Unruptured intracranial aneurysm treatment [Neurosurgery Wiki]

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====== Unruptured intracranial aneurysm treatment ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1psP2_LnavdLe-cl9C_9cjbFgTIB7RyB4zOPqWb3zxNMASOkaW/?limit=15&utm_campaign=pubmed-2&fc=20230615140644}}
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The [[unruptured intracranial aneurysm]] treatment depends on the [[unruptured intracranial aneurysm natural history]]-the related risk of rupture vs. the risk of surgical management. The present meta-analysis sought to assess the association between the surgical outcomes of anterior and posterior circulation UIAs. The present study investigated the comparative articles involving the surgical treatment of anterior vs. posterior circulation UIAs through electronic databases, including the Cochrane Library, PubMed (1980 to March 2023), Medline (1980 to March 2023), and EMBASE (1980 to March 2023). Quoting all exclusion and inclusion criteria, nine articles finally remained for statistical analysis. The entire number of patients included in these nine articles was 3,253 (2,662 in the anterior and 591 in the posterior circulation UIAs group). The present meta-analysis proposes that the surgical treatment of anterior circulation UIAs is associated with better outcomes compared with the surgical management of posterior circulation UIAs
((Fotakopoulos G, Lempesis IG, Georgakopoulou VE, Trakas N, Sklapani P, Faropoulos K, Fountas KN. Surgical outcomes of patients with unruptured anterior vs. inferior circulation aneurysms: A meta‑analysis. Med Int (Lond). 2023 Dec 28;4(1):5. doi: 10.3892/mi.2023.129. PMID: 38283132; PMCID: PMC10811444.)).

===== Rupture prevention =====

see [[High-resolution magnetic resonance vessel wall imaging]]

The management of UIAs should focus on the control of hypertension during the follow-up. Aneurysms on the posterior communicating artery, posterior circulation, and cavernous carotid arteries require intensive surveillance or timely treatment
((Geng J, Wang S, Wang Y, Wang W, Fang G, Yang G, Fan X, Hu P, He C, Zhang H. Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms. Clin Neuroradiol. 2023 Jun 15. doi: 10.1007/s00062-023-01324-9. Epub ahead of print. PMID: 37318560.)).
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The establishment of [[drug]] therapy to prevent rupture of [[unruptured intracranial aneurysm]]s (IAs) is needed. Previous human and animal studies have gradually clarified candidate drugs for the [[prevention]] of [[intracranial aneurysm]] rupture. However, because most of these candidates belong to classes of drugs frequently co-administered to prevent [[cardiovascular disease]]s, epidemiological studies evaluating these drugs simultaneously should be performed. Furthermore, because drugs included in the same class may have different effects in terms of disease prevention, drug-by-drug assessments are important for planning intervention trials.

Shimizu et al. performed a [[cross-sectional study]] enrolling patients diagnosed with IAs between July 2011 and June 2019. Patients were divided into ruptured or unruptured groups. The drugs investigated were selected according to [[evidence]] suggested by either human or animal studies. [[Univariate]] and [[multivariate logistic regression]] analyses were performed to assess the association of drug treatment with rupture status. They also performed drug-by-drug assessments of the association, including dose-response relationships, with rupture status.

In total, 310 patients with ruptured and 887 patients with unruptured IAs were included. Multivariate analysis revealed an inverse association of statins (odds ratio (OR), 0.54; 95% confidence interval (CI) 0.38-0.77), calcium channel blockers (OR, 0.41; 95% CI 0.30-0.58), and [[angiotensin II receptor blocker]]s (ARBs) (OR, 0.67; 95% CI 0.48-0.93) with ruptured IAs. Moreover, inverse dose-response relationships with rupture status were observed for [[pitavastatin]] and [[rosuvastatin]] among [[statin]]s, [[benidipine]], [[cilnidipine]], and [[amlodipine]] among [[calcium channel blocker]]s, and [[valsartan]], [[azilsartan]], [[candesartan]], and [[olmesartan]] among ARBs. Only non-aspirin non-steroidal anti-inflammatory drugs were positively associated with ruptured IAs (OR, 3.24; 95% CI 1.71-6.13).

The present analysis suggests that several types of [[statin]]s, [[calcium channel blocker]]s, and ARBs are candidate drugs for the preventive treatment of unruptured IAs
((Shimizu K, Imamura H, Tani S, Adachi H, Sakai C, Ishii A, Kataoka H, Miyamoto S, Aoki T, Sakai N. Candidate drugs for preventive treatment of unruptured intracranial aneurysms: A cross-sectional study. PLoS One. 2021 Feb 12;16(2):e0246865. doi: 10.1371/journal.pone.0246865. PMID: 33577580.)).

===== Treatment decision =====

see [[Unruptured intracranial aneurysm treatment decision]].

In the early 1990's, [[endovascular]] treatment using embolic [[coil]]s for the treatment of [[intracranial aneurysm]]s was established. Since then, there has been a significant body of peer-reviewed literature written by medical experts regarding the use, safety, and efficacy of these detachable embolic coils. With the publishing of the [[ISAT]] ([[Intracranial Subarachnoid Aneurysm Trial]]) trial data in [[2005]], which compared clinical outcomes of neurosurgical clipping and endovascular coiling, embolic coiling became the preferred method for treatment of the majority of [[unruptured intracranial aneurysm]]s 
((Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P;
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group.
International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus
endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a
randomised comparison of effects on survival, dependency, seizures, rebleeding,
subgroups, and aneurysm occlusion. Lancet. 2005 Sep 3-9;366(9488):809-17. PubMed 
PMID: 16139655.
)).

===== Surgery =====

see [[Unruptured intracranial aneurysm surgery]].

===== Endovascular treatment (EVT) =====

see [[Unruptured intracranial aneurysm endovascular treatment]].

===== References =====