Sex-Specific Differences in Intracranial Aneurysm Rupture Presentation and Model Performance: Evidence from a...

Area of Science:

• Neurology
• Vascular Biology
• Biostatistics

Background:

• Intracranial aneurysms (IA) pose a significant health risk, with rupture leading to subarachnoid hemorrhage.
• Understanding sex-specific differences in IA rupture is critical for accurate risk stratification and clinical management.

Purpose of the Study:

• To investigate sex-specific differences in intracranial aneurysm rupture presentation.
• To compare the performance of sex-stratified versus pooled classification models in predicting IA rupture status.

Main Methods:

• Retrospective analysis of 303 intracranial aneurysms (IAs) from 203 patients (46 males, 157 females).
• Development of sex-specific logistic regression models incorporating clinical and lesion characteristics.
• Evaluation of model performance using cross-application between sexes.

Main Results:

• Female patients presented with smaller ruptured IAs (<5 mm) more often, particularly at the Anterior Communicating Artery (ACOM), with rupture risk peaking between ages 40-59.
• While males had higher hemoglobin, metabolic factors were more significant predictors in females (AUC-ROC: 0.80) than males (AUC-ROC: 0.50).
• Cross-application of models between sexes significantly reduced performance, indicating distinct biological feature spaces for rupture mechanisms.

Conclusions:

• Women in this cohort exhibited distinct IA rupture patterns (smaller size, midlife presentation) compared to men.
• Sex-specific risk factors and biological mechanisms for IA rupture necessitate tailored predictive models.
• Pooled risk models may misclassify rupture status; future research should focus on sex-inclusive, longitudinal studies for robust prediction tools.