PHASES and ELAPSS Scores Are Associated with Aneurysm Growth: A Study of 431 Unruptured Intracranial Aneurysms

Brinjikji, Waleed; Pereira, Vítor Mendes; Khumtong, Rujimas; Kostensky, Alex; Tymianski, Michael; Krings, Timo; Radovanovich, Ivan

doi:10.1016/j.wneu.2018.03.003

Cited by 31 publications

(22 citation statements)

References 15 publications

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“…Our findings are in line with a recent study that found increasing ELAPSS score to be associated with aneurysm growth in a cohort of 353 patients with 431 unruptured intracranial aneursyms [12]. The reason for the underestimation of the 5-year growth risk for low-risk aneurysms in our validation cohort may be in part because median follow-up time in the validation cohort was only 2.1 years, which limits reliability of the Kaplan-Meier estimated observed probabilities at 5 years.…”

Section: Discussionsupporting

confidence: 93%

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

et al. 2019

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Background and Purpose Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. Methods From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). Results We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. Conclusions The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.

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Section: Discussionsupporting

confidence: 93%

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

et al. 2019

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“…In this study, smoking status displayed a dose-response trend even after adjusting for confounding factors such as age, sex, and family history of stroke. Previous studies have reported that smoking was associated with the growth and rupture of intracranial aneurysms 5,19) . Brinjikji et al reported that intracranial aneurysms among current smokers had high growth rates 19) .…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies have reported that smoking was associated with the growth and rupture of intracranial aneurysms 5,19) . Brinjikji et al reported that intracranial aneurysms among current smokers had high growth rates 19) . These findings implicate smoking in contributing to both the incidence and growth of intracranial aneurysms.…”

Section: Discussionmentioning

confidence: 96%

Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan

et al. 2020

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Objective: Although it is well known that smoking is a risk factor for subarachnoid hemorrhage, the association between smoking and unruptured intracranial aneurysms remains unclear. The aim of the present study was to investigate whether smoking status was associated with unruptured intracranial aneurysms among Japanese brain health checkup examinees. Materials and Methods: We conducted a cross-sectional study of 1,496 adults (aged 26-90 years) undergoing brain health checkups at a single community medical support hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily undergo a brain health checkup for early detection of unruptured intracranial aneurysms or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such as smoking status, and were classified into three groups: never, former, and current smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance angiography was performed by an expert physician. Multiple logistic regression models were used to estimate the odds ratio for unruptured intracranial aneurysms. We performed statistical analyses by age, sex, and family history of stroke. Results: The number of participants with unruptured intracranial aneurysms was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5) years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for unruptured intracranial aneurysms of 1.21 (0.48-3.08) among former smokers and 2.88 (1.10-7.50) among current smokers were compared to those of never smokers (p-trend = 0.041). After stratifying by age, sex, and family history of stroke, no interactions were found. Conclusion: This cross-sectional study conducted in Japan showed that smoking was positively associated with unruptured intracranial aneurysms among brain health checkup examinees.

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“…Following their initial detection, 10–12% of UIAs grow within 3 years, rising to 45% after 19 years. 11 13–15 Initial aneurysm size is an important factor for subsequent growth. Aneurysm enlargement is variably defined but an increase of at least 1 mm in any direction is generally accepted to be significant.…”

Section: Aneurysm Growthmentioning

confidence: 99%

Management of incidental unruptured intracranial aneurysms

Renowden

Nelson

2020

Pract Neurol

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The widespread use of MR has led to the increasingly frequent diagnosis of unruptured incidental intracranial aneurysms. Most are small (<7 mm diameter) and will never rupture. Yet, their recognition causes much anxiety, and their optimal management remains controversial. This review addresses the difficulties in managing incidental unruptured saccular intracranial aneurysms. Note that our conclusions and recommendations do not apply to symptomatic unruptured aneurysms or to fusiform, dissecting, mycotic, traumatic and paediatric aneurysms, each of which has a different natural history.

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PHASES and ELAPSS Scores Are Associated with Aneurysm Growth: A Study of 431 Unruptured Intracranial Aneurysms

Cited by 31 publications

References 15 publications

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk

Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan

Management of incidental unruptured intracranial aneurysms

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