Risk of Rupture After Intracranial Aneurysm Growth

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Abstract
Unruptured intracranial aneurysms (UIAs) occur in approximately 3% of the adult population.1 The number of incidentally discovered UIAs has increased owing to the rising availability and use of brain imaging.2 Most UIAs are smaller than 7 mm and have a low risk of rupture.3 Preventive endovascular or neurosurgical aneurysm treatment is often considered, but these treatment options carry a substantial risk of procedure-related complications.4 In many patients with small aneurysms, the aneurysm remains untreated because the risk of treatment complications is estimated to be higher than the risk of rupture. Most of these patients are monitored over time with repeated magnetic resonance angiography or computed tomography angiography to detect aneurysm growth. If aneurysm growth is detected, the aneurysm is often treated. This policy is based on observations that aneurysms with detected growth have a higher risk of rupture than aneurysms without growth.5-10 Although the relative risk of rupture after detection of growth is increased, the absolute risk of rupture after detection of aneurysm growth is unknown. This absolute risk is pivotal for consultation with patients after detection of growth of the aneurysm, because the risk of rupture needs to be weighed against the risk of treatment complications. The purpose of this multicenter cohort study was to determine the absolute risk of rupture of an aneurysm after detection of growth on follow-up imaging and to develop a prediction model for rupture based on predictors of rupture.

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