Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
Acta Neurochir (Wien). 2024 Mar 8;166(1):125. doi: 10.1007/s00701-024-06021-1.
Controversy remains regarding the appropriate screening for intracranial aneurysms or for the treatment of aneurysmal subarachnoid hemorrhage (aSAH) for patients without known high-risk factors for rupture. This study aimed to assess how sex affects both aSAH presentation and outcomes for aSAH treatment.
A retrospective cohort study was conducted of all patients treated at a single institution for an aSAH during a 12-year period (August 1, 2007-July 31, 2019). An analysis of women with and without high-risk factors was performed, including a propensity adjustment for a poor neurologic outcome (modified Rankin Scale [mRS] score > 2) at follow-up.
Data from 1014 patients were analyzed (69% [n = 703] women). Women were significantly older than men (mean ± SD, 56.6 ± 14.1 years vs 53.4 ± 14.2 years, p < 0.001). A significantly lower percentage of women than men had a history of tobacco use (36.6% [n = 257] vs 46% [n = 143], p = 0.005). A significantly higher percentage of women than men had no high-risk factors for aSAH (10% [n = 70] vs 5% [n = 16], p = 0.01). The percentage of women with an mRS score > 2 at the last follow-up was significantly lower among those without high-risk factors (34%, 24/70) versus those with high-risk factors (53%, 334/633) (p = 0.004). Subsequent propensity-adjusted analysis (adjusted for age, Hunt and Hess grade, and Fisher grade) found no statistically significant difference in the odds of a poor outcome for women with or without high-risk factors for aSAH (OR = 0.7, 95% CI = 0.4-1.2, p = 0.18).
A higher percentage of women versus men with aSAH had no known high-risk factors for rupture, supporting more aggressive screening and management of women with unruptured aneurysms.
对于没有已知破裂高危因素的患者，颅内动脉瘤的筛查以及蛛网膜下腔出血（aSAH）的治疗仍存在争议。本研究旨在评估性别如何影响 aSAH 的表现和治疗结果。
对一家医疗机构在 12 年期间（2007 年 8 月 1 日至 2019 年 7 月 31 日）收治的所有 aSAH 患者进行回顾性队列研究。对有和没有高危因素的女性患者进行了分析，包括对随访时神经功能预后不良（改良 Rankin 量表[mRS]评分＞2）进行倾向评分调整。
对 1014 例患者的数据进行了分析（69%[n=703]为女性）。女性患者明显比男性患者年长（平均±标准差，56.6±14.1 岁 vs 53.4±14.2 岁，p＜0.001）。女性患者吸烟史的比例明显低于男性患者（36.6%[n=257] vs 46%[n=143]，p=0.005）。女性患者无 aSAH 高危因素的比例明显高于男性患者（10%[n=70] vs 5%[n=16]，p=0.01）。无高危因素的女性患者在末次随访时 mRS 评分＞2 的比例明显低于有高危因素的女性患者（34%，24/70 例 vs 53%，334/633 例）（p=0.004）。随后进行的倾向评分调整分析（调整年龄、Hunt 和 Hess 分级和 Fisher 分级）发现，有无 aSAH 高危因素的女性患者不良预后的几率无统计学差异（OR=0.7，95%CI=0.4-1.2，p=0.18）。
与 aSAH 男性患者相比，更多的女性患者没有已知的破裂高危因素，这支持对未破裂动脉瘤的女性患者进行更积极的筛查和治疗。
