Low PHASES-Estimated Rupture Risk Among Patients Presenting with Ruptured Intracranial Aneurysms: A Retrospective Single-Centre Observational Study
5 affiliations
- 1Department of Neurosurgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-168 Bydgoszcz, Poland
- 2Department of Neurosurgery, John Paul II Catholic University of Lublin, 20-950 Lublin, Poland
- 3Department of Plastic Surgery, Lublin Oncology Center, 20-090 Lublin, Poland
- 4Department of Information Technology and Medical Statistics with E-Health Laboratory, Faculty of Medical Sciences, Medical University of Lublin, 20-059 Lublin, Poland
- 5Department of Neurosurgery, Collegium Medicum in Bydgoszcz, 85-168 Bydgoszcz, Poland
Abstract
Background/Objectives: The PHASES score is widely used to estimate the 5-year rupture risk of unruptured intracranial aneurysms, yet many patients present with aneurysmal subarachnoid haemorrhage despite low calculated risk. This study aimed to characterise the demographic and aneurysm-related profile of patients with ruptured aneurysms classified as low risk by PHASES. Methods: This retrospective single-centre observational study included 243 consecutive patients with radiologically confirmed ruptured intracranial aneurysms treated between 2013 and 2021. PHASES scores and estimated 5-year rupture risks were calculated retrospectively. Age, sex, arterial hypertension, aneurysm size, location, and multiplicity were analysed using non-parametric statistical methods. Results: The mean PHASES score was 5.16 ± 3.43 points. An estimated 5-year rupture risk below 1% was assigned to 125 patients (51.44%), and 54 patients (22.22%) had PHASES scores of 0–2. Ruptured aneurysms measuring ≤7 mm occurred in 147 patients (60.49%), and 210 patients (86.42%) were younger than 70 years. Internal carotid artery aneurysms were the most frequent overall, whereas anterior communicating artery aneurysms had the smallest median diameter while remaining among the most common rupture sites. Arterial hypertension was associated with larger aneurysm diameter. Conclusions: Low PHASES-estimated risks were common in this cohort of patients presenting with aneurysm rupture. Because the study included no comparison group with unruptured aneurysms, it cannot assess PHASES calibration or predictive performance. PHASES should therefore be used as a population-based decision-support tool rather than a stand-alone predictor of individual rupture risk, with morphology, imaging findings, documented growth, and patient-specific factors incorporated into clinical assessment.
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BibTeX
@article{krakowiak2026phasesestimated,
title = {{Low PHASES-Estimated Rupture Risk Among Patients Presenting with Ruptured Intracranial Aneurysms: A Retrospective Single-Centre Observational Study}},
author = {Mateusz Krakowiak and Bartłomiej Kulesza and Cezary Grochowski and Barbara Maria Myszkowska and Damian Palus and Agnieszka Brzozowska and Paweł Sokal},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207793},
url = {https://www.mdpi.com/2077-0383/15/20/7793},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low PHASES-Estimated Rupture Risk Among Patients Presenting with Ruptured Intracranial Aneurysms: A Retrospective Single-Centre Observational Study
AU - Mateusz Krakowiak
AU - Bartłomiej Kulesza
AU - Cezary Grochowski
AU - Barbara Maria Myszkowska
AU - Damian Palus
AU - Agnieszka Brzozowska
AU - Paweł Sokal
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207793
UR - https://www.mdpi.com/2077-0383/15/20/7793
AB - Background/Objectives: The PHASES score is widely used to estimate the 5-year rupture risk of unruptured intracranial aneurysms, yet many patients present with aneurysmal subarachnoid haemorrhage despite low calculated risk. This study aimed to characterise the demographic and aneurysm-related profile of patients with ruptured aneurysms classified as low risk by PHASES. Methods: This retrospective single-centre observational study included 243 consecutive patients with radiologically confirmed ruptured intracranial aneurysms treated between 2013 and 2021. PHASES scores and estimated 5-year rupture risks were calculated retrospectively. Age, sex, arterial hypertension, aneurysm size, location, and multiplicity were analysed using non-parametric statistical methods. Results: The mean PHASES score was 5.16 ± 3.43 points. An estimated 5-year rupture risk below 1% was assigned to 125 patients (51.44%), and 54 patients (22.22%) had PHASES scores of 0–2. Ruptured aneurysms measuring ≤7 mm occurred in 147 patients (60.49%), and 210 patients (86.42%) were younger than 70 years. Internal carotid artery aneurysms were the most frequent overall, whereas anterior communicating artery aneurysms had the smallest median diameter while remaining among the most common rupture sites. Arterial hypertension was associated with larger aneurysm diameter. Conclusions: Low PHASES-estimated risks were common in this cohort of patients presenting with aneurysm rupture. Because the study included no comparison group with unruptured aneurysms, it cannot assess PHASES calibration or predictive performance. PHASES should therefore be used as a population-based decision-support tool rather than a stand-alone predictor of individual rupture risk, with morphology, imaging findings, documented growth, and patient-specific factors incorporated into clinical assessment.
SN - 2077-0383
ER -