Analysis of Nonmodifiable Risk Factors for Intracranial Aneurysm Rupture in a Large, Retrospective Cohort

Amenta, Peter S.; Yadla, Sanjay; Campbell, Peter G.; Maltenfort, Mitchell; Dey, Saugat; Ghosh, Sayantani; Ali, Muhammad; Jallo, Jack; Tjoumakaris, Stavropoula; Gonzalez, L. Fernando; Dumont, Aaron S.; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1227/neu.0b013e3182354d68

Cited by 62 publications

(30 citation statements)

References 31 publications

(30 reference statements)

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“…22 Additionally, the critical AR for rupture has varied among previous studies, with AR cutoff values ranging from 1.3 to 1.8, and remains controversial. 6,19,22,23,26 In our study, an AR of Ն1.6 was significantly associated with aneurysm rupture.…”

Section: Irregular Wall and Ar Of Symmetric Bilateral Aneurysms Predisupporting

confidence: 52%

“…Previous studies on AR indicated conflicting results, finding a significant difference between the ruptured and unruptured groups, proving that AR is a relevant predictor in estimating the aneurysm rupture risk. 6,19,[22][23][24][25][26][27][28][29][30][31] The conflicting results can be explained by the lack of adjustment for patient-specific risk factors for aneurysm rupture and by the use of different imaging techniques and measurement methodology. 22,27 Regarding AR, only 3 previous studies aimed to minimize the confounding factors by studying patients with multiple intracranial aneurysms.…”

Section: Irregular Wall and Ar Of Symmetric Bilateral Aneurysms Predimentioning

confidence: 99%

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Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study

Huang

Meng

Hou

et al. 2016

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Previous studies of geometric and morphologic parameters of intracranial aneurysms have been conducted to determine rupture risk, which remains incompletely defined due to patient-specific risk factors, such as sex, hypertension, and age. To this end, we compared characteristics of ruptured and unruptured aneurysms in the same patients with symmetric bilateral intracranial aneurysms.

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Section: Irregular Wall and Ar Of Symmetric Bilateral Aneurysms Predisupporting

confidence: 52%

Section: Irregular Wall and Ar Of Symmetric Bilateral Aneurysms Predimentioning

confidence: 99%

Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study

Huang

Meng

Hou

et al. 2016

American Journal of Neuroradiology

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“…9,11 Implementation of additional (aneurysm-related) risk factors for aneurysm rupture, such as aspect ratio (aneurysm neck-to-dome length/neckwidth), [22][23][24][25][26][27][28] size ratio (maximum aneurysm diameter/average vessel diameter), [29][30][31] and irregular aneurysm shape, 13,[32][33][34][35][36] might improve current rupture risk assessment. However, assessment whether implementation of additional risk factors improves risk prediction has several difficulties, such as the need of large numbers of patients-years as a result of an annual rupture rate of ≈1%.…”

Section: Discussionmentioning

confidence: 99%

PHASES Score for Prediction of Intracranial Aneurysm Growth

Backes

Vergouwen

Groenestege

et al. 2015

Stroke

144

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Background and Purpose-Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods-In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results-We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5-10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22-1.43). With the lowest quartile of the PHASES score (0-1) as reference, hazard ratios were for the second (PHASES 2-3) 1.07 (95% CI, 0.49-2.32), the third (PHASES 4) 2.29 (95% CI, 1.05-4.95), and the fourth quartile (PHASES 5-14) 2.85 (95% CI, 1.43-5.67). Conclusions-Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

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“…11,18,25 Regarding aspect ratio, most but not all previous studies showed that mean aspect ratios were higher in ruptured aneurysms than in unruptured aneurysms. 10,12,[15][16][17][18][19][20][21][22][23][24][29][30][31] The conflicting results in case-control studies comparing geometric and morphological aneurysm characteristics between patients with ruptured aneurysms and patients with unruptured aneurysms can be explained by the lack of adjustment for patient specific risk factors for aneurysm rupture and by the use of different imaging techniques and measurement methodology. 15 Similar to our study, 2 previous studies aimed to minimize the risk of confounding by patient-specific characteristics by studying patients with aneurysmal SAH and multiple intracranial aneurysms, and demonstrated that a high aspect ratio was associated with aneurysm rupture.…”

Section: Discussionmentioning

confidence: 99%

Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms

Backes

Vergouwen

Velthuis

et al. 2014

Stroke

167

119

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Background and Purpose-Prediction of the risk of rupture of unruptured intracranial aneurysms is mainly based on aneurysm size and location. Previous studies identified features of aneurysm shape and flow angles as additional risk factors for aneurysm rupture, but these studies were at risk for confounding by patient-specific risk factors such as hypertension and age. In this study, we avoided this risk by comparing characteristics of ruptured and unruptured aneurysms in patients with both aneurysmal subarachnoid hemorrhage and multiple intracranial aneurysms. Methods-We included patients with aneurysmal subarachnoid hemorrhage and multiple aneurysms who presented to our hospital between 2003 and 2013. We identified the ruptured aneurysm based on bleeding pattern on head computed tomography or surgical findings. Aneurysm characteristics (size, location, shape, aspect ratio [neck-to-dome length / neck-width], flow angles, sidewall or bifurcation type, and contact with bone) were evaluated on computed tomographic angiograms. We calculated odds ratios with 95% confidence intervals with conditional univariable logistic regression analysis. Analyses were repeated after adjustment for aneurysm size and location. Key Words: anatomy and histology ◼ intracranial aneurysm ◼ multidetector computed tomography ◼ subarachnoid hemorrhage

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Analysis of Nonmodifiable Risk Factors for Intracranial Aneurysm Rupture in a Large, Retrospective Cohort

Abstract: An AR >1.6, dome diameter >10 mm, a deviated neck, and right-sidedness are independently associated with aneurysm rupture.

Cited by 62 publications

References 31 publications

Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study

Geometric Parameter Analysis of Ruptured and Unruptured Aneurysms in Patients with Symmetric Bilateral Intracranial Aneurysms: A Multicenter CT Angiography Study

PHASES Score for Prediction of Intracranial Aneurysm Growth

Difference in Aneurysm Characteristics Between Ruptured and Unruptured Aneurysms in Patients With Multiple Intracranial Aneurysms

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