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Purpose <p>Determine whether mirror intracranial aneurysms (MIAs) confer risk beyond aneurysm multiplicity and describe their distribution and longitudinal change.</p> Methods <p>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.</p> Results <p>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 &gt; SIA IRR 4.46 (<i>q</i> = 0.0003), MIA &gt; aMIA IRR 2.29 (<i>q</i> = 0.0044). SAH-specific mortality incidence was higher in MIAs (1.21/100 PY) than SIAs (0.36/100 PY; IRR 3.36, <i>q</i> = 0.0057) and aMIAs (0.19/100 PY; IRR 6.37, <i>q</i> = 0.0002). IPW survival was poorer for MIAs vs aMIAs (weighted log-rank χ<sup>2</sup> = 9.95, <i>p</i> = 0.0016) and vs SIAs (χ<sup>2</sup> = 18.09, <i>p</i> = 2.11 × 10⁻<sup>5</sup>). Lesion-level GEE showed no symmetry-specific increase in rupture risk (omnibus <i>p</i> = 0.72). Lesion-level growth ≥ 1&#xa0;mm (RR 1.67, <i>q</i> = 0.0380) and morphology change (RR 2.10, <i>q</i> = 0.0121) were higher in MIAs. With aneurysm count adjustment, effects attenuated with wide CIs, consistent with limited power.</p> Conclusion <p>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.</p>

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MIAs (Mirror Intracranial Aneurysms): symmetry-related patient risk or consequence of multiplicity?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月26日

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  • Bartlomiej Roj,
  • Rosa Sun,
  • Lucie Ferguson,
  • Nitin Mukerji

摘要

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 χ2 = 9.95, p = 0.0016) and vs SIAs (χ2 = 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.