Unruptured intracranial aneurysms: Why should we focus on small aneurysms? A comprehensive update of recent findings.

Polish journal of radiology Pub Date : 2024-01-12 eCollection Date: 2024-01-01 DOI:10.5114/pjr.2024.134424
Maciej Jakub Frączek, Roger Marek Krzyżewski, Kornelia Maria Kliś, Borys Maria Kwinta, Tadeusz Jan Popiela, Krzysztof Stachura
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Abstract

Intracranial aneurysms (IAs) are a significant public health concern because they have the potential to cause deva-stating consequences, including death and disability. Despite advances in diagnostic and treatment modalities, the outcomes for patients with aneurysmal subarachnoid haemorrhage (aSAH) remain poor, with high rates of rebleeding, vasospasm, and cerebral ischaemia. IAs are a significant risk factor for aSAH, and it is estimated that up to 3% of the general population have IAs. Recent studies using novel imaging modalities have shown that the prevalence of IAs may be much higher, with 6.6% of adults aged 40-84 years having intradural saccular IAs ≥ 2 mm. The risk of rupture for IAs is difficult to predict, and the decision to treat them invasively is based on a balance between the estimated rupture risk and the procedural risks of the treatment. However, the mortality and morbidity rates among patients treated for IAs can be as high as 5%. There is a need for clear guidelines on the treatment of IAs, and this review aims to provide an update on recent findings in this area. To achieve this goal, the authors identified and summarized recent, high-impact studies on IAs. The review focuses on the diagnostic and treatment options for IAs, as well as the risks associated with these interventions. The authors also provide an overview of the natural history of IAs and discuss the challenges and uncertainties in managing these patients.

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未破裂的颅内动脉瘤:为什么要关注小动脉瘤?最新研究结果的全面更新。
颅内动脉瘤(IAs)是一个重大的公共卫生问题,因为它有可能造成严重后果,包括死亡和残疾。尽管诊断和治疗方法不断进步,但动脉瘤性蛛网膜下腔出血(aSAH)患者的预后仍然很差,再出血、血管痉挛和脑缺血的发生率很高。蛛网膜下腔出血是蛛网膜下腔出血的重要危险因素,据估计多达3%的普通人群患有蛛网膜下腔出血。最近使用新型成像模式进行的研究表明,IAs 的发病率可能要高得多,在 40-84 岁的成年人中,有 6.6% 的人硬膜囊内 IAs ≥ 2 毫米。IAs的破裂风险难以预测,是否对其进行有创治疗取决于估计的破裂风险和治疗的程序风险之间的平衡。然而,IAs 患者的死亡率和发病率可高达 5%。目前需要制定明确的 IAs 治疗指南,本综述旨在提供该领域的最新研究成果。为了实现这一目标,作者们确定并总结了近期有关IAs的高影响力研究。综述侧重于 IAs 的诊断和治疗方案,以及这些干预措施的相关风险。作者还概述了 IAs 的自然病史,并讨论了管理这些患者所面临的挑战和不确定性。
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