Comprehensive evaluation of cerebral aneurysm instability biomarkers in a large-scale longitudinal Chinese cohort

Intracranial aneurysms (IAs) have an incidence rate of 3%-7% in the general population. While IA rupture rates based on natural history studies are very low (<1% per year), rupture is associated with poor outcomes. With increased utilization of non-invasive imaging including computed tomography angiography (CTA) and magnetic resonance angioplasty (MRA), and recent advancement of computer-aided automatic detection of IAs with advanced artificial intelligence in recent years, there is increasing detection of IAs. However, the assessment of aneurysm instability still faces great challenges, and is an active area of research. Many large cohort studies have compared ruptured and unruptured aneurysms, yet the follow-up data is still lacking and does not strictly predict the biological behavior of aneurysms [1]. PHASES score was proposed from six prospective longitudinal cohorts to predict the risk of IA rupture, but the proposed scoring system was based on empirical targets and not scientifically exhaustive, and it has been reported to be of limited use in multiple real-world studies [2].