LAUSR

BACKGROUND Mirror intracranial aneurysms with different rupture status is a useful model to investigate features associated with aneurysm rupture. Morphological and hemodynamic analysis of ruptured middle cerebral artery (MCA) mirror aneurysms are rarely reported. The purpose of this study was to determine the morphological or hemodynamic characteristics associated with ruptured MCA mirror aneurysms. METHODS We performed a retrospective analysis of consecutive 317 patients with MCA aneurysms. Ruptured MCA mirror aneurysms (one ruptured and mirror unruptured aneurysm) were included. In the matched-pairs of ruptured and unruptured mirror aneurysms, thirteen morphological parameters were measured using three-dimensional CT angiography and 6 hemodynamic parameters were evaluated using high resolution computational fluid dynamic simulations. The association of morphological and hemodynamic characteristics with rupture of MCA mirror aneurysms was determined. RESULTS A total of 20 (6.31%) patients with 40 MCA mirror aneurysms were included in this study. There were significant differences in morphological and hemodynamic parameters between the ruptured and unruptured mirror aneurysms. Irregular aneurysms were 3 times more common in the ruptured aneurysms than in the unruptured aneurysms. A larger aneurysm (p=0.025), a higher aneurysm (p=0.020), a larger size ratio (p=0.009), a higher bottleneck ratio (p=0.033), an irregular aneurysm (p=0.022), a higher maximum intra-aneurysmal WSS (p=0.020), and a lower normalized average WSS (p=0.008) were associated with MCA mirror aneurysm rupture CONCLUSIONS: Larger aneurysms, a larger size ratio, irregular aneurysms, lower spatial average WSS and higher maximum WSS may contribute to evaluate the risk of rupture of MCA aneurysms independent of patient characteristics.