Comparison of Unruptured Intracranial Aneurysm Treatment Score and PHASES Score in Subarachnoid Hemorrhage Patients With Multiple Intracranial Aneurysms.

Axel Neulen,Sven R Kantelhardt,Tobias Pantel,Jochem König,Marc A Brockmann,Florian Ringel

doi:10.3389/fneur.2021.616497

Abstract

Objective: 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.Methods: We retrospectively applied PHASES and UIATS scoring to the aneurysms of 40 consecutive patients with SAH and multiple intracranial aneurysms.Results: 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.Conclusion: 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.

Highlights

We retrospectively identified all patients admitted to the Department of Neurosurgery of the University Medical Center of Mainz, Germany, between March 2010 and July 2016 with a diagnosis of spontaneous SAH [16, 17]
UIATS and PHASES scores were developed from prospective data on UIAs [9, 10], we applied the scores to our SAH cohort
Score compared with UIATS in discriminating between ruptured aneurysms and UIAs. This is most likely because aneurysm size, which we found to be the most robust discriminator between ruptured aneurysms and UIAs, has a greater influence on the PHASES score—the UIATS places a high weight on aneurysm size-related treatment risk, which is in favor of conservative treatment and evens out the points awarded for aneurysm size and in favor of treatment

Summary

Introduction

We retrospectively identified all patients admitted to the Department of Neurosurgery of the University Medical Center of Mainz, Germany, between March 2010 and July 2016 with a diagnosis of spontaneous SAH [16, 17]. The patients diagnosed with multiple intracranial aneurysms were included in this study. In the cases with multiple aneurysms, the ruptured aneurysm was derived from the bleeding pattern. All data were collected in anonymized tables. The data required for UIATS and PHASES score were extracted from the charts. We analyzed the diagnostic images (computed tomography angiography and digital subtraction angiography) obtained on admission with

Methods

Results

Discussion

Conclusion