Follow-up Imaging of Low-Risk Unruptured Intracranial Aneurysms

Abstract

According to the American Heart Association/American Stroke Association (AHA/ASA) Guidelines,1 “For patients with unruptured intracranial aneurysms (UIAs) that are managed noninvasively without either surgical or endovascular intervention, radiographic follow-up magnetic resonance angiography (MRA) or CT angiography (CTA) at regular intervals is indicated. The optimal interval and duration of recommended follow-up are uncertain.” The undisputed prerequisite for value-based follow-up imaging of people with occult findings is that the surveillance strategy improves the overall health through disease prevention at the individual level (clinical medicine) or at the population level (public health). In value-based health care, hospitals and physicians are encouraged to improve the overall health and reduce unnecessary costs in an evidence-based way. Value-based care differs from a fee-for-service or capitated approach, in which the driving incentive for hospitals and physicians is often times money. For example, if repeated follow-up imaging studies do not improve health at the individual or population level, the benefits of surveillance do not extend to people but to service providers. In a value-based follow-up strategy, the number of clinical visits, medical tests, and interventions are well in balance with the money spent on improving short-term and long-term health of an individual or population.

Unruptured intracranial aneurysms: Why should we focus on small aneurysms? A comprehensive update of recent findings

“…It has been questioned that if repeated follow-up imaging does not improve the health of patients, should it be continued? That is the case for low-risk unruptured IAs [ 27 ]. However, determining ones with low rupture risk may be a challenging task.…”

Rapid Growth Progression of an Intracranial Internal Carotid Artery Aneurysm in a Patient with Multiple Inflammatory/Autoimmune Diseases Treated with a Flow Diverter

“…The optimal interval and duration of recommended follow-up are uncertain." The surveillance strategy improves the overall health through disease prevention [3]. Cylindrical stent devices have additional advantages compared to traditional microsurgical or endovascular therapies is that IAs with no neck can be treated efficaciously, and the aneurysm itself, clearly the most fragile part of the vasculature in question, does not need to be manipulated directly [4].…”