Biological and morphometric factors associated with rupture of middle cerebral artery aneurysms: a retrospective analysis of predictors and functional outcomes
Factores biológicos y morfométricos asociados a la rotura de aneurismas de la arteria cerebral media: análisis retrospectivo de predictores y resultados funcionales
Jose Luis Acha Luis Contreras Oscar Santos Victor Aldea Erick Ponce Barbara Chia
Abstract
Introduction: Microsurgical clipping remains the standard treatment for middle cerebral artery (MCA) aneurysms, although the relative significance of morphometric indices compared with biological factors in rupture prediction remains controversial. Objective: To identify independent predictors of rupture in MCA aneurysms and to evaluate functional outcomes following a microsurgical preservation-oriented protocol. Methods: A retrospective study of 96 patients was conducted at a tertiary referral center. Multivariable logistic regression analysis incorporated biologically plausible factors (age, hypertension, smoking) and variables with p < 0.20 in univariate analysis. Diagnostic performance was assessed using ROC curves. Functional status was evaluated using the modified Rankin Scale (mRS) up to six months postoperatively. Results: Ruptured aneurysms accounted for 87.5% of cases. In multivariable analysis, age emerged as the only independent predictor of rupture (OR 1.05; 95% CI 1.01-1.09; p = 0.023). Dome diameter showed a nonsignificant trend toward rupture (6.80 mm vs. 5.80 mm; p = 0.072; AUC 0.64), outperforming aspect ratio (AUC 0.53). At six months, 90.1% of patients achieved functional independence (mRS 0-2). Conclusions: Age is the most robust predictor of rupture in MCA aneurysms, suggesting that rupture risk is closely linked to biological vascular degeneration rather than static geometric parameters.
Keywords
Resumen
Introducción: El clipaje microquirúrgico sigue siendo el tratamiento estándar para los aneurismas de la arteria cerebral media (ACM), sin embargo, la importancia relativa de los índices morfométricos en comparación con los factores biológicos para la predicción de la rotura sigue siendo controvertida. Objetivo: Identificar predictores independientes de rotura en aneurismas de la ACM y evaluar los resultados funcionales tras un protocolo microquirúrgico orientado a la preservación. Métodos: Se realizó un estudio retrospectivo de 96 pacientes en un centro de referencia terciario. El análisis de regresión logística multivariante incorporó factores biológicamente plausibles (edad, hipertensión, tabaquismo) y variables con p < 0,20 en el análisis univariante. El rendimiento diagnóstico se evaluó mediante curvas ROC. El estado funcional se evaluó mediante la Escala de Rankin modificada (mRS) hasta seis meses después de la cirugía. Resultados: Los aneurismas rotos representaron el 87,5% de los casos. En el análisis multivariante, la edad se identificó como el único predictor independiente de rotura (OR 1,05; IC del 95%: 1,01-1,09; p = 0,023). El diámetro del domo mostró una tendencia no significativa hacia la rotura (6,80 mm frente a 5,80 mm; p = 0,072; AUC 0,64), superando a la relación de aspecto (AUC 0,53). A los seis meses, el 90,1% de los pacientes alcanzó la independencia funcional (mRS 0-2). Conclusiones: La edad es el predictor más robusto de rotura en los aneurismas de la arteria cerebral media, lo que sugiere que el riesgo de rotura está estrechamente relacionado con la degeneración vascular biológica más que con parámetros geométricos estáticos.
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References
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Submitted date:
05/19/2026
Reviewed date:
06/05/2026
Accepted date:
06/08/2026
Publication date:
06/19/2026
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