Unruptured Familial Intracranial Aneurysms: Are these at greater risk of rupture? Macquarie Neurosurgery Evidence Based Surgery presentation Date:23rd February 2012 Leon Lai EBS presentation 1
Clinical case34F; incidental paraclinoid aneurysm (5mm) Non-smoker; No Hypertension Brother died of ruptured aneurysm Is this aneurysm at greater risk of rupture compared to sporadic one? (Treat or not treat?)
Searchable question (PICO format)• P = Familial Unruptured Intracranial Aneurysms• I = Observation• C = Sporadic/Non-familial Unruptured Intracranial Aneurysms• O = Rupture; SAH
Search strategy P 1. exp Intracranial Aneurysm/ep, ge, pa [Epidemiology, Genetics, Pathology] AND Familial.mp. Or 5. exp Intracranial Aneurysm/ep, ge, pa [Epidemiology, Genetics, Pathology] AND Family study.mp. I NA C NA O exp Aneurysm, Ruptured/ep, ge, pa [Epidemiology, Genetics, Pathology] Or exp Subarachnoid Hemorrhage/ep, ge, pa [Epidemiology, Genetics, Pathology]
FIAs: Other featuresMultiple aneurysms more commonDe novo aneurysms more commonRupture tend to occur within same decade of life as that ofsiblingCompared to sporadic aneurysms, Rupture tends to be 5 years earlier Rupture is at a smaller size (1-2mm)
(Stroke. 2009;40:1952-1957) Prospective, 26 clinical centres in North America, Australia, NZ. 2 or more affected family members Smoker or Hypertension or both 17x increased risk of rupture (ISUIA 0.069%) 2 ruptures 1.2% per year(96% aneurysms<7mm)
FIA study: Ruptured IAs during prospective follow up
ISUIA Data“Family history of SAH does not increase the risk of rupture in this group”
SUAVA Data(Prospective, 2000 to 2004; 12 clinical centres in Japan, aneurysms<5mm)
Conclusion34F; incidental paraclinoid aneurysm (5mm) Non-smoker; No Hypertension Brother died of ruptured aneurysm Is this aneurysm at greater risk of rupture compared to sporadic one?Retrospective data: 2 to 5x increased risk of rupture; rupture is 5 years earlier and at a smaller size (1-2mm) Prospective data (1 study) –17x increased risk of rupture
Conclusion X = risk of rupture/year; Y = life expectancy (years)ISUIA: X=0.069%; Y=40 Risk = 2.72% over next 40 yearsSUAVE: X=0.34%; Y=40 Risk = 12.74% over next 40 years FIA Study: X=1.2%; Y=40 Risk = 38.30% over next 40 years TREAT!
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