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TheScientificWorldJournal 2015The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis... (Review)
Review
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.
Topics: Disease Management; Humans; Intracranial Aneurysm; Prognosis; Risk; Treatment Outcome
PubMed: 26146657
DOI: 10.1155/2015/954954 -
Deutsches Arzteblatt International Apr 2020About 2 million adults in Germany harbor an unruptured intracranial aneurysm (IA). Rupture can lead to a life-threatening subarachnoid hemorrhage. If an IA is detected... (Review)
Review
BACKGROUND
About 2 million adults in Germany harbor an unruptured intracranial aneurysm (IA). Rupture can lead to a life-threatening subarachnoid hemorrhage. If an IA is detected incidentally in cranial imaging, it must be decided how to proceed.
METHODS
This review includes key publications that were identified by a selective search in the PubMed database using the search term "unruptured intracranial aneurysms," which was performed in July 2019, and based on information obtained from the German Federal Statistical Office on the frequency of the hospital discharge diagnosis "cerebral aneurysm," excluding the diagnosis "subarachnoid hemorrhage," in Germany from 2005 to 2017.
RESULTS
The number of patients in Germany who were admitted or treated for an unruptured IA increased by a factor of 2.3 from 2005 to 2017. The average 5-year rupture risk of approximately 3% must be weighed against the approximately 4% risk associated with an endovascular or microneurosurgical treatment. This emphasizes the need for more precise data on the risk of rupture and for algorithms enabling individualized decision-making for patients with unruptured IA. Risk factors such as IA morphology, arterial hypertension, active smoking, and alcohol consumption (>150 g/week) can markedly increase the risk of rupture, which is generally relatively low. Growing aneurysms are 12 times more likely to rupture than stable ones. Follow-up imaging is thus essential whenever observation rather than intervention is chosen as the initial management.
CONCLUSION
Patients with unruptured IA should be massessed and managed individually. It is also important that risk factors should be treated, if present. Eligible patients are currently being recruited for a phase III clinical trial on the efficacy of blood pressure reduction combined with acetylsalicylic acid intake to counteract inflammatory processes in the arterial wall.
Topics: Germany; Humans; Intracranial Aneurysm; Precision Medicine; Risk Factors
PubMed: 32449895
DOI: 10.3238/arztebl.2020.0235 -
The Cochrane Database of Systematic... May 2021Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as...
BACKGROUND
Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Morbidity and mortality in aneurysmal subarachnoid hemorrhage are substantial: in people with subarachnoid hemorrhage, 12% die immediately, more than 30% die within one month, 25% to 50% die within six months, and 30% of survivors remain dependent. However, most intracranial aneurysms do not bleed, and the best treatment approach is still a matter of debate.
OBJECTIVES
To assess the risks and benefits of interventions for people with unruptured intracranial aneurysms.
SEARCH METHODS
We searched CENTRAL (Cochrane Library 2020, Issue 5), MEDLINE Ovid, Embase Ovid, and Latin American and Caribbean Health Science Information database (LILACS). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception to 25 May 2020. There were no language restrictions. We contacted experts in the field to identify further studies and unpublished trials.
SELECTION CRITERIA
Unconfounded, truly randomized trials comparing conservative treatment versus interventional treatments (microsurgical clipping or endovascular coiling) and microsurgical clipping versus endovascular coiling for individuals with unruptured intracranial aneurysms.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion according to the above criteria, assessed trial quality and risk of bias, performed data extraction, and applied the GRADE approach to the evidence. We used an intention-to-treat analysis strategy.
MAIN RESULTS
We included two trials in the review: one prospective randomized trial involving 80 participants that compared conservative treatment to endovascular coiling, and one randomized controlled trial involving 136 participants that compared microsurgical clipping to endovascular coiling for unruptured intracranial aneurysms. There was no difference in outcome events between conservative treatment and endovascular coiling groups. New perioperative neurological deficits were more common in participants treated surgically (16/65, 24.6%; 15.8% to 36.3%) versus 7/69 (10.1%; 5.0% to 19.5%); odds ratio (OR) 2.87 (95% confidence interval (CI) 1.02 to 8.93; P = 0.038). Hospitalization for more than five days was more common in surgical participants (30/65, 46.2%; 34.6% to 58.1%) versus 6/69 (8.7%; 4.0% to 17.7%); OR 8.85 (95% CI 3.22 to 28.59; P < 0.001). Clinical follow-up to one year showed 1/48 clipped versus 1/58 coiled participants had died, and 1/48 clipped versus 1/58 coiled participants had become disabled (modified Rankin Scale > 2). All the evidence is of very low quality.
AUTHORS' CONCLUSIONS
There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (major stroke), and duration of hospitalizations.
Topics: Conservative Treatment; Early Termination of Clinical Trials; Humans; Intracranial Aneurysm; Microsurgery; Randomized Controlled Trials as Topic; Stents; Stroke
PubMed: 33971026
DOI: 10.1002/14651858.CD013312.pub2 -
Stroke and Vascular Neurology Sep 2016Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major... (Review)
Review
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
Topics: Animals; Cerebrovascular Circulation; Diffusion of Innovation; Endovascular Procedures; Humans; Intracranial Aneurysm; Treatment Outcome
PubMed: 28959469
DOI: 10.1136/svn-2016-000027 -
Experimental Neurology Jul 2022Calcification of intracranial aneurysms is a well-known phenomenon. Whether microsurgical or endovascular techniques are used, calcifications may increase the difficulty... (Review)
Review
Calcification of intracranial aneurysms is a well-known phenomenon. Whether microsurgical or endovascular techniques are used, calcifications may increase the difficulty of treatment. However, the implications of calcification on aneurysm biology and stability have received little attention. We review both investigational and clinical methods that are used to detect aneurysmal calcification. We also discuss the pathophysiology of aneurysm calcification, specifically the role that inflammation and smooth muscle cells play. We finally turn our attention to the clinical implications of aneurysm calcification including rupture risk and treatment considerations. Calcification may represent an important feature in the life cycle of an aneurysm and as imaging methods continue to improve, we may yet discover a biomarker for this process.
Topics: Humans; Intracranial Aneurysm; Myocytes, Smooth Muscle; Neurodegenerative Diseases
PubMed: 35346670
DOI: 10.1016/j.expneurol.2022.114052 -
Brain Pathology (Zurich, Switzerland) May 2015Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial... (Review)
Review
Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial aneurysms involve radiological surveillance and neurosurgical or endovascular interventions. There is no pharmacological treatment available to decrease the risk of aneurysm rupture and subsequent subarachnoid hemorrhage. There is growing interest in the pathogenesis of intracranial aneurysm focused on the development of drug therapies to decrease the incidence of aneurysm rupture. The study of rodent models of intracranial aneurysms has the potential to improve our understanding of intracranial aneurysm development and progression. This review summarizes current mouse models of intact and ruptured intracranial aneurysms and discusses the relevance of these models to human intracranial aneurysms. The article also reviews the importance of these models in investigating the molecular mechanisms involved in the disease. Finally, potential pharmaceutical targets for intracranial aneurysm suggested by previous studies are discussed. Examples of potential drug targets include matrix metalloproteinases, stromal cell-derived factor-1, tumor necrosis factor-α, the renin-angiotensin system and the β-estrogen receptor. An agreed clear, precise and reproducible definition of what constitutes an aneurysm in the models would assist in their use to better understand the pathology of intracranial aneurysm and applying findings to patients.
Topics: Animals; Disease Models, Animal; Humans; Intracranial Aneurysm; Mice
PubMed: 25041057
DOI: 10.1111/bpa.12175 -
Ugeskrift For Laeger Jul 2019The purpose of this review is to increase the knowledge about diagnosis and treatment of aneurysmal subarachnoid haemorrhage (aSAH), which is an infrequent and critical... (Review)
Review
The purpose of this review is to increase the knowledge about diagnosis and treatment of aneurysmal subarachnoid haemorrhage (aSAH), which is an infrequent and critical condition with a high risk of severe morbidity and mortality. The outcome is improved by correct and efficient diagnosis and early treatment, including aneurysm repair. General practitioners and doctors in the departments for emergency medicine should be aware of the symptoms of aSAH.
Topics: Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage
PubMed: 31368433
DOI: No ID Found -
Clinical Neurology and Neurosurgery Jan 2022The genetics of intracranial aneurysms is complex. Much work has been done looking at the extracellular matrix surrounding cerebral vasculature as well as the role of... (Review)
Review
The genetics of intracranial aneurysms is complex. Much work has been done looking at the extracellular matrix surrounding cerebral vasculature as well as the role of matrix metalloproteinases. This comprehensive review summarizes what is known to date about the important genetic components that predispose to aneurysm formation and critically discusses the published findings. We discuss promising pre-clinical models of aneurysm formation and subarachnoid hemorrhage, and highlight avenues for future discovery, while considering limitations in the research to date. This review will further serve as a comprehensive reference guide to understand the genetic underpinnings for aneurysm pathophysiology and act as a primer for further investigation.
Topics: Animals; Humans; Intracranial Aneurysm
PubMed: 34863053
DOI: 10.1016/j.clineuro.2021.107060 -
Acta Clinica Croatica Dec 2021Intracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of... (Review)
Review
Intracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of the necessity of treatment of patients with an asymptomatic intracranial aneurysm. For long, the only treatment option was surgical clipping of aneurysm neck. In the last 25 years, endovascular techniques have been developed as an alternative solution for patients who are not eligible for neurosurgical procedures. Research has shown better results of embolization procedures with lower rates of complications, but a higher rate of recanalization is still a major drawback of endovascular coiling. There are no strict protocols and the treatment of choice for intracranial aneurysms should be agreed upon by both the physician and the patient. This review aims to provide an insight into the management of intracerebral aneurysms with emphasis on the decision making problems faced by clinicians.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Neurosurgical Procedures; Treatment Outcome
PubMed: 35734498
DOI: 10.20471/acc.2021.60.04.24 -
Neurologia Medico-chirurgica Jul 2019Considered with a poor outcome of subarachnoid hemorrhage due to rupture of intracranial aneurysms (IAs), treatment interventions to prevent rupture of the lesions are... (Review)
Review
Considered with a poor outcome of subarachnoid hemorrhage due to rupture of intracranial aneurysms (IAs), treatment interventions to prevent rupture of the lesions are mandatory for social health. As treatment option is limited to surgical manipulations, like microsurgical clipping, endovascular coiling or deployment of flow diverter, and these surgical interventions have a potential risk of complications in nature, a proper selection of rupture-prone IAs among ones incidentally found is essential. Today, a rupture risk in each case is estimated by several factors like patient characteristics and morphological ones of each lesion. However, unfortunately, an IA without treatment sometimes unexpectedly ruptures resulting in a devastating outcome or an IA surgically treated is turned out to have a thick wall. To achieve more efficient treatment interventions, the development of a novel diagnostic modality is required. Here, mainly through the accumulation of experimental findings, the crucial contribution of macrophage-mediated chronic inflammatory responses to IA progression have been revealed, making macrophage being a promising target for a diagnosis. If we could non-invasively visualize accumulation of macrophages in lesions, this imaging technique 'macrophage imaging' may enable a qualitative evaluation of IAs to stratify rupture-prone 'dangerous' lesions among many stable ones. Thereby, a development of macrophage imaging makes an indication of surgical interventions being more accurate and also greatly facilitates a development of a novel medical therapy if used as a surrogate marker.
Topics: Aneurysm, Ruptured; Humans; Intracranial Aneurysm; Macrophages
PubMed: 31080227
DOI: 10.2176/nmc.st.2019-0034