Risk of rupture of unruptured cerebral aneurysms in elderly patients.
OBJECTIVE
The aim of this study was to identify risk factors for rupture of unruptured cerebral aneurysms (UCAs) in elderly Japanese patients aged 70 years or older.


METHODS
The participants included all patients 70 years of age or older in 3 prospective studies in Japan (the Unruptured Cerebral Aneurysm Study of Japan [UCAS Japan], UCAS II, and the prospective study at the Jikei University School of Medicine). A total of 1,896 patients aged 70 years or older with 2,227 UCAs were investigated. The median and mean follow-up periods were 990 and 802.7 days, respectively.


RESULTS
The mean aneurysm size was 6.2 ± 3.9 mm. Sixty-eight patients (3.6%) experienced subarachnoid hemorrhage during the follow-up period. Multivariable analysis per patient revealed that in patients aged 80 years or older (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.16-3.49, p = 0.012), aneurysms 7 mm or larger (HR, 3.08; 95% CI, 1.35-7.03, p = 0.007 for 7-9 mm; HR, 7.82; 95% CI, 3.60-16.98, p < 0.001 for 10-24 mm; and HR, 43.31; 95% CI, 12.55-149.42, p < 0.001 for ≥25 mm) and internal carotid-posterior communicating artery aneurysms (HR, 2.45; 95% CI, 1.23-4.88, p = 0.011) were independent predictors for UCA rupture in elderly patients.


CONCLUSIONS
In our pooled analysis of prospective cohorts in Japan, patient age and aneurysm size and location were significant risk factors for UCA rupture in elderly patients.
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. t-hishi@md.okayama-u.ac.jp.
Tomohito
T
Hishikawa
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Isao
I
Date
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Koji
K
Tokunaga
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Shinjiro
S
Tominari
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Kazuhiko
K
Nozaki
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Yoshiaki
Y
Shiokawa
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Kiyohiro
K
Houkin
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Yuichi
Y
Murayama
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Toshihiro
T
Ishibashi
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Hiroyuki
H
Takao
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Toshikazu
T
Kimura
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Takeo
T
Nakayama
From the Department of Neurological Surgery (T.H., I.D., K.T.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Health Informatics (S.T., T.N.), Kyoto University School of Public Health, Kyoto; Department of Neurosurgery (K.N.), Shiga University of Medical Science, Shiga; Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurosurgery (K.H.), Hokkaido University Graduate School of Medicine, Sapporo; Division of Endovascular Neurosurgery (Y.M., T.I., H.T.), Department of Neurosurgery, The Jikei University School of Medicine, Tokyo; Department of Neurosurgery (T.K.), NTT Medical Center Tokyo; and UCAS Coordinating Office (A.M.), University of Tokyo, Department of Neurological Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Akio
A
Morita
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors