Background and Purpose Risk factors for formation and rupture of intracranial aneurysms (IAs) have been extensively investigated, and it is apparent that IAs and subarachnoid hemorrhage (SAH) are more common in females than males. Much is unknown about why IAs occur more frequently in females, but previous investigators have implicated hormonal and flow geometry variations in the development of compromised vessel wall integrity. The purpose of this study was to evaluate morphological characteristics of aneurysms within our population and differences in morphology and/or anatomic locations between males and females.

Methods A retrospective review was performed of patients undergoing 3D angiograms for intracranial aneurysms at a comprehensive stroke center between January 1, 2012 and January 1, 2018. Data collected included patient demographic information, comorbidities and aneurysm characteristics evaluated by 3D angiogram. All statistical analyses were completed in SAS 9.4.

Results 276 patients (203 female, 73 male) with 404 aneurysms were included. Of the 276 patients, 113 (81 female, 32 male) presented with ruptured IAs. On univariate analysis, female patients had significantly greater odds of having a posterior circulation aneurysm than males (p = 0.0073; OR, 4.30; 95% CI 1.48 to 12.48). For males and females, the most frequent locations were the anterior communicating artery and internal carotid artery, respectively. No statistically significant differences were observed in neck diameter, dome to neck ratio, or presence of secondary aneurysmal sacs.

Conclusion The sex differences in aneurysm morphology and location require further investigation. Aneurysms found in male and female patients had different anatomic distributions; the most frequent location was the anterior communicating artery for men and the internal carotid artery for women. No statistically significant differences were discovered in the studied morphological parameters. Sex differences in IA characteristics may reveal unknown information about the pathophysiology of formation of IAs and possible disparities in treatment outcomes. In the future, these sex differences could impact management strategies.

Disclosures E. Roney: None. D. Lukins: None. M. Nisiewicz: None. A. Alhajeri: None. S. Grupke: None. J. Fraser: None.