Predictors for Occurrence and Anatomical Distribution of Multiple Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage.

Roethlisberger, Michel; Achermann, Rita; Bawarjan, Schatlo; Stienen, Martin N; Fung, Christian; Dalonzo, Donato; Maldaner, Nicolai; Ferrari, Andrea; Corniola, Marco V; Schöni, Daniel Stephan; Valsecchi, Daniele; Maduri, Rodolfo; Seule, Martin A; Burkhardt, Jan-Karl; Marbacher, Serge; Bijlenga, Philippe; Blackham, Kristine A; Bucher, Heiner C; Mariani, Luigi; Guzman, Raphael; ... (2018). Predictors for Occurrence and Anatomical Distribution of Multiple Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage. World neurosurgery, 111, e199-e205. Elsevier 10.1016/j.wneu.2017.12.046

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BACKGROUND

Literature on multiple intracranial aneurysms (MIA) in patients with aneurysmal subarachnoid hemorrhage (aSAH) largely focuses on risk factor analysis and consists essentially of retrospective cohort studies of limited sample size, or else studies in populations outside Europe and North America.

OBJECTIVE

The purpose of this cohort study was to determine the predictors for aneurysm multiplicity and to investigate the anatomical distribution of MIA in a representative Western cohort of aSAH patients.

METHODS

The Swiss Study of Subarachnoid Hemorrhage (SOS) database includes anonymized data from all tertiary neurovascular facilities in Switzerland. The dataset 2009-2014 was used to compare characteristics of aSAH patients with MIA and aSAH patients with a single intracranial aneurysm (SIA) by means of descriptive and multivariate regression analysis.

RESULTS

Out of 1689 unselected aSAH patients, 467 had MIA (prevalence: 27.6%). The location of the ruptured index aneurysm was correlated with the probability of finding bystander aneurysm(s) and predicted their likely anatomical distribution. Patients with a ruptured basilar artery (OR 2.08, 95%CI 1.28-3.37) or a ruptured middle cerebral artery (OR 1.86, 95%CI 1.36-2.55) aneurysm had the highest likelihood for MIA. Larger size of the index aneurysm (OR per 1mm 1.03, 95%CI 1.01-1.06) was also positively correlated with aneurysm multiplicity. Males compared to females were less likely to have MIA (OR 0.78, 95%CI 0.61-1.01).

CONCLUSION

In patients suffering from aSAH the location of the ruptured index aneurysm correlates with the probability of finding bystander aneurysm(s) and predicts the sites where bystander aneurysm(s) are the most likely found.

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