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Giant intracranial aneurysms: natural history and 1-year case fatality after endovascular or surgical treatment.
J Neurosurg 2019; :1-9JN

Abstract

OBJECTIVE

Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs.

METHODS

In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality.

RESULTS

The retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23-2.16) in ruptured GIAs and 3.96 (95% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality.

CONCLUSIONS

Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov).

Authors+Show Affiliations

1Department of Neurosurgery, Charité-Berlin. 2Department of Neurosurgery, Helios Clinic, Bad Saarow. 3Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Germany.4Department of Neuroradiology, Clinic Hirslanden, Zurich, Switzerland.5Department of Neurosurgery, Technical University of Munich.6Department of Neurosurgery, Georg-August-University Goettingen.7Department of Neurology, Charité-Berlin. 8Center for Stroke Research, Berlin.1Department of Neurosurgery, Charité-Berlin.9Institute of Clinical Epidemiology and Biometry, University of Würzburg.9Institute of Clinical Epidemiology and Biometry, University of Würzburg.5Department of Neurosurgery, Technical University of Munich.10Department of Neurosurgery, DONAUISAR Klinik Deggendorf.11Department of Neurosurgery, Hannover Medical School, Hannover.6Department of Neurosurgery, Georg-August-University Goettingen.12Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.13Department of Neurosurgery, University Hospital Zurich.14Department of Neurosurgery, University Hospital Geneva, Switzerland.15Department of Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy.16Department of Neuroradiology, University Hospital Toulouse, France.9Institute of Clinical Epidemiology and Biometry, University of Würzburg. 17Comprehensive Heart Failure Center Würzburg, University of Würzburg; and. 18Clinical Trial Center Würzburg, University Hospital Würzburg, Germany.1Department of Neurosurgery, Charité-Berlin.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31812141

Citation

Dengler, Julius, et al. "Giant Intracranial Aneurysms: Natural History and 1-year Case Fatality After Endovascular or Surgical Treatment." Journal of Neurosurgery, 2019, pp. 1-9.
Dengler J, Rüfenacht D, Meyer B, et al. Giant intracranial aneurysms: natural history and 1-year case fatality after endovascular or surgical treatment. J Neurosurg. 2019.
Dengler, J., Rüfenacht, D., Meyer, B., Rohde, V., Endres, M., Lenga, P., ... Vajkoczy, P. (2019). Giant intracranial aneurysms: natural history and 1-year case fatality after endovascular or surgical treatment. Journal of Neurosurgery, pp. 1-9. doi:10.3171/2019.8.JNS183078.
Dengler J, et al. Giant Intracranial Aneurysms: Natural History and 1-year Case Fatality After Endovascular or Surgical Treatment. J Neurosurg. 2019 Dec 6;1-9. PubMed PMID: 31812141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Giant intracranial aneurysms: natural history and 1-year case fatality after endovascular or surgical treatment. AU - Dengler,Julius, AU - Rüfenacht,Daniel, AU - Meyer,Bernhard, AU - Rohde,Veit, AU - Endres,Matthias, AU - Lenga,Pavlina, AU - Uttinger,Konstantin, AU - Rücker,Viktoria, AU - Wostrack,Maria, AU - Kursumovic,Adisa, AU - Hong,Bujung, AU - Mielke,Dorothee, AU - Schmidt,Nils Ole, AU - Burkhardt,Jan-Karl, AU - Bijlenga,Philippe, AU - Boccardi,Edoardo, AU - Cognard,Christophe, AU - Heuschmann,Peter U, AU - Vajkoczy,Peter, Y1 - 2019/12/06/ PY - 2018/11/20/received PY - 2019/08/21/accepted PY - 2019/12/8/entrez PY - 2019/12/8/pubmed PY - 2019/12/8/medline KW - CM = conservative management KW - CND = cranial nerve deficit KW - EM = endovascular management KW - GCS = Glasgow Coma Scale KW - GIA = giant intracranial aneurysm KW - ISAT = International Subarachnoid Aneurysm Trial KW - ISUIA = International Study of Unruptured Intracranial Aneurysms KW - SAH = subarachnoid hemorrhage KW - SM = surgical management KW - UCAS Japan = Unruptured Cerebral Aneurysm Study of Japan KW - UIATS = Unruptured Intracranial Aneurysm Treatment Score KW - WFNS = World Federation of Neurosurgical Societies KW - aneurysm rupture KW - giant intracranial aneurysm KW - mRS = modified Rankin Scale KW - subarachnoid hemorrhage KW - vascular disorders SP - 1 EP - 9 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs. METHODS: In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality. RESULTS: The retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23-2.16) in ruptured GIAs and 3.96 (95% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality. CONCLUSIONS: Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.Clinical trial registration no.: NCT02066493 (clinicaltrials.gov). SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31812141/Giant_intracranial_aneurysms:_natural_history_and_1-year_case_fatality_after_endovascular_or_surgical_treatment L2 - https://thejns.org/doi/10.3171/2019.8.JNS183078 DB - PRIME DP - Unbound Medicine ER -