Browse > Article
http://dx.doi.org/10.3340/jkns.2021.0070

True Posterior Communicating Artery Aneurysms with High Risk of Rupture despite Very Small Diameter  

Shin, Dong Gyu (Department of Neurosurgery, School of Medicine, Kyungpook National University)
Park, Jaechan (Department of Neurosurgery, School of Medicine, Kyungpook National University)
Kim, Myungsoo (Department of Neurosurgery, School of Medicine, Kyungpook National University)
Kim, Byoung-Joon (Department of Neurosurgery, School of Medicine, Kyungpook National University)
Shin, Im Hee (Department of Medical Statistics, School of Medicine, Daegu Catholic University)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.2, 2022 , pp. 215-223 More about this Journal
Abstract
Objective : This retrospective study investigated the clinical and angiographic characteristics of ruptured true posterior communicating artery (PCoA) aneurysms in comparison with junctional PCoA aneurysms presenting with a subarachnoid hemorrhage. Methods : The medical records and radiological data of 93 consecutive patients who underwent three-dimensional rotational angiography and surgical or endovascular treatment for a ruptured junctional or true PCoA aneurysm over an 8-year period were examined. Results : The maximum diameter of the ruptured true PCoA aneurysm (n=13, 14.0%) was significantly smaller than that of the ruptured junctional PCoA aneurysms (n=80, 4.45±1.44 vs. 7.68±3.36 mm, p=0.001). In particular, the incidence of very small aneurysms <4 mm was 46.2% (six of 13 patients) in the ruptured true PCoA aneurysm group, yet only 2.5% (two of 80 patients) in the ruptured junctional PCoA aneurysm group. Meanwhile, the diameter of the PCoA was significantly larger in the true PCoA aneurysm group than that in the junctional PCoA aneurysm group (1.90±0.57 vs. 1.15±0.49 mm, p<0.001). In addition, the ipsilateral PCoA/P1 ratio was significantly larger in the true PCoA aneurysm group than that in the group of a junctional PCoA aneurysm (mean PCoA/P1 ratio±standard deviation, 2.67±1.22 vs. 1.14±0.88; p<0.001). No between-group difference was identified for the modified Fisher grade, clinical grade at admission, and 3-month modified Rankin Scale score. Conclusion : A true PCoA aneurysm was found to be associated with a larger PCoA and ruptured at a smaller diameter than a junctional PCoA aneurysm. In particular, the incidence of a ruptured aneurysm with a very small diameter <4 mm was significantly higher among the patients with a true PCoA aneurysm.
Keywords
Internal carotid artery; Intracranial aneurysm; Subarachnoid hemorrhage;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Guo J, Chen Q, Miao H, Feng H, Zhu G, Chen Z : True posterior communicating artery aneurysms with or without increased flow dynamical stress: report of three cases. Clin Neurol Neurosurg 116 : 93-95, 2014   DOI
2 Ikawa F, Morita A, Tominari S, Nakayama T, Shiokawa Y, Date I, et al. : Rupture risk of small unruptured cerebral aneurysms. J Neurosurg 25 : 1-10, 2019
3 Komotar RJ, Mocco J, Solomon RA : Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J. Lawrence pool memorial research symposium--controversies in the management of cerebral aneurysms. Neurosurgery 62 : 183-193; discussion 193-194, 2008   DOI
4 Lee Y, Kim M, Park J, Kim BJ, Son W, Jung S : Mirroring with indocyanine green angiography in aneurysm surgery: technical note and case presentations. World Neurosurg 132 : e696-e703, 2019   DOI
5 Nader-Sepahi A, Casimiro M, Sen J, Kitchen ND : Is aspect ratio a reliable predictor of intracranial aneurysm rupture? Neurosurgery 54 : 1343-1347; discussion 1347-1348, 2004   DOI
6 Pierot L, Barbe C, Ferre JC, Cognard C, Soize S, White P, et al. : Patient and aneurysm factors associated with aneurysm rupture in the population of the ARETA study. J Neuroradiol 47 : 292-300, 2020   DOI
7 Schneiders JJ, Marquering HA, van den Berg R, VanBavel E, Velthuis B, Rinkel GJ, et al. : Rupture-associated changes of cerebral aneurysm geometry: high-resolution 3D imaging before and after rupture. AJNR Am J Neuroradiol 35 : 1358-1362, 2014   DOI
8 Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. : European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 35 : 93-112, 2013   DOI
9 Taylor CL, Steele D, Kopitnik TA Jr, Samson DS, Purdy PD : Outcome after subarachnoid hemorrhage from a very small aneurysm: a case-control series. J Neurosurg 100 : 623-625, 2004   DOI
10 Ujiie H, Tamano Y, Sasaki K, Hori T : Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 48 : 495-502; discussion 502-503, 2001   DOI
11 Takeda M, Kashimura H, Chida K, Murakami T : Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery. Surg Neurol Int 6 : 101, 2015   DOI
12 Kudo T : An operative complication in a patient with a true posterior communicating artery aneurysm: case report and review of the literature. Neurosurgery 27 : 650-653, 1990   DOI
13 Kuzmik GA, Bulsara KR : Microsurgical clipping of true posterior communicating artery aneurysms. Acta Neurochir (Wien) 154 : 1707-1710, 2012   DOI
14 Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360 : 1267-1274, 2002   DOI
15 Muller TB, Vik A, Romundstad PR, Sandvei MS : Risk factors for unruptured intracranial aneurysms and subarachnoid hemorrhage in a prospective population-based study. Stroke 50 : 2952-2955, 2019   DOI
16 Suzuki T, Takao H, Rapaka S, Fujimura S, Ioan Nita C, Uchiyama Y, et al. : Rupture risk of small unruptured intracranial aneurysms in Japanese adults. Stroke 51 : 641-643, 2020   DOI
17 UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, et al. : The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366 : 2474-2482, 2012   DOI
18 Yoshida M, Watanabe M, Kuramoto S : "True" posterior communicating artery aneurysm. Surg Neurol 11 : 379-381, 1979
19 Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ : Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke 38 : 1404-1410, 2007   DOI
20 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. : Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362 : 103-110, 2003   DOI
21 Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. : Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46 : 2368-2400, 2015   DOI
22 He W, Gandhi CD, Quinn J, Karimi R, Prestigiacomo CJ : True aneurysms of the posterior communicating artery: a systematic review and metaanalysis of individual patient data. World Neurosurg 75 : 64-72; discussion 49, 2011   DOI
23 He W, Hauptman J, Pasupuleti L, Setton A, Farrow MG, Kasper L, et al. : True posterior communicating artery aneurysms: are they more prone to rupture? A biomorphometric analysis. J Neurosurg 112 : 611-615, 2010   DOI
24 International Study of Unruptured Intracranial Aneurysms Investigators : Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med 339 : 1725-1733, 1998   DOI
25 Kaspera W, Majchrzak H, Kopera M, Ladzinski P : "True" aneurysm of the posterior communicating artery as a possible effect of collateral circulation in a patient with occlusion of the internal carotid artery. A case study and literature review. Minim Invasive Neurosurg 45 : 240-244, 2002   DOI
26 Yang ZG, Liu J, Ge J, Li ZF, Tian CO, Han J, et al. : A novel proximal end stenting technique for assisting embolization of a complex true posterior communicating aneurysm. J Clin Neurosci 28 : 148-151, 2016   DOI
27 Nakano Y, Saito T, Yamamoto J, Takahashi M, Akiba D, Kitagawa T, et al. : Surgical treatment for a ruptured true posterior communicating artery aneurysm arising on the fetal-type posterior communicating artery- -two case reports and review of the literature. J UOEH 33 : 303-312, 2011   DOI
28 Park J, Woo H, Kang DH, Kim YS, Kim MY, Shin IH, et al. : Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes. J Neurosurg 122 : 383-391, 2015   DOI
29 Rahman M, Ogilvy CS, Zipfel GJ, Derdeyn CP, Siddiqui AH, Bulsara KR, et al. : Unruptured cerebral aneurysms do not shrink when they rupture: multicenter collaborative aneurysm study group. Neurosurgery 68 : 155-160; discussion 160-161, 2011   DOI
30 Sonobe M, Yamazaki T, Yonekura M, Kikuchi H : Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke 41 : 1969-1977, 2010   DOI
31 Fung C, Mavrakis E, Filis A, Fischer I, Suresh M, Tortora A, et al. : Anatomical evaluation of intracranial aneurysm rupture risk in patients with multiple aneurysms. Neurosurg Rev 42 : 539-547, 2019   DOI
32 Backes D, Vergouwen MD, Velthuis BK, van der Schaaf IC, Bor AS, Algra A, et al. : Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Stroke 45 : 1299-1303, 2014   DOI
33 Bjorkman J, Frosen J, Tahtinen O, Backes D, Huttunen T, Harju J, et al. : Irregular shape identifies ruptured intracranial aneurysm in subarachnoid hemorrhage patients with multiple aneurysms. Stroke 48 : 1986-1989, 2017   DOI