Abstract
To evaluate if the unruptured intracranial aneurysm treatment score (UIATS) is a sensitive tool to detect aneurysms at risk of rupture, we conducted an a posteriori retrospective study on ruptured intracranial aneurysms. We performed a retrospective analysis of adult patients admitted to our center from January 2010 to April 2016 with aneurysmal subarachnoid hemorrhage. The UIATS was applied to all ruptured aneurysms. Patients for whom the UIATS recommended treatment were labeled as “true positives,” whereas patients for whom the UIATS recommended observation were labeled as “false negatives.” Patients for whom the UIATS was inconclusive were excluded from the final analysis. Based on the UIATS recommendation, a sensitivity analysis was performed. A total of 262 patients with aneurysmal subarachnoid hemorrhage were screened. Of these, 212 were included in our analysis. Median age was 53 years (23–90). Most patients were females (n = 134, 63%), with an equal distribution between low-grade and high-grade hemorrhages (Hunt & Hess ≥ 3 n = 107, 50%). UIATS recommended treatment in n = 52, 25% cases (TP), was inconclusive in n = 93, 44% (excluded), and recommended observation in n = 67, 32% (FN). Based on these data, the UIATS showed a sensitivity of 44% (CI 35–53%). The UIATS exhibits rather low sensitivity for detecting aneurysms at risk of rupture.
Highlights
In order to assess whether the unruptured intracranial aneurysm treatment score (UIATS) is a sensitive enough tool to identify aneurysms at risk of rupture, we evaluated a cohort of patients with aneurysmal subarachnoid hemorrhage (aSAH) with the UIATS a posteriori
While the methodology of our study was rather simple, it provides understandable data in regard to a straightforward question: could the UIATS correctly identify aneurysms at risk of rupture? Our study suggests that the UIATS does not have sufficient sensitivity to be considered a reliable tool in Unruptured intracranial aneurysms (UIA) decision-making
No prospective cohort studies exist to unequivocally answer the question of which UIA should be treated in order to prevent devastating aSAH
Summary
The most relevant studies to this matter are the International Study of Unruptured Intracranial Aneurysms (ISUIA) [29] from North American and Europe, with a retrospective arm encompassing 1449 patients with 1937 UIA, and a prospective one with 4060 patients; the unruptured cerebral aneurysm study (UCAS) [11], with 5720 prospectively analyzed Japanese patients; and the study performed by Juvela et al [13] in 142 patients harboring 181 untreated UIA between 1956 and 1978 in Finland Based on these works, several risk factors for aneurysm rupture have been identified, such as aneurysm size and location, arterial hypertension, and smoking status. A meta-analysis on endovascular coiling vs. surgical clipping for UIA revealed 1% mortality and 8–9% ischemia for both treatment modalities [26]
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