You are here

  • Home
  • Online First
  • Clinical and angiographic characteristics of ruptured and unruptured distal cerebral aneurysms: a review of a large series of cases in a high-volume center

Article Text

Article menu
Download PDFPDF
Hemorrhagic stroke
Case series
Clinical and angiographic characteristics of ruptured and unruptured distal cerebral aneurysms: a review of a large series of cases in a high-volume center
  1. Roberta Cao1,2,
  2. Adonis Mattar1,
  3. Esteban Torche1,
  4. Roberto Riva1,
  5. Morgane Laubacher1,
  6. Ricardo Moreno-Gomez1,
  7. Francis Turjman1,
  8. Andrea Falini2,
  9. Pietro Panni3,
  10. Omer F Eker1
  1. 1Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
  2. 2Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  3. 3Department of Neuroradiology and Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  1. Correspondence to Dr Roberta Cao, Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France; robertacao1{at}gmail.com; Dr Adonis Mattar; adonis.mattar{at}chu-lyon.fr

Abstract

Objective To evaluate clinical, angiographic features, and endovascular approach of ruptured and unruptured distal intracranial aneurysms (DIAs).

Methods From January 2013 to February 2022, details of all consecutive intracranial aneurysms (IAs) treated endovascularly in our center were collected and retrospectively reviewed. IAs involving the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery (distal to anterior communicating artery, limen insula, and P1 segment, respectively), and those distal to superior cerebellar artery, anterior–inferior cerebellar artery, and posterior inferior cerebellar artery's first segment were classified based on their etiology, location, size, and shape. Demographic, clinical, angiographic, and procedural variables, as well as follow-up outcomes were evaluated.

Results Of 2542 IAs, 151 (5.9%) DIAs were counted (average size 5.4±2.9 mm), including 61 (40.4%) unruptured and 90 (59.6%) ruptured. No difference in the aneurysmal size was observed, but aneurysms smaller than 4 mm were observed more frequently in the ruptured group (36.7% vs 18%; P=0.01). In addition, ruptured DIAs were more often non-saccular (40% vs 18%; P=0.004) and irregular (93.3% vs 59%; P<0.001), They were treated mostly by coiling, glue, and parent artery sacrifice (P=0.02, P=0.006, and P=0.001), whereas unruptured DIAs were treated by stent-assisted coiling and flow-diverter stents (P=0.001 and P<0.001, respectively), without any differences in occlusion (81.6% vs 82.5%) and recanalization (21.1% vs 17.5%) rates. Procedure-related complications occurred in 20/151 (13.2%) patients, without any differences between subgroups. Ruptured DIAs were more often re-treated (18.4% vs 5.3%, P=0.02). In multivariate analyses, irregular shape appeared as an independent predictor of ruptured presentation (OR=8.1, 95% CI 3.0 to 21.7; P<0.001).

Conclusions Compared with unruptured DIAs, ruptured DIAs were more often non-saccular, irregular, and smaller than 4 mm. Despite different therapeutical approaches, ruptured and unruptured DIAs presented comparable occlusion and recanalization rates.

  • Aneurysm
  • Intervention
  • Technique
  • Complication

https://doi.org/10.1136/jnis-2023-021164

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • RC and AM are joint first authors.

    • Twitter @PietroPanni

    • PP and OFE contributed equally.

    • Contributors RC and AM contributed equally and share first authorship. OFE and PP share last authorship. RC, AM, ET, RR, ML, RM-G, and FT filled the main registry and revised all images. RC, AM, OFE, PP, and AF drafted the manuscript and carried out the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.