A case-control study on blood vessel morphology, hemodynamic parameters, and rupture status of posterior...

Individual assessment of intracranial aneurysm (IA) rupture risk is difficult; a deeper understanding of the factors that precipitate rupture is crucial to advance clinical decision-making. This study aims to analyze risk factors for rupture in posterior communicating artery (PComA) aneurysms, focusing on the influence of vascular morphology and hemodynamic parameters. Specifically, it examined demographic and clinical characteristics, vessel morphology, and hemodynamic factors, aiming to identify predictors of aneurysm rupture and inform preventive strategies.

A retrospective analysis was conducted using clinical data of 362 patients with ruptured and unruptured PComA aneurysms from January 2020 to December 2024. Statistical analyses assessed differences between groups, associations between demographic and clinical characteristics, vessel morphology, and hemodynamic parameters and rupture status, and predictive factors for aneurysm rupture.

Two hundred and twenty-four patients with ruptured PComA aneurysms (50 male, 174 female) in the ruptured PComA aneurysm group were compared with 138 patients with unruptured PComA aneurysms (30 male, 108 female) in the unruptured PComA aneurysm group. Findings revealed significant differences in smoking status, educational experience, blood pressure, aneurysm size, shape feature, aneurysm inclination angle, size ratio (SR),wall shear stress (WSS), and flow velocity (FV) (p < 0.05). Smoking status, systolic pressure and diastolic pressure, aneurysm size, irregular shapes, aneurysm inclination angle and SR in the ruptured PComA aneurysm group were higher than those in the unruptured PComA aneurysm group (p < 0.05). And educational experience, WSS, and FV in the ruptured PComA aneurysm group were lower than those in the unruptured PComA aneurysm group (p < 0.05).

In hypertensive smokers with lower educational experience, several factors may be associated with a higher risk of PComA aneurysm rupture: larger aneurysm size, irregular shape, higher inclination angle and SR, as well as lower WSS and FV. However, the relative contributions of morphological and hemodynamic factors, their possible correlations, and the ability of these markers to predict rupture risk require external validation. Therefore, larger prospective studies, multi-center investigations, and follow-up of ethnically diverse cohorts of patients with unruptured PComA aneurysms are warranted.