title: Smoking and Intracranial Aneurysm Morphology.
abstract: BACKGROUND
  Smoking is a well-known independent risk factor for both aneurysm formation and rupture. There is mounting evidence that aneurysm morphology beyond size can have a significant role in aneurysm formation and rupture risk by its effects on aneurysmal hemodynamics.
  
  
  OBJECTIVE
  To study the variation in aneurysm morphology between smokers and nonsmokers and delineate how changes in these factors might affect aneurysm formation and rupture.
  
  
  METHODS
  We generated 3-dimensional models of aneurysms and their surrounding vasculature by analyzing preoperative computed tomography angiograms with Slicer software. We then examined the association between smoking status and intrinsic, transitional, and extrinsic aspects of aneurysm morphology in both univariate and multivariate statistical analyses.
  
  
  RESULTS
  From 2005 to 2013, 199 cerebral aneurysms in never smokers and current smokers were evaluated/treated at a single institution with available computed tomography angiograms (102 in never smokers and 97 in current smokers). Multivariate analysis of current smokers vs never smokers demonstrated that aneurysms in current smokers were significantly associated with multiple aneurysms (odds ratio [OR]: 2.15, P = .03), larger daughter vessel diameters (OR: 3.13, P = .01), larger size ratio (OR: 1.78, P = .01), and location at the basilar apex (OR: 6.26, P = .02).
  
  
  CONCLUSIONS
  The differences in aneurysm morphology between smoking and nonsmoking patient populations may elucidate the effects of smoking on aneurysm formation and eventual rupture. We identified several aspects of aneurysm morphology significantly associated with smoking status that may provide the morphological basis for how smoking leads to increased aneurysm rupture.
authors.affiliation: *Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D017542:Aneurysm, Ruptured / Q000209:etiology / Q000473:pathology; D001699:Biometry; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000209:etiology* / Q000473:pathology*; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D012984:Software; D014057:Tomography, X-Ray Computed