A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

Tomofumi Takenaka; Hajime Nakamura; Shuhei Yamada; Tomoki Kidani; Akihiro Tateishi; Shingo Toyota; Toshiyuki Fujinaka; Takuyu Taki; Akatsuki Wakayama; Haruhiko Kishima

doi:10.1016/j.wnsx.2024.100370

A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

World Neurosurg X. 2024 Mar 25:23:100370. doi: 10.1016/j.wnsx.2024.100370. eCollection 2024 Jul.

Authors

Affiliations

¹ Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
² Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan.
³ Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
⁴ Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan.

Abstract

Objective: The risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms.

Methods: We retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021. We defined the NBA as the angle formed by the MCA aneurysm neck and M2 superior or inferior branch vessel line. The superior and inferior NBA were measured on admission via three-dimensional computed tomography angiography on admission. We divided the patients into clipping (106 patients) and coiling (22 patients) groups according to the treatment. Risk factors associated with procedural CI were analyzed in each group.

Results: Both groups showed that an enlarged superior NBA was a significant risk factor for procedural CI (clipping, P < 0.0005; coiling group, P = 0.007). The receiver operating characteristic curve showed the closed thresholds of the superior NBA with procedural CI in both groups (clipping group, 128.5°, sensitivity and specificity of 0.667 and 0.848, respectively; coiling group, 130.9°, sensitivity and specificity of 1 and 0.889, respectively).

Conclusion: The NBA can estimate the procedural risk of ruptured MCA aneurysms. In addition, an enlarged superior NBA is a risk factor for procedural CI in both clipping and coiling techniques.

Keywords: Ischemic complication; Middle cerebral artery aneurysms; Subarachnoid hemorrhage.