Screening for intracranial aneurysms in persons ⩾35 years with hypertension and atherosclerotic disease who smoke(d).

Autor:	Mensing LA; UMC Utrecht Brain Centre, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands., van Tuijl RJ; Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands., de Kort GA; Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands., van der Schaaf IC; Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands., Visseren FL; Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands., Rinkel GJ; UMC Utrecht Brain Centre, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands., Velthuis BK; Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands., Ruigrok YM; UMC Utrecht Brain Centre, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2023 Dec; Vol. 8 (4), pp. 1071-1078. Date of Electronic Publication: 2023 Aug 10.
DOI:	10.1177/23969873231193296
Abstrakt:	Introduction: Lifetime risk of aneurysmal subarachnoid haemorrhage (aSAH) is high (7%) in persons ⩾35 years with hypertension who smoke(d). Whether screening for intracranial aneurysms (IAs) to prevent aSAH is effective in these patients is unknown. Patients and Methods: Participants were retrieved from a cohort of patients with clinically manifest atherosclerotic vascular disease included between 2012 and 2019 at the University Medical Centre Utrecht (SMART-ORACLE, NCT01932671) in whom CT-angiography (CTA) of intracranial arteries was performed. We selected patients ⩾35 years with hypertension who smoke(d). CTAs were reviewed for the presence of IAs by experienced neuroradiologists. Patients with IAs were offered follow-up imaging to detect aneurysmal growth. We determined aneurysm prevalence and developed a diagnostic model for IA risk at screening using multivariable logistic regression. Results: IA were found in 25 of 500 patients (5.0% prevalence, 95%CI: 3.3%-7.3%). Median 5 year risk of rupture assessed with the PHASES score was 0.9% (IQR: 0.7%-1.3%). During a median follow-up of 57 months (IQR: 39-83 months) no patients suffered from aSAH. Aneurysmal growth was detected in one patient for whom preventive treatment was advised. IA risk at screening ranged between 1.6% and 13.4% with predictors being age, female sex and current smoking. Discussion and Conclusion: IA prevalence in persons ⩾35 years with hypertension and atherosclerotic vascular disease who smoke(d) was 5%. Given the very small proportion of IA that needed preventive treatment, we currently do not advise screening for Caucasian persons older than 35 years of age who smoke and have hypertension in general. Whether screening may be effective for certain subgroups (e.g. women older than 50 years of age) or other ethnic populations should be the subject of future studies. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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