{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:10:30Z","timestamp":1791861030735,"version":"4.3.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose:<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We pooled individual patient data from 9 cohorts totaling 9940 patients (6555 women, 66%) with 12\u2009193 unruptured intracranial aneurysms, and 24\u2009357 person-years follow-up. Rupture occurred in 163 women (rupture rate 1.04%\/person-years [95% CI, 0.89\u20131.21]) and 63 men (rupture rate 0.74%\/person-years [95% CI, 0.58\u20130.94]). 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 (\u22657 mm, 24% versus 23%) than men. The unadjusted women-to-men hazard ratio was 1.43 (95% CI, 1.07\u20131.93) and the adjusted women\/men ratio was 1.39 (95% CI, 1.02\u20131.90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Women 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.121.035187","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T05:00:27Z","timestamp":1641358827000},"page":"362-369","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":78,"title":["Sex Difference and Rupture Rate of Intracranial Aneurysms: An Individual Patient Data Meta-Analysis"],"prefix":"10.1161","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4812-434X","authenticated-orcid":true,"given":"Charlotte C.M.","family":"Zuurbier","sequence":"first","affiliation":[{"name":"UMC 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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6621-2028","authenticated-orcid":true,"given":"Rob","family":"Molenberg","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liselore A.","family":"Mensing","sequence":"additional","affiliation":[{"name":"UMC 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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-9521","authenticated-orcid":true,"given":"Marieke J.H.","family":"Wermer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-4983","authenticated-orcid":true,"given":"Seppo","family":"Juvela","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Helsinki, Finland (S.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1264-7667","authenticated-orcid":true,"given":"Antti E.","family":"Lindgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Neurosurgery of NeuroCenter (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juha E.","family":"J\u00e4\u00e4skel\u00e4inen","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Neurosurgery of NeuroCenter (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Koivisto","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Neurosurgery of NeuroCenter (A.E.L, J.E.J., T.K.), Kuopio University Hospital, Finland."},{"name":"Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio (A.E.L, J.E.J., T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomosato","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Hospital Organization, Mito Medical Center, Japan (T.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6934-4456","authenticated-orcid":true,"given":"Maarten","family":"Uyttenboogaart","sequence":"additional","affiliation":[{"name":"Neurology and Medical Imaging Center (M.U.), University Medical Center Groningen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-5680","authenticated-orcid":true,"given":"J. Marc C.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlien W.","family":"Aalbers","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery (R.M., J.M.C.v.D., M.W.A.), University Medical Center Groningen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2497-5772","authenticated-orcid":true,"given":"Akio","family":"Morita","sequence":"additional","affiliation":[{"name":"Medical Center UCAS Japan Coordinating Office- University of Tokyo- Nippon Medical School, Neurological Surgery (A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinjiro","family":"Tominari","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, School of Public Health, Kyoto University, 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