Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Int J Stroke. 2022 Jan;17(1):30-36. doi: 10.1177/17474930211024584. Epub 2021 Jun 17.
Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after aneurysmal subarachnoid hemorrhage, prevention of aneurysmal subarachnoid hemorrhage has the highest potential to prevent poor outcome from aneurysmal subarachnoid hemorrhage.
In this review, we describe the groups at high risk of aneurysmal subarachnoid hemorrhage who may benefit from preventive screening for unruptured intracranial aneurysms followed by preventive treatment of unruptured intracranial aneurysms found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening.
Modeling studies show that persons with two or more affected first-degree relatives with aneurysmal subarachnoid hemorrhage and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for unruptured intracranial aneurysms. One modeling study also suggests that persons with only one affected first-degree relative with aneurysmal subarachnoid hemorrhage are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of aneurysmal subarachnoid hemorrhage of up to 7%, but the prevalence of unruptured intracranial aneurysms in such persons and the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening -such as risk of incidental findings, very small unruptured intracranial aneurysms that require regular follow-up, preventive treatment with inherent risk of complications and anxiety - should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged.
Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all aneurysmal subarachnoid hemorrhage patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of unruptured intracranial aneurysm become available, the groups of persons who may benefit from screening could increase considerably.
颅内动脉瘤破裂导致的蛛网膜下腔出血（动脉瘤性蛛网膜下腔出血）是中风的一种毁灭性亚型。由于初始出血引起的脑损伤是动脉瘤性蛛网膜下腔出血后不良预后的主要原因，因此预防动脉瘤性蛛网膜下腔出血具有预防动脉瘤性蛛网膜下腔出血不良预后的最大潜力。
在本综述中，我们描述了那些可能受益于未破裂颅内动脉瘤预防性筛查的高危人群，并对发现的未破裂颅内动脉瘤进行预防性治疗。此外，我们描述了筛查的优缺点，并就如何进行筛查咨询提出了建议。
模型研究表明，有两个或两个以上一级亲属患有动脉瘤性蛛网膜下腔出血的人以及常染色体显性多囊肾病（ADPKD）患者是未破裂颅内动脉瘤筛查的候选人群。一项模型研究还表明，仅有一个一级亲属患有动脉瘤性蛛网膜下腔出血的人也可能是筛查的候选人群。另一组可能受益于筛查的人群是≥35 岁的吸烟者和高血压患者，因为他们的动脉瘤性蛛网膜下腔出血终生风险高达 7%，但此类人群中未破裂颅内动脉瘤的患病率以及该人群中筛查的效率和成本效益尚不清楚。筛查的最终目标是增加筛查候选者的高质量生命年限，因此筛查的益处，但也有许多缺点，如偶然发现的风险、需要定期随访的非常小的未破裂颅内动脉瘤、预防治疗的固有并发症风险和焦虑——应与候选者讨论，以便在颅内血管成像之前做出明智的决定。
已经确定了一些可能受益于筛查的人群，但由于这些人群仅占所有动脉瘤性蛛网膜下腔出血患者的少数，因此仍需要确定其他高危人群。还需要进一步研究来确定迄今为止确定的人群中动脉瘤形成和破裂的低风险或高风险人群，以提高筛查的效率。此外，如果可以使用新的可以降低未破裂颅内动脉瘤破裂风险的医疗治疗策略，那么可能受益于筛查的人群将会大大增加。
