Clinical and radio-anatomical risk factors for the rupture of anterior communicating artery aneurysms

Objective: To identify the clinical and radio-anatomical risk factors for the rupture of anterior communicating artery aneurysm (ACoAA). Methods: Patients with ACoAAs, which were confirmed by CTA, MRA and/or DSA in the period from June 2008 to June 2003, were collected from prospectively established cerebral aneurysm database. According to the state of aneurysm, the selected patients were divided into ACoAA rupture group and non-rupture group. The possible clinical and radio-anatomical risk factors for the rupture of ACoAA were analyzed by using univariate and multivariate logistic regression methods. Results: A total of 251 patients with ACoAA were enrolled in this study; among them, 131 patients had ruptured ACoAA. Univariate analysis showed that the patient's age of rupture group was significantly lower than that of non-rupture group (P < 0.01), and in the rupture group the proportion of patients < 60 years old and the proportion of patients with hypertension were also significantly higher than those in the non-rupture group. In the rupture group, the average maximum diameter of ACoAA was significantly larger than that in the non-rupture group (P < 0.01), and the proportion of maximum diameter ≥ 3 mm ACoAA was much higher than that in the nonrupture group. In the rupture group, the proportion of developmental asymmetry of A1 segment of anterior cerebral artery (i.e. aplasia or dysplasia) was strikingly higher than that in the non-rupture group. Multivariate logistic regression analysis revealed that patient's age < 60 years old, history of hypertension, maximum diameter of aneurysm Qjkg ≥ 3 mm and presence of hypoplasia or aplasia of A1 of anterior cerebral artery were independent risk factors for the rupture of ACoAA. Conclusion: Patient's age < 60 years old, history of hypertension, maximum diameter of aneurysm ≥3 mm and presence of hypoplasia or aplasia of A1 of anterior cerebral artery are independent risk factors for the rupture of ACoAA. These factors can be used as important reference indexes in making therapeutic plan for un-ruptured ACoAA. (authors)