Backes Daan, Rinkel Gabriel J E, Laban Kamil G, Algra Ale, Vergouwen Mervyn D I
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., K.G.L., A.A., M.D.I.V.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands.
Stroke. 2016 Apr;47(4):951-7. doi: 10.1161/STROKEAHA.115.012162. Epub 2016 Feb 23.
Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient- and aneurysm-specific risk factors for aneurysm growth.
We searched EMBASE and MEDLINE for cohort studies describing risk factors for aneurysm growth. Two authors independently assessed study eligibility and rated quality with the Newcastle Ottawa Scale. With univariable Poisson regression analysis, we calculated risk ratios (RRs) with corresponding 95% confidence intervals (95% CI) of risk factors for aneurysm growth. Heterogeneity was assessed with I(2).
Eighteen studies on 15 patient-populations described 3990 patients with 4972 unruptured aneurysms. A total of 437 aneurysms (9%) enlarged during 13 987 aneurysm-years of follow-up. Compared with aneurysms ≤4 mm, RRs were 2.56 (95% CI, 1.93-3.39; I(2)=98%) for ≥5 mm, 2.80 (95% CI, 2.01-3.90; I(2)=96%) for ≥7 mm, and 5.38 (95% CI, 3.76-7.70; I(2)=97%) for ≥10 mm. Compared with aneurysms on the middle cerebral artery, the RR for basilar artery was 1.94 (95% CI, 1.32-2.83; I(2)=57%). RRs were 2.03 (95% CI, 1.52-2.71; I(2)=59%) for smoking at baseline, 2.04 (95% CI, 1.56-2.66; I(2)=90%) for multiple unruptured aneurysms, 1.26 (95% CI, 0.97-1.62; I(2)=59%) for women, 1.24 (95% CI, 0.98-1.58; I(2)=40%) for hypertension, and 2.32 (95% CI, 1.46-3.68; I(2)=91%) for irregular aneurysm shape. Compared with other regions, RR was 0.75 (95% CI, 0.58-0.96) for Japan and 0.64 (95% CI, 0.45-0.90) for Finland.
Most risk factors for aneurysm growth are consistent with risk factors for rupture. In contrast with rupture, the risk of growth was smaller in Japanese and Finnish cohorts compared with other regions. Pooling of individual patient data from low- and high-risk geographical regions is needed to assess independent predictors of aneurysm growth.
对于未治疗的颅内动脉瘤，常需进行随访成像。我们对动脉瘤生长的患者及动脉瘤特异性危险因素进行了系统评价和荟萃分析。
我们在EMBASE和MEDLINE中检索描述动脉瘤生长危险因素的队列研究。两位作者独立评估研究的纳入资格，并使用纽卡斯尔渥太华量表对质量进行评分。通过单变量泊松回归分析，我们计算了动脉瘤生长危险因素的风险比（RRs）及相应的95%置信区间（95%CI）。采用I²评估异质性。
18项针对15个患者群体的研究描述了3990例患者的4972个未破裂动脉瘤。在13987个动脉瘤年的随访期间，共有437个动脉瘤（9%）增大。与直径≤4mm的动脉瘤相比，直径≥5mm的动脉瘤的RR为2.56（95%CI，1.93 - 3.39；I² = 98%），直径≥7mm的动脉瘤的RR为2.80（95%CI，2.01 - 3.90；I² = 96%），直径≥10mm的动脉瘤的RR为5.38（95%CI，3.76 - 7.70；I² = 97%）。与大脑中动脉的动脉瘤相比，基底动脉动脉瘤的RR为1.94（95%CI，1.32 - 2.83；I² = 57%）。基线时吸烟的RR为2.03（95%CI，1.52 - 2.71；I² = 59%），多发未破裂动脉瘤的RR为2.04（95%CI，1.56 - 2.66；I² = 90%），女性的RR为1.26（95%CI，0.97 - 1.62；I² = 59%），高血压的RR为1.24（95%CI，0.98 - 1.58；I² = 40%），动脉瘤形状不规则的RR为2.32（95%CI，1.46 - 3.68；I² = 91%）。与其他地区相比，日本的RR为0.75（95%CI，0.58 - 0.96），芬兰的RR为0.64（95%CI，0.45 - 0.90）。
大多数动脉瘤生长的危险因素与破裂的危险因素一致。与破裂不同，日本和芬兰队列中动脉瘤生长的风险低于其他地区。需要汇总来自低风险和高风险地理区域的个体患者数据，以评估动脉瘤生长的独立预测因素。
