Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
Neurol Sci. 2019 Aug;40(8):1683-1693. doi: 10.1007/s10072-019-03916-1. Epub 2019 Apr 29.
Aneurysm rebleeding after rupture can result in a catastrophic outcome with high mortality and morbidity. In this study, we evaluated the correlation of IARS (intracranial aneurysm rupture score) and aneurysm rebleeding. The aim of this study was to explore the clinical utility of IARS for better clinical decision-making.
The patients with ruptured intracranial aneurysms between January 2017 and September 2018 were reviewed. Propensity scoring match was performed to construct a cohort. The morphological and hemodynamic parameters were obtained. The difference between stable aneurysms and rebleeding aneurysms was compared. Subsequently, the correlation of IARS and aneurysm rebleeding was studied.
The matching process constructed a cohort, including 5 rebleeding aneurysms and 15 stable aneurysms. By comparing the difference between stable aneurysms and rebleeding aneurysms, the statistical significance was found in diameter of neck (p = 0.036), aspect ratio (p = 0.004) and size ratio (p = 0.029), normalized wall shear stress average (p = 0.026), low shear area ratio (p = 0.028), oscillatory shear index (OSI) (p = 0.031), and deviated angle (p = 0.025). The IARS here had a strong correlation with the aneurysm rebleeding, and the interval from the first bleeding to the rebleeding tended to shorten with the increase of IARS (R = 0.715, p = 0.027). IARS had a good predicting value for the aneurysm rebleeding (area under the curve = 0.756, p < 0.001).
Based on this preliminary study, intracranial aneurysm rupture score may correlate to the rebleeding in ruptured aneurysms. For ruptured aneurysms with high IARS scores, surgery should be given priority, and medical treatment is not recommended.
破裂后的颅内动脉瘤再出血可导致灾难性后果，病死率和病残率均较高。本研究旨在评估颅内动脉瘤破裂评分（IARS）与动脉瘤再出血的相关性，探讨 IARS 对临床决策的应用价值。
回顾性分析 2017 年 1 月至 2018 年 9 月期间破裂的颅内动脉瘤患者。采用倾向性评分匹配构建队列，获取动脉瘤的形态学和血流动力学参数，比较稳定动脉瘤与再出血动脉瘤之间的差异，进而分析 IARS 与动脉瘤再出血的相关性。
通过倾向性评分匹配构建了包含 5 例再出血动脉瘤和 15 例稳定动脉瘤的队列。通过比较稳定动脉瘤与再出血动脉瘤之间的差异，发现瘤颈直径（p=0.036）、形态比（p=0.004）和大小比（p=0.029）、标准化壁切应力平均值（p=0.026）、低剪切面积比（p=0.028）、振荡剪切指数（OSI）（p=0.031）和偏离角（p=0.025）具有统计学意义。IARS 与动脉瘤再出血具有较强的相关性，且首次出血至再出血的间隔时间随 IARS 的增加而缩短（R=0.715，p=0.027）。IARS 对动脉瘤再出血具有良好的预测价值（曲线下面积为 0.756，p<0.001）。
本研究初步表明，IARS 可能与破裂动脉瘤的再出血相关。对于 IARS 评分较高的破裂动脉瘤，建议优先手术治疗，不推荐药物治疗。
