J Cerebrovasc Endovasc Neurosurg.  2021 Mar;23(1):1-5. 10.7461/jcen.2020.E2020.07.001.

Characteristics of patients with ruptured very small intracranial aneurysm sized less than 3 mm

• Park GT
• Kim JH
• Jung YJ
• Chang CH

• KMID: 2514332
• DOI: http://doi.org/10.7461/jcen.2020.E2020.07.001

Abstract

Objective
If the size of an intracranial aneurysm is below 3 mm, clinicians rarely treat them because of the low risk of rupture. But subarachnoid hemorrhage (SAH) due to the rupture of very small intracranial aneurysm (VSIA) (saccular aneurysm sized less than 3 mm) may lead to many critical neurological complications. So we analyzed the characteristics and differences between the ruptured VSIA group and the ruptured non-VSIA group.
Methods
421 saccular aneurysms from patients with SAH between January 2016 and December 2019 were included. Patient information including age, sex, and medical history and information about the aneurysm including location, size, aspect ratio, inflow angle, and height-width ratio were collected. And we compared the VSIA group with non-VSIA group about these characteristics
Results
12.1% (51/421) of the aneurysms were included in the VSIA group, while the non-VSIA group consisted of 87.9% of the aneurysms (370/421). The female predominance was significantly higher in the VSIA group than that in the non-VSIA group (p=0.011). No significant difference was observed in location, medical history, height-width ratio between the groups. The mean value of the inflow angle in the VSIA group was much lower than that in the non-VSIA group, but no statistically significant association between rupture risk and the inflow angle was observed. The average aspect ratio was significantly lower than that in the non-VSIA group.
Conclusions
Ruptured VSIA group has higher percentage of females and lower aspect ratio than ruptured non-VSIA group. Further studies regarding the characteristics of ruptured and unruptured VSIA patients is required for assistance in clinical decision related to treatment of VSIA group before the aneurysmal sac rupture.

Keyword

Intracranial aneurysm; Subarachnoid hemorrhage

Figure

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  Fig. 1. Three-dimensional digital subtraction angiography reconstruction image of a ruptured very small intracranial aneurysm on the anterior communicating artery. Intracranial aneurysm size was determined using the following parameters. A. Neck, B. Height, and C. Width.

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  Fig. 2. Three-dimensional digital subtraction angiography reconstruction image of a ruptured very small intracranial aneurysm. Inflow angle was defined as the angle between the parent vessel’s flow and the aneurysm height. A. inflow angle, B. parent vessel flow, C. aneurysm height direction.

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