scholarly journals Rapid Documented Growth of Aneurysm Bleb Led to Rupture of an Incidental Intracranial Anterior Communicating Artery Aneurysm

2017 ◽  
Vol 78 (05) ◽  
pp. 521-524 ◽  
Author(s):  
Jorn Fierstra ◽  
Giuseppe Esposito ◽  
Gerasimos Baltsavias ◽  
Oliver Bozinov ◽  
Luca Regli ◽  
...  
Keyword(s):  
High Risk ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Short Term ◽  
Anterior Communicating Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Background A major challenge in the management of patients with unruptured intracranial aneurysms (UIAs) is to identify criteria indicating a higher risk of future UIA rupture. We report a rare patient with documented short-term bleb growth of an UIA followed by a fatal aneurysm rupture supporting the high risk of rupture of short-term shape changes in UIAs. Case Description A 72-year-old man with an incidental unruptured anterior communicating artery aneurysm of 9 mm showed a bleb growth on the aneurysm sac at 6-week follow-up computed tomography angiography (CTA). Aneurysm treatment was recommended by the interdisciplinary board (PHASES score: 9 points; rupture risk 4.3% in 5 years). The patient wanted to discuss the treatment plan with his family before making a final decision. Two days after the CTA showing bleb growth, he was admitted emergently with a severe subarachnoid hemorrhage (SAH) (World Federation of Neurologic Surgeons grade 5; Fisher 3). The aneurysm was occluded with coils. However, the patient died on day 14 after SAH due to delayed ischemic neurologic deficits and multiple organ failure. Conclusions This case illustrates the high rupture risk of an UIA presenting a documented growth of an aneurysm bleb over a short follow-up time. In retrospect, this patient might have benefited from emergent aneurysm occlusion. The interest of this report comes from the proof that aneurysmal bleb growth constitutes a high risk for short-term aneurysm rupture.

Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

2017 ◽  
Vol 78 (06) ◽  
pp. 610-616 ◽  
Author(s):  
Helena Švihlová ◽  
Alena Sejkorová ◽  
Tomáš Radovnický ◽  
Daniel Adámek ◽  
Jaroslav Hron ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Rupture Risk ◽  
Anterior Communicating Artery Aneurysm ◽  
Computational Fluid Dynamics Cfd ◽  
Inflow Jet ◽  
Rupture Site

AbstractComputational fluid dynamics (CFD) has been studied as a tool for the stratification of aneurysm rupture risk. We performed CFD analysis in a patient operated on for a ruptured anterior communicating artery aneurysm. The point of rupture was identified during surgery. The aneurysm and blood vessels were segmented from computed tomography angiography to prepare a model for simulations. We found that the streamlines showed a concentrated inflow jet directed straight at the rupture point, and high wall shear stress was found at the point of rupture in the aneurysm sac. Thus specific local hemodynamics may be indicative of the aneurysm rupture site.

scholarly journals Clinical relevance of short-term follow-up of unruptured intracranial aneurysms

2019 ◽  
Vol 47 (1) ◽  
pp. E7 ◽  
Author(s):  
Rob Molenberg ◽  
Marlien W. Aalbers ◽  
Jan D. M. Metzemaekers ◽  
Aryan Mazuri ◽  
Gert-Jan Luijckx ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Intracranial Aneurysms ◽  
Significant Risk ◽  
Patient Specific ◽  
Rupture Risk ◽  
Short Term ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture

OBJECTIVEUnruptured intracranial aneurysms are common incidental findings on brain imaging. Short-term follow-up for conservatively treated aneurysms is routinely performed in most cerebrovascular centers, although its clinical relevance remains unclear. In this study, the authors assessed the extent of growth as well as the rupture risk during short-term follow-up of conservatively treated unruptured intracranial aneurysms. In addition, the influence of patient-specific and aneurysm-specific factors on growth and rupture risk was investigated.METHODSThe authors queried their prospective institutional neurovascular registry to identify patients with unruptured intracranial aneurysms and short-term follow-up imaging, defined as follow-up MRA and/or CTA within 3 months to 2 years after initial diagnosis. Medical records and questionnaires were used to acquire baseline information. The authors measured aneurysm size at baseline and at follow-up to detect growth. Rupture was defined as a CT scan–proven and/or CSF-proven subarachnoid hemorrhage (SAH).RESULTSA total of 206 consecutive patients with 267 conservatively managed unruptured aneurysms underwent short-term follow-up at the authors’ center. Seven aneurysms (2.6%) enlarged during a median follow-up duration of 1 year (range 0.3–2.0 years). One aneurysm (0.4%) ruptured 10 months after initial discovery. Statistically significant risk factors for growth or rupture were autosomal-dominant polycystic kidney disease (RR 8.3, 95% CI 2.0–34.7), aspect ratio > 1.6 or size ratio > 3 (RR 10.8, 95% CI 2.2–52.2), and initial size ≥ 7 mm (RR 10.7, 95% CI 2.7–42.8).CONCLUSIONSSignificant growth of unruptured intracranial aneurysms may occur in a small proportion of patients during short-term follow-up. As aneurysm growth is associated with an increased risk of rupture, the authors advocate that short-term follow-up is clinically relevant and has an important role in reducing the risk of a potential SAH.

Analysis of Anterior Cerebral Artery Tortuosity: Association with Anterior Communicating Artery Aneurysm Rupture

2019 ◽  
Vol 122 ◽  
pp. e480-e486 ◽  
Author(s):  
Roger M. Krzyżewski ◽  
Kornelia M. Kliś ◽  
Borys M. Kwinta ◽  
Małgorzata Gackowska ◽  
Krzysztof Stachura ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm

Ruptured anterior communicating artery aneurysm encased in a tuberculum sellae meningioma

1999 ◽  
Vol 91 (5) ◽  
pp. 871-874 ◽  
Author(s):  
Masahiro Ogino ◽  
Masashi Nakatsukasa ◽  
Toru Nakagawa ◽  
Ikuro Murase
Keyword(s):  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Resonance Imaging ◽  
Content Type ◽  
Intratumoral Hemorrhage ◽  
Tuberculum Sellae Meningioma ◽  
Anterior Communicating Artery Aneurysm ◽  
Preoperative Magnetic Resonance ◽  
Tuberculum Sellae

✓ This 70-year-old woman suffered a subarachnoid hemorrhage (SAH) from a ruptured anterior communicating artery aneurysm encased in a meningioma in the tuberculum sellae. Although preoperative magnetic resonance imaging disclosed that the aneurysmal complex was completely enclosed in the tumor, angiographic studies did not reveal arterial narrowing. The embedded aneurysm caused diffuse SAH rather than intratumoral hemorrhage. These factors indicated very little adhesion between the tumor and the encased arteries. Surgery was performed on the 20th day post-SAH. Intraoperative findings revealed that the tumor did not adhere to the enclosed vasculature except at the point of rupture of the aneurysm. The authors were able to clip the aneurysm safely after piecemeal removal of the tumor, which was finally extirpated without fear of aneurysm rupture. Careful stepwise procedures were essential to treat the aneurysm and the tumor simultaneously.

scholarly journals PHASES Score for Prediction of Intracranial Aneurysm Growth

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1221-1226 ◽  
Author(s):  
Daan Backes ◽  
Mervyn D.I. Vergouwen ◽  
Andreas T. Tiel Groenestege ◽  
A. Stijntje E. Bor ◽  
Birgitta K. Velthuis ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Cox Regression ◽  
Continuous Variable ◽  
Aneurysm Rupture ◽  
Hazard Ratios ◽  
Unruptured Intracranial Aneurysms ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Aneurysm Growth

Background and Purpose— Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods— In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results— We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5–10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22–1.43). With the lowest quartile of the PHASES score (0–1) as reference, hazard ratios were for the second (PHASES 2–3) 1.07 (95% CI, 0.49–2.32), the third (PHASES 4) 2.29 (95% CI, 1.05–4.95), and the fourth quartile (PHASES 5–14) 2.85 (95% CI, 1.43–5.67). Conclusions— Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

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