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MIAs (Mirror Intracranial Aneurysms): symmetry-related patient risk or consequence of multiplicity?
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Journal Article
MIAs (Mirror Intracranial Aneurysms): symmetry-related patient risk or consequence of multiplicity?
2025
Overview
Purpose
Determine whether mirror intracranial aneurysms (MIAs) confer risk beyond aneurysm multiplicity and describe their distribution and longitudinal change.
Methods
Retrospective two-centre UK cohort of unruptured intracranial aneurysms (UIAs) diagnosed 2006–2020; outcomes to 2022. Endpoints: first rupture, SAH-specific/all-cause mortality, time to treatment, and lesion-level growth/morphology change. Rates used Poisson models with person-time offsets; lesion-level risks used GEE (modified Poisson). Rupture-free survival used inverse-probability-weighted Kaplan–Meier. Models adjusted for baseline aneurysm count.
Results
1,985 UIAs were identified; 289 (14.6%) were MIAs. MIAs clustered at the MCA bifurcation (57.8%) and ICA terminus (34.6%). First-rupture incidence was higher in MIAs (1.74/100 person-years (PY)) than aMIAs (0.76/100 PY) or SIAs (0.39/100 PY); MIA > SIA IRR 4.46 (
q
= 0.0003), MIA > aMIA IRR 2.29 (
q
= 0.0044). SAH-specific mortality incidence was higher in MIAs (1.21/100 PY) than SIAs (0.36/100 PY; IRR 3.36,
q
= 0.0057) and aMIAs (0.19/100 PY; IRR 6.37,
q
= 0.0002). IPW survival was poorer for MIAs vs aMIAs (weighted log-rank χ
2
= 9.95,
p
= 0.0016) and vs SIAs (χ
2
= 18.09,
p
= 2.11 × 10⁻
5
). Lesion-level GEE showed no symmetry-specific increase in rupture risk (omnibus
p
= 0.72). Lesion-level growth ≥ 1 mm (RR 1.67,
q
= 0.0380) and morphology change (RR 2.10,
q
= 0.0121) were higher in MIAs. With aneurysm count adjustment, effects attenuated with wide CIs, consistent with limited power.
Conclusion
MIAs were associated with higher patient-time rupture and SAH-specific mortality and greater lesion-level instability, but not with an independent per-aneurysm rupture hazard. The excess patient-level risk is largely explained by exposure (multiplicity); a symmetry-related effect remains plausible but unconfirmed. Larger, prospectively harmonised datasets are needed.
Publisher
Springer Vienna,Springer Nature B.V
Subject
/ Aged
/ Aneurysm
/ Aneurysm, Ruptured - epidemiology
/ Female
/ Humans
/ Intracranial Aneurysm - diagnostic imaging
/ Intracranial Aneurysm - epidemiology
/ Intracranial Aneurysm - mortality
/ Intracranial Aneurysm - pathology
/ Lesions
/ Male
/ Medicine
/ Rupture
/ Subarachnoid Hemorrhage - epidemiology
/ Subarachnoid Hemorrhage - mortality
/ Survival
