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Original research
Geometric variations associated with posterior communicating artery aneurysms
  1. Jian Zhang1,
  2. Anil Can2,
  3. Pui Man Rosalind Lai3,
  4. Srinivasan Mukundan, Jr.4,
  5. Victor M Castro5,
  6. Dmitriy Dligach6,
  7. Sean Finan7,
  8. Vivian Gainer8,
  9. Nancy Shadick9,
  10. Guergana Savova7,
  11. Shawn N Murphy10,
  12. Tianxi Cai11,
  13. Scott T Weiss12,
  14. Rose Du3
  1. 1Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  2. 2Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
  3. 3Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  4. 4Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Research Information Science and Computing, Mass General Brigham Inc, Somerville, Massachusetts, USA
  6. 6Computer Science, Loyola University Chicago, Chicago, Illinois, USA
  7. 7Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
  8. 8Research Information Systems and Computing, Mass General Brigham Inc, Boston, Massachusetts, USA
  9. 9Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  10. 10Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  11. 11Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  12. 12Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Rose Du, Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; rdu{at}bwh.harvard.edu

Abstract

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.

  • aneurysm
  • subarachnoid
  • hemorrhage

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Footnotes

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Partners Institutional Review Board, 2006P001829.

  • Data availability statement Data are available upon reasonable request; email: rdu@bwh.harvard.edu

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