UPDATE ON Screening for unruptured aneurysms INTRACRANIAL Who to - - PowerPoint PPT Presentation

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UPDATE ON INTRACRANIAL ANEURYSM

Nerissa U. Ko, MD, MAS Recent Advances in Neurology February 15, 2018

Current controversies

• Screening for unruptured aneurysms
• Who to screen?
• What to do with small aneurysms?
• When to screen?
• How often?
• Predicting aneurysms at high risk for

rupture

• Any risk factors?
• When to treat?

Guideline recommendations

• Family history > 2 first

degree family members with IA or SAH

• Genetic risk factors
• Polycystic kidney disease
• Ehler’s-Danlos, aortic

coarctation, microcephalic

• steodysplastic primordial

dwarfism

• History of prior SAH
• Non-invasive imaging

initially 6-12 months (CTA/MRA/DSA)

• Follow-up one year or

every other year to determine if:

• Aneurysm size > 7mm
• Aneurysm enlargement
• Consideration for treatment

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• PHASES score
• Population

(Finnish, Japanese)

• HTN
• Age > 70
• Size
• Hx SAH
• Aneurysm location
• Score < 3 associated

with lower, but not negligible risk of bleed

Summary

• Small aneurysms have a very low risk of

growth and rupture

• Recent modeling and systematic review

studies recommend no monitoring or intervention in small aneurysms in the general population

• However, the dilemma of identifying which

small aneurysm will rupture remains problematic

Future directions

• Better selection of high risk patients to

monitor, including women with FMD

• Use of new grading scales like PHASES if

validated

• Biological imaging of growth, areas of

activity

• High resolution MRA, feromoxytol
• Development of biomarkers to predict risk
• DNA, mRNA, microRNAs, proteomics