To treat or not to treat? An inverse probability weighting analysis of intracranial aneurysms with inconclusive UIATS scores

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2026-03-01 Epub Date: 2026-01-15 DOI:10.1016/j.jocn.2026.111865

Tiago Pedro , Carolina Silva , Pedro Simão , Osvaldo Sousa , Vasco Carvalho , Patrícia Polónia , António Vilarinho , Pedro Alberto Silva , Maria Luís Silva , Luís Albuquerque

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引用次数: 0

Abstract

Introduction

Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.

Methods

We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).

Results

After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.

Conclusions

Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.

Key messages

What is already known on this topic: Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.

What this study adds: In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.

How this study might affect research, practice or policy: These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.

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治疗还是不治疗？uats评分不确定的颅内动脉瘤的逆概率加权分析

当未破裂颅内动脉瘤治疗评分（uats）不确定时，未破裂颅内动脉瘤（UIAs）的治疗具有挑战性，使患者处于治疗的“灰色地带”。该研究比较了UIAs患者和不确定uats评分患者保守治疗和介入治疗的一年结果。方法回顾性分析了2018-2024年在三级中心接受血管造影证实的囊性UIAs和不确定uats评分的149例成人患者。患者按治疗策略分层：保守（68例）或介入（81例），血管内或手术。应用治疗加权逆概率（IPTW）来平衡基线协变量。一年的结果包括动脉瘤破裂、手术并发症、缺血和出血事件、再治疗和功能状态（mRS）。结果IPTW后加权伪人群中保守治疗125例，治疗143例。与保守治疗相比，干预与更好的功能结果相关（aOR为2.526,95% CI为1.075-5.935,p = 0.033）。在保守治疗的患者中，动脉瘤破裂率为4.0%。结论积极治疗未破裂颅内动脉瘤患者和不确定的uats指导在一年内获得了更好的功能结果，强调需要通过更广泛的未来研究来改进当前的决策策略。关键信息：在未破裂颅内动脉瘤治疗评分（uats）不确定的情况下，未破裂颅内动脉瘤的治疗是不确定的，这使得临床医生没有明确的指导。在这个亚组中直接比较保守和介入策略的证据是有限的。本研究补充的内容：在uats建议不确定的患者中，与保守治疗相比，介入治疗与更好的一年功能预后相关。本研究如何影响研究、实践或政策：这些发现支持即使在uats不确定的情况下也要考虑积极治疗，强调个体化、多学科决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.