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. 2021 Oct 1;78(10):1228-1235.
doi: 10.1001/jamaneurol.2021.2915.

Risk of Rupture After Intracranial Aneurysm Growth

Laura T van der Kamp  1 , Gabriel J E Rinkel  1 , Dagmar Verbaan  2 , René van den Berg  3 , W Peter Vandertop  2 , Yuichi Murayama  4 , Toshihiro Ishibashi  4 , Antti Lindgren  5   6 , Timo Koivisto  6   7 , Mario Teo  8 , Jerome St George  8 , Ronit Agid  9 , Ivan Radovanovic  9 , Junta Moroi  10 , Keiji Igase  11 , Ido R van den Wijngaard  12 , Melissa Rahi  13   14 , Jaakko Rinne  13   14 , Johanna Kuhmonen  13   14 , Hieronymus D Boogaarts  15 , George K C Wong  16 , Jill M Abrigo  17 , Akio Morita  18 , Yoshiaki Shiokawa  19 , Katharina A M Hackenberg  20 , Nima Etminan  20 , Irene C van der Schaaf  21 , Nicolaas P A Zuithoff  22 , Mervyn D I Vergouwen  1
Affiliations

Risk of Rupture After Intracranial Aneurysm Growth

Laura T van der Kamp et al. JAMA Neurol. .

Erratum in

  • Error in Figure.
    [No authors listed] [No authors listed] JAMA Neurol. 2022 Mar 1;79(3):312. doi: 10.1001/jamaneurol.2021.5146. JAMA Neurol. 2022. PMID: 35006239 Free PMC article. No abstract available.

Abstract

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 data were 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 1 mm or greater increase in 1 direction at follow-up imaging.

Main outcomes and measures: The primary outcome was 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 (7 mm or 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr van den Berg reports fees from Cerenovus paid to his institution outside the submitted work. Dr Boogaarts reports fees for serving as a consultant for Stryker Neurovascular outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Time to Rupture After Observation of Intracranial Aneurysm Growth
See this image and copyright information in PMC

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