The unruptured intracranial aneurysm treatment score

Etminan, Nima; Brown, Robert D.; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C.; Derdeyn, Colin P.; Raabe, Andreas; Mocco, J; Korja, Miikka; Abdulazim, Amr; Amin‐Hanjani, Sepideh; Salman, Rustam Al-Shahi; Barrow, Daniel L.; Bederson, Joshua B.; Bonafé, Alain; Dumont, Aaron S.; Fiorella, David; Gruber, Andreas; Hankey, Graeme J.; Hasan, David; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael; Kirkpatrick, Peter J.; Knuckey, Neville W.; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vítor Mendes; Molyneux, Andrew; Morgan, M.; Mori, Kentaro; Murayama, Yuichi; Saijo, Nagahiro; Nakayama, Naoki; Niemelä, Mika; Ogilvy, Christopher S.; Piérot, Laurent; Rabinstein, Alejandro A.; Roos, Yvo B.W.E.M.; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans Jakob; Vergouwen, Mervyn D.I.; Wanke, Isabel; Wermer, Marieke J.H.; Wong, George Kwok Chu; Wong, John H.; Zipfel, Gregory J.; Connolly, E. Sander; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, A.; Rüfenacht, Daniel A.; Vajkoczy, Peter; McDougall, Cameron G.; Hänggi, Daniel; LeRoux, Peter D.; Rinkel, Gabriël J.E.; Macdonald, R. Loch

doi:10.1212/wnl.0000000000001891

Cited by 317 publications

(188 citation statements)

References 29 publications

(28 reference statements)

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“…19 In practice, other potential causes have to be searched for and treated, whereas the unruptured aneurysm can be managed according to current guidelines. 20 The opponents suggested that catheter angiography was not necessary after normal CT and LP, because these patients had "benign TCH." This suggestion was based on two prospective studies of patients with sudden headaches, who were all investigated by brain CT without contrast and LP after normal CT, but who had no catheter angiography after normal CT and LP.…”

Section: History Of the Recognition Of Rcvs As A Common Cause Of Tchmentioning

confidence: 99%

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

2016

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During the last 10 years, reversible cerebral vasoconstriction syndrome (RCVS) has emerged as the most frequent cause of thunderclap headache (TCH) in patients without aneurysmal subarachnoid hemorrhage, and as the most frequent cause of recurrent TCHs. The typical TCHs of RCVS are multiple, recurring over a few days to weeks, excruciating, short-lived, and brought up by exertion, sexual activities, emotion, Valsalva maneuvers, or bathing, among other triggers. All these triggers induce sympathetic activation. In a minority of cases with RCVS, TCH heralds stroke and rarely death. Early diagnosis of RCVS in patients who present with isolated headache enables proper management and might reduce the risk of eventual stroke. This review describes the characteristics, triggers, diagnosis, and management of TCH in RCVS. One aim is to underline that the TCH pattern of RCVS is so typical that it enables, according to the 2013 revision of the International Classification of Headache Disorders, the diagnosis of "probable RCVS" in patients with such a headache pattern, normal cerebral angiography, and no other cause. Another objective is to discuss the role of physical and emotional stress in RCVS and in other related conditions involving similar triggers.

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Section: History Of the Recognition Of Rcvs As A Common Cause Of Tchmentioning

confidence: 99%

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

2016

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“…8 Risk scores combining multiple risk factors to predict the rupture of unruptured sIAs have been developed, such as Population, Hypertension, Age, Size of sIA, Earlier SAH From Another sIA, Site of sIA (PHASES) 17 and the Unruptured Intracranial Aneurysm Treatment Score (UIATS). 18 To determine the usefulness of size and irregular sIA shape as markers of an unstable rupture-prone sIA wall at different locations and in different patient subpopulations, we studied an unselected consecutive series of ruptured and unruptured saccular nonmycotic aneurysms diagnosed and treated 1980 to 2014 in the Kuopio University Hospital (KUH). We focused especially on those sIAs that eventually ruptured, and on how well size or shape would have identified those sIAs as rupture prone and thus necessitating treatment.…”

Section: May 2016mentioning

confidence: 99%

Irregular Shape of Intracranial Aneurysm Indicates Rupture Risk Irrespective of Size in a Population-Based Cohort

Lindgren

Koivisto

Björkman

et al. 2016

Stroke

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166

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Larger size increased the risk of rupture also in the Japanese (Unruptured Cerebral Aneurysm Study [UCAS]) and Finnish natural history studies. 5,7 Observational studies, however, demonstrate that a significant portion of those sIAs that ruptured did so Background and Purpose-Size and shape of saccular intracranial aneurysms (sIA) reflect the condition of the sIA wall and were risk factors for rupture in previous follow-up studies. We investigated how well size or shape identify ruptureprone sIAs. Methods-In a population-based registry, we investigated the characteristics of ruptured sIAs treated in a single neurosurgical center . In addition to univariate analysis, logistic regression was used in multivariate analysis, and sensitivity and specificity of size or shape were calculated using receiver operating characteristic curves. Results-Ruptured sIAs were on average larger than unruptured sIAs (median, 7 versus 4 mm; P<0.000), but location and patient background affected the size at rupture. Of the ruptured sIAs, 38% were smaller than 7 mm and 18% were smaller than 4 mm. Of those sIAs that had ruptured at a small (<7 mm) size, 87% had an irregular shape. In multivariate analysis, irregular shape had the strongest association with presentation as ruptured sIA (odds ratio, 7.1; 95% confidence interval, 6.0-8.3), with better sensitivity (91%) and specificity (76%), in contrast to smoking (odds ratio, 0.7; 95% confidence interval, 0.6-0.9; sensitivity, 28%; specificity 57%) and Population, Hypertension, Age, Size of sIA, Earlier SAH from another sIA, Site of sIA score (odds ratio, 1.5; 95% confidence interval, 1.4-1.6). Conclusions-Irregular

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“…Even if these tests are easily applicable and correlate well with the severity of the disease, they have numerous limitations and thus need more validation. [6][7][8][9] For instance, aneurysm size remains a major criterion for treatment as it is assumed that large IAs are at higher risk for rupture than small IAs. However, small IAs with regular shape may also rupture.…”

Section: Introductionmentioning

confidence: 99%

Role of hemodynamics in initiation/growth of intracranial aneurysms

Diagbouga

Morel

Bijlenga

et al. 2018

Eur J Clin Investigation

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Background: Intracranial aneurysm (IA) is a disease of the vascular wall resulting in abnormal enlargement of the vessel lumen. It is a common pathology with a prevalence of 2%-3% in the adult population. IAs are mostly small, quiescent and asymptomatic; yet, upon rupture, severe brain damage or even death is frequently encountered. In addition to clinical factors, hemodynamic forces, mainly wall shear stress (WSS), have been associated with the initiation of IAs and possibly with their risk of rupture. However, the mechanism by which WSS contributes to aneurysm growth and rupture is not completely understood. Design: PubMed and Ovid MEDLINE databases were searched. In addition, key review articles were screened for relevant original publications. Results: Current knowledge about the relation between WSS and IA has been obtained from both computational fluid dynamic studies in patients and experimental models of IA formation and growth. It is increasingly recognized that a high wall shear stress (gradient) participates to IA formation and that both low and high WSS can drive IA growth. Primary cilia (PC) play an important role as mechanosensors as patients with polycystic kidney disease, which is characterized by the absence or dysfunction of PC, have increased risk to develop IAs as well as increased risk of rupture. Conclusion: Wall shear stress is a key player in IA initiation and progression. It is involved in vascular wall remodelling and inflammation, processes underlying aneurysm pathophysiology. K E Y W O R D Sendothelium, intracranial aneurysms, primary cilium, wall shear stress

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The unruptured intracranial aneurysm treatment score

Cited by 317 publications

References 29 publications

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

The Typical Thunderclap Headache of Reversible Cerebral Vasoconstriction Syndrome and its Various Triggers

Irregular Shape of Intracranial Aneurysm Indicates Rupture Risk Irrespective of Size in a Population-Based Cohort

Role of hemodynamics in initiation/growth of intracranial aneurysms

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