Etminan Nima, de Sousa Diana Aguiar, Tiseo Cindy, Bourcier Romain, Desal Hubert, Lindgren Anttii, Koivisto Timo, Netuka David, Peschillo Simone, Lémeret Sabrina, Lal Avtar, Vergouwen Mervyn DI, Rinkel Gabriel Je
Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Stroke Centre, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
Eur Stroke J. 2022 Sep;7(3):V. doi: 10.1177/23969873221099736. Epub 2022 Jun 3.
Unruptured intracranial aneurysms (UIA) occur in around 3% of the population. Important management questions concern if and how to perform preventive UIA occlusion; if, how and when to perform follow up imaging and non-interventional means to reduce the risk of rupture. Using the Standard Operational Procedure of ESO we prepared guidelines according to GRADE methodology. Since no completed randomised trials exist, we used interim analyses of trials, and meta-analyses of observational and case-control studies to provide recommendations to guide UIA management. All recommendations were based on very low evidence. We suggest preventive occlusion if the estimated 5-year rupture risk exceeds the risk of preventive treatment. In general, we cannot recommend endovascular over microsurgical treatment, but suggest flow diverting stents as option only when there are no other low-risk options for UIA repair. To detect UIA recurrence we suggest radiological follow up after occlusion. In patients who are initially observed, we suggest radiological monitoring to detect future UIA growth, smoking cessation, treatment of hypertension, but not treatment with statins or acetylsalicylic acid with the indication to reduce the risk of aneurysm rupture. Additionally, we formulated 15 expert-consensus statements. All experts suggest to assess UIA patients within a multidisciplinary setting (neurosurgery, neuroradiology and neurology) at centres consulting >100 UIA patients per year, to use a shared decision-making process based on the team recommendation and patient preferences, and to repair UIA only in centres performing the proposed treatment in >30 patients with (ruptured or unruptured) aneurysms per year per neurosurgeon or neurointerventionalist. These UIA guidelines provide contemporary recommendations and consensus statement on important aspects of UIA management until more robust data come available.
未破裂颅内动脉瘤（UIA）在约3%的人群中存在。重要的管理问题涉及是否以及如何进行预防性UIA闭塞；是否、如何以及何时进行随访成像和非介入手段以降低破裂风险。我们依据欧洲卒中组织（ESO）的标准操作程序，按照GRADE方法制定了指南。由于不存在完整的随机试验，我们使用试验的中期分析以及观察性和病例对照研究的荟萃分析来提供建议，以指导UIA的管理。所有建议都基于非常低的证据。如果估计的5年破裂风险超过预防性治疗的风险，我们建议进行预防性闭塞。一般而言，我们不推荐血管内治疗优于显微外科治疗，但仅当没有其他低风险的UIA修复选项时，才建议将血流导向支架作为一种选择。为了检测UIA复发，我们建议在闭塞后进行放射学随访。对于最初接受观察的患者，我们建议进行放射学监测以检测未来UIA的生长、戒烟、治疗高血压，但不建议使用他汀类药物或阿司匹林进行治疗以降低动脉瘤破裂风险。此外，我们制定了15条专家共识声明。所有专家建议在每年会诊超过100例UIA患者的中心，在多学科环境（神经外科、神经放射学和神经病学）中对UIA患者进行评估，采用基于团队建议和患者偏好的共同决策过程，并且仅在每位神经外科医生或神经介入专家每年对超过30例（破裂或未破裂）动脉瘤患者进行拟议治疗的中心进行UIA修复。这些UIA指南在更有力的数据可用之前，就UIA管理的重要方面提供了当代建议和共识声明。
