Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients

J Neurosurg. 2014 Sep;121(3):599-604. doi: 10.3171/2014.5.JNS132048. Epub 2014 Jun 27.


Object: The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) increases with the advancing age of the general population. The goal of the present study was to identify risk factors for the growth of UIAs detected with serial MR angiography (MRA) in patients 70 years of age or older.

Methods: This prospective study enrolled 79 patients (age range 70-84 years) with 98 UIAs. Patients were followed up every 4 months, including an assessment of the aneurysm diameter and morphological changes on MRA, neurological status, and other medical conditions. Aneurysm growth was categorized into two different patterns on the basis of the MRA findings: 1) maximum increase in aneurysm diameter of 2 mm or more; and 2) obvious morphological change, such as the appearance of a bleb.

Results: The mean duration of follow-up was 38.5 months (250.2 patient-years). Aneurysm rupture did not occur, but aneurysm growth was observed in 8 aneurysms (8 patients) during the study period. Univariate analysis showed that female sex, patient age ≥ 75 years, and an aneurysm location in the internal carotid artery (ICA) or middle cerebral artery (MCA) were associated with aneurysm growth (p = 0.04, p = 0.04, and p < 0.001, respectively). Multivariate analysis demonstrated that female sex was the only independent predictor of aneurysm growth (p = 0.0313, OR 2.3, 95% CI 1.3-30.2).

Conclusions: Female sex is an independent risk factor for the growth of UIAs in elderly patients. In addition, an age ≥ 75 years and aneurysm location in the ICA or MCA are characteristics that may warrant additional attention during follow-up imaging.

Keywords: ACA = anterior cerebral artery; ACoA = anterior communicating artery; CTA = CT angiography; HICH = hypertensive intracerebral hemorrhage; ICA = internal carotid artery; MCA = middle cerebral artery; MRA = MR angiography; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; UIA = unruptured intracranial saccular aneurysm; elderly; female; growth; unruptured intracranial aneurysm; vascular disorders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aneurysm / diagnostic imaging*
  • Aneurysm / epidemiology*
  • Carotid Artery, Internal / diagnostic imaging*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Angiography
  • Male
  • Middle Cerebral Artery / diagnostic imaging*
  • Multivariate Analysis
  • Prevalence
  • Prospective Studies
  • Radiography
  • Risk Factors
  • Sex Factors*