What to do and absolutely nothing to do with the ‘slow-explosion bomb’ called… brain aneurysm?

Revolving around the story: “Many young people suddenly burst their brain circuits” posted on Youth Online, Assoc˳ Prof˳ Dr˳ NGUYEN HUY THANH – President of Ho Chi Minh City Stroke Association and Head of Cerebrovascular Disease Department (People’s Hospital 115) – has more detailed recommendations, on what to do and not to do with an unruptured aneurysm˳

He said: “Not long ago, a young patient came to the cerebrovascular department to be examined, because by chance he discovered a small aneurysm about 5mm in the internal carotid artery˳

His expression was rather worried, perhaps because it was explained that immediate intervention was needed to remove the aneurysm˳ So what should we do if one day suddenly learn we have a small aneurysm in the brain artery?”˳

The disease is quite common, but…

* So is brain aneurysm a fairly common disease, sir?

– In fact, cerebral aneurysms are quite common, estimated at 2-3% in the population and may be higher in the elderly population˳ Thus, in Vietnam it is estimated that there are 2-3 million “slow-explosion bombs” out of a total of 100 million people˳

However, the current rate of meningeal hemorrhage is only about 6-10 cases per 100,000 population˳ That means more than 3,000 new brain aneurysms have rupture˳

* You say brain aneurysm is a “slow-explosion bomb” but you think there are cases where “nothing needs to be done”, is this a contradiction?

– Surely someone will scream at the doctor when they hear: “You don’t need to do anything more, just wait for the day… to break”˳ But this makes perfect sense in many cases˳

There are many factors that increase the risk of aneurysm rupture such as age, hypertension, smoking, family history of aneurysm rupture… However, aneurysm size is considered the most important factor and decisive in treatment˳

To date, “The International Study of Unruptured Intracranial Aneurysms (ISUIA)” is considered the largest study of unruptured cerebral aneurysms˳ ˳

The ISUIA study included 1,692 patients with aneurysms 2mm or larger˳ Among them, 1,077 patients had unruptured aneurysms˳

Based on the summary of this study, we can see that the risk of rupture of aneurysms smaller than 7mm is extremely low˳

It can be said that there is no % risk of rupture at 5 years with aneurysms located in sites of anterior circulation˳

Meanwhile, the risk of rupture of posterior communicating aneurysms is higher, only 1˳5% over 5 years (equivalent to 0˳3%/year)˳ However, the risk of rupture is increased if the aneurysm size is between 7-12mm and especially when larger than 12mm˳

Only invasively treat aneurysms larger than 12mm

* So, according to you, with an unruptured brain aneurysm, what solutions are there currently?

There are 3 basic solutions:

– Aneurysm clamp surgery: There are 2 meta-analyses, evaluating the results of surgery to clamp an unruptured aneurysm˳ The results show that the disability rate is 4˳1% and 10˳9%; The mortality rate was 1% and 2˳9%, respectively˳ The risk of death may be more than 20% with posterior circulation aneurysms or large aneurysms˳

– Aneurysm occlusion: Based on meta-analyses, the rate of poor outcomes in the intervention group was 3-4%; 1-2% mortality rate˳ In the ISUIA study, the mortality rate in the intervention group was 3˳1%˳ The risk of death is also higher with posterior circulation aneurysms or large aneurysms˳

– Conservative treatment includes controlling blood pressure, avoiding tobacco and alcohol˳ Importantly, the aneurysm should be monitored with noninvasive vascular imaging techniques (MRA or CTA) after 6 months or 1 year to assess for growth˳

It should be noted that only 1 imaging technique should be selected for monitoring (if MRA is selected for the first time, MRA should be repeated afterwards) to avoid errors between the two techniques˳ This is a reasonable choice for unruptured aneurysms less than 7mm in size˳

* So when should invasive treatment of unruptured aneurysm, sir?

– This is a particularly important issue, because the indication for intervention can also cause complications, causing patients to have disabling or fatal events˳

One thing is for sure, aneurysms larger than 12mm should be treated early, especially when the patient is young and has a family history˳ As for aneurysms with size from 7-12mm, caution should be exercised because currently there is no evidence to show the benefit of intervention compared with conservative treatment in this subject˳

Indications for early intervention will be considered for each case-specific risk factors such as age, family history, location in the posterior communicating artery, increased size during follow-up…

With unruptured aneurysms less than 5mm in size, it should be treated conservatively by controlling blood pressure, avoiding tobacco and alcohol˳ At the same time, monitor the size change every 6 months to have timely intervention indications˳

In contrast, with ruptured aneurysms, regardless of size, early intervention is essential because it can reduce the risk of death when the aneurysm ruptures again˳

Aneurysm in the brain, vague symptoms, great consequences

The most important consequence of an aneurysm in the brain is episodic ischemia and stroke˳