Controversies on treatment of unruptured intracranial aneurysms. Value of UIATS and PHASES scores in a daily practice in a Spanish population

Abstract

Appropriate management of unruptured intracranial aneurysms (UIAs) is still a matter of debate. Whether to treat patients with conservative management (CM) or with interventional management (IM) has been addressed in multiple reports with controversial risk/benefit balances. Our objective is to analyze in-hospital management decision and treatment results of UIAs and to evaluate the management of these UIAs with the UIATS and PHASES scores introduced in 2015. A total of 54 patients/71 UIAs diagnosed in 2015–2016 were reviewed. IM was performed in 34 patients/47 UIAs with surgical (15) or endovascular approaches (19), with a female predominance (59%) and 51-yo median age. Median size of UIAs was 6 mm (2–26). Aneurysm obliteration reached 100% in both groups. Major complications ranged between 5%–13%, with no reoperations or mortality. Epidemiologic risk factors in our population detected >95% of patients without family history, high-risk ethnicity, drug habit, or symptoms from UIAs. Patients with CM had lower UIATS/PHASES scores than those with IM, matching the recommendation from these scores. In contrast, UIATS score in UIAs that were managed with IM showed lower punctuations than expected, showing an institutional preference for IM. In multiple UIAs, UIATS/PHASES scores of the aneurysm leading to IM (excluding other lower risk lesions treated with the same approach) showed higher punctuations, especially in the surgical group. Final decision on treatment of UIAs in our center was mostly based on high-risk profile of aneurysm and multiplicity than on scores, p < 0.001. In our experience UIATS/PHASES scores help in decision-making process, however institutional characteristics should be taken into consideration.