Sex differences in aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery aneurysms: a retrospective study

Abstract

ObjectivesRuptured anterior communicating artery (ACoA) aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in aneurysm morphologies and clinical outcomes in patients with ruptured ACoA aneurysms.SettingA tertiary referral hospital.ParticipantsA total of 574 consecutive patients with ACoA aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA aneurysms were included in the study.Main outcome measuresAneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge.ResultsThe aneurysm sizes (p=0.001), aneurysm heights (p=0.011), size ratios (p<0.001), flow angles (p=0.047) and vessel angles (p=0.046) were larger in the male patients than in the females. The female patients more often had larger vessel sizes (p=0.002). Multivariate logistic analysis revealed that significant differences in aneurysm morphologies between men and women were aneurysm size (OR 1.1, 95% CI 1.0 to 1.3; p=0.036), aneurysm height (OR 0.8, 95% CI 0. to 0.9; p=0.006) and size ratio (OR 1.4, 95% CI 0.5 to 1.7; p=0.001). There were no statistically significant differences in the outcomes between men and women (OR 1.0, 95% CI 0.6 to 1.7, p=0.857).ConclusionsThe men were independently associated with larger aneurysm sizes, greater aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA aneurysms.

What Are the Predictors of Intracranial Aneurysm Rupture in Indonesian Population Based on Angiographic Findings? Insight from Intracranial Aneurysm Registry on Three Comprehensive Stroke Centres in Indonesia

“…This theory also supports our findings where the mean female age in this study is above the median age of natural menopause [23]. This study is in line with previous studies where males are associated with larger aneurysm size [22,24,25] but contradicts those where females are associated with multiple IA count [25][26][27].…”

Why Are Women Predisposed to Intracranial Aneurysm?

“…This is in agreement with the majority of anterior communicating artery aneurysms in men and their higher risk of rupture than IAs at other locations ( 18 , 36 ). Regarding this specific IA location, women exhibit a lower rate of ruptured anterior communicating artery aneurysms than men in whom these IAs are larger ( 16 , 33 ). This greater IA size may thus participate to the higher proportion of men with ruptured anterior communicating artery.…”

“…For both women and men, outcomes varied according to the location of aneurysmal subarachnoid hemorrhage but the overall outcomes after IA rupture are similar in women and men (16,20,26,33).…”

“…The location of aneurysmal subarachnoid hemorrhage also differs between women and men. According to the preferential location of IA on internal carotid artery in women, the posterior communicating artery is also the most common site of IA rupture in women, whereas anterior communicating artery aneurysm ruptures are overrepresented in men ( 16 , 18 , 20 , 26 , 33 – 35 ). This is in agreement with the majority of anterior communicating artery aneurysms in men and their higher risk of rupture than IAs at other locations ( 18 , 36 ).…”

Prediction of Clinical Outcome at Discharge After Rupture of Anterior Communicating Artery Aneurysm Using the Random Forest Technique

“…Twelve aneurysm morphologic parameters were evaluated, including aneurysm projection, A1 segment configuration, aneurysm size, vessel size, aneurysm height, perpendicular height, neck size, aspect ratio, size ratio, aneurysm angles, vessel angle, and flow angle. These parameters have been defined elsewhere (13)(14)(15). For completeness and the reader's convenience, we provide detailed aneurysm sizes and angle measurements in Supplementary Figure 1.…”