gms | German Medical Science

Objective: Today the most accepted recommendation to treat asymptomatic aneurysms is in accordance to results of the ISUIA study. In this study factors such as aneurysm size and location were integrated in the rupture risk prediction together with known epidemiological risk factors. The goal of this retrospective analysis was to focus on the ruptured aneurysm in patients with subarachnoid haemorrhage (SAH) with regards to size, location and configuration in correlation with risk factors.

Methods: The analysis was based on data from 405 patients admitted to our department in a five-years period due to aneurysmal SAH. The aneurysm related data included size, location and configuration of the aneurysm. The clinical data in this analysis comprised initial grading according to the WFNS and Fisher and risk factors for aneurysm rupture, such as age, gender, hypertension and smoking. The correlation between aneurysm related factors and risk factors was performed using GraphPad^® V5.

Results: Our patient population revealed a median age of 53.0±12.5 years with a male to female ratio of 1:1.6. The median ruptured aneurysm size was 5.9±4.4 mm with a distribution of 85.6% in the anterior circulation and 14.4% posteriorly. Aneurysm size in our population was distributed as such: a) <3mm = 19.7%, b) 4–7mm = 52.6%, c) 8–12mm = 17.8%, d) 13–25mm = 9.2% and e) >25mm=0.6%. 66.6 % of the patients had a history of hypertension, 33.3% for smoking. Spearman analysis showed that hypertension and aneurysm size were significantly correlated (r²: -0.174, p<0.005). T-test revealed that patients with hypertension as a risk factor had significantly smaller ruptured aneurysms as patients without hypertension (Mean 6.06±3.2 mm vs. 7.71±4.8 mm, respectively, p<0.001). Furthermore this correlation was pronounced for patients with nicotine abuse. Aneurysm size was not correlated to aneurysm configuration, whereas aneurysm location in the posterior circulation was significantly correlated (r²: 0.148, p<0.005) to poorer WFNS grades.

Conclusions: The present analysis of aneurysm related factors in patients with SAH demonstrated a highly significant correlation of the ruptured aneurysm size and the history for risk factors. Despite the limitation of a retrospective analysis the present data suggest that the rupture risk of smaller aneurysms increases significantly in patients with hypertension. Moreover the combination of hypertension and nicotine abuse potentiated this effect.