Journal Article

Blebs in intracranial aneurysms: prevalence and general characteristics

Mut, Fernando, Rezai Jahromi, Behnam, Amin-Hanjani, Sepideh, Detmer, Felicitas J, Zhou, Ji, Maiti, Spandan, See, Alfred P, Charbel, Fady T, Frösen, Juhana, Niemelä, Mika, Salimi Ashkezari, Seyedeh Fatemeh, Chung, Bong Jae, Cebral, Juan R, Robertson, Anne M, Yu, Alexander K, Stapleton, Christopher J

2021

Overview

BackgroundBlebs are rupture risk factors in intracranial aneurysms (IAs), but their prevalence, distribution, and associations with clinical factors as well as their causes and effects on aneurysm vulnerability remain unclear.MethodsA total of 122 blebs in 270 IAs selected for surgery were studied using patient-specific vascular reconstructions from 3D angiographic images. Bleb geometry, location on the aneurysm, and frequency of occurrence in aneurysms at different locations were analyzed. Associations between gender, age, smoking, hypertension, hormone therapy, dental infection, and presence of blebs were investigated.ResultsOf all aneurysms with blebs, 77% had a single bleb and 23% had multiple blebs. Only 6% of blebs were at the neck, while 46% were in the body and 48% in the dome. Aneurysms with blebs were larger (p<0.0001), more elongated (p=0.0002), and with wider necks than aneurysms without blebs. Bleb presence was associated with dental infection (p=0.0426) and negatively associated with hormone therapy (p=0.0426) in women. Anterior and posterior communicating arteries had larger percentages of aneurysms with blebs than internal carotid arteries. Patients with a history of hypertension tended to have a larger percentage of aneurysms with blebs. However, these trends did not reach significance in this sample.ConclusionsBlebs are common in IAs, and most aneurysms harboring blebs have a single bleb. Blebs in the aneurysm neck are rare, but they are equally common in the body and dome. The presence of blebs in IAs was associated with dental infection, and negatively associated with hormone replacement therapy.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Adult / Age / Aged / Aged, 80 and over / Agreements / aneurysm / Aneurysm, Ruptured - diagnostic imaging / Aneurysm, Ruptured - epidemiology / Aneurysm, Ruptured - surgery / Aneurysms / Carotid Artery, Internal - physiopathology / Cerebral Angiography - methods / Female / hemorrhage / Hemorrhagic Stroke / Humans / Hypertension / Hypertension - diagnostic imaging / Hypertension - epidemiology / Hypertension - surgery / Intracranial Aneurysm - diagnostic imaging / Intracranial Aneurysm - epidemiology / Intracranial Aneurysm - surgery / Male / Medical imaging / Middle Aged / Prevalence / Questionnaires / Risk Factors / Smoking - adverse effects / Smoking - epidemiology / Surgery / Three dimensional imaging