Morphologic and hemodynamic risk factors for paraophthalmic segment aneurysm rupture

To evaluate the impact of morphologic and hemodynamic characteristics on paraophthalmic segment aneurysms (PSAs) with the goal of identifying reliable risk factors for PSAs rupture. A case-control study was conducted among patients with a newly diagnosed PSAs who were treated at one of three Chinese medical institutions between January 2018 and December 2023. Propensity score matching was employed to balance differences in age; sex; and history of hypertension, diabetes, and/or hyperlipidemia between patients with ruptured PSAs and those with unruptured PSAs. Six morphologic and six hemodynamic characteristics of the aneurysms were assessed, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for rupture. Receiver operating characteristic curves were used to assess the area under the curve (AUC) for each characteristic in identifying cases of aneurysm rupture. A total of 16 ruptured and 64 unruptured aneurysms were evaluated. Multivariate logistic regression analysis demonstrated that aspect ratio (odds ratio [OR] = 12.89, 95% confidence interval [CI]: 3.23–51.46; P < 0.001) and aneurysm bleb (OR = 5.73, 95% CI: 1.04–31.46; P = 0.045) were independent morphologic risk factors and maximal wall shear stress (WSSmax) (OR = 1.08, 95% CI: 1.02–1.13; P = 0.004) and relative residence time (RRT) (OR = 9.19, 95% CI: 2.64–31.94; P < 0.001) were independent hemodynamic risk factors for aneurysm rupture. Three models for aneurysm rupture were constructed based on morphologic parameters, hemodynamic parameters, or a combination of both. The AUCs for these models were 0.8750, 0.9102, and 0.9304, respectively, with no significant difference between the models (all P > 0.05, DeLong test). Aspect ratio, aneurysm bleb, WSSmax, and RRT are independent risk factors for PSAs rupture. Both morphologic and hemodynamic factors can be used to effectively identify the rupture risk of aneurysms, providing reliable clinical evaluation criteria.