Smoking Associated with Increased Aneurysm Size in Patients with Anterior Communicating Artery Aneurysms

Background: Hypertension and smoking are risk factors for aneurysm formation or rupture. We aimed to identify differences in aneurysm morphologies associated with hypertension or smoking in patients with anterior communicating artery (AcoA) aneurysms.

Methods: Between December 2007 and February 2015, 574 consecutive patients with AcoA aneurysms were identified from the Electronic Medical Record System. We extracted data on histories of hypertension alone, smoking alone, nonhypertension and nonsmoking, and both hypertension and smoking. The morphologic parameters of aneurysms were remeasured via computed tomography angiography image reconstruction. Multivariate logistic regression analyses were used to determine the differences in morphologies in patients with hypertension or who smoked.

Results: In the study, 495 patients with single AcoA aneurysm were included. Age, sex, vessel size, aneurysm size and height, size ratio, A1 segment configuration, and aneurysm shape were significantly different among the groups. A larger aneurysm occurred more often in patients who only smoked compared with those without hypertension who did not smoke (adjusted odds ratio, 1.19; 95% confidence interval, 1.04-1.36; P = 0.012). Patients with hypertension who also smoked more commonly had a larger aneurysm size than those with hypertension alone (adjusted odds ratio, 0.89; 95% confidence interval, 0.79-0.99; P = 0.040). There were significant differences in age, sex, and aneurysm morphology between the smoking patients and those with hypertension alone.

Conclusions: Aneurysm size was an independent morphologic parameter associated with smoking in patients with ACoA aneurysms compared with other aneurysm morphologies. Smoking may be associated independently with increased aneurysm size and should be given up in patients with AcoA aneurysms.