Intracranial Aneurysms Research Articles

Treatment of unruptured intracranial vertebral artery dissection aneurysms with Flow Diverter compared with conventional stent-assisted coiling—a single-center study

AimFlow diverters (FDs) are being increasingly used off-label for treatment of intracranial vertebral artery dissection aneurysms (IVADAs). However, the safety and efficacy of FDs for unruptured IVADAs remain unclear. This study was performed to investigate whether FDs-alone are safer and more effective than conventional stent-asisted coiling.MethodsWe retrospectively analyzed 152 patients who underwent endovascular stenting from December 2011 to December 2022. The baseline data, aneurysm characteristics, surgical details, perioperative complications, follow-up angiography, and clinical outcomes were collected and compared between patients who underwent stenting with FD-alone versus conventional stent-asisted coiling. Propensity score matching was also conducted.ResultsAll 152 patients underwent successful endovascular therapy. Forty patients were treated with FDs-alone, and 112 were treated with conventional stent-asisted coiling (including 62 with double stents). The complete occlusion rate was 93.75% in the FD group and 93.61% in the conventional stent group (p = 0.979). The complication rate was 5.00% in the FD group and 8.93% in the conventional stent group (p = 0.653). The in-stent restenosis rate was 3.13% in the FD group and 5.32% in the conventional stent group (p = 0.615). The procedure duration was significantly shorter in the FD than conventional stent group (p = 0.034). After propensity score matching, 37 patients with FDs were successfully matched, and the procedure duration was still significantly shorter in the FD group (p = 0.042).ConclusionFD placement is a safe and effective treatment for IVADAs. It is also a simpler procedure with a shorter operation time than conventional stent placement.Trial registration number: ChiCTR2300074171ClinicalTrials.gov ID:NCT06134557

TRF-AspGTC promotes intracranial aneurysm formation by controlling TRIM29-mediated galectin-3 ubiquitination

tRF-AspGTC promotes intracranial aneurysm formation by controlling TRIM29-mediated galectin-3 ubiquitination

Anterior choroidal artery aneurysm case series: a clinical decision algorithm for endovascular and surgical treatment using a novel classification system.

Anterior choroidal artery (AChA) aneurysms represent 2-5% of intracranial aneurysms. The proximity of the origin of the AChA to the aneurysm neck poses a risk of thromboembolic complications following treatment. AChA occlusion can result in significant neurological deficits. We present a case-series of patients with AChA aneurysms and their treatment outcomes. We describe how treatment was chosen based on aneurysm and patient-specific factors to minimize risks, enhance efficacy of treatment, and improve patient outcomes. We retrospectively reviewed 27 patients who underwent treatment for AChA aneurysms at a single institution from 2015-2024. Clinical presentation, aneurysm characteristics, procedural details, and follow-up data were collected. Twenty-seven AChA aneurysms (median diameter 2.94mm), were treated in 29 procedures. Treatments included clipping (11 aneurysms), flow diversion (13), or coiling (5). The five coiled aneurysms were ruptured at presentation. Three patients experienced permanent infarction (10.3%), two in the setting of vasospasm after coiling and one after flow diversion in a patient who proved to have resistance to clopidogrel. At a median follow-up of 4.73months (IQR = 1.23-14.03), 25 patients (93%) had favorable functional recovery (mRS 0-2). Patients treated for AChA aneurysms experienced favorable functional outcomes by utilizing surgical and endovascular techniques carefully chosen based on aneurysm and patient-specific factors. Two patients did not achieve independence post-coiling due to disability from their initial subarachnoid hemorrhage. There were no treatment related causes of unfavorable functional outcomes.

Flow diversion for the treatment of distal circulation aneurysms: A randomized comparison.

Flow diversion (FD) has expanded beyond initial indications (proximal carotid artery aneurysms) to include distal circulation aneurysms (on the anterior, middle, or posterior cerebral arteries). Our objective was to examine results obtained from aneurysms in these locations in the Flow Diversion in the Treatment of Intracranial Aneurysms Trial (FIAT) which compared FD with alternative standard management options (ASMO). FIAT was an all-inclusive parallel-group 1:1 randomized study comparing FD with one of 4 ASMOs (coiling +/-stenting, parent vessel occlusion (PVO), clipping, or observation, pre-specified by clinical judgment). The primary safety outcome was death or dependency (mRS >2) at 3 months. The composite primary outcome was "treatment failure," defined as initial failure to treat the aneurysm; aneurysm rupture or retreatment during follow-up; death or dependency (mRS>2); or angiographic residual aneurysm adjudicated by independent core laboratory at 12 months. This subgroup analysis was not prespecified and there was no blinding. Of the 323 patients in FIAT, 46 (14%) with distal circulation aneurysms were randomly allocated: 23 to FD and 23 to ASMO (coiling +/-stenting (16 patients), PVO (1), clipping (3), and observation (3)). Death or dependency at 3 months occurred in one patient (allocated ASMO). Treatment failures occurred in 6/23 FD-treated patients (26.1%; 95%CI: 12.6%-46.5%) compared to 11/22 patients treated with ASMO (50.0%; 95%CI: 30.7%-69.3%; RR=0.52, [0.23-1.17]; P=0.13). Serious adverse events were similar. Distal circulation aneurysms treated with FDs in FIAT showed an encouraging trend, but this analysis was underpowered. Further randomized trials are needed. ASMO = Alternative standard management options; FD = Flow Diversion; FIAT = Flow Diversion in the Treatment of Intracranial Aneurysms Trial; PVO = Parent Vessel Occlusion; mRS = modified Rankin Scale.

Ambivalence as agency in Camille Reynaud’s Et par endroits ça fait des nœuds (2021)

This article examines ambivalence and agency in contemporary life writing through focusing on an autopathography which highlights these features of self-narrative in original ways while also holding them in unusual tension. Camille Reynaud’s first publication, Et par endroits ça fait des nœuds (2021), addresses the abrupt loss of selfhood resulting from a ruptured cerebral aneurysm she experienced four years prior to publication. It draws the reader not only into a clinical reconstruction of trauma and treatment but also into the warp and weft of Reynaud’s ongoing, uneven attempt to re-establish agency and a stable sense of self. This article examines how the text, and the emerging sense of selfhood that it helps to produce, are shaped by medical imperatives, by voracious intertextual interlacing, and by the ways in which the author thinks with photography. It also asks how the premise of her book inflects important questions in life writing such as the tension between self-knowledge and self-invention, and the ways in which the self is socially constructed, understood, and talked about. Finally, it argues that Et par endroits ça fait des nœuds offers a newly ambivalent approach to life-writing’s emphasis on the body, embodiment, and corporeal experience through its focus on the body’s secret life and on the brain as locus of the self. The argument is underpinned with reference to the phenomenology of illness as theorized by Havi Carel, and Catherine Malabou’s ideas of post-traumatic subjectivity.

Flow-diverting stents for the treatment of unruptured distal anterior cerebral artery aneurysms: analysis of the CRETA Registry

BackgroundData about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow...

Cancer-type somatic mutations in saccular cerebral aneurysms.

Intracranial aneurysms (IAs) are a major cause of subarachnoidal hemorrhage (SAH) which can have a significant morbidity and mortality. The processes underlying the aneurysm development remains unclear. We performed whole exome sequencing of DNA derived from 20 saccular cerebral aneurysms of 20 patients, followed by somatic variant calling. Eleven (55%) of the 20 patients had detectable nonsynonymous somatic mutations and in total, 48 mutations were detected in the aneurysm samples. The mutations were highly enriched in cancer-related genes and 77% were predictably deleterious. A p.Tyr562Asp somatic mutation was detected in the PDGFRB gene; somatic mutations at the same codon have been reported in fusiform cerebral aneurysms. These results widen the concept on the role of somatic mutations in cerebral aneurysms, indicating their possible role in the more common saccular aneurysm, similarly to the rarer fusiform aneurysm.

Overview of perianeurysmal edema following the endovascular management of cerebral aneurysms: A pooled analysis of 48 cases.

Perianeurysmal edema occurring after endovascular treatment for cerebral aneurysms is uncommon compared to surgical clipping. The clinical aspects and the exact explanation are poorly understood. We searched PubMed, Google Scholar, and Web of Science. We used the following keywords: "endovascular management of cerebral aneurysms," "perianeurysmal cerebral edema," "perianeurysmal cerebral edema after endovascular treatment endovascular treatment," "intracranial aneurysms with perianeurysmal edema," and "vessel wall enhancement after endovascular therapy." For each case, demographic, clinicopathological, therapeutic, and follow-up data were gathered and analyzed. Perianeurysmal edema after endovascular treatment has a clear female predilection, with a male: female ratio of 12:29 (25%; 60.41%). The average time from EVT to the onset of edema ranged from 1day to about 8years. The aneurysm dimension ranged from 6.8 to 25mm as the largest size reported. Most patients were asymptomatic (18 [37.5 %]), and headache was the presenting symptom in 10 patients (20.8%). Aneurysmal wall enhancement was reported in 16 (33.3 %) patients with perianeurysmal edema. About 12 patients (25%) developed post-EVT hydrocephalus. The most common coil used was the platinum type (31 [64.58%]). Most of the patients were treated expectantly with follow-up (17 [35.41 %]), while steroids were used only in 14 (29.16%) patients. Most of the patients have their edema resolved (29 [60.41%]) or stable (9 [37.5%]). There is growing evidence supporting the incidence of post-embolization inflammatory reactions involving the vessel wall and the surrounding parenchyma; however, the exact clinical perspectives and the predisposing factors are not fully uncovered. This analysis highlights the possible presentations and short-term outcome of patients presenting with perianeurysmal edema after endovascular management of cerebral aneurysms.

Stent retriever expansion as a corrective maneuver to optimize inadequately deployed flow diverter stents.

As flow diversion (FD) is becoming increasingly important in the endovascular treatment of intracranial aneurysms, the rate of technical complications is also increasing. Inadequate FD implantation may lead to both ischemic complications and decreased treatment efficacy. The aim of this study was to evaluate the efficacy of off-label stent retriever (SR) use in managing technical complications associated with FD implantation. A retrospective analysis of data from patients who underwent FD treatment at two neuroradiology centers was performed. The objective was to identify cases in which the FD was inadequately deployed and SR expansion was performed as a corrective maneuver. The analysis included anatomic characteristics, technical information, angiographic and clinical outcomes, and complications. A total of 35 corrective maneuvers with SR were performed in 25 FD treatments. The corrective maneuvers in all treatments were successful, and no additional devices or therapies were required. No procedural complications or technical difficulties were documented. With the growing role of FDs in neurointerventional treatment, familiarity with corrective maneuvers after technical complications or inadequate implantation is important. The findings in our selected cohort demonstrated that SR expansion is an effective and safe corrective maneuver for incompletely opened FDs.

FRED-UK: Multicentre UK experience of FRED and FRED Jr flow re-direction endoluminal device for intracranial aneurysms: 6 months and 1 year clinical and anatomical results.

Flow diverting stents (FDS) are an established endovascular treatment for intracranial aneurysms but are reported to have varying rates of adequate occlusion and thromboembolic complications. This study reports clinical safety and efficacy results of the FRED and FRED Jr FDS in clinical practice in the UK at 6 months and 1 year. The FRED-UK study is a single arm, multicentre, prospective, observational study conducted in the UK. Safety was reviewed by evaluating morbidity (modified Rankin Score ≤2) and mortality. Efficacy was assessed as adequate occlusion of the treated aneurysm. A clinical event committee and core laboratory independently assessed clinical and anatomical results. Seven neurointerventional centers treated 61 patients, 57 of which met the full inclusion and exclusion criteria. Of these, 75.4% were treated with FRED and 24.6% with FRED Jr. The aneurysms were located on the cavernous or supraclinoid internal carotid artery (ICA) in 75.4%, on the anterior cerebral artery (ACA) or anterior communicating artery (Acom) in 21.1%, and on the middle cerebral artery (MCA) in 3.5%. 57.9% of aneurysms were small (<10 mm), 40.4% were large (10-24 mm) and 1.8% were giant (≥25 mm). All-cause morbidity and mortality were 0% at 6 and 12 months, and adequate occlusion was 86.7% at 12 months in the per protocol population. The FRED and FRED Jr devices are safe and efficacious in the treatment of intracranial aneurysms.

Identification of Key Risk Factors for Rupture in Small Intracranial Aneurysms: A Multicenter Study.

Predicting rupture risk in small intracranial aneurysms (IAs) < 5 mm is crucial for guiding clinical decisions. This study aims to identify key clinical and morphological risk factors associated with rupture in small IAs, providing better insight for decision-making. A retrospective analysis was performed on patients with small IAs from one center, with external validation data from another center. Logistic regression identified significant risk factors for aneurysm rupture, which were incorporated into a predictive model. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration plots, and the Hosmer-Lemeshow (H-L) goodness-of-fit test. Clinical utility was assessed via decision curve analysis (DCA). The training cohort consisted of 226 patients (ruptured, n = 181; unruptured, n = 92), while 136 patients (ruptured, n = 100; unruptured, n = 59) were used for external validation. Significant risk factors included hypertension, smoking, anterior communicating artery aneurysms (AcomA), daughter sacs, aspect ratio (AR), and size ratio (SR). The model demonstrated strong predictive ability with AUCs of 0.969 and 0.967 in the training and validation cohorts, respectively. Calibration plots indicated a good agreement between predicted and observed rupture risks, while DCA highlighted the model's clinical relevance. This study identifies and validates critical risk factors associated with small IA rupture and presents a clinically useful, high-accuracy predictive model to aid in individualized patient management.

Computational analysis of flow and transport suggests reduced oxygen levels within intracranial aneurysms, especially in individuals with sickle-cell disease.

Sickle cell disease (SCD) is a genetic condition characterized by an abundance of sickle hemoglobin in red blood cells. SCD patients are more prone to intracranial aneurysms (ICA) compared to the general population, with distinctive features such as multiple intracranial aneurysms: 66% of SCD patients with ICAs have multiples ICAs, compared to 20% in non-sickle patients. The exact mechanism behind these associations is not fully understood, but there is a hypothesized link between hypoxia and impaired synthesis of extracellular matrix, which may weaken the vessel walls, favoring aneurysm formation and rupture. SCD patients experience reduced blood oxygen levels, potentially exacerbating hypoxia in ICAs, and potentially contributing to aneurysm development and early onset in these patients. In this work, we performed a series of computational studies (Fluent) using idealized geometries to investigate the key differences in the oxygen transport and blood flow dynamics inside an aneurysm formation for sickle and non-sickle cases. We found that using SCD parameters resulted in a 14% to 68% reduction in blood flow and a 37% to 70% reduction in oxygen availability within the aneurysm, depending on the vessel curvature and the aneurysm throat diameter, due to factors including oxygen-dependent viscosity and alteration in the oxygen transport. The results indicate that depending on geometry and flow characteristics, some degree of hypoxia maybe present in aneurysm bulb and would be more severe in SCD patients. This study hopes to bring into attention the potential presence of hypoxic environment in the aneurysm bulb.

Human Genetic Evidence to Inform Clinical Development of IL-6 Signaling Inhibition for Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm (AAA) represents a significant cause of mortality, yet no medical therapies have proven efficacious. The aim of the current study was to leverage human genetic evidence to inform clinical development of IL-6 (interleukin-6) signaling inhibition for the treatment of AAA. Associations of rs2228145, a missense variant in the IL6R gene region, are expressed per additional copy of the C allele, corresponding to the genetically predicted effect of IL-6 signaling inhibition. We consider genetic associations with AAA risk in the AAAgen consortium (39 221 cases and 1 086 107 controls) and UK Biobank (1963 cases and 365 680 controls). To validate against known effects of IL-6 signaling inhibition, we present associations with rheumatoid arthritis, polymyalgia rheumatica, and severe COVID-19. To explore mechanism specificity, we present associations with thoracic aortic aneurysm, intracranial aneurysm, and coronary artery disease. We further explored genetic associations in clinically relevant subgroups of the population. We observed strong genetic associations with AAA risk in the AAAgen consortium, UK Biobank, and FinnGen (odds ratios: 0.91 [95% CI, 0.90-0.92], P=4×10-30; 0.90 [95% CI, 0.84-0.96], P=0.001; and 0.86 [95% CI, 0.82-0.91], P=7×10-9, respectively). The association was similar for fatal AAA but with greater uncertainty due to the lower number of events. The association with AAA was of greater magnitude than associations with coronary artery disease and even rheumatological disorders for which IL-6 inhibitors have been approved. No strong associations were observed with thoracic aortic aneurysm or intracranial aneurysm. Associations attenuated toward the null in populations with concomitant rheumatological or connective tissue disease. Inhibition of IL-6 signaling is a promising strategy for treating AAA but not other types of aneurysmal disease. These findings serve to help inform clinical development of IL-6 signaling inhibition for AAA treatment.

Fourth-generation Pipeline™ Vantage flow diversion: First reported US experience of safety and feasibility.

The Pipeline™ Vantage embolization device (Medtronic, Irvine, CA) is the fourth generation of Pipeline flow diverter devices, offering numerous technical improvements. This study aimed to assess the feasibility and safety of The Pipeline™ Vantage embolization device (Medtronic, Irvine, CA). This was a single-center retrospective study describing the use of The Pipeline™ Vantage embolization device for the treatment of intracranial aneurysms. Technical feasibility and safety were assessed in terms of intra and postprocedural complications, as well as neurological morbidity upon follow-up. Both ruptured and unruptured aneurysms were included. We included 12 patients in our study (mean age 62; females: n = 9/12, 75%). Aneurysm morphology varied between saccular (41.6%), fusiform (41.6%), blister (8.3%), and pseudoaneurysm (8.3%). Three cases (25%) involved ruptured aneurysms treated in the acute setting. A transradial access was used in 10 cases (83.3%). There was a 100% success in deployment. Seven cases (58.3%) were treated with adjunct embolization device other than a flow diversion. Eight cases (66.6%) were treated with a single flow diversion, three cases (25%) were treated with two flow diversion, and one case (8.3%) was treated with three flow diversion stents. There were no intraoperative complications. There was one postprocedural complication in a dissecting ruptured PICA aneurysm that was ultimately treated with two flow diversion stents and an intrasaccular device. To our knowledge, this is the first US series assessing the periprocedural safety and feasibility of consecutive patients with intracranial aneurysms treated with the Pipeline™ Vantage device (Medtronic, Irvine, CA).

A Rare Arterial Congenital Variant: The Internal Carotid Artery Agenesis.

The cerebral arterial circle has been extensively investigated in recent literature. A scarce congenital arterial variant is considered the internal carotid artery (ICA) agenesis. The computed tomography angiogram of a 65-year-old female patient is reported. The left ICA was absent in the head and neck region. Intracranially, the left middle cerebral artery derived from a hyperplastic posterior communicating artery, and the first segment of the left anterior cerebral artery was absent. This variant corresponds to Lie's type A agenesis of the ICA that coexisted with an aneurysm on the anterior communicating artery. Overall, the absence of ICA has a prevalence of <0.01%. It was associated with clinical symptoms of cerebrovascular insufficiency or intracranial aneurysm. Although extremely rare, the congenital variant is important for radiologists and neurosurgeons planning a surgical procedure in the area.

Different antiplatelet regimens for stenting versus coiling for acutely-ruptured cerebral aneurysms

To investigate the safety, efficacy and risk factors for complications of stenting with optional coiling versus coiling alone for acutely ruptured cerebral aneurysms (ARCAs) using different antiplatelet schemes, 2021 patients were prospectively enrolled into the stenting group (n = 967) and the coiling group (n = 1054). Four different antiplatelet regimens were used. The clinical and treatment data were analyzed and compared. In the stenting group, the common antiplatelet regimen was applied in 259 patients (26.8%), loading regimen in 210 (21.7%), intravenous tirofiban regimen in 240 (24.8%), and premedication free regimen in 258 (26.7%). The aneurysm occlusion degrees in the coiling vs. stenting group were not significantly (P > 0.05) different after treatment. Complications occurred in 168 (15.94%) and 171 (17.68%) patients in the coiling and the stenting group, respectively. Fifteen (1.55%) patients experienced stent-related ischemic complications. The only significant (P < 0.05) independent protective factor for complete occlusion was stent-assisted coiling in the stenting group but aneurysm daughter sac in the coiling group. Significant (P < 0.05) independent risk factors for poor mRS (3–6) were posterior circulation aneurysms and neurological bleeding complications in the stenting group and neurological complications in the coiling group. In the stenting group, the only independent risk factor was parent artery stenosis for neurological complications, Raymond grade III for neurological ischemic complications, and the ice cream technique for total complications in the stenting group. In conclusion, different antiplatelet schemes can be safely and efficiently used for intracranial stenting with optional coiling as compared with coiling alone for ARCAs.

Establishment of a decision tree prediction model for the treatment of intracranial aneurysms using temperature-sensitive embolic agents based on geometric features

Establishment of a decision tree prediction model for the treatment of intracranial aneurysms using temperature-sensitive embolic agents based on geometric features

Predictors of self-care performance in patients with unruptured intracranial aneurysms

In South Korea, there has been an increasing number of patients diagnosed with unruptured intracranial aneurysms (UIAs), requiring rigorous self-care to prevent rupture. This study aimed to identify predictors of self-care performance in patients with UIAs, focusing on illness perception and social support. A cross-sectional correlation design was employed. Data from 150 participants was analyzed. The Brief Illness Perception Questionnaire (B-IPQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Self-Care Performance Tool were used for measurement. Pearson correlation was used to analyze the correlation among the participants’ perceived illness perception, social support, and self-care performance. Differences in the level of self-care performance according to sociodemographic and clinical characteristics and correlations among continuous variables were identified using univariate statistics. Hierarchical multiple regression was used to identify predictors of self-care performance. The results showed that the self-care performance score was positively correlated with illness perception and social support. Regression analysis showed that being a non-smoker, not consuming alcohol, receiving social support from family, receiving social support from medical personnel, and strong illness perception positively affected the self-care performance score. Our findings should be considered when developing education and intervention programs to enhance self-care performance among patients with UIAs.

Developing a nearly automated open-source pipeline for conducting computational fluid dynamics simulations in anterior brain vasculature: a feasibility study

Intracranial aneurysms (IA) pose significant health risks and are often challenging to manage. Computational fluid dynamics (CFD) simulation has emerged as a powerful tool for understanding lesion-specific hemodynamics in and around IAs, aiding in the clinical management of patients with an IA. However, the current workflow of CFD simulations is time-consuming, complex, and labor-intensive and, thus, does not fit the clinical environment. To address these challenges, we have developed a semi-automated pipeline integrating multiple open-source software packages to streamline the CFD simulation process. Specifically, the study utilized medical angiography data from 18 patients. An in-house open-source DL image segmentation model (ARU-Net) was employed to generate 3D computer models of the anterior circulation. The segmented intracranial vasculature models, including IAs, were further refined using the Vascular Modeling Toolkit (VMTK), an open-source Python package. This step involved smoothing the surface of the models and extending the inlet and outlet regions to ensure a realistic representation of the vascular geometry. The refined vascular models were then converted into computational meshes using an open-source mesh generator known as TetGen. This process was nearly automated and required minimal user interaction(s). Blood flow simulations of the cerebral vascular models were performed using established SimVascular solvers (an open-source finite element platform for vascular applications) through an application programming interface (API). The CFD simulation process was also conducted using the manual workflow for comparative purposes. The initial assessment compared the geometries derived from manual and DL-based segmentation. The DL-based segmentation demonstrated reliable performance, closely aligning with manually segmented results, evidenced by excellent Pearson correlation coefficient (PCC) values and low relative difference (RD) values ranging from 3% to 10% between the computed geometrical variables derived from both methods. The statistical analysis of the computed hemodynamic variables, including velocity informatics and WSS-related variables, indicated good to excellent reliability for most parameters (e.g., ICC of 0.85–0.95). Given the data investigated, the proposed automated workflow streamlines the process of conducting CFD simulations. It generates results consistent with the current standard manual CFD protocol while minimizing dependence on user input.

Discriminators of Paraclinoid Aneurysm Rupture Based On Morphological Computer-Assisted Semiautomated Measurement (CASAM) and Hemodynamic Analysis.

Paraclinoid aneurysms, arising from the proximal dural ring and extending to the origin of the posterior communicating artery of the internal carotid artery (ICA), represent asignificant proportion of all intracranial aneurysms (IAs). Accurate prediction of the rupture risk of paraclinoid aneurysms is crucial for optimal management. The objective of this study was to identify risk factors for the rupture of paraclinoid aneurysms on the basis of computer-assisted semiautomated measurement (CASAM) and hemodynamics. The clinical, demographic and radiological data of the 304 paraclinoid aneurysms (285 unruptured and 19 ruptured) included were extracted from the Chinese Intracranial Aneurysm Project (CIAP) database. Morphological parameters were quantified via CASAM, and hemodynamic simulations were performed via computational fluid dynamics (CFD). Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for aneurysm rupture. The mean age of the patients was 56.91 ± 11.0 years, with afemale predominance (71.7%). Univariate analysis revealed that the undulation index (UI) and nonsphericity index (NSI) were significantly greater in ruptured paraclinoid aneurysms than in unruptured aneurysms. The proportion of ruptured paraclinoid aneurysms located laterally on the ICA was significantly lower than that of those located anteriorly (p = 0.002). Multivariate logistic regression analysis revealed that agreater UI (OR = 1.086, 95% CI 1.012-1.165; p = 0.022) and larger low shear area (LSA) (OR = 1.034, 95% CI 1.004-1.064; p = 0.028) were independent risk factors for rupture. Our findings indicate that agreater UI and alarger LSA are independent risk factors for the rupture of paraclinoid aneurysms. Compared with aneurysms in other orientations, paraclinoid aneurysms located anteriorly to the ICA are more prone to rupture. These findings may be useful in developing more consummate predictive models to enhance the management and surveillance of paraclinoid aneurysms in the future, leading to improved clinical decision-making and better patient outcomes.