Scoring of Growth of Unruptured Intracranial Aneurysms

Abstract

The purpose was to obtain a reliable scoring for growth of unruptured intracranial aneurysms (UIAs) in a long-term follow-up study from variables known at baseline and to compare it with the ELAPSS (Earlier subarachnoid hemorrhage, Location of the aneurysm, Age > 60 years, Population, Size of the aneurysm, and Shape of the aneurysm) score obtained from an individual-based meta-analysis. The series consists of 87 patients with 111 UIAs and 1669 person-years of follow-up between aneurysm size measurements (median follow-up time per patient 21.7, range 1.2 to 51.0 years). These were initially diagnosed between 1956 and 1978, when UIAs were not treated in our country. ELAPSS scores at baseline did not differ between those with and those without aneurysm growth. The area under the curve (AUC) for the receiver operating curve (ROC) of the ELAPSS score for predicting long-term growth was fail (0.474, 95% CI 0.345–0.603), and the optimal cut-off point was obtained at ≥7 vs. <7 points for sensitivity (0.829) and specificity (0.217). In the present series UIA growth was best predicted by female sex (4 points), smoking at baseline (3 points), and age <40 years (2 points). The AUC for the ROC of the new scoring was fair (0.662, 95% CI 0.546–0.779), which was significantly better than that of ELAPSS score (p < 0.05). The optimal cut-off point was obtained at ≥4 vs. <4 points for sensitivity (0.971) and specificity (0.304). A new simple scoring consisting of only female sex, cigarette smoking and age <40 years predicted growth of an intracranial aneurysm in long-term follow-up, significantly better than the ELAPSS score.

Outcome of Patients with Multiple Intracranial Aneurysms after Subarachnoid Hemorrhage and Future Risk of Rupture of Unruptured Aneurysm

“…Correspondingly, a previous UIA study based on this cohort was considered to be of high study quality and have low sources of bias relative to other UIA studies [ 11 , 20 ]. A major strength and advantage of this cohort is also the simple treatment scoring with only four variables which is easy and simple to use in everyday clinical practice [ 15 , 16 , 18 ]. Although Finns have been considered to have a higher risk for SAH, its incidence is not higher when the study design with the inclusion and exclusion criteria, the accuracy of diagnosis, and the sex and age distributions of the population are carefully taken into account [ 7 ].…”

“…This hospital was responsible for neurosurgical services for nearly the whole Finnish population. For details of the cohort with the inclusion and exclusion criteria, as well as follow-up arrangements, see the previous reports [ 1 , 8 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 21 ].…”

“…Detailed follow-up procedures have been reported previously [ 1 , 8 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 21 ]. Briefly, the follow-up was based on visits to outpatient clinics, postal questionnaires and telephone interviews obtained from patients and family members approximately every 10 years since the early 1960s.…”

“…This score showed the following factors to predict an increased rupture risk: age < 40 years, current smoking, and UIA location and size [ 15 , 16 ]. The same factors also increased the growth risk of UIAs [ 14 , 17 , 18 ]. Location of UIAs in the anterior communicating artery (ACOM) and posterior communicating artery (PCOM) and the maximum size of UIA were included in both scoring systems, and these also yielded the highest score points.…”

“…This cohort represents an almost lifelong prospective follow-up study of UIAs among patients of working age without treatment selection bias [ 1 , 8 , 9 , 12 , 13 , 14 , 17 , 18 ], and it was considered to be of a high quality among all the known UIA series [ 11 , 20 ]. The aim was to study whether future rupture risk of UIAs differs according to the outcome status after SAH and treatment of the ruptured one.…”