gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Article

Send article

Small intracranial aneurysms of the anterior circulation – A zero percent rupture risk?

Kleine intrakranielle Aneurysmen der vorderen Zirkulation – Ohne Rupturrisiko?

Meeting Abstract

Search Medline for

  • presenting/speaker Thiemo F. Dinger - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Anna Michel - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Maryam Said - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Mehdi Chihi - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Yahya Ahmadipour - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV202

doi: 10.3205/22dgnc196, urn:nbn:de:0183-22dgnc1967

Published: May 25, 2022

© 2022 Dinger 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: According to the largest prospective multicentric observational ISUIA-trial, small (<7 mm) unruptured intracranial aneurysms (IA) of the anterior circulation carry neglectable 5-years rupture risk. At the same time, many patients admitted with subarachnoid hemorrhage due to ruptured IA present with small IA in the anterior circulation. In this study, we analyzed the rates and risk factors for rupture related to specific locations of small IA within the anterior circulation.

Methods: From the institutional observational cohort containing data on 2453 consecutive patients with 3806 IA treated between 01/2003 and 06/2016, 1676 IA with the sack size <7mm located in the anterior circulation were included in the study. Different demographic, clinical, laboratory, and radiographic characteristics of patients and IA were collected. Univariate and multivariate analyses were performed.

Results: The highest rate of RIA was observed for IA in the anterior communicating artery (ACoA, 54.2%), which was significantly higher than for any other location within the anterior circulation (≥A2-branch of the anterior cerebral artery (31.5%, OR=0.39, p<0.0001), internal carotid artery (14.7%, OR=0.14, p<0.0001), and middle cerebral artery (9.5%, OR=0.09, p<0.0001)), and even higher than for small IA of the posterior circulation (46.5%, OR=0.74, p=0.039). In the subgroup analysis of patient- and IA-specific risk factors for rupture of ACoA (n=380), the following parameters were independently associated with the ruptured status of IA: sack size (aOR=1.42 per-mm-increase, p<0.0001), arterial hypertension (aOR=3.56, p<0.0001), alcohol abuse (aOR=8.27, p=0.005), hypothyroidism (aOR=0.31, p=0.004), and regular medication with beta-blockers (aOR=0.30, p<0.0001), angiotensin-1 receptor antagonists (aOR=0.18, p<0.0001) and statins (aOR=0.48, p=0.043).

Conclusion: Small IA of ACoA carry considerable rupture risk, which is higher than for any other location of IA. The reported independent predictors might help for a better estimation of the rupture risk. Particularly modifiable risk factors might become therapeutic targets for preventing IA rupture in ACoA.