Unruptured Intracranial Aneurysms — Risk of Rupture and Risks of Surgical Intervention

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

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Management of carotid artery stenosis in patients with coexistent unruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2018.9.jns182155 ◽

2020 ◽

Vol 132 (1) ◽

pp. 94-97 ◽

Cited By ~ 2

Author(s):

Tiziano Tallarita ◽

Thomas J. Sorenson ◽

Lorenzo Rinaldo ◽

Gustavo S. Oderich ◽

Thomas C. Bower ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Intracranial Aneurysms ◽

Early Period ◽

Aneurysm Rupture ◽

Artery Stenosis ◽

Consecutive Series ◽

Carotid Revascularization ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture

OBJECTIVEConcomitant unruptured intracranial aneurysms (UIAs) are present in patients with carotid artery stenosis not infrequently and result in unique management challenges. Thus, we investigated the risk of rupture of an aneurysm after revascularization of a carotid artery in a contemporary consecutive series of patients seen at our institution.METHODSData from patients who underwent a carotid revascularization in the presence of at least one concomitant UIA at our institution from 1991 to 2018 were retrospectively reviewed. Patients were evaluated for the incidence of aneurysm rupture within 30 days (early period) and after 30 days (late period) of carotid revascularization, as well as for the incidence of periprocedural complications from the treatment of carotid stenosis and/or UIA.RESULTSOur study included 53 patients with 63 concomitant UIAs. There was no rupture within 30 days of carotid revascularization. The overall risk of rupture was 0.87% per patient-year. Treatment (coiling or clipping) of a concomitant UIA, if pursued, could be performed successfully after carotid revascularization.CONCLUSIONSCarotid artery revascularization in the setting of a concomitant UIA can be performed safely without an increased 30-day or late-term risk of rupture. If indicated, treatment of the UIA can take place after the patient recovers from the carotid procedure.

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Risk of Rupture of Unruptured Intracranial Aneurysms in Relation to Patient and Aneurysm Characteristics

Stroke ◽

10.1161/01.str.0000260955.51401.cd ◽

2007 ◽

Vol 38 (4) ◽

pp. 1404-1410 ◽

Cited By ~ 370

Author(s):

Marieke J.H. Wermer ◽

Irene C. van der Schaaf ◽

Ale Algra ◽

Gabriël J.E. Rinkel

Keyword(s):

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture

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Unruptured intracranial aneurysms: natural history and management decisions

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.5.6 ◽

2004 ◽

Vol 17 (5) ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Leodante B. da Costa ◽

Thorsteinn Gunnarsson ◽

M. Christopher Wallace

Keyword(s):

Neurological Deficit ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

International Study ◽

Special Importance ◽

Surgical Morbidity ◽

Mortality And Morbidity ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture

Aneurysmal subarachnoid hemorrhage (SAH) carries a grim prognosis, with high mortality and morbidity rates. The mortality rate in the first 30 days postrupture is estimated to be in the range of 40 to 50%, and almost half of the survivors will be left with a neurological deficit. Unlike patients with aneurysmal SAH, those with unruptured intracranial aneurysms usually experience no neurological deficit, and their treatment is prophylactic, aiming to reduce the risk of future bleeding and its consequences. The risk of rupture therefore assumes special importance when making decisions regarding which patient or aneurysm to treat. In previous reports the risk of bleeding for unruptured aneurysms has been stated as approximately 2% per year. The retrospective part of the International Study of Unruptured Intracranial Aneurysms (ISUIA) reported very low annual bleeding rates (0.05–1%) and high surgical morbidity and mortality rates (8–18%), prompting discussion in which the benefits of prophylactic treatment in the majority of these lesions were questioned. Prospective data from the second part of the ISUIA recently included rupture rates ranging from 0 to 10% per year. The aim of this paper was to review the evidence that is currently available for neurosurgeons to use when making decisions regarding patients who would benefit from treatment of an unruptured intracranial aneurysm.

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Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns-07/12/1086 ◽

2007 ◽

Vol 107 (6) ◽

pp. 1086-1091 ◽

Cited By ~ 15

Author(s):

Shigeo Yamashiro ◽

Toru Nishi ◽

Kazunari Koga ◽

Tomoaki Goto ◽

Daisuke Muta ◽

...

Keyword(s):

Quality Of Life ◽

Intracranial Aneurysms ◽

Short Form ◽

Reference Population ◽

Anxiety And Depression ◽

Unruptured Intracranial Aneurysms ◽

Number Of Patients ◽

Sf 36 ◽

Risk Of Rupture

Object The aim of this study was to assess the quality of life (QOL) of patients who underwent surgery for asymptomatic unruptured intracranial aneurysms (UIAs). Methods The authors assessed QOL in 149 patients who had undergone microsurgical clipping of asymptomatic UIAs. They surveyed these patients using universal methods such as the 36-Item Short Form Health Survey (SF-36) for health-related QOL and the Hospital Anxiety and Depression Scale for anxiety and depression assessments. Results The patients' mean scores for each of the eight domains of SF-36 were comparable to those of a Japanese reference population. Analysis of data from the average-QOL and low-QOL subgroups showed that the low-QOL group contained a higher number of patients with preexisting heart diseases and restricted activities of daily living. Operative procedures and complications did not affect QOL. Conclusions Because 86% of the patients who underwent surgery manifested a QOL similar to the reference population, the authors suggest that elective surgery for asymptomatic UIAs is a reasonable treatment, especially in patients who are troubled by the risk of rupture. Postoperative decreases in QOL are not invariably attributable to the operation or its associated complications, but may be correlated with other chronic disorders. To select the appropriate treatment for asymptomatic UIAs, neurosurgeons and patients need information on the expected postoperative QOL.

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Intracranial Aneurysms: Does Size Really Matter?

Neurosurgery Open ◽

10.1093/neuopn/okaa015 ◽

2020 ◽

Vol 1 (4) ◽

Author(s):

Kashif Majeed ◽

Srikanth R Boddu ◽

Joseph Carnevale ◽

Elif Ezgi Cenberlitas ◽

Nicholas Williams ◽

...

Keyword(s):

Intracranial Aneurysms ◽

International Study ◽

Surgical Clipping ◽

Aneurysmal Rupture ◽

Ruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture ◽

Brainstem Stroke ◽

Size Groups ◽

The Mean

Abstract BACKGROUND To stratify the risk of aneurysmal rupture, size remains the primary criterion as proposed by 2 ISUIA (International Study of Unruptured Intracranial Aneurysms) trials that recommend the observation of ≤7 mm aneurysms because of their low propensity to rupture. These recommendations are controversial, given the severe outcomes following hemorrhage. OBJECTIVE To retrospectively assess whether size correlates with aneurysmal rupture, and to analyze outcomes of endovascular and microsurgical procedures. METHODS All aneurysms presenting between 2016 and 2019 were reviewed. Age, gender, comorbidities, ruptured status, modes of treatment, and their outcomes were noted. Regression analysis was performed to correlate size with rupture. The type of intervention was based on clinical and aneurysmal characteristics and the likelihood of obliteration. RESULTS Of the 668 aneurysms, 116 had ruptured. In size groups 0 to 6 mm, 7 to 12 mm, 13 to 18 mm, 18 to 24 mm, and giant, the ruptured aneurysms were 60.3%, 30.2%, 1.7%, 0.9%, and 6.9%, respectively. The majority (423) were managed endovascularly, of which 84 (19.9%) were ruptured. A total of 97 (14.5%) underwent clipping, of which 31 were ruptured. The mean modified Rankin Scale for both treated groups was zero. One death in each group and a single brainstem stroke in the coiled group were noted. A total of 139 were followed, of which none had ruptured. The mean modified Raymond-Roy classification for endovascular therapy was 1.1, with 380 completely occluded; 15 had a score of 2, and 28 of score 3. CONCLUSION The ruptured aneurysms were mostly smaller than reported previously. Surgical clipping was at equipoise with endovascular treatments. Further studies to correlate aneurysmal characteristics to the risk of rupture are needed.

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Rupture immediately after growth of unruptured intracranial aneurysms during follow-up

Surgical Neurology International ◽

10.25259/sni_262_2019 ◽

2019 ◽

Vol 10 ◽

pp. 164

Author(s):

Taro Yanagawa ◽

Yoichi Harada ◽

Toru Hatayama ◽

Takuji Kono

Keyword(s):

Intracranial Aneurysms ◽

Internal Carotid ◽

Artery Aneurysm ◽

Resonance Imaging ◽

Middle Cerebral Artery Aneurysm ◽

Ruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture ◽

Cerebral Artery Aneurysm

Background: The annual rupture rate of small unruptured intracranial aneurysms (UIAs) <5 mm is generally low; further, small UIAs are often treated conservatively. While the growth of aneurysms during follow-up is associated with a high risk of rupture, the urgency for surgical treatment of asymptomatic enlarged UIAs remains controversial. We experienced two patients in whom UIAs ruptured shortly after asymptomatic growth during follow-up. Case Description: A 1-mm right middle cerebral artery aneurysm was incidentally found in a 63-year-old woman. Preventive surgery was planned because the aneurysm grew rapidly; however, the aneurysm ruptured preoperatively. A 68-year-old woman had a small (4 mm) aneurysm at the left internal carotid-posterior communicating artery. The aneurysm grew rapidly after many years. Several hours after magnetic resonance imaging was performed, she presented to the hospital with loss of consciousness, and a diagnosis of subarachnoid hemorrhage due to the ruptured aneurysm was made. Conclusion: UIAs that rapidly increase during follow-up may be regarded as impending ruptured aneurysms.

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