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(Stroke. 2001;32:1933.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Risk of Subarachnoid Hemorrhage From a De Novo Aneurysm

Seppo Juvela, MD, PhD

Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

To the Editor:

I read with interest a recent article¹ concerning risk of de novo aneurysm formation and recommendations for future screening for these aneurysms after successful clipping of an intracranial aneurysm. Although the results of the study are reliable, the conclusions are not based on the data of this and previous studies. The patients whose aneurysms have been treated successfully should not unnecessarily be made anxious and fearful for decades because of a very low risk for subarachnoid hemorrhage (SAH) from a potential de novo aneurysm.

In our first angiographic follow-up study (published in 1993²), of 31 patients with a mean follow-up of 9 years (range 0.8 to 23.0 years; total follow-up of 279 person-years), formation rate of a de novo aneurysm cases was 2.2%/y, which was similar to that in a recent study (1.8%/y).³ In both of these studies, the formation rate of new aneurysms was likely too high, because new SAH cases were overrepresented in these study populations. Interestingly, in the study of Tsutsumi and colleagues,¹ the formation rate of a de novo aneurysm was lower and similar (0.89% per year) to that in our recent study (0.84%/y), obtained among 89 patients with a mean follow-up time of 20.1 years per patient (range 1.2 to 38.9 years; total follow-up time 1789 person-years),⁴ which suggests that aneurysm formation rate is lower if the follow-up is not restricted to a high-risk population. In our study, there were 15 de novo aneurysm cases, and female gender and cigarette smoking increased this risk. . . . [Full Text of this Article]

Kazuo Tsutsumi, MD; Keisuke Ueki, MD Takaaki Kirino, MD

Department of Neurosurgery, Aizu Chuou Hospital, and Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan

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