TY - JOUR
T1 - Giant intracranial aneurysms
T2 - Natural history and 1-year case fatality after endovascular or surgical treatment
AU - on behalf of the Giant Intracranial Aneurysm Study Group
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
AU - Bauknecht, H. C.
AU - Bohner, G.
AU - Liebig, T.
AU - Wiener, E.
AU - Gläsker, S.
AU - Klingler, J. H.
AU - Scheiwe, C.
AU - van Velthoven, V.
AU - Zentner, J.
AU - Durner, G.
AU - König, R.
AU - Pedro, M. T.
AU - Wirtz, R.
AU - Fiss, I.
AU - Kombos, T.
AU - Guhl, S.
AU - Schroeder, H. W.S.
AU - Strowitzki, M.
AU - Eicker, S.
AU - Steiger, H.
AU - Turowski, B.
AU - Abdulazim, A.
AU - Etminan, N.
AU - Haenggi, D.
AU - Grote, A.
AU - Marbacher, S.
AU - Wang, W. T.
AU - Hernesniemi, J.
AU - Lehecka, M.
AU - Niemelä, M.
AU - Nurminen, V.
N1 - Publisher Copyright:
© AANS 2021, except where prohibited by US copyright law
PY - 2021/1
Y1 - 2021/1
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.
AB - 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.
KW - Aneurysm rupture
KW - Giant intracranial aneurysm
KW - Subarachnoid hemorrhage
KW - Vascular disorders
KW - 3112 Neurosciences
KW - 3124 Neurology and psychiatry
KW - 3126 Surgery, anesthesiology, intensive care, radiology
UR - https://www.scopus.com/pages/publications/85090986307
U2 - 10.3171/2019.8.JNS183078
DO - 10.3171/2019.8.JNS183078
M3 - Article
SN - 0022-3085
VL - 134
SP - 49
EP - 57
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 1
ER -