A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Risk of Rupture After Intracranial Aneurysm Growth
Tekijät: van der Kamp Laura T., Rinkel Gabriel J. E., Verbaan Dagmar, van den Berg René, Vandertop W. Peter, Murayama Yuichi, Ishibashi Toshihiro, Lindgren Antti, Koivisto Timo, Teo Mario, St George Jerome, Agid Ronit, Radovanovic Ivan, Moroi Junta, Igase Keiji, van den Wijngaard Ido R., Rahi Melissa, Rinne Jaakko, Kuhmonen Johanna, Boogaarts Hieronymus D., Wong George K. C., Abrigo Jill M., Morita Akio, Shiokawa Yoshiaki, Hackenberg Katharina A. M., Etminan Nima, van der Schaaf Irene C., Zuithoff Nicolaas P. A., Vergouwen Mervyn D. I.
Kustantaja: AMER MEDICAL ASSOC
Julkaisuvuosi: 2021
Journal: JAMA Neurology
Lehden akronyymi: JAMA NEUROL
Vuosikerta: 78
Numero: 10
Aloitussivu: 1228
Lopetussivu: 1235
Sivujen määrä: 8
ISSN: 2168-6149
eISSN: 2168-6157
DOI: https://doi.org/10.1001/jamaneurol.2021.2915
IMPORTANCE Unruptured intracranial aneurysms not undergoing preventive endovascular or neurosurgical treatment are often monitored radiologically to detect aneurysm growth, which is associated with an increase in risk of rupture. However, the absolute risk of aneurysm rupture after detection of growth remains unclear.
OBJECTIVE To determine the absolute risk of rupture of an aneurysm after detection of growth during follow-up and to develop a prediction model for rupture.
DESIGN, SETTING, AND PARTICIPANTS Individual patient datawere obtained from 15 international cohorts. Patients 18 years and older who had follow-up imaging for at least 1 untreated unruptured intracranial aneurysm with growth detected at follow-up imaging and with 1 day or longer of follow-up after growth were included. Fusiform or arteriovenous malformation-related aneurysms were excluded. Of the 5166 eligible patients who had follow-up imaging for intracranial aneurysms, 4827 were excluded because no aneurysm growth was detected, and 27 were excluded because they had less than 1 day follow-up after detection of growth.
EXPOSURES All included aneurysms had growth, defined as 1mmor greater increase in 1 direction at follow-up imaging.
MAIN OUTCOMES AND MEASURES The primary outcomewas aneurysm rupture. The absolute risk of rupture was measured with the Kaplan-Meier estimate at 3 time points (6 months, 1 year, and 2 years) after initial growth. Cox proportional hazards regression was used to identify predictors of rupture after growth detection. RESULTS A total of 312 patients were included (223 [71%] were women; mean [SD] age, 61 [12] years) with 329 aneurysms with growth. During 864 aneurysm-years of follow-up, 25 (7.6%) of these aneurysms ruptured. The absolute risk of rupture after growth was 2.9% (95% CI, 0.9-4.9) at 6 months, 4.3%(95% CI, 1.9-6.7) at 1 year, and 6.0% (95% CI, 2.9-9.1) at 2 years. In multivariable analyses, predictors of rupture were size (7mmor larger hazard ratio, 3.1; 95% CI, 1.4-7.2), shape (irregular hazard ratio, 2.9; 95% CI, 1.3-6.5), and site (middle cerebral artery hazard ratio, 3.6; 95% CI, 0.8-16.3; anterior cerebral artery, posterior communicating artery, or posterior circulation hazard ratio, 2.8; 95% CI, 0.6-13.0). In the triple-S (size, site, shape) prediction model, the 1-year risk of rupture ranged from 2.1% to 10.6%.
CONCLUSION AND RELEVANCE Within 1 year after growth detection, rupture occurred in approximately 1 of 25 aneurysms. The triple-S risk prediction model can be used to estimate absolute risk of rupture for the initial period after detection of growth.
