From the University Department of Neurology Utrecht, The Netherlands.
Correspondence to Gabriel J.E. Rinkel, MD, University Department of Neurology, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. E-mail g.j.e.rinkel{at}neuro.azu.nl
Background and Purpose—The estimates
on the prevalence and the risk of rupture of intracranial saccular
aneurysms vary widely between studies. We conducted a
systematic review on prevalence and risk of rupture of intracranial
aneurysms and classified the data according to study design,
study population, and aneurysm characteristics.
Methods—We searched for studies published between 1955 and 1996
by means of a MEDLINE search and a cumulative review of the reference
lists of all relevant publications. Two authors independently assessed
eligibility of all studies and extracted data on study design and on
numbers and characteristics of patients and aneurysms.
Results—For data on prevalence we found 23 studies, totalling
56 304 patients; 6685 (12%) of these patients were from 15
angiography studies. Prevalence was 0.4% (95% confidence interval,
0.4% to 0.5%) in retrospective autopsy studies, 3.6% (3.1 to 4.1)
for prospective autopsy studies, 3.7% (3.0 to 4.4) in retrospective
angiography studies, and 6.0% (5.3 to 6.8) in prospective angiography
studies. For adults without specific risk factors, the prevalence was
2.3% (1.7 to 3.1); it tended to increase with age. The prevalence was
higher in patients with autosomal dominant polycystic kidney disease
(relative risk [RR], 4.4 [2.7 to 7.2]), a familial predisposition
(RR, 4.0 [2.7 to 6.0]), or atherosclerosis (RR, 2.3
[1.7 to 3.1]). Only 8% (5 to 11) of the aneurysms were
>10 mm. For the risk of rupture, we found nine studies, totalling
3907 patient-years. The overall risk per year was 1.9% (1.5 to 2.4);
for aneurysms =10 mm, the annual risk was 0.7% (0.5 to
1.0). The risk was higher in women (RR, 2.1[1.1 to 3.9]) and for
aneurysms that were symptomatic (RR, 8.3 [4.0 to
17]), >10 mm (RR, 5.5 [3.3 to 9.4]), or in the posterior
circulation (RR, 4.1 [1.5 to 11]).
Conclusions—Data on prevalence and risk of rupture vary
considerably according to study design, study population, and
aneurysm characteristics. If all available evidence with
inherent overestimation and underestimation is taken together, for
adults without risk factors for subarachnoid
hemorrhage, aneurysms are found in approximately 2%.
The vast majority of these aneurysms are small (=10 mm)
and have an annual risk of rupture of approximately 0.7%.
© 1998 American Heart Association, Inc.
Comments, Opinions, and Reviews
Prevalence and Risk of Rupture of Intracranial Aneurysms
A Systematic Review
Key Words: subarachnoid hemorrhage • aneurysms • epidemiology • systematic review
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|
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|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
|
|
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|
|
|
 |
|
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|
|
|
|
|
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|
|
|
|
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|
|
|
|
|
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|
|
|
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|
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