on October 6, 2005
Published online before print October 6, 2005, doi: 10.1161/01.STR.0000185686.28035.d2
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on June 9, 2005
From the Departments of Neurology and Neurosurgery (M.J.H.W., P.G., A.A., G.J.E.R.), Rudolf Magnus Institute of Neuroscience, and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands. * To whom correspondence should be addressed. E-mail: m.wermer{at}neuro.azu.nl.
Background and Purpose--Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and risk factors for recurrent SAH in patients who regained independence after SAH and in whom all aneurysms were occluded by means of clipping. Methods--From a cohort of patients with SAH admitted between 1985 and 2001, we included those patients who were discharged home or to a rehabilitation facility. We interviewed these patients about new episodes of SAH. We retrieved all medical records and radiographs in case of reported recurrences. If patients had died, we retrieved the cause of death. We analyzed the incidence of and risk factors for recurrent SAH by Kaplan-Meier curves and Cox regression analysis. Results--Of 752 patients with 6016 follow-up years (mean follow up 8.0 years), 18 had a recurrence. In the first 10 years after the initial SAH, the cumulative incidence of recurrent SAH was 3.2% (95% confidence interval [CI], 1.5% to 4.9%) and the incidence rate 286 of 100 000 patient-years (95% CI, 160 to 472 per 100 000). Risk factors were smoking (hazard ratio [HR], 6.5; 95% CI, 1.7 to 24.0), age (HR, 0.5 per 10 years; 95% CI, 0.3 to 0.8) and multiple aneurysms at the time of the initial SAH (HR, 5.5; 95% CI, 2.2 to 14.1). Conclusions--After SAH, the incidence of a recurrence within the first 10 years is 22 (12 to 38) times higher than expected in populations with comparable age and sex. Whether this increased risk justifies screening for recurrent aneurysms in patients with a history of SAH requires further study.
Revised on July 4, 2005
Accepted on August 23, 2005
Incidence of Recurrent Subarachnoid Hemorrhage After Clipping for Ruptured Intracranial Aneurysms
Marieke J.H. Wermer MD*;
Key words: cerebral aneurysm • epidemiology • subarachnoid hemorrhage
This article has been cited by other articles:
 |
|
 |
|
  M J H Wermer, P Greebe, A Algra, and G J E Rinkel Long-term mortality and vascular event risk after aneurysmal subarachnoid haemorrhage J. Neurol. Neurosurg. Psychiatry, December 1, 2009; 80(12): 1399 - 1401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.J. van Rooij and M. Sluzewski Opinion: Imaging Follow-Up after Coiling of Intracranial Aneurysms AJNR Am. J. Neuroradiol., October 1, 2009; 30(9): 1646 - 1648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Raymond Counterpoint: Has the Last Word Been Said? AJNR Am. J. Neuroradiol., October 1, 2009; 30(9): 1649 - 1652. [Full Text] [PDF]
|
|
|
|
|
|
R.A. Willinsky, J. Peltz, L. da Costa, R. Agid, R.I. Farb, and K.G. terBrugge Clinical and Angiographic Follow-up of Ruptured Intracranial Aneurysms Treated with Endovascular Embolization AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 1035 - 1040. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Schaafsma, M. E. Sprengers, W. J. van Rooij, M. Sluzewski, C. B.L.M. Majoie, M. J.H. Wermer, and G. J.E. Rinkel Long-Term Recurrent Subarachnoid Hemorrhage After Adequate Coiling Versus Clipping of Ruptured Intracranial Aneurysms Stroke, May 1, 2009; 40(5): 1758 - 1763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.E. Sprengers, W.J. van Rooij, M. Sluzewski, G.J.E. Rinkel, B.K. Velthuis, G.A.P. de Kort, and C.B.L.M. Majoie MR Angiography Follow-Up 5 Years after Coiling: Frequency of New Aneurysms and Enlargement of Untreated Aneurysms AJNR Am. J. Neuroradiol., February 1, 2009; 30(2): 303 - 307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Koffijberg, G. Rinkel, and E. Buskens Do Intraindividual Variation in Disease Progression and the Ensuing Tight Window of Opportunity Affect Estimation of Screening Benefits? Med Decis Making, January 1, 2009; 29(1): 82 - 90. [Abstract] [PDF]
|
|
|
|
|
|
M.E. Sprengers, J. Schaafsma, W.J. van Rooij, M. Sluzewski, G.J.E. Rinkel, B.K. Velthuis, J.C. van Rijn, and C.B. Majoie Stability of Intracranial Aneurysms Adequately Occluded 6 Months after Coiling: A 3T MR Angiography Multicenter Long-Term Follow-Up Study AJNR Am. J. Neuroradiol., October 1, 2008; 29(9): 1768 - 1774. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Spencer The state of the art of medicine: Deciding on preventive screening tests after bleeding in the brain Neurology, May 27, 2008; 70(22): e92 - e94. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, H. Koffijberg, I. C. van der Schaaf, and For the ASTRA Study Group Effectiveness and costs of screening for aneurysms every 5 years after subarachnoid hemorrhage Neurology, May 27, 2008; 70(22): 2053 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Greebe and G. J.E. Rinkel Life Expectancy After Perimesencephalic Subarachnoid Hemorrhage Stroke, April 1, 2007; 38(4): 1222 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.N. de Gast, M.E. Sprengers, W.J. van Rooij, C. Lavini, M. Sluzewski, and C.B. Majoie Long-Term 3T MR Angiography Follow-Up after Therapeutic Occlusion of the Internal Carotid Artery to Detect Possible de Novo Aneurysm Formation AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 508 - 510. [Abstract] [Full Text] [PDF]
|
|