Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm: Risk of De Novo Aneurysm Formation

Joanna Y. Wang, Ryan Smith, Xiaobu Ye, Wuyang Yang, Justin M. Caplan, Martin Radvany, Geoffrey P. Colby, Alexander Coon, Rafael J. Tamargo, Judy Huang

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

BACKGROUND: Although rare, de novo intracranial aneurysms (DNIAs) may develop in patients with a history of intracranial aneurysms (IAs). OBJECTIVE: To evaluate the benefit of routine radiographic screening for DNIAs. METHODS: Data for 2153 patients with IAs were retrospectively analyzed. A total of 185 patients underwent screening for DNIAs at frequent intervals. RESULTS: Overall, DNIAs were detected in 26 patients (1.2%). Of the 185 patients with surveillance, DNIAs developed in 9 (4.9%). The risk of DNIA detection was 1.14% per person-year of follow-up (95% confidence interval: 0.6%-2.2%). Patients with imaging follow-up had a significantly higher rate of DNIA detection compared with patients without regular imaging surveillance (4.9% vs 0.86%; P < .001), but surveillance was associated with smaller lesions (with surveillance: 3.8 ± 1.8 mm, without: 7.0 ± 4.4 mm, mean ± standard deviation; P = .026). A unimodal distribution of time to detection was found in those with surveillance, with a peak between 0 and 2 years. There was a trend toward an association of cigarette smoking and DNIA detection within 10 years (P = .06); 6 of the 26 patients (23.1%) with DNIAs had a history of cigarette smoking, with all 6 patients continuing to smoke up to the detection of the DNIAs, which were detected in 2.5 ± 1.8 years. CONCLUSION: The low 1.14% per-person year risk of DNIA detection and small DNIA size at detection cannot justify routine screening for DNIAs in all patients with a personal history of IAs. If imaging follow-up is considered for selected patients, early screening will likely yield the most benefit in patients who continue to smoke cigarettes.

Original languageEnglish (US)
Pages (from-to)32-42
Number of pages11
JournalNeurosurgery
Volume77
Issue number1
DOIs
StatePublished - Mar 23 2015

Keywords

  • De novo intracranial aneurysm
  • Intracranial aneurysm
  • Screening
  • Subarachnoid hemorrhage
  • Unruptured intracranial aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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