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.