located in the posterior circulation are considered to have higher annual bleed rates than those in the anterior circulation. The aim of the study was to compare the morphometric factors differentiating between IAs located in the anterior and posterior cerebral circulation.

Methods

A total number of 254 IAs diagnosed between 2009 and 2012 were retrospectively analyzed. All patients qualified for diagnostic, three-dimensional rotational angiography. IAs were assigned to either the anterior or posterior cerebral circulation subsets for the analysis. Means were compared with a t-test. The univariate and stepwise logistic regression analyses were used to determine the predictors of morphometric differences between the groups. For the defined predictors, ROC (receiver-operating characteristic) curves and interactive dot diagrams were calculated with the cutoff values of the morphometric factors.

Results

The number of anterior cerebral circulation IAs was 179 (70.5 %); 141 (55.5 %) aneurysms were ruptured. Significant differences between anterior and posterior circulation IAs were found for: the parent artery size (5.08 ± 1.8 mm vs. 3.95 ± 1.5 mm; p < 0.05), size ratio (2.22 ± 0.9 vs. 3.19 ± 1.8; p < 0.045) and aspect ratio (AR) (1.91 ± 0.8 vs. 2.75 ± 1.8; p = 0.02). Predicting factors differentiating anterior and posterior circulation IAs were: the AR (OR = 2.20; 95 % CI 1.80–270; Is 270 correct or should it be 2.70 and parent artery size (OR = 0.44; 95 % CI 0.38–0.54). The cutoff point in the ROC curve was 2.185 for the AR and 4.89 mm for parent artery size.

Conclusions

Aspect ratio and parent artery size were found to be predictive morphometric factors in differentiating between anterior and posterior cerebral IAs.
Literature
1.
go back to reference Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A (2006) Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 65(1):18–25, discussion 25–27PubMedCrossRef Beck J, Rohde S, Berkefeld J, Seifert V, Raabe A (2006) Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiography. Surg Neurol 65(1):18–25, discussion 25–27PubMedCrossRef
2.
go back to reference Carter BS, Sheth S, Chang E, Sethl M, Ogilvy CS (2006) Epidemiology of the size distribution of intracranial bifurcation aneurysms: smaller size of distal aneurysms and increasing size of unruptured aneurysms with age. Neurosurgery 58(2):217–223, discussion 217–223PubMedCrossRef Carter BS, Sheth S, Chang E, Sethl M, Ogilvy CS (2006) Epidemiology of the size distribution of intracranial bifurcation aneurysms: smaller size of distal aneurysms and increasing size of unruptured aneurysms with age. Neurosurgery 58(2):217–223, discussion 217–223PubMedCrossRef
3.
go back to reference Chien A, Castro MA, Tateshima S, Sayre J, Cebral J, Viñuela F (2009) Quantitative hemodynamic analysis of brain aneurysms at different locations. AJNR Am J Neuroradiol 30(8):1507–1512PubMedCrossRef Chien A, Castro MA, Tateshima S, Sayre J, Cebral J, Viñuela F (2009) Quantitative hemodynamic analysis of brain aneurysms at different locations. AJNR Am J Neuroradiol 30(8):1507–1512PubMedCrossRef
4.
go back to reference Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Viñuela F (2013) Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms. J Neurosurg 119(1):190–197PubMedCrossRef Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Viñuela F (2013) Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms. J Neurosurg 119(1):190–197PubMedCrossRef
5.
6.
go back to reference Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, Hopkins LN, Meng H (2008) Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63(2):185–196, discussion 196–197PubMedCentralPubMedCrossRef Dhar S, Tremmel M, Mocco J, Kim M, Yamamoto J, Siddiqui AH, Hopkins LN, Meng H (2008) Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery 63(2):185–196, discussion 196–197PubMedCentralPubMedCrossRef
7.
go back to reference Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ (1981) Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54(2):151–169PubMedCrossRef Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ (1981) Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54(2):151–169PubMedCrossRef
8.
go back to reference Jou L-D, Lee DH, Morsi H, Mawad ME (2008) Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29(9):1761–1767PubMedCrossRef Jou L-D, Lee DH, Morsi H, Mawad ME (2008) Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29(9):1761–1767PubMedCrossRef
9.
go back to reference Kashiwazaki D, Kuroda S, Sapporo SAH Study Group (2013) Size ratio can highly predict rupture risk in intracranial small (<5 mm) aneurysms. Stroke J Cereb Circ 44(8):2169–2173CrossRef Kashiwazaki D, Kuroda S, Sapporo SAH Study Group (2013) Size ratio can highly predict rupture risk in intracranial small (<5 mm) aneurysms. Stroke J Cereb Circ 44(8):2169–2173CrossRef
10.
go back to reference Krejza J, Arkuszewski M, Kasner SE, Weigele J, Ustymowicz A, Hurst RW, Cucchiara BL, Messe SR (2006) Carotid artery diameter in men and women and the relation to body and neck size. Stroke J Cereb Circ 37(4):1103–1105CrossRef Krejza J, Arkuszewski M, Kasner SE, Weigele J, Ustymowicz A, Hurst RW, Cucchiara BL, Messe SR (2006) Carotid artery diameter in men and women and the relation to body and neck size. Stroke J Cereb Circ 37(4):1103–1105CrossRef
11.
go back to reference Lauric A, Baharoglu MI, Gao B-L, Malek AM (2012) Incremental contribution of size ratio as a discriminant for rupture status in cerebral aneurysms: comparison with size, height, and vessel diameter. Neurosurgery 70(4):944–951, discussion 951–952PubMedCrossRef Lauric A, Baharoglu MI, Gao B-L, Malek AM (2012) Incremental contribution of size ratio as a discriminant for rupture status in cerebral aneurysms: comparison with size, height, and vessel diameter. Neurosurgery 70(4):944–951, discussion 951–952PubMedCrossRef
12.
go back to reference Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H (2004) Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography. J Neurosurg 101(6):908–914PubMedCrossRef Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H (2004) Incidence and risk factors for the growth of unruptured cerebral aneurysms: observation using serial computerized tomography angiography. J Neurosurg 101(6):908–914PubMedCrossRef
13.
go back to reference Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360(9342):1267–1274CrossRef Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360(9342):1267–1274CrossRef
14.
go back to reference Nikolic I, Tasic G, Bogosavljevic V, Nestorovic B, Jovanovic V, Kojic Z, Djoric I, Djurovic B (2012) Predictable morphometric parameters for rupture of intracranial aneurysms - a series of 142 operated aneurysms. Turk Neurosurg 22(4):420–426PubMed Nikolic I, Tasic G, Bogosavljevic V, Nestorovic B, Jovanovic V, Kojic Z, Djoric I, Djurovic B (2012) Predictable morphometric parameters for rupture of intracranial aneurysms - a series of 142 operated aneurysms. Turk Neurosurg 22(4):420–426PubMed
15.
go back to reference Pai BS, Varma RG, Kulkarni RN, Nirmala S, Manjunath LC, Rakshith S (2007) Microsurgical anatomy of the posterior circulation. Neurol India 55(1):31–41PubMedCrossRef Pai BS, Varma RG, Kulkarni RN, Nirmala S, Manjunath LC, Rakshith S (2007) Microsurgical anatomy of the posterior circulation. Neurol India 55(1):31–41PubMedCrossRef
16.
go back to reference Perlmutter D, Rhoton AL Jr (1976) Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45(3):259–272PubMedCrossRef Perlmutter D, Rhoton AL Jr (1976) Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45(3):259–272PubMedCrossRef
17.
go back to reference Pico F, Labreuche J, Gourfinkel-An I, Amarenco P (2006) Basilar artery diameter and 5-year mortality in patients with. Stroke 37(9):2342–2347PubMedCrossRef Pico F, Labreuche J, Gourfinkel-An I, Amarenco P (2006) Basilar artery diameter and 5-year mortality in patients with. Stroke 37(9):2342–2347PubMedCrossRef
18.
go back to reference Raaymakers TW, Rinkel GJ, Limburg M, Algra A (1998) Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke J Cereb Circ 29(8):1531–1538CrossRef Raaymakers TW, Rinkel GJ, Limburg M, Algra A (1998) Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke J Cereb Circ 29(8):1531–1538CrossRef
19.
go back to reference Rahman M, Ogilvy CS, Zipfel GJ, Derdeyn CP, Siddiqui AH, Bulsara KR, Kim LJ, Riina HA, Mocco J, Hoh BL (2011) Unruptured cerebral aneurysms do not shrink when they rupture: multicenter collaborative aneurysm study group. Neurosurgery 68(1):155–160, discussion 160–161PubMedCrossRef Rahman M, Ogilvy CS, Zipfel GJ, Derdeyn CP, Siddiqui AH, Bulsara KR, Kim LJ, Riina HA, Mocco J, Hoh BL (2011) Unruptured cerebral aneurysms do not shrink when they rupture: multicenter collaborative aneurysm study group. Neurosurgery 68(1):155–160, discussion 160–161PubMedCrossRef
20.
go back to reference Rahman M, Smietana J, Hauck E, Hoh B, Hopkins N, Siddiqui A, Levy EI, Meng H, Mocco J (2010) Size ratio correlates with intracranial aneurysm rupture status: a prospective study. Stroke J Cereb Circ 41(5):916–920CrossRef Rahman M, Smietana J, Hauck E, Hoh B, Hopkins N, Siddiqui A, Levy EI, Meng H, Mocco J (2010) Size ratio correlates with intracranial aneurysm rupture status: a prospective study. Stroke J Cereb Circ 41(5):916–920CrossRef
21.
go back to reference Sekhar LN, Tariq F, Morton RP, Ghodke B, Hallam DK, Barber J, Kim LJ (2013) Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery 72(2):284–298, discussion 298–299PubMedCrossRef Sekhar LN, Tariq F, Morton RP, Ghodke B, Hallam DK, Barber J, Kim LJ (2013) Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients. Neurosurgery 72(2):284–298, discussion 298–299PubMedCrossRef
22.
go back to reference Strother CM, Graves VB, Rappe A (1992) Aneurysm hemodynamics: an experimental study. AJNR Am J Neuroradiol 13(4):1089–1095PubMed Strother CM, Graves VB, Rappe A (1992) Aneurysm hemodynamics: an experimental study. AJNR Am J Neuroradiol 13(4):1089–1095PubMed
23.
go back to reference Suzuki J, Ohara H (1978) Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg 48(4):505–514PubMedCrossRef Suzuki J, Ohara H (1978) Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg 48(4):505–514PubMedCrossRef
24.
go back to reference Tanaka M, Sakaguchi M, Miwa K, Okazaki S, Furukado S, Yagita Y, Mochizuki H, Kitagawa K (2013) Basilar artery diameter is an independent predictor of incident cardiovascular events. Arterioscler Thromb Vasc Biol 33(9):2240–2244PubMedCrossRef Tanaka M, Sakaguchi M, Miwa K, Okazaki S, Furukado S, Yagita Y, Mochizuki H, Kitagawa K (2013) Basilar artery diameter is an independent predictor of incident cardiovascular events. Arterioscler Thromb Vasc Biol 33(9):2240–2244PubMedCrossRef
25.
go back to reference Taylor CL, Kopitnik TA Jr, Samson DS, Purdy PD (2003) Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg 99(1):15–22PubMedCrossRef Taylor CL, Kopitnik TA Jr, Samson DS, Purdy PD (2003) Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg 99(1):15–22PubMedCrossRef
26.
go back to reference Tremmel M, Dhar S, Levy EI, Mocco J, Meng H (2009) Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study. Neurosurgery 64(4):622–630, discussion 630–631PubMedCentralPubMedCrossRef Tremmel M, Dhar S, Levy EI, Mocco J, Meng H (2009) Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study. Neurosurgery 64(4):622–630, discussion 630–631PubMedCentralPubMedCrossRef
27.
go back to reference Tykocki T, Nauman P, Dowżenko A (2014) Morphometric predictors of posterior circulation aneurysms risk rupture. Neurol Res DOI:1743132813Y0000000306 Tykocki T, Nauman P, Dowżenko A (2014) Morphometric predictors of posterior circulation aneurysms risk rupture. Neurol Res DOI:1743132813Y0000000306
28.
go back to reference Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45(1):119–129, discussion 129–130PubMedCrossRef Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F (1999) Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45(1):119–129, discussion 129–130PubMedCrossRef
29.
go back to reference Ujiie H, Tamano Y, Sasaki K, Hori T (2001) Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 48(3):495–502, discussion 502–503PubMedCrossRef Ujiie H, Tamano Y, Sasaki K, Hori T (2001) Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 48(3):495–502, discussion 502–503PubMedCrossRef
30.
go back to reference Wiebers DO, Whisnant JP, Huston J, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O'Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110PubMedCrossRef Wiebers DO, Whisnant JP, Huston J, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O'Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110PubMedCrossRef
31.
go back to reference Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, Siddiqui AH, Levy EI, Meng H (2011) Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke J Cereb Circ 42(1):144–152CrossRef Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, Siddiqui AH, Levy EI, Meng H (2011) Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke J Cereb Circ 42(1):144–152CrossRef
Metadata
Title
Aneurysms of the anterior and posterior cerebral circulation: comparison of the morphometric features
Authors
Tomasz Tykocki
Bogusław Kostkiewicz
Publication date
01-09-2014
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 9/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-014-2173-y

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