Screening for Unruptured Familial Intracranial Aneurysms: Subarachnoid Hemorrhage 2 Years after Angiography Negative for Aneurysms

Abstract The screening of asymptomatic individuals in families with intracranial aneurysms has been advocated to detect unruptured aneurysms before a major hemorrhage occurs. We report a 39-year-old male member of a large Dutch family, with a documented history of intracranial aneurysms, who suffered a subarachnoid hemorrhage 2 years after cerebral digital subtraction angiography using intravenously administered contrast medium showed no abnormalities. Conventional arteriography demonstrated three intracranial aneurysms measuring 3 × 3 mm. Potential alternative screening procedures are discussed.

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Polycystic kidney disease and intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1983.58.4.0488 ◽

1983 ◽

Vol 58 (4) ◽

pp. 488-491 ◽

Cited By ~ 76

Author(s):

Toshimitsu Wakabayashi ◽

Shigekiyo Fujita ◽

Yoshiro Ohbora ◽

Tohru Suyama ◽

Norihiko Tamaki ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Kidney Disease ◽

Early Diagnosis ◽

Polycystic Kidney Disease ◽

Intracranial Aneurysms ◽

Polycystic Kidney ◽

Content Type ◽

Unruptured Aneurysms ◽

History Of ◽

Fine Print

✓ From August, 1981, to August, 1982, the authors performed four-vessel angiography in 17 patients with polycystic kidney disease (PKD) who had no neurological deficit and no history of subarachnoid hemorrhage. Seven cases of unruptured aneurysms were found among these 17 patients (an incidence of 41.2%). Five of the unruptured aneurysms were operated on prophylactically, with no mortality or morbidity. Nine of the 17 patients had hypertension and, of these, two (22.2%) had aneurysms. Of the eight patients without hypertension, five (62.5%) had aneurysms. This study suggests that the coexistence of PKD and intracranial aneurysms might not be due to the hypertension that occurs concomitant with PKD, but instead may be attributable to congenital factors. The authors stress the necessity of early diagnosis and early operation for unruptured aneurysms in patients with PKD.

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Risk Profile of Intracranial Aneurysms

Stroke ◽

10.1161/strokeaha.111.625871 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3376-3381 ◽

Cited By ~ 36

Author(s):

Koji Sato ◽

Yuhei Yoshimoto

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Healing Process ◽

Age Distribution ◽

Unruptured Aneurysms ◽

Portal Site ◽

Rupture Rate ◽

Unruptured Intracranial Aneurysms ◽

Short Period ◽

History Of

Background and Purpose— Management of asymptomatic unruptured intracranial aneurysms remains controversial, and recent prospective follow-up studies showed that the rupture rate of small aneurysms is very low. These results are inconsistent with the finding that the majority of ruptured aneurysms in patients with subarachnoid hemorrhage are small. Methods— A Markov model was constructed to simulate the natural history of intracranial aneurysms. All epidemiological and statistical data obtained from the Portal Site of Official Statistics of Japan (e-Stat) were adjusted to the standardized age distribution. From the selected data of aneurysm formation, the prevalence of unruptured aneurysms was estimated as 1.45% and the incidence of subarachnoid hemorrhage calculated to be 19.7/100 000/year in the whole standardized population. Results— The function for rupture rate constant with time was first analyzed. Selected values for annual rupture rates of 0.3%, 0.5%, 0.7%, and 1.0% showed inconsistencies in the relationship between the prevalence of unruptured aneurysm and the incidence of subarachnoid hemorrhage. Next, the function for a short period of high risk followed by a long period of low risk was considered. Annual rupture rates of 0.5%, 0.7%, and 1.0% indicated epidemiological compatibility with additional early rupture rates of 20%, 15%, and 10%, respectively. Conclusions— This study suggests that some aneurysms bleed shortly after formation and thus are rarely detected as unruptured aneurysms. Most aneurysms without early rupture remain stable for the remainder of life through some healing process, and prophylactic treatment for incidentally identified small unruptured aneurysms has no rationale.

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Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm9092808 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2808

Author(s):

Wojciech Poncyljusz ◽

Kinga Kubiak ◽

Leszek Sagan ◽

Bartosz Limanówka ◽

Katarzyna Kołaczyk

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Clinical Results ◽

Class I ◽

Unruptured Aneurysms ◽

Patient Demographics ◽

Stent Deformation ◽

Unruptured Intracranial Aneurysms ◽

Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

Interventional Neuroradiology ◽

10.1177/1591019920959534 ◽

2020 ◽

pp. 159101992095953

Author(s):

Dylan Noblett ◽

Lotfi Hacein-Bey ◽

Ben Waldau ◽

Jordan Ziegler ◽

Brian Dahlin ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Significant Risk ◽

Retrospective Chart Review ◽

Anterior Circulation ◽

Unruptured Aneurysms ◽

Methamphetamine Use ◽

Aneurysm Size ◽

Unruptured Intracranial Aneurysms ◽

History Of

Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

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Small (< 10-mm) incidentally found intracranial aneurysms, Part 1: reasons for detection, demographics, location, and risk factors in 212 consecutive patients

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11234 ◽

2011 ◽

Vol 31 (6) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Ioannis Loumiotis ◽

Anne Wagenbach ◽

Robert D. Brown ◽

Giuseppe Lanzino

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Imaging Techniques ◽

Imaging Study ◽

Consecutive Series ◽

Common Location ◽

Unruptured Intracranial Aneurysms ◽

Paraclinoid Aneurysms ◽

History Of

Object The widespread use of imaging techniques for evaluating nonspecific symptoms (vertigo, dizziness, memory concerns, unsteadiness, and the like) and focal neurological symptoms related to cerebrovascular disease has led to increased identification of asymptomatic incidentally discovered unruptured intracranial aneurysms (UIAs). The management of these incidental aneurysms is controversial and many factors need to be considered. The authors describe reasons leading to diagnosis, demographics, and risk factors in a large consecutive series of patients with small incidentally found UIAs. Methods The authors prospectively evaluated 335 patients harboring 478 small (< 10-mm) UIAs between January 2008 and May 2011. Patients with known aneurysms, possibly symptomatic aneurysms, arteriovenous malformation–related aneurysms, patients with a history of subarachnoid hemorrhage from another aneurysm, and patients harboring extradural aneurysms were excluded from the analysis. Only truly incidental small aneurysms (272 aneurysms in 212 patients) were considered for the present analysis. Data regarding the reason for detection, demographics, location, and presence of potential risk factors for aneurysm formation were prospectively collected. Results There were 158 female (74.5%) and 54 male (25.5%) patients whose mean age was 60.6 years (median 62 years). The most common reason for undergoing the imaging study that led to a diagnosis of the aneurysms was evaluation for nonspecific spells and symptoms related to focal cerebrovascular ischemia (43.4%), known/possible intracranial or neck pathology (24%), and headache (16%). The most common location (27%) of the aneurysm was the middle cerebral artery; the second most common (22%) was the paraclinoid internal carotid artery (excluding cavernous sinus aneurysms). Sixty-nine percent of patients were current or prior smokers, 60% had a diagnosis of hypertension, and 23% had one or more relatives with a history of intracranial aneurysms with or without subarachnoid hemorrhage. Conclusions Small incidental UIAs are more commonly diagnosed in elderly individuals during imaging performed to investigate ill-defined spells or focal cerebrovascular ischemic symptoms, or during the evaluation of known or probable unrelated intracranial/neck pathology. Hypertension, smoking, and family history of aneurysms are common in this patient population, and the presence of these risk factors has important implications for treatment recommendations. Although paraclinoid aneurysms (excluding intracavernous aneurysms) are uncommon in patients with ruptured intracranial aneurysms, this location is very common in patients with small incidental UIAs.

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Embolization of Non-Ruptured Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199990050s117 ◽

1999 ◽

Vol 5 (1_suppl) ◽

pp. 93-96 ◽

Cited By ~ 1

Author(s):

C.F. Dowd ◽

C.C. Phatouros ◽

A.M. Malek ◽

T.E. Lempert ◽

P.M. Meyers ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Three Dimensional ◽

Giant Aneurysm ◽

Epidemiological Data ◽

Anterior Circulation ◽

Unruptured Aneurysms ◽

Aneurysm Neck ◽

Technical Developments ◽

History Of ◽

Anterior Circulation Aneurysms

Options for treatment of intracranial aneurysms have expanded with the advent of the Guglielmi Detachable Cod (GDC) eight years ago. We have reviewed 435 cases of intracranial aneurysms treated at UCSF by endovascular means using the GDC system. Of these, 55% represent anterior circulation aneurysms, and 45% are located in the posterior circulation. Additionally, 55% of the aneurysms presented with subarachnoid hemorrhage (SAH) and 45% were unruptured. Factors which hindered optimal coiling include the following: wide aneurysm neck in relation to the overall aneurysm size, mural thrombus, giant aneurysm, arteries originating from the aneurysm sac, and middle cerebral location. After initial experience was gained, we tended to avoid these aneurysms especially in the non-ruptured group. This may be especially important in light of new epidemiological data suggesting that the natural history of unruptured aneurysms is significantly lower than previously thought. New technical developments which may reduce the risk of treating unruptured aneurysms include the two-dimensional coil, the three-dimensional coil, the balloon-assist technique for wide-necked aneurysms, and combined stent-coil procedures.

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Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture

Journal of Neurosurgery ◽

10.3171/jns/2008/108/5/1052 ◽

2008 ◽

Vol 108 (5) ◽

pp. 1052-1060 ◽

Cited By ~ 105

Author(s):

Seppo Juvela ◽

Matti Porras ◽

Kristiina Poussa

Keyword(s):

Risk Factors ◽

Intracranial Aneurysms ◽

Smoking Status ◽

Significant Risk ◽

Significant Risk Factor ◽

Aneurysm Rupture ◽

Unruptured Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

History Of

Object The authors conducted a study to investigate the long-term natural history of unruptured intracranial aneurysms and the predictive risk factors determining subsequent rupture in a patient population in which surgical selection of cases was not performed. Methods One hundred forty-two patients with 181 unruptured aneurysms were followed from the 1950s until death or the occurrence of subarachnoid hemorrhage or until the years 1997 to 1998. The annual and cumulative incidence of aneurysm rupture as well as several potential risk factors predictive of rupture were studied using life-table analyses and Cox's proportional hazards regression models including time-dependent covariates. The median follow-up time was 19.7 years (range 0.8–38.9 years). During 2575 person-years of follow up, there were 33 first-time episodes of hemorrhage from previously unruptured aneurysms, for an average annual incidence of 1.3%. In 17 patients, hemorrhage led to death. The cumulative rate of bleeding was 10.5% at 10 years, 23% at 20 years, and 30.3% at 30 years after diagnosis. The diameter of the unruptured aneurysm (relative risk [RR] 1.11 per mm in diameter, 95% confidence interval [CI] 1–1.23, p = 0.05) and patient age at diagnosis inversely (RR 0.97 per year, 95% CI 0.93–1, p = 0.05) were significant independent predictors for a subsequent aneurysm rupture after adjustment for sex, hypertension, and aneurysm group. Active smoking status at the time of diagnosis was a significant risk factor for aneurysm rupture (RR 1.46, 95% CI 1.04–2.06, p = 0.033) after adjustment for size of the aneurysm, patient age, sex, presence of hypertension, and aneurysm group. Active smoking status as a time-dependent covariate was an even more significant risk factor for aneurysm rupture (adjusted RR 3.04, 95% CI 1.21–7.66, p = 0.02). Conclusions Cigarette smoking, size of the unruptured intracranial aneurysm, and age, inversely, are important factors determining risk for subsequent aneurysm rupture. The authors conclude that such unruptured aneurysms should be surgically treated regardless of their size and of a patient's smoking status, especially in young and middle-aged adults, if this is technically possible and if the patient's concurrent diseases are not contraindications. Cessation of smoking may also be a good alternative to surgery in older patients with small-sized aneurysms.

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Analysis of intracranial aneurysms treated at a University Hospital in Curitiba

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1625660 ◽

2012 ◽

Vol 31 (02) ◽

pp. 55-60

Author(s):

Johnni Oswaldo Zamponi Junior ◽

Paulo Eduardo Carneiro da Silva ◽

Guilherme Zandavalli Ramos ◽

Guilherme Mailio Buchaim ◽

Lucas Cunha de Andrade ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Treatment Outcome ◽

Subarachnoid Hemorrhage ◽

Hospital Admission ◽

Intracranial Aneurysms ◽

Smoking Habit ◽

University Hospital ◽

Anterior Circulation ◽

History Of

Abstract Objective: The aim of this paper is analyze the population and the types of intracranial aneurysms treated in the neurosurgery service of the Hospital Universitário Evangélico of Curitiba (HUEC), checking possible relations of this pathology with some risk factors and analyzing also the result of the treatment of this patients. Method: We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 2006 to December 2010, composing a sample of 93 patients. The variables analyzed were gender, age, history of hypertension, smoking habit, diabetes mellitus, site of aneurysm, score scales Hunt-Hess and Fisher at hospital admission and treatment outcome of aneurysms using the Glasgow Outcome Scale (GOS). Results: The patients studied were predominantly women (73%), ranging in age from 51 to 60 years (38%), with a history of hypertension (61%). At admission, the grade 1 in a Hunt-Hess scale was most frequent (31%), while grade 4 on a scale of Fisher was more prevalent (26%). Aneurysms were more frequent in the anterior circulation, mainly affecting the middle cerebral artery. The most frequent score in GOS was 5 (40%). Conclusion: Subarachnoid hemorrhage is an event that may worsen the outcome of treatment of patients with intracranial aneurysms, so there is a correlation between the amount of bleeding identified on CT and prognostic evolution.

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Risk Factors for Growth of Unruptured Intracranial Aneurysms: Follow-up Study by Serial 0.5–T Magnetic Resonance Angiography

Neurosurgery ◽

10.1227/01.neu.0000217366.02567.d2 ◽

2006 ◽

Vol 58 (6) ◽

pp. 1047-1053 ◽

Cited By ~ 55

Author(s):

Nobuhiko Miyazawa ◽

Iwao Akiyama ◽

Zentaro Yamagata

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Family History ◽

Unruptured Aneurysms ◽

Logistic Analysis ◽

Aneurysm Size ◽

History Of ◽

Aneurysm Growth ◽

Independent Risk Factors

Abstract OBJECTIVE: The independent risk factors for aneurysm growth were retrospectively investigated in 130 patients with unruptured aneurysms who were followed up by 0.5–T serial magnetic resonance angiography with stereoscopic images. METHODS: Age, sex, site of aneurysm, size of aneurysm, multiplicity of aneurysms, type of circle of Willis, length of follow-up period, cerebrovascular event, hypertension, diabetes, hyperlipidemia, smoking habit, and family history of subarachnoid hemorrhage were investigated using multiple logistic analysis. RESULTS: Fourteen patients (16 aneurysms) among the 130 patients (159 aneurysms) showed aneurysm growth (10.8%) during follow-up of 10 to 69 months (mean 29.3 ± 10.5 mo). Multiple logistic analysis disclosed that location on the middle cerebral artery (odds ratio [OR] 0.08, P < 0.01), multiplicity of aneurysms (OR 68.5, P < 0.01), aneurysm size of 5 mm or larger (OR 1.17, P = 0.05), and family history of subarachnoid hemorrhage (OR 10.9, P < 0.01) were independent risk factors. CONCLUSION: Location on the middle cerebral artery, multiplicity, aneurysm size of 5 mm or larger, and family history of subarachnoid hemorrhage are independent risk factors for aneurysm growth. These results may help to determine the treatment choice for unruptured aneurysms.

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Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽

10.1227/01.neu.0000185583.25420.df ◽

2005 ◽

Vol 57 (6) ◽

pp. 1096-1102 ◽

Cited By ~ 71

Author(s):

YiLing Cai ◽

Laurent Spelle ◽

Huan Wang ◽

Michel Piotin ◽

Charbel Mounayer ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Endovascular Procedures ◽

The Elderly ◽

High Grade ◽

Single Center ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

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