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Preventive screening for intracranial aneurysms.

Gabriel Je Rinkel1, Ynte M Ruigrok1

  • 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.

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Preventing aneurysmal subarachnoid hemorrhage (aSAH) is key to improving outcomes. This review identifies high-risk groups for screening of unruptured intracranial aneurysms, aiding informed decisions about preventive care.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Preventive Medicine

Background:

  • Aneurysmal subarachnoid hemorrhage (aSAH) is a severe stroke type with poor outcomes, largely due to initial brain damage.
  • Preventing aSAH offers the greatest potential to improve patient outcomes.

Purpose of the Study:

  • To identify individuals at high risk for aSAH who could benefit from screening for unruptured intracranial aneurysms (UIAs).
  • To discuss the advantages, disadvantages, and counseling strategies for UIA screening.

Main Methods:

  • Review of modeling studies and risk factors for aSAH.
  • Analysis of potential screening candidates and associated counseling considerations.

Main Results:

  • High-risk groups for UIA screening include individuals with multiple affected first-degree relatives, autosomal dominant polycystic kidney disease (ADPKD), and potentially those with one affected relative.
  • Smokers aged 35+ with hypertension are also considered due to high lifetime aSAH risk, though UIA prevalence and screening efficiency are unknown.
  • Screening aims to increase quality life years, necessitating discussion of benefits and downsides like incidental findings and treatment risks.

Conclusions:

  • While some high-risk groups for aSAH screening are identified, they represent a minority of patients; further research is needed to identify additional groups.
  • Improved risk stratification for aneurysm development and rupture within identified groups is crucial for efficient screening.
  • New medical treatments could expand eligibility for UIA screening and aSAH prevention.