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Published on: August 11, 2015
Difference in Rupture Risk Between Familial and Sporadic Intracranial Aneurysms: An Individual Patient Data
Charlotte C M Zuurbier1, Liselore A Mensing1, Marieke J H Wermer1
1From the Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (C.C.M.Z., L.A.M., G.J.E.R., Y.M.R.), and Julius Centre for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht; Department of Neurology (M.J.H.W.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (S.J.), University of Helsinki; Neurosurgery of NeuroCenter (A.E.L., T.K., J.E.J.), University of Eastern Finland, Kuopio, Finland; Department of Neurosurgery (T.Y.), National Hospital Organization, Mito Medical Center, Japan; Departments of Neurosurgery (R.M., J.M.C.v.D., M.U., M.A.), University Medical Center Groningen, the Netherlands; University of Tokyo-Nippon Medical School (A.M.); Department of Health Informatics, School of Public Health (S.T.), Kyoto University; Department of Neurosurgery (H.A.), Juntendo University Medical School, Tokyo; Department of Neurosurgery (K.N.), Shiga University of Medical Science; and Department of Endovascular Neurosurgery (Y.M., T.I., H.T.), Tokyo Jikei University School of Medicine, Japan.
Patients with a family history of unruptured intracranial aneurysms (UIAs) face a significantly higher rupture risk. This finding underscores the importance of considering family history in UIA risk assessment.
Area of Science:
- Neurology
- Epidemiology
- Genetics
Background:
- Unruptured intracranial aneurysms (UIAs) pose a significant health risk.
- Familial UIA, where multiple family members are affected, suggests a genetic component.
- The comparative rupture risk between familial and sporadic UIAs requires precise quantification.
Purpose of the Study:
- To assess the rupture risk in patients with familial unruptured intracranial aneurysms (UIAs) compared to sporadic UIAs.
- To quantify the increased risk of aneurysm rupture associated with a family history of UIAs.
- To inform clinical risk assessment by evaluating the impact of family history on UIA rupture.
Main Methods:
- Individual patient data (IPD) meta-analysis of prospective UIA cohorts.
- Systematic literature search of Embase and PubMed up to December 2020.
- Cox proportional hazard regression adjusted for PHASES score and smoking, comparing familial vs. sporadic UIA rupture rates.
Main Results:
- Pooled IPD from 8 cohorts (2,297 patients) showed an adjusted hazard ratio (HR) of 2.56 (95% CI 1.18-5.56) for familial UIA rupture.
- Rupture rates were 0.89%/person-year in familial cases versus 0.66%/person-year in sporadic cases.
- Inclusion of 2 additional cohorts (9,511 patients total) yielded an adjusted HR of 1.44 (95% CI 0.86-2.40).
Conclusions:
- Familial UIA is associated with a 2.5-fold increased risk of rupture compared to sporadic UIA.
- Family history is a critical factor to consider in the clinical assessment of UIA rupture risk.
- Further research may refine risk stratification by incorporating detailed family history information.
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