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Aneurysm prevalence and quality of life during screening in relatives of patients with unruptured intracranial aneurysms
Screening for unruptured intracranial aneurysms (UIAs) is effective for first-degree relatives
(FDRs) of patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether screening is
also effective for FDRs of patients with UIA is unknown. We determined the yield of screening in
such FDRs, assessed rupture risk and treatment decisions of aneurysms that were found, iden-
tified potential high-risk subgroups, and studied the effects of screening on quality of life (QoL).
Methods
In this prospective cohort study, we included FDRs, aged 20–70 years, of patients with UIA
without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 partici-
pating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic
resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a
prediction model for UIA risk at screening using multivariable logistic regression...Show moreBackground and Objectives
Screening for unruptured intracranial aneurysms (UIAs) is effective for first-degree relatives
(FDRs) of patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether screening is
also effective for FDRs of patients with UIA is unknown. We determined the yield of screening in
such FDRs, assessed rupture risk and treatment decisions of aneurysms that were found, iden-
tified potential high-risk subgroups, and studied the effects of screening on quality of life (QoL).
Methods
In this prospective cohort study, we included FDRs, aged 20–70 years, of patients with UIA
without a family history of aSAH who visited the Neurology outpatient clinic in 1 of 3 partici-
pating tertiary referral centers in the Netherlands. FDRs were screened for UIA with magnetic
resonance angiography between 2017 and 2021. We determined UIA prevalence and developed a
prediction model for UIA risk at screening using multivariable logistic regression. QoL was
evaluated with questionnaires 6 times during the first year after screening and assessed with a
linear mixed-effects model.
Results
We detected 24 UIAs in 23 of 461 screened FDRs, resulting in a 5.0% prevalence (95% CI
3.2–7.4). The median aneurysm size was 3 mm (interquartile range [IQR] 2–4 mm), and the
median 5-year rupture risk assessed with the PHASES score was 0.7% (IQR 0.4%–0.9%). All
UIAs received follow-up imaging, and none were treated preventively. After a median follow-up of
24 months (IQR 13–38 months), no UIA had changed. Predicted UIA risk at screening ranged
between 2.3% and 14.7% with the highest risk in FDRs who smoke and have excessive alcohol
consumption (c-statistic: 0.76; 95% CI 0.65–0.88). At all survey moments, health-related QoL
and emotional functioning were comparable with those in a reference group from the general
population. One FDR with a positive screening result expressed regret about screening.
Discussion
Based on the current data, we do not advise screening FDRs of patients with UIA because
all identified UIAs had a low rupture risk. We observed no negative effect of screening on QoL. A
longer follow-up should determine the risk of aneurysm growth requiring preventive treatment.
Show less
- All authors
- Mensing, L.A.; Tuijl, R.J. van; Greving, J.P.; Velthuis, B.K.; Schaaf, I.C. van der; Wermer, M.J.H.; Verbaan, D.; Vandertop, W.P.; Zuithoff, N.P.A.; Rinkel, G.J.E.; Ruigrok, Y.M.
- Date
- 2023-08-29
- Journal
- Neurology
- Volume
- 101
- Issue
- 9
- Pages
- e904 - e912