Morphological and hemodynamic determinants of rupture in mirror posterior communicating artery aneurysms

This study aims to assess the risk factors associated with ruptured mirror posterior communicating artery aneurysms (PComAAs) through hemodynamic visualization and morphological analysis.

A total of 71 patients with ruptured mirror posterior communicating artery aneurysms (PComAAs) were reviewed. Morphological and hemodynamic characteristics were compared between ruptured and unruptured aneurysms. Multivariate logistic regression analysis was employed to identify independent risk factors. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to determine the optimal threshold for independent risk factors. Finally, hemodynamic visualization analysis of the aneurysms was conducted.

Univariate analysis revealed that aneurysm size, aspect ratio (AR), size ratio (SR), non-sphericity index (NSI), presence of daughter sacs, minimum wall shear stress (WSS), low-WSS areas, and complex flow patterns were all associated with aneurysm rupture. However, multivariate logistic regression identified SR, AR, and NSI as the only significant independent risk factors. ROC curve analysis showed that SR (AUC = 0.808) provided the highest AUC value, with a threshold value of 1.26. Hemodynamic visualization analysis revealed that the flow velocity within the aneurysm was consistent with WSS, with low-velocity and low-WSS regions frequently observed at the top or daughter sacs of the aneurysm, which were associated with rupture.

Morphology and hemodynamics were associated with aneurysm rupture and SR had the best predictive effect.