A mathematical model of utility for single screening of asymptomatic unruptured intracranial aneurysms at the age of 50 years

Li, Lucia M.; Bulters, Diederik; Kirollos, Ramez

doi:10.1007/s00701-012-1371-8

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…In family members with 1 affected first-degree relative, screening compared with no screening had an incremental cost-effectiveness ratio of $56 500 per QALY. 189 Finally, Li and colleagues 190 examined various screening models of the asymptomatic general population. Overall, screening resulted in a QALY loss, which equated to a negative clinical impact.…”

Section: Cost-effectiveness Of Screeningmentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

803

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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Section: Cost-effectiveness Of Screeningmentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

803

352

View full text Add to dashboard Cite

show abstract

“…Despite the high sensitivity and specificity provided by these advanced brain‐imaging methods, they are costly and include the risk of complications associated with contrast media or repeated exposure to radiation. In a mathematical analysis, MRA screening of asymptomatic patients was shown to be cost‐effective only when the 5‐year risk of rupture was higher than 13%, as this risk level balanced the cost of MRA and subsequent transarterial embolization for patients with an indication for therapy with the cost of medical care caused by a ruptured aneurysm . In comparison, transcranial Doppler/color‐coded carotid duplex imaging has the advantage of a relatively lower cost in screening aneurysms in the general population than MRA.…”

Section: Discussionmentioning

confidence: 99%

“…In a mathematical analysis, MRA screening of asymptomatic patients was shown to be costeffective only when the 5-year risk of rupture was higher than 13%, as this risk level balanced the cost of MRA and subsequent transarterial embolization for patients with an indication for therapy with the cost of medical care caused by a ruptured aneurysm. 7 In comparison, transcranial Doppler/color-coded carotid duplex imaging has the advantage of a relatively lower cost in screening aneurysms in the general population than MRA. Although direct transcranial Doppler visualization of aneurysms has been reported to have sensitivity of 73% to 78% in some cohorts, the technique is relatively operator dependent, and the sensitivity for aneurysms smaller than 5 mm is poor.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of intracranial aneurysms in asymptomatic population was estimated to range from 1.8% to 3.7% . Because of the low incidence in asymptomatic patients and the relatively higher cost of brain‐imaging studies suitable for detecting aneurysms, the benefits of aneurysm screening in the general population remains unclear . Currently, aneurysm screening with brain CTA/MRA is only recommended for patients with an increased risk of intracranial aneurysms, such as those with a family history of intracranial aneurysms/subarachnoid hemorrhage, autosomal dominant polycystic kidney disease, and coarctation of the aorta…”

mentioning

confidence: 99%

“…[4][5][6] Because of the low incidence in asymptomatic patients and the relatively higher cost of brain-imaging studies suitable for detecting aneurysms, the benefits of aneurysm screening in the general population remains unclear. 7 Currently, aneurysm screening with brain CTA/MRA is only recommended for patients with an increased risk of intracranial aneurysms, such as those with a family history of intracranial aneurysms/subarachnoid hemorrhage, autosomal dominant polycystic kidney disease, and coarctation of the aorta. 8 Transcranial Doppler/color-coded carotid duplex imaging is extensively used to identify abnormalities of the extracranial and intracranial vessels through direct visualization and changes in hemodynamic parameters.…”

mentioning

confidence: 99%

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Association Between Flow Acceleration in the Carotid Artery and Intracranial Aneurysms

Chang

Wai

Lim

et al. 2018

J of Ultrasound Medicine

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Objectives In physiologic pulsatile flow, velocity acceleration is an independent factor determining wall shear stress experienced by the vascular endothelium. The purpose of this study was to evaluate Doppler indices of systolic velocity acceleration in extracranial cerebral vessels and the occurrence of intracranial aneurysms. Methods We reviewed medical records and 3.0‐T brain magnetic resonance imaging with 3‐dimensional time‐of‐flight magnetic resonance angiography of 1323 adults who underwent health checkups from June 2006 to November 2011, in whom 53 intracranial aneurysms were identified in 45 patients. Doppler ultrasound parameters of the carotid and vertebral arteries were analyzed in these 45 patients with aneurysms and compared with another 45 control participants matched for age and sex. We defined the maximum systolic acceleration (ACCmax) as the maximum slope of the early phase of systolic acceleration on the Doppler waveform and the maximum acceleration index (AImax) as the ratio of the ACCmax and peak systolic velocity. Results The Doppler analysis showed a significantly increased AImax and ACCmax in the common carotid artery (CCA), internal carotid artery, and vertebral artery in the aneurysm group. A cutoff 13.89 s−1 for the AImax of the CCA had sensitivity of 80% with a negative predictive value of 99% for intracranial aneurysms. Conclusions This study suggests that the AImax of the CCA with a cutoff of 13.89 s−1 may be an alternative to 3‐dimensional time‐of‐flight magnetic resonance angiography or computed tomographic angiography as a screening tool for intracranial aneurysms. Further prospective studies are needed to validate the diagnostic performance and cost‐effectiveness of these indices for screening.

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Prevalence of Intracranial Aneurysm in Women With Fibromuscular Dysplasia

et al. 2017

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IMPORTANCE The prevalence of intracranial aneurysm in patients with fibromuscular dysplasia (FMD) is uncertain.OBJECTIVE To examine the prevalence of intracranial aneurysm in women diagnosed with FMD. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included 669 women with intracranial imaging registered in the US Registry for Fibromuscular Dysplasia, an observational disease-based registry of patients with FMD confirmed by vascular imaging and currently enrolling at 14 participating US academic centers. Registry enrollment began in 2008, and data were abstracted in September 2015. Patients younger than 18 years at the time of FMD diagnosis were excluded. Imaging reports of all patients with reported internal carotid, vertebral, or suspected intracranial artery aneurysms were reviewed. Only saccular or broad-based aneurysms 2 mm or larger in greatest dimension were included. Extradural aneurysms in the internal carotid artery were included; fusiform aneurysms, infundibulae, and vascular segments with uncertainty were excluded. MAIN OUTCOMES AND MEASURESPercentage of women with FMD with intracranial imaging who had an intracranial aneurysm. RESULTSOf 1112 female patients in the registry, 669 (60.2%) had undergone intracranial imaging at the time of enrollment (mean [SD] age at enrollment, 55.6 [10.9] years). Of the 669 patients included in the analysis, 86 (12.9%; 95% CI, 10.3%-15.9%) had at least 1 intracranial aneurysm. Of these 86 patients, 25 (53.8%) had more than 1 intracranial aneurysm. Intracranial aneurysms 5 mm or larger occurred in 32 of 74 patients (43.2%), and 24 of 128 intracranial aneurysms (18.8%) were in the posterior communicating or posterior arteries. The presence of intracranial aneurysm did not vary with location of extracranial FMD involvement. A history of smoking was significantly associated with intracranial aneurysm: 42 of 78 patients with intracranial aneurysm (53.8%) had a smoking history vs 163 of 564 patients without intracranial aneurysm (28.9%; P < .001). CONCLUSIONS AND RELEVANCEThe prevalence of intracranial aneurysm in women diagnosed with FMD is significantly higher than reported in the general population. Although the clinical benefit of screening for intracranial aneurysm in patients with FMD has yet to be proven, these data lend support to the recommendation that all patients with FMD undergo intracranial imaging if not already performed.

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A mathematical model of utility for single screening of asymptomatic unruptured intracranial aneurysms at the age of 50 years

Abstract: The QALY benefit and cost-effectiveness of screening are most sensitive to the 5-year risk of rupture. Screening is beneficial only in populations with a high risk of rupture; this should be the focus of future research.

Cited by 14 publications

References 34 publications

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Association Between Flow Acceleration in the Carotid Artery and Intracranial Aneurysms

Prevalence of Intracranial Aneurysm in Women With Fibromuscular Dysplasia

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