Introduction: Predicting the risk of rupture of cerebral aneurysm is difficult. We studied morphological factors associated with rupture of aneurysms in patients with multiple cerebral aneurysms.
Methods: Between January 2007 and December 2012, 3D rotational angiographic images of 189 consecutive aneurysms (total 85 patients; 85 ruptured, 104 unruptured aneurysms) were reviewd to assess the following parameters: Considering morphological factors of aneurysm; maximal size, aspect ratio, bottle neck ratio, height/width ratio, multi-lobulation, daughter sac. Considering geometry of parent vessels; inflow parent artery diameter, parent vessel mean diameter, aneurismal angle, vessel angle, inflow angle, parent daughter angle, size ratio (type 1& 2). Univariate statistics were applied to all parameters and significant parameters were identified in multivariate logistic regression analysis, yielding area under the curve (AUC) and optimal thresholds in the receiver-operating characteristic.
Results: Maximal size, aspect ratio, bottle neck ratio, height/width ratio, multi-lobulation, daughter sac and aneurismal angle, angle of parent daughter vessels, size ratio (type 1& 2) were significantly associated with ruptured aneurysms on univariate analysis. Multivariate logistic regression analysis demonstrated that aspect ratio (odds ratio, 1.214; 95% confidence interval, 1.048–1.405) and daughter sac (odds ratio, 3.124; 95% confidence interval 1.053-9.265) were independently significant factors related to geometry of aneurysms. Parameters considering geometry of parent vessels revealed that size ratio (type 1) (odds ratio, 1.135; 95% confidence interval, 1.053–1.223) and parent daughter angle (odds ratio, 1.021; 95% confidence interval, 1.001-1.043) had independent correlation with ruptured aneurysms. From the receiver operating characteristic analysis, aspect ratio and size ratio (type 1) had the highest area under the curve values of 0.83 and 0.86, respectively.
Conclusions: In a case-control study of patients with multiple cerebral aneurysms, aspect ratio, size ratio (type 1), daughter sac and parent-daughter angle are strongly associated with rupture in multiple aneurysms.
Patient Care: It can give us some clues to predict which aneurysm is at risk of rupture in patients with multiple cerebral aneurysms.
Learning Objectives: By the conclusion of this session, participants should be able to consider these morphological factors as predictors of rupture of aneurysms in patients with multiple aneurysms.