Morphological and hemodynamic predictors of rupture in anterior communicating artery aneurysms: a retrospective...

This study aims to investigate the association of clinical characteristics, vascular morphological features, and hemodynamic parameters with rupture risk in anterior communicating artery (ACoA) aneurysms.

A retrospective analysis was conducted on 293 patients with ACoA aneurysms, categorized into ruptured and unruptured groups. Clinical data, vascular morphological parameters, and hemodynamic variables were compared between groups. Binary logistic regression analysis was used to identify independent predictors of aneurysm rupture.

Statistically significant differences were observed between the ruptured and unruptured groups in terms of sex, smoking status, systolic and diastolic blood pressure at admission, curvature of the affected A1 segment, spatial angle between the affected internal carotid artery and ipsilateral A1 segment, and the curvature length of the A1 segment. Hemodynamic parameters, including wall shear stress (WSS) and the presence of blood flow vortices, were notably elevated in ruptured aneurysms. Binary logistic regression analysis identified the curvature of the affected A1 segment (odds ratio [OR] = 0.001, 95% confidence interval [CI]: 0.000-0.173, p = 0.010), the angle between the affected A1 and A2 segments (OR = 0.963, 95% CI: 0.933-0.994, p = 0.020), and WSS on the affected side (OR = 0.140, 95% CI: 0.072-0.269, p < 0.001) as significant independent indicators of rupture risk.

Among patients with ACoA aneurysms, increased curvature of the A1 segment and elevated WSS on the affected side were the most robust predictors of rupture. These parameters remained significant across both univariate and multivariate analyses, underscoring their potential utility in clinical risk stratification.