Characteristics of Unruptured Compared to Ruptured Intracranial Aneurysms: A Multicenter Case–Control Study
| Autor: | Daniel C. Walsh, Varinder S Alg, Observational Subarachnoid Haemorrhage (Gosh) study investigators, Diederik Bulters, Isabel C Hostettler, Neil Kitchen, Nichole Shahi, Joan Grieve, Fatima Jichi, Henry Houlden, Martin M. Brown, Stephen Bonner, David J. Werring |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Aneurysm Ruptured 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Aneurysm Risk Factors medicine.artery Odds Ratio medicine Anterior cerebral artery Humans cardiovascular diseases Posterior communicating artery Aged Retrospective Studies business.industry Intracranial Aneurysm Odds ratio Middle Aged Subarachnoid Hemorrhage medicine.disease Surgery Anterior communicating artery Case-Control Studies Middle cerebral artery Female Neurology (clinical) Internal carotid artery business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 83:43-52 |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyx365 |
| Popis: | BACKGROUND: Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE: To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS: We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS: A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION: We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms. |
| Databáze: | OpenAIRE |
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