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Letter by Kirchoff-Torres and Labovitz Regarding Article, “Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors: A Prospective Finnish Cohort Study”

2014; Lippincott Williams & Wilkins; Volume: 45; Issue: 10 Linguagem: Inglês

10.1161/strokeaha.114.006791

1524-4628

Kathryn F. Kirchoff-Torres, Daniel L. Labovitz,

Cerebrovascular and Carotid Artery Diseases

HomeStrokeVol. 45, No. 10Letter by Kirchoff-Torres and Labovitz Regarding Article, "Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors: A Prospective Finnish Cohort Study" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Kirchoff-Torres and Labovitz Regarding Article, "Lifelong Rupture Risk of Intracranial Aneurysms Depends on Risk Factors: A Prospective Finnish Cohort Study" Kathryn F. Kirchoff-Torres, MD and Daniel L. Labovitz, MD Kathryn F. Kirchoff-TorresKathryn F. Kirchoff-Torres Department of Neurology, Albert Einstein College of Medicine, Bronx, NY and Daniel L. LabovitzDaniel L. Labovitz Department of Neurology, Albert Einstein College of Medicine, Bronx, NY Originally published14 Aug 2014https://doi.org/10.1161/STROKEAHA.114.006791Stroke. 2014;45:e210Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2014: Previous Version 1 To the Editor:We read with interest the article by Dr Korja et al1 about the lifelong natural history of unruptured intracranial aneurysms (UIAs) in 118 Finnish patients but worry that the results may be overgeneralized. UIAs discovered because another aneurysm ruptured are likely different from UIAs found for other reasons. The authors report a lifetime risk of aneurysm rupture of 29%, with annual rupture rate per patient of 1.6% and per aneurysm of 1.2%. Of patients with UIAs <7 mm at baseline, 25% had subarachnoid hemorrhage (SAH) in follow-up, and the majority of these had grown to ≥7 mm by the time of rupture. The long follow-up period of mean 18.5 years (range, 0.8–52.3 years), as well as the absence of confounding from elective treatment of unruptured aneurysms felt to be at highest risk of rupture, was important advantages of the study. The authors' conclusion that the study represents the lifetime course of UIAs, however, must be taken in the context of why these patient's aneurysms were initially discovered. The great majority of the patients in this study (93%) presented with SAH. The distinction between the natural history of UIAs in patients without a history of SAH and in those with a history of SAH is critical, because a history of SAH has been identified as a significant risk for UIA rupture.2,3 The authors briefly mention this as a limitation of the study, but we feel that it is important to illustrate this point. For example, in the retrospective arm of the International Study of Unruptured Intracranial Aneurysms (ISUIA),2 UIAs 10 mm in diameter, history of SAH did not influence risk of rupture. Although SAH was not associated with risk of UIA rupture in the recent Unruptured Cerebral Aneurysm Study of Japan (UCAS Japan),4 this cohort included a small percentage of patients with prior history of SAH and untreated UIAs.The lifetime risk of rupture of UIA of 29% in this cohort composed almost entirely of survivors of SAH illustrates the importance of consideration for treatment of residual UIAs in patients presenting with SAH, especially in those with risk factors such as female sex, current smoking or UIAs ≥7 mm. In addition, it supports that increased attention and consideration for treatment should also be paid to small aneurysms in survivors of SAH. In current practice, clinicians are increasingly faced with decisions about whether to treat small aneurysms discovered incidentally by tests such as computed tomography angiography or magnetic resonance angiography in patients with no history of SAH. Attempts to apply the findings of this study to predict lifetime risk of UIA rupture in patients with no history of SAH should be done with caution.Kathryn F. Kirchoff-Torres, MDDaniel L. Labovitz, MDDepartment of NeurologyAlbert Einstein College of MedicineBronx, NYDisclosuresNone. References 1. Korja M, Lehto H, Juvela S. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective Finnish cohort study.Stroke. 2014; 45:1958–1963.LinkGoogle Scholar2. The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention [published correction appears in N Engl J Med. 1999;340:744].N Engl J Med. 1998; 339:1725–1733.CrossrefMedlineGoogle Scholar3. Ishibashi T, Murayama Y, Urashima M, Saguchi T, Ebara M, Arakawa H, et al. Unruptured intracranial aneurysms: incidence of rupture and risk factors.Stroke. 2009; 40:313–316.LinkGoogle Scholar4. The UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort.N Engl J Med. 2012; 366:2474–2482.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Korja M and Kaprio J (2015) Controversies in epidemiology of intracranial aneurysms and SAH, Nature Reviews Neurology, 10.1038/nrneurol.2015.228, 12:1, (50-55), Online publication date: 1-Jan-2016. October 2014Vol 45, Issue 10 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.114.006791PMID: 25123216 Originally publishedAugust 14, 2014 PDF download Advertisement SubjectsCerebral Aneurysm