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.

Natural history of unruptured intracranial aneurysms

2004 ◽  
Vol 17 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Robert D. Ecker ◽  
L. Nelson Hopkins
Keyword(s):  
Natural History ◽  
Aspect Ratio ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
International Study ◽  
Prospective Data ◽  
Initial Decision ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Benign Course

Since the publication of the retrospective part of the International Study of Unruptured Intracranial Aneurysms (ISUIA) in 1998, there has been a significant focus in the neurosurgical literature on the natural history of these lesions. The prospective data from the second part of the ISUIA, which was published in 2003, provided further evidence that small, asymptomatic intracranial aneurysms may have a more benign course than previously believed. With the data from the ISUIA as a reference point, in this paper the authors strive to provide a source of practical clinical data to aid cerebrovascular physicians in the initial decision to treat or observe a patient with a small, asymptomatic intracranial aneurysm. The issues covered will include previous rupture, symptoms other than rupture, aneurysm size, site, and aspect ratio. It is the authors' goal to provide a useful practical framework on the relevant clinical issues as an aid to practitioners treating patients who present with intracranial aneurysms.

scholarly journals Markers of disease severity and positive family history are associated to significant risk perception in rheumatoid arthritis, while compliance with therapy is not: a cross-sectional study in 415 Mexican outpatients

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Irazú Contreras-Yáñez ◽  
Pilar Lavielle ◽  
Patricia Clark ◽  
Virginia Pascual-Ramos
Keyword(s):  
Rheumatoid Arthritis ◽  
Regression Analysis ◽  
Risk Perception ◽  
Family History ◽  
Disease Activity ◽  
Short Form ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Positive Family History ◽  
Significant Risk

Abstract Background Assessing risk perception (RP) helps explain how rheumatoid arthritis (RA) patients integrate their ideas concerning the disease and how this understanding affects their self-care management. Compliance with treatment impacts disease-related outcomes and could be associated with RP to variable degrees and at different levels. The primary objective was to determine a potential association between RP and compliance with therapy in RA outpatients and to identify additional factors. The secondary objective was to identify factors associated with judgment bias such as unrealistic RP. Patients and methods Between January 2018 and June 2019, 450 consecutive outpatients who received RA-related treatment were invited to a face-to-face interview to obtain socio-demographic data, RA-related information, comorbidities, and the following outcomes: adherence, persistence, and concordance with medications assessed with a questionnaire locally designed; RP with the RP questionnaire (RPQ); disease activity with the Routine Assessment of Patient Index Data-3 (RAPID-3); disability with the Health Assessment Questionnaire Disability Index (HAQ-DI); quality of life with Medical Outcomes Study Short Form-36 (SF-36) instrument; pain and overall disease with the respective visual analogue scale (VAS); and health literacy assessed with 3 questions. Significant RP was defined according to a cut-off based on the 75th percentile value of the sample in which the RPQ was validated. Unrealistic RP was defined based on the coincidence of the presence/absence of significant RP and less/more than 7 unfavorable medical criteria. Multiple logistic regression analysis was used. Patients provided written informed consent and the study received Internal Review Board approval. Results There were 415 patients included, primarily middle-aged women with long-standing disease and moderate disease activity. Almost half of the patients were receiving corticosteroids and 15.9% intensive RA-related treatment. There were 44.1% of the patients concordant with treatment and 22.6% had significant RP. The patients’ treatment behavior was not retained in the regression analysis; meanwhile, rheumatoid nodes, surgical joint replacement, family history of RA, and higher RAPID-3 score were associated with significant RP. There were 56 patients with unrealistic RP; significant RP and more unfavorable medical criteria were associated with unrealistic RP. Conclusions Compliance with therapy was not associated with significant RP in RA outpatients.

Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms

1995 ◽  
Vol 83 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Nancy A. Obuchowski ◽  
Michael T. Modic ◽  
Michele Magdinec
Keyword(s):  
Family History ◽  
Natural History ◽  
Life Expectancy ◽  
Intracranial Aneurysms ◽  
Positive Family History ◽  
Aneurysm Rupture ◽  
Average Life Expectancy ◽  
Content Type ◽  
Rupture Rate ◽  
History Of

✓ Although the technology exists for accurate noninvasive screening for intracranial aneurysms, the efficacy of screening depends on several key parameters of the natural history of aneurysms. Recent studies suggest that the prevalence of intracranial aneurysms may reach 20% in the subpopulation of patients with a family history of these lesions; other key parameters are less certain. The authors investigated factors that impact the efficacy of screening to establish interim guidelines. Three plausible models for the natural history of aneurysms were constructed. For each model the monetary cost of screening and the average gain in life expectancy were computed for a range of screening ages and prevalence rates. It is shown that the efficacy of screening depends on the pattern of aneurysm rupture. If aneurysms develop and rupture rapidly, then screening has no benefit. On the other hand, if aneurysms remain at risk for some time after formation, then screening may improve average life expectancy depending on when it occurs. The authors recommend that patients with a positive family history of aneurysms who are 30 years of age or younger be screened. This recommendation is based on the belief that the gains attributable to screening, assuming a constant rupture rate, outweigh the losses attributable to screening using a decreasing rupture rate model.

scholarly journals P.114 Headache outcomes after treatment of unruptured intracranial aneurysms: systematic review and meta-analysis

2019 ◽  
Vol 46 (s1) ◽  
pp. S43-S44
Author(s):  
C Dandurand ◽  
H Parhar ◽  
F Naji ◽  
S Prakash ◽  
PA Gooderham
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Rating Scale ◽  
Meta Analysis ◽  
Effect Estimate ◽  
Significant Heterogeneity ◽  
Unruptured Intracranial Aneurysm ◽  
Standard Mean Difference ◽  
Unruptured Intracranial Aneurysms

Background: Headaches are a major cause of disability and healthcare cost worldwide. When investigating headaches etiology, incidental unruptured intracranial aneurysms are often considered unrelated. We conducted a systematic review and meta-analysis to assess headaches outcomes (severity) after treatment of unruptured intracranial aneurysm. Methods: MEDLINE and EMBASE were systematically reviewed. Results: The data from eligible studies (n=7) was extracted and analyzed. 309 nonduplicated patients provided patient-level data for analysis. All studies used the 10-point numeric rating scale (NRS). 88% of patients were treated with endovascular technique. Overall, the observed effect estimate under a random effects model was found to be a standard mean difference in pre- and post-intervention headache severity of -0.448 (95% CI: -0.566 to -0.329). No significant heterogeneity was noted. No significant publication bias was demonstrated. Conclusions: This is the first and largest systematic review assessing postoperative headache outcomes after treatment of unruptured intracranial aneurysm. A significant reduction in headache intensity after treatment is observed in the current published literature. This study highlights an interesting clinical phenomenon that still warrants scientific effort before it can influence clinical practice. We encourage future study to stratify headache outcomes by aneurysm size, location and treatment modality.

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 Cerebral Aneurysms: Evaluation and Management

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Norman Ajiboye ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Mario Zanaty ◽  
Rodney Bell
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Imaging Techniques ◽  
Cerebral Aneurysms ◽  
Current Evidence ◽  
Management Options ◽  
Comprehensive Overview ◽  
Aneurysmal Rupture ◽  
Unruptured Intracranial Aneurysms ◽  
Optimum Management

The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis of an unruptured intracranial aneurysm is a source of significant stress to the patient because of the concerns for aneurysmal rupture, which is associated with substantial rates of morbidity and mortality. Therefore, it is important that decisions regarding optimum management are made based on the comparison of the risk of aneurysmal rupture with the risk associated with intervention. This review provides a comprehensive overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management options for unruptured intracranial aneurysms based on the current evidence in the literature. Furthermore, the authors discuss the genetic abnormalities associated with intracranial aneurysm and current guidelines for screening in patients with a family history of intracranial aneurysms. Since there is significant controversy in the optimum management of small unruptured intracranial aneurysms, we provided a systematic approach to their management based on patient and aneurysm characteristics as well as the risks and benefits of intervention.

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.

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