Brain Center Rudolf Magnus, Depart-ment of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Cell Biology, Department of Biology, Science Fac-ulty, Utrecht University, Utrecht, The Netherlands.
Neurosurgery. 2018 Apr 1;82(4):431-440. doi: 10.1093/neuros/nyx238.
Intracranial aneurysm rupture prediction is poor, with only a few risk factors for rupture identified and used in clinical practice.
To provide an overview of all the risk factors (including genetic, molecular, morphological, and hemodynamic factors) that have potential for use in clinical practice.
We systematically searched PubMed and EMBASE and focused on factors that can be easily assessed in clinical practice, might be used for rupture prediction in clinical practice, and/or are potential targets for further research. Studies were categorized according to methodological quality, and a meta-analysis was performed, if possible.
We included 102 studies describing 144 risk factors that fulfilled predefined criteria. There was strong evidence for the morphological factors irregular shape (studied in 4 prospective cohort studies of high-quality, pooled odds ratio [OR] of 4.8 [95% confidence interval 2.7-8.7]), aspect ratio (pooled OR 10.2 [4.3-24.6]), size ratio, bottleneck factor, and height-to-width ratio to increase rupture risk. Moderate level of evidence was found for presence of contact with the perianeurysmal environment (pooled OR 3.5 [1.4-8.4]), unbalanced nature of this contact (pooled OR 17.8 [8.3-38.5]), volume-to-ostium ratio, and direction of the aneurysm dome (pooled OR 1.5 [1.2-1.9]).
Irregular aneurysm shape was identified as a risk factor with potential for use in clinical practice. The risk factors aspect ratio, size ratio, bottleneck factor, height-to-width ratio, contact with the perianeurysmal environment, volume-to-ostium ratio, and dome-direction should first be confirmed in multivariate analysis and incorporated in prediction models.
颅内动脉瘤破裂的预测效果不佳，目前仅确定了少数几个破裂风险因素，并将其应用于临床实践中。
本文旨在综述所有具有潜在临床应用价值的风险因素（包括遗传、分子、形态和血流动力学因素）。
我们系统地检索了 PubMed 和 EMBASE 数据库，重点关注那些易于在临床实践中评估、可能用于临床实践中的破裂预测、以及/或可能成为进一步研究潜在目标的因素。根据方法学质量对研究进行分类，如果可能的话，还进行了荟萃分析。
我们纳入了 102 项研究，这些研究共描述了 144 个符合既定标准的风险因素。形态学因素的不规则形状（4 项高质量前瞻性队列研究进行了研究，汇总优势比 [OR]为 4.8 [95%置信区间 2.7-8.7]）、长宽比（汇总 OR 10.2 [4.3-24.6]）、大小比、瓶颈因素和高宽比增加破裂风险的证据确凿。存在与瘤周环境接触（汇总 OR 3.5 [1.4-8.4]）、这种接触的不平衡性质（汇总 OR 17.8 [8.3-38.5]）、容积-瘤口比和动脉瘤瘤顶方向的证据等级为中等，这些因素也被认为是增加破裂风险的因素。
不规则动脉瘤形状被确定为具有临床应用潜力的风险因素。长宽比、大小比、瓶颈因素、高宽比、与瘤周环境接触、容积-瘤口比和瘤顶方向等风险因素应首先在多变量分析中得到确认，并纳入预测模型中。
