Journal of Clinical Neuroscience xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Clinical Study
Cognitive function, depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms Shao-Hua Su a,1, Wei Xu b,1, Jian Hai a,⇑, Fei Yu a, Yi-Fang Wu a, Yi-Gang Liu c, Lin Zhang d a
Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China Department of Trauma Center, Emergency, Shanghai Changning Central Hospital, Shanghai, China c Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China d Department of Neurosurgery, Shanghai sixth people’s hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China b
a r t i c l e
i n f o
Article history: Received 4 September 2013 Accepted 30 December 2013 Available online xxxx Keywords: Anxiety Depression Intracranial aneurysms Mild cognitive impairment Quality of life
a b s t r a c t Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication. Ó 2014 Elsevier Ltd. All rights reserved.
1. Introduction The worldwide prevalence of unruptured intracranial aneurysms (UIA) is around 2% [1]. The most severe risk for UIA is life-threatening bleeding, with the rupture incidence of UIA in the general adult population at least 1% per year [2]. Usually treatment (coiling or clipping) is an acceptable option for patients with cerebral aneurysms. However, the clinical goal in treating patients with UIA is to maximize the duration of high-quality life by optimally balancing the risks of aneurysm rupture with the risk of treatment-related adverse outcomes. Due to multiple different factors of UIA (including aneurysm location, vascular morphology and underlying systemic diseases), treatment-related risks exceed the risk of aneurysm rupture for some patients, and cerebral aneurysms in these patients undergo no further treatment [3]. In China, the detection rate of UIA greatly has increased with the ⇑ Corresponding author. Tel.: +86 21 6611 1096; fax: +86 21 5605 0502. 1
E-mail address: [email protected] (J. Hai). These authors have contributed equally to the manuscript.
utilization of CT angiography (CTA), MR angiography (MRA) and digital subtraction angiography (DSA). According to the findings of the International Study of Unruptured Intracranial Aneurysms (ISUIA), small anterior circulation aneurysms (25 points at the time of enrolment (able to care for themselves in daily life). Exclusion criteria were as follows: (i) other cerebrovascular diseases such as arteriovenous malformation, (ii) history of SAH, (iii) severe systemic disease, (iv) taking psychotropic medicines, (v) aneurysm rupture during the follow-up period, and (vi) neurological conditions which might influence cognitive and psychological function during the follow-up period (such as traumatic brain injury, ischemic lesions, or epilepsy). The healthy control group consisted of subjects without systemic disease, mental disease or cerebrovascular disease, and were matched on variables including age, sex, and living area. Moreover, a previous published study [18] used normative data from the general Swedish population as the healthy control group. The validated data for Chinese normals were also used in this paper, as the data were relatively constant and all age brackets and ethnic backgrounds were included. This could be regarded as the standard data of the healthy Chinese population. Hence, Chinese normals were also applied as a control group in the present study. The study was approved by the Ethics Committee of the Tongji Hospital, Tongji University, China. All the investigations were permitted by the participants and all signed informed consent. 2.2. Assessments MoCA is a cognitive screening instrument designed to address some of the limitations of the Mini-Mental State Examination [19,20]. Cognitive function was measured by means of the validated Chinese version of MoCA, which involves items in visual space and execution, naming, memory, attention, language, abstraction, delayed recall and orientation [21]. In the Chinese version of MoCA, scores below 25 are considered abnormal
(sensitivity 100%, specificity 96%), and scores below 25 points but P14 points are considered to indicate mild cognitive impairment (MCI) (sensitivity 87.2%, specificity 83.6%) [22]. The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) were used to assess depression and anxiety. On the basis of 20 items, depression or anxiety are categorized into mild (scores 50–60), moderate (scores 61–70) and severe (scores >70) [23]. The QoL was evaluated using the Short Form-36 questionnaire (SF-36) [24], a valid and reliable QoL assessment in vascular disease [25]. The Chinese version of SF-36, which has a reasonable sensitivity and specificity [26], includes eight health related domains: physical functioning, physical role functioning, bodily pain, general health perception, vitality, social functioning, emotional role functioning and mental health. A higher SF-36 score indicates a better QoL. 2.3. Data collection All patients eligible for the study were advised to have a followup DSA every year. Meanwhile, patients were asked to attend a face-to-face discussion with our doctor at 1 year and 5 years after detection of the untreated UIA. Patients who agreed to participate in this study were not explicitly told that the interview contained psychological and cognitive testing in an attempt to draw out more honest responses to the MoCA, SF-36, SDS and SAS items. All questionnaires were administered via face-to-face interview in our clinical rooms and were performed by the same examiner (S-H.S). 2.4. Data analysis Data were analyzed with the Statistical Package for the Social Sciences version 17.0 (SPSS, Chicago IL, USA). Measurement data are presented as mean ± standard deviation. A non-parametric test was used for comparisons as it is appropriate for small sample sizes and skewed distributions. The Wilcoxon matched-pairs signed-ranks test was used for two related samples tests. The Mann–Whitney U test was used for two independent samples tests. Numerical data are presented as percentages. The Chi-squared test was performed on numerical data. p < 0.05 was considered significant for all analyses. 3. Results 3.1. Patient characteristics We selected 47 patients with untreated UIA for this long-term follow-up study. One refused to participate, two were lost to follow-up, six suffered aneurysm rupture during the follow-up period, and seven underwent surgical treatment for UIA during the follow-up period. Thus, the final study group comprised 31 patients (12 men and 19 women), with a median age of 48.1 ± 5.7 years (range 38–60). Three patients had multiple aneurysms, with one patient having aneurysms in the anterior communicating artery (AcomA) and posterior communicating artery (PcomA), one patient having aneurysms in the AcomA, PcomA and internal carotid artery, and one patient having aneurysms in the PcomA and posterior inferior cerebellar artery. Each of these aneurysms were counted in the subgroup analysis of aneurysm location and size. Based on initial DSA, the mean aneurysm size was 5.3 ± 2.5 mm (range 1–12.6), and it was 5.4 ± 2.6 mm (range 1.1–12.6) at the end of the 5 year follow-up period. No significant changes of aneurysmal morphology or other cerebrovascular morphology were found during the follow-up period. The healthy controls consisted of 31 people matched for age, sex and living area. Six individuals were excluded in order to balance the baseline characteristics (smoking, hypertension,
Please cite this article in press as: Su S-H et al. Cognitive function, depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms. J Clin Neurosci (2014), http://dx.doi.org/10.1016/j.jocn.2013.12.032
S.-H. Su et al. / Journal of Clinical Neuroscience xxx (2014) xxx–xxx
education background) between the two groups. After these exclusions, 25 individuals were identified as the final healthy control group. Characteristics of patients with untreated UIA and healthy controls are presented in Table 1. 3.2. Cognitive function All the patients in our study were screened at 1 month, 1 year and 5 years after the discovery of their UIA. The mean total MoCA scores of the patient and control groups are shown in Figure 1. The mean total MoCA score of patients at 1 month was 27.9 ± 1.3 points (range 25–30) and was 27.3 ± 1.1 points (range 25–29) at 1 year. These results were within the normal range provided by the healthy controls (1 month: 27.6 ± 0.7 points, range 27–29; and 1 year: 27.7 ± 1.0 points, range 26–30) and Chinese normals (27.2 ± 1.1 points) [27]. However, 30 (97%) of 31 patients were considered to have MCI, scoring 20.8 ± 1.5 points (range 18–25) at 5 years. This result was significantly lower than the healthy controls at the same time point (27.5 ± 1.1 points, range 25–29) and Chinese normals. The mean MoCA scores of patients with untreated UIA for each MoCA domain at each time point are shown in Figure 2. All the patient MoCA subscores were similar at 1 month and 1 year, while a decrease in overall MoCA subscores was found at 5 years. The differences between the 1 month and 5 years were statistically significant for the domains of visual space and execution (z = 4.163, p = 0.000), naming (z = 4.772, p = 0.000), attention (z = 4.714. p = 0.000), language (z = 3.644, p = 0.000), abstraction (z = 4.413, p = 0.000), delayed recall (z = 4.158, p = 0.000) and
3
orientation (z = 4.748, p = 0.000). A significant difference was also found between scores at 1 year and 5 years in the domains of visual space and execution (z = 4.456, p = 0.000), naming (z = 4.63, p = 0.000), attention (z = 4.347. p = 0.000), language (z = 4.065, p = 0.000), abstraction (z = 4.630, p = 0.000), delayed recall (z = 3.654, p = 0.000) and orientation (z = 4.284, p = 0.000). 3.3. Depression and anxiety According to the SDS and SAS, 22 (71%) patients with untreated UIA were considered to be mildly to severely depressed with a mean of 54.8 ± 13.8 points, and 26 (84%) patients were found to be have mild to severe anxiety with a mean of 59.2 ± 11.9 points at 1 year after discovering the UIA. The mean SDS and SAS scores of healthy controls were 46.5 ± 11.3 points and 41.1 ± 10.2 points, respectively, at the corresponding time-point. However, only 12 (39%) patients were mildly to severely depressed (47.1 ± 10.6 points), and 10 (32%) patients had mild to severe anxiety (46.9 ± 11.9 points) at 5 years after detection of the UIA. At the same time-point, the mean SDS and SAS scores of healthy controls were 46.3 ± 11.3 points and 42.3 ± 9.3 points, respectively. The difference between the two groups was statistically significant at 1 year (SDS: z = 2.393, p = 0.017; SAS: z = 4.754, p = 0.000), but were not significantly different at 5 years (SDS: z = 0.323, p = 0.747; SAS: z = 0.832, p = 0.405). A significant decrease in depression and anxiety in patients with untreated UIA was found over time (Table 2, 3). 3.4. QoL
Table 1 Characteristics of patients with untreated unruptured intracranial aneurysms and healthy controls Patients with untreated UIA (n = 31)
Healthy controls (n = 25)
48.1 ± 5.7 (38–60)
49.5 ± 6.6 (34–60)
12 (39%) 12 (39%) 11 (35%) 13 (42%) 6 (19%) 5 (16%)
9 (36%) 15 (60%) 11 (44%) 16 (64%) 10 (40%) 3 (12%)
Years of education P12 years 6–12 years 66 years
9 (29%) 20 (65%) 2 (6%)
13 (52%) 11 (44%) 1 (4%)
Aneurysm location AcomA PcomA MCA ICA PCA ACA PICA
10 (29%) 7 (20%) 5 (14%) 3 (9%) 2 (6%) 5 (14%) 3 (9%)
N/A N/A N/A N/A N/A N/A N/A
Aneurysm size 10 mm
29 (83%) 4 (11%) 2 (6%)
N/A N/A N/A
Aneurysm quantity Single Multiple
28 (90%) 3 (10%)a
N/A N/A
Mean age, years, ±SD (range) Male Smoker Alcohol drinker Hypertension Diabetes Heart disease
Data are presented as n (%) unless otherwise stated. ACA = anterior cerebral artery, AcomA = anterior communicating artery, ICA = internal carotid artery, MCA = middle cerebral artery, N/A = not available, PCA = posterior cerebral artery, PcomA = posterior communicating artery, PICA = posterior inferior cerebellar artery, SD = standard deviation, UIA = unruptured intracranial aneurysm. a Three PcomA, one PICA, one ICA, two AcomA; all
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Clinical Study
Cognitive function, depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms Shao-Hua Su a,1, Wei Xu b,1, Jian Hai a,⇑, Fei Yu a, Yi-Fang Wu a, Yi-Gang Liu c, Lin Zhang d a
Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai 200065, China Department of Trauma Center, Emergency, Shanghai Changning Central Hospital, Shanghai, China c Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China d Department of Neurosurgery, Shanghai sixth people’s hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China b
a r t i c l e
i n f o
Article history: Received 4 September 2013 Accepted 30 December 2013 Available online xxxx Keywords: Anxiety Depression Intracranial aneurysms Mild cognitive impairment Quality of life
a b s t r a c t Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication. Ó 2014 Elsevier Ltd. All rights reserved.
1. Introduction The worldwide prevalence of unruptured intracranial aneurysms (UIA) is around 2% [1]. The most severe risk for UIA is life-threatening bleeding, with the rupture incidence of UIA in the general adult population at least 1% per year [2]. Usually treatment (coiling or clipping) is an acceptable option for patients with cerebral aneurysms. However, the clinical goal in treating patients with UIA is to maximize the duration of high-quality life by optimally balancing the risks of aneurysm rupture with the risk of treatment-related adverse outcomes. Due to multiple different factors of UIA (including aneurysm location, vascular morphology and underlying systemic diseases), treatment-related risks exceed the risk of aneurysm rupture for some patients, and cerebral aneurysms in these patients undergo no further treatment [3]. In China, the detection rate of UIA greatly has increased with the ⇑ Corresponding author. Tel.: +86 21 6611 1096; fax: +86 21 5605 0502. 1
E-mail address: [email protected] (J. Hai). These authors have contributed equally to the manuscript.
utilization of CT angiography (CTA), MR angiography (MRA) and digital subtraction angiography (DSA). According to the findings of the International Study of Unruptured Intracranial Aneurysms (ISUIA), small anterior circulation aneurysms (25 points at the time of enrolment (able to care for themselves in daily life). Exclusion criteria were as follows: (i) other cerebrovascular diseases such as arteriovenous malformation, (ii) history of SAH, (iii) severe systemic disease, (iv) taking psychotropic medicines, (v) aneurysm rupture during the follow-up period, and (vi) neurological conditions which might influence cognitive and psychological function during the follow-up period (such as traumatic brain injury, ischemic lesions, or epilepsy). The healthy control group consisted of subjects without systemic disease, mental disease or cerebrovascular disease, and were matched on variables including age, sex, and living area. Moreover, a previous published study [18] used normative data from the general Swedish population as the healthy control group. The validated data for Chinese normals were also used in this paper, as the data were relatively constant and all age brackets and ethnic backgrounds were included. This could be regarded as the standard data of the healthy Chinese population. Hence, Chinese normals were also applied as a control group in the present study. The study was approved by the Ethics Committee of the Tongji Hospital, Tongji University, China. All the investigations were permitted by the participants and all signed informed consent. 2.2. Assessments MoCA is a cognitive screening instrument designed to address some of the limitations of the Mini-Mental State Examination [19,20]. Cognitive function was measured by means of the validated Chinese version of MoCA, which involves items in visual space and execution, naming, memory, attention, language, abstraction, delayed recall and orientation [21]. In the Chinese version of MoCA, scores below 25 are considered abnormal
(sensitivity 100%, specificity 96%), and scores below 25 points but P14 points are considered to indicate mild cognitive impairment (MCI) (sensitivity 87.2%, specificity 83.6%) [22]. The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) were used to assess depression and anxiety. On the basis of 20 items, depression or anxiety are categorized into mild (scores 50–60), moderate (scores 61–70) and severe (scores >70) [23]. The QoL was evaluated using the Short Form-36 questionnaire (SF-36) [24], a valid and reliable QoL assessment in vascular disease [25]. The Chinese version of SF-36, which has a reasonable sensitivity and specificity [26], includes eight health related domains: physical functioning, physical role functioning, bodily pain, general health perception, vitality, social functioning, emotional role functioning and mental health. A higher SF-36 score indicates a better QoL. 2.3. Data collection All patients eligible for the study were advised to have a followup DSA every year. Meanwhile, patients were asked to attend a face-to-face discussion with our doctor at 1 year and 5 years after detection of the untreated UIA. Patients who agreed to participate in this study were not explicitly told that the interview contained psychological and cognitive testing in an attempt to draw out more honest responses to the MoCA, SF-36, SDS and SAS items. All questionnaires were administered via face-to-face interview in our clinical rooms and were performed by the same examiner (S-H.S). 2.4. Data analysis Data were analyzed with the Statistical Package for the Social Sciences version 17.0 (SPSS, Chicago IL, USA). Measurement data are presented as mean ± standard deviation. A non-parametric test was used for comparisons as it is appropriate for small sample sizes and skewed distributions. The Wilcoxon matched-pairs signed-ranks test was used for two related samples tests. The Mann–Whitney U test was used for two independent samples tests. Numerical data are presented as percentages. The Chi-squared test was performed on numerical data. p < 0.05 was considered significant for all analyses. 3. Results 3.1. Patient characteristics We selected 47 patients with untreated UIA for this long-term follow-up study. One refused to participate, two were lost to follow-up, six suffered aneurysm rupture during the follow-up period, and seven underwent surgical treatment for UIA during the follow-up period. Thus, the final study group comprised 31 patients (12 men and 19 women), with a median age of 48.1 ± 5.7 years (range 38–60). Three patients had multiple aneurysms, with one patient having aneurysms in the anterior communicating artery (AcomA) and posterior communicating artery (PcomA), one patient having aneurysms in the AcomA, PcomA and internal carotid artery, and one patient having aneurysms in the PcomA and posterior inferior cerebellar artery. Each of these aneurysms were counted in the subgroup analysis of aneurysm location and size. Based on initial DSA, the mean aneurysm size was 5.3 ± 2.5 mm (range 1–12.6), and it was 5.4 ± 2.6 mm (range 1.1–12.6) at the end of the 5 year follow-up period. No significant changes of aneurysmal morphology or other cerebrovascular morphology were found during the follow-up period. The healthy controls consisted of 31 people matched for age, sex and living area. Six individuals were excluded in order to balance the baseline characteristics (smoking, hypertension,
Please cite this article in press as: Su S-H et al. Cognitive function, depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms. J Clin Neurosci (2014), http://dx.doi.org/10.1016/j.jocn.2013.12.032
S.-H. Su et al. / Journal of Clinical Neuroscience xxx (2014) xxx–xxx
education background) between the two groups. After these exclusions, 25 individuals were identified as the final healthy control group. Characteristics of patients with untreated UIA and healthy controls are presented in Table 1. 3.2. Cognitive function All the patients in our study were screened at 1 month, 1 year and 5 years after the discovery of their UIA. The mean total MoCA scores of the patient and control groups are shown in Figure 1. The mean total MoCA score of patients at 1 month was 27.9 ± 1.3 points (range 25–30) and was 27.3 ± 1.1 points (range 25–29) at 1 year. These results were within the normal range provided by the healthy controls (1 month: 27.6 ± 0.7 points, range 27–29; and 1 year: 27.7 ± 1.0 points, range 26–30) and Chinese normals (27.2 ± 1.1 points) [27]. However, 30 (97%) of 31 patients were considered to have MCI, scoring 20.8 ± 1.5 points (range 18–25) at 5 years. This result was significantly lower than the healthy controls at the same time point (27.5 ± 1.1 points, range 25–29) and Chinese normals. The mean MoCA scores of patients with untreated UIA for each MoCA domain at each time point are shown in Figure 2. All the patient MoCA subscores were similar at 1 month and 1 year, while a decrease in overall MoCA subscores was found at 5 years. The differences between the 1 month and 5 years were statistically significant for the domains of visual space and execution (z = 4.163, p = 0.000), naming (z = 4.772, p = 0.000), attention (z = 4.714. p = 0.000), language (z = 3.644, p = 0.000), abstraction (z = 4.413, p = 0.000), delayed recall (z = 4.158, p = 0.000) and
3
orientation (z = 4.748, p = 0.000). A significant difference was also found between scores at 1 year and 5 years in the domains of visual space and execution (z = 4.456, p = 0.000), naming (z = 4.63, p = 0.000), attention (z = 4.347. p = 0.000), language (z = 4.065, p = 0.000), abstraction (z = 4.630, p = 0.000), delayed recall (z = 3.654, p = 0.000) and orientation (z = 4.284, p = 0.000). 3.3. Depression and anxiety According to the SDS and SAS, 22 (71%) patients with untreated UIA were considered to be mildly to severely depressed with a mean of 54.8 ± 13.8 points, and 26 (84%) patients were found to be have mild to severe anxiety with a mean of 59.2 ± 11.9 points at 1 year after discovering the UIA. The mean SDS and SAS scores of healthy controls were 46.5 ± 11.3 points and 41.1 ± 10.2 points, respectively, at the corresponding time-point. However, only 12 (39%) patients were mildly to severely depressed (47.1 ± 10.6 points), and 10 (32%) patients had mild to severe anxiety (46.9 ± 11.9 points) at 5 years after detection of the UIA. At the same time-point, the mean SDS and SAS scores of healthy controls were 46.3 ± 11.3 points and 42.3 ± 9.3 points, respectively. The difference between the two groups was statistically significant at 1 year (SDS: z = 2.393, p = 0.017; SAS: z = 4.754, p = 0.000), but were not significantly different at 5 years (SDS: z = 0.323, p = 0.747; SAS: z = 0.832, p = 0.405). A significant decrease in depression and anxiety in patients with untreated UIA was found over time (Table 2, 3). 3.4. QoL
Table 1 Characteristics of patients with untreated unruptured intracranial aneurysms and healthy controls Patients with untreated UIA (n = 31)
Healthy controls (n = 25)
48.1 ± 5.7 (38–60)
49.5 ± 6.6 (34–60)
12 (39%) 12 (39%) 11 (35%) 13 (42%) 6 (19%) 5 (16%)
9 (36%) 15 (60%) 11 (44%) 16 (64%) 10 (40%) 3 (12%)
Years of education P12 years 6–12 years 66 years
9 (29%) 20 (65%) 2 (6%)
13 (52%) 11 (44%) 1 (4%)
Aneurysm location AcomA PcomA MCA ICA PCA ACA PICA
10 (29%) 7 (20%) 5 (14%) 3 (9%) 2 (6%) 5 (14%) 3 (9%)
N/A N/A N/A N/A N/A N/A N/A
Aneurysm size 10 mm
29 (83%) 4 (11%) 2 (6%)
N/A N/A N/A
Aneurysm quantity Single Multiple
28 (90%) 3 (10%)a
N/A N/A
Mean age, years, ±SD (range) Male Smoker Alcohol drinker Hypertension Diabetes Heart disease
Data are presented as n (%) unless otherwise stated. ACA = anterior cerebral artery, AcomA = anterior communicating artery, ICA = internal carotid artery, MCA = middle cerebral artery, N/A = not available, PCA = posterior cerebral artery, PcomA = posterior communicating artery, PICA = posterior inferior cerebellar artery, SD = standard deviation, UIA = unruptured intracranial aneurysm. a Three PcomA, one PICA, one ICA, two AcomA; all
