A Clinical Decision Tool for Patients with Cerebral Aneurysms

Summary and Comment |
September 29, 2015

A Clinical Decision Tool for Patients with Cerebral Aneurysms

  1. Seemant Chaturvedi, MD

Providing advice about an unruptured cerebral aneurysm, which is potentially lethal, can be challenging. Both conservative treatment and intervention have potential hazards.

  1. Seemant Chaturvedi, MD

Observational studies have shown that certain features can increase the risk for brain aneurysm rupture, such as size and location of the aneurysm. To develop a scoring system that would guide aneurysm decision making and to determine the extent of agreement among specialists regarding this decision, these authors convened a multidisciplinary group of neurologists, neurosurgeons, and radiologists.

The 39 panelists and 30 external reviewers participated in a Delphi process in which they rated aneurysm features and patient factors that increased or decreased the likelihood of recommending interventional treatment. Among the features included were patient age, aneurysm risk factors, life expectancy, and comorbid diseases. Radiologic features included aneurysm size, location, morphology, and multiplicity. Treatment-related risks were assessed based on patient age and aneurysm size and complexity. Based on this information, an unruptured intracranial aneurysm treatment score (UIATS) can be calculated, providing a recommendation for either interventional treatment or conservative management.

Overall, the UIATS magnitude correlated well with agreement among panel members (r2=0.323, P=0.002) and decently with agreement among external reviewers (r2=0.399, P<0.001).

Comment

This study provides a tool that clinicians can use when encountering patients with unruptured cerebral aneurysms. The clinical and radiological factors judged to be important by a multidisciplinary panel are not that surprising, but providing a quantitative score that can be translated into a treatment recommendation could prove valuable, especially for “borderline” treatment candidates. Further validation of the UIATS to demonstrate low rupture rates in conservatively managed patients would be an important next step.

Editor Disclosures at Time of Publication

  • Disclosures for Seemant Chaturvedi, MD at time of publication Consultant / Advisory board Abbott Vascular; Boehringer Ingelheim; Genentech Grant / Research support Pfizer Editorial boards Neurology; Stroke; Journal of Stroke and Cerebrovascular Diseases Leadership positions in professional societies American Academy of Neurology (Vice Chair of Vascular Neurology Section)

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