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Unruptured Giant Intracranial Aneurysms: Risk Factors for Mortality and Long-Term Outcome

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Abstract

This study aims to investigate the long-term outcomes of unruptured giant intracranial aneurysms (GIAs) with different treatment modalities and to analyze the factors affecting prognosis. We performed a retrospective medical record review of patients with unruptured GIAs treated at our institution from 2011 to 2018. Prognosis was compared to the best medical treatment without intervention (conservative treatment, CT) and surgical (ST) or endovascular (ET) treatment. Risk factors for mortality were investigated. A total of 276 patients were included in this study. Patients received CT in 16.3%, ST in 30.1%, and ET in 53.6% of cases. After an average 7-year follow-up, the rupture rate after CT was 22.2%, accounting for an annual rupture rate of 7.3%. The postoperative complication rate was 30.1% and 8.1% after ST and ET, respectively. The recurrence rate after ET was 10.1%, compared with ST which was 1.2%. The follow-up mortality in unruptured GIAs was 26.7% after CT, 7.2% after ST, and 5.4% after ET. Older age (50~59, HR 5.877; 60~69, HR 8.565), size ≥ 40 mm (HR 3.916), and posterior circulation location (HR 6.411) were associated with increased mortality. ET significantly decreased mortality (HR 0.191). Unruptured GIAs warrant treatment if feasible due to the high rupture rate and mortality of the natural history. Older age, posterior circulation location, and larger size are risk factors for poor prognosis. Both ST and ET showed a lower mortality rate than CT. ST showed less likely recurrence compared to ET, while ET had a lower complication rate than ST.

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Availability of Data and Material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

This study is supported by National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2015BAI12B04), Beijing Science and Technology Supporting Plan (D16110000381605), Beijing Municipal Administration of Hospitals’ Mission Plan (SML20150501), and National Natural Science Foundation of China (81571110, 81771234).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China

    Junlin Lu, Mingtao Li, Yuanli Zhao, Xiaolin Chen & Jizong Zhao

  2. Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, TX, USA

    Jan-Karl Burkhardt

  3. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Yuanli Zhao & Jizong Zhao

  4. Stroke Center, Beijing Institute for Brain Disorders, Beijing, China

    Yuanli Zhao & Jizong Zhao

  5. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China

    Yuanli Zhao & Jizong Zhao

  6. Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience, Beijing, China

    Yuanli Zhao & Jizong Zhao

  7. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China

    Youxiang Li

  8. Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China

    Yang Zhao

Authors
  1. Junlin Lu
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  2. Mingtao Li
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  3. Jan-Karl Burkhardt
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  4. Yuanli Zhao
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  5. Youxiang Li
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  6. Xiaolin Chen
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  7. Yang Zhao
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  8. Jizong Zhao
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Contributions

JL designed the study, wrote the manuscript, researched the data, and contributed to the discussion. ML designed the study, contributed to the discussion, and edited the manuscript. JB, YLZ, YL, XC, and YZ contributed to the discussion and edited the manuscript. JZ designed the study, researched the data, reviewed/edited the manuscript, and contributed to the discussion.

Corresponding author

Correspondence to Jizong Zhao.

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The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the Beijing Tiantan Hospital Research Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Lu, J., Li, M., Burkhardt, JK. et al. Unruptured Giant Intracranial Aneurysms: Risk Factors for Mortality and Long-Term Outcome. Transl. Stroke Res. 12, 593–601 (2021). https://doi.org/10.1007/s12975-020-00861-6

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  • DOI: https://doi.org/10.1007/s12975-020-00861-6

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