Association of Menopausal Age with Unruptured Intracranial Aneurysm Morphology

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Background: The prevalence of unruptured intracranial aneurysms (UIAs) increases rapidly in aging women compared with younger women. The impact of menopausal age on UIAs and treatment outcomes with endovascular therapy has not been well studied. We hypothesized that premenopausal age may have a protective effect on presentation size and treatment outcomes. Objective: To evaluate the association of menopause with UIA size and outcome with endovascular therapy. Methods: Retrospective analysis of consecutive female patients with UIAs treated with endovascular therapy at our academic tertiary care center. UIA characteristics, complications, and outcomes were recorded and compared. Results: 117 patients were included: 23 patients in the premenopausal age (PRM) group and 94 in the postmenopausal age (POM) group. 93.6% of all aneurysms in the PRM group were in the internal carotid artery (ICA) segments (p < 0.05). Hence only ICA segment aneurysms were further studied. A total of 21 patients in the PRM group and 60 in the POM group were found to have ICA segment aneurysms. Baseline characteristics were similar between the 2 groups. The mean size of the aneurysms in the PRM group was 8.6 ± 3.9 versus 10.8 ± 5.6 mm in the POM group (p = 0.055). There was a trend to higher aneurysm neck size seen in the POM group (4.7 ± 2.5 vs. 3.7 ± 1.7 mm; p = 0.07). The number of aneurysm lobes was higher in the PRM group (1.23 ± 0.54 vs. 1.07 ± 0.31; p = 0.18). In multivariate analysis, the PRM group had a significantly higher number of UIA lobes. Complications and endovascular therapy outcomes were similar between the 2 groups. Conclusions: A trend to increased UIA maximal diameter and neck size was seen in the POM group compared to the PRM group. The PRM group had a significantly higher number of UIA lobes. Larger prospective trials are needed to confirm these findings.

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