Giant intracranial aneurysms: Natural history and 1-year case fatality after endovascular or surgical treatment

on behalf of the Giant Intracranial Aneurysm Study Group

doi:10.3171/2019.8.JNS183078

Giant intracranial aneurysms: Natural history and 1-year case fatality after endovascular or surgical treatment

on behalf of the Giant Intracranial Aneurysm Study Group

Charité – Universitätsmedizin Berlin
Helios Clinic
University Hospital Brandenburg
Hirslanden Klinik Aarau
Georg-August-Universität Göttingen
Center for Stroke Research Berlin
University of Würzburg
DONAUISAR Klinik Deggendorf
Donau-Isar-Klinikum
Medizinische Hochschule Hannover
Universitätsklinikum Hamburg-Eppendorf
University Hospital Zurich
Geneva University Hospitals
Faculty of Medicine
Ospedale Niguarda Ca' Granda
Centre Hospitalier Universitaire de Toulouse
University Hospital Würzburg
Albert-Ludwigs-Universität Freiburg
University Medical Center Ulm and Center of Excellence 'Metabolic Disorders'
University of Minnesota Twin Cities
Helios Klinikum Hildesheim
Ernst-Moritz-Arndt Universität Greifswald
Trauma Center Murnau
Heinrich-Heine-University
Universitätsmedizin Mannheim
University Heart Center
University of Regensburg
University of Duisburg-Essen
Friedrichshain Hospital
BG Klinikum Bergmannstrost
Technical University of Munich
Klinikum Stuttgart
Unfallkrankenhaus Berlin
University of Bonn and University Hospital Bonn
University of Leipzig
Cantonal Hospital Aarau
Universita La Sapienza
Medical University of Vienna
Helsinki University Central Hospital
Scientific Center for Children's Health RAMS
University Medical Center Utrecht
Erasmus University Medical Center
Budweis Hospital
Jikei University School of Medicine
Baptist Neuroscience Institute

Research output: Contribution to journal › Article › peer-review

44 Scopus citations

Abstract

OBJECTIVE Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs. METHODS In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality. RESULTS The retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23-2.16) in ruptured GIAs and 3.96 (95% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality. CONCLUSIONS Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.

Original language	English
Pages (from-to)	49-57
Number of pages	9
Journal	Journal of Neurosurgery
Volume	134
Issue number	1
DOIs	https://doi.org/10.3171/2019.8.JNS183078
State	Published - Jan 2021

Keywords

Aneurysm rupture
Giant intracranial aneurysm
Subarachnoid hemorrhage
Vascular disorders

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10.3171/2019.8.JNS183078

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@article{18688da3b4b946aebf291cfedb35bfa5,

title = "Giant intracranial aneurysms: Natural history and 1-year case fatality after endovascular or surgical treatment",

abstract = "OBJECTIVE Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs. METHODS In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality. RESULTS The retrospective cohort comprised 219 patients with GIAs (21.9\% ruptured GIAs and 78.1\% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1\% ruptured and 82.9\% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95\% CI 1.23-2.16) in ruptured GIAs and 3.96 (95\% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100\%/22.0\% during CM, 36.0\%/3.0\% after SM, and 39.0\%/12.0\% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0\% during CM, 1.2\% after SM, and 2.5\% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95\% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality. CONCLUSIONS Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.",

keywords = "Aneurysm rupture, Giant intracranial aneurysm, Subarachnoid hemorrhage, Vascular disorders",

author = "\{on behalf of the Giant Intracranial Aneurysm Study Group\} and Julius Dengler and Daniel R{\"u}fenacht and Bernhard Meyer and Veit Rohde and Matthias Endres and Pavlina Lenga and Konstantin Uttinger and Viktoria R{\"u}cker and Maria Wostrack and Adisa Kursumovic and Bujung Hong and Dorothee Mielke and Schmidt, \{Nils Ole\} and Burkhardt, \{Jan Karl\} and Philippe Bijlenga and Edoardo Boccardi and Christophe Cognard and Heuschmann, \{Peter U.\} and Peter Vajkoczy and Bauknecht, \{H. C.\} and G. Bohner and T. Liebig and E. Wiener and S. Gl{\"a}sker and Klingler, \{J. H.\} and C. Scheiwe and \{van Velthoven\}, V. and J. Zentner and G. Durner and R. K{\"o}nig and Pedro, \{M. T.\} and R. Wirtz and I. Fiss and T. Kombos and S. Guhl and Schroeder, \{H. W.S.\} and M. Strowitzki and S. Eicker and H. Steiger and B. Turowski and A. Abdulazim and N. Etminan and D. Haenggi and R. Kalff and J. Walter and A. Brawanski and Schebesch, \{K. M.\} and A. Ardeshiri and U. Sure and K. Wrede",

note = "Publisher Copyright: {\textcopyright} AANS 2021, except where prohibited by US copyright law",

year = "2021",

month = jan,

doi = "10.3171/2019.8.JNS183078",

language = "English",

volume = "134",

pages = "49--57",

journal = "Journal of Neurosurgery",

issn = "0022-3085",

publisher = "American Association of Neurological Surgeons",

number = "1",

}

TY - JOUR

T1 - Giant intracranial aneurysms

T2 - Natural history and 1-year case fatality after endovascular or surgical treatment

AU - on behalf of the Giant Intracranial Aneurysm Study Group

AU - Dengler, Julius

AU - Rüfenacht, Daniel

AU - Meyer, Bernhard

AU - Rohde, Veit

AU - Endres, Matthias

AU - Lenga, Pavlina

AU - Uttinger, Konstantin

AU - Rücker, Viktoria

AU - Wostrack, Maria

AU - Kursumovic, Adisa

AU - Hong, Bujung

AU - Mielke, Dorothee

AU - Schmidt, Nils Ole

AU - Burkhardt, Jan Karl

AU - Bijlenga, Philippe

AU - Boccardi, Edoardo

AU - Cognard, Christophe

AU - Heuschmann, Peter U.

AU - Vajkoczy, Peter

AU - Bauknecht, H. C.

AU - Bohner, G.

AU - Liebig, T.

AU - Wiener, E.

AU - Gläsker, S.

AU - Klingler, J. H.

AU - Scheiwe, C.

AU - van Velthoven, V.

AU - Zentner, J.

AU - Durner, G.

AU - König, R.

AU - Pedro, M. T.

AU - Wirtz, R.

AU - Fiss, I.

AU - Kombos, T.

AU - Guhl, S.

AU - Schroeder, H. W.S.

AU - Strowitzki, M.

AU - Eicker, S.

AU - Steiger, H.

AU - Turowski, B.

AU - Abdulazim, A.

AU - Etminan, N.

AU - Haenggi, D.

AU - Kalff, R.

AU - Walter, J.

AU - Brawanski, A.

AU - Schebesch, K. M.

AU - Ardeshiri, A.

AU - Sure, U.

AU - Wrede, K.

PY - 2021/1

Y1 - 2021/1

N2 - OBJECTIVE Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs. METHODS In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality. RESULTS The retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23-2.16) in ruptured GIAs and 3.96 (95% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality. CONCLUSIONS Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.

AB - OBJECTIVE Clinical evidence on giant intracranial aneurysms (GIAs), intracranial aneurysms with a diameter of at least 25 mm, is limited. The authors aimed to investigate the natural history, case fatality, and treatment outcomes of ruptured and unruptured GIAs. METHODS In this international observational registry study, patients with a ruptured or unruptured GIA received conservative management (CM), surgical management (SM), or endovascular management (EM). The authors investigated rupture rates and case fatality. RESULTS The retrospective cohort comprised 219 patients with GIAs (21.9% ruptured GIAs and 78.1% unruptured GIAs) whose index hospitalization occurred between January 2006 and November 2016. The index hospitalization in the prospective cohort (362 patients with GIAs [17.1% ruptured and 82.9% unruptured]) occurred between December 2008 and February 2017. In the retrospective cohort, the risk ratio for death at a mean follow-up of 4.8 years (SD 2.2 years) after CM, compared with EM and SM, was 1.63 (95% CI 1.23-2.16) in ruptured GIAs and 3.96 (95% CI 2.57-6.11) in unruptured GIAs. In the prospective cohort, the 1-year case fatality in ruptured GIAs/unruptured GIAs was 100%/22.0% during CM, 36.0%/3.0% after SM, and 39.0%/12.0% after EM. Corresponding 1-year rupture rates in unruptured GIAs were 25.0% during CM, 1.2% after SM, and 2.5% after EM. In unruptured GIAs, the HR for death within the 1st year in patients with posterior circulation GIAs was 6.7 (95% CI 1.5-30.4, p < 0.01), with patients with a GIA at the supraclinoid internal carotid artery as reference. Different sizes of unruptured GIAs were not associated with 1-year case fatality. CONCLUSIONS Rupture rates for unruptured GIAs were high, and the natural history and treatment outcomes for ruptured GIAs were poor. Patients undergoing SM or EM showed lower case fatality and rupture rates than those undergoing CM. This difference in outcome may in part be influenced by patients in the CM group having been found poor candidates for SM or EM.

KW - Aneurysm rupture

KW - Giant intracranial aneurysm

KW - Subarachnoid hemorrhage

KW - Vascular disorders

UR - https://www.scopus.com/pages/publications/85090986307

U2 - 10.3171/2019.8.JNS183078

DO - 10.3171/2019.8.JNS183078

M3 - Article

C2 - 31812141

AN - SCOPUS:85090986307

SN - 0022-3085

VL - 134

SP - 49

EP - 57

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

IS - 1

ER -

Giant intracranial aneurysms: Natural history and 1-year case fatality after endovascular or surgical treatment

Abstract

Keywords

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