Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 1;92(2):370-381.
doi: 10.1227/neu.0000000000002212. Epub 2022 Nov 17.

Impact of Very Small Aneurysm Size and Anterior Communicating Segment Location on Outcome after Aneurysmal Subarachnoid Hemorrhage

Michel Roethlisberger  1 , Soheila Aghlmandi  2 , Jonathan Rychen  1 , Alessio Chiappini  1 , Daniel W Zumofen  3 , Schatlo Bawarjan  4 , Martin N Stienen  5   6 , Christian Fung  7   8 , Donato D'Alonzo  9 , Nicolai Maldaner  5 , Valentin K Steinsiepe  6 , Marco V Corniola  10 , Johannes Goldberg  8 , Alessandro Cianfoni  11 , Thomas Robert  11 , Rodolfo Maduri  12 , Guillaume Saliou  13 , Daniele Starnoni  13 , Johannes Weber  6 , Martin A Seule  6 , Jan Gralla  8 , David Bervini  8 , Zsolt Kulcsar  5 , Jan-Karl Burkhardt  14 , Oliver Bozinov  5   6 , Luca Remonda  9 , Serge Marbacher  9 , Karl-Olof Lövblad  10 , Marios Psychogios  1 , Heiner C Bucher  2 , Luigi Mariani  1 , Philippe Bijlenga  10 , Kristine A Blackham  1 , Raphael Guzman  1 ; Swiss SOS group
Affiliations

Impact of Very Small Aneurysm Size and Anterior Communicating Segment Location on Outcome after Aneurysmal Subarachnoid Hemorrhage

Michel Roethlisberger et al. Neurosurgery. .

Abstract

Background: Very small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated.

Objective: To assess the clinical and radiological outcome(s) of patients with aSAH diagnosed with vsACoA after aneurysm treatment and at discharge.

Methods: Information on n = 1868 patients was collected in the Swiss Subarachnoid Hemorrhage Outcome Study registry between 2009 and 2014. The presence of a new focal neurological deficit at discharge, functional status (modified Rankin scale), mortality rates, and procedural complications (in-hospital rebleeding and presence of a new stroke on computed tomography) was assessed for vsACoA and compared with the results observed for aneurysms in other locations and with diameters of 5 to 25 mm.

Results: This study analyzed n = 1258 patients with aSAH, n = 439 of which had a documented ruptured ACoA. ACoA location was found in 38% (n = 144/384) of all very small ruptured aneurysms. A higher in-hospital bleeding rate was found in vsACoA compared with non-ACoA locations (2.8 vs 2.1%), especially when endovascularly treated (2.1% vs 0.5%). In multivariate analysis, aneurysm size of 5 to 25 mm, and not ACoA location, was an independent risk factor for a new focal neurological deficit and a higher modified Rankin scale at discharge. Neither very small aneurysm size nor ACoA location was associated with higher mortality rates at discharge or the occurrence of a peri-interventional stroke.

Conclusion: Very small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.

PubMed Disclaimer

Comment in

References

    1. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med. 1998;339(24):1725-1733.
    1. Morita A, Kirino T, Hashi K, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474-2482.
    1. Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: SUAVe study, Japan. Stroke. 2010;41(9):1969-1977.
    1. Waqas M, Chin F, Rajabzadeh-Oghaz H, et al. Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien). 2020;162(6):1353-1362.
    1. Bender MT, Wendt H, Monarch T, et al. Small aneurysms account for the majority and increasing percentage of aneurysmal subarachnoid hemorrhage: a 25-year, single institution study. Neurosurgery. 2018;83(4):692-699.

Publication types

MeSH terms