PHASES score and treatment scoring with cigarette smoking in the long-term prediction of rupturing of unruptured intracranial aneurysms
- 1 January 2022
- journal article
- research article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 136 (1), 156-162
- https://doi.org/10.3171/2020.11.jns203480
Abstract
Treatment indications in unruptured intracranial aneurysms (UIAs) are challenging because of the lack of prospective natural history studies without treatment selection and the decreasing incidence of aneurysm rupture. The purpose of this study was to test whether the population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm (PHASES) score obtained from an individual-based meta-analysis could predict the long-term rupture risk of UIAs. The series included 142 patients of working age with UIAs diagnosed before 1979, when these were not treated but were followed up until the first rupture, death, or the last contact. PHASES scores were recorded for all patients by using the baseline variables and compared with the new treatment score obtained from a recent cohort, consisting of age, smoking status, and aneurysm size and location. Of the 142 patients, 34 had an aneurysm rupture during a total follow-up of 3064 person-years. The median time between diagnosis and an aneurysm rupture was 10.6 years. The PHASES score at baseline was higher in those with an aneurysm rupture than in the others (5.3 ± 2.3 vs 4.2 ± 2.2, p = 0.012), and the difference relative to the new treatment score was 5.3 ± 2.4 versus 3.0 ± 2.2 (p < 0.001). The receiver operating characteristic curve of the PHASES score for predicting rupture showed a fair area under the curve (0.674, 95% CI 0.558–0.790) where the optimal cutoff point was obtained at ≥ 6 versus < 6 points for sensitivity (0.500) and specificity (0.811). The area under the curve of the new score was 0.755 (95% CI 0.657–0.853), with the optimal cutoff point at ≥ 5 versus < 5 points for sensitivity (0.607) and specificity (0.789). The PHASES and the new scores predicted the long-term aneurysm rupture risk moderately well, with the latter, which also included smoking, being slightly better and easier in clinical practice. The findings suggest that treatment decisions about UIAs in patients of working age can be done with an improved cost-effectiveness.Keywords
This publication has 31 references indexed in Scilit:
- Modifiable Risk Factors for Aneurysmal Subarachnoid HemorrhageStroke, 2013
- European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid HaemorrhageCerebrovascular Diseases, 2013
- The Natural Course of Unruptured Cerebral Aneurysms in a Japanese CohortThe New England Journal of Medicine, 2012
- Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm ruptureJournal of Neurosurgery, 2008
- Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm RuptureStroke, 2003
- Factors Affecting Formation and Growth of Intracranial AneurysmsStroke, 2001
- Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm ruptureJournal of Neurosurgery, 2000
- Natural history of unruptured intracranial aneurysms: a long-term follow-up studyJournal of Neurosurgery, 1993
- Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage.Stroke, 1993
- Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysmsJournal of Neurosurgery, 1981