Intracranial aneurysm (IA) is a serious cerebrovascular disease. This study aimed to investigate the clinical characteristics and plasma biomarkers associated with IA.

A total of 207 participants were enrolled: 45 with unruptured IA, 95 with ruptured IA, and 67 controls. Clinical characteristics, plasma biomarkers, peripheral blood macrophage subsets, and inflammatory cytokines in arterial wall tissue (from six ruptured IA patients and controls) were analyzed.

Compared to controls, ruptured IA patients exhibited elevated D-dimer, high-sensitivity C-reactive protein and glucose, while unruptured IA patients showed increased platelet count and plateletcrit. Compared to unruptured cases, ruptured IA patients demonstrated higher glucose and D-dimer levels, but lower prothrombin activity and activated partial thromboplastin time. Logistic regression identified association between elevated epithelial neutrophil-activating peptide 78 (ENA78) and platelet with unruptured IA, whereas elevated glucose, D-dimer and matrix metalloproteinase-9 (MMP-9) were associated with ruptured IA. Arterial wall analysis showed upregulation of MMP-9, intercellular adhesion molecule-1, and ENA78 in IA patients. Ruptured IA patients exhibited an altered peripheral blood profile characterized by higher CD14⁻CD16⁺ cell proportion and decreased CD14⁺CD16⁻ cells compared to controls.

Both inflammatory cytokines and coagulation parameters are implicated in IA pathogenesis, suggesting their potential roles in the development and rupture of IA.