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. 2022 Dec;64(12):2363-2371.
doi: 10.1007/s00234-022-02987-w. Epub 2022 Jun 13.

Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort

P Lognon  1 , F Gariel  2 , G Marnat  2 , J Darcourt  3 , P Constant Dit Beaufils  4   5 , J Burel  6 , E Shotar  7 , J F Hak  8 , C Fauché  9 , B Kerleroux  10 , A Guédon  11 , J Ognard  12 , G Forestier  13 , R Pop  14 , C Paya  15 , J B Veyrières  15 , P Sporns  16   17 , J B Girot  18 , R Zannoni  19 , F Zhu  20 , A Crespy  1 , V L'Allinec  18 , D Mihoc  14 , A Rouchaud  13 , J C Gentric  12 , W Ben Hassen  10 , N Raynaud  9 , B Testud  8 , F Clarençon  7 , B Kaczmarek  6 , R Bourcier  4   5 , G Bellanger  3 , G Boulouis  1 , Kevin Janot  21 ; JENI Research Collaborative
Affiliations

Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort

P Lognon et al. Neuroradiology. 2022 Dec.

Abstract

Purpose: The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level.

Objective: In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneurysmal rupture or growth.

Methods: Academic centers treating patients with intracranial aneurysms were invited to prospectively collect de-identified data from all patients admitted at their institution for a subarachnoid hemorrhage-related to intracranial aneurysmal rupture between January 1 and March 31, 2021 through a trainee-led research collaborative network. Each responding center was provided with an electronic case record form (CRF) which collected all the elements of the PHASES, ELAPSS, and UCAS scores.

Results: A total of 319 patients with aneurysmal subarachnoid hemorrhage were included at 17 centers during a 3-month period. One hundred eighty-three aneurysms (57%) were less than 7 mm. The majority of aneurysms were located on the anterior communicating artery (n = 131, 41%). One hundred eighty-four patients (57%), 103 patients (32%), and 58 (18%) were classified as having a low risk of rupture or growth, according to the PHASES, UCAS, and ELAPSS scores, respectively.

Conclusion: In a prospective study of European patients with aneurysmal subarachnoid hemorrhage, we showed that 3 common risk-assessment tools designed for patients with unruptured intracranial aneurysms would have not identified most patients to be at high or intermediate risk for rupture, questioning their use for decision-making in the setting of unruptured aneurysms.

Keywords: Aneurysm; Subarachnoid hemorrhage.

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