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The natural history and treatment options for unruptured intracranial aneurysms.

Loewenstein JE, Gayle SC, Duffis EJ, Prestigiacomo CJ, Gandhi CD - Int J Vasc Med (2012)

Bottom Line: To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention.Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options.Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.

ABSTRACT
Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

No MeSH data available.


Related in: MedlinePlus

3D DSA of a giant, left, petrous ICA aneurysm. Stent-assisted coiling was performed on this patient.
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fig3: 3D DSA of a giant, left, petrous ICA aneurysm. Stent-assisted coiling was performed on this patient.

Mentions: Another adjunctive therapy for wide-neck UIAs is microcatheter-delivered stenting. The hope among neurosurgeons is that stent-assisted coil embolization (SAC) may improve long-term durability and effectiveness by minimizing herniation and increasing packing density [47]. After establishing procedural safety and periprocedural effectiveness [48], Sedat et al. reported that long-term complete aneurysmal occlusion occurred in 71% of patients, with aneurysmal regrowth in 4 out of 38 patients at first angiographic followup and no regrowth in any other followups [49]. Still, other investigators wanted to fully value the safety and efficacy of SAC and subsequently created the Interstate Collaboration of Stent Coiling (ICES). Initial results of the ICES study concluded that this technique was helpful for treatment of UIAs but not RIAs and produced morbidity and mortality rates of 2.8% and 2.0%, respectively [50]. The midterm report of the ICES study, which then encompassed 216 SAC-treated aneurysms, reported that 40% of aneurysms demonstrated complete occlusion and 88% had ≥90% aneurysm occlusion, illustrating that SAC is viable option for wide-neck aneurysms [51]. Figure 3 presents a UIA for which SAC was the chosen treatment modality.


The natural history and treatment options for unruptured intracranial aneurysms.

Loewenstein JE, Gayle SC, Duffis EJ, Prestigiacomo CJ, Gandhi CD - Int J Vasc Med (2012)

3D DSA of a giant, left, petrous ICA aneurysm. Stent-assisted coiling was performed on this patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303690&req=5

fig3: 3D DSA of a giant, left, petrous ICA aneurysm. Stent-assisted coiling was performed on this patient.
Mentions: Another adjunctive therapy for wide-neck UIAs is microcatheter-delivered stenting. The hope among neurosurgeons is that stent-assisted coil embolization (SAC) may improve long-term durability and effectiveness by minimizing herniation and increasing packing density [47]. After establishing procedural safety and periprocedural effectiveness [48], Sedat et al. reported that long-term complete aneurysmal occlusion occurred in 71% of patients, with aneurysmal regrowth in 4 out of 38 patients at first angiographic followup and no regrowth in any other followups [49]. Still, other investigators wanted to fully value the safety and efficacy of SAC and subsequently created the Interstate Collaboration of Stent Coiling (ICES). Initial results of the ICES study concluded that this technique was helpful for treatment of UIAs but not RIAs and produced morbidity and mortality rates of 2.8% and 2.0%, respectively [50]. The midterm report of the ICES study, which then encompassed 216 SAC-treated aneurysms, reported that 40% of aneurysms demonstrated complete occlusion and 88% had ≥90% aneurysm occlusion, illustrating that SAC is viable option for wide-neck aneurysms [51]. Figure 3 presents a UIA for which SAC was the chosen treatment modality.

Bottom Line: To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention.Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options.Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.

ABSTRACT
Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.

No MeSH data available.


Related in: MedlinePlus