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A pproximately 3% of the adult population has an unruptured intracranial aneurysm.1 Identification of an unruptured aneurysm offers an opportunity for preventive endovascular or microsurgical occlusion, but both treatment methods carry risks of complications.2,3 For many small aneurysms, the risk of rupture is considered to be much lower than this risk of complications, [2][3][4] and such aneurysms are often left untreated. Because aneurysms tend to increase in size over time, and larger size is associated with higher risk of rupture, follow-up imaging to assess growth of aneurysms is recommended for aneurysms that are left untreated. 5 Moreover, growth may be a good surrogate marker for rupture in follow-up and treatment studies on unruptured intracranial aneurysms because risk prediction models for rupture also predict growth. 6 In this systematic review and meta-analysis, we aim to identify patient-and aneurysm-specific risk factors for aneurysm growth. MethodsWe performed a MEDLINE and EMBASE search (last search February 20, 2015) using the following search terms: aneurysm* and unruptured or incidental and intracranial or cerebral or brain or intracerebral or cranial and grow* or increase or enlarge* or develop* or progress*. The search terms were limited to title and abstract. One author (D.B.) screened all records with regard to title and abstract. We included all cohort studies with aneurysm growth as an outcome measure in which effect estimates for aneurysm growth were given or could be calculated. Exclusion criteria were (1) article written in language other than English, Dutch, German, French, Spanish, or Italian; (2) studies on vascular malformations other than intracranial aneurysms; (3) reviews, editorials, letters, conference abstracts, case reports, and case series <15 patients; and (4) in vitro studies, animal studies, simulation studies, or mathematical models. Two authors (D.B. and K.G.L.) independently screened all remaining full-text articles on their eligibility for inclusion. We also checked the prospectively collected personal database of one of the authors (G.J.E.R.) and cross-checked the reference lists of all included studies for further relevant studies until no further publication was found (Figure 1).Background and Purpose-Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient-and aneurysm-specific risk factors for aneurysm growth. Data ExtractionTwo authors (D.B. and K.G.L.) independently extracted crude data and effect estimates (odds ratio, relative risk, and hazard ratio) for patient-and aneurysm-specific risk factors for aneurysm growth. In case multiple publications reported on the same patient population, we included data from the publication with the largest number of patients. If other publications on the same patient population provided data on risk factors that were not described in the publication with the largest patient population, we also included those data. Patient charact...

No abstract

A single, high-quality computed tomography angiography is the preferred diagnostic strategy. Short-term complications are rare and often transient. Long-term outcome is excellent with respect to disability and death, but high-quality studies focused at neuropsychological sequelae are needed.

In clinical trials, endothelin receptor antagonists (ETRAs) reduced vasospasm but did not improve functional outcome after subarachnoid hemorrhage (SAH). We assessed the effects of treatment with ETRAs on clinically relevant outcomes in animal studies modelling SAH by performing a systematic review of the literature for controlled animal studies of ETRAs for the treatment of SAH. Primary outcomes were neurobehavioral outcomes and case fatality. Secondary outcomes were cerebral vasospasm and cerebral blood flow. Summary estimates were calculated using normalized mean difference random effects meta-analysis. We included 27 studies (55 experiments, 639 animals). Neurobehavioral scores were reported in none of the experiments, and case fatality in 8 (15%). Treatment with ETRAs was associated with a pooled odds ratio for case fatality of 0.61 (95% confidence interval (CI), 0.27 to 1.39); a 54% increase (95% CI, 39 to 69) in cerebral arterial diameter; and a 93% increase (95% CI, 58 to 129) in cerebral blood flow. We conclude that there is no evidence from animal studies that treatment with an ETRA improves clinically relevant outcomes after SAH. The reduction in cerebral vasospasm observed in animal studies is consistent with that observed in clinical trials, an effect that is not associated with better functional outcome in patients.