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Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis
Hieronymus D Boogaarts1, Jasper H van Lieshout, Martinus J van Amerongen
1Departments of 1 Neurosurgery.
Journal of Neurosurgery
|February 7, 2015
Summary
Aneurysm size is a significant risk factor for rebleeding after subarachnoid hemorrhage. Larger aneurysms (greater than 7-10 mm) show a substantially higher risk of rebleeding, confirming the need for prompt treatment.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Aneurysmal rebleeding is a critical determinant of poor outcomes following subarachnoid hemorrhage.
- Identifying predictors of rebleeding is essential for timely and appropriate treatment decisions.
- The relationship between aneurysm size and rebleeding risk remains incompletely understood.
Purpose of the Study:
- To conduct a meta-analysis evaluating the association between aneurysm diameter and the rate of rebleeding before treatment.
- To assess the influence of confounding factors such as age, aneurysm location, and hypertension on rebleeding risk.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases up to April 2013.
- Inclusion of seven studies with 2121 patients reporting aneurysm diameter and rebleeding rates.
- Quality assessment using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Main Results:
- Overall rebleeding occurred in 17.0% of patients; rates were 14.0% for small aneurysms and 23.6% for large aneurysms.
- Larger aneurysms were significantly associated with a higher risk of rebleeding (OR 2.56; p=0.00).
- A persistent relationship between lesion size and rebleeding risk was observed even after age adjustment.
Conclusions:
- Aneurysm size is a crucial, independent risk factor for aneurysmal rebleeding.
- Clinical risk assessment should incorporate aneurysm diameter to guide treatment decisions.
- Acute treatment for large ruptured aneurysms is strongly supported by these findings.
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