Analysis of Clinical and Morphological Risk Factors for Ruptured Intracranial Aneurysm: A Systematic Review and Meta-analysis

Abstract

Background: The mortality of ruptured intracranial aneurysm (IA) remains high, reaching up to 50%. The objective of this meta-analysis is to identify the clinical and morphological risk factors associated with ruptured IA. Methods: A comprehensive systematic literature search was conducted in PubMed, SagePub, ScienceDirect, ProQuest and Cochrane Library to identify studies on the clinical and morphological risk factors for ruptured IA. The risk factors were assessed by calculating pooled odds ratios (ORs) or weighted mean differences (WMDs). Review Manager 5.4 software was used to conduct the meta-analysis. Results: This meta-analysis included 14 studies, comprising a total of 11,546 patients diagnosed with IA. The pooled analysis revealed significant associations between the clinical risk factors and ruptured IA: age (WMD=-2.59, 95% confidence interval [CI]: -4.22 to -0.96, p=0.002), smoking history (OR=1.38, 95% CI: 1.08−1.76, p=0.010), alcohol consumption history (OR=1.22, 95% CI: 1.11−1.35, p<0.0001), diabetes mellitus (OR=0.55, 95% CI: 0.42−0.73, p<0.0001), heart disease (OR=0.56, 95% CI: 0.38−0.83, p=0.004) and family history of subarachnoid haemorrhage (SAH) (OR=0.58, 95% CI: 0.50−0.67, p<0.00001). The following morphological risk factors were significantly associated with ruptured IA: irregular shape (OR=5.43, 95% CI: 4.62−6.38, p<0.00001), larger size (OR=2.48, 95% CI: 1.68−3.64, p<0.00001), bifurcation (OR=2.63, 95% CI: 1.52−4.56, p=0.0006), daughter sac (OR=5.92, 95% CI: 3.16−11.08, p<0.00001) and larger bottle-neck ratio (WMD=0.35, 95% CI: 0.14−0.56, p=0.0008). Conclusions: In patients with IA, age, smoking history and alcohol consumption history elevated the risk of IA rupture. Morphological risk factors included irregular shape, larger size, bifurcation, daughter sac and larger bottle-neck ratio. Controlled diabetes mellitus, heart disease and familial background of SAH decreased the risk of ruptured IA.