Intracerebral aneurysm’s risk of rupture: ITARR SCORE. A new predictive tool

Abstract

Background. The worldwide prevalence of intracerebral aneurysms is 3.2%. Around 20 to 50% of cases, the aneurysm will rupture and cause a subarachnoid hemorrhage, which has a high morbimortality. Due to brain imaging accessibility and the developing of new diagnostic tools, the number of diagnosis of unruptured intracerebral aneurysms is increasing. However, we still have limited knowledge about risk factors and weak prediction models to decide which should be the best treatment to prevent its rupture. Aims. The main porpoise of the study is to create a predictive risk SCORE for patients with unruptured intracerebral aneurysms. Secondary objectives are to perform a descriptive analysis of patients with intracerebral aneurysms as well as to determinate whether statins and antiplatelet drugs decrease the risk of rupture of intracerebral aneurysms. Methods. Patients diagnosed, treated or follow-up of an intracerebral aneurysm (ruptured or unruptured) from Hospital Universitari Germans Trias i Pujol until December 2017 were recruited. We collected demographic, analytic, clinic, radiologic and angiographic variables and compared them in a bivariate and a multivariable analysis with a logistic regression. Results. Up to 287 patients with a total of 345 intracerebral aneurysms (175 non-ruptured aneurysms and 170 ruptured aneurysms) were included in our sample. In the multivariate analysis, the variables inversely associated with rupture were: multiple aneurysms (OR 0.41, 95% CI 0.24-0.70), antiplatelet treatment (OR 0.23, 95% CI 0.09-0.59), statin treatment (OR 0.44, 95% CI 0.21-0.90) and paraophthalmic location (OR 0.15, 95% CI 0.03-0.72); and the variables independently associated with rupture were: age (OR 1.02, 95% CI 1.00-1.05), anterior and posterior communicating arteries location (OR 3.01, 95% CI 1.68-5.37), saccular type (OR 9.19, 95% CI 1.05-80.74) and lobulation (OR 1.48, 95% CI 1.11-1.99). Female gender (OR 0.80, 95% CI 0.44-1.47), small sac size (OR 1.02, 95% CI 0.94-1.11) and small neck size (OR 0.87, 95% CI 0.71- 1.08) were also included in the model even though they were not statistically independent.

Conclusions. The Intracerebral Aneurysm’s Risk of Rupture SCORE (ITARR SCORE) is a new easy- to-use predictive tool that, once validated, it can be useful in the daily clinical practice. Statins

and antiplatelet drugs decrease the risk of rupture