ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms

Daan Backes; Gabriel J E Rinkel; Jacoba P Greving; Birgitta K Velthuis; Yuichi Murayama; Hiroyuki Takao; Toshihiro Ishibashi; Michiya Igase; Karel G terBrugge; Ronit Agid; Juha E Jääskeläinen; Antti E Lindgren; Timo Koivisto; Mikael von Und Zu Fraunberg; Shunji Matsubara; Junta Moroi; George K C Wong; Jill M Abrigo; Keiji Igase; Katsumi Matsumoto; Marieke J H Wermer; Marianne A A van Walderveen; Ale Algra; Mervyn D I Vergouwen

doi:10.1212/WNL.0000000000003865

ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms

Neurology. 2017 Apr 25;88(17):1600-1606. doi: 10.1212/WNL.0000000000003865. Epub 2017 Mar 31.

Authors

Daan Backes¹, Gabriel J E Rinkel², Jacoba P Greving², Birgitta K Velthuis², Yuichi Murayama², Hiroyuki Takao², Toshihiro Ishibashi², Michiya Igase², Karel G terBrugge², Ronit Agid², Juha E Jääskeläinen², Antti E Lindgren², Timo Koivisto², Mikael von Und Zu Fraunberg², Shunji Matsubara², Junta Moroi², George K C Wong², Jill M Abrigo², Keiji Igase², Katsumi Matsumoto², Marieke J H Wermer², Marianne A A van Walderveen², Ale Algra², Mervyn D I Vergouwen²

Affiliations

¹ From the Department of Neurology and Neurosurgery (D.B., G.J.E.R., A.A., M.D.I.V.), Brain Centre Rudolf Magnus, Julius Centre for Health Sciences and Primary Care (J.P.G., A.A.), and Department of Radiology (B.K.V.), University Medical Centre Utrecht, the Netherlands; Division of Endovascular Neurosurgery (Y.M., H.T., T.I.), Department of Neurosurgery, Jikei University School of Medicine, Tokyo; Department of Geriatrics and Neurology (M.I.), Ehime University School of Medicine, Toon City, Japan; Division of Neuroradiology (K.G.t.B., R.A.), Department of Medical Imaging, Toronto Western Hospital, Ontario, Canada; Department of Neurosurgery (J.E.J., A.E.L., T.K., M.v.u.z.F.), NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland; Department of Neurosurgery (S.M.), Kawasaki Medical School Hospital, Kurashiki City; Department of Surgical Neurology (J.M.), Research Institute for Brain and Blood Vessels, Akita, Japan; Division of Neurosurgery and Department of Imaging and Interventional Radiology (G.K.C.W., J.M.A.), Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (K.I.), Washokai Sadamoto Hospital, Matsuyama, Ehime; Department of Neurosurgery (K.M.), Iseikai Hospital, Osaka City, Japan; and Departments of Neurology (M.J.H.W.) and Radiology (M.A.A.v.W.), Leiden University Medical Centre, the Netherlands. [email protected].
² From the Department of Neurology and Neurosurgery (D.B., G.J.E.R., A.A., M.D.I.V.), Brain Centre Rudolf Magnus, Julius Centre for Health Sciences and Primary Care (J.P.G., A.A.), and Department of Radiology (B.K.V.), University Medical Centre Utrecht, the Netherlands; Division of Endovascular Neurosurgery (Y.M., H.T., T.I.), Department of Neurosurgery, Jikei University School of Medicine, Tokyo; Department of Geriatrics and Neurology (M.I.), Ehime University School of Medicine, Toon City, Japan; Division of Neuroradiology (K.G.t.B., R.A.), Department of Medical Imaging, Toronto Western Hospital, Ontario, Canada; Department of Neurosurgery (J.E.J., A.E.L., T.K., M.v.u.z.F.), NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland; Department of Neurosurgery (S.M.), Kawasaki Medical School Hospital, Kurashiki City; Department of Surgical Neurology (J.M.), Research Institute for Brain and Blood Vessels, Akita, Japan; Division of Neurosurgery and Department of Imaging and Interventional Radiology (G.K.C.W., J.M.A.), Prince of Wales Hospital, The Chinese University of Hong Kong, China; Department of Neurosurgery (K.I.), Washokai Sadamoto Hospital, Matsuyama, Ehime; Department of Neurosurgery (K.M.), Iseikai Hospital, Osaka City, Japan; and Departments of Neurology (M.J.H.W.) and Radiology (M.A.A.v.W.), Leiden University Medical Centre, the Netherlands.

PMID: 28363976
DOI: 10.1212/WNL.0000000000003865

Abstract

Objective: To develop a risk score that estimates 3-year and 5-year absolute risks for aneurysm growth.

Methods: From 10 cohorts of patients with unruptured intracranial aneurysms and follow-up imaging, we pooled individual data on sex, population, age, hypertension, history of subarachnoid hemorrhage, and aneurysm location, size, aspect ratio, and shape but not on smoking during follow-up and family history of intracranial aneurysms in 1,507 patients with 1,909 unruptured intracranial aneurysms and used aneurysm growth as outcome. With aneurysm-based multivariable Cox regression analysis, we determined predictors for aneurysm growth, which were presented as a risk score to calculate 3-year and 5-year risks for aneurysm growth by risk factor status.

Results: Aneurysm growth occurred in 257 patients (17%) and 267 aneurysms (14%) during 5,782 patient-years of follow-up. Predictors for aneurysm growth were earlier subarachnoid hemorrhage, location of the aneurysm, age >60 years, population, size of the aneurysm, and shape of the aneurysm (ELAPSS). The 3-year growth risk ranged from <5% to >42% and the 5-year growth risk from <9% to >60%, depending on the risk factor status.

Conclusions: The ELAPSS score consists of 6 easily retrievable predictors and can help physicians in decision making on the need for and timing of follow-up imaging in patients with unruptured intracranial aneurysms.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Brain / diagnostic imaging
Disease Progression
Female
Follow-Up Studies
Humans
Intracranial Aneurysm / diagnosis*
Intracranial Aneurysm / physiopathology
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neuroimaging
Prognosis
Proportional Hazards Models
Risk
Rupture, Spontaneous / diagnosis
Young Adult