Unruptured intracranial aneurysm follow-up and treatment after morphological change is safe: observational study and systematic review

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 87; no. 12; pp. 1277 - 1282
• Main Authors: Gondar, Renato, Gautschi, Oliver Pascal, Cuony, Johanna, Perren, Fabienne, Jägersberg, Max, Corniola, Marco-Vincenzo, Schatlo, Bawarjan, Molliqaj, Granit, Morel, Sandrine, Kulcsár, Zsolt, Mendes Pereira, Vitor, Rüfenacht, Daniel, Schaller, Karl, Bijlenga, Philippe
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2016
• Subjects: Adult; Aged; Alcohol; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; Aneurysms; Carotid arteries; Cohort Studies; Consent; Female; Humans; Hypertension; Incidental Findings; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Kaplan-Meier Estimate; Longitudinal Studies; Magnetic Resonance Angiography; Male; Medical imaging; Middle Aged; Morphology; Mortality; Patient Safety; Patient Selection; Patients; Risk Assessment; Risk factors; Smoking; Studies; Systematic review; Veins & arteries; Watchful Waiting
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp-2016-313584

BackgroundThe management of small unruptured incidentally discovered intracranial aneurysms (SUIAs) is still controversial. The aim of this study is to assess the safety of a management protocol of SUIAs, where selected cases with SUIAs are observed and secured only if signs of instability (growth) are documented.MethodsA prospective consecutive cohort of 292 patients (2006–2014) and 368 SUIAs (anterior circulation aneurysms (ACs) smaller than 7 mm and posterior circulation aneurysms smaller than 4 mm without previous subarachnoid haemorrhage) was observed (mean follow-up time of 3.2 years and 1177.6 aneurysm years). Factors associated with aneurysm growth were systematically reviewed from the literature.ResultsThe aneurysm growth probability was 2.6±0.1% per year. The rate of unexpected aneurysm rupture before treatment was 0.24% per year (95% CI 0.17% to 2.40%). The calculated rate of aneurysm rupture after growth was 6.3% per aneurysm-year (95% CI 1% to 22%). Aneurysms located in the posterior circulation and aneurysms with lobulation were more likely to grow. Females or patients suffering hypertension were more likely to have an aneurysm growing. The probability of aneurysms growth increased with the size of the dome and was proportional to the number of aneurysms diagnosed in a patient.ConclusionsIt is safe to observe patients diagnosed with SUIAs using periodic imaging. Intervention to secure the aneurysm should be performed after growth is observed.