The incidence and treatment of asymptomatic, unruptured cerebral aneurysms

1994 ◽  
Vol 80 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Toshio Nakagawa ◽  
Kazuo Hashi
Keyword(s):  
Early Detection ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Unruptured Cerebral Aneurysms

✓ The importance of early detection by various radiological techniques of asymptomatic, unruptured aneurysms as a means of preventing subarachnoid hemorrhage (SAH) is discussed in this report. Four hundred volunteers underwent clinical and radiological evaluations between March, 1988, and September, 1992. Studies included a neurological examination as well as digital subtraction cerebral angiography via a femoral arterial catheter, computerized tomography, T1- and T2-weighted magnetic resonance (MR) imaging of the whole brain, and MR angiography. The evaluation revealed 27 asymptomatic, unruptured intracranial aneurysms in 26 volunteers, for an incidence of 6.5%. The subjects ranged in age from 39 to 71 years, with an average of 55 years. The aneurysms were located on the internal carotid artery in 13 cases (48%), the anterior communicating artery in six (22%), the middle cerebral artery in six (22%), and the basilar artery in two (7%). Aneurysms ranged in size from 5 mm or less in 16 cases, 6 to 10 mm in nine, and 11 to 15 mm in one; one aneurysm was more than 15 mm, with a maximum diameter of 2 cm. Volunteers with a family history of SAH within the second degree of consanguinity showed a higher incidence of aneurysms (17.9%). Aneurysm clipping was performed on 20 of the 26 cases with no significant morbidity or mortality. These findings support the contention that aggressive early detection of unruptured aneurysms may improve the outcome in patients harboring cerebral aneurysms by preventing the devastating effects of SAH.

Delineation of unruptured cerebral aneurysms by computerized angiotomography

1982 ◽  
Vol 57 (4) ◽  
pp. 527-534 ◽  
Author(s):  
Syoji Asari ◽  
Toru Satoh ◽  
Masaru Sakurai ◽  
Yuji Yamamoto ◽  
Kazuhiko Sadamoto
Keyword(s):  
Cerebral Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Sylvian Fissure ◽  
Anterior Communicating Artery ◽  
Basal Cistern ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Iodine Level ◽  
Unruptured Cerebral Aneurysms

✓ Unruptured aneurysms were diagnosed in 15 of 86 patients with cerebral aneurysms during 2 years beginning in April, 1979. One patient with severe head injury was excluded from the series. Fifteen aneurysms in the other 14 patients were first detected by computerized angiotomography. Six aneurysms were located in the middle cerebral artery, three in the upper half of the basilar artery, two in the anterior communicating artery, two in the posterior cerebral artery, and two at the internal carotid-posterior communicating artery junction (both in the same patient). Three were smaller than 5 mm, eight were between 6 and 10 mm, and four were larger than 10 mm. The noncontrast-enhanced computerized tomography (CT) findings associated with 15 aneurysms were as follows: five showed defects in the basal cistern or Sylvian fissure, four were calcified or high-density masses, and in six instances there was no evidence of an aneurysm. Unruptured aneurysms may be suggested by a well demarcated, round, isodense mass which forms a defect in the basal cistern or Sylvian fissure on a plain CT image, and are highly and homogeneously enhanced by computerized angiotomography. A carotid artery blood iodine level of 15 mg/ml is required to obtain clear images. The authors conclude that computerized angiotomography is useful in the delineation of unruptured aneurysms.

Natural history and general management of unruptured intracranial aneurysms

2004 ◽  
Vol 17 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Peng Roc Chen ◽  
Kai Frerichs ◽  
Robert Spetzler
Keyword(s):  
Natural History ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Population Based ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
History Of ◽  
Unruptured Cerebral Aneurysms ◽  
Noninvasive Neuroimaging

After an aneurysmal subarachnoid hemorrhage, nearly half of the patients die and the half who survive suffer from irreversible cerebral damage. With increasing use of noninvasive neuroimaging techniques (for example, magnetic resonance and computerized tomography angiography), more unruptured cerebral aneurysms are found. To understand the prevalence of unruptured aneurysms in the general population, along with the risks of aneurysm formation, data on growth and rupture rates are crucial. The risk of rupture in aneurysms smaller than 10 mm is still not quite clear without a population-based prospective study. Nevertheless, a 0.5 to 2% annual risk may be a reasonable estimate. Growing aneurysms and those larger than 10 mm carry a higher rate of rupture. The management of an unruptured intracranial aneurysm should be based on a thorough understanding of the natural history of these lesions and careful evaluation of the morbidity and mortality levels associated with each treatment option.

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

2000 ◽  
Vol 93 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Seppo Juvela ◽  
Matti Porras ◽  
Kristiina Poussa
Keyword(s):  
Risk Factors ◽  
Smoking Status ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Fine Print

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.

Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms

2002 ◽  
Vol 96 (1) ◽  
pp. 43-49 ◽  
Author(s):  
H. Richard Winn ◽  
John A. Jane ◽  
James Taylor ◽  
Donald Kaiser ◽  
Gavin W. Britz
Keyword(s):  
Prevalence Rate ◽  
Cerebral Aneurysms ◽  
Anterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Incidental Aneurysms ◽  
Unruptured Cerebral Aneurysms ◽  
The University ◽  
Yearly Rate ◽  
Fine Print

Object. The prevalence of unruptured cerebral aneurysms is unknown, but is estimated to be as high as 5%. The goal of this study was to determine the prevalence of asymptomatic incidental aneurysms. Methods. The authors studied all cerebral arteriography reports produced at a single institution, the University of Virginia, between April 1969 and January 1980. A review of 3684 arteriograms demonstrated 24 cases of asymptomatic aneurysms, yielding a prevalence rate of 0.65%. The majority (67%) of the 24 patients harboring unruptured aneurysms were women. More than 90% of the unruptured aneurysms were located in the anterior circulation and in locations similar to those found in patients with ruptured aneurysms. Nearly 80% of the aneurysms were smaller than 1 cm in their greatest diameter. The frequency of asymmetrical unruptured aneurysms (0.6–1.5%) was constant throughout all relevant age ranges (35–84 years). Conclusions. While keeping in mind appropriate caveats in extrapolating from these data, the prevalence rate of asymptomatic unruptured aneurysms found in the present study allows an estimation of the yearly rate of rupture of these lesions. The authors suggest that this yearly rate of rupture falls within the range of 1 to 2%.

Experimental induction of cerebral aneurysms in monkeys

1987 ◽  
Vol 67 (6) ◽  
pp. 903-905 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Choegon Kim ◽  
Haruhiko Kikuchi ◽  
Masayuki Kojima ◽  
Yoo Kang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Experimental Hypertension ◽  
Content Type ◽  
Experimental Induction ◽  
The Common ◽  
The Brain ◽  
Fine Print

✓ Saccular cerebral aneurysms were successfully induced in two monkeys treated with ligation of the common carotid artery, experimental hypertension, and β-aminopropionitrile feeding. The cerebral aneurysms developed on the large arteries at the base of the brain, such as the anterior communicating artery and the internal carotid artery at the origin of the posterior communicating artery. Because of the similarity of the monkey to man as a species, the present results strongly suggest the significance of postnatal aggravating factors in the development of cerebral aneurysms in man.

Superciliary Keyhole Approach for Small Unruptured Aneurysms in Anterior Cerebral Circulation

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons300-ons309 ◽  
Author(s):  
Jaechan Park ◽  
Hyunjin Woo ◽  
Dong-Hun Kang ◽  
Joo-Kyung Sung ◽  
Yongsun Kim
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Control Group ◽  
Anterior Communicating Artery ◽  
Consecutive Series ◽  
Pterional Approach ◽  
Unruptured Aneurysms ◽  
Operative Duration ◽  
Unruptured Intracranial Aneurysms ◽  
Keyhole Approach

Abstract Background: Neurovascular surgeons have been trying to find a solution to the problem of surgical invasiveness by applying minimally invasive keyhole approaches. Objective: To evaluate the feasibility and surgical outcomes of a superciliary keyhole approach for unruptured intracranial aneurysms (UIAs) as an alternative to a pterional approach. Methods: The authors report on a consecutive series of patients who underwent a superciliary approach for clipping UIAs smaller than 15 mm arising at the supraclinoid internal carotid artery (ICA), A1 segment, anterior communicating artery (ACoA), and M1 segment including the middle cerebral artery (MCA) bifurcation. The data were compared with a historical control group (n = 90) who underwent a pterional approach for UIAs. Results: A total of 120 aneurysms were successfully clipped in 102 patients with a mean age of 58 years. There was no direct mortality related to the surgery, and only 1 (1.0%) patient developed significant morbidity adversely affecting the Glasgow Outcome Scale score. The superciliary approach demonstrated statistically significant advantages over the pterional approach, including a shorter operative duration (mean, 120 min), no intraoperative blood transfusion, and extremely rare postoperative epidural hemorrhages. In addition, temporalis atrophy was rare and palsy of the frontalis persisting more than 6 months only occurred in 6 patients (5.9%) and was resolved within 2 years. The overall cosmetic outcome was excellent. Conclusion: A superciliary approach can be a reasonable alternative to a pterional approach for small (<15 mm) UIAs arising at the supraclinoid ICA, A1, ACoA, and M1 segment including the MCA bifurcation.

scholarly journals The Medina Embolic Device: early clinical experience from a single center

2016 ◽  
Vol 9 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Marta Aguilar Perez ◽  
Pervinder Bhogal ◽  
Rosa Martinez Moreno ◽  
Hansjörg Bäzner ◽  
Oliver Ganslandt ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Clinical Status ◽  
Anterior Communicating Artery ◽  
Major Step ◽  
Unruptured Aneurysms ◽  
True Value ◽  
Unruptured Intracranial Aneurysms ◽  
Flow Diverters

ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

Intraoperative factors associated with surgical outcome in patients with unruptured cerebral aneurysms: the experience of a single surgeon

2003 ◽  
Vol 99 (3) ◽  
pp. 452-457 ◽  
Author(s):  
Arthur A. Grigorian ◽  
Alvin Marcovici ◽  
Eugene S. Flamm
Keyword(s):  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Predictive Tool ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Unruptured Cerebral Aneurysms ◽  
Unexpected Outcomes ◽  
Expected Outcomes ◽  
Fine Print

Object. Some well-known predictors of clinical outcomes in patients with ruptured aneurysms are not useful for forecasting outcome in patients with unruptured aneurysms. The goal of this study was to analyze outcomes in patients harboring unruptured cerebral aneurysms in different locations and to create a predictive tool for assessing both favorable outcome and morbidity in a large series of unruptured aneurysms. Methods. The authors analyzed data from 387 patients with nonruptured intracranial cerebral aneurysms who underwent surgery for clip placement. Intraoperative data were reviewed and seven factors that might influence outcomes were identified. These included the following: 1) aneurysm size larger than 10 mm; 2) presence of a broad aneurysm neck; 3) presence of plaque calcification near the aneurysm neck; 4) application of clips to more than one aneurysm during the same surgery; 5) temporary occlusion; 6) multiple clip applications and repositioning; and 7) use of multiple clips. The entire group of patients with unruptured aneurysms was divided into two subgroups on the basis of outcome. Each patient was subsequently assessed to formulate the factor accumulation index (FAI), the sum of different factors observed in a given patient. The subgroup of patients with expected outcomes was composed of 312 patients, whereas the subgroup of unexpected outcomes consisted of 31 patients. Depending on the anatomical locations of the aneurysms, the combined mortality—morbidity rate ranged from 5.7 to 25%, with the best results for patients harboring ophthalmic artery aneurysms and the worst results for those with vertebrobasilar system (VBS) aneurysms. The majority of patients with expected outcomes who harbored aneurysms of the middle cerebral artery, the internal carotid artery, and the VBS had a lower FAI, whereas the majority of patients with unexpected outcomes had a higher FAI. Conclusions. It is possible to predict outcomes in patients with unruptured cerebral artery aneurysms by calculating the FAI. The rate of postoperative morbidity increases with the FAI within the range of three to four factors.

scholarly journals Initial Experience with LVIS EVO Stents for the Treatment of Intracranial Aneurysms

2020 ◽  
Vol 9 (12) ◽  
pp. 3966
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Thromboembolic Complication ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Low Profile ◽  
Class 1 ◽  
Occlusion Rate

Background: Over the years, a variety of intracranial stents have been developed, which has expanded the therapy options available for cerebral aneurysms. The Low profile visible intraluminal support (LVIS) EVO stents are new devices, which officially appeared on the market in 2020. The purpose of the study is to report the initial technical and clinical experience with the new stent in the treatment of intracranial aneurysms. Materials and Methods: Between February and September 2020, 30 patients with 35 intracranial aneurysms (29 unruptured and 6 ruptured) were treated using the LVIS EVO stent in our department. The aneurysms were located within internal carotid artery (ICA) (42.9%), middle cerebral artery (MCA) (31.4%), anterior communicating artery (AComA) (11.4%), basilar artery (BA) (11.4%) and anterior cerebral artery (ACA) (2.9%). Stent-assisted coil embolization was performed in all cases. Results: All stents were deployed successfully in the desired position. Immediate complete occlusion of the treated aneurysms, described as Raymond–Roy occlusion classification (RROC) class 1, was achieved in all cases. No technical complications were observed. One thromboembolic complication occurred in the group of unruptured aneurysms and one patient died due to cerebral edema from aneurysms rupture group. Conclusion: In our observation, the showed a satisfactory safety profile LVIS EVO stents seem to be very flexible, can be safely maneuvered and deployed in tortuous vessels. They showed a good initial occlusion rate when used for treating intracranial aneurysms with SAC (stent-assisted coiling).

Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms

2006 ◽  
Vol 104 (2) ◽  
pp. 188-194 ◽  
Author(s):  
Han Soo Chang
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
International Study ◽  
Medical Decision ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Median Diameter ◽  
History Of

Object Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons’ experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms. Methods The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured aneurysms. The lifetime lesion rupture probability for individual patients with various ages and aneurysm sizes was also computed, thereby providing a useful index to help patients in the medical decision-making process. The computer model produced a sample of unruptured aneurysms in the general population with a prevalence of 4.2% and a median diameter of 5.8 mm. These unruptured aneurysms—affected by the rupture rate reported in the ISUIA—had a yearly SAH incidence of 19.6 per 100,000 persons. The median diameter of these aneurysms was 9.4 mm. Conclusions Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture—a useful measure for deciding on the optimal treatment for unruptured aneurysms.

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