BACKGROUND AND PURPOSE: We updated our previous review from 1996 on the risk of rupture of unruptured intracranial aneurysms, aiming to include the newly published articles. METHODS: We reviewed all studies from our former meta-analysis and performed a Medline search for new studies published after 1996. We calculated overall risks of rupture for studies with a mean follow-up time of <5, 5 to 10, and >10 years. Relative risks (RR) were calculated by comparing the risk of rupture in patients with and without potential risk factors. We aimed to perform multivariable analyses of the different risk factors with meta-regression analysis. RESULTS: We included 19 studies (10 new) with 4705 patients and 6556 unruptured aneurysms (follow-up 26 122 patient-years). The overall rupture risks were 1.2% (follow-up <5 years), 0.6% (follow-up 5 to 10 years), and 1.3% (follow-up >10 years). In the univariable analysis, statistically significant risk factors for rupture were age >60 years (RR 2.0; 95% confidence interval [CI], 1.1 to 3.7), female gender (RR 1.6; 95% CI, 1.1 to 2.4), Japanese or Finnish descent (RR 3.4; 95% CI, 2.6 to 4.4), size >5 mm (RR 2.3; 95% CI, 1.0 to 5.2), posterior circulation aneurysm (RR 2.5; 95% CI, 1.6 to 4.1), and symptomatic aneurysm (RR 4.4; 95% CI, 2.8 to 6.8). Meta-regression analysis yielded implausible results. CONCLUSIONS: Age, gender, population, size, site, and type of aneurysm should be considered in the decision whether to treat an unruptured aneurysm. Pooled multivariable analyses of individual data are needed to identify independent risk factors and to provide more reliable risk estimates for individual patients.
BACKGROUND AND PURPOSE: We updated our previous review from 1996 on the risk of rupture of unruptured intracranial aneurysms, aiming to include the newly published articles. METHODS: We reviewed all studies from our former meta-analysis and performed a Medline search for new studies published after 1996. We calculated overall risks of rupture for studies with a mean follow-up time of <5, 5 to 10, and >10 years. Relative risks (RR) were calculated by comparing the risk of rupture in patients with and without potential risk factors. We aimed to perform multivariable analyses of the different risk factors with meta-regression analysis. RESULTS: We included 19 studies (10 new) with 4705 patients and 6556 unruptured aneurysms (follow-up 26 122 patient-years). The overall rupture risks were 1.2% (follow-up <5 years), 0.6% (follow-up 5 to 10 years), and 1.3% (follow-up >10 years). In the univariable analysis, statistically significant risk factors for rupture were age >60 years (RR 2.0; 95% confidence interval [CI], 1.1 to 3.7), female gender (RR 1.6; 95% CI, 1.1 to 2.4), Japanese or Finnish descent (RR 3.4; 95% CI, 2.6 to 4.4), size >5 mm (RR 2.3; 95% CI, 1.0 to 5.2), posterior circulation aneurysm (RR 2.5; 95% CI, 1.6 to 4.1), and symptomatic aneurysm (RR 4.4; 95% CI, 2.8 to 6.8). Meta-regression analysis yielded implausible results. CONCLUSIONS: Age, gender, population, size, site, and type of aneurysm should be considered in the decision whether to treat an unruptured aneurysm. Pooled multivariable analyses of individual data are needed to identify independent risk factors and to provide more reliable risk estimates for individual patients.
Authors: Felicitas J Detmer; Sara Hadad; Bong Jae Chung; Fernando Mut; Martin Slawski; Norman Juchler; Vartan Kurtcuoglu; Sven Hirsch; Philippe Bijlenga; Yuya Uchiyama; Soichiro Fujimura; Makoto Yamamoto; Yuichi Murayama; Hiroyuki Takao; Timo Koivisto; Juhana Frösen; Juan R Cebral Journal: Neurosurg Focus Date: 2019-07-01 Impact factor: 4.047
Authors: Mario Zanaty; Nohra Chalouhi; Stavropoula I Tjoumakaris; Robert H Rosenwasser; Pascal M Jabbour Journal: Transl Stroke Res Date: 2013-11-24 Impact factor: 6.829
Authors: N K de Rooij; F H H Linn; J A van der Plas; A Algra; G J E Rinkel Journal: J Neurol Neurosurg Psychiatry Date: 2007-04-30 Impact factor: 10.154
Authors: Felicitas J Detmer; Bong Jae Chung; Carlos Jimenez; Farid Hamzei-Sichani; David Kallmes; Christopher Putman; Juan R Cebral Journal: Neuroradiology Date: 2018-11-19 Impact factor: 2.804