2015 AHA/ASA指南:未破裂颅内动脉瘤的管理
Unruptured intracranial aneurysms (UIAs) are relatively common in the general population, found in ≈3.2% (95% confidence interval [CI], 1.9%–5.2%) of the adult population (mean age 50 years) worldwide, and they are being discovered incidentally with an increasing frequency because of the widespread use of high-resolution magnetic resonance imaging (MRI) scanning. The large majority of UIAs will never rupture. For example, of the 1 million adults in the general population with a mean age of 50 years, ≈32000 harbor a UIA, but only 0.25% of these, or 1 in 200 to 400, will rupture. To put these numbers in perspective, in any given year, ≈80 of 32000 of these UIAs would be expected to present with subarachnoid hemorrhage (SAH). Complicating matters further is the fact that aneurysms that rupture may not be the same as the ones found incidentally. Physicians are now often faced with the dilemma of whether to treat patients who present with an incidental finding of an unruptured aneurysm or to manage them conservatively. Patients and families may push for the surgical or endovascular management of an incidental UIA out of fear of the unknown and potentially catastrophic outcome that could occur. However, no treatment comes without risk, and the benefit of treating an incidental UIA must outweigh the potential risks of treating it.
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