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Angiographic characteristics of ruptured paraclinoid aneurysms: risk factors for rupture

 Se-yang Oh  ;  Myeong Jin Kim  ;  Byung Moon Kim  ;  Kwan Sung Lee  ;  Bum-soo Kim  ;  Yong Sam Shin 
 ACTA NEUROCHIRURGICA, Vol.155(8) : 1493-1499, 2013 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured/diagnosis ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/pathology* ; Angiography*/methods ; Female ; Humans ; Intracranial Aneurysm/diagnosis ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/pathology* ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Young Adult
Paraclinoid aneurysm ; Endovascular treatment ; Microsurgical treatment ; Subarachnoid hemorrhage
BACKGROUND: The diagnosis and treatment of unruptured paraclinoid aneurysms has been increasing with the recent advent of diagnostic tools and less invasive endovascular therapeutic options. Considering the low incidence of rupture, investigation of the characteristics of ruptured paraclinoid aneurysm is important to predict rupture risk of the paraclinoid aneurysms. The objective of this study is to evaluate probable factors for rupture by analyzing the characteristics of ruptured paraclinoid aneurysms. METHODS: A total of 2,276 aneurysms (1,419 ruptured and 857 unruptured) were diagnosed and treated endovascularly or microsurgically between 2001 and 2011. Among them, 265 were paraclinoid aneurysms, of which 37 were ruptured. Removing 12 blister-like aneurysms, 25 ruptured and 228 unruptured saccular aneurysms were included and the medical records and radiological images were retrospectively analyzed. RESULTS: Of 25 aneurysms, 16 (64.0%) were located in the superior direction. Five were inferior located lesions (20%) and four were medially located lesions (16.0%). Laterally located lesions were not found. The mean size of aneurysms was 9.4 ± 5.6 mm. Ten aneurysms (40.0%) were ≥ 10 mm in size. Thirteen aneurysms (52.0%) were lobulated. The superiorly located aneurysms were larger than the other aneurysms (10.3 ± 5.8 mm vs. 7.7 ± 4.9 mm) and more frequently lobulated (ten of 16 vs. three of nine). In a comparative analysis, the ruptured aneurysms were located more in the superior direction compared with unruptured aneurysms (64 vs. 23.2%, p < 0.0001). Large aneurysms (36.0 vs. 7.9%, p < 0.0001), longer fundus diameter (mean 9.4 ± 5.6 vs. 4.8 ± 3.3 mm, p = 0.001), dome-to-neck ratio (mean 1.8 ± 0.9 vs. 1.2 ± 0.5, p < 0.0001), and lobulated shape aneurysms were more likely to be ruptured aneurysms (13 of 25 ruptured aneurysms, 52.0%, p = 0.001). CONCLUSIONS: Rupture risk of the paraclinoid aneurysm is very low. However, superiorly located paraclinoid aneurysms appear more likely to rupture than other locations. Angiographically, more conservative indication for the treatment of paraclinoid aneurysm should be recommended except for superior located lesions.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
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