Multiple Intracranial Aneurysms - The PHASES Scores Applicability in 272 Patients Harboring a Total Number of 666 Multiple Intracranial Aneurysms - Abstract
Background: The subgroup of patients with multiple intracranial aneurysms (MIA) accounts for about 20% of all patients suffering from intracranial aneurysms (IA). There are controversial findings regarding a higher rupture risk in patients with MIA, leading to uncertainties in assessment of individual risk for aneurysm rupture. Our present study aimed to perform a further external validation by applying the PHASES Score of the largest IA retrospectively to 272 patients with a total number of 666 MIA from two different German neurovascular centers.
Methods: We analyzed 272 patients harboring a total number of 666 MIA regarding the accuracy of the PHASES Score for prediction of SAH using Receiver Operating Characteristics. Additionally, we analyzed the patients with aneurysmal subarachnoid hemorrhage (SAH) more closely.
Results: The PHASES Score achieved an Area under the curve of 0.57 in prediction of SAH in patients with MIA with corresponding sensitivity of 62% and specificity of 49%. We observed the following distribution of corresponding 5-year rupture risk in patients with aneurysmal SAH: <1% risk (38%), 1-1.9% risk (33%), 2-4.9% risk (19%) and >5% risk (10%).
Conclusion: The PHASES Score shows low sensitivity and specificity in discrimination of ruptured and unruptured IAs in the important subgroup of patients with MIA; attention should be paid to applying the PHASES Score as described in the original publication. Further investigation MIA and individualized rupture risk assessment using new approaches are needed. At present, the PHASES Score remains the best evaluated clinical score for all patients with IA.