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A correction has been published: N Engl J Med 1999;340(9):744.

Volume 339:1725-1733 December 10, 1998 Number 24 Next

	Full Text PDF Editorial by Caplan, L. R. Letters Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Berenstein, A. Related Article PubMed Citation

ABSTRACT

Background The management of unruptured intracranial aneurysms requires knowledge of the natural history of these lesions and the risks of repairing them.

Methods A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospective and prospective components. In the retrospective component, we assessed the natural history of unruptured intracranial aneurysms in 1449 patients with 1937 such aneurysms; 727 of the patients had no history of subarachnoid hemorrhage from a different aneurysm (group 1), and 722 had a history of subarachnoid hemorrhage from a different aneurysm that had been repaired successfully (group 2). In the prospective component, we assessed treatment-related morbidity and mortality in 1172 patients with newly diagnosed unruptured intracranial aneurysms.

Results In group 1, the cumulative rate of rupture of aneurysms that were less than 10 mm in diameter at diagnosis was less than 0.05 percent per year, and in group 2, the rate was approximately 11 times as high (0.5 percent per year). The rupture rate of aneurysms that were 10 mm or more in diameter was less than 1 percent per year in both groups, but in group 1, the rate was 6 percent the first year for giant aneurysms (25 mm in diameter). The size and location of the aneurysm were independent predictors of rupture. The overall rate of surgery-related morbidity and mortality was 17.5 percent in group 1 and 13.6 percent in group 2 at 30 days and was 15.7 percent and 13.1 percent, respectively, at 1 year. Age independently predicted surgical outcome.

Conclusions The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.

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Address reprint requests to Dr. David O. Wiebers, at the ISUIA Coordinating Center, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.

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N Engl J Med 1999; 340:1439, May 6, 1999. Correspondence

Unruptured Intracranial Aneurysms
Berenstein A., Flamm E. S., Kupersmith M. J., Connolly E. S., Mohr J.P., Solomon R. A., Stieg P. E., Friedlander R., Brett A., Wiebers D. O., Piepgras D. G., Huston J., The International Study of Unruptured Intracranial Aneurysms Investigators , Caplan L. R.
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Speth C. P., Raaymakers T. W.M., Rinkel G. J.E., Bossuyt P. M.M., The Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group
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N Engl J Med 2000; 342:739-740, Mar 9, 2000. Correspondence

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