Purpose Both the International Study of Unruptured Intracranial Aneurysms (ISUIA) criteria and the PHASES score are being widely used by physicians when trying to weigh the risk of intervention on an unruptured aneurysm. Published in 2003, the ISUIA study predicted the risk of aneurysmal rupture based primarily upon its size and site. Posterior circulation aneurysms larger than 7 mm were reported as having the highest rupture risk when compared to their counterparts in the anterior circulation. A decade later, the PHASES score was developed to calculate aneurysmal rupture risk based upon the patient population, history of hypertension, age, size of aneurysm, history of earlier subarachnoid hemorrhage (SAH), and site of aneurysm. A cumulative score of 8 predicts a 5-year risk of rupture of 3.2%. Our study was designed to investigate the characteristics of ruptured aneurysms at a large, academic teaching hospital and to compare these to the data published in both the ISUIA and PHASES studies.
Materials and methods Using our institutional subarachnoid hemorrhage database, we identified patients with intracranial aneurysms treated at Emory University Hospital over the last decade. These patients were then stratified by ethnicity, size and location of aneurysm, history of hypertension, history of earlier SAH, and age. In addition, we included smoking as a parameter of interest in our analysis.
Results A total of 520 ruptured aneurysms were identified in this preliminary study, with the following results
In addition, except for scores of 13 and 14, all other PHASES score groups contained patients of whom at least 20% smoked.
Conclusion Approximately 77% of the aneurysms in our preliminary study ruptured at a size smaller than 7 mm, regardless of location in either the anterior or posterior circulations. More than half the patients had a PHASES score of less than 4, with almost 90% of our patients having a score of less than 8. This score is reported as having a 5-year rupture risk of 3.2%, a similar percentage to the risk of 5-year mortality from surgical or endovascular intervention. As our database continues to grow, we plan to continually re-analyze these findings. However, from our preliminary study, it seems that a strict adherence to the ISUIA criteria and the PHASES score does not prevent the majority of morbidity-mortality from ruptured intracranial aneurysms. Further studies are needed to re-evaluate these tools.
Disclosures A. Salehani: None. D. McCracken: None. S. Halani: None. J. Boulter: None. L. Philipp: None. G. Pradilla: None. R. Nogueira: None.
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