Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms: A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms: A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
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DOI：
10.1161/01.cir.102.18.2300
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发表时间：
2000-10
期刊：
影响因子：
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通讯作者：
J. Bederson;I. Awad;D. Wiebers;D. Piepgras;E. Haley;T. Brott;G. Hademenos;D. Chyatte;R. Rosenwasser;C. Caroselli
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文献类型：
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作者：
J. Bederson;I. Awad;D. Wiebers;D. Piepgras;E. Haley;T. Brott;G. Hademenos;D. Chyatte;R. Rosenwasser;C. Caroselli
动脉瘤性蛛网膜下腔出血（SAH）的30天死亡率为45%，大约一半的幸存者遭受不可逆的脑损伤。1根据每年每10万人6例的发病率，每年将有15000名美国人患有动脉瘤性SAH。基于人群的发病率差异很大，从每10万人中有6到16例，日本和芬兰报告的发病率最高。2 3 4 5约5%到15%的卒中病例继发于囊状动脉瘤破裂。虽然预防出血被认为是降低死亡率的最有效策略，6但未破裂颅内动脉瘤（UIA）患者的最佳管理仍存在争议。管理决策需要准确评估各种治疗方案的风险，并与疾病的自然史进行比较。UIA的自然史和治疗结局受以下因素的影响：（1）患者因素，如既往蛛网膜下腔出血、年龄和并存疾病;（2）动脉瘤特征，如大小、位置和形态;（3）管理因素，如手术团队和治疗医院的经验。这些影响因素导致了所报告的蛛网膜下腔出血和UIA治疗风险的相当大的差异。迄今为止，还没有关于治疗干预与保守治疗的前瞻性随机试验，将来可能不会进行此类研究。根据Cook et al建议的分类系统，7项假阳性和假阴性错误可能性较低的随机临床试验提供了可用于临床建议的最高证据等级（I级）。具有高假阴性和阳性错误可能性的随机试验提供了II级证据。III级证据是通过对同期患者进行非随机同期队列比较而产生的。
Aneurysmal subarachnoid hemorrhage (SAH) has a 30-day mortality rate of 45%, with approximately half the survivors sustaining irreversible brain damage.1 On the basis of an annual incidence of 6 per 100 000, ≈15 000 Americans will have an aneurysmal SAH each year. Population-based incidence rates vary considerably from 6 to 16 per 100 000, with the highest rates reported from Japan and Finland.2 3 4 5 Approximately 5% to 15% of stroke cases are secondary to ruptured saccular aneurysms. Although the prevention of hemorrhage has been advocated as the most effective strategy aimed at lowering mortality rates,6 the optimal management of patients with unruptured intracranial aneurysms (UIAs) remains controversial. Management decisions require an accurate assessment of the risks of various treatment options compared with the natural history of the condition. The natural history of UIAs and treatment outcomes are influenced by (1) patient factors, such as previous aneurysmal SAH, age, and coexisting medical conditions; (2) aneurysm characteristics, such as size, location, and morphology; and (3) factors in management, such as the experience of the surgical team and the treating hospital. These many influences have contributed to considerable variability in the reported risks for aneurysmal SAH and the treatment of UIAs. There are no prospective randomized trials of treatment interventions versus conservative management to date, and it is possible that no such studies will be carried out in the future. According to a classification system suggested by Cook et al,7 randomized clinical trials with low likelihoods of false-positive and false-negative errors provide the highest level of evidence (level I) that can be applied to a clinical recommendation. Randomized trials with high likelihoods of false-negative and positive errors provide level II evidence. Level III evidence is generated with nonrandomized concurrent cohort comparisons between contemporaneous patients who did and …