<?xml version="1.1" encoding="utf-8"?>
<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">PAR</journal-id><journal-title-group><journal-title>Proceedings of Anticancer Research</journal-title></journal-title-group><issn>2208-3545</issn><eissn>2208-3553</eissn><publisher><publisher-name>Bio-Byword Scientific Publishing Pty. Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.26689/par.v8i6.8921</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title>Risk Factors Associated with Rupture of Multiple Intracranial Aneurysms</title><url>https://artdesignp.com/journal/PAR/8/6/10.26689/par.v8i6.8921</url><author>DongYanhua,XuWenjuan,LiuAihua</author><pub-date pub-type="publication-year"><year>2024</year></pub-date><volume>8</volume><issue>6</issue><history><date date-type="pub"><published-time>2024-11-25</published-time></date></history><abstract>Objective: To identify risk factors associated with multiple intracranial aneurysm (MIA) rupture. Methods: This retrospective study included patients with MIAs diagnosed at the center between February 2010 and December 2015. Patients were grouped based on their history of aneurysmal subarachnoid hemorrhage (aSAH) into ruptured and unruptured categories. In the ruptured group, aneurysms were further classified as ruptured MIAs (R-MIAs) and unruptured MIAs (U-MIAs). Patient- and aneurysm-related factors were analyzed using univariate analysis to determine their significance in rupture risk. Receiver operating characteristic (ROC) analysis was employed to calculate the area under the curve (AUC) and identify optimal thresholds for five morphological parameters distinguishing R-MIAs from U-MIAs. Results: Of 368 enrolled patients, 327 (86 with ruptured aneurysms and 241 unruptured) were included in the analysis. Among the ruptured group, 66 patients had R-MIAs and 96 had U-MIAs. Univariate analysis identified statistically significant factors associated with rupture, including BMI, irregular aneurysm shape, size, aspect ratio, size ratio, and bottleneck (P &amp;lt; 0.05). Size, size ratio, and bottleneck exhibited high AUC values (AUC &amp;gt; 0.7). ROC analysis determined an optimal threshold of 4.6 mm for MIA rupture size. Conclusions: Lower BMI, irregular aneurysm shape, larger size, larger size ratio, and bottleneck are associated with an increased risk of MIA rupture. Notably, MIAs may rupture at smaller sizes compared to single intracranial aneurysms.</abstract><keywords/></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>Deshmukh AS, Priola SM, Katsanos AH, et al., 2024, The Management of Intracranial Aneurysms: Current Trends and Future Directions. Neurol Int, 16(1): 74–94. https://doi.org/10.3390/neurolint16010005</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B2" content-type="article"><label>2</label><element-citation publication-type="journal"><p>Claassen J, Park S, 2022, Spontaneous Subarachnoid Haemorrhage. Lancet, 400(10355): 846–862. https://doi.org/10.1016/S0140-6736(22)00938-2</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B3" content-type="article"><label>3</label><element-citation publication-type="journal"><p>Werring DJ, Banerjee G, 2023, Convexity Subarachnoid Haemorrhage. Lancet, 401(10372): 193–194. https://doi.org/10.1016/S0140-6736(23)00004-1</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B4" content-type="article"><label>4</label><element-citation publication-type="journal"><p>Rigante L, Boogaarts HD, Bartels RHMA, et al., 2021, Factors Associated with Subsequent Subarachnoid Hemorrhages in Patients with Multiple Intracranial Aneurysms. World Neurosurg, 154: e185–e198. https://doi.org/10.1016/j.wneu.2021.07.014</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B5" content-type="article"><label>5</label><element-citation publication-type="journal"><p>Chen C, Wang C, Zhang C, et al., 2023, Prognostic Risk Factors of One-stage Surgical Clipping in aSAH Elderly Patients with MIAs. J Craniofac Surg, 34(7): 2071–2076. https://doi.org/10.1097/SCS.0000000000009387</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B6" content-type="article"><label>6</label><element-citation publication-type="journal"><p>Dinger TF, Darkwah Oppong M, Park C, et al., 2022, Development of Multiple Intracranial Aneurysms: Beyond the Common Risk Factors. J Neurosurg, 137(4): 1056–1063. https://doi.org/10.3171/2021.11.JNS212325</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B7" content-type="article"><label>7</label><element-citation publication-type="journal"><p>Pei Y, Wang Z, Hao S, et al., 2023, Analysis of Independent Risk Factors for Aneurysm Rupture Based on Carotid Tortuosity Index and Morphological Parameters of Single Intracranial Aneurysms in Anterior Circulation. Clin Neurol Neurosurg, 234: 107993. https://doi.org/10.1016/j.clineuro.2023.107993</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B8" content-type="article"><label>8</label><element-citation publication-type="journal"><p>Chen R, Zhang S, Xiao A, et al., 2022, Risk Factors for Intracranial Aneurysm Rupture in Pediatric Patients. Acta Neurochir (Wien), 164(4): 1145–1152. https://doi.org/10.1007/s00701-021-04957-2</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B9" content-type="article"><label>9</label><element-citation publication-type="journal"><p>Juvela S, Poussa K, Porras M, 2001, Factors Affecting Formation and Growth of Intracranial Aneurysms: A Long-Term Follow-Up Study. Stroke, 32(2): 485–491. https://doi.org/10.1161/01.str.32.2.485</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B10" content-type="article"><label>10</label><element-citation publication-type="journal"><p>De Rooij NK, Linn FH, van der Plas JA, et al., 2007, Incidence of Subarachnoid Haemorrhage: A Systematic Review with Emphasis on Region, Age, Gender and Time Trends. J Neurol Neurosurg Psychiatry, 78(12): 1365–1372. https://doi.org/10.1136/jnnp.2007.117655</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B11" content-type="article"><label>11</label><element-citation publication-type="journal"><p>Jabbarli R, Dinger TF, Darkwah Oppong M, et al., 2018, Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms: A Systematic Review and Meta-Analysis. Stroke, 49(4): 848–855. https://doi.org/10.1161/STROKEAHA.117.020342</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B12" content-type="article"><label>12</label><element-citation publication-type="journal"><p>Wang GX, Yang Y, Liu LL, et al., 2021, Risk of Rupture of Small Intracranial Aneurysms (≤ 5 mm) Among the Chinese Population. World Neurosurg, 147: e275–e281. https://doi.org/10.1016/j.wneu.2020.12.034</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B13" content-type="article"><label>13</label><element-citation publication-type="journal"><p>Vlak MH, Rinkel GJ, Greebe P, et al., 2013, Risk of Rupture of An Intracranial Aneurysm Based on Patient Characteristics: A Case-Control Study. Stroke, 44(5): 1256–1259. https://doi.org/10.1161/STROKEAHA.111.000679</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B14" content-type="article"><label>14</label><element-citation publication-type="journal"><p>Florez WA, Martinez-Perez R, Deora H, et al., 2023, An Update of Predictors of Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis. Journal of Neurosurgical Sciences, 67(1): 1–9. https://doi.org/10.23736/s0390-5616.22.05445-5</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B15" content-type="article"><label>15</label><element-citation publication-type="journal"><p>Lu J, Li M, Burkhardt JK, et al., 2021, Unruptured Giant Intracranial Aneurysms: Risk Factors for Mortality and Long-Term Outcome. Transl Stroke Res, 12(4): 593–601. https://doi.org/10.1007/s12975-020-00861-6</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B16" content-type="article"><label>16</label><element-citation publication-type="journal"><p>Lin H, Yin Y, Li J, et al., 2024, Exploring the Causal Links Between Cigarette Smoking, Alcohol Consumption, and Aneurysmal Subarachnoid Hemorrhage: A Two-Sample Mendelian Randomization Analysis. Front Nutr, 11: 1397776. https://doi.org/10.3389/fnut.2024.1397776</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B17" content-type="article"><label>17</label><element-citation publication-type="journal"><p>Flor LS, Anderson JA, Ahmad N, et al., 2024, Health Effects Associated with Exposure to Secondhand Smoke: A Burden of Proof Study. Nat Med, 30(1): 149–167. https://doi.org/10.1038/s41591-023-02743-4. Erratum in Nat Med, 30(4): 1213. https://doi.org/10.1038/s41591-024-02832-y</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B18" content-type="article"><label>18</label><element-citation publication-type="journal"><p>Esmaeeli S, Valencia J, Buhl LK, et al., 2021, Anesthetic Management of Unruptured Intracranial Aneurysms: A Qualitative Systematic Review. Neurosurg Rev, 44(5): 2477–2492. https://doi.org/10.1007/s10143-020-01441-w</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B19" content-type="article"><label>19</label><element-citation publication-type="journal"><p>Signorelli F, Pailler-Mattei C, Gory B, et al., 2018, Biomechanical Characterization of Intracranial Aneurysm Wall: A Multiscale Study. World Neurosurg, 119: e882–e889. https://doi.org/10.1016/j.wneu.2018.07.290</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B20" content-type="article"><label>20</label><element-citation publication-type="journal"><p>Vlak MH, Algra A, Brandenburg R, et al., 2011, Prevalence of Unruptured Intracranial Aneurysms, with Emphasis on Sex, Age, Comorbidity, Country, and Time Period: A Systematic Review and Meta-Analysis. Lancet Neurol, 10(7): 626–636. https://doi.org/10.1016/S1474-4422(11)70109-0</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B21" content-type="article"><label>21</label><element-citation publication-type="journal"><p>Kesav P, Manesh Raj D, John S, 2023, Cerebrovascular Fibromuscular Dysplasia – A Practical Review. Vasc Health Risk Manag, 19: 543–556. https://doi.org/10.2147/VHRM.S388257</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B22" content-type="article"><label>22</label><element-citation publication-type="journal"><p>Tominari S, Morita A, Ishibashi T, et al., 2015, Prediction Model for 3-Year Rupture Risk of Unruptured Cerebral Aneurysms in Japanese Patients. Ann Neurol, 77(6):1050–1059. https://doi.org/10.1002/ana.24400</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B23" content-type="article"><label>23</label><element-citation publication-type="journal"><p>Huang YW, Wang XY, Li ZP, et al., 2023, The Rupture Risk Factors of Mirror Intracranial Aneurysms: A Systematic Review and Meta-Analysis Based on Morphological and Hemodynamic Parameters. PLoS One, 18(6): e0286249. https://doi.org/10.1371/journal.pone.0286249</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B24" content-type="article"><label>24</label><element-citation publication-type="journal"><p>Nishiwaki T, Ikedo T, Kushi Y, et al., 2024, Hemodynamic Differences Determining Rupture and Non-Rupture in Middle Cerebral Aneurysms After Growth. PLoS One, 19(8): e0307495. https://doi.org/10.1371/journal.pone.0307495</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B25" content-type="article"><label>25</label><element-citation publication-type="journal"><p>Jagadeesan BD, Delgado Almandoz JE, Kadkhodayan Y, et al., 2014, Size and Anatomic Location of Ruptured Intracranial Aneurysms in Patients with Single and Multiple Aneurysms: A Retrospective Study from A Single Center. J Neurointerv Surg, 6(3): 169–174. https://doi.org/10.1136/neurintsurg-2012-010623</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B26" content-type="article"><label>26</label><element-citation publication-type="journal"><p>Schirmer CM, Bulsara KR, Al-Mufti F, et al., 2023, Antiplatelets and Antithrombotics in Neurointerventional Procedures: Guideline Update. J Neurointerv Surg, 15(11): 1155–1162. https://doi.org/10.1136/jnis-2022-019844</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B27" content-type="article"><label>27</label><element-citation publication-type="journal"><p>Axier A, Rexiati N, Wang Z, et al., 2022, Effect of Hemodynamic Changes on the Risk of Intracranial Aneurysm Rupture: A Systematic Review and Meta-Analysis. Am J Transl Res, 14(7): 4638–4647.</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B28" content-type="article"><label>28</label><element-citation publication-type="journal"><p>Guo KK, Liu CY, Li GH, et al., 2024, Differences and Correlations of Morphological and Hemodynamic Parameters between Anterior Circulation Bifurcation and Side-wall Aneurysms. Curr Med Sci, 44(2): 391–398. https://doi.org/10.1007/s11596-024-2846-6</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B29" content-type="article"><label>29</label><element-citation publication-type="journal"><p>Backes D, Vergouwen MD, Velthuis BK, et al., 2014, Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients with Multiple Intracranial Aneurysms. Stroke, 45(5): 1299–1303. https://doi.org/10.1161/STROKEAHA.113.004421</p><pub-id pub-id-type="doi"/></element-citation></ref><ref id="B30" content-type="article"><label>30</label><element-citation publication-type="journal"><p>Zhang W, Xiang C, Liu B, et al., 2024, The Value of Systemic Immune Inflammation Index, White Blood Cell to Platelet Ratio, and Homocysteine in Predicting the Instability of Small Saccular Intracranial Aneurysms. Sci Rep, 14(1): 24312. https://doi.org/10.1038/s41598-024-74870-y</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
