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Should we screen for familial intracranial aneurysm?
F Crawley1, A Clifton, M M Brown
1Division of Clinical Neuroscience, St. George's Hospital Medical School, Department of Neuroradiology, Atkinson Morley's Hospital, Institute of Neurology, London, UK.
Stroke
|February 5, 1999
Summary
Screening for intracranial aneurysms in individuals with a strong family history is not effective in reducing poor outcomes. Current screening methods do not significantly alter morbidity and mortality rates from ruptured aneurysms.
Area of Science:
- Neurology
- Medical Imaging
- Public Health
Background:
- Intracranial aneurysms pose a significant health risk.
- A family history of multiple affected first-degree relatives increases individual risk.
- The efficacy of screening in this high-risk group is not well-established.
Purpose of the Study:
- To determine if screening for intracranial aneurysms is beneficial for individuals with a family history of two or more affected first-degree relatives.
- To evaluate the effectiveness of different screening strategies.
Main Methods:
- Three theoretical models were developed: screening with magnetic resonance angiography (MRA) followed by digital subtraction angiography (DSA), DSA alone, and no screening.
- Screening was simulated every 10 years with surgical treatment for detected aneurysms.
- Assumptions included aneurysm prevalence, rupture rates, and risks associated with MRA, DSA, and surgery.
Main Results:
- Over 30 years, screening 1000 individuals with MRA/DSA or DSA alone resulted in 14 and 18 poor outcomes, respectively.
- Without screening, 15 individuals experienced poor outcomes in the same period.
- The differences in poor outcomes between screening strategies and no screening were not substantial.
Conclusions:
- Screening for intracranial aneurysms in individuals with a family history of >/=2 affected first-degree relatives is not effective in reducing morbidity and mortality.
- Screening is only potentially effective if the incidence of asymptomatic aneurysms exceeds 10%.