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158 Morphological Parameters for Anterior Communicating Artery Aneurysm Rupture Risk Assessment.

INTRODUCTION
Several demographic, morphological, and hemodynamic factors influence the rupture of an intracranial aneurysm. The authors aim to investigate whether the morphological factors of an aneurysm in anterior communicating artery (ACOM Art) influence the rupture.


METHODS
Several 1-dimensional, 2-dimensional, and 3-dimensional parameters were evaluated in 3D digital subtraction angiography. The measurements were performed in blinded fashion to determine whether the size and shape parameters influence the rupture. A total of 30 anterior communicating aneurysms (ruptured = 15 and unruptured = 15) were taken for analysis. Five 1-dimensional factors such as diameter of neck, maximum width of aneurysm, maximum height of the aneurysm, and maximum perpendicular height of aneurysm and parent artery diameter were calculated. Two dimensional factors such as aspect ratio, size ratio, aneurysm angle, vessel angle, flow angle, parent daughter angle, and bottleneck factor were estimated. Three-dimensional parameters such as conicity index were also calculated. A pictorial representation of method of calculation has been depicted below. The standard demographic risk factors such as female sex, hypertension, and smoking were also considered to match the 2 groups. Two-tailed independent student t tests were used to determine the statistical difference between the morphological indices. Area under curve (AUC) was estimated in the receiver operating characteristic (ROC) curve for risk assessment analysis.


RESULTS
Standard size and shape parameters are poor determinants of rupture of an ACOM Art aneurysm. The parent daughter angle (0.67), aspect ratio (0.56), bottle neck factor (0.55), and conicity index (0.44) were found to be the most significant factors in ROC curve analysis. However, the strength of association remains poor for each of them.


CONCLUSION
Standard morphometric parameters are not good predictors of rupture of ACOM Art aneurysms. Multifactorial analysis including complex shape indices along with hemodynamic parameters are required to determine the rupture risk.