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CEREBRAL ANEURYSMS

Secondary Prevention Strategies

Secondary prevention strategies would target at-risk populations found on initial screen to have small unruptured aneurysms and for whom treatment is being delayed, and for patients who have been found to have multiple aneurysms.  Secondary prevention strategies might include coiling aneurysms found incidentally or on routine screening, and providing routine screening and follow up for at risk populations as well as patients who had been treated for an aneurysm in the past-remember that up to 30% of patient’s with one aneurysm have multiple aneurysms, some of which may not have appeared on initial imaging.

Take Home Points:

• Cerebral aneurysm formation and rupture, while not as prevalent as heart disease or stroke, remains a serious cause of morbidity and mortality in this country.
• Though risks associated with screening are low when using MRA or CTA technology, the cost of instituting a population wide screening program may be prohibitive.
• Screening should be targeted at certain at-risk subgroups of the population.  Randomized controlled trials and subsequent formalized screening protocols are needed.  For now, screening should be considered on an individual basis.
• Lifestyle modifications such as smoking cessation, weight reduction, blood pressure and cholesterol control, and increased physical activity address the modifiable risk factors for aneurysm formation and rupture.  In at risk populations, such measures reduce risk, while in the general population they represent good overall health maintenance.
• Treatment options include intravascular coiling, surgical clipping and “watchful waiting.”  Symptomatic intradural aneurysms of all sizes, multiple aneurysms in patients with SAH, basilar tip aneurysms, and aneurysms greater than 10 mm in size should all be considered for treatment¹⁹.  In addition, smaller aneurysms with daughter sac formation, smaller aneurysms in young patients, or in patients with a family history should be considered for treatment¹⁹.

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