Small Cerebral Aneurysms: Can We Identify Patients at Risk for Rupture?
Authors: Robert M. Starke
Journal: Annals of Internal Medicine (2017)

Editorials4 July 2017Small Cerebral Aneurysms: Can We Identify Patients at Risk for Rupture?Robert M. Starke, MD, MScRobert M. Starke, MD, MScFrom University of Miami Miller School of Medicine, Miami, Florida.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1215 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although the prevalence of unruptured intracranial aneurysms (UIAs) is 1% to 3% in the general population, it exceeds 19% in high-risk groups (1, 2). These aneurysms may produce a devastating form of stroke by rupturing and producing subarachnoid hemorrhage. Although subarachnoid hemorrhage accounts for a small percentage of strokes, it represents nearly 25% of potential life-years lost through stroke because of its predilection for a relatively young population and the poor outcomes in these patients (2, 3).Because of imaging improvements and availability, small UIAs are increasingly diagnosed (4). Optimal management of these lesions remains unclear because of heterogeneity in ...References1. Rinkel GJ. Natural history, epidemiology and screening of unruptured intracranial aneurysms. J Neuroradiol. 2008;35:99-103. [PMID: 18242707] doi:10.1016/j.neurad.2007.11.004 CrossrefMedlineGoogle Scholar2. Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, et al; American Heart Association Stroke Council. Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2368-400. [PMID: 26089327] doi:10.1161/STR.0000000000000070 CrossrefMedlineGoogle Scholar3. Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology. 1998;50:1413-8. [PMID: 9595997] CrossrefMedlineGoogle Scholar4. Komotar RJ, Starke RM, Connolly ES. Brain magnetic resonance imaging scans for asymptomatic patients: role in medical screening. Mayo Clin Proc. 2008;83:563-5. [PMID: 18452687] doi:10.4065/83.5.563 CrossrefMedlineGoogle Scholar5. Malhotra A, Wu X, Forman HP, GrossettaNardini HK, Matouk CC, Gandhi D, et al. Growth and rupture risk of small unruptured intracranial aneurysms. A systematic review. Ann Intern Med. 2017;167:26-33. doi:10.7326/M17-0246 LinkGoogle Scholar6. Raymond J, Roy D, Weill A, Guilbert F, Nguyen T, Molyneux AJ, et al; Trial on Endovascular Aneurysm Management (TEAM) collaborative group. Unruptured intracranial aneurysms and the Trial on Endovascular Aneurysm Management (TEAM): the principles behind the protocol. J Vasc Interv Neurol. 2008;1:22-6. [PMID: 22518212] MedlineGoogle Scholar7. Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007;38:1404-10. [PMID: 17332442] CrossrefMedlineGoogle Scholar8. Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366:2474-82. [PMID: 22738097] doi:10.1056/NEJMoa1113260 CrossrefMedlineGoogle Scholar9. Juvela S, Korja M. Intracranial aneurysm parameters for predicting a future subarachnoid hemorrhage: a long-term follow-up study. Neurosurgery. 2017. [PMID: 28327974] doi:10.1093/neuros/nyw049 CrossrefMedlineGoogle Scholar10. Wiebers DO, Whisnant JP, Huston J, Meissner I, Brown RD, Piepgras DG, et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103-10. [PMID: 12867109] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Miami Miller School of Medicine, Miami, Florida.Disclosures: Author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1215.Corresponding Author: Robert M. Starke, MD, MSc, University of Miami Hospital Miller School of Medicine, Lois Pope LIFE Center, 1095 Northwest 14th Terrace, 2nd Floor (D4-6), Miami, FL 33136; e-mail, [email protected]miami.edu.This article was published at Annals.org on 6 June 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGrowth and Rupture Risk of Small Unruptured Intracranial Aneurysms Ajay Malhotra , Xiao Wu , Howard P. Forman , Holly K. Grossetta Nardini , Charles C. Matouk , Dheeraj Gandhi , Christopher Moore , and Pina Sanelli Metrics Cited byUnruptured cerebral aneurysm risk stratification: Background, current research, and future directions in aneurysm assessmentRisk Factors for Higher Volume of Hemorrhage in Ruptured Anterior Circulation Intracranial Aneurysms 4 July 2017Volume 167, Issue 1Page: 59-60KeywordsAneurysmsArteriesHospital medicineLongitudinal studiesMedical risk factorsObservational studiesPatientsStrokeSubarachnoid hemorrhage ePublished: 6 June 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...