Differences between Ruptured and Unruptured Small Intracranial Aneurysms in Elderly Patients

초록

Objective: In 1998, the International Study of Unruptured Intracranial Aneurysms (ISUIA) claimed that the annual risk of rupture associated with small (less than 10 mm in diameter) unruptured aneurysms without any previous subarachnoid hemorrhages was only 0.05% per year. However, in clinical practice the majority of ruptured aneurysms are small. We investigated elderly patients with small (<6 mm) ruptured and unruptured intracranial aneurysms to determine the differences between the two groups. Methods: We retrospectively reviewed elderly patients with ruptured aneurysms (Group 1) and unruptured aneurysms (Group 2) who underwent neck clipping or coil embolization in our hospital between January 2009 and December 2012. We studied the patients’ characteristics, locations of aneurysms, sizes of aneurysms, and existence of a daughter sac. Results: Age, hypertension, anterior cerebral artery (ACA) + anterior communicating artery (ACoA), paraclinoid aneurysm, aneurysmal neck size, height to width ratio, height to neck ratio (aspect ratio), and existence of a daughter sac had significant differences between the two groups in univariate analysis. The existence of a daughter sac (odds ratio [OR] 18.1, 95% confidence interval [CI] 5.7-110.4), height to width ratio (OR 28.1, 95% CI 11.1-187.6), and ACA + ACoA (OR 9.5, 95% CI 1.6-9.0) showed statistical differences between Group 1 and Group 2. Conclusion: The existence of a daughter sac, height to width ratio, and location (especially ACA or ACoA) should be considered to decide treatment in elderly patients with small intracranial aneurysms less than 6mm to prevent devastating subarachnoid hemorrhages.

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