Abstract
This study analyzed the rupture risk of intracranial aneurysms (IAs) according to aneurysm characteristics by comparing the differences between two aneurysms in different locations within the same patient. We utilized this self-controlled model to exclude potential interference from all demographic factors to study the risk factors related to IA rupture. A total of 103 patients were diagnosed with IAs between January 2011 and April 2015 and were enrolled in this study. All enrolled patients had two IAs. One IA (the case) was ruptured, and the other (the control) was unruptured. Aneurysm characteristics, including the presence of a daughter sac, the aneurysm neck, the parent artery diameter, the maximum aneurysm height, the maximum aneurysm width, the location, the aspect ratio (AR, maximum perpendicular height/average neck diameter), the size ratio (SR, maximum aneurysm height/average parent diameter) and the width/height ratio (WH ratio, maximum aneurysm width/maximum aneurysm height), were collected and analyzed to evaluate the rupture risks of the two IAs within each patient and to identify the independent risk factors associated with IA rupture. Multivariate, conditional, backward, stepwise logistic regression analysis was performed to identify the independent risk factors associated with IA rupture. The multivariate analysis identified the presence of a daughter sac (odds ratio [OR], 13.80; 95% confidence interval [CI], 1.65–115.87), a maximum aneurysm height ≥7 mm (OR, 4.80; 95% CI, 1.21–18.98), location on the posterior communicating artery (PCOM) or anterior communicating artery (ACOM; OR, 3.09; 95% CI, 1.34–7.11) and SR (OR, 2.13; 95% CI, 1.16–3.91) as factors that were significantly associated with IA rupture. The presence of a daughter sac, the maximum aneurysm height, PCOM or ACOM locations and SR (>1.5±0.7) of unruptured IAs were significantly associated with IA rupture.
Highlights
Unruptured intracranial aneurysms (IAs) are found in 3–8% of the general population [1]
Many researchers have reported that hypertension increased the risk of aneurysm rupture [5,6,7,8,9]; other researchers have reported that hypertension was not a risk factor for aneurysm rupture [10,11,12]
Previous studies have reported that gender differences, smoking, and alcohol consumption were independent risk factors for aneurysm rupture [13, 14], while other studies have reported that these demographic variables were not risk factors for aneurysm rupture [9, 15, 16]
Summary
Unruptured intracranial aneurysms (IAs) are found in 3–8% of the general population [1]. When we studied aneurysmal risk factors (e.g., size and location), excluding the effects of demographic risk factors (e.g., age, sex, and hypertension) related to aneurysm rupture in a multivariate regression model was difficult because of differences among the individual patients. In patients with aneurysms of similar sizes and geometries, vessel-wall properties and flow characteristics could vary substantially because of differences in patients’ demographic risk factors [21]. Such confounding demographic risk factors may have led to statistical bias in previous studies. Several studies have reported using a case-control study model in patients with multiple IAs to identify the risk factors of IA rupture. We conducted this 1:1 (self) case-control study model to study the natural risk factors of IA rupture
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