gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Risk factors and clinical value of radiographic characteristics of ruptured anterior communicating artery aneurysms

Risikofaktoren und klinische Bedeutung von radiographischen Parametern bei rupturierten Arteria communicans anterior Aneurysmen

Meeting Abstract

  • presenting/speaker Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Oliver Gembruch - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Yahya Ahmadipour - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV143

doi: 10.3205/19dgnc158, urn:nbn:de:0183-19dgnc1588

Published: May 8, 2019

© 2019 Darkwah Oppong et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The most frequent location for intracranial aneurysms is anterior communicating artery. In case of aneurysm rupture, various demographic, clinical and radiographic aspects may influence the course and outcome of subarachnoid hemorrhage (SAH). We sought to evaluate radiographic parameters related to ruptured anterior communicating artery aneurysms (ACOAA) and address their impact on clinical course of SAH.

Methods: All SAH cases due to ruptured ACOAA were eligible for this study. Data were extracted from institutional aneurysm database containing 994 consecutive SAH patients treated between January 2003 and June 2016. Alongside with demographic and clinical features of SAH patients, the following radiographic parameters were collected from digital subtraction angiographies: maximal diameter of aneurysmal sack, perpendicular height of sack, neck size, sack/neck-ratio, ASPECT-ratio, wall irregularity, biolobularity, presence of daughter sack, direction of aneurysmal sack, as well as anatomic variations of A1 branches of anterior cerebral artery (ACA). The primary endpoints were rebleeding before treatment, occurrence of infarctions in ACA territory, in-hospital mortality and unfavorable outcome (modified Rankin scale >2) at 6 months after SAH. Univariate and multivariate analyses were performed.

Results: 332 SAH patients with ruptured ACOAA (33.4%) were included in the final analysis. Of all analyzed radiographic characteristics of ACOAA, only maximal sack size predicted the severity of intraventricular (p<0.0001) and intracerebral hemorrhages (p=0.002) accompanying SAH, in-hospital mortality (p=0.019) and unfavorable outcome (p=0.038). Pretreatment rebleeding was related to maximal sack size (p=0.007) and perpendicular height (p=0.027). The risk of ACA infarctions was independently associated with neck size (p=0.043), perpendicular height (inversely, p=0.043) and ASPECT ratio (p=0.019). In turn, asymmetry of A1 branches measured as ratio of larger branch to smaller one, was the major independent predictor for maximal sack size (p=0.015), perpendicular height (p=0.006) and presence of daughter sack (p=0.031).

Conclusion: Maximal sack size is an easily assessable and clinically most reliable radiographic characteristic of ruptured ACOAA. Asymmetry of A1 branches strongly contributes to size and morphology of ACOAA. Association between neck size and ACA infarct risk might be related to challenging treatment of wide necked ACOAA.