Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
Lancet Neurol. 2014 Apr;13(4):385-92. doi: 10.1016/S1474-4422(14)70021-3. Epub 2014 Mar 5.
Individuals with two or more first-degree relatives who have had aneurysmal subarachnoid haemorrhage (aSAH) have an increased risk of aneurysms and aSAH. We investigated the yield of long-term serial screening for intracranial aneurysms in these individuals.
In a cohort study, we reviewed the results of screening of individuals with a positive family history of aSAH (two or more first-degree relatives who had had aSAH or unruptured intracranial aneurysms) done at the University Medical Centre Utrecht (Utrecht, Netherlands) between April 1, 1993, and April 1, 2013. Magnetic resonance angiography or CT angiography was done from age 16-18 years to 65-70 years. After a negative screen, we advised individuals to contact us after 5 years, but did not actively call them for repeated screening. We recorded familial history of ruptured and unruptured intracranial aneurysms, smoking history, hypertension, previous aneurysms, screening dates, and screening results. We identified risk factors for positive initial and follow-up screens with univariable and multivariable regression analysis.
We identified aneurysms in 51 (11%, 95% CI 9-14) of 458 individuals at first screening, in 21 (8%, 5-12) of 261 at second screening, in seven (5%, 2-11) of 128 at third screening, and three (5%, 1-14) of 63 at fourth screening. Five (3%, 95% CI 1-6) of 188 individuals without a history of aneurysms and with two negative screens had a de-novo aneurysm in a follow-up screen. Smoking (odds ratio 2·7, 95% CI 1·2-5·9), history of previous aneurysms (3·9, 1·2-12·7), and familial history of aneurysms (3·5, 1·6-8·1) were significant risk factors for aneurysms at first screening in the multivariable analysis. History of previous aneurysms was the only significant risk factor for aneurysms at follow-up screening (hazard ratio 4·5, 1·1-18·7). Aneurysms were identified in six (5%, 95% CI 2-10) of 129 individuals who were screened before age 30 years. One patient developed a de-novo aneurysm that ruptured 3 years after the last negative screen.
In individuals with a family history of aSAH, the yield of long-term screening is substantial even after more than 10 years of follow-up and two initial negative screens. We advocate long-term serial screening in these individuals, although the risk of aSAH within screening intervals is not eliminated.
The Dutch Heart Foundation.
有两个或两个以上一级亲属患有蛛网膜下腔出血（aSAH）的个体，其动脉瘤和 aSAH 的风险增加。我们研究了这些个体进行长期连续颅内动脉瘤筛查的效果。
在一项队列研究中，我们回顾了乌得勒支大学医学中心（荷兰乌得勒支）于 1993 年 4 月 1 日至 2013 年 4 月 1 日期间对有阳性家族史的 aSAH（两个或两个以上一级亲属患有 aSAH 或未破裂颅内动脉瘤）的个体进行的筛查结果。从 16-18 岁到 65-70 岁进行磁共振血管造影或 CT 血管造影。阴性筛查后，我们建议个体在 5 年后与我们联系，但没有主动要求他们进行重复筛查。我们记录了家族史中破裂和未破裂的颅内动脉瘤、吸烟史、高血压、既往动脉瘤、筛查日期和筛查结果。我们使用单变量和多变量回归分析确定阳性初始和随访筛查的危险因素。
在第一次筛查中，在 458 名个体中发现了 51 例（11%，95%CI 9-14）动脉瘤，在第二次筛查中，在 261 名个体中发现了 21 例（8%，5-12），在第三次筛查中，在 128 名个体中发现了 7 例（5%，2-11），在第四次筛查中，在 63 名个体中发现了 3 例（5%，1-14）。在没有动脉瘤史且两次阴性筛查的 188 名个体中，有 5 名（3%，95%CI 1-6）在随访筛查中发现新发动脉瘤。吸烟（比值比 2.7，95%CI 1.2-5.9）、既往动脉瘤史（3.9，1.2-12.7）和家族性动脉瘤史（3.5，1.6-8.1）是多变量分析中首次筛查出现动脉瘤的显著危险因素。既往动脉瘤史是随访筛查出现动脉瘤的唯一显著危险因素（风险比 4.5，1.1-18.7）。在 129 名 30 岁前接受筛查的个体中发现了 6 例（5%，95%CI 2-10）动脉瘤。1 名患者在最后一次阴性筛查后 3 年出现新发动脉瘤破裂。
在有蛛网膜下腔出血家族史的个体中，即使在 10 年以上的随访和两次初始阴性筛查后，长期筛查的效果也非常显著。我们主张对这些个体进行长期连续的筛查，尽管在筛查间隔内发生蛛网膜下腔出血的风险并未消除。
荷兰心脏基金会。
