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(Stroke. 2004;35:375.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Advances in Vascular Surgery

R. Loch Macdonald, MD, PhD

From the Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Ill.

Correspondence and reprint requests to R. Loch Macdonald, MD, PhD, Section of Neurosurgery, MC3026 University of Chicago Medical Center 5841 South Maryland Ave, Chicago, IL 60637. E-mail rlmacdon@uchicago.edu

Key Words: Advances in Stroke • cerebral aneurysm • subarachnoid hemorrhage • vascular surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Aneurysms

Unruptured Aneurysms
The first report of the International Study of Unruptured Intracranial Aneurysms (ISUIA) cited very low rates of subarachnoid hemorrhage (SAH) for previously unruptured aneurysms.¹ Data were collected retrospectively. It was difficult to reconcile these rates with those reported from prior studies, with the known sizes of ruptured aneurysms and with clinical experience. Prior reports including prospective studies suggested that unruptured aneurysms carried a 1% to 2% risk of hemorrhage per year.^2–4 The second report from the ISUIA prospectively enrolled 4060 patients with unruptured aneurysms.⁵ Of these, 1692 had no intervention for their aneurysm, 1917 had open surgery, and 451 had endovascular procedures. The rupture rates were more in agreement with prior studies (Table). Risk factors for SAH were increasing aneurysm size and aneurysm location at the basilar apex or posterior communicating artery. The risk of surgical repair increased significantly with increasing patient age, posterior circulation location of the aneurysm, history of ischemic cerebrovascular disease, and presence of symptoms from the aneurysm. Thirty-day mortality occurred in 1.5%, morbidity in 3%, poor cognitive function plus morbidity (a Rankin score of 3 to 5) in 4%, and overall total morbidity and mortality in 13%. The data indicate that the decision to treat a ruptured aneurysm needs to include a careful analysis of the patient, their risk factors for poor outcome, and the features of the aneurysm. Endovascular treatment is an option, although overall complete obliteration rates were only about 50% in this study, and risk of treatment was similar to but . . . [Full Text of this Article]

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