Abstract
Objective: Morphological and hemodynamic parameters might predict rupture of intracranial aneurysms (IAs). A practical model for the study is patients with ruptured mirror IAs in which one is ruptured and the other is unruptured. Although there have been analyses of the morphology and hemodynamics of ruptured mirror posterior communicating artery aneurysms (PComAAs), the sample sizes in these studies were small and only considered hemodynamics or morphological characters. Therefore, this study aimed to investigate the morphological and hemodynamic parameters associated with ruptured mirror PComAAs.Methods: We considered 72 patients with ruptured mirror PComAAs using computational fluid dynamics (CFDs). Ruptured mirror PComAAs were divided into ruptured and unruptured groups. Fourteen morphological and eight hemodynamic parameters were calculated and compared. Significant parameters were analyzed by the multivariate logistic regression to identify independent risk factors. Receiver operating characteristic (ROC) analysis was performed, and the area under the ROC curve (AUC) was calculated for all independent risk factors to determine the predictability and identify the optimal threshold.Results: Four hemodynamic and three morphological parameters were significantly different between ruptured and unruptured groups: normalized wall shear stress (NWSS), mean WSS, low wall shear WSS area (LSA%), size, aspect ratio (AR), size ratio (SR), and inflow angle (IA). Multivariate logistic regression analysis showed that AR, SR, NWSS, mean WSS, and LSA% were all independent factors significantly associated with PComAAs rupture. The ROC analysis for independent risk factors indicated that AR (0.751), NWSS (0.755), mean WSS (0.69), and LSA (0.778) had merely acceptable AUC values. Only SR (0.803) had a high acceptable AUC value. The threshold value of SR was 1.96.Conclusions: SR (>1.96) was the most significant parameter associated with IA rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture.
Highlights
With the development and popularization of non-invasive cerebrovascular technology, unruptured intracranial aneurysms are more often detected in about 3–7% of the population [1, 2]
Multivariate logistic regression analysis showed that aspect ratio (AR), size ratio (SR), normalized wall shear stress (NWSS), mean WSS, and LSA% were all independent factors significantly associated with Posterior communicating artery aneurysms (PComAAs) rupture
SR (>1.96) was the most significant parameter associated with intracranial aneurysms (IAs) rupture, whereas AR, NWSS, mean WSS, and LSA independently characterized the status of IA rupture
Summary
With the development and popularization of non-invasive cerebrovascular technology, unruptured intracranial aneurysms are more often detected in about 3–7% of the population [1, 2]. The rupture of intracranial aneurysms (IAs) is the principal cause of subarachnoid hemorrhage (SAH), leading to tremendous mortality and disability [3]. Because these aneurysms have a relatively low risk of rupture, and both endovascular and clipping treatment may cause complications during surgery, it is crucial to balance the risks of rupture and complications [4]. Xiang et al considered that low WSS and high OSI (oscillatory shear index) were related to the rupture of aneurysm [5] This may have been caused by differences in individual patients and aneurysm locations. This is the most significant number of mirror PComAAs studied to identify risk factors associated with IA rupture to the best of our knowledge
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