Unruptured intracranial aneurysms - Risk of rupture and risks of surgical intervention

Authors
Wiebers, D Whisnant, J Forbes, G Meissner, I Brown, R Piepgras, D Huston, J Nichols, D O'Fallon, W Peacock, J Jaeger, L Kassell, N Kongable-Beckman, G Torner, J Rajput, M Drake, C Kurtzke, J Marler, J Walker, M Meyer, F Atkinson, J Marsh, W Thielen, K Ferguson, G Barr, H Lownie, S Hachinski, V Fox, A Sahjpaul, R Parrent, A Mayer, C Lindsay, K Teasdale, E Bone, I Fatukasi, J Lindsay, M Cail, W Sagher, O Davis, M Sengupta, R Bates, D Gholkar, A Murdy, J Wilson, S Praharaj, S Partridge, G Reynolds, C Hind, N Ogilvy, C Crowell, R Gress, D Schaefer, P Choi, I Buckley, D Sloan, K King, D Giannotta, S Ameriso, S Teitelbaum, T Thomson, E Fishback, D Vajda, J Nyary, I Czirjak, S Horvath, M Szikora, I Pasztor, E Varady, P Erdos, A Edner, G Wahlgren, N Lindqvist, M Antonsson, A Da Pian, R Pasqualin, A Chioffi, F Beltramello, A Zampieri, G Benati, A Rossi, G Ronkainen, A Hernesniemi, J Vapalahti, M Rinne, J Luukkonen, M Vihavainen, M Savolainen, S Koivisto, T Leivo, S Helin, K Steinberg, G Marks, M Vanefsky, M Norbash, A Thompson, R Bell, T Marcellus, M Meyer, A Kerr, R Adams, C Molyneux, A Vinden, S Bacon, F Shrimpton, J Parker, S Day, A Nadeau, S Stachniak, J Friedman, W Fessler, R Peters, K Jacob, R Roper, S Smith, A LaFrentz, P Howard, M Loftus, C Adams, H Crosby, D Rogers, M Broderick, J Tew, J Brott, T van Loveren, H Yeh, H Zuccarello, M Tomsick, T Gaskill-Shipley, M Minneci, L McMahon, N Castel, J Orgogozo, J Loiseau, H Bourgeois, P Berge, J Dousset, V Cuny, E Richard, M Agbi, C Hugenholtz, H Benoit, B Morrish, W Wee, R Grahovac, S Pratt, L Mortensen, M Andreoli, A Testa, C Comani, V Trevisan, C Limoni, P Carlucci, F Leonardi, M Sturiale, C Pendl, G Eder, H Klein, G Eder, M Leber, K Horner, T Leipzig, T Payner, T Denardo, A Scott, J Redelman, K Fisher, W Rosner, M Vitek, G Hand, M Flack, WF Sichez, J Pertuiset, B Fohanno, D Marsault, C Casasco, A Biondi, A Capelle, L Duffau, H Winn, H Grady, M Newell, D Longstreth, W Thompson, P Bybee, H Jones, D Findlay, J Petruk, K Steinke, D Ashforth, R Stenerson, P Schindel, D Vanderhoven, H Neves, J Zager, E Flamm, E Raps, E Hurst, R Parrott, S Sellers, M Torchia, M Anderson, B West, M Fewer, D Hill, N Sutherland, G Ross, I McClarty, B Brownstone, R Williams, O Narotam, P Christane, L McGinn, G Gladish, D Kirkpatrick, P Pickard, J Antoun, N Simpson, D Higgins, N Turner, C Tebbs, S Holness, R Malloy, D Phillips, S Maloney, W Molina-de-Orozco, V Baxter, B Connolly-Campbell, K MacDougall, A Gentili, F Wallace, M ter Brugge, K Willinsky, R Tymianski, M Rickards, L Tucker, W Lambert, C Montanera, W Rychlewski, C Flood, C Villani, R Sganzerla, E Tomei, G Bettinelli, A Leonardi, M Ceccarelli, G Righini, A Bello, L Marras, C Nelson, R Lewis, T Renowden, C Clarke, Y Varian, L Chyatte, D Sila, C Perl, J Masaryk, T Porterfield, R Shaw, M Foy, P Nixon, T Dunn, L Clitheroe, N Smith, T Eldridge, P Humphrey, P Wiseman, J Hawkins, K Owen, L Ost, K Saminaden, S Mohr, G Schondorf, R Carlton, J Maleki, M Just, N Brien, S Entis, S Tampieri, D Simons, N Mooij, J Metzemackers, J Hew, J Beks, J van der Veen, A Bosma, I Sprengers, M Rinkel, G van Gijn, J Ramos, L Tulleken, C Greebe, P van Vliet, F Borgesen, S Jespersen, B Boge-Rasmussen, T Willumsen, L Homer, D Eller, T Carpenter, J Meyer, J Munson, R Small, B Nussbaum, E Heros, R Latchaw, R Camarata, P Lundgren, J Mattsen, N Whittle, I Sellar, R O'Sullivan, M Steers, A Statham, P Malcolm, G Price, R Hoffman, B Yonas, H Wechsler, L Thompson-Dobkin, J Jungreis, C Kassam, A Kirby, L Parent, A Lewis, A Azordegan, P Smith, R Alexander, L Gordon, D Russell, W Brown, R Benashvili, G Perry, R Scalzo, D Mandybur, G Morgan, C Karanjia, P Madden, K Kelman, D Gallant, T Vanderspek, H Choucair, A Neal, J Mancl, K Saveland, H Brandt, L Holtas, S Trulsson, B Macdonald, R Weir, B Mojtahedi, S AMidei, C Vermeulen, M Bosch, D Hulsmans, F Albrecht, K Roos, Y Vet, A Gorissen, A Mechielsen, M Martin, N Gobin, Y Saver, J Vinuela, F Duckwiler, G Kelly, D Frazee, J da Graca, R Gravori, T Illingworth, R Richards, P Wade, J Colquhoun, I Bashir, E Shortt, S Weaver, J Fisher, M Stone, B Chaturvedi, S Davidson, R Davidson, K Giombini, S Solero, C Boiardi, A Cimino, C Valentini, S Silvani, A Alberts, M Friedman, A Gentry, A Hoffman, K Hughes, R Lillihei, K Earnest, M Nichols, J Kindt, G Anderson, A Levy, S Nichols, J Smith, R Breeze, R Noonan, V Gress, D Dowd, C Vanwestrop, J Wilson, C Berger, M Hannegan, L Heros, R Marcos, J Ugarte, L Kitchen, N Taylor, W Kumar, M Grieve, J Durity, F Boyd, M Fairholm, D Griesdale, D Honey, C Redekop, G Toyota, B Turnbull, I Woodhurst, W Zwimpfer, T Teal, P Grabe, D Brevner, A Piepgras, A Schmiedek, P Schwartz, A Weber, T Biller, J Brem, S Cybulski, G Chadwick, L Bronstein, K Pietila, T Brock, M Krug, D Krznaric, I Hernesniemi, J Kivisaari, R
Citation
D. Wiebers et al., Unruptured intracranial aneurysms - Risk of rupture and risks of surgical intervention, N ENG J MED, 339(24), 1998, pp. 1725-1733
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
NEW ENGLAND JOURNAL OF MEDICINE
ISSN journal
0028-4793 → ACNP
Volume
339
Issue
24
Year of publication
1998
Pages
1725 - 1733
Database
ISI
SICI code
0028-4793(199812)339:24<1725:UIA-RO>2.0.ZU;2-6
Abstract
Background The management of unruptured intracranial aneurysms requires kno wledge of the natural history of these lesions and the risks of repairing t hem. Methods A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospect ive and prospective components. In the retrospective component, we assessed the natural history of unruptured intracranial aneurysms in 1449 patients with 1937 such aneurysms; 727 of the patients had no history of subarachnoi d hemorrhage from a different aneurysm (group 1), and 722 had a history of subarachnoid hemorrhage from a different aneurysm that had been repaired su ccessfully (group 2). In the prospective component, we assessed treatment-r elated morbidity and mortality in 1172 patients with newly diagnosed unrupt ured intracranial aneurysms. Results In group 1, the cumulative rate of rupture of aneurysms that were l ess than 10 mm in diameter at diagnosis was less than 0.05 percent per year , and in group 2, the rate was approximately 11 times as high (0.5 percent per year). The rupture rate of aneurysms that were 10 mm or more in diamete r was less than 1 percent per year in both groups, but in group 1, the rate was 6 percent the first year for giant aneurysms (greater than or equal to 25 mm in diameter). The size and location of the aneurysm were independent predictors of rupture. The overall rate of surgery-related morbidity and m ortality was 17.5 percent in group 1 and 13.6 percent in group 2 at 30 days and was 15.7 percent and 13.1 percent, respectively, at 1 year. Age indepe ndently predicted surgical outcome. Conclusions The likelihood of rupture o f unruptured intracranial aneurysms that were less than 10 mm in diameter w as exceedingly low among patients in group 1 and was substantially higher a mong those in group 2. The risk of morbidity and mortality related to surge ry greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter. (N E ngl J Med 1998;339:1725-33.) (C) 1998, Massachusetts Medical Society.