X-ray and anatomical features of arterial aneurisms of bifurcation of basilary artery
Objective ‒ to determine the main x-ray anatomical characteristics of arterial aneurisms (AA) of bifurcation of basilar artery (BA) and predictors of hemorrhagic transformation, taking into account the main options for the course of the disease.
Materials and methods. Total on examination and treatment in the vascular departments of Romodanov Neurosurgery Institute for the period from 1998 to 2019 there were 687 (100 %) patients with AA of vertebrobasilar basin. AA of bifurcation of BA was diagnosed in 210 (30.6 %) patients. The hemorrhagic type of the course of the disease, in the presence of AA of bifurcation of BA occurred in 138 (65.7 %) cases. Asymptomatic unbroken AA of bifurcations of BA were detected in 58 (27.6 %) patients. The pseudotumor type of disease was diagnosed in 12 (5.7 %), ischemic in 2 (0.9 %) patients.
Results. The main variants of the clinical course of AA of bifurcation of BA are established. Given the X-ray and anatomical features, certain prevailing for a particular variant of the course of the disease, the most stable characteristics of AA of bifurcation of BA, including the size, shape, neck and the ratio of the height of the dome to the diameter of the neck of AA.
Conclusions. According to the results of the study, the main variants of the clinical course of AA of bifurcation of BA were identified: hemorrhagic (65.7 %), asymptomatic (27.6 %), pseudotumor (5.7 %) and ischemic (0.9 %). Localization of AA in the area of BA bifurcation is a rather formidable predictor of a possible hemorrhagic variant of the course of the disease (138 (65.7 %)) out of 210 patients). Based on the analysis of the results of the examination of patients with AA of bifurcation of BA with hemorrhagic disease, it should be considered that convincing factors (predictors) of a possible rupture of AA of bifurcation of BA are its sizes from 4 to 15 mm (81 %) in combination with complex (incorrect) form AA (76 %). With the size of AA of bifurcation of BA <4 mm or having sizes from 16 to 25 mm, the risk of hemorrhagic course is much lower, respectively 10.1 and 7.9 %. The ratio of the height of the dome to the width of the neck of the AA of bifurcation of BA >3.0, according to the results of our study, is not a predictor of the hemorrhagic course of AA of bifurcation of BA, in the presence of a narrow neck of AA. In the presence of a small size of AA of bifurcation of BA (<4 mm), regardless of its shape, the probability of hemorrhagic transformation, without taking into account risk factors and the results of dynamic observation of the size and shape of AA, is minimal. The probable factors that can explain the absence of hemorrhagic transformation of AA of bifurcation of BA with a pseudotumor course are the mismatch between the internal and external sizes of AA according to data of CT and SCAG, which indicate a significant thickness of the AA wall of this group and the presence of thrombogenesis or stratification in its cavity. The ischemic type of the course of the disease in the presence of AA of bifurcation of BA of large size, complex shape and wide neck of AA can be argued for by the presence of concomitant pronounced deformations of vertebral arteries in extracranial sections.
Eliava ShSh, Eristavi AR, Dobrovolskikh GF et al. Selection of surgical approach to aneurysms of distal basilar artery. Voprosy neyrokhirurgii. 2008;1: 37-43 (in Russian).
Lebedev VV, Krylov VV, Surgery of acute cerebral aneurysm rupture. Moscow: Meditsina;1996. 219 p. (in Russian).
Filatov YuM, Eliava ShSh, Myakota AE. Microsurgical treat- ment of posterior circulation aneurysms. Voprosy neyrokhirurgii. 1990;5: 3-6 (in Russian).
Drake CG, Peerless SJ, Hernesniemi UA. Surgery of vertebrobasilar aneurysms. London, Ontario experience on 1767 patients. Wein, New York: Springer Verlag;1996. DOI: 10.1007/978-3-7091-9409-6
Hernesniemi J. Aneurysms of vertebrobasilar tree. Acta Neurochir. (Wien). 2002;144 (4):411. PMID: 12083065
Yasargil MG. Microneurosugery. Vol. 1–2. Stuttgart: Thieme;1984.
Wiebers DO, Whisnant JP, Huston J 3rd et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103-10. PMID: 12867109 DOI: 10.1016/s0140-6736(03)13860-3
Krylov VV, Zavalishin EE. Surgical treatment of ruptured posterior circulation aneurysms. Neyro-khirurgiya. 2010;2:14-25 (in Russian).
Molyneux A, Kerr R, Stratton I et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360 (9342):1267-74. PMID: 12414200 DOI: 10.1016/s0140-6736(02)11314-6
Panarin VA, Krivoshapkin AL, Orlov KYu et al. Changes in strategy and treatment outcomes of cerebral aneurysms. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2012;3:35-9.
Pierot L, Boulin A, Castaings L et al. Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. J Neurosurgery. 1996;38(5):948-53. PMID: 8727820 DOI: 10.1097/00006123-199605000-00019
Pandey AS, Koebbe C, Rosenwasser RH et al. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery. 2007;60 (4):626-36. PMID: 17415199 DOI: 10.1227/01.NEU.0000255433.47044.8F
Tateshima S, Murayama Y, Gobin ER et al. Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils: anatomic and clinical outcomes in 73 patients from a single institution. Neurosurgery. 2000;47 (6):1332-9. PMID: 11126904
Wang GX, Yu JY, Wen L et al. Risk factors for the rupture of middle cerebral artery bifurcation aneurysms using CT angiography. PLoS One. 2016;11(12): e0166654. PMID: 27977691 PMCID: PMC5157982 DOI: 10.1371/journal.pone.0166654
Backes D, Vergouwen MD, Velthuis BK et al. Difference in aneurysm characteristics between ruptured and unruptured aneurysms in patients with multiple intracranial aneurysms. Stroke. 2014;45(5):1299-303. PMID: 24652309 DOI: 10.1161/STROKEAHA.113.004421
Inagawa T, Hada H, Katoh Y. Unruptured intracranial aneurysms in elderly patients. Surg Neurol. 1992;38(5):364-70. PMID: 1485213 DOI: 10.1016/0090-3019(92)90023-g
Shojima M, Morita A, Nakatomi H, Tominari S. Size is the most important predictor of aneurysm rupture among multiple cerebral aneurysms: post hoc subgroup analysis of unruptured cerebral aneurysm study Japan. Neurosurgery. 2017. DOI: 10.1093/neuros/nyx307
Wiebers DO, Whisnant JP, Huston J et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103-10. PMID: 12867109 DOI: 10.1016/s0140-6736(03)13860-3
Cai W, Hu C, Gong J, Lan Q. Anterior communica-ting artery aneurysm morphology and the risk of rupture. World Neurosurgery. 2018;109:119-26. PMID: 28958928 DOI: 10.1016/j.wneu.2017.09.118
Cai W, Shi D, Gong J et al. Are morphologic parameters actually correlated with the rupture status of anterior communicating artery aneurysms? World Neurosurgery. 2015;84(5):1278-83. PMID: 26054869 DOI: 10.1016/j.wneu.2015.05.060
Dhar S, Tremmel M, Mocco J et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery. 2008;63(2):185-97. PMID: 18797347 PMCID: PMC2570753 DOI: 10.1227/01.NEU.0000316847.64140.81
Jiang H, Weng YX, Zhu Y et al. Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system. Acta Neurochir. (Wien). 2016;158(7):1367-75. PMID: 27165300 DOI: 10.1007/s00701-016-2826-0
Huang ZQ, Meng ZH, Hou ZJ et al. Geometric parameter analysis of ruptured and unruptured aneurysms in patients with symmetric bilateral intracranial aneurysms: a multicenter ct angiography study. AJNR 2016;37(8):1413-7. PMID: 27102312 DOI: 10.3174/ajnr.A4764
Ivanov D, Dol A, Polienko A. Patient-specific hemodynamics and stress-strain state of cerebral aneurysms. Acta Bioeng Biomech. 2016;18(2):917. DOI: 10.5277/ABB-00373-2015-0
Orz Y, Alyamany M. The impact of size and location on rupture of intracranial aneurysms. Asian J Neurosurg. 2015;10(1):26-31. PMCID: PMC4352624
PMID: 25767572 doi: 10.4103/1793-5482.144159
Bijlenga P, Ebeling C, Jaegersberg M et al. Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms. Stroke. 2013;44(11):3018-26. PMID: 23899912 DOI: 10.1161/STROKEAHA.113.001667
Maslehaty H, Capone C, Frantsev R et al. Predictive anatomical factors for rupture in middle cerebral artery mirror bifurcation aneurysms. J Neurosurg. 2018;128(6):1799-807 PMID: 28841119 DOI: 10.3171/2017.2.JNS162705
Mehan WA, Romero JM, Hirsch JA et al. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morpho-logy and growth predict rupture? J Neurointerv Surg. 2014;6(10):761-6. PMID: 24275611 DOI: 10.1136/neurintsurg-2013-010944
Weir B, Amidei C, Kongable G et al. The aspect ratio (dome/neck) of ruptured and unruptured aneurysms. J Neurosurg. 2003;99(3):447-51. PMID: 12959428 DOI: 10.3171/jns.2003.99.3.0447
Thubrikar MJ. Vascular mechanics and pathology. New York: Springer Science+Business media; 2007. 494 p. DOI: 10.1007/978-0-387-68234-1
Lindgren AE, Koivisto T, Björkman J et al. Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort. Stroke. 2016;47(5):1219-26. PMID: 27073241 DOI: 10.1161/STROKEAHA.115.012404
Ujiie H, Tachibana H, Hiramatsu O et al. Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery. 1999;45(1):119-29. PMID: 10414574 DOI: 10.1097/00006123-199907000-00028
Ujiie H, Tamano Y, Sasaki K, Hori T. Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery. 2001;48(3):495-502. PMID: 11270538 DOI: 10.1097/00006123-200103000-00007
Weir B. Aneurysms affecting the nervous system. Baltimore: Williams & Wilkins; 1987. 671 p.
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