American Heart Association issues aneurysm recommendations

October 29, 2000

DALLAS, Oct. 31 - The American Heart Association has issued its first recommendations for physicians to follow for treating weakened blood vessels in the brain that have not yet ruptured. Recommendations for treating these unruptured intracranial aneurysms are published in the Oct. 31 issue of Circulation: Journal of the American Heart Association and the November issue of Stroke: Journal of the American Heart Association.

Aneurysms are blood filled pouches that form in weak spots of an artery wall. They can be difficult to detect and may not be dangerous if they remain intact. However, if one bursts in the brain, a deadly stroke called subarachnoid hemorrhage results.

"It is difficult to predict which unruptured aneurysms will rupture and which ones will never bleed," says Joshua Bederson, M.D. director of cerebrovascular surgery at Mount Sinai Hospital, New York, and chairman of the association's Stroke Council task force. "Since all treatments carry at least some risk of complications, deciding which patients should be treated is critical."

Whether to treat and how to treat patients with unruptured aneurysms has been controversial. The Stroke Council of the American Heart Association formed a task force to review existing literature and to develop treatment guidelines.

It is believed that 1 percent to 5 percent of the population may harbor unruptured brain aneurysms. Approximately six people in 100,000, or about 15,000 Americans, have a stroke from a ruptured aneurysm each year. Symptoms depend on the size and location of the aneurysm in the brain and may include impaired vision and headaches. However, the majority remain symptomless until they rupture.

The task force consensus is that widespread screening for people without symptoms is unnecessary. Screening should be considered for individuals with a family history of aneurysm or subarachnoid hemorrhage or those with certain genetic syndromes which might make them more susceptible to aneurysm formation.

In addition, the task force recommends that treatment of small aneurysms (less than 10mm) that have no symptoms should depend on the patient's age, severity and progression of the aneurysm.

"We recommend considering surgery for young patients regardless of aneurysm size, and for anyone with aneurysm symptoms, a previous ruptured aneurysm or any growth of the aneurysm," says Bederson. "We favor observation in older patients with the smallest symptomless aneurysms due to the higher risk of treatment and the shorter life expectancy."

Close observation with repeated brain scans is recommended for those who do not undergo surgery.

"We hope these guidelines will serve as a framework for the development of treatment plans for individuals with unruptured intracranial aneurysms and a basis for future research," says Bederson.
-end-
Task force members are Issam A. Awad, M.D.; David O. Wiebers, M.D.; David Piepgras, M.D.; E. Clarke Haley, Jr., M.D.; Thomas Brott, M.D.; George Hademenos, Ph.D.; Douglas Chyatte, M.D., Robert Rosenwasser, M.D.; and Cynthia Caroselli, R.N.

American Heart Association

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