Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms

Clinical article

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Object

This study was performed to investigate the risk factors related to the growth of small, asymptomatic, unruptured aneurysms in patients with no history of subarachnoid hemorrhage (SAH).

Methods

Between January 2005 and December 2010, a total of 508 patients in whom unruptured intracranial aneurysms were diagnosed at the University of California, Los Angeles medical center did not receive treatment to prevent rupture. Of these, 235 patients with no history of SAH who had asymptomatic, small, unruptured aneurysms (< 7 mm) were monitored with 3D CT angiography images. Follow-up images of the lesions were used to measure aneurysm size changes. Patient medical history, family history of SAH, aneurysm size, and location were studied to find the risk factors associated with small aneurysm growth.

Results

A total of 319 small aneurysms were included, with follow-up durations of 29.2 ± 20.6 months. Forty-two aneurysms increased in size during the follow-up; 5 aneurysms grew to become ≥ 7 mm within 38.2 ± 18.3 months. A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (p = 0.07). A history of stroke was the only factor associated with single aneurysm growth (p = 0.03). The number of aneurysms (p = 0.011), number of aneurysms located within the posterior circulation (p = 0.030), and patient history of transient ischemic attack (p = 0.044) were related to multiple aneurysm growth.

Conclusions

Multiple small aneurysms are more likely to grow, and multiple aneurysms located in the posterior circulation may require additional attention. Although single aneurysms have a lower risk of growth, a trend of higher growth rates in single aneurysms was found.

Abbreviations used in this paper:ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; BA = basilar artery; CTA = CT angiography; ICA = internal carotid artery; ICA-Ca = cavernous segment of ICA; ICA-Oph = ophthalmic segment of ICA; ISUIA = International Study of Unruptured Intracranial Aneurysms; MCA = middle cerebral artery; MRA = MR angiography; PCA = posterior cerebral artery; PCoA = posterior communicating artery; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery; TIA = transient ischemic attack; UCLA = University of California, Los Angeles; UIA = unruptured intracranial aneurysm; VA = vertebral artery.
Article Information

Contributor Notes

Address correspondence to: Aichi Chien, Ph.D., Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Box 951721, 10833 LeConte Avenue, Los Angeles, California 90095. email: aichi@ucla.edu.Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.JNS121469.
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