J Korean Neurosurg Soc.  2017 Jul;60(4):424-432. 10.3340/jkns.2016.0910.003.

The Incidence and Characteristics of Patients with Small Ruptured Aneurysms (<5 mm) in Subarachnoid Hemorrhage

• Choi JH
• Park HS

• KMID: 2387880
• DOI: http://doi.org/10.3340/jkns.2016.0910.003

Abstract

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 ≥5 mm (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±2.99 mm (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 (≥5 mm) 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.

Keyword

Subarachnoid hemorrhage; Intracranial aneurysm; Rupture; Risk factors

MeSH Terms

Aneurysm
Aneurysm, Ruptured*
Anterior Cerebral Artery
Arteries
Female
Humans
Hypertension
Incidence*
Intracranial Aneurysm
Male
Risk Factors
Rupture
Smoke
Smoking
Subarachnoid Hemorrhage*
Smoke

Figure

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  Fig. 1 Distribution of patients with ruptured aneurysms stratified by age and gender. A: Male patients. B: Female patients.

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  Fig. 2 Distribution of patients with ruptured aneurysms, stratified by size of the aneurysm.

Reference

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