Access the full text.
Sign up today, get DeepDyve free for 14 days.
W. Brinjikji, Y. Zhu, G. Lanzino, H. Cloft, M. Murad, Z. Wang, D. Kallmes (2016)
Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-AnalysisAmerican Journal of Neuroradiology, 37
Raghav Gupta, C. Griessenauer, N. Adeeb, M. Chua, Justin Moore, A. Patel, A. Thomas, C. Ogilvy (2016)
Evaluating Imaging Follow-Up Strategies and Costs of Unruptured Intracranial Aneurysms Treated with Endovascular Techniques: A Survey of Academic Neurovascular Centers in the United States.World neurosurgery, 94
Justiina Huhtakangas, H. Lehto, K. Seppä, R. Kivisaari, M. Niemelä, J. Hernesniemi, M. Lehecka (2015)
Long-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage: Patients With Multiple Aneurysms at RiskStroke, 46
A. Bor, H. Koffijberg, M. Wermer, G. Rinkel (2010)
Optimal screening strategy for familial intracranial aneurysmsNeurology, 74
E. Güresir, H. Vatter, P. Schuss, J. Platz, J. Konczalla, Richard Rochement, J. Berkefeld, V. Seifert (2013)
Natural History of Small Unruptured Anterior Circulation Aneurysms: A Prospective Cohort StudyStroke, 44
P. Villablanca, G. Duckwiler, R. Jahan, S. Tateshima, N. Martin, J. Frazee, N. Gonzalez, J. Sayre, F. Viñuela (2013)
Natural history of asymptomatic unruptured cerebral aneurysms evaluated at CT angiography: growth and rupture incidence and correlation with epidemiologic risk factors.Radiology, 269 1
N. Alshafai, O. Falenchuk, M. Cusimano (2015)
Practises and controversies in the management of asymptomatic aneurysms: Results of an international surveyBritish Journal of Neurosurgery, 29
J. Wardlaw, P. White (2000)
The detection and management of unruptured intracranial aneurysms.Brain : a journal of neurology, 123 ( Pt 2)
JP Greving, GJ Rinkel, E Buskens, A Algra (2009)
Cost-effectiveness of preventive treatment of intracranial aneurysms: new data and uncertainties, 73
D. Romano, S. Cioni, S. Vinci, G. Pero, C. Comelli, A. Comai, S. Peschillo, D. Mardighian, L. Castellan, F. Resta, M. Piano, S. Comelli, L. Barletta, A. Puliti, S. Leonini, S. Bracco (2016)
Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centersJournal of NeuroInterventional Surgery, 9
A. Morita, T. Kirino, K. Hashi, N. Aoki, S. Fukuhara, N. Hashimoto, T. Nakayama, M. Sakai, A. Teramoto, S. Tominari, T. Yoshimoto (2012)
The natural course of unruptured cerebral aneurysms in a Japanese cohort.The New England journal of medicine, 366 26
M. Sonobe, T. Yamazaki, M. Yonekura, H. Kikuchi (2010)
Small Unruptured Intracranial Aneurysm Verification Study: SUAVe Study, JapanStroke, 41
B. Nahed, M. Diluna, Thomas Morgan, E. Ocal, Abigail Hawkins, K. Ozduman, K. Kahle, A. Chamberlain, A. Amar, M. Gunel (2005)
Hypertension, Age, and Location Predict Rupture of Small Intracranial AneurysmsNeurosurgery, 57
Adnan Qureshi, M. Suri, A. Nasar, J. Kirmani, A. Divani, Wei He, L. Hopkins (2005)
Trends in Hospitalization and Mortality for Subarachnoid Hemorrhage and Unruptured Aneurysms in the United StatesNeurosurgery, 57
AS Bor, H Koffijberg, MJ Wermer, GJ Rinkel (2010)
Optimal screening strategy for familial intracranial aneurysms: a cost-effectiveness analysis, 74
S. Juvela, K. Poussa, H. Lehto, M. Porras (2013)
Natural History of Unruptured Intracranial Aneurysms: A Long-term Follow-up StudyStroke, 44
G. Rinkel, M. Djibuti, A. Algra, J. Gijn (1998)
Prevalence and risk of rupture of intracranial aneurysms: a systematic review.Stroke, 29 1
S. Suh, H. Cloft, J. Huston, K. Han, D. Kallmes (2014)
Interobserver variability of aneurysm morphology: discrimination of the daughter sacJournal of NeuroInterventional Surgery, 8
J. Greving, G. Rinkel, E. Buskens, A. Algra (2009)
Cost-effectiveness of preventive treatment of intracranial aneurysmsNeurology, 73
V. Yamaki, W. Brinjikji, M. Murad, G. Lanzino (2016)
Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-AnalysisAmerican Journal of Neuroradiology, 37
P. Mitchell, J. Jakubowski (2000)
Estimate of the maximum time interval between formation of cerebral aneurysm and ruptureJournal of Neurology, Neurosurgery & Psychiatry, 69
Koji Sato, Y. Yoshimoto (2011)
Risk Profile of Intracranial Aneurysms: Rupture Rate Is Not Constant After FormationStroke, 42
Y. Murayama, H. Takao, T. Ishibashi, T. Saguchi, M. Ebara, I. Yuki, H. Arakawa, K. Irie, M. Urashima, A. Molyneux (2016)
Risk Analysis of Unruptured Intracranial Aneurysms: Prospective 10-Year Cohort StudyStroke, 47
M. Bruneau, S. Amin‐Hanjani, P. Koroknay-Pál, P. Bijlenga, B. Jahromi, H. Lehto, R. Kivisaari, K. Schaller, F. Charbel, Sajeel Khan, C. Mélot, M. Niemela, J. Hernesniemi (2016)
Surgical Clipping of Very Small Unruptured Intracranial Aneurysms: A Multicenter International Study.Neurosurgery, 78 1
K. Fargen, Hector Soriano-Baron, J. Rushing, W. Mack, J. Mocco, F. Albuquerque, A. Ducruet, M. Mokin, I. Linfante, S. Wolfe, John Wilson, J. Hirsch (2017)
A survey of intracranial aneurysm treatment practices among United States physiciansJournal of NeuroInterventional Surgery, 10
P. Bijlenga, Christian Ebeling, M. Jaegersberg, P. Summers, Alister Rogers, Alan Waterworth, J. Iavindrasana, J. Macho, V. Pereira, P. Bukovics, E. Vivas, M. Sturkenboom, Jessica Wright, C. Friedrich, Alejandro Frangi, J. Byrne, K. Schaller, D. Rufenacht, A. Narata, Alison Clarke, J. Yarnold, F. Kover, B. Schatlo, S. Hudak, P. Teta, J. Blasco, A. González, K. Lovblad, S. Coley, T. Dóczi, R. Risselada, T. Sola, P. Lawford, U. Patel, Pankaj Singh, Jeremy Wickins, Bernice Elger, Derick Beyleveld, S. Wood, P. Hasselmeyer, A. Arbona, R. Meyer, R. Hose, G. Lonsdale, M. Hofmann-Apitius, D. Rüfenacht, M. Jägersberg, Jeremy Wilkins, C. Friedrich, M. Sturkenboom, V. Mendes-Pereira, K. Lovblad, D. Rüfenacht, G. Zilani, I. Hudák, T. Dóczi, T. Sola (2013)
Risk of Rupture of Small Anterior Communicating Artery Aneurysms Is Similar to Posterior Circulation AneurysmsStroke, 44
Neal Kassell, J. Torner (1983)
Size of intracranial aneurysms.Neurosurgery, 12 3
SC Johnston, DR Gress, JG Kahn (1999)
Which unruptured cerebral aneurysms should be treated? a cost-utility analysis, 52
M. Wermer, I. Schaaf, A. Algra, G. Rinkel (2007)
Risk of Rupture of Unruptured Intracranial Aneurysms in Relation to Patient and Aneurysm Characteristics: An Updated Meta-AnalysisStroke, 38
Kristen Schwab, P. Gailloud, G. Wyse, R. Tamargo (2008)
Limitations of magnetic resonance imaging and magnetic resonance angiography in the diagnosis of intracranial aneurysms.Neurosurgery, 63 1
A. Go, D. Mozaffarian, V. Roger, E. Benjamin, J. Berry, M. Blaha, S. Dai, E. Ford, C. Fox, Sheila Franco, H. Fullerton, C. Gillespie, S. Hailpern, J. Heit, V. Howard, Mark Huffman, S. Judd, B. Kissela, S. Kittner, D. Lackland, J. Lichtman, L. Lisabeth, R. Mackey, D. Magid, G. Marcus, A. Marelli, D. Matchar, Darren Mcguire, E. Mohler, C. Moy, M. Mussolino, R. Neumar, G. Nichol, D. Pandey, N. Paynter, M. Reeves, P. Sorlie, J. Stein, A. Towfighi, T. Turan, S. Virani, N. Wong, D. Woo, M. Turner (2014)
Heart disease and stroke statistics--2014 update: a report from the American Heart Association.Circulation, 129 3
(2016)
of Veterans Affairs
A. Zali, R. Khoshnood, A. Zarghi (2014)
De novo aneurysms in long-term follow-up computed tomographic angiography of patients with clipped intracranial aneurysms.World neurosurgery, 82 5
S. Johnston, D. Gress, J. Kahn (1999)
Which unruptured cerebral aneurysms should be treated?Neurology, 52
A. Molyneux, J. Birks, Alison Clarke, M. Sneade, R. Kerr (2015)
The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)Lancet, 385
D. Backes, G. Rinkel, K. Laban, A. Algra, M. Vergouwen (2016)
Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth: A Systematic Review and Meta-AnalysisStroke, 47
A. Malhotra, Xiao Wu, H. Forman, Holly Nardini, C. Matouk, D. Gandhi, Christopher Moore, P. Sanelli (2017)
Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review.Annals of internal medicine, 167 1
E. Arias (2014)
United States life tables, 2010.National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 63 7
D. Wiebers (2003)
Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatmentThe Lancet, 362
Didier Martin (1998)
Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention.The New England journal of medicine, 339 24
Y. Ohashi, T. Horikoshi, M. Sugita, T. Yagishita, H. Nukui (2004)
Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage.Surgical neurology, 61 3
B. Carter, S. Sheth, E. Chang, Manish Sethl, C. Ogilvy (2006)
Epidemiology of the Size Distribution of Intracranial Bifurcation Aneurysms: Smaller Size of Distal Aneurysms and Increasing Size of Unruptured Aneurysms with AgeNeurosurgery, 58
E. Connolly (2014)
International study of unruptured intracranial aneurysms.Journal of neurosurgery, 121 5
S. Juvela, M. Porras, O. Heiskanen (1993)
Natural history of unruptured intracranial aneurysms: a long-term follow-up study.Journal of neurosurgery, 79 2
S. Juvela, M. Porras, K. Poussa (2008)
Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture.Journal of neurosurgery, 108 5
T. Steiner, S. Juvela, A. Unterberg, C. Jung, M. Forsting, G. Rinkel (2013)
European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid HaemorrhageCerebrovascular Diseases, 35
I. Schaaf, M. Wermer, B. Velthuis, E. Buskens, P. Bossuyt, G. Rinkel (2006)
Psychosocial impact of finding small aneurysms that are left untreated in patients previously operated on for ruptured aneurysmsJournal of Neurology, Neurosurgery & Psychiatry, 77
Mohamad Chmayssani, Jean Rebeiz, Tania Rebeiz, H. Batjer, B. Bendok (2011)
Relationship of Growth to Aneurysm Rupture in Asymptomatic Aneurysms ≤ 7 mm: A Systematic Analysis of the LiteratureNeurosurgery, 68
(2010)
Optimal screening strategy for familial intracranial aneurysms?PharmacoEconomics & Outcomes News, 609
D. Kashiwazaki, S. Kuroda (2013)
Size Ratio Can Highly Predict Rupture Risk in Intracranial Small (<5 mm) AneurysmsStroke, 44
Gregory Thompson, Robert Brown, S. Amin‐Hanjani, Joseph Broderick, K. Cockroft, E. Connolly, G. Duckwiler, Catherine Harris, Virginia Howard, S. Johnston, Philip Meyers, A. Molyneux, Christopher Ogilvy, Andrew Ringer, J. Torner (2015)
Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke AssociationStroke, 46
ImportanceUnruptured intracranial aneurysms (UIAs) are relatively common in the general population and are being increasingly diagnosed; a significant proportion are tiny (≤3 mm) aneurysms. There is significant heterogeneity in practice and lack of clear guidelines on the management of incidental, tiny UIAs. It is important to quantify the implications of different management strategies in terms of health benefits to patients. ObjectiveTo evaluate the effectiveness of routine treatment (aneurysm coiling) vs 3 strategies for imaging surveillance compared with no preventive treatment or routine follow-up of tiny UIAs. Design, Setting, and ParticipantsA decision-analytic model-based comparative effectiveness analysis was conducted from May 1 to June 30, 2017, using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included 10 000 iterations simulating adult patients with incidental detections of UIAs 3 mm or smaller and no history of subarachnoid hemorrhage. InterventionsThe following 5 management strategies for tiny UIAs were evaluated: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every 5 years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. Main Outcomes and MeasuresA Markov decision model for lifetime rupture was constructed from a societal perspective per 10 000 patients with incidental, tiny UIAs. Outcomes were assessed in terms of quality-adjusted life-years. Probabilistic, 1-way, and 2-way sensitivity analyses were performed. ResultsIn this analysis of 10 000 iterations simulating adult patients with a mean age of 50 years, the base-case calculation shows that the management strategy of no treatment or preventive follow-up has the highest health benefit (mean [SD] quality-adjusted life-years, 19.40 [0.31]). Among the management strategies that incorporate follow-up imaging, MRA every 5 years is the best strategy with the next highest effectiveness (mean [SD] quality-adjusted life-years, 18.05 [0.62]). The conclusion remains robust in probabilistic and 1-way sensitivity analyses. No routine follow-up remains the optimal strategy when the annual growth rate and risk of rupture of growing aneurysms are varied. When the annual risk of rupture of nongrowing UIAs is less than 1.7% (0.23% in base case scenario), no follow-up is the optimal strategy. If annual risk of rupture is more than 1.7%, coiling should be performed directly. Conclusions and RelevanceGiven the current literature, no preventive treatment or imaging follow-up is the most effective strategy in patients with aneurysms that are 3 mm or smaller, resulting in better health outcomes. More aggressive imaging surveillance for aneurysm growth or preventive treatment should be reserved for patients with a high risk of rupture. Given these findings, it is important to critically evaluate the appropriateness of current clinical practices, and potentially determine specific guidelines to reflect the most effective management strategy for patients with incidental, tiny UIAs.
JAMA Neurology – American Medical Association
Published: Jan 20, 2018
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.