Risk factors for the rupture of intracranial aneurysms: a systematic review and meta-analysis

Abstract

Purpose: The study aimed to identify potential risk factors for aneurysm rupture by performing a systematic review and meta-analysis. Materials and methods: We systematically searched the PubMed, Embase, and Cochrane Library electronic databases for eligible studies from their inception until June 2023. Results: Eighteen studies involving 17,069 patients with unruptured intracranial aneurysm (UIA) and 2,699 aneurysm ruptures were selected for the meta-analysis. Hyperlipidemia [odds ratio (OR): 0.47; 95% confidence interval (CI): 0.39–0.56; p < 0.001] and a family history of subarachnoid hemorrhage (SAH) (OR: 0.81; 95% CI: 0.71–0.91; p = 0.001) were associated with a reduced risk of aneurysm rupture. In contrast, a large-size aneurysm (OR: 4.49; 95% CI: 2.46–8.17; p < 0.001), ACA (OR: 3.34; 95% CI: 1.94–5.76; p < 0.001), MCA (OR: 2.16; 95% CI: 1.73–2.69; p < 0.001), and VABA (OR: 2.20; 95% CI: 1.24–3.91; p = 0.007) were associated with an increased risk of aneurysm rupture. Furthermore, the risk of aneurysm rupture was not affected by age, sex, current smoking, hypertension, diabetes mellitus, a history of SAH, and multiple aneurysms. Conclusion: This study identified the predictors of aneurysm rupture in patients with UIAs, including hyperlipidemia, a family history of SAH, a large-size aneurysm, ACA, MCA, and VABA; patients at high risk for aneurysm rupture should be carefully monitored. Systematic Review Registration: Our study was registered in the INPLASY platform (INPLASY202360062).