Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms

Lee, Young-Jun; Parreira, Tiago; Matouk, Charles; Menezes, Ravi; Mandell, Daniel M.; terBrugge, Karel G.; Willinsky, Robert A.; Krings, Timo

doi:10.1007/s00234-014-1437-9

Cited by 15 publications

(17 citation statements)

References 15 publications

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“…A previous study indicated that the characteristics or natural history of IAs in patients with multiple aneurysms might be different from those with a single IA. 40 For instance, it was reported that posterior circulation aneurysms were less frequent in patients with multiple IAs than in patients with a single aneurysm, which we also observed in our study (only 3% of IAs were located at the posterior circulation). Moreover, previous models were trained to discriminate ruptured cohorts from unruptured cohorts without associating the coexisting IAs within each patient.…”

Section: Discussionsupporting

confidence: 87%

Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms

Rajabzadeh-Oghaz

Wang

Varble

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In patients with SAH with multiple intracranial aneurysms, often the hemorrhage pattern does not indicate the rupture source. Angiographic findings (intracranial aneurysm size and shape) could help but may not be reliable. Our purpose was to test whether existing parameters could identify the ruptured intracranial aneurysm in patients with multiple intracranial aneurysms and whether composite predictive models could improve the identification. MATERIALS AND METHODS:We retrospectively collected angiographic and medical records of 93 patients with SAH with at least 2 intracranial aneurysms (total of 206 saccular intracranial aneurysms, 93 ruptured), in which the ruptured intracranial aneurysm was confirmed through surgery or definitive hemorrhage patterns. We calculated 13 morphologic and 10 hemodynamic parameters along with location and type (sidewall/bifurcation) and tested their ability to identify rupture in the 93 patients. To build predictive models, we randomly assigned 70 patients to training and 23 to holdout testing cohorts. Using a linear regression model with a customized cost function and 10-fold cross-validation, we trained 2 rupture identification models: RIM C using all parameters and RIM M excluding hemodynamics. RESULTS:The 25 study parameters had vastly different positive predictive values (31%-87%) for identifying rupture, the highest being size ratio at 87%. RIM C incorporated size ratio, undulation index, relative residence time, and type; RIM M had only size ratio, undulation index, and type. During cross-validation, positive predictive values for size ratio, RIM M , and RIM C were 86% 6 4%, 90% 6 4%, and 93% 6 4%, respectively. In testing, size ratio and RIM M had positive predictive values of 85%, while RIM C had 92%. CONCLUSIONS:Size ratio was the best individual factor for identifying the ruptured aneurysm; however, RIM C , followed by RIM M , outperformed existing parameters.ABBREVIATIONS: AR ¼ aspect ratio; CFD ¼ computational fluid dynamics; D ¼ maximum diameter; H ¼ height (perpendicular); H max ¼ maximum height; IA ¼ intracranial aneurysm; NWSS ¼ normalized wall shear stress; OSI ¼ oscillatory shear index; RIM ¼ rupture identification model; RRS ¼ rupture resemblance score; RRT ¼ relative residence time; SR ¼ size ratio; UI ¼ undulation index; WSS ¼ wall shear stress

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Section: Discussionsupporting

confidence: 87%

Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms

Rajabzadeh-Oghaz

Wang

Varble

et al. 2019

AJNR Am J Neuroradiol

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“…We also agree with the conclusions made by Lee et al in their study of over 200 mirror-like IAs. 22 They showed that the frequency of mirror-like IAs varies depending on the location, with mirror-like IAs being overrepresented among intracavernous IAs, for example. It suggests that different pathophysiological mechanisms may be at the root of the different aneurysm locations.…”

Section: Discussionmentioning

confidence: 99%

Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery?

Bourcier

Lenoble

Guyomarc’h-Delasalle

et al. 2017

Journal of Neurosurgery

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OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A segments and the angle between the A and A segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A-A angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A-A angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.

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“…Mirror intracranial aneurysms occur in 2–12% of all patients with intracranial aneurysms ( 11 12 14 16 ). Despite their frequency of occurrence, they are not well studied.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, they reported middle cerebral artery (MCA) as the most common site of mirror aneurysms, followed by a non-cavernous internal carotid artery (ICA), posterior communicating artery (PcomA), and cavernous ICA. However, the findings of Lee et al ( 12 ) were controversial. As per the study, there existed a difference of opinion regarding female predisposition and a family history of intracranial aneurysm and cited to be similar to non-mirror aneurysms; and a predilection shown for cavernous ICA was contrary to the results of Meissner et al ( 11 ).…”

Section: Introductionmentioning

confidence: 97%

“…Mirror aneurysms are a subset of multiple aneurysms that comprise 2–12% of all intracranial aneurysms. Different terminologies for mirror aneurysms have been described in previous reports (i.e., mirror intracranial multiple aneurysms, mirror-like intracranial aneurysm, and intracranial mirror aneurysm) along with different definitions ( 11 12 13 14 15 16 ). In the present study, the term ‘a mirror aneurysm’ was employed and defined as ‘aneurysms developing bilaterally and symmetrically on same-named vessels.’…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

et al. 2018

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ObjectiveMirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options.Materials and MethodsA retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed.ResultsIn study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ≤ 10 mm, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality.ConclusionBy adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.

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Clinical characteristics and preferential location of intracranial mirror aneurysms: a comparison with non-mirror multiple and single aneurysms

Abstract: Patients with mirror aneurysms had similar clinical characteristics to non-mirror multiple aneurysm patients. Mirror aneurysms showed a predilection for the cavernous carotid artery, whereas they were comparatively rare in the posterior circulation.

Cited by 15 publications

References 15 publications

Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms

Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms

Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery?

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

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