Risk Analysis of Unruptured Intracranial Aneurysms Prospective 10-Year Cohort Study
Risk Analysis of Unruptured Intracranial Aneurysms Prospective 10-Year Cohort Study
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DOI：
10.1161/strokeaha.115.010698
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发表时间：
2016-02-01
期刊：
影响因子：
8.3
通讯作者：
Molyneux, Andrew J.
中科院分区：
文献类型：
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作者：
Murayama, Yuichi;Takao, Hiroyuki;Molyneux, Andrew J.
背景和目的-未破裂的颅内动脉瘤的自然史仍然不清楚，管理策略是没有很好地defined.Methods-From 2003年1月至2012年12月，我们招募了动脉瘤患者在我们的机构。共有2252例患者的2897个动脉瘤符合分析条件，1960个符合条件的动脉瘤接受了保守治疗。使用计算机断层扫描血管造影术、数字减影血管造影术或磁共振血管造影术进行精确的三维评估。然后，我们评估了与动脉瘤特征、人口统计学和已知健康/生活方式风险因素相关的动脉瘤破裂风险、死亡率和发病率。结果-平均随访时间为7388动脉瘤年。在观察期间，56个动脉瘤破裂，导致每年的总破裂率为0.76%（95%置信区间，0.58-0.98）。平均初次访视至破裂间隔为547天。动脉瘤大小、位置、子瘤囊和蛛网膜下腔出血史是动脉瘤破裂的重要独立预测因素。与2- 4 mm动脉瘤相比，>= 5 mm的动脉瘤破裂风险显著增加（未校正风险比，12.24; 95%置信区间，7.15-20.93）。在56例发生出血的患者中，29例（52%）死亡或重度残疾。在患有大或巨大动脉瘤的患者中，无一例恢复无缺陷，破裂后死亡率为69%。对于动脉瘤尺寸
Background and Purpose-The natural history of unruptured intracranial aneurysms remains unclear, and management strategy is not well defined.Methods-From January 2003 to December 2012, we enrolled patients with aneurysm in our institution. In total, 2252 patients with 2897 aneurysms were eligible for analysis, and 1960 eligible aneurysms were conservatively managed. Precise 3-dimensional evaluation was conducted using computed tomography angiography, digital subtraction angiography, or magnetic resonance angiography. We then assessed the risk of aneurysm rupture, mortality, and morbidity associated with aneurysm characteristics, demographics, and known health/lifestyle risk factors.Results-The mean follow-up duration was 7388 aneurysm-years. During observation, 56 aneurysms ruptured, resulting in an overall rupture rate per year of 0.76% (95% confidence interval, 0.58-0.98). The mean initial visit to rupture interval was 547 days. Aneurysm size, location, daughter sac, and history of subarachnoid hemorrhage were significant independent predictors for aneurysm rupture. Aneurysms that were >= 5 mm were associated with a significantly increased risk of rupture when compared with 2- to 4-mm aneurysms (unadjusted hazard ratio, 12.24; 95% confidence interval, 7.15-20.93). Of 56 patients who experienced hemorrhage, 29 (52 %) died or were rendered severely disabled. Of the patients who had large or giant aneurysms, none recovered without deficits, and the mortality rate after rupture was 69%. For aneurysms sized