Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

 Of course your anxiety will be off the charts since you know that if a hemorrhagic stroke occurs you know your doctor HAS NOTHING GUARANTEED FOR RECOVERY!

Postdiagnostic Anxiety and Depression Increase Rupture Risk and Mortality in Unruptured Intracranial Aneurysms

Muhammed Amir Essibayi, MD, MSc https://orcid.org/0000-0001-8325-2382 m.amir.essibayi@gmail.com, 

Ahmed Y. Azzam, MD, MEng https://orcid.org/0000-0002-4256-0159, 

Hamza Adel Salim, MD https://orcid.org/0000-0002-5208-8425, Alireza Karandish, BA, 

Mustafa S. Alhasan, MBBS, DABR https://orcid.org/0009-0002-4401-5127, Dhairya A. Lakhani, MD https://orcid.org/0000-0001-7577-1887, 

Huanwen Chen, MD https://orcid.org/0000-0003-2455-748X, Dheeraj Gandhi, MD https://orcid.org/0000-0001-6741-5970, 

Adam A. Dmytriw, MD, MPH, MSc https://orcid.org/0000-0003-0131-5699, Deepak Khatri, MD https://orcid.org/0000-0003-1902-9623, 

Neil Haranhalli, MD, MSc, and David J. Altschul, MD https://orcid.org/0000-0002-5130-1378Author Info & Affiliations

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https://doi.org/10.1161/STROKEAHA.126.054546

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BACKGROUND:

Postdiagnostic anxiety and depression’s impact on management and outcomes in patients with unruptured intracranial aneurysms remains underexplored. We assessed associations with treatment patterns and outcomes using a large multi-institutional database.

METHODS:

This retrospective cohort study used TriNetX Global Collaborative Network records (2015–2025; >130 million patients across ≈250 health care organizations), identifying 127 361 adults with unruptured intracranial aneurysms. Addressing immortal time bias, we used a 127-day landmark analysis (median time to psychiatric diagnosis), requiring event-free survival before cohort assignment. Of 119 211 patients surviving to the landmark, those with anxiety/depression diagnosed within 0 to 127 days (n=7250) were 1:1 propensity score matched to controls (n=111 961), yielding 6800 per cohort. Cox proportional hazards models evaluated outcomes from a landmark.

RESULTS:

Matched cohorts (6800 each) had balanced characteristics (all standardized mean differences <0.10) and comparable follow-up (median, 1550 versus 1600 days). Anxiety/depression was associated with higher all-cause mortality (6.3% versus 4.5%; hazard ratio [HR], 1.28 [95% CI, 1.11–1.48]; P<0.001) and rupture (3.1% versus 2.2%; HR, 1.33 [95% CI, 1.08–1.64]; P=0.007). Five-year survival was 93.7% in the anxiety/depression cohort versus 95.5% in matched controls. Preventive treatment showed nonsignificant trends toward lower rates (odds ratio, 0.80 [95% CI, 0.62–1.03]; P=0.082). Sensitivity analysis using a 365-day landmark (n=10 200 per cohort) expanded eligibility by including diagnoses between days 128 and 365, and confirmed findings (mortality HR, 1.22 [95% CI, 1.08–1.38]; rupture HR, 1.28 [95% CI, 1.08–1.52]). Fine-Gray competing risk models yielded consistent results (mortality subdistribution HR, 1.27; rupture subdistribution HR, 1.31). Dose-response patterns emerged for psychiatric medication adherence: low (mortality HR, 1.50 [95% CI, 1.12–2.00]; P=0.006), moderate (HR, 1.29 [95% CI, 0.98–1.70]; P=0.071), and high (HR, 1.16 [95% CI, 0.89–1.51]; P=0.270). E values were 1.88 for mortality and 1.99 for rupture.

CONCLUSIONS:

Postdiagnostic anxiety and depression are associated with increased rupture risk and mortality in patients with unruptured intracranial aneurysms. Residual confounding cannot be excluded. These findings require further investigation to establish causality and suggest that an integrated psychiatric assessment may be considered in unruptured intracranial aneurysm management.

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Medtronic unveils next-generation Artisse intrasaccular device alongside new data at LINNC Paris 2024

 Ask your competent? doctor and hospital about this. If they know nothing; RUN AWAY!

Medtronic unveils next-generation Artisse intrasaccular device alongside new data at LINNC Paris 2024

Medtronic has today announced the European launch of Artisse—a new intrasaccular device designed to treat intracranial aneurysms by conforming to the shape of the aneurysm. The launch coincides with interim data that examine the safety, efficacy and performance of the device being presented for the first time at LINNC Paris 2024 (3–5 June, Paris, France).

Artisse was designed to address the needs of complex wide-neck bifurcation aneurysms that have traditionally been managed by stent-assisted coiling, coil adjunctive neck-bridging devices and other intrasaccular basket devices. The former two methods require multiple steps and multiple devices, with stent-assisted coiling requiring dual antiplatelet therapy, which can present challenges in ruptured aneurysms.

Medtronic claims that Artisse offers a simple, one-step technique in treating these complex and simpler aneurysms alike.

Artisse is highly conformable, engineered from dual layers of high-density platinum core and nitinol drawn filled tubing (DFT) wires in a flared design. This sophisticated construction allows it to flex to conform to the unique contours of most aneurysms while exerting the optimum outward radial force needed to fill the space securely, the company also states in a recent press release.

“Artisse behaves differently to other intrasaccular devices because I can control the optimal positioning of the device in the aneurysm,” said Riitta Rautio (Turku University Hospital, Turku, Finland). “Due to its conformability and softness, I can reach the optimal position of Artisse in the aneurysm with partial re-sheathing of the device and slight movement of the microcatheter.”

The device’s flexibility, smooth distal tip and gentle deployment make Artisse atraumatic—reducing risk to, and stress on, the aneurysm walls.

Early-experience analysis presented at LINNC Paris 2024, from a study involving 35 patients enrolled into the multicentre, core lab-adjudicated European INSPIRE-A registry, shows that 80% of patients treated with Artisse achieved complete occlusion by a six-month angiographic assessment, indicating successful aneurysm occlusion with no residual filling.

“Artisse is a promising device that appears to be a step in the right direction for intrasaccular technology,” said Tufail Patankar (Leeds General Infirmary, Leeds, UK). “Its softness and conformability allows you to manipulate the device within the aneurysm. Complex wide-neck angled aneurysms that were previously difficult to treat with other intrasaccular devices now seem to be treatable with Artisse.”

According to Medtronic, Artisse is simple to use and faster when compared with coils, or balloon- or stent-assisted coiling. In deployment, the device opens gradually and smoothly with a ‘flowering mechanism’, with no kick-back, so that it feels like pushing a coil. The device also features a handheld electrolytic detachment system that provides immediate confirmation, instant audio and visual feedback upon detachment, and complete radiopacity.

Medtronic offers expert clinical support, including access to simulation software, further supporting sizing selection with Artisse, the recent release notes.

“At this time, I experience very satisfying results for both unruptured and ruptured aneurysms treated with the Artisse device,” said Cyril Dargazanli (University Hospital of Montpellier, Montpellier, France).

“Combined with simulation and the radial approach, Artisse is redefining the standard of care of unruptured aneurysms, offering each patient a safe and customised solution, reinforcing the perspective of aneurysm screening in populations at risk to finally achieve the ultimate goal of our community: reducing subarachnoid haemorrhage worldwide,” added Vincent Costalat (University Hospital of Montpellier, Montpellier, France).

ARISE I Consensus Review on the Management of Intracranial Aneurysms

 You really don't want these 'managed', you want them immobilized so they don't break. Ask your doctor for that solution, and not politely.

ARISE I Consensus Review on the Management of Intracranial Aneurysms

Stavropoula I. Tjoumakaris,

Ricardo Hanel,

J Mocco,

M. Ali-Aziz Sultan,

Michael Froehler,

Barry B. Lieber,

Alexander Coon,

Satoshi Tateshima,

David J. Altschul,

Sandra Narayanan,

… See all authors

Originally published22 Apr 2024https://doi.org/10.1161/STROKEAHA.123.046208Stroke. 2024;55:1428–1437

Abstract

BACKGROUND:

Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option(Well then, start by creating a prospective protocol on this. You need a starting point, otherwise nothing will ever get done!) for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms.

METHODS:

A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA.

RESULTS:

Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast–enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care.

CONCLUSIONS:

Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.

Footnotes

The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.

For Sources of Funding and Disclosures, see page 1435.

Correspondence to: Stavropoula I. Tjoumakaris, MD, Department of Neurosurgery, Thomas Jefferson University Hospital at Sidney Kimmel Medical College, 901 Walnut St, Ste 3F, Philadelphia, PA 19106. Email stavropoula.tjoumakaris@jefferson.edu

Systematic Review and Meta‐Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms

FYI.

Systematic Review and Meta‐Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms

Sergio A. Pineda‐Castillo,

Evan R. Jones,

Keely A. Laurence,

Lauren R. Thoendel,

Tanner L. Cabaniss,

Yan D. Zhao,

Bradley N. Bohnstedt and

Chung‐Hao Lee

Originally published25 Jan 2024https://doi.org/10.1161/SVIN.123.001118Stroke: Vascular and Interventional Neurology. 2024;0:e001118

Abstract

BACKGROUND

Currently, endovascular treatment of intracranial aneurysms is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapies; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils is still debated. We performed a systematic review of literature that reported the Raymond–Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow‐up occlusion effectivenesses for the treatment of unruptured saccular intracranial aneurysms.

METHODS

A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, and Web of Science). We retrieved studies published between 2000 and 2022, reporting immediate and follow‐up RROC rates of subjects treated with different endovascular intracranial aneurysm therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates.

RESULTS

A total of 80 studies from 15 countries were included for data extraction. The RROC rates determined from angiogram were obtained for 21 331 patients (72.5% women, pooled mean age: 58.2 [95% CI]: 56.8–59.6), harboring 22 791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%–50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%–30.8%), the middle cerebral artery (24.5%, 95% CI: 19.2%–30.8%), and the basilar tip (14.4%, 95% CI: 11.3%–18.3%). The complete occlusion probability (RROC‐I) was analyzed for Guglielmi detachable coils, the Woven EndoBridge, and flow diverters. The RROC‐I rate was the highest in balloon‐assisted coiling (73.9%, 95% CI: 65.0%–81.2%) and the lowest in the Woven EndoBridge (27.8%, 95% CI: 13.2%–49.2%). The follow‐up RROC‐I probability was homogenous in all analyzed devices.

CONCLUSION

We observed that the coil‐based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon‐assisted coils. Out of the analyzed devices, the Woven EndoBridge exhibited the shortest time to achieve >90% probability of follow‐up complete occlusion (∼18 months). Overall, the Guglielmi detachable coils remain the gold standard for endovascular treatment of unruptured saccular aneurysms.

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Flow diverters with surface modification in patients with intracranial aneurysms: a systematic review and meta-analysis

 Ask your doctor if this intervention guarantees no strokes as a result.

Flow diverters with surface modification in patients with intracranial aneurysms: a systematic review and meta-analysis

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, , , , ,

https://doi.org/10.1016/j.wneu.2023.12.132Get rights and content

Abstract

Background

Flow diverters with surface modification (FDSM) are increasingly used in the treatment of intracranial aneurysms. We aimed to evaluate the effectiveness and safety across different devices and antiplatelet therapies using a systematic review and meta-analysis.

Methods

A systematic review was performed to identify original studies of ≥10 patients with intracranial aneurysms treated with FDSM from database inception through August 2023. Primary effectiveness outcome was the rate of complete aneurysm occlusion at follow-up ≥6 months. Safety outcomes included ischemic stroke, hemorrhage and in-stent thrombosis, and were stratified by FDSM devices and antiplatelet therapies. Certainty of evidence was evaluated following the GRADE approach.

Results

Twenty-seven studies were included, yielding 2161 patients with 2373 aneurysms. 70.5% of the aneurysms were located on the internal carotid artery (ICA). 10.3% were acutely ruptured. The complete aneurysm occlusion rate was 72.3% at follow-up ≥6 months. Sensitivity analysis in the ICA aneurysm cohort yielded comparable occlusion rates between PED-Shield (80.4%) and Phenox-HPC (77.5%, P=0.54), but a lower 66.2% rate for FRED-X (P=0.02). The rate of in-stent thrombosis and stenosis tended to be higher in Phenox-HPC (3.4%) and FRED-X (4.3%) versus PED-Shield (0.8%, P=0.05).

Conclusions

FDSM were safe with satisfactory effectiveness for intracranial aneurysms. More specific investigations are warranted to explore their performance in aneurysms beyond the ICA and optimal antiplatelet therapy.

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Safety and efficacy results of the Flow Redirection Endoluminal Device (FRED) stent system in the treatment of intracranial aneurysms: US pivotal trial

Wrong endpoint. Safe installation of the device is only an intermediate step. What are your followup steps to get to 100% recovery? This is why survivors need to be in charge, a lot of stroke research has the wrong endpoint.

 Safety and efficacy results of the Flow Redirection Endoluminal Device (FRED) stent system in the treatment of intracranial aneurysms: US pivotal trial

1. http://orcid.org/0000-0001-7372-7049Cameron G McDougall1,
2. Orlando Diaz2,
3. Alan Boulos3,
4. http://orcid.org/0000-0002-9519-0059Adnan H Siddiqui4,5,
5. Justin Caplan1,
6. Johanna T Fifi6,
7. Aquilla S Turk7,
8. http://orcid.org/0000-0002-7747-0188Yasha Kayan8,
9. http://orcid.org/0000-0002-1544-4910Pascal Jabbour9

1. Correspondence to Dr Cameron G McDougall, Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; cgm@jhmi.edu

Abstract

Objective To evaluate the safety and effectiveness of the Flow Redirection Endoluminal Device (FRED) flow diverter in support of an application for Food and Drug Administration approval in the USA.

Methods 145 patients were enrolled in a prospective, single-arm multicenter trial. Patients with aneurysms of unfavorable morphology for traditional endovascular therapies (large, wide-necked, fusiform, etc) were included. The trial was designed to demonstrate non-inferiority in both safety and effectiveness, comparing trial results with performance goals (PGs) established from peer-reviewed published literature. The primary safety endpoint was death or major stroke (National Institutes of Health Stroke Scale score ≥4 points) within 30 days of the procedure, or any major ipsilateral stroke or neurological death within the first year. The primary effectiveness endpoint was complete occlusion of the target aneurysm with ≤50% stenosis of the parent artery at 12 months after treatment, and in which an alternative treatment of the target intracranial aneurysm had not been performed.

Results 145 patients underwent attempted placement of a FRED device, and one or more devices were placed in all 145 patients. 135/145 (93%) had a single device placed. Core laboratory adjudication deemed 106 (73.1%) of the aneurysms large or giant. A safety endpoint was experienced by 9/145 (6.2%) patients, successfully achieving the safety PG of <15%. The effectiveness PG of >46% aneurysm occlusion was also achieved, with the effectiveness endpoint being met in 80/139 (57.6%)

Conclusion As compared with historically derived performance benchmarks, the FRED flow diverter is both safe and effective for the treatment of appropriately selected intracranial aneurysms.

Clinical registration number NCT01801007

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/neurintsurg-2021-017469

 

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

Looks like a lot of research needs to be done to prevent these complications. If we had a great stroke association  we could add this in the overall stroke recovery strategy.  BUT WE HAVE NO STROKE LEADERSHIP OR STRATEGY.

Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

 

1. http://orcid.org/0000-0002-8129-2273Kemal Alpay1,
2. Tero Hinkka2,
3. Antti E Lindgren3,4,5,
4. Juha-Matti Isokangas6,
5. http://orcid.org/0000-0003-4243-9591Rahul Raj7,
6. Riitta Parkkola1,8,
7. Matias Sinisalo1,
8. Jussi Numminen9,
9. Juha-Pekka Pienimäki2,
10. Petri Saari10,
11. Janne Seppänen2,
12. Kari Palosaari6,
13. http://orcid.org/0000-0001-8385-0622Riitta Rautio1,8

1. Correspondence to Dr Kemal Alpay, Department of Radiology, TYKS Turku University Hospital, Varsinais-Suomi, 20521 Turku, Finland; kemalp@utu.fi

Abstract

Background 

 Flow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.

Methods 

This is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.

Results 

110 patients (64 females; mean age 55.7 years; range 12–82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0–2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).

Conclusions  

FD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

Data availability statement

Data are not available for public, however upon a reasonable request it may be provided.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/neurintsurg-2021-017641

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

After your doctor reviews the pros and cons of this device you can decide what to do. Ask your doctor the chances of your aneurysm rupturing and the likely damage from that.  With all that information presented you can make an informed decision.

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review 

Show all authors

Muhammad Waqas, Rimal H Dossani, Modhi Alkhaldi, ...

First Published June 30, 2021 Research Article 

https://doi.org/10.1177/15910199211027991

Article information

Abstract

Introduction

The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data.

Methods

The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed.

Results

Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies).

Conclusion

This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

Keywords

Flow diversion, Flow Redirection Endoluminal Device (FRED), Intracranial aneurysms

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Screening for intracranial aneurysms in individuals with a positive first-degree family history: a systematic review

 They tell us nothing on what should be done if screening is positive for this problem. SO COMPLETELY USELESS RESEARCH. I blame the mentors and senior researchers for allowing this crapola and they in turn can blame non-existent stroke leaders for not having a stroke strategy to follow.

Screening for intracranial aneurysms in individuals with a positive first-degree family history: a systematic review

Author links open overlay panelWillemVan Hoe¹

Johannesvan Loon²⁵JelleDemeestere³⁵RobinLemmens³⁵JoPeluso⁴StevenDe Vleeschouwer²⁵

https://doi.org/10.1016/j.wneu.2021.02.112Get rights and content

ABSTRACT

BACKGROUND

Subarachnoid hemorrhage (SAH) secondary to rupture of an intracranial aneurysm (IA) is a devastating condition with high morbidity and mortality. Individuals with a positive family history of aneurysmal SAH (aSAH) or IA can have an increased risk for aSAH or IA themselves. Screening is currently recommended in families with ≥ 2 affected first degree relatives.

OBJECTIVES

To assess the usefulness and cost-effectiveness of IA screening in individuals with a positive first-degree family history, relative to the number of family members affected.

METHODS

We performed a systematic literature search using Pubmed and Google Scholar and identified additional studies by reviewing reference lists. Only original studies and review papers were considered. We excluded genetic diseases associated with IA and studies with unclear data concerning the number of first- versus second-degree relatives affected.

RESULTS

This review included 37 articles. Individuals with ≥ 2 affected first degree relatives had a higher prevalence of IA (average 13.1% vs. 3% in the general population). Similarly, we found a higher prevalence of IA in individuals with ≥ 1 affected first degree relative (average 4.8%, up to 19% in individuals with additional risk factors). The risk of aSAH was also increased in both categories. Recent studies stressed the importance of serial screening over time and suggested that such screening can be cost-effective in persons with only one first-degree relative with IA or aSAH.

CONCLUSION

While current guidelines do not recommend screening individuals with ≥ 1 first degree relative affected, we found strong arguments in favor of this approach.