The Unruptured Intracranial Aneurysm Treatment Score (UIATS) serves as a decision-support tool in the management of unruptured intracranial aneurysms (UIAs). Developed through Delphi consensus methodology, which synthesizes expert opinions, the UIATS incorporates 29 critical factors spanning patient characteristics, aneurysm details, and treatment considerations.

Patient Considerations:

This aspect of the UIATS takes into account the patient's age, history of subarachnoid hemorrhage from another aneurysm, familial history, and ethnic background, among other variables. It also considers lifestyle factors such as smoking and hypertension, which can influence the risk profile.

Aneurysm Characteristics:

The UIATS evaluates the aneurysm itself, factoring in its maximum diameter, shape, location, and other morphological features that may signal a higher risk of rupture or complications.

Treatment Implications:

The UIATS helps balance the potential benefits of proactive aneurysm repair against the merits of a conservative approach. It integrates the patient's life expectancy and comorbid conditions to inform the decision-making process.

The scoring system produces two separate scores—one that indicates a potential benefit from repair and another favoring conservative management. These scores reflect the cumulative consideration of risk factors and treatment impact, guiding clinicians in evaluating the appropriate intervention strategy.

Interpreting UIATS:

For Repair: A higher score in the repair category suggests that proactive intervention may be beneficial, considering the balance of risks associated with the aneurysm and the patient's specific circumstances.

For Conservative Management: A higher score in this category leans toward managing the patient without immediate surgery, monitoring the aneurysm while considering the patient's broader health status and life expectancy.

Decision Threshold:

If the difference between the two scores is greater than three points, the higher score dictates the recommended approach.

A score difference of two points or less implies a more nuanced decision-making process, wherein a clear recommendation is less evident, and individualized patient factors and preferences take precedence.

Clinical Utility:

The UIATS model aids healthcare professionals by providing a structured framework to evaluate the myriad factors that influence management decisions for UIAs. By quantifying the elements of risk and juxtaposing them against each other, the UIATS offers a nuanced perspective that aligns with individual patient profiles and aneurysm characteristics. This enables clinicians to tailor their approach, ensuring that each decision is patient-centered and grounded in a comprehensive understanding of the clinical scenario.

Important note for consideration: 

The unruptured intracranial aneurysm treatment score (UIATS) was found to recommend overtreatment based on some practice patterns, in some studies. This prompts a cautious application of UIATS, advocating for a thorough review of each case against the score's recommendations.