Morphological, Hemodynamic, and Clinical Independent Risk Factors for Anterior Communicating Artery Aneurysms

Abstract

Background and Purpose-The pathogenesis of cerebral aneurysms still raises some controversies. The aim of this study was to identify morphological, hemodynamic, and clinical independent risk factors for anterior communicating artery (ACoA) aneurysm development. Methods-Computed tomography angiography and transcranial color-coded sonography were performed in 77 patients with a nonbleeding ACoA aneurysm and in 73 controls. Symmetry of A1 segments of the anterior cerebral arteries, angles between A1 and A2 segments, tortuosity, diameter, mean velocity (V m ), pulsatility index, and volume flow rate in both A1 segments were determined. Moreover, all study participants completed a survey on their medical history. Multivariate backward stepwise logistic regression analysis was performed to identify independent risk factors for ACoA aneurysm development. Results-Smoking, hypertension, asymmetry of A1 segments, the angle between A1 and A2 segments, A1 segment diameter, V m , pulsatility index, and volume flow rate turned out to be associated with the occurrence of ACoA aneurysms on univariate analysis. Multivariate analysis identified smoking (odds ratio, 2.036; 95% confidence interval, 1.277-3.245), asymmetry of A1 segments >40% (odds ratio, 2.524; 95% confidence interval, 1.275-4.996), pulsatility index (odds ratio, 0.004; 95% confidence interval, 0.000-0.124), and the angle between A1 and A2 segments ≤100° (odds ratio, 4.665; 95% confidence interval, 2.247-9.687) as independent strong risk factors for ACoA aneurysm development. Conclusions-The risk of ACoA aneurysm formation is determined by several independent clinical, morphological, and hemodynamic factors. The strongest independent risk factors include smoking, asymmetry of A1 segments >40%, low blood flow pulsatility, and the angle between A1 and A2 segments ≤100°. (Stroke. 2014;45:2906-2911.)

Small versus Large Ruptured Intracranial Aneurysm: Concerns with the Site of Aneurysm

“…It is well known that the formation of Acom aneurysms is associated with the hemodynamics in cases with A1 dysplasia or hypoplasia [9]. Increased wall shear stress and flow velocity in the unilateral A1 may enhance the formation of Acom aneurysm [10].…”

Morphological and hemodynamic analysis of posterior communicating artery aneurysms prone to rupture: a matched case–control study

“…Kaspera et al 15 found that the risk of anterior communicating artery aneurysm formation is determined by several independent clinical, morphological, and hemodynamic factors. The strongest independent risk factors include smoking, asymmetry of A1 segments >40%, low blood flow pulsatility, and angle between A1 and A2 segments ≤100°.…”

Pulsatility Index as a Diagnostic Parameter of Reciprocating Wall Shear Stress Parameters in Physiological Pulsating Waveforms

“…Vascular remodeling and dysfunction were correlated with reciprocating WSS parameters such as the oscillatory shear index (OSI) [4], WSS gradients, percentage of negative wall shear stress (P[%]) or the ratio of minimum to maximum shear stress rates ( min/max ) [5–7]. WSS parameters were shown to have positive correlation with a large variety of vascular dysfunction mechanisms such as reduction in Nitric Oxide (NO) production, endothelial cell activation and platelet adhesion leading to vascular pathologies, including intimal hyperplasia [8], atherosclerosis [9], early plaque deposition and arterial thrombogenesis [10–12], plaque progression [4,6] and vulnerability [13], arterial aneurysm location [14,15], growth [16] and rupture [17,18].…”

“…PI is readily accessible in-vivo [34]. It has been shown to correlate with presence of arterial stenosis [35], and been recently recognized as an important factor in aneurysmal flows [7,15,18,36] or acute intracerebral hemorrhage [37]. In a different context, the PI is called reverse/forward flow index (measured in percent, see Hashimoto and Ito [38], for instance) and it shows correlations with the pulse pressure amplification and arterial stiffness.…”