Neulen Axel, Pantel Tobias, König Jochem, Brockmann Marc A, Ringel Florian, Kantelhardt Sven R
Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
Front Neurol. 2021 Apr 7;12:616497. doi: 10.3389/fneur.2021.616497. eCollection 2021.
Unruptured Intracranial Aneurysm (UIA) Treatment Score (UIATS) and PHASES score are used to inform treatment decision making for UIAs (treatment or observation). We assessed the ability of the scoring systems to discriminate between ruptured aneurysms and UIAs in a subarachnoid hemorrhage (SAH) cohort with multiple aneurysms. We retrospectively applied PHASES and UIATS scoring to the aneurysms of 40 consecutive patients with SAH and multiple intracranial aneurysms. PHASES score discriminated better between ruptured aneurysms and UIAs than UIATS. PHASES scores and the difference between the UIATS subscores were higher for ruptured aneurysms compared with UIAs, which reached significance for the PHASES score. PHASES score estimated a low 5-year rupture risk in a larger proportion of the UIAs (≤0.7% in 62.3%, ≤1.7% in 98.4%) than of the ruptured aneurysms (≤0.7% in 22.5%, ≤1.7% in 82.5%). In the 40 ruptured aneurysms, UIATS provided recommendation for treatment in 11 (27.5%), conservative management in 14 (35.0%), and was inconclusive in 15 cases (37.5%). In the 61 UIAs, UIATS recommended treatment in 16 (26.2%), conservative management in 29 (47.5%), and was inconclusive in 16 (26.2%) cases. Similar to previous SAH cohorts, a significant proportion of the ruptured aneurysms exhibited a low-rupture risk. Nevertheless, PHASES score discriminated between ruptured aneurysms and UIAs in our cohort; the lower discriminatory power of UIATS was due to high weights of aneurysm-independent factors. We recommend careful integration of the scores for individual decision making. Large-scale prospective trials are required to establish score-based treatment strategies for UIAs.
未破裂颅内动脉瘤（UIA）治疗评分（UIATS）和PHASES评分用于为UIA的治疗决策（治疗或观察）提供参考。我们评估了在患有多个动脉瘤的蛛网膜下腔出血（SAH）队列中，这些评分系统区分破裂动脉瘤和UIA的能力。我们对40例连续的SAH和多个颅内动脉瘤患者的动脉瘤进行了PHASES和UIATS评分的回顾性应用。PHASES评分在区分破裂动脉瘤和UIA方面比UIATS表现更好。与UIA相比，破裂动脉瘤的PHASES评分和UIATS子评分之间的差异更高，PHASES评分达到了显著性。PHASES评分估计，与破裂动脉瘤相比，更大比例的UIA（62.3%的UIA破裂风险≤0.7%，98.4%的UIA破裂风险≤1.7%）的5年破裂风险较低（22.5%的破裂动脉瘤破裂风险≤0.7%，82.5%的破裂动脉瘤破裂风险≤1.7%）。在40个破裂动脉瘤中，UIATS建议治疗11个（27.5%），保守治疗14个（35.0%），15例（37.5%）结果不明确。在61个UIA中，UIATS建议治疗16个（26.2%），保守治疗29个（47.5%），16例（26.2%）结果不明确。与之前的SAH队列相似，相当一部分破裂动脉瘤表现出低破裂风险。然而，PHASES评分在我们的队列中能够区分破裂动脉瘤和UIA；UIATS较低的区分能力是由于与动脉瘤无关的因素权重较高。我们建议在个体决策时仔细整合这些评分。需要进行大规模前瞻性试验来建立基于评分的UIA治疗策略。
