Prospective assessment of aneurysmal rupture risk scores in patients with subarachnoid hemorrhage: a multicentric cohort

Purpose The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. Objective In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid he...

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Published in:Neuroradiology 2022-12, Vol.64 (12), p.2363-2371
Main Authors: Lognon, P., Gariel, F., Marnat, G., Darcourt, J., Constant dit Beaufils, P., Burel, J., Shotar, E., Hak, J. F., Fauché, C., Kerleroux, B., Guédon, A., Ognard, J., Forestier, G., Pop, R., Paya, C., Veyrières, J. B., Sporns, P., Girot, J. B., Zannoni, R., Zhu, F., Crespy, A., L’Allinec, V., Mihoc, D., Rouchaud, A., Gentric, J. C., Ben Hassen, W., Raynaud, N., Testud, B., Clarençon, F., Kaczmarek, B., Bourcier, R., Bellanger, G., Boulouis, G., Janot, Kevin
Format: Article
Language:English
Subjects:
Aneurysm
Aneurysms
Cognitive science
Decision making
Hemorrhage
Imaging
Interventional Neuroradiology
Medicine
Medicine & Public Health
Neurology
Neuroradiology
Neuroscience
Neurosciences
Neurosurgery
Patients
Phases
Radiology
Risk assessment
Risk communication
Rupture
Subarachnoid hemorrhage
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Summary:Purpose The natural evolution of unruptured intracranial aneurysms (UIA) is indeed difficult to predict at the individual level. Objective In a large prospective multicentric European cohort, we aimed to evaluate whether the PHASES, UCAS, and ELPASS scores in patients with aneurysmal subarachnoid hemorrhage would have predicted a high risk of aneurysmal rupture or growth. Methods Academic centers treating patients with intracranial aneurysms were invited to prospectively collect de-identified data from all patients admitted at their institution for a subarachnoid hemorrhage-related to intracranial aneurysmal rupture between January 1 and March 31, 2021 through a trainee-led research collaborative network. Each responding center was provided with an electronic case record form (CRF) which collected all the elements of the PHASES, ELAPSS, and UCAS scores. Results A total of 319 patients with aneurysmal subarachnoid hemorrhage were included at 17 centers during a 3-month period. One hundred eighty-three aneurysms (57%) were less than 7 mm. The majority of aneurysms were located on the anterior communicating artery ( n  = 131, 41%). One hundred eighty-four patients (57%), 103 patients (32%), and 58 (18%) were classified as having a low risk of rupture or growth, according to the PHASES, UCAS, and ELAPSS scores, respectively. Conclusion In a prospective study of European patients with aneurysmal subarachnoid hemorrhage, we showed that 3 common risk-assessment tools designed for patients with unruptured intracranial aneurysms would have not identified most patients to be at high or intermediate risk for rupture, questioning their use for decision-making in the setting of unruptured aneurysms.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-022-02987-w