• Vittorio Stumpo, Kristy Latour, Gianluca Trevisi, Iacopo Valente, Sonia D'Arrigo, Annunziato Mangiola, Alessandro Olivi, and Carmelo Lucio Sturiale.
• Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
• World Neurosurg. 2021 Mar 1; 147: e262-e271.

BackgroundDecisions to treat unruptured intracranial aneurysms remain challenging, as the risk of rupture needs to be balanced with risk of intervention. In 2015, the Unruptured Intracranial Aneurysm Treatment Score (UIATS) was introduced to assist physicians in the decision making process. As its reliability is still debated, we retrospectively applied UIATS to a multicenter cohort of aneurysmal subarachnoid hemorrhage patients to test its performance in suggesting treatment in patients with known natural history.MethodsDemographical, clinical, and radiological data of subarachnoid patients admitted in 2 referral cerebrovascular centers were collected. UIATS was individually calculated for each patient, and resulting recommendations were pooled in 3 groups (favor treatment, favor conservative management, unclear indication).ResultsOne-hundred and forty-six patients were included in this study. In the event of aneurysm discovery previous to their rupture, UIATS calculation revealed that 40 (27.4%) patients would have received an indication-to-treat advice (mean score: 4.58 ± 1.32), 46 (31.5%) would have been suggested a conservative management (mean score: -7.07 ± 4.15), and 60 (41.1%) would have been included in an unclear recommendation group (mean score: 0.07 ± 1.42). UIATS sensitivity ranged between 27% and 68% depending on the inclusion of patients with unclear indication within the conservative or intervention group.ConclusionsIn our study, UIATS would have failed to provide a clear recommendation to treat in up to 72.6% of patients whose aneurysm eventually ruptured. In agreement with previous reports, we provide additional evidence that some unruptured intracranial aneurysms may elude UIATS sensitivity. Further long-term prospective studies are necessary to assess UIATS reliability in real-world clinical practice.Copyright © 2020 Elsevier Inc. All rights reserved.

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