Unruptured intracranial aneurysm (UIA)

see also International Study of Unruptured Intracranial Aneurysms.

Around 3% of the adult global population has unruptured intracranial aneurysms (UIAs) 1)

It is clear that more incidental intracranial aneurysms will be encountered in the future and advancing technology can be expected to demonstrate them with increasing regularity.

The prevalence of Unruptured intracranial aneurysm (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 a 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 2).

Although the diagnosis of unruptured intracranial aneurysm (IA) has become more frequent, its natural history and management still remain controversial 3).

A better comprehension of its evolution could optimize our therapeutic strategies.

It has been shown that even small aneurysms may enlarge and bleed unpredictably with the passage of time.

Many factors are involved in management of patients with unruptured intracranial aneurysms. Site, size, and group specific risks of the natural history should be compared with site, size, and age-specific risks of repair for each patient 4).

Pooled multivariable analyses of individual data are needed to identify independent risk factors and to provide more reliable risk estimates for individual patients 5).

Studies on natural history of unruptured intracranial aneurysms suggest 10 year cumulative bleeding-related mortality and severe morbidity of no less than 7.5%. In the study of Krisht et al., surgical clipping resulted in an 0.8% rate of mortality and 3.4% permanent morbidity. This suggests that surgical clipping has the potential of a superior outcome to the natural history of patients who have an estimated life expectancy of no less than 10 years 6).

Higher in patients with autosomal dominant polycystic kidney disease (ADPKD) or a positive family history of intracranial aneurysm or subarachnoid haemorrhage than in people without comorbidity.

In Finland and Japan, the higher incidence of subarachnoid haemorrhage is not explained by a higher prevalence of UIAs, implicating higher risks of rupture 7).

During 1995 to 2004, a period of increasing neuroimaging utilization, Gabriel et al., did not observe an increased rate of detection of unruptured brain arteriovenous malformation (BAVM), despite increased detection of unruptured intracranial aneurysm (IA)s 8).

A analysis identified differentially expressed genes and miRNAs in unruptured human cerebral aneurysms, suggesting the possibility of a role for miRNAs in aneurysm formation 9)

see Unruptured intracranial aneurysm rupture risk

see Unruptured intracranial aneurysm screening.

Most unruptured intracranial aneurysms don’t have symptoms. “Most of these patients are found incidentally, when they get an MRI scan or computed tomography angiography scan for something unrelated.

see Unruptured intracranial aneurysm diagnosis.

see Unruptured intracranial aneurysm treatment.

Unruptured intracranial aneurysm Outcome.

see Unruptured intracranial aneurysm case series.

Unruptured intracranial aneurysm case reports.

Vlak MH, Rinkel GJ, Greebe P, Algra A. Risk of rupture of an intracranial aneurysm based on patient characteristics: a case–control study. Stroke. 2013;44(5):1256–9.
Chan DY, Abrigo JM, Cheung TC, Siu DY, Poon WS, Ahuja AT, Wong GK. Screening for intracranial aneurysms? Prevalence of unruptured intracranial aneurysms in Hong Kong Chinese. J Neurosurg. 2015 Oct 16:1-5. [Epub ahead of print] PubMed PMID: 26473778.
Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown RD Jr, Connolly ES Jr, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H, Kirkpatrick PJ, Knuckey N, Koivisto T, Lanzino G, Lawton MT, LeRoux P, McDougall CG, Mee E, Mocco J, Molyneux A, Morgan MK, Mori K, Morita A, Murayama Y, Nagahiro S, Pasqualin A, Raabe A, Raymond J, Rinkel GJ, Rüfenacht D, Seifert V, Spears J, Steiger HJ, Steinmetz H, Torner JC, Vajkoczy P, Wanke I, Wong GK, Wong JH, Macdonald RL. Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group. Stroke. 2014 May;45(5):1523-30. doi: 10.1161/STROKEAHA.114.004519. Epub 2014 Mar 25. PubMed PMID: 24668202.
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O'Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003 Jul 12;362(9378):103-10. PubMed PMID: 12867109.
Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007 Apr;38(4):1404-10. Epub 2007 Mar 1. PubMed PMID: 17332442.
Krisht AF, Gomez J, Partington S. Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period. Neurosurgery. 2006 Feb;58(2):207-16; discussion 207-16. PubMed PMID: 16462473.
Vlak MH, Algra A, Brandenburg R, Rinkel GJ. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol. 2011 Jul;10(7):626-36. doi: 10.1016/S1474-4422(11)70109-0. Review. PubMed PMID: 21641282.
Gabriel RA, Kim H, Sidney S, McCulloch CE, Singh V, Johnston SC, Ko NU, Achrol AS, Zaroff JG, Young WL. Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population. Stroke. 2010 Jan;41(1):21-6. doi: 10.1161/STROKEAHA.109.566018. Epub 2009 Nov 19. PubMed PMID: 19926839; PubMed Central PMCID: PMC2847493.
Bekelis K, Kerley-Hamilton JS, Teegarden A, Tomlinson CR, Kuintzle R, Simmons N, Singer RJ, Roberts DW, Kellis M, Hendrix DA. MicroRNA and gene expression changes in unruptured human cerebral aneurysms. J Neurosurg. 2016 Dec;125(6):1390-1399. PubMed PMID: 26918470; PubMed Central PMCID: PMC5001931.
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