Zuurbier Charlotte C M, Bourcier Romain, Constant Dit Beaufils Pacôme, Redon Richard, Desal Hubert, Bor Anne S E, Rinkel Gabriel J E, Greving Jacoba P, Ruigrok Ynte M
Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., G.J.E.R., Y.M.R.), University Medical Center Utrecht, Utrecht University, the Netherlands.
Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut Du Thorax, Inserm 1087, CNRS, UNIV Nantes, Pays de la Loire, France (R.B., P.C.D.B., R.R., H.D.).
Stroke. 2023 Apr;54(4):1015-1020. doi: 10.1161/STROKEAHA.122.041393. Epub 2023 Feb 27.
In first-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH), the risk of an intracranial aneurysm can be predicted at initial screening but not at follow-up screening. We aimed to develop a model for predicting the probability of a new intracranial aneurysm after initial screening in people with a positive family history of aSAH.
In a prospective study, we obtained data from follow-up screening for aneurysms of 499 subjects with ≥2 affected first-degree relatives. Screening took place at the University Medical Center Utrecht, the Netherlands, and the University Hospital of Nantes, France. We studied associations between potential predictors and the presence of aneurysms using Cox regression analysis and the predictive performance at 5, 10, and 15 years after initial screening using C statistics and calibration plots, while correcting for overfitting.
In 5050 person-years of follow-up, intracranial aneurysms were found in 52 subjects. The risk of aneurysm at 5 years was 2% to 12%, at 10 years, 4% to 28%, and at 15 years, 7% to 40%. Predictors were female sex, history of intracranial aneurysms/aneurysmal subarachnoid hemorrhage, and older age. The sex, previous history of intracranial aneurysm/aSAH, older age score had a C statistic of 0.70 (95% CI, 0.61-0.78) at 5 years, 0.71 (95% CI, 0.64-0.78) at 10 years, and 0.70 (95% CI, 0.63-0.76) at 15 years and showed good calibration.
The sex, previous history of intracranial aneurysm/aSAH, older age score provides risk estimates for finding new intracranial aneurysms at 5, 10, and 15 years after initial screening, based on 3 easily retrievable predictors; this can help to define a personalized screening strategy after initial screening in people with a positive family history for aSAH.
在动脉瘤性蛛网膜下腔出血（aSAH）患者的一级亲属中，颅内动脉瘤的风险在初次筛查时可预测，但在随访筛查时则不然。我们旨在建立一个模型，用于预测有aSAH家族史阳性人群初次筛查后出现新的颅内动脉瘤的概率。
在一项前瞻性研究中，我们收集了499名有≥2名受影响一级亲属的受试者动脉瘤随访筛查的数据。筛查在荷兰乌得勒支大学医学中心和法国南特大学医院进行。我们使用Cox回归分析研究潜在预测因素与动脉瘤存在之间的关联，并使用C统计量和校准图在初次筛查后5年、10年和15年评估预测性能，同时校正过度拟合。
在5050人年的随访中，52名受试者发现了颅内动脉瘤。5年时动脉瘤风险为2%至12%，10年时为4%至28%，15年时为7%至40%。预测因素为女性、颅内动脉瘤/动脉瘤性蛛网膜下腔出血病史和年龄较大。性别、既往颅内动脉瘤/aSAH病史、年龄较大评分在5年时C统计量为0.70（95%CI，0.61 - 0.78），10年时为0.71（95%CI，0.64 - 0.78），15年时为0.70（95%CI，?0.63 - 0.76），并显示出良好的校准。
基于3个易于获取的预测因素，性别、既往颅内动脉瘤/aSAH病史、年龄较大评分可提供初次筛查后5年、10年和15年发现新颅内动脉瘤风险的估计；这有助于为有aSAH家族史阳性人群初次筛查后制定个性化的筛查策略。
