Evidence map›Paper›PMID 34983236›Full record

SynthesisStroke2022

Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis.

Charlotte C M Zuurbier, Rob Molenberg, Liselore A Mensing, Marieke J H Wermer, Seppo Juvela, Antti E Lindgren, Juha E Jääskeläinen, Timo Koivisto, Tomosato Yamazaki, Maarten Uyttenboogaart and 14 more

Registry-linked trialOpen access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Stroke, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05526352 (@neurIST), which is not on this map. Cited by 45 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 5 pooled it
7.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05526352 recruitingnot on this map

@neurIST : Informatique biomédicale intégrée Pour la Gestion Des anévrismes cérébraux

Typeobservational_patient_registrySponsorUniversity Hospital, GenevaRan2015 to 2040Enrolled20,000ConditionsIntracranial Aneurysm
3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 5 syntheses or guidelines pooled it, 66 citations in OpenAlex.

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  16. Sex and gender-related differences in neurological diseases: current challenges and recommendations for clinical practice.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors at 13 institutions in 4 countries.

Charlotte C M ZuurbierUMC Utrecht Brain Center, Department of Neurology and Neurosurgery (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.), University Medical Center Utrecht, the Netherlands.ORCID 0000-0002-4812-434X
Rob MolenbergDepartments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands.ORCID 0000-0002-6621-2028
Liselore A MensingUMC Utrecht Brain Center, Department of Neurology and Neurosurgery (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.), University Medical Center Utrecht, the Netherlands.
Marieke J H WermerDepartment of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.).ORCID 0000-0002-6838-9521
Seppo JuvelaDepartment of Clinical Neurosciences, University of Helsinki, Finland (S.J.).ORCID 0000-0003-4944-4983
Antti E LindgrenDepartment of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland.ORCID 0000-0002-1264-7667
Juha E JääskeläinenDepartment of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland.
Timo KoivistoDepartment of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland.
Tomosato YamazakiDepartment of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.).
Maarten UyttenboogaartNeurology and Medical Imaging Center (M.U.), University Medical Center Groningen, the Netherlands.ORCID 0000-0002-6934-4456
J Marc C van DijkDepartments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands.ORCID 0000-0002-0814-5680
Marlien W AalbersDepartments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands.
Akio MoritaMedical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.).ORCID 0000-0002-2497-5772
Shinjiro TominariDepartment of Health Informatics, School of Public Health, Kyoto University, Japan (S.T.).
Hajime AraiDepartment of Neurosurgery, Juntendo University- Medical School, Tokyo, Japan (H.A.).
Kazuhiko NozakiDepartment of Neurosurgery, Shiga University of Medical Science, Japan (K.N.).ORCID 0000-0003-1623-068X
Yuichi MurayamaDepartment of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.).ORCID 0000-0003-3490-385X
Toshihiro IshibashiDepartment of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.).ORCID 0000-0003-1044-5604
Hiroyuki TakaoDepartment of Endovascular Neurosurgery, Tokyo Jikei University School of Medicine, Japan (Y.M., T.I., H.T.).ORCID 0000-0002-9285-9642
Renato GondarNeurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.).ORCID 0000-0002-6291-0347
Philippe BijlengaNeurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Switzerland (R.G., P.B.).
Gabriel J E RinkelUMC Utrecht Brain Center, Department of Neurology and Neurosurgery (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.), University Medical Center Utrecht, the Netherlands.
Jacoba P GrevingJulius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, the Netherlands.ORCID 0000-0001-8533-2175
Ynte M RuigrokUMC Utrecht Brain Center, Department of Neurology and Neurosurgery (C.C.M.Z, L.A.M., G.J.E.R., Y.M.R.), University Medical Center Utrecht, the Netherlands.ORCID 0000-0002-5396-2989
University Medical Center Groningen · NLUtrecht University · NLJikei University School of Medicine · JPUniversity of Eastern Finland · FIUniversity Hospital of Geneva · CHJuntendo University · JPKyoto University · JPLeiden University Medical Center · NLNational Hospital Organization Mito Medical Center · JPNippon Medical School · JPShiga University of Medical Science · JPUniversity Medical Center Utrecht · NLUniversity of Helsinki · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeIn previous studies, women had a higher risk of rupture of intracranial aneurysms than men, but female sex was not an independent risk factor. This may be explained by a higher prevalence of patient- or aneurysm-related risk factors for rupture in women than in men or by insufficient power of previous studies. We assessed sex differences in rupture rate taking into account other patient- and aneurysm-related risk factors for aneurysmal rupture.

methodsWe searched Embase and Pubmed for articles published until December 1, 2020. Cohorts with available individual patient data were included in our meta-analysis. We compared rupture rates of women versus men using a Cox proportional hazard regression model adjusted for the PHASES score (Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm, Site of Aneurysm), smoking, and a positive family history of aneurysmal subarachnoid hemorrhage.

resultsWe pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12 193 unruptured intracranial aneurysms, and 24 357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%/person-years [95% CI, 0.89-1.21]) and 63 men (rupture rate 0.74%/person-years [95% CI, 0.58-0.94]). Women were older (61.9 versus 59.5 years), were less often smokers (20% versus 44%), more often had internal carotid artery aneurysms (24% versus 17%), and larger sized aneurysms (≥7 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07-1.93) and the adjusted women/men ratio was 1.39 (95% CI, 1.02-1.90).

conclusionsWomen have a higher risk of aneurysmal rupture than men and this sex difference is not explained by differences in patient- and aneurysm-related risk factors for aneurysmal rupture. Future studies should focus on the factors explaining the higher risk of aneurysmal rupture in women.

Indexed as

AgedAge FactorsAneurysm, RupturedCohort StudiesFemaleHumansIntracranial AneurysmMaleMiddle AgedPrevalenceProspective StudiesRisk FactorsSex FactorsSmokingSubarachnoid Hemorrhageintracranial aneurysmprevalencerisk factorsexsubarachnoid hemorrhage

Identifiers

PMID34983236
PMCPMC8785514
OpenAlexW4205140771

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.