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Unruptured Intracranial Aneurysm Risk Scores Underperform in Predicting Subsequent Rupture: A Retrospective

Kamil Krystkiewicz¹, Aleksander Kowal¹, Magdalena Krystkiewicz-Orzechowska²

¹Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, 93-513 Lodz, Poland.

Neurology International

|November 26, 2025

Summary

Current risk scores like PHASES, UIATS, and ELAPSS inadequately predict unruptured intracranial aneurysm rupture risk. These tools often failed to recommend treatment for aneurysms that later ruptured, highlighting a need for improved diagnostic accuracy.

Keywords:

ELAPSS PHASES UIATS intracranial aneurysm rupture risk subarachnoid hemorrhage

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Published on: September 19, 2018

Area of Science:

Neurosurgery
Radiology
Public Health

Background:

Incidental unruptured intracranial aneurysms (UIAs) require risk stratification for management.
Existing tools (PHASES, UIATS, ELAPSS) have unclear real-world predictive accuracy.
Evaluating these scores' performance on actual ruptured aneurysms is crucial.

Purpose of the Study:

To assess the real-world performance of PHASES, UIATS, and ELAPSS in guiding UIA management.
To determine if these scores would have recommended treatment for aneurysms that subsequently ruptured.
To identify limitations in current risk stratification for intracranial aneurysms.

Main Methods:

Retrospective analysis of patients treated for aneurysmal subarachnoid hemorrhage (aSAH).
Calculation of PHASES, UIATS, and ELAPSS scores for ruptured and unruptured aneurysms.
Receiver-operating characteristic (ROC) analysis to evaluate discrimination for rupture.

Main Results:

Age was the sole independent predictor of rupture (OR = 1.05/year).
UIATS favored conservative management in 56.3% of ruptured aneurysms.
PHASES and ELAPSS showed no significant difference between ruptured and unruptured groups.

Conclusions:

PHASES, ELAPSS, and UIATS did not reliably differentiate between ruptured and unruptured aneurysms.
Most ruptured aneurysms would not have been recommended for treatment using current scores.
There is a critical need for more precise, individualized risk assessment tools for UIAs.