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

Abstract

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.

Increased Wall Enhancement Extent Representing Higher Rupture Risk of Unruptured Intracranial Aneurysms

“…The risk of aneurysm rupture in Chinese people is assumed to be similar to Japanese. Thus, populations from China had three points for geographical region 5,14) . PHASES risk scores in this dataset were divided into two levels based on the rupture risk (high risk ≥10 points, intermediate-low risk <10 points).…”

Small vs. Large Unruptured Cerebral Aneurysm: Concerns With the Age of Patient

“…The prevalence of unruptured cerebral aneurysms (UCAs) varies from 2.3% to 7.0% in Chinese population ( 1 , 2 ), and the older UCA patients have increasingly been diagnosed in the last few decades due to development of imaging technology and steadily aging society ( 3 , 4 ). Because of vasculature tortuosity and sclerosis, more comorbidities, and shorter life expectancy ( 5 , 6 ), the optimal management of older patients with UCAs remains controversial and challenging.…”

Identification of potential key pathways, genes and circulating markers in the development of intracranial aneurysm based on weighted gene co-expression network analysis

“…Intracranial aneurysm (IA) is a disease resulted from weak brain control, characterized by local expansion or dilation of brain artery; typically, cystic aneurysm is the most commonly seen, which is the leading cause inducing spontaneous subarachnoid haemorrhage (SAH) [1]. The overall prevalence rate of unruptured intracranial aneurysm (UIA) among populations with no common disease is 3.2%, with the average age of 50 years old [2,3]. In recent years, IA has been increasingly detected due to the frequent application of imaging technique in clinic [4,5].…”