Patient and aneurysm factors associated with aneurysm rupture in the population of the ARETA study

Laurent Pierot (1) , Coralie Barbe (2) , Jean-Christophe Ferré (3, 4) , Christophe Cognard (5) , Sébastien Soize (1) , Phil White (6) , Laurent Spelle (7)

1 URCA - Université de Reims Champagne-Ardenne
2 Hôpital universitaire Robert Debré [Reims]
3 Empenn - Neuroimagerie: méthodes et applications
4 Département de Radiologie [CHU de Rennes]
5 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
6 ION - Institute of Neuroscience [Newcastle]
7 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]

Background and purpose - Identifying patients with intracranial aneurysms (IA) who have a high risk of rupture is critical to determine optimal management. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study, dedicated to evaluating endovascular treatment of IA. We aimed to identify factors associated with ruptured status, using this very large series of patients with ruptured and unruptured aneurysms. Methods - Several analyses were conducted in the ARETA population: univariate and multivariate analyses in the whole population of patients and aneurysms to determine patient and aneurysm factors associated with aneurysm rupture, as well as a matched pair analysis (based on aneurysm size) conducted in the subgroup of patients with only one aneurysm to analyze the patient and aneurysm factors simultaneously. Results - From December 2013 to May 2015, 1289 patients with 1761 aneurysms were included in ARETA. The multivariate analysis identified four patient factors: elevated blood pressure (EBP), no familial history, single IA, and active smoking, and four aneurysm factors: size≥5mm, narrow neck, irregular shape, and ACA/Acom location, associated with rupture status. In the matched pair analysis, five risk factors of rupture were identified: no familial history of aneurysm, narrow neck, active smoking, ACA/Acom location, and irregular shape. Conclusions - The most important patient factors associated with IA rupture are smoking and EBP. Given that size is a well-identified aneurysm factor, narrow neck also seems to be associated with aneurysm rupture. Further studies are needed to confirm this factor and determine underlying mechanisms. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01942512.

Mots clés: Aneurysm; Coiling

Domaines: Sciences du Vivant [q-bio]

Laurent Pierot, Coralie Barbe, Jean-Christophe Ferré, Christophe Cognard, Sébastien Soize, et al.. Patient and aneurysm factors associated with aneurysm rupture in the population of the ARETA study. American Journal of Neuroradiology, 2020, 47 (4), pp.292-300. ⟨10.1016/j.neurad.2019.07.007⟩. ⟨hal-02371090⟩