Aneurysm morphology and prediction of rupture: An international study of unruptured intracranial aneurysms analysis

J. Mocco, Robert D Jr. Brown, James C. Torner, Ana W. Capuano, Kyle M. Fargen, Madhavan L. Raghavan, David G. Piepgras, Irene Meissner, John III Huston

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: 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. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS: 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 patientswith ruptured aneurysms during follow-upwere 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. RESULTS: 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). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)491-495
Number of pages5
JournalClinical Neurosurgery
Volume82
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Intracranial Aneurysm
Aneurysm
Rupture
Ruptured Aneurysm
Natural History
Angiography
Neck
Multivariate Analysis
Retrospective Studies
Databases
Prospective Studies

Keywords

  • Aneurysm
  • Cerebral aneurysm
  • Cerebrovascular circulation
  • Hemorrhagic stroke
  • Morphology
  • Natural history
  • Subarachnoid hemorrhage
  • Unruptured

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Aneurysm morphology and prediction of rupture : An international study of unruptured intracranial aneurysms analysis. / Mocco, J.; Brown, Robert D Jr.; Torner, James C.; Capuano, Ana W.; Fargen, Kyle M.; Raghavan, Madhavan L.; Piepgras, David G.; Meissner, Irene; Huston, John III.

In: Clinical Neurosurgery, Vol. 82, No. 4, 01.04.2018, p. 491-495.

Research output: Contribution to journalArticle

Mocco, J. ; Brown, Robert D Jr. ; Torner, James C. ; Capuano, Ana W. ; Fargen, Kyle M. ; Raghavan, Madhavan L. ; Piepgras, David G. ; Meissner, Irene ; Huston, John III. / Aneurysm morphology and prediction of rupture : An international study of unruptured intracranial aneurysms analysis. In: Clinical Neurosurgery. 2018 ; Vol. 82, No. 4. pp. 491-495.
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AU - Mocco, J.

AU - Brown, Robert D Jr.

AU - Torner, James C.

AU - Capuano, Ana W.

AU - Fargen, Kyle M.

AU - Raghavan, Madhavan L.

AU - Piepgras, David G.

AU - Meissner, Irene

AU - Huston, John III

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N2 - BACKGROUND: 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. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS: 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 patientswith ruptured aneurysms during follow-upwere 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. RESULTS: 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). CONCLUSION: 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.

AB - BACKGROUND: 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. OBJECTIVE: To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS: 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 patientswith ruptured aneurysms during follow-upwere 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. RESULTS: 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). CONCLUSION: 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.

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