Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms

Quality of Life, Anxiety, and Depression in Patients With an Untreated Intracranial Aneurysm or Arteriovenous Malformation

“…Including these psychological factors in the equation is not straightforward, because little is known about their importance. 4 Thus, we evaluated health-related quality of life (QOL) and symptoms of anxiety and depression in patients with an untreated aneurysm or AVM.…”

Unruptured Intracranial Aneurysms: Some Questions Answered, Many Questions Remain

“…Some of these available guidelines 8 , cost-utility analyses 9 , and expert opinion recommendations 10,11 were published prior to the availability of more detailed aneurysm site-and size-specific natural history data, and morbidity and mortality of surgery and endovascular therapies from large prospective cohort studies. Most experts are in agreement that larger UIAs and those that are symptomatic should be considered for interventional treatment [12][13][14][15][16][17] because of the unacceptably high risk of UIA rupture with conservative management.…”

“…Another decision and cost-effectiveness analyses suggested that treatment of very small aneurysms, <7 mm in diameter, is not cost-effective 19 . The early retrospective natural history data from ISUIA contributed to a 2000 American Heart Association guideline 8 which suggested that repair of small UIAs in patients with no history of SAH could "no longer be generally advocated". However, it is noteworthy that the guideline was developed prior to the availability of prospective ISUIA data, published in 2003 6 .…”

“…Despite the data nicely summarized by Dr. Pelz, numerous important questions remain regarding the management of UIAs: 1) do we have valid and reliable aneurysm-location and sizespecific natural history data for the spectrum of UIAs so commonly seen in clinical practice, 2) do we have contemporary data regarding the objective outcomes-included death and major functional and cognitive morbidities-for surgical and endovascular management of UIAs, 3) if we manage conservatively, what is the risk of UIA growth (which should likely mandate surgical or endovascular intervention), 4) are there aneurysm characteristics, beyond those published in the available observation studies and in the realm of morphological characteristics and computational fluid dynamics, which might assist us in defining the long term rupture risks at the time of UIA detection, 5) in the absence of a clinical trial, can we directly compare the available natural history and interventional data via some other analytic approach, such as a propensity analysis, 6) are there genotypic predictors of aneurysm occurrence, rupture, growth and morphology change, or biomarkers and genotypic predictors of outcome of aneurysm management, 7) is there clinical equipoise in the management of some subgroup of patients with UIAs such that a randomized clinical trial should be performed and what would be the best design of such a trial, 8) given that cigarette smoking and hypertension are risk factors for subarachnoid hemorrhage in general and for UIA formation, would aggressive treatment of these risk factors lower the likelihood of rupture, and 9) are there medical treatments such as aspirin 25 that could conceivably lower the risk of aneurysm rupture?…”

Adenosine-Induced Transient Asystole

“…1 Although cerebral aneurysms can present with other symptoms related to their mass effect, such as cranial nerve palsies, the most significant sequelae are related to subarachnoid (SAH) secondary to aneurysm rupture. The mortality rate following aneurysm rupture, or SAH, remains at 20% to 40%, and up to 50% of those who survive are left disabled.…”