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Natural history of untreated unruptured intracranial aneurysms in the elderly.

老年未破裂颅内动脉瘤未经治疗的自然病史。

  • 影响因子:1.20
  • DOI:10.23736/S0390-5616.16.03891-1
  • 作者列表:"Rinaldo L","Shepherd DL","Murphy ME","Vine RL","Brown RD Jr","Rabinstein AA","Lanzino G
  • 发表时间:2020-04-01
Abstract

BACKGROUND:The effect of age on risk of intracranial aneurysm rupture is not well understood. We investigated the clinical course of patients 65 years and older with conservatively managed unruptured intracranial aneurysms (UIA) and determined risk factors for rupture in this population. METHODS:We reviewed prospectively collected data on baseline characteristics and long-term follow-up for patients aged 65 years and older with an UIA that were initially managed with observation. The association between patient and aneurysmal characteristics and risk of rupture was performed using a multivariate Cox proportional hazard regression model. RESULTS:There were 214 patients (mean age: 74.7 years, SD: 6.0) included in our study. The median follow-up time was 3.7 years, with a cumulative follow-up time of 883.7 person-years. During the study period, seven patients (3.3%) received interventional treatment of their UIA and eight patients (3.7%) experienced aneurysmal subarachnoid hemorrhage, yielding an annual risk of rupture of 0.9%. All aneurysms that ruptured were at least 10 mm in size. Increasing patient age [unit relative risk (RR) 1.19, 95% CI: 1.07-1.36, P=0.002], larger aneurysmal size (unit RR 1.10, 95% CI: 1.02-1.17, P=0.021), and increasing PHASES Score (unit RR 1.62, 95% CI: 1.32-2.06, P<0.001) were associated with higher risk of rupture. CONCLUSIONS:Our data do not suggest that UIA in older patients carry a high risk of rupture. A conservative approach appears justified in these patients, with the exception of selected patients with larger aneurysms (>10 mm in diameter) and low risk of interventional procedure.

摘要

背景: 年龄对颅内动脉瘤破裂风险的影响尚不清楚。我们调查了 65 岁及以上保守治疗的未破裂颅内动脉瘤 (UIA) 患者的临床过程,并确定了该人群破裂的危险因素。 方法: 我们回顾了前瞻性收集的 65 岁及以上 UIA 患者的基线特征和长期随访数据,这些患者最初接受观察。使用多变量 Cox 比例风险回归模型进行患者和动脉瘤特征与破裂风险之间的关联。 结果: 有 214 例患者 (平均年龄: 74.7 岁,SD: 6.0) 纳入我们的研究。中位随访时间 3.7 年,累计随访时间 883.7 人年。在研究期间,7 例患者 (3.3%) 接受了 UIA 的介入治疗,8 例患者 (3.7%) 经历了动脉瘤性蛛网膜下腔出血,每年破裂的风险为 0.9%。所有破裂的动脉瘤大小至少为 10毫米。患者年龄增加 [单位相对危险度 (RR) 1.19,95% CI: 1.07-1.36,P = 0.002],动脉瘤体积较大 (单位 RR 1.10,95% CI: 1.02-1.17, P = 0.021),分期评分增加 (单位 RR 1.62,95% CI: 1.32-2.06,P<0.001) 与较高的破裂风险相关。 结论: 我们的数据并不表明老年患者的 UIA 具有很高的破裂风险。在这些患者中,保守治疗似乎是合理的,但选择性动脉瘤较大 (直径> 10毫米) 和介入手术风险较低的患者除外。

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