Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms
To the Editor:
I read with great interest a recent article concerning recommendations for the management of unruptured intracranial aneurysms, published both in Stroke and in Circulation.1 The authors state, “Thus far, all natural history studies have been performed on patients selected for conservative management [italics added].” The reason for this seems to be that the recommendations are based almost exclusively on the results obtained from the International Study of Unruptured Intracranial Aneurysms (ISUIA). However, it is well known that the results of the ISUIA are in conflict with those of other studies.
The above-quoted statement is not true. In Helsinki, patients with unruptured aneurysms diagnosed before 1979 were not treated surgically.2 3 4 5 This gave us the possibility for a long-term follow-up of patients with unruptured aneurysms but without surgical selection of cases, and thus there was no bias caused by surgery. Our first cases have been reported as case reports, but the results of patient series have been repeatedly published with improved use of statistics since 1970, as the number of patients and follow-up years increased.2 3 4 5 The follow-up has been prospective, without loss of cases during the follow-up.
For my detailed opinions for potential …