Bleeding risk of small intracranial aneurysms in a population treated in a reference center

Detalhes bibliográficos
Autor(a) principal: Lepski,Guilherme
Data de Publicação: 2019
Outros Autores: Lobão,Carlos A. F., Taylor,Stella, Mesquita Filho,Paulo M., Tatagiba,Marcos
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos de neuro-psiquiatria (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2019000500300
Resumo: ABSTRACT Large multicenter studies have shown that small intracranial aneurysms are associated with a minimal risk of bleeding. Nevertheless, other large series have shown that most ruptured aneurysms are, in fact, the smaller ones. In the present study, we questioned whether small aneurysms are indeed not dangerous. Methods: We enrolled 290 patients with newly-diagnosed aneurysms at our institution over a six-year period (43.7% ruptured). We performed multivariate analyses addressing epidemiological issues, cardiovascular diseases, and three angiographic parameters (largest aneurysm diameter, neck diameter and diameter of the nutrition vessel). Risk estimates were calculated using a logistic regression model. Aneurysm size parameters were stratified according to receiver operating characteristic (ROC) curves. Finally, we calculated odds ratios for rupture based on the ROC analysis. Results: The mean largest diameter for the ruptured versus unruptured groups was 13.3 ± 1.7 mm versus 22.2 ± 2.2 mm (p < 0.001). Multivariate analysis revealed a positive correlation between rupture and arterial hypertension (p < 0.001) and an inverse correlation with all three angiographic measurements (all p < 0.01). Aneurysms from the anterior cerebral artery bled more often (p < 0.05). According to the ROC curves, at the largest diameter of 15 mm, the sensitivity and specificity to predict rupture were 83% and 36%, respectively. Based on this stratification, we calculated the chance of rupture for aneurysms smaller than 15 mm as 46%, which dropped to 25% for larger aneurysms. Conclusion: In the population studied at our institution, small aneurysms were more prone to bleeding. Therefore, the need for intervention for small aneurysms should not be overlooked.
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spelling Bleeding risk of small intracranial aneurysms in a population treated in a reference centerIntracranial aneurysmruptureABSTRACT Large multicenter studies have shown that small intracranial aneurysms are associated with a minimal risk of bleeding. Nevertheless, other large series have shown that most ruptured aneurysms are, in fact, the smaller ones. In the present study, we questioned whether small aneurysms are indeed not dangerous. Methods: We enrolled 290 patients with newly-diagnosed aneurysms at our institution over a six-year period (43.7% ruptured). We performed multivariate analyses addressing epidemiological issues, cardiovascular diseases, and three angiographic parameters (largest aneurysm diameter, neck diameter and diameter of the nutrition vessel). Risk estimates were calculated using a logistic regression model. Aneurysm size parameters were stratified according to receiver operating characteristic (ROC) curves. Finally, we calculated odds ratios for rupture based on the ROC analysis. Results: The mean largest diameter for the ruptured versus unruptured groups was 13.3 ± 1.7 mm versus 22.2 ± 2.2 mm (p < 0.001). Multivariate analysis revealed a positive correlation between rupture and arterial hypertension (p < 0.001) and an inverse correlation with all three angiographic measurements (all p < 0.01). Aneurysms from the anterior cerebral artery bled more often (p < 0.05). According to the ROC curves, at the largest diameter of 15 mm, the sensitivity and specificity to predict rupture were 83% and 36%, respectively. Based on this stratification, we calculated the chance of rupture for aneurysms smaller than 15 mm as 46%, which dropped to 25% for larger aneurysms. Conclusion: In the population studied at our institution, small aneurysms were more prone to bleeding. Therefore, the need for intervention for small aneurysms should not be overlooked.Academia Brasileira de Neurologia - ABNEURO2019-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2019000500300Arquivos de Neuro-Psiquiatria v.77 n.5 2019reponame:Arquivos de neuro-psiquiatria (Online)instname:Academia Brasileira de Neurologiainstacron:ABNEURO10.1590/0004-282x20190046info:eu-repo/semantics/openAccessLepski,GuilhermeLobão,Carlos A. F.Taylor,StellaMesquita Filho,Paulo M.Tatagiba,Marcoseng2019-06-06T00:00:00Zoai:scielo:S0004-282X2019000500300Revistahttp://www.scielo.br/anphttps://old.scielo.br/oai/scielo-oai.php||revista.arquivos@abneuro.org1678-42270004-282Xopendoar:2019-06-06T00:00Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologiafalse
dc.title.none.fl_str_mv Bleeding risk of small intracranial aneurysms in a population treated in a reference center
title Bleeding risk of small intracranial aneurysms in a population treated in a reference center
spellingShingle Bleeding risk of small intracranial aneurysms in a population treated in a reference center
Lepski,Guilherme
Intracranial aneurysm
rupture
title_short Bleeding risk of small intracranial aneurysms in a population treated in a reference center
title_full Bleeding risk of small intracranial aneurysms in a population treated in a reference center
title_fullStr Bleeding risk of small intracranial aneurysms in a population treated in a reference center
title_full_unstemmed Bleeding risk of small intracranial aneurysms in a population treated in a reference center
title_sort Bleeding risk of small intracranial aneurysms in a population treated in a reference center
author Lepski,Guilherme
author_facet Lepski,Guilherme
Lobão,Carlos A. F.
Taylor,Stella
Mesquita Filho,Paulo M.
Tatagiba,Marcos
author_role author
author2 Lobão,Carlos A. F.
Taylor,Stella
Mesquita Filho,Paulo M.
Tatagiba,Marcos
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Lepski,Guilherme
Lobão,Carlos A. F.
Taylor,Stella
Mesquita Filho,Paulo M.
Tatagiba,Marcos
dc.subject.por.fl_str_mv Intracranial aneurysm
rupture
topic Intracranial aneurysm
rupture
description ABSTRACT Large multicenter studies have shown that small intracranial aneurysms are associated with a minimal risk of bleeding. Nevertheless, other large series have shown that most ruptured aneurysms are, in fact, the smaller ones. In the present study, we questioned whether small aneurysms are indeed not dangerous. Methods: We enrolled 290 patients with newly-diagnosed aneurysms at our institution over a six-year period (43.7% ruptured). We performed multivariate analyses addressing epidemiological issues, cardiovascular diseases, and three angiographic parameters (largest aneurysm diameter, neck diameter and diameter of the nutrition vessel). Risk estimates were calculated using a logistic regression model. Aneurysm size parameters were stratified according to receiver operating characteristic (ROC) curves. Finally, we calculated odds ratios for rupture based on the ROC analysis. Results: The mean largest diameter for the ruptured versus unruptured groups was 13.3 ± 1.7 mm versus 22.2 ± 2.2 mm (p < 0.001). Multivariate analysis revealed a positive correlation between rupture and arterial hypertension (p < 0.001) and an inverse correlation with all three angiographic measurements (all p < 0.01). Aneurysms from the anterior cerebral artery bled more often (p < 0.05). According to the ROC curves, at the largest diameter of 15 mm, the sensitivity and specificity to predict rupture were 83% and 36%, respectively. Based on this stratification, we calculated the chance of rupture for aneurysms smaller than 15 mm as 46%, which dropped to 25% for larger aneurysms. Conclusion: In the population studied at our institution, small aneurysms were more prone to bleeding. Therefore, the need for intervention for small aneurysms should not be overlooked.
publishDate 2019
dc.date.none.fl_str_mv 2019-05-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2019000500300
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1590/0004-282x20190046
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dc.publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
publisher.none.fl_str_mv Academia Brasileira de Neurologia - ABNEURO
dc.source.none.fl_str_mv Arquivos de Neuro-Psiquiatria v.77 n.5 2019
reponame:Arquivos de neuro-psiquiatria (Online)
instname:Academia Brasileira de Neurologia
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reponame_str Arquivos de neuro-psiquiatria (Online)
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repository.name.fl_str_mv Arquivos de neuro-psiquiatria (Online) - Academia Brasileira de Neurologia
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