ebs unruptured aneurysms 2012
TRANSCRIPT
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EBS presentation 1
Unruptured Familial Intracranial Aneurysms:
Are these at greater risk of rupture?
Macquarie Neurosurgery
Evidence Based Surgery presentation
Date:23rd February 2012
Leon Lai
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Clinical case
34F; incidental paraclinoid aneurysm (5mm)
Brother died of ruptured aneurysm
Non-smoker; No Hypertension
Is this aneurysm at greater risk of rupture compared to sporadic one?
(Treat or not treat?)
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Searchable question (PICO format)
• P = Familial Unruptured Intracranial Aneurysms
• I = Observation
• C = Sporadic/Non-familial Unruptured Intracranial Aneurysms
• O = Rupture; SAH
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Search strategy
P 1. exp Intracranial Aneurysm/ep, ge, pa [Epidemiology, Genetics, Pathology] AND Familial.mp.
Or
2. exp Intracranial Aneurysm/ep, ge, pa [Epidemiology, Genetics, Pathology] AND Family study.mp.
I NA
C NA
O exp Aneurysm, Ruptured/ep, ge, pa [Epidemiology, Genetics, Pathology]
Or exp Subarachnoid Hemorrhage/ep, ge, pa [Epidemiology, Genetics, Pathology]
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Medline Search results
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Scopus Search results
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Summary of search results
Year Results
Medline Search 1950-2012 55 articles
Scopus search 1960-2012 57 articles
Cochrane Review NA 0 articles
Duplicates References NA 26 articles
Subtotal 99 articles
Relevance (title/abstract) 32 articles
Bibliography/References 6 articles
TOTAL 38 articles
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Retrospective FIA Series
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Prevalence among aSAHs
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Risk of rupture compared to non-FIA cases?
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FIAs: Other features
Compared to sporadic aneurysms,
Rupture tends to be 5 years earlier
Rupture is at a smaller size (1-2mm)
Rupture tend to occur within same decade of life as that of sibling
De novo aneurysms more common
Multiple aneurysms more common
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Prospective FIA Series
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(Stroke. 2009;40:1952-1957)
Prospective, 26 clinical centres in North America, Australia, NZ.
Smoker or Hypertension or both
2 ruptures 1.2% per year
(96% aneurysms<7mm)
17x increased risk of rupture(ISUIA 0.069%)
2 or more affected family members
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FIA study: Ruptured IAs during prospective follow up
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ISUIA Data
“Family history of SAH does not increase the risk of rupture in this group”
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SUAVA Data(Prospective, 2000 to 2004; 12 clinical centres in Japan, aneurysms<5mm)
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Brother died of ruptured aneurysm
Non-smoker; No Hypertension
Prospective data (1 study) –17x increased risk of rupture
Conclusion
Retrospective data: 2 to 5x increased risk of rupture; rupture is 5 years earlier and at a smaller size (1-2mm)
Is this aneurysm at greater risk of rupture compared to sporadic one?
34F; incidental paraclinoid aneurysm (5mm)
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FIA Study: X=1.2%; Y=40 Risk = 38.30% over next 40 years
Conclusion
X = risk of rupture/year; Y = life expectancy (years)
ISUIA: X=0.069%; Y=40 Risk = 2.72% over next 40 years
SUAVE: X=0.34%; Y=40 Risk = 12.74% over next 40 years
TREAT!