Abstract
Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a meta-analysis examining risk factors for intracranial aneurysm growth in longitudinal studies and examined the association between aneurysm growth and rupture. We searched the literature for longitudinal studies of patients with unruptured aneurysms. We examined the associations of demographics, multiple aneurysms, prior subarachnoid hemorrhage, family history of aneurysm or subarachnoid hemorrhage, smoking, and hypertension; and aneurysm shape, size, and location with aneurysm growth. We studied the association between aneurysm growth and rupture. A meta-analysis was performed by using a random-effects model by using summary statistics from included studies. Twenty-one studies including 3954 patients with 4990 aneurysms with 13,294 aneurysm-years of follow-up were included. The overall proportion of growing aneurysms was 3.0% per aneurysm-year (95% CI, 2.0%-4.0%). Patient risk factors for growth included age older than 50 years (3.8% per year versus 0.9% per year, P < .01), female sex (3.2% per year versus 1.3% per year, P < .01), and smoking history (5.5% per year versus 3.5% per year, P < .01). Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P < .01), and aneurysm size (P < .01). Aneurysm growth was associated with a rupture rate of 3.1% per year compared with 0.1% per year for stable aneurysms (P < .01). Observational evidence provided multiple clinical and anatomic risk factors for aneurysm growth, including age older than 50 years, female sex, smoking history, and nonsaccular shape. These findings should be considered when counseling patients regarding the natural history of unruptured intracranial aneurysms.
Highlights
MethodsWe searched the literature for longitudinal studies of patients with unruptured aneurysms
BACKGROUND AND PURPOSEUnderstanding risk factors for intracranial aneurysm growth is important for patient management
Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P Ͻ .01), and aneurysm size (P Ͻ .01)
Summary
We searched the literature for longitudinal studies of patients with unruptured aneurysms. We studied the association between aneurysm growth and rupture. All studies with longitudinal follow-up of unruptured intracranial aneurysms reporting growth were included. Inclusion criteria were the following: 1) a series of Ͼ10 patients, with available data on clinical and anatomic risk factors for aneurysm growth; 2) a series with a mean or median follow-up of at least 12 months; 3) studies published in English; and 4) studies of a consecutive series of patients with unruptured aneurysms undergoing clinical and/or angiographic follow-up. Studies with Ͻ10 patients, published, in a language other than English, or with a mean or median follow-up of Ͻ12 months were excluded. Studies comparing the characteristics of ruptured and unruptured intracranial aneurysms on presentation were excluded as well. Inconsistencies were handled by a third reviewer with final say regarding inclusion or exclusion of a given study
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