Growth rates of intracranial aneurysms: exploring constancy

Hendrik Koffijberg Ph.D. 1 , Erik Buskens M.D., Ph.D. 1 , 2 , Ale Algra M.D., Ph.D. 1 , 3 , Marieke J. H. Wermer M.D., Ph.D. 3 , and Gabriel J. E. Rinkel M.D. 3
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  • 1 Julius Center for Health Sciences and Primary Care;
  • 3 Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht; and
  • 2 Department of Epidemiology, University Medical Center Groningen, The Netherlands
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Object

The annual rate of rupture of intracranial aneurysms is often assumed to be constant, but it is unknown whether this assumption is true. Recent case reports have suggested that aneurysms grow fast in a short period of time. The authors of the present report investigated the plausibility of a constant growth rate for intracranial aneurysms.

Methods

Assuming a constant aneurysm growth rate within an individual and varying rates between individuals, a hypothetical cohort was simulated. Individuals with high growth rates will display aneurysm formation and rupture at a young age; such persons disappear early from the hypothetical cohort. As a result the mean lesion growth rate varies over time. In hypothetical cohorts with different initial mean growth rates, the authors calculated age-specific incidence rates (per 100,000 person-years) of subarachnoid hemorrhage and compared these rates with population-based data on the incidence of subarachnoid hemorrhage (per 100,000 person-years).

Results

A hypothetical cohort with a mean initial growth rate of 0.18 mm/year reproduced most closely the incidence rates observed in the population. However, even for this most plausible hypothetical cohort, age-specific incidence rates in the model differed substantially and statistically significantly from those observed in the population.

Conclusions

Based on the results of this study, it is unlikely that intracranial aneurysms in general grow at a constant time-independent rate. The authors hypothesized that the actual growth process is irregular and discontinuous, which results in periods with and without aneurysm growth and with high and low risks of rupture.

Abbreviations used in this paper: ACoA = anterior communicating artery; ASTRA = Aneurysm Screening After Surgical Treatment for Ruptured Aneurysms; CI = confidence interval; ICA = internal carotid artery; IDR = incidence density ratio; IMGR = initial mean growth rate; MCA = middle cerebral artery; SAH = subarachnoid hemorrhage; VBS = vertebrobasilar system.

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Contributor Notes

Address correspondence to: Hendrik Koffijberg, Ph.D., Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Room STR 6.131/7.113, 3508 GA Utrecht, The Netherlands. email: h.koffijberg@umcutrecht.nl.
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