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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O G Nilsson, A Lindgren, N Stahl, L Brandt, and H Saveland Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden J. Neurol. Neurosurg. Psychiatry, November 1, 2000; 69(5): 601 - 607. [Abstract] [Full Text] [PDF]
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P. M. White, J. M. Wardlaw, and V. Easton Can Noninvasive Imaging Accurately Depict Intracranial Aneurysms? A Systematic Review Radiology, November 1, 2000; 217(2): 361 - 370. [Abstract] [Full Text]
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E. J. Roos, G. J. E. Rinkel, B. K. Velthuis, and A. Algra The relation between aneurysm size and outcome in patients with subarachnoid hemorrhage Neurology, June 27, 2000; 54(12): 2334 - 2336. [Abstract] [Full Text] [PDF]
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P Mitchell and J Jakubowski Risk analysis of treatment of unruptured aneurysms J. Neurol. Neurosurg. Psychiatry, May 1, 2000; 68(5): 577 - 580. [Abstract] [Full Text]
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T. Ingall, K. Asplund, M. Mahonen, and R. Bonita A Multinational Comparison of Subarachnoid Hemorrhage Epidemiology in the WHO MONICA Stroke Study Stroke, May 1, 2000; 31(5): 1054 - 1061. [Abstract] [Full Text] [PDF]
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J. M. Wardlaw and P. M. White The detection and management of unruptured intracranial aneurysms Brain, February 1, 2000; 123(2): 205 - 221. [Abstract] [Full Text] [PDF]
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P. J Kirkpatrick and R S McConnell Screening for familial intracranial aneurysms BMJ, December 11, 1999; 319(7224): 1512 - 1513. [Full Text]
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The Magnetic Resonance Angiography in Relatives of Risks and Benefits of Screening for Intracranial Aneurysms in First-Degree Relatives of Patients with Sporadic Subarachnoid Hemorrhage N. Engl. J. Med., October 28, 1999; 341(18): 1344 - 1350. [Abstract] [Full Text] [PDF]
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 L. Mariani, M. G. Bianchetti, G. Schroth, and R. W. Seiler Cerebral aneurysms in patients with autosomal dominant polycystic kidney disease—to screen, to clip, to coil? Nephrol. Dial. Transplant., October 1, 1999; 14(10): 2319 - 2322. [Full Text] [PDF]
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P.M. White, K.W. Lindsay, E. Teasdale, G.M. Teasdale, J.M. Wardlaw, M. M. Brown, F. Crawley, and A. Clifton Should We Screen for Familial Intracranial Aneurysm? • Response Stroke, October 1, 1999; 30 (10): 2238g - 2248. [Full Text] [PDF]
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T. W. M. Raaymakers Aneurysms in relatives of patients with subarachnoid hemorrhage: Frequency and risk factors Neurology, September 1, 1999; 53(5): 982 - 982. [Abstract] [Full Text]
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Y. Yoshimoto and S. Wakai Cost-Effectiveness Analysis of Screening for Asymptomatic, Unruptured Intracranial Aneurysms : A Mathematical Model Stroke, August 1, 1999; 30(8): 1621 - 1627. [Abstract] [Full Text] [PDF]
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S. C. Johnston, D. R. Gress, and J. G. Kahn Which unruptured cerebral aneurysms should be treated?: A cost-utility analysis Neurology, June 1, 1999; 52(9): 1806 - 1806. [Abstract] [Full Text] [PDF]
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F. Crawley, A. Clifton, and M. M. Brown Should We Screen for Familial Intracranial Aneurysm? Stroke, February 1, 1999; 30(2): 312 - 316. [Abstract] [Full Text] [PDF]
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E. H. Brilstra, G. J. E. Rinkel, Y. van der Graaf, W. J. J. van Rooij, and A. Algra Treatment of Intracranial Aneurysms by Embolization with Coils : A Systematic Review Stroke, February 1, 1999; 30(2): 470 - 476. [Abstract] [Full Text] [PDF]
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T. Truelsen, R. Bonita, J. Duncan, N. E. Anderson, and E. Mee Changes in Subarachnoid Hemorrhage Mortality, Incidence, and Case Fatality in New Zealand Between 1981–1983 and 1991–1993 Stroke, November 1, 1998; 29(11): 2298 - 2303. [Abstract] [Full Text] [PDF]
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T. W. M. Raaymakers, G. J. E. Rinkel, M. Limburg, and A. Algra Mortality and Morbidity of Surgery for Unruptured Intracranial Aneurysms : A Meta-Analysis Stroke, August 1, 1998; 29(8): 1531 - 1538. [Abstract] [Full Text] [PDF]
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