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How should small unruptured intracranial aneurysms be managed? - a systematic literature study
EANS Academy. Olsen K. Sep 27, 2019; 276149; EP01083
Mrs. Kirstine Hermann Olsen
Mrs. Kirstine Hermann Olsen

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Abstract
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Background: The latest Danish guidelines on management of unruptured intracranial aneurysms (UIAs), recommend that all aneurysms should receive immediate closure. However, it is important to consider that also treatment itself involves a risk. Recent studies have suggested that small UIAs have a relatively low risk of rupture until growth, because studies have shown a 12-fold increase in rupture risk with growth. Through literature this study will evaluate the risk factors for growth of UIAs.
Methods: To assess the possible risk factors affecting aneurysms growth PubMed were searched using following combination of terms: (Intracranial aneurysm [MESH]) AND (unruptured OR non-ruptured) AND (surveillance OR follow-up) AND (growth OR progression) NOT (polycystic kidney disease). English articles published after 01/01/2000 regarding humans and intradural saccular aneurysms in adults were included. The proposed risk factors were age, overweight, gender, hypertension, hypercholesterolemia, smoking, diabetes, excessive alcohol consumption, multiple aneurysms, family history and site.
Results: 89 articles were found and 46 were relevant based on the title. After reviewing abstracts, 18 were included and critically read.
Size was a significant risk factor for growth in 11/16 studies and is the most consistently significant risk factor. Site is a significant risk factor in 6/17 studies and the second most consistently significant risk factor. All the other proposed risk factors were found sporadically significant among the studies. The annual growth rate was between 1.8-18.7%, and less than 5% in 11/12 studies. Annual rupture rate ranged from 0.0-1.8%, and 0.0-0.55% for aneurysms < 7mm.
Conclusions: This study found that the annual rupture rate of UIAs < 7 mm is low. It also suggests that the initial size should be the main assessment point when planning the management of UIAs. It could be beneficial to manage carefully chosen small asymptomatic UIAs conservatively with surveillance imaging until growth is seen.
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