Ajay Malhotra, MD, MMM (*); Xiao Wu, BS (*); Howard P. Forman, MD, MBA; Holly K. Grossetta Nardini, MLS; Charles C. Matouk, MD; Dheeraj Gandhi, MD; Christopher Moore, MD; Pina Sanelli, MD, MPH
Disclosures: Dr. Moore reports nonfinancial support from the Agency for Healthcare Research and Quality during the conduct of the study and personal fees from the American College of Emergency Physicians and grants from Philips Healthcare outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0246.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Malhotra (e-mail, firstname.lastname@example.org). Statistical code: Not applicable. Data set: See Table, Appendix Tables 1, 2, 3, 4, 5, 6 and 7, Figures 1, 2, 3, and Appendix Figure.
Requests for Single Reprints: Ajay Malhotra, MD, MMM, Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar Street, New Haven, CT 06520; e-mail, email@example.com.
Current Author Addresses: Drs. Malhotra and Forman and Ms. Wu: Diagnostic Radiology, PO Box 208042, New Haven, CT 06520.
Ms. Grossetta Nardini: Medical Library, PO Box 208014, New Haven, CT 06520.
Dr. Matouk: Surgery–Neurosurgery, PO Box 208082, New Haven, CT 06520.
Dr. Gandhi: Diagnostic Rad-22 S Greene, N2E23, Department of Diagnostic Radiology, 22 South Greene Street, Room N2E23 N2W78, Baltimore, MD 21201.
Dr. Moore: 464 Congress Avenue, #260, New Haven, CT 06519.
Dr. Sanelli: Department of Radiology, Northwell Health, 300 Community Drive, Manhasset, NY 11030.
Author Contributions: Conception and design: A. Malhotra, X. Wu, P. Sanelli.
Analysis and interpretation of the data: A. Malhotra, X. Wu, C.C. Matouk, C. Moore, P. Sanelli.
Drafting of the article: A. Malhotra, X. Wu, H.P. Forman, H.K. Grossetta Nardini, D. Gandhi, C. Moore, P. Sanelli.
Critical revision for important intellectual content: A. Malhotra, X. Wu, H.P. Forman, H.K. Grossetta Nardini, C.C. Matouk, D. Gandhi, C. Moore, P. Sanelli.
Final approval of the article: A. Malhotra, X. Wu, H.P. Forman, H.K. Grossetta Nardini, C.C. Matouk, D. Ghandi, C. Moore, P. Sanelli.
Provision of study materials or patients: A. Malhotra.
Statistical expertise: X. Wu.
Administrative, technical, or logistic support: X. Wu, H.P. Forman, H.K. Grossetta Nardini.
Collection and assembly of data: A. Malhotra, X. Wu, H.K. Grossetta Nardini.
Small unruptured intracranial aneurysms (UIAs) are increasingly diagnosed. Management depends on growth and rupture risks, which may vary by aneurysm size.
To summarize evidence about the growth and rupture risk of UIAs 7 mm and smaller and to explore differences in growth and rupture risks of very small (≤3 mm) and small (≤5 mm) aneurysms.
MEDLINE, EMBASE, Scopus, and the Cochrane Library from inception to 2017 (with no language restrictions).
Published case series and observational studies that reported natural history data on UIAs 7 mm and smaller.
2 reviewers abstracted study information, evaluated study quality, and graded strength of evidence.
Of 26 studies, 5, 10, and 8 described the growth rate of aneurysms 3 mm and smaller, 5 mm and smaller, and 7 mm and smaller, respectively, whereas rupture rates were reported in 7, 11, and 13 studies for aneurysms 3 mm and smaller, 5 mm and smaller, and 7 mm and smaller, respectively. The annualized growth rate was less than 3% in all but 1 study for all 3 size categories. The annualized rupture rate was 0%, less than 0.5%, and less than 1% for the 3 size categories, respectively. Strength of evidence was very low quality for growth rates and low quality for rupture rates.
Heterogeneous definitions of growth; heterogeneous and selective treatment and follow-up methods, particularly in high-risk patients.
Poor-quality evidence suggests that small UIAs have low growth and rupture rates and very small UIAs have little or no risk for rupture.
Ajay Malhotra, Xiao Wu, Howard P. Forman, Holly K. Grossetta Nardini, Charles C. Matouk, Dheeraj Gandhi, et al. Growth and Rupture Risk of Small Unruptured Intracranial Aneurysms: A Systematic Review. Ann Intern Med. 2017;167:26–33. doi: 10.7326/M17-0246
Download citation file:
Published: Ann Intern Med. 2017;167(1):26-33.
Published at www.annals.org on 6 June 2017
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use