Outcome of Patients with Multiple Intracranial Aneurysms after Subarachnoid Hemorrhage and Future Risk of Rupture of Unruptured Aneurysm

Abstract

The purpose was to study the risk of rupture of unruptured intracranial aneurysms (UIAs) of patients with multiple intracranial aneurysms after subarachnoid hemorrhage (SAH), in a long-term follow-up study, from variables known at baseline. Future rupture risk was compared in relation to outcome after SAH. The series consists of 131 patients with 166 UIAs and 2854 person-years of follow-up between diagnosis of UIA and its rupture, death or the last follow-up contact. These were diagnosed before 1979, when UIAs were not treated in our country. Those patients with a moderate or severe disability after SAH, according to the Glasgow Outcome Scale, had lower rupture rates of UIA than those with a good recovery or minimal disability (4/37 or 11%, annual UIA rupture rate of 0.5% (95% confidence interval (CI) 0.1–1.3%) during 769 follow-up years vs. 27/94 or 29%, 1.3% (95% CI 0.9–1.9%) during 2085 years). Those with a moderate or severe disability differed from others by their older age. Those with a moderate or severe disability tended to have a decreased cumulative rate of aneurysm rupture (log rank test, p = 0.066) and lower relative risk of UIA rupture (hazard ratio 0.39, 95% CI 0.14–1.11, p = 0.077). Multivariable hazard ratios showed at least similar results, suggesting that confounding factors did not have a significant effect on the results. The results of this study without treatment selection of UIAs suggest that patients with a moderate or severe disability after SAH have a relatively low risk of rupture of UIAs. Their lower treatment indication may also be supported by their known higher treatment risks.

Application of zone classification in multiple intracranial aneurysmal subarachnoid hemorrhage treatment strategies

“…Andic et al [ 16 ] believed that one-stage MIA treatment with combined endovascular techniques was technically feasible but that its safety due to relatively high complication rates remained controversial (i.e., because unruptured tiny aneurysms weighted the low annual spontaneous rupture rate and potential surgical risks) [ 17 ]. A long-term follow-up study [ 18 ] revealed that patients with moderate or severe disability after SAH have a relatively low risk of UIA rupture. Furthermore, over shorter follow-up, intervention and observation appear similarly safe for bystander aneurysms in MIAs [ 19 ].…”

Retrospective Application of Risk Scores to Unruptured Anterior Communicating Artery Aneurysms

“…The AComA complex is a prevalent site for UIAs, constituting up to 33% of cases. A number of studies underscore its elevated risk of rupture, as indicated by a meta-analysis reporting a 2.51 times higher risk for AComA aneurysms compared to those in other anterior circulation sites [15,16]. Moreover, small AComA UIAs have been reported to bear a similar risk of rupture to posterior circulation aneurysms [17].…”

Unruptured Anterior Communicating Artery Aneurysms: Management Strategy and Results of a Single-Center Experience

“…The anterior communicating artery (AComA) region stands out from other anatomical locations due to its congestion of functionally important structures, namely, numerous perforators, and relatively frequent prevalence of AComA UIAs. Additionally, AComA UIAs may exhibit twice the risk of rupture than other UIAs with an annual risk of rupture as high as 2.2% [2,3].…”