Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis

J Neurosurg. 2011 Apr;114(4):994-1002. doi: 10.3171/2010.8.JNS10241. Epub 2010 Oct 8.


Object: The goal was to investigate whether morphological features of aneurysms can be identified that determine initial success and recurrence rates of coiled aneurysms of the basilar artery tip, the posterior communicating artery (PCoA), and the anterior communicating artery.

Methods: The authors evaluated 202 aneurysms in connection with their pretreatment morphological features including size, neck-to-dome ratio, angulation of the aneurysm in relation to the parent artery, orientation of the aneurysm dome, and associated anatomical variations. The mean follow-up was 19 months (range 6-96 months) after endovascular coil occlusion. Using multivariate logistic regression, probabilities for initial complete occlusion and long-term stability of the treatment were calculated.

Results: Recanalization occurred in 49 of 202 cases. Favorable factors for long-term stability included small aneurysms with small necks. However, additional factors related to local hemodynamic forces could be identified for the different aneurysm locations, which may influence initial success rates and long-term stability of aneurysm treatment with endovascular coiling. These factors were a medial dome orientation and a symmetrical disposition of both A(1) segments (for the anterior communicating artery), a posteroinferior dome orientation and a small-size PCoA (for the PCoA), and a cranial symmetrical fusion (for the basilar artery tip).

Conclusions: A detailed pretreatment analysis of morphological features of aneurysms may help to determine those aneurysms that are more prone to recurrence, which could add to the treatment decision and the follow-up algorithm.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / surgery
  • Aneurysm, Ruptured / therapy
  • Angiography, Digital Subtraction
  • Anterior Cerebral Artery / pathology
  • Anterior Cerebral Artery / surgery
  • Basilar Artery / pathology
  • Basilar Artery / surgery
  • Cerebral Angiography
  • Embolization, Therapeutic
  • Endovascular Procedures*
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Intracranial Aneurysm / pathology*
  • Intracranial Aneurysm / surgery*
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neurosurgical Procedures*
  • Posterior Cerebral Artery / pathology
  • Posterior Cerebral Artery / surgery
  • Recurrence
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult