Choi, Joon-Ho
(Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University)
,
Park, Hyun-Seok
(Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University)
Objective : Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of pati...
Objective : Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of patients with small ruptured aneurysms. Methods : We reviewed all patients admitted to our hospital with subarachnoid hemorrhage from January 2005 to December 2015. The patients were divided into two groups : those with aneurysms <5 mm (group S) and those with aneurysms ${\geq}5mm$ (group L). The patient's age and sex, size and location of aneurysms, and risk factors such as hypertension, diabetes, alcohol use, and smoking were compared between the two groups. Results : Eight-hundred eleven patients were diagnosed with ruptured aneurysms, and 337 (41.6%) were included in group S. The mean size of all aneurysms was $6.10{\pm}2.99mm$ (range, 0.7-37.7); aneurysms with a diameter of 4-5 mm accounted for the largest subgroup of all aneurysms. Female sex was significantly associated with the incidence of small ruptured aneurysms (odds ratio [OR] 1.50, 95% confidence intervals [CI] 1.02-2.19, p=0.037). Despite female predominance in the incidence of small ruptured aneurysms, the proportion of small ruptured aneurysms in young (<50 years) men was high. In men, there were no significant differences regarding the location of the aneurysms between group S and group L (p=0.267), with the most frequent location being the anterior communicating artery (ACoA) in both group S (50.9%) and group L (51.4%). However, in women, there were significant differences regarding the location of the aneurysms between group S and group L (p=0.023), with the most frequent locations being the ACoA (33.0%) in group S, and the posterior communicating artery (30.6%) in group L. In women, two locations were significantly associated with small (<5 mm) ruptured aneurysms: the ACoA (OR 2.14, 95% CI 1.01-4.54, p=0.047) and anterior cerebral artery (OR 3.54, 95% CI 1.19-10.54, p=0.023). Multiplicity and smoking were significantly associated with large (${\geq}5mm$) ruptured aneurysms in women. The use of alcohol was related to small ruptured aneurysms in men over 50 years of age (OR 2.23, 95% CI 1.03-4.84, p=0.042). Conclusion : In this study, small (<5 mm) ruptured aneurysms exhibited different incidences by age, sex, location, and risk factors such as multiplicity, smoking, and alcohol use.
Objective : Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of patients with small ruptured aneurysms. Methods : We reviewed all patients admitted to our hospital with subarachnoid hemorrhage from January 2005 to December 2015. The patients were divided into two groups : those with aneurysms <5 mm (group S) and those with aneurysms ${\geq}5mm$ (group L). The patient's age and sex, size and location of aneurysms, and risk factors such as hypertension, diabetes, alcohol use, and smoking were compared between the two groups. Results : Eight-hundred eleven patients were diagnosed with ruptured aneurysms, and 337 (41.6%) were included in group S. The mean size of all aneurysms was $6.10{\pm}2.99mm$ (range, 0.7-37.7); aneurysms with a diameter of 4-5 mm accounted for the largest subgroup of all aneurysms. Female sex was significantly associated with the incidence of small ruptured aneurysms (odds ratio [OR] 1.50, 95% confidence intervals [CI] 1.02-2.19, p=0.037). Despite female predominance in the incidence of small ruptured aneurysms, the proportion of small ruptured aneurysms in young (<50 years) men was high. In men, there were no significant differences regarding the location of the aneurysms between group S and group L (p=0.267), with the most frequent location being the anterior communicating artery (ACoA) in both group S (50.9%) and group L (51.4%). However, in women, there were significant differences regarding the location of the aneurysms between group S and group L (p=0.023), with the most frequent locations being the ACoA (33.0%) in group S, and the posterior communicating artery (30.6%) in group L. In women, two locations were significantly associated with small (<5 mm) ruptured aneurysms: the ACoA (OR 2.14, 95% CI 1.01-4.54, p=0.047) and anterior cerebral artery (OR 3.54, 95% CI 1.19-10.54, p=0.023). Multiplicity and smoking were significantly associated with large (${\geq}5mm$) ruptured aneurysms in women. The use of alcohol was related to small ruptured aneurysms in men over 50 years of age (OR 2.23, 95% CI 1.03-4.84, p=0.042). Conclusion : In this study, small (<5 mm) ruptured aneurysms exhibited different incidences by age, sex, location, and risk factors such as multiplicity, smoking, and alcohol use.
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문제 정의
Therefore, the main purpose of this study was to investigate the incidence and characteristics of patients with small (<5 mm) ruptured aneurysms.
제안 방법
After categorizing aneurysms by differences of 1 mm in diameter, aneurysms with a diameter of 4–5 mm accounted for the largest subgroup of aneurysms (Fig. 2).
A total of 811 patients were included in this study (Table 1), after excluding 95 cases of 21 patients with a dissecting aneurysm, 47 patients with SAH of unknown origin, and 27 patients for whom no angiographic data were available. Various factors retrieved from medical records and radiological findings were analyzed, including the size and location of aneurysms, as well as associated risk factors including hypertension, diabetes mellitus, aneurysm multiplicity, alcohol use, and smoking. Multiplicity of aneurysm was defined in this study as the occurrence of more than two aneurysms.
대상 데이터
Nine hundred six patients were admitted at our hospital with SAH between January 2005 and December 2015. A total of 811 patients were included in this study (Table 1), after excluding 95 cases of 21 patients with a dissecting aneurysm, 47 patients with SAH of unknown origin, and 27 patients for whom no angiographic data were available. Various factors retrieved from medical records and radiological findings were analyzed, including the size and location of aneurysms, as well as associated risk factors including hypertension, diabetes mellitus, aneurysm multiplicity, alcohol use, and smoking.
Nine hundred six patients were admitted at our hospital with SAH between January 2005 and December 2015. A total of 811 patients were included in this study (Table 1), after excluding 95 cases of 21 patients with a dissecting aneurysm, 47 patients with SAH of unknown origin, and 27 patients for whom no angiographic data were available.
데이터처리
The chi-square test and t-test were used for comparisons between group S and group L, as appropriate. Odds ratio (OR) for comparison of the two groups were summarized with 95% confidence intervals (CI) and p values using logistic regression analysis. p values lower than 0.
성능/효과
After evaluating the risk factors, the presence of hypertension or diabetes was not mean to be statistically significant between group S and group L. Multiplicity of the aneurysms and smoking were more frequent in group L than group S. The risk factors of multiplicity of the aneurysms (OR 0.65, 95% CI 0.46–0.93, p=0.019) and smoking (OR 0.32, 95% CI 0.17–0.64, p=0.001) were statistically significant only in women, as seen in Table 2.
Furthermore, a large portion of the ruptured aneurysms encountered in clinical practice are small in size1,3,10,16,29). In this study, 41.6% of patients had ruptured aneurysms less than 5 mm, and the largest proportion of aneurysms were between 4 and 5 mm among all aneurysms.
In this study, small ruptured aneurysms <5 mm were found in a large portion of about 40% of all SAH patients, and revealed a different distribution among variables including age, sex, location, and risk factors such as multiplicity, alcohol use, and smoking, compared with ruptured aneurysms ≥5 mm.
In this study, the ACoA was the most common aneurysm site in men, accounting for approximately 50% of both small and large aneurysms. However, in women, small aneurysms were more likely to occur in the ACoA, but large aneurysms were more likely to occur in the PCoA.
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