Angular morphometric factors associated with intraoperative rupture in anterior communicating artery aneurysms: A prospective observational study

Objective: To evaluate the association between angular morphometric parameters of anterior communicating artery (AComA) aneurysms and intraoperative rupture, and to assess the relationship of inflammatory biomarkers (high-sensitivity C-reactive protein (hs-CRP), homocysteine) with aneurysm wall inflammation. Methods: In this prospective observational study, 37 patients with AComA aneurysms undergoing microsurgical clipping (Jan 2023-Dec 2025) were included. All presented with aneurysmal subarachnoid hemorrhage (Fisher Grade ≥1). Morphometric parameters-aneurysm size, aspect ratio, size ratio, height-width ratio, vessel angle, flow angle, parent vessel angle, and inclination angle-were measured using computed tomography (CT) angiography and intraoperative microscopy. Aneurysm inflammation was defined by macroscopic features (wall thickening, discoloration, adhesions, friability). Preoperative hs-CRP and homocysteine levels were recorded. Patients were categorized into intraoperative rupture (n=13) and unruptured (n=24) groups. Statistical analysis used SPSS v26.0 (p≤0.05). Results: Vessel angle (74.76±15.9 vs. 56.8±25.8; p=0.03) and flow angle (153.24±15.3 vs. 137.58±22.4; p=0.035) were significantly higher in ruptured cases. Parent vessel angle was higher in unruptured aneurysms (121.88±33.4 vs. 98.85±10.2; p=0.02). hs-CRP (68.86±57.3 vs. 30.86±49.8; p=0.032) and homocysteine (12.47±5.2 vs. 9.38±3.4; p=0.041) were elevated in inflamed aneurysms but showed no association with intraoperative rupture. Conclusions: Vessel, flow, and parent vessel angles are significantly associated with intraoperative rupture risk. While hs-CRP and homocysteine reflect aneurysm inflammation, they do not predict intraoperative rupture. CT Angiography (CTA)-based morphometric parameters may assist in surgical risk stratification.