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DOI: 10.1055/s-0034-1383786
Can Treatment Decision of Unruptured Intracranial Aneurysms Be Based on Phases Score Only?
Background: The natural history of unruptured incidentally discovered intracranial aneurysms (UIA) remains unpredictable. Therefore, when asymptomatic, the management remains subject of controversy. PHASES score1 was recently proposed for prediction of 5-year risk of rupture of UIA.
Methods: The aim of this study is to validate the PHASES score using our prospective and consecutive dataset (2006-2012). We compared scores calculated from the untreated follow-up cohort of UIA between cases with stable lesions and those with aneurysm growth or rupture. Second, scores calculated for UIA and patients diagnosed with Sub-Arachnoid Hemorrhage (SAH) were compared.
Results: Two hundred thirty seven patients were followed up with a mean follow-up time of 2.1 years and 744.1 aneurysm years. Thirteen cases were observed with growing aneurysms and two ruptures. The PHASES score of patients with observed aneurysm growth or rupture showed a trend toward higher values (median 3; 95%CI 3 to 5) than in patients with unruptured stable lesions (median 3; 95%CI 2 to 3; p = 0.1610). Comparing 128 SAH patients with 150 cases diagnosed with incidental aneurysm we observed that SAH patients had a significantly higher PHASES score (SAH: median 5; 95%CI 5 to 5 versus UIA: median 4; 95%CI 3 to 4; p < 0.0001).
Conclusion: Before being validated in a prospective cohort the PHASES score should be used with caution. It does not apply to patients with a familial history, PKD disease or symptomatic aneurysms and does not take into account smoking among other important risk factors.
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