scholarly journals The International Study on Unruptured Intracranial Aneurysms (ISUIA)

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. NA-NA ◽  
Author(s):  
ROBERT E. HARBAUGH
Keyword(s):  
Intracranial Aneurysms ◽  
International Study ◽  
Unruptured Intracranial Aneurysms

scholarly journals Unruptured intracranial aneurysms: natural history and management decisions

2004 ◽  
Vol 17 (5) ◽  
pp. 1-6 ◽  
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.

scholarly journals Unruptured Intracranial Aneurysms

2007 ◽  
Vol 13 (3) ◽  
pp. 225-237 ◽  
Author(s):  
J. Raymond ◽  
T. Nguyen ◽  
M. Chagnon ◽  
G. Gevry ◽  
Keyword(s):  
Randomized Trial ◽  
Intracranial Aneurysms ◽  
International Study ◽  
Preventive Treatment ◽  
Clinical Practices ◽  
Unruptured Aneurysms ◽  
Expert Opinions ◽  
Unruptured Intracranial Aneurysms ◽  
Objective Evidence ◽  
Treatment Risks

In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms. We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'Isère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm. Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year. The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis of a recently initiated randomized trial on unruptured aneurysms (TEAM), which is a benefit of endovascular treatment of 4% compared to observation over ten years. Only data from a randomized trial could provide convincing objective evidence in favour or against preventive treatment of unruptured intracranial aneurysms.

scholarly journals Intracranial Aneurysms: Does Size Really Matter?

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.

scholarly journals Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location

2012 ◽  
Vol 117 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Jason Mackey ◽  
Robert D. Brown ◽  
Charles J. Moomaw ◽  
Laura Sauerbeck ◽  
Richard Hornung ◽  
...  
Keyword(s):  
Family History ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Demographic Data ◽  
Positive Family History ◽  
International Study ◽  
Study Cohort ◽  
Familial Predisposition ◽  
Unruptured Intracranial Aneurysms ◽  
Patient Demographic Data

Object Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their characteristics with a large cohort of nonfamilial IAs. Methods The Familial Intracranial Aneurysm (FIA) study is a multicenter international study with the goal of identifying genetic and other risk factors for formation and rupture of IAs in a highly enriched population. The authors compared the FIA study cohort with the International Study of Unruptured Intracranial Aneurysms (ISUIA) cohort with regard to patient demographic data, IA location, and IA multiplicity. To improve comparability, all patients in the ISUIA who had a family history of IAs or subarachnoid hemorrhage were excluded, as well as all patients in both cohorts who had a ruptured IA prior to study entry. Results Of 983 patients enrolled in the FIA study with definite or probable IAs, 511 met the inclusion criteria for this analysis. Of the 4059 patients in the ISUIA study, 983 had a previous IA rupture and 657 of the remainder had a positive family history, leaving 2419 individuals in the analysis. Multiplicity was more common in the FIA patients (35.6% vs 27.9%, p < 0.001). The FIA patients had a higher proportion of IAs located in the middle cerebral artery (28.6% vs 24.9%), whereas ISUIA patients had a higher proportion of posterior communicating artery IAs (13.7% vs 8.2%, p = 0.016). Conclusions Heritable structural vulnerability may account for differences in IA multiplicity and location. Important investigations into the underlying genetic mechanisms of IA formation are ongoing.

Unruptured Intracranial Aneurysms and Multiple Aneurysms

2002 ◽  
Vol 15 (5) ◽  
pp. 589-596
Author(s):  
M. Fontanella ◽  
D. Garbossa ◽  
V. Luparello
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Treatment Options ◽  
Clinical Status ◽  
International Study ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Risk Of Treatment

Surgery on unruptured intracranial aneurysms (UIAs) could be a good strategy for prevention of haemorrhage, but management decisions require an accurate assessment of the risks of various treatment options, compared with the natural history of subarachnoid haemorrhage (SAH). The International Study for Unruptured Aneurysms (ISUIA) showed that the natural history is different for patients with UIAs who have not experienced SAH, than it is for patients with a history of prior SAH due to a separate aneurysm, in whom the risk is increased. The size of the UIAs is the best predictor of future rupture and the site can also be. The role of elective neuroradiological screening is the subject of discussion. In fact, the possibility of treatment should be considered on the basis of the patient's age and clinical status. Factors that favour surgery include a young patient with a long life expectancy, previously ruptured aneurysms, a familiarity, large and symptomatic aneurysms and low risk of treatment. The role of endovascular treatment is also discussed.

scholarly journals The natural history of unruptured intracranial aneurysms

2004 ◽  
Vol 17 (5) ◽  
pp. 1-5 ◽  
Author(s):  
J Mocco ◽  
Ricardo J. Komotar ◽  
Sean D. Lavine ◽  
Philip M. Meyers ◽  
E. Sander Connolly ◽  
...  
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
International Study ◽  
General Rule ◽  
Unruptured Intracranial Aneurysm ◽  
Risk Of Bleeding ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
History Of

Since the publication of preliminary results from the International Study of Unruptured Intracranial Aneurysms in 1998 there has been a great deal of debate concerning the natural history of these lesions and their attendant risk of aneurysmal subarachnoid hemorrhage. Therefore, the authors reviewed a selected number of crucial studies concerning this topic to determine the best evidence-based estimate of a rupture rate for these lesions. Based on this analysis, the yearly risk of bleeding for an unruptured intracranial aneurysm is estimated to be approximately 1% for aneurysms 7 to 10 mm in diameter. This risk of rupture increases with aneurysm size and it likewise diminishes as the size of the lesion decreases. This general rule serves as a reasonable interpretation of the results reported in the current body of literature.

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