UPDATE ON Screening for unruptured aneurysms INTRACRANIAL Who to - PowerPoint PPT Presentation

2/16/2018 Current controversies UPDATE ON • Screening for unruptured aneurysms INTRACRANIAL • Who to screen? ANEURYSM • What to do with small aneurysms? • When to screen? • How often? Nerissa U. Ko, MD, MAS • Predicting aneurysms at high risk for Recent Advances in Neurology rupture February 15, 2018 • Any risk factors? • When to treat? Guideline recommendations • Family history > 2 first • Non-invasive imaging degree family initially 6-12 months members with IA or (CTA/MRA/DSA) SAH • Follow-up one year or • Genetic risk factors every other year to determine if: • Polycystic kidney disease • Ehler’s-Danlos, aortic • Aneurysm size > 7mm coarctation, microcephalic • Aneurysm enlargement osteodysplastic primordial • Consideration for treatment dwarfism • History of prior SAH 1

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2/16/2018 • PHASES score Summary • Population (Finnish, Japanese) • Small aneurysms have a very low risk of • HTN growth and rupture • Age > 70 • Recent modeling and systematic review • Size studies recommend no monitoring or • Hx SAH intervention in small aneurysms in the • Aneurysm location general population • Score < 3 associated • However, the dilemma of identifying which with lower, but not small aneurysm will rupture remains negligible risk of bleed problematic Future directions • Better selection of high risk patients to monitor, including women with FMD • Use of new grading scales like PHASES if validated • Biological imaging of growth, areas of activity • High resolution MRA, feromoxytol • Development of biomarkers to predict risk • DNA, mRNA, microRNAs, proteomics 4