Background Hemodynamic stress, conditioned by the morphology of the surrounding vasculature, plays an important role in aneurysm formation. Our goal was to identify image-based location-specific parameters that are associated with posterior communicating artery (PCoA) aneurysms.
Methods Three-dimensional morphological parameters obtained from CT angiography or digital subtraction angiography from 187 patients with unilateral PCoA aneurysms, diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. In order to control for genetic and clinical risk factors, we chose the contralateral unaffected PCoA as a control group. We examined diameters and angles of the surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small aneurysms (≤5 mm) only and an unmatched analysis of 432 PCoA aneurysms and 197 control patients without PCoA aneurysms were also performed.
Results In a multivariable conditional logistic regression model we showed that smaller diameter size ratio (OR 1.45×10−5, 95% CI 1.12×10−7 to 1.88×10−3) and larger daughter-daughter angle (OR 1.04, 95% CI 1.02 to 1.07) were significantly associated with PCoA aneurysm presence after correcting for other variables. In subgroup analyses of small aneurysms (≤5 mm) and in an unmatched analysis the significance and direction of these results were preserved.
Conclusions Larger daughter-daughter angles and smaller diameter size ratio are significantly associated with the presence of PCoA aneurysms. These simple parameters can be utilized to guide the risk assessment for the formation of PCoA aneurysms in high risk patients.
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Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.
Contributors JZ: data collection and analysis. AC: data collection, statistical analysis and drafting of manuscript. PMRL: data collection and critical review of the manuscript. SM: critical review of the manuscript. VC: data collection and critical review of the manuscript. DD: data collection and critical review of the manuscript. SF: data collection and critical review of the manuscript. VG: data collection and critical review of the manuscript. NS: data collection and critical review of the manuscript. GS: data collection and critical review of the manuscript. SNM: critical review of the manuscript. TC: critical review of the manuscript. SW: critical review of the manuscript. RD: data collection, data analysis, and critical review of the manuscript.
Funding This study was supported by Partners Personalized Medicine, the National Institutes of Health grant numbers U54 HG007963, U01 HG008685, and R01 HG009174, and National Natural Science Foundation of China grant number 81 571 121.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.