Retrospective Clinical Study On Rupture Risk Factors Of Intracranial Aneurysms

Background:Unruptured intracranial aneurysms(UIAs)are with a prevalence of 3.2%of the adult population worldwide,and they are being discovered incidentally with an increasing frequency because of the fast development of neuroimaging technology,such as the worldwide use of high-resolution magnetic resonance imaging(MRI)scanning.The annual rupture rate of intracranial aneurysms(IAs)is 0.8%?2.0%,indicating that the large majority of UIAs will never rupture.However,due to many uncertainties of patients and aneurysms,once the rupture occurs,subarachnoid hemorrhage(SAH)as a result has a high lethality and morbidity which accounts for about 80-85%of non-traumatic SAH.In recent years,there have been many studies on the risk factors of UIAs rupture.However,due to the complexity of pathophysiology and natural history aneurysm itself,there is still controversy between the various studies,and it has not yet formed a unified conclusion.Objective:To explore risk factors of ruptured intracranial aneurysms on basis of patient and aneurysm characteristics with a view to provide a reference for clinical practice.Methods:From January 2008 to March 2016,183 patients?227 aneurysms con-sistent with inclusion and exclusion standards in Zhongda Hospital affiliated to Southeast university were consecutively enrolled in this retrospective study.We retrospectively collected and analyzed clinical and imaging data of them.Accor-ding to the rupture of aneurysms,subjects were divided into unruptured group and ruptured group.The data were brought into univariable analysis,which we-re followed by binary logistic regression analysis.We also compared with the PHASES and ELAPSS score between the two groups.The ROC curve was us-ed to evaluate the predictive value of PHASES score in the diagnosis of intrac-ranial aneurysms rupture.Results:The UIAs group included 91 patients?111 aneurysms,of which the ratio of male to female is 0.82 and average age is 62.79±1.14;the RIAs group included 93 patients?116 aneurysms,of which the ratio of male to female is 0.40 and average age is 59.44±1.20.Univariable analysis demonstrated that age<50,female,hypertension,diabetes,maximum diameter of aneurysm,location,irregular aneurysm were with statistical significance(P<0.05),while menopause,smoking,alcohol drinking,hyperlipidemia,multiple aneurysms were not statistically significant.Logistic regression analysis showed that age<50,hypertension,diabetes,posterior communicating artery aneurysm,posterior circulation aneurysm,irregular aneurysm increased the rupture risk significantly(P<0.05),while female and maximum diameter of aneurysm were not with statistical significance.Patients with ruptured intracranial aneurysms got higher scores than UIAs group in terms of both PHASES and ELAPSS score model(P=0.000).The ROC curve of the PHASES score showed that the area under the curve was 0.668>0.5,the difference was statistically significant(P = 0.000).Conclusion:This study showed that age<50,hypertension,posterior communica-ting artery and posterior circulation aneurysms,irregular aneurysms are associa-ted with an increased risk of rupture.Management of hypertension and hyperli-pidemia,smoking and alcohol cessation are essential for people habouring intr-acranial aneurysms who are younger than 50 years old.People with posterior c-ommunicating artery aneurysms?posterior circulation aneurysms and irregular a-neurysms demand for imaging follow-up.ELAPSS and PHASES score models can be used to predict the risk of aneurysm growth and rupture respectively.