The cerebral vasculature, as well as unruptured intracranial aneurysms (UIAs) are complex biologic entities. Their behavior cannot be ascribed to just their location and size. A multidisciplinary international research group published a consensus statement in Stroke (Stroke. 2014;45:1523-1530) in 2014 which echoed this sentiment. We do not have a prospective randomized double blind clinical trial to base decisions on whether and how to treat UIAs. The TEAM trial aimed at assessing the role of prophylactic vascular intervention of UIAs, but never materialized due to poor recruitment.
In order to advance the science of treating UIAs, we need risk prediction models of rupture. PHASES score was proposed in 2013 by Greving et al where pooled data from 8382 participants in six prospective cohort studies was used, and age, hypertension, history of SAH, aneurysm size, aneurysm location, and geographical region were the predictors of 5 year rupture risk. In addition, risk prediction models for complications of interventions (surgical vs endovascular) are also needed in order to carry out an informed decision analysis on a patient with UIA. In the current study, Backes et al carried out a cross-sectional survey of functional status, working capacity and life satisfaction in 159 patients treated with microsurgery or endovascular intervention for UIA between Jan 1st 2000 and Jan 1st 2013. The questionnaire was sent out in June 2014, and 69% (110) patients responded. 81% patients reported complete recovery after treatment. With regards to life satisfaction (measured using validated LiSat score), patients with high life satisfaction decreased from 76% before treatment to 52% during recovery, and 67% in the long term.
These findings underlie the important concept that in addition to aneurysm and patient characteristics, treatment effects also should play an integral role in the decision analysis of whether and how to treat a UIA in a patient. An unnecessary intervention may end up doing more harm that good.
