The Complementary Role of Size and Morphology in Predicting Intracranial Aneurysm Rupture: An Intrapatient Matched...

Area of Science:

• Neurosurgery
• Vascular Neurology
• Medical Imaging

Background:

• Managing multiple intracranial aneurysms (IAs) is complex, especially identifying ruptured IAs and treating unruptured ones.
• Traditional risk scores often rely on aneurysm size, necessitating better anatomical predictors.

Purpose of the Study:

• To investigate anatomical determinants of intracranial aneurysm rupture using an intra-patient matched design.
• To identify morphological and topographical factors predicting rupture beyond patient-specific risks.

Main Methods:

• Retrospective analysis of 55 patients with 136 IAs.
• Intra-patient comparison of ruptured index aneurysms and unruptured bystanders.
• Generalized Linear Mixed Model to assess morphological predictors of rupture.

Main Results:

• Absolute dome width (OR 1.56) and blebs (OR 7.27) significantly predicted intra-patient rupture.
• Aneurysms at anterior (OR 9.83) and posterior communicating arteries (OR 8.99) showed the highest rupture propensity.
• Size ratio and neck size were not significant predictors (p > 0.05).

Conclusions:

• Intracranial aneurysm rupture risk correlates with absolute size (width) and focal wall instability (blebs).
• Anterior and posterior communicating artery locations are high-risk sites.
• Treatment decisions for unruptured IAs should integrate absolute size and local wall irregularities.