Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
LetterLETTER

When Dealing with Unruptured Aneurysms, What Do Low Morbidity and Mortality Mean?

R.A. Pérez Falero and O.L. Piloto
American Journal of Neuroradiology October 2012, 33 (9) E120; DOI: https://doi.org/10.3174/ajnr.A3314
R.A. Pérez Falero
aDepartment of Neurosurgery Hospital Hermanos Ameijeiras La Havana, Cuba
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
O.L. Piloto
aDepartment of Neurosurgery Hospital Hermanos Ameijeiras La Havana, Cuba
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • References
  • PDF
Loading

After reading with interest “Endovascular Therapy of 500 Small Asymptomatic Unruptured Intracranial Aneurysms,”1 we have some remarks to share with the authors and readers.

Oishi et al1 included in their introduction the following comment, “Current evidence does not conclusively justify the conservative management of small asymptomatic UIA [unruptured intracranial aneurysms] ”; but is there any class I or II study that supports any particular treatment in patients with UIAs? Regardless of the fact that published series on this particular issue2 have increasing numbers of cases and even outstanding results compared with outcomes of patients with ruptured aneurysms, they lack the best available statistical design. Therefore and despite the intrinsic limitations of the International Study of Unruptured Intracranial Aneurysms,3 this study remains as a landmark article on the natural history of intracranial aneurysms and, thus, an obligated control group.

In the article of Oishi et al,1 most of the aneurysms (90%) were located in the anterior circulation. The authors have treated them with the following results: 20% residual aneurysms and 1% combined mortality and permanent morbidity. According to these numbers, almost 1 in 4 patients did not receive any benefit from the intervention or their conditions worsened. What would the outcome have been if observation was the chosen strategy instead? In agreement with the opinion of Molyneux4 on this issue and relying on the reported results, can we justify any kind of intervention for an asymptomatic lesion?

Concerning the learning curve of Oishi et al,1 the combined complete occlusion and residual neck were 67% of the first 100 treated lesions, while they were 68% in the final group. Even if there was no significant difference between these 2 variables, residual aneurysms increased from 22% to 31%, and they said, “The reasons for decreased failure seem to be related to the practitioners' technical advances and the development of the right devices. …” How can the authors explain this statement?

On the discussion related to the effectiveness of coiling in preventing aneurysmal SAH, the authors state, “These results suggest that endovascular therapy of UIAs, particularly that of small asymptomatic UIAs, provides sufficient protection from aneurysmal SAH in short-to-midterm periods.” However, how can we accept this suggestion if they have not included an observational group that truly reflects the incidence of SAH in UIAs? Again, the controversy about the natural history of UIAs shows up and dilutes the hidden benefits that any intervention can provide.

Regardless of the above-mentioned problems, Oishi et al1 have displayed high proficiency and remarkable technical skills in dealing with this complex group of aneurysms.

References

  1. 1.↵
    1. Oishi H,
    2. Yamamoto M,
    3. Shimizu T,
    4. et al
    . Endovascular therapy of 500 small asymptomatic unruptured intracranial aneurysms. AJNR Am J Neuroradiol 2012; 33: 958– 64
    Abstract/FREE Full Text
  2. 2.↵
    1. Im SH,
    2. Han MH,
    3. Kwon Ok,
    4. et al
    . Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: procedural morbidity and patient outcome. AJNR Am J Neuroradiol 2009; 30: 79– 84
    Abstract/FREE Full Text
  3. 3.↵
    1. Wiebers DO,
    2. Whisnant JP,
    3. Huston J 3rd.,
    4. et al.
    , for the International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362: 103– 10
    CrossRefPubMed
  4. 4.↵
    1. Molyneux AJ
    . The treatment of unruptured cerebral aneurysms: cause for concern? AJNR Am J Neuroradiol 2011; 32: 1076– 77
    FREE Full Text
  • © 2012 by American Journal of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 33 (9)
American Journal of Neuroradiology
Vol. 33, Issue 9
1 Oct 2012
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
When Dealing with Unruptured Aneurysms, What Do Low Morbidity and Mortality Mean?
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
When Dealing with Unruptured Aneurysms, What Do Low Morbidity and Mortality Mean?
R.A. Pérez Falero, O.L. Piloto
American Journal of Neuroradiology Oct 2012, 33 (9) E120; DOI: 10.3174/ajnr.A3314

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
When Dealing with Unruptured Aneurysms, What Do Low Morbidity and Mortality Mean?
R.A. Pérez Falero, O.L. Piloto
American Journal of Neuroradiology Oct 2012, 33 (9) E120; DOI: 10.3174/ajnr.A3314
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Fair Performance of CT in Diagnosing Unilateral Vocal Fold Paralysis
  • Reply:
  • Regarding “Altered Blood Flow in the Ophthalmic and Internal Carotid Arteries in Patients with Age-Related Macular Degeneration Measured Using Noncontrast MR Angiography at 7T”
Show more LETTERS

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire