Unruptured intracranial aneurysms in elderly patients

Inagawa, Tetsuji; Hada, Hiroshi; Katoh, Yoshiharu

doi:10.1016/0090-3019(92)90023-g

Cited by 72 publications

(27 citation statements)

References 37 publications

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“…[5][6][7] The annual bleeding rate of asymptomatic UIAs has been investigated by retrospective and prospective studies. 2,3,5,[10][11][12][13][14][15][16][17][18][19][20][21] However, the estimates of UIA rupture risk vary considerably and appear to depend on study design, study population, and aneurysm characteristics. 1,2,6 In a study by Wiebers et al, 6 5-year cumulative rupture rates for UIAs located in the ICA, anterior communicating artery, ACA, or MCA were 0%, 2.6%, 14.5%, and 40% for aneurysms Ͻ7 mm, 7-12 mm, 13-24 mm, and Ն25 mm, respectively, compared with rates of 2.5%, 14.5%, 18.4%, and 50%, respectively, for the same-sized categories involving posterior circulation and posterior communicating artery aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

Im¹,

Han²,

Kwon³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

Im¹,

Han²,

Kwon³

et al. 2008

AJNR Am J Neuroradiol

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“…11,19,27,29,57,61,70 In these studies, 17 of 686 patients died after operation (2.5%; 95% CI, 1.5% to 3.9%). Data on morbidity were available in 5 of 7 studies: 80 of 629 patients had postoperative sequelae (12.7%; 95% CI, 10.1% to 15.3%).…”

Section: Subgroup Analysis Of Studies Of Good Qualitymentioning

confidence: 99%

Mortality and Morbidity of Surgery for Unruptured Intracranial Aneurysms

Raaymakers

Rinkel

Limburg

et al. 1998

Stroke

455

240

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Background and Purpose-Greater availability and improvement of neuroradiological techniques have resulted in more frequent detection of unruptured aneurysms. Because prognosis of subarachnoid hemorrhage is still poor, preventive surgery is increasingly considered as a therapeutic option. Elective surgery requires reliable data on its risks. Therefore, we performed a meta-analysis on the mortality and morbidity of surgery for unruptured intracranial aneurysms. Methods-Through Medline and additional searches by hand, we retrieved studies on clipping of unruptured (additional, symptomatic, or incidental) aneurysms published from 1966 through June 1996. Two authors independently extracted data. We used weighted linear regression for data analysis. Results-We included 61 studies that involved 2460 patients (57% female; mean age, 50 years) and at least 2568 unruptured aneurysms (27% Ͼ25 mm, 30% located in the posterior circulation). Mortality was 2.6% (95% confidence interval [CI], 2.0% to 3.3%). Permanent morbidity occurred in 10.9% (95% CI, 9.6% to 12.2%) of patients.Postoperative mortality was significantly lower in more recent years for nongiant aneurysms and aneurysms with an anterior location; the last 2 characteristics were also associated with a significantly lower morbidity. Conclusions-In studies published between 1966 and 1996 on clipping of unruptured aneurysms, mortality was 2.6% and morbidity was 10.9%. In calculating the pros and cons of preventive surgery, these proportions should be taken into account. (Stroke. 1998;29:1531-1538.)

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“…2,3,7,12,14,19,26,29,32,34,39,42,43,45,46) A retrospective study of 360 patients with a mean follow up of 6.25 years reported a risk of 2.3%/year. 46) An annual risk of 1.4%/year was found in 142 patients with 181 unruptured-asymptomatic intracranial aneurysms.…”

Section: Resultsmentioning

confidence: 99%

Treatment Strategy for Patients with Unruptured Intracranial Aneurysms.

Zuccarello

2001

Neurol. Med. Chir.(Tokyo)

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The increased sensitivity of neuroimaging techniques has enabled the more frequent diagnosis of unruptured aneurysms. Because the most devastating complication of an unruptured aneurysm is subarachnoid hemorrhage, it has been considered desirable to treat these aneurysms before they rupture. However, the optimal treatment strategy for patients with unruptured aneurysms remains controversial. The management decision requires knowledge of the natural history and an accurate assessment of the risks related to various treatment options. On December 10, 1998 the New England Journal of Medicine published an article by the International Study of Unruptured Intracranial Aneurysms Investigators. The study retrospectively assessed the natural history of unruptured aneurysms in 1449 patients; in addition, treatment-related mortality and morbidity were examined in a prospective cohort of 1172 patients. The major finding was that the rate of rupture for aneurysms smaller than 10 mm in diameter in patients with no history of subarachnoid hemorrhage was 0.05% per year, and that the mortality and morbidity associated with surgery greatly exceeded the risk of rupture in such patients. This report has generated tremendous controversy in the treatment of unruptured aneurysms and has influenced our decision making. The results of this study are critically analyzed and potential flaws presented. To develop recommendations for treatment, the literature was reviewed. The conclusion of this search is that there is insufficient evidence to recommend a standard of management. Therapeutic guidelines are provided, particularly for patients with small incidental aneurysms and no history of subarachnoid hemorrhage.

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Unruptured intracranial aneurysms in elderly patients

Cited by 72 publications

References 37 publications

Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

Mortality and Morbidity of Surgery for Unruptured Intracranial Aneurysms

Treatment Strategy for Patients with Unruptured Intracranial Aneurysms.

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