Highlights
- •The coexistence of ACA A1 segment agenesis/hypoplasia and fPCA increased aneurysm rupture in patients with AComA aneurysms.
- •The size of AComA aneurysms alone is not a guide for rupture.
- •Circle of Willis variations should be evaluated in detail in order to decide on treatment in AcomA aneurysms.
Abstract
Purpose
To investigate the effect of the coexistence of fetal-type posterior communicating
artery (fPCA) and anterior cerebral artery (ACA) A1 segment agenesis/hypoplasia on
the rupture of an anterior communicating artery (AComA) aneurysm.
Materials and Methods
A total of 216 patients consecutively presenting with AComA aneurysms between January
2014 and December 2021 on digital subtraction angiography were evaluated. Patients
without three-dimensional rotational angiography images, those aged under 18 years,
those with suspected mycotic aneurysms, and those with dissecting and giant aneurysms
were excluded from the study. The aneurysms were divided into two groups as ruptured
and non-ruptured. Hemodynamic filling patterns were classified into four different
types.
Results
The study included 192 AComA aneurysms, 44.8% (n = 86) ruptured and 55.2% (n = 106)
non-ruptured. According to hemodynamic filling patterns, in type 1, the frequency
of non-ruptured aneurysms was statistically significantly higher than that of ruptured
aneurysms (39.5% vs 18.9%; p = 0.001). In type 4, where fPCA and ACA A1 segment agenesis/hypoplasia
coexists, the frequency of ruptured aneurysms was significantly higher than that of
non-ruptured aneurysms (10.5% vs 22.7%; p = 0.026). The most common aneurysm size
range was 4–7 mm (n = 85; 44.3%). There was no statistically significant difference
in size between the ruptured and non-ruptured aneurysms (p = 0.627).
Conclusion
According to the hemodynamic filling classification, we observed that the presence
of type 4 filling pattern, i.e., the coexistence of ACA A1 segment agenesis/hypoplasia
and fPCA, increased the risk of rupture in AComA aneurysms.
Keywords
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Article info
Publication history
Accepted:
February 15,
2023
Received:
December 18,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
