Analysis Of Clinical Characteristics And Morphological Risk Factors For Ruptured Posterior Communicating Artery Aneurysms

Objectives:In this study,after reviewing the clinical data and imaging data of patients diagnosed with posterior communication aneurysms in the First Affiliated Hospital of Kunming Medical University in the past 4 years in the Department of Minimally Invasive Neurosurgery,we statistically summarized the clinical characteristics and morphological data of the aneurysms to screen out the risk factors associated with rupture and bleeding of posterior communication aneurysms,in the hope of providing a reference for clinical decision making in the treatment of posterior communication aneurysms.Methods:First,the clinical data of patients who were diagnosed with intracranial aneurysm after acepted the cranial CTA angiography,magnetic resonance angiography(MRA)or digital subtraction cerebral angiography from January 2016 to December 2020,and a total of 72 patients with posterior communication aneurysm at the inclusion and exclusion criteria were screened.The clinical data were then reviewed.The clinical data and morphological parameters of the aneurysms were then collected and summarized in an EXCeld spreadsheet.After dividing the collected patients into ruptured and for-ruptured groups according to whether subarachnoid hemorrhage occurred,the data were imported into SPSS software for statistical analysis using chi-square test and independent samples t-test for comparison between groups,followed by logistic regression analysis of risk factors associated with ruptured posterior communication aneurysms.Results:A total of 72 cases of posterior communication aneurysms were included in this study,with a male to female ratio of approximately 1:2.72.The rupture rate of posterior communication aneurysms in female patients was 60%;the rupture rate of posterior communication aneurysms in males was 50%,with no statistically significant difference between groups.The rupture rate of posterior communication aneurysms in the non-elderly group younger than 60 years was higher than that in the elderly group(60.5%vs.51.7%),with no statistically significant difference between the groups.The rate of posterior communication aneurysm rupture was higher in male patients with a history of smoking than in male patients without a smoking history(66.6%vs 30%),with no statistically significant difference between the groups.Hypertension was an independent risk factor for bleeding from ruptured posterior communication aneurysms(OR:5.82,95%CI:1.23-27.51).The overall mean of the maximum diameter of posterior communication artery aneurysm in the ruptured group was smaller than the overall mean of the maximum diameter of posterior communication artery aneurysm in the unruptured group(4.92±2.37 mm vs.7.65±4.31),which was statistically significantly different;the risk of ruptured bleeding was highest for posterior communication artery aneurysms smaller than 5 mm,with a statistically significant difference and an independent risk factor for ruptured bleeding from posterior communication artery aneurysms(OR.10.95,95%CI:1.76-67.82).Angle of incidence greater than 90 degrees was an independent risk factor for aneurysm rupture(OR:7.88,95%CI:1.27-48.59).The rupture rate was higher in posterior communication aneurysms with irregular morphology than in those with regular morphology,with a statistically significant difference(66.7%vs.43.3%).Posterior communication aneurysms with daughter sacs and bleb were more likely to rupture,and multifactorial analysis showed that daughter sacs and bleb were independent risk factors for posterior communication aneurysm rupture(OR:11.92,95%CI:2.06-68.76).Posterior communicating aneurysms with the dome of the aneurysm directed posteriorly and inferiorly had the highest rupture rate(73.2%)than the other direction.Conclusion(s):History of hypertension,daughter sac and aneurysm bleb,inflow angle greater than 90°,and maximum aneurysm diameter less than 5 mm are risk factors for posterior communication aneurysm rupture;The rupture rate of posterior communication aneurysms with irregular morphology is higher than that of posterior communication aneurysms with regular morphology;Posterior communicating artery aneurysms with the dome of the aneurysm directed posteriorly and inferiorly are more likely to rupture and bleed than posterior communicating artery aneurysms directed in other directions.