UMC Utrecht Brain Centre, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur Stroke J. 2023 Dec;8(4):1071-1078. doi: 10.1177/23969873231193296. Epub 2023 Aug 10.
Lifetime risk of aneurysmal subarachnoid haemorrhage (aSAH) is high (7%) in persons ⩾35 years with hypertension who smoke(d). Whether screening for intracranial aneurysms (IAs) to prevent aSAH is effective in these patients is unknown.
Participants were retrieved from a cohort of patients with clinically manifest atherosclerotic vascular disease included between 2012 and 2019 at the University Medical Centre Utrecht (SMART-ORACLE, NCT01932671) in whom CT-angiography (CTA) of intracranial arteries was performed. We selected patients ⩾35 years with hypertension who smoke(d). CTAs were reviewed for the presence of IAs by experienced neuroradiologists. Patients with IAs were offered follow-up imaging to detect aneurysmal growth. We determined aneurysm prevalence and developed a diagnostic model for IA risk at screening using multivariable logistic regression.
IA were found in 25 of 500 patients (5.0% prevalence, 95%CI: 3.3%-7.3%). Median 5 year risk of rupture assessed with the PHASES score was 0.9% (IQR: 0.7%-1.3%). During a median follow-up of 57 months (IQR: 39-83 months) no patients suffered from aSAH. Aneurysmal growth was detected in one patient for whom preventive treatment was advised. IA risk at screening ranged between 1.6% and 13.4% with predictors being age, female sex and current smoking.
IA prevalence in persons ⩾35 years with hypertension and atherosclerotic vascular disease who smoke(d) was 5%. Given the very small proportion of IA that needed preventive treatment, we currently do not advise screening for Caucasian persons older than 35 years of age who smoke and have hypertension in general. Whether screening may be effective for certain subgroups (e.g. women older than 50 years of age) or other ethnic populations should be the subject of future studies.
终生患有蛛网膜下腔出血（aSAH）的风险（7%）在 ⩾35 岁且有高血压的吸烟人群中较高。目前尚不清楚对这些患者进行颅内动脉瘤（IA）筛查以预防 aSAH 是否有效。
参与者从 2012 年至 2019 年期间在乌得勒支大学医学中心（SMART-ORACLE，NCT01932671）纳入的有临床表现的动脉粥样硬化血管疾病的队列中获取。我们选择 ⩾35 岁且有高血压的吸烟人群。由有经验的神经放射科医生对颅内动脉的 CT 血管造影（CTA）进行复查，以确定是否存在 IAs。对存在 IAs 的患者进行随访影像学检查，以检测动脉瘤的生长情况。我们使用多变量逻辑回归确定了筛查时 IA 风险的动脉瘤患病率和诊断模型。
在 500 名患者中，25 名（5.0%的患病率，95%CI：3.3%-7.3%）发现了 IA。使用 PHASES 评分评估的 5 年破裂风险中位数为 0.9%（IQR：0.7%-1.3%）。在中位数为 57 个月（IQR：39-83 个月）的随访期间，没有患者发生 aSAH。对一名发现有动脉瘤生长的患者建议进行预防性治疗。筛查时的 IA 风险在 1.6%-13.4%之间，预测因素为年龄、女性和当前吸烟。
在 ⩾35 岁且有高血压和动脉粥样硬化性血管疾病且吸烟的人群中，IA 的患病率为 5%。鉴于需要预防性治疗的 IA 比例非常小，我们目前不建议对一般年龄超过 35 岁、吸烟且有高血压的白种人进行筛查。筛查是否对某些亚组（例如年龄超过 50 岁的女性）或其他种族人群有效，应成为未来研究的课题。
