Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis

J Mocco; Robert D Brown Jr; James C Torner; Ana W Capuano; Kyle M Fargen; Madhavan L Raghavan; David G Piepgras; Irene Meissner; John Huston III; International Study of Unruptured Intracranial Aneurysms Investigators

doi:10.1093/neuros/nyx226

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Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis

Journal article

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Peer reviewed

Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis

J Mocco, Robert D Brown Jr, James C Torner, Ana W Capuano, Kyle M Fargen, Madhavan L Raghavan, David G Piepgras, Irene Meissner, John Huston III and International Study of Unruptured Intracranial Aneurysms Investigators

Neurosurgery, Vol.82(4), pp.491-496

04/01/2018

DOI: 10.1093/neuros/nyx226

PMCID: PMC6256940

PMID: 28605486

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Abstract

There are conflicting data between natural history studies suggesting a very low risk of rupture for small, unruptured intracranial aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured aneurysms than expected. To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. A case-control design was used to analyze morphological characteristics associated with aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured aneurysms during follow-up were matched (by size and location) with 198 patients with unruptured intracranial aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, aneurysm angle, neck diameter, parent vessel diameter, and calculated aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence unruptured intracranial aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.

Multivariate Analysis

Humans

Middle Aged

Risk Factors

Aneurysm, Ruptured - epidemiology

Aneurysm, Ruptured - etiology

Intracranial Aneurysm - complications

Case-Control Studies

Adult

Female

Aged

Intracranial Aneurysm - pathology

Cohort Studies

Details

Title: Subtitle: Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis
Creators: J Mocco - Department of Neurosurgery, Mount Sinai Medical Center, New York, New York
Robert D Brown Jr - Department of Neurology, Mayo Clinic, Rochester, Minnesota
James C Torner - Department of Epidemiology, University of Iowa, Iowa City, Iowa
Ana W Capuano - Department of Epidemiology, University of Iowa, Iowa City, Iowa
Kyle M Fargen - Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
Madhavan L Raghavan - Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina
David G Piepgras - Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
Irene Meissner - Department of Neurology, Mayo Clinic, Rochester, Minnesota
John Huston III - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
International Study of Unruptured Intracranial Aneurysms Investigators
Resource Type: Journal article
Publication Details: Neurosurgery, Vol.82(4), pp.491-496
DOI: 10.1093/neuros/nyx226
PMID: 28605486
PMCID: PMC6256940
NLM abbreviation: Neurosurgery
ISSN: 0148-396X
eISSN: 1524-4040
Publisher: United States
Grant note: R01 NS028492 / NINDS NIH HHS RC1 NS068092 / NINDS NIH HHS
Language: English
Date published: 04/01/2018
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
Record Identifier: 9983995164802771

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