Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study

Bor, A. Stijntje E.; Rinkel, Gabriël J.E.; Norden, J. van; Wermer, Marieke J.H.

doi:10.1016/s1474-4422(14)70021-3

Cited by 80 publications

(67 citation statements)

References 25 publications

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“…55 In long-term serial MRA or computerized tomographic angiography (CTA) screening of people with ≥2 first-degree relatives with a history of aneurysmal SAH (aSAH) or UIA, aneurysms were identified in 11% of 458 subjects at first screening, 8% of 261 at second screening, 5% of 128 at third screening, and 5% of 63 at fourth screening, which represents a substantial risk of UIA with up to 10 years of follow-up, even after 2 initial negative screenings. 58 In this study, significant risk factors for UIA at first screening were smoking, history of previous aneurysm, and family history of aneurysm. In the follow-up screening, the only significant risk factor was history of previous aneurysm.…”

Section: Family History and Geneticsmentioning

confidence: 70%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

834

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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Section: Family History and Geneticsmentioning

confidence: 70%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

834

352

View full text Add to dashboard Cite

show abstract

“…Findings from several studies also suggested that cerebral aneurysm rupture risk is reduced in patients taking aspirin (4). Recent data support long-term serial screening in individuals with a family history of aneurysmal SAH (5). Despite the risk factors, including hypertension, cigarette smoking and alcohol use, are more common in men, aneurysmal SAH belongs to a few diseases which the incidence is higher in women than in men (1)(2)(3)6,7).…”

Section: Introductionmentioning

confidence: 90%

A higher aneurysmal subarachnoid hemorrhage incidence in women prior to menopause: a retrospective analysis of 4,895 cases from eight hospitals in China

Wáng

Zhang

et al. 2016

Quant. Imaging Med. Surg.

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Background: Subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm is a devastating disease.Despite the risk factors, including hypertension, cigarette smoking and alcohol use, are more common in men, aneurysmal SAH belongs to a few diseases which the incidence is higher in women than in men. Sex hormones, especially estrogen, might be protective against this condition. Hormone replacement therapy (HRT) seems to be associated with a reduced risk for aneurysmal SAH. This study aims to know the prevalence of aneurysmal SAH of men and women at different ages. Methods:The age and gender information of 4,895 case of aneurysmal SAH (3,016 females, 1,879 males) were collected retrospectively from eight institutions in mainland China. The prevalence of aneurysmal SAH of men and women at different ages was analyzed.Results: The data showed women had a higher incidence of aneurysmal SAH than men starting at late thirties, and men might have a higher incidence of aneurysmal SAH than women only before 37-year-old.Conclusions: Menopause may not be the only dominant factor causing higher incidence of aneurysmal SAH in women than in men. Quant Imaging Med Surg 2016;6(2):151-156 qims.amegroups.com the short-term and long-term risks of aneurysmal rupture with the risk associated with the intervention, whether it would be surgical clipping or endovascular management. Controversy remains regarding optimum management, and thorough assessments of the risks and benefits of contemporary management options, specific to aneurysm size, location, and many other aneurysm and patient factors, are needed. Endovascular management options continue to improve as micro-catheter technology advances and newer devices and embolic materials are developed. The most commonly used endovascular option is the Guglielmi detachable coil system. This system allows delivery of soft platinum coils into intracranial aneurysms. Overall, clinical trial data showed better recovery data with patients treated endovascularly than treated surgically (3). Findings from several studies also suggested that cerebral aneurysm rupture risk is reduced in patients taking aspirin (4). Recent data support long-term serial screening in individuals with a family history of aneurysmal SAH (5).Despite the risk factors, including hypertension, cigarette smoking and alcohol use, are more common in men, aneurysmal SAH belongs to a few diseases which the incidence is higher in women than in men (1-3,6,7). Women have a significantly higher risk for de novo cerebral aneurysm formation than men in a long-term follow-up study, being female is a significant independent risk factor for aneurysm growth; and women are more likely than men to have multiple cerebral aneurysms (7-9). It has been noted that the incidence was higher in younger men, whereas after the age of 55, the incidence was higher in women (2). Furthermore, earlier age at menopause may be associated with a greater risk of cerebral aneurysm (10). Therefore, a sex-specific hormonal factor may play a role in the pathogen...

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“…5 Moreover, a long-term serial screening study for UIAs in families with 2 or more aSAHs or UIAs showed a substantial yield of 3%-5% of newly identified UIAs after more than 10 years of follow-up and 2 initial negative screenings, 3 supporting the rationale of offering screening in this population.…”

mentioning

confidence: 89%

Screening for intracranial aneurysms? Prevalence of unruptured intracranial aneurysms in Hong Kong Chinese

Chan¹,

Abrigo

Cheung

et al. 2016

JNS

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OBJECT The objective of this study was to generate data on the local prevalence of unruptured intracranial aneurysms (UIAs) in asymptomatic Hong Kong Chinese individuals. First-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH) were recruited as surrogates of the general population and to explore the potential role of screening in this locality. METHODS The authors identified first-degree relatives of consecutive patients with subarachnoid hemorrhage from a ruptured aneurysm who were admitted to a university hospital in Hong Kong from June 2008 to December 2010. Magnetic resonance angiography (MRA) was the imaging modality used to screen the cerebral vasculature of these asymptomatic individuals. If MRA showed abnormal findings, CT angiography was performed to confirm the MRA findings. RESULTS In total, 7 UIAs were identified from the 305 MR angiograms obtained. The prevalence of UIAs in first-degree relatives of patients with aSAH in the Hong Kong Chinese population was 2.30% (95% CI1.02%–4.76%). This percentage was lower than the prevalence rate of 3.2% from a meta-analysis of the literature. The sizes of the UIAs detected ranged from 1.4 mm to 7.5 mm; 85.7% of the UIAs detected in this study were < 5 mm, in contrast to 66% noted in the literature. One of the UIAs identified underwent endovascular stent placement with a flow diverter. None of the UIAs identified ruptured or became symptomatic during a median follow-up period of 3.5 years. CONCLUSIONS The prevalence of UIAs in first-degree relatives of patients with aSAH in the Hong Kong Chinese population was lower than that in Caucasians. At the same time, most of the UIAs detected in this study were small (85.7% were < 5 mm, vs 66% in a meta-analysis). With a similar incidence of aSAH in Hong Kong (7.5 per 100,000 person-years) as compared with data cited in the literature, the hypothesis that UIA rupture risk size threshold is different in Chinese patients should be further investigated.

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Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study

Cited by 80 publications

References 25 publications

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

A higher aneurysmal subarachnoid hemorrhage incidence in women prior to menopause: a retrospective analysis of 4,895 cases from eight hospitals in China

Screening for intracranial aneurysms? Prevalence of unruptured intracranial aneurysms in Hong Kong Chinese

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