Prediction model for 3‐year rupture risk of unruptured cerebral aneurysms in <scp>J</scp>apanese patients

Tominari, Shinjiro; Morita, Akio; Ishibashi, Toshiyuki; Yamazaki, Takahisa; Takao, Hiroyuki; Murayama, Yuichi; Sonobe, Makoto; Yonekura, Masahiro; Saito, Nobuhito; Shiokawa, Yoshiaki; Date, Isao; Tominaga, Teiji; Nozaki, Kazuhiko; Houkin, Kiyohiro; Miyamoto, Susumu; Kirino, Takaaki; Hashi, Kazuo; Nakayama, Takeo

doi:10.1002/ana.24400

Cited by 120 publications

(84 citation statements)

References 37 publications

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“…Aneurysm growth and rupture share several risk factors such as female sex, hypertension, smoking, and aneurysm size, location, and shape, which suggests that aneurysm growth and rupture are processes with, in part, similar pathogenesis. 4,26,27 This is supported by studies that show highly increased risks of aneurysm rupture in growing aneurysms. 24,28,29 However, there are also striking differences between risk factors for aneurysm growth and risk factors for aneurysm rupture.…”

Section: Strokementioning

confidence: 83%

“…Multiple intracranial aneurysms and smoking at baseline are strong risk factors for aneurysm growth, but were of limited predictive value for aneurysm rupture in recently published prediction tools for aneurysm rupture. 4,26 Other risk factors such as a previous SAH and a positive family history of intracranial aneurysms were of limited predictive for aneurysm growth, but are strongly related to aneurysm rupture. 4,30 In addition, one would expect to find a higher risk of aneurysm growth in populations that whave a high risk of aneurysm rupture, such as the Japanese or Finnish population.…”

Section: Strokementioning

confidence: 99%

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Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth

Backes

Rinkel

Laban

et al. 2016

Stroke

178

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A pproximately 3% of the adult population has an unruptured intracranial aneurysm.1 Identification of an unruptured aneurysm offers an opportunity for preventive endovascular or microsurgical occlusion, but both treatment methods carry risks of complications.2,3 For many small aneurysms, the risk of rupture is considered to be much lower than this risk of complications, [2][3][4] and such aneurysms are often left untreated. Because aneurysms tend to increase in size over time, and larger size is associated with higher risk of rupture, follow-up imaging to assess growth of aneurysms is recommended for aneurysms that are left untreated. 5 Moreover, growth may be a good surrogate marker for rupture in follow-up and treatment studies on unruptured intracranial aneurysms because risk prediction models for rupture also predict growth. 6 In this systematic review and meta-analysis, we aim to identify patient-and aneurysm-specific risk factors for aneurysm growth. MethodsWe performed a MEDLINE and EMBASE search (last search February 20, 2015) using the following search terms: aneurysm* and unruptured or incidental and intracranial or cerebral or brain or intracerebral or cranial and grow* or increase or enlarge* or develop* or progress*. The search terms were limited to title and abstract. One author (D.B.) screened all records with regard to title and abstract. We included all cohort studies with aneurysm growth as an outcome measure in which effect estimates for aneurysm growth were given or could be calculated. Exclusion criteria were (1) article written in language other than English, Dutch, German, French, Spanish, or Italian; (2) studies on vascular malformations other than intracranial aneurysms; (3) reviews, editorials, letters, conference abstracts, case reports, and case series <15 patients; and (4) in vitro studies, animal studies, simulation studies, or mathematical models. Two authors (D.B. and K.G.L.) independently screened all remaining full-text articles on their eligibility for inclusion. We also checked the prospectively collected personal database of one of the authors (G.J.E.R.) and cross-checked the reference lists of all included studies for further relevant studies until no further publication was found (Figure 1).Background and Purpose-Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient-and aneurysm-specific risk factors for aneurysm growth. Data ExtractionTwo authors (D.B. and K.G.L.) independently extracted crude data and effect estimates (odds ratio, relative risk, and hazard ratio) for patient-and aneurysm-specific risk factors for aneurysm growth. In case multiple publications reported on the same patient population, we included data from the publication with the largest number of patients. If other publications on the same patient population provided data on risk factors that were not described in the publication with the largest patient population, we also included those data. Patient charact...

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Section: Strokementioning

confidence: 83%

Section: Strokementioning

confidence: 99%

Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth

Backes

Rinkel

Laban

et al. 2016

Stroke

178

View full text Add to dashboard Cite

show abstract

“…Whereas some highly cited previous work, such as the CRASH and IMPACT score papers for prognostication of outcome after traumatic brain injury and a recent score paper for prognostication of long-term aneurysm rupture risks, use point estimates with CIs to display score outputs, we chose to display outcome ranges for mRS, TICS, and SIP scores, to facilitate communication with patients and relatives, and among physicians. [36][37][38] However, knowing that some researchers and clinicians prefer point estimates as score output, we included them in the FRESH smartphone app.…”

Section: -31mentioning

confidence: 99%

“…Separate scores to prognosticate 1-year cognition (FRESH-cog) and quality of life (FRESH-quol) were developed controlling for education and premorbid disability. Poor functional outcome (mRS 5 4-6) for score levels 1 through 9 respectively was present in 3,6,12,38, 61, 83, 92, 98, and 100% at 1-year follow-up. Performance of FRESH (AUC 5 0.90), FRESH-cog (AUC 5 0.80), and FRESH-quol (AUC 5 0.78) was high.…”

mentioning

confidence: 96%

Prognostication of long‐term outcomes after subarachnoid hemorrhage: The FRESH score

Witsch

Frey

Patel

et al. 2016

Annals of Neurology

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“…Nearly 50% of patients with a sporadic aneurysm rupture have a ruptured intracranial aneurysm (RIA) sized <5 mm [4]. The risk of aneurysm rupture differs according to their sites, and aneurysm in certain locations ruptures even when the size is small [5]. In addition, the risk factors associated with aneurysm rupture differs by each site [6].…”

Section: Introductionmentioning

confidence: 99%

Small versus Large Ruptured Intracranial Aneurysm: Concerns with the Site of Aneurysm

et al. 2017

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Background: Although size is one of the strongest predictors, small aneurysms often rupture. We compared the characteristics of small and large ruptured intracranial aneurysms (RIAs) according to their location to find the factors associated with small RIAs in each location. Methods: Patients with subarachnoid hemorrhage due to saccular RIAs were consecutively enrolled. The sizes were dichotomized as small (<5 mm) or large, and the location was classified as paraclinoid-distal internal carotid artery, sidewalls of anterior or middle cerebral artery (MCA; sidewall), MCA-bifurcation, anterior or posterior communicating artery (Acom or Pcom, respectively), and posterior circulation RIAs. Independent factors associated with small RIAs compared to large RIAs were investigated in each location. Results: Small RIAs were observed in 384 of 791 patients (48.5%), and were most commonly located at Acom (17.1%) followed by Pcom (9.0%) and sidewalls (7.2%). Female sex (OR 3.038; 95% CI 2.099-4.395), young age (OR 0.971; 95% CI 0.958-0.985), hypertension (OR 1.412; 95% CI 1.033-1.930) and multiple aneurysms (OR 1.942; 95% CI 1.335-2.824) were associated with small RIAs. By location, sidewall aneurysms (OR 2.183; 95% CI 1.049-4.542) were associated with small RIAs, whereas MCA-bifurcation (OR 0.318; 95% CI 0.168-0.599) and Pcom aneurysms (OR 0.511; 95% CI 0.277-0.944) were associated with large RIAs. The presence of multiple aneurysms (OR 4.69; 95% CI 1.45-21.19) was associated with small RIAs at sidewalls, and young age, female sex, hypertension and the presence of bilateral A1 (OR 1.85; 95% CI 1.09-3.13) were associated with small RIAs at Acom. Acom RIAs with bilateral A1 was smaller than those with unilateral A1 (4.7 ± 2.1 vs. 5.8 ± 2.6 mm; p < 0.001). Conclusions: Intracranial aneurysms which rupture below 5 mm are not uncommon, and the factors associated with small-sized RIAs differ according to location. Sidewall aneurysms, with multiple aneurysms and Acom aneurysms with bilateral A1 may rupture even at small size.

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Prediction model for 3‐year rupture risk of unruptured cerebral aneurysms in Japanese patients

Abstract: A simple scoring system that only needs easily available patient and aneurysmal information was constructed. This can be used in clinical decision making regarding management of unruptured cerebral aneurysms.

Cited by 120 publications

References 37 publications

Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth

Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth

Prognostication of long‐term outcomes after subarachnoid hemorrhage: The FRESH score

Small versus Large Ruptured Intracranial Aneurysm: Concerns with the Site of Aneurysm

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