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This was a retrospective review of 1340 patients with 1595 unruptured saccular intracranial aneurysms that underwent endovascular coil embolization between February 2010 and December 2014. The clinical outcomes of patients with procedural rupture of saccular intracranial aneurysms were compared with those of 198 patients presenting with spontaneously ruptured aneurysms. Procedural rupture developed in 19 patients, and the morbidity related to procedural rupture was 26.3% with no mortality. Hunt and Hess scale grades and hospitalization days of patients with procedural rupture were equivalent to those of patients presenting with spontaneous aneurysm rupture. In multivariate analysis, spontaneous aneurysm rupture was a significant risk factor for worse clinical outcome. This study showed better clinical outcomes in the procedural-rupture group.

The authors studied 313 posterior communicating artery aneurysms (145 ruptured, 168 unruptured) with image-based computational fluid dynamics. Aneurysms were classified into different angioarchitecture types depending on the location of the aneurysm with respect to parent artery bifurcation. Ruptured aneurysms had higher, more concentrated, and more oscillatory wall shear stress distributions; stronger and more concentrated inflow jets; and more complex and unstable flow patterns compared with unruptured aneurysms. They conclude that high-flow intrasaccular hemodynamic characteristics, commonly found in bifurcation-type angioarchitectures, are associated with the posterior communicating artery aneurysm rupture status.