COMMENTARY

Optimal Treatment Of Small Unruptured Aneurysms

Mark J. Alberts, MD

Disclosures

September 23, 2010

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Hello. My name is Dr. Mark Alberts, Professor of Neurology and Director of the stroke program at Northwestern University and Northwestern Memorial Hospital.

Today I would like to talk to you about an article in the September 2010 issue of Stroke by Sonobe and colleagues[1] from Japan. This group looked at the risk for rupture in small aneurysms (smaller than 5 mm) producing a subarachnoid hemorrhage. Overall, this group studied more than 400 patients who had more than 500 aneurysms. What they found was that, overall, the annual risk for aneurysm rupture was quite low, at 0.5% per year. In patients who had a single aneurysm, the annual risk for rupture was even a little lower, at 0.3% per year, whereas patients who had multiple small aneurysms had a risk for rupture of almost 1% per year.

Several other factors correlated with an increased risk for rupture. These included being male, having a history of hypertension, a diameter greater than 4 mm in size for the aneurysm, and having more than 1 aneurysm. All of these factors increased the risk for aneurysm rupture substantially. Still, I think it is important to note that overall the risk for rupture was generally quite low.

When considering whether to treat these patients with small aneurysms, it's important to factor in the risks and complication rates of any type of therapy, whether it is an endovascular treatment or a direct surgical treatment. The bottom line for me is that in general, patients with small aneurysms have a very low annual risk for rupturing and perhaps the best course of action would be to aggressively control their risk factors and then consider some treatment if they're in a very high-risk group.

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