Extended follow-up of unruptured intracranialaneurysms detected by presymptomatic screening inpatients with autosomal dominant polycystickidney disease

Maria V. Irazabal, John Huston, Vickie Kubly, Sandro Rossetti, Jamie L. Sundsbak, Marie C. Hogan, Peter C. Harris, Robert D. Brown, Vicente E. Torres

Research output: Contribution to journalArticle

75 Scopus citations

Abstract

Background and objectives Autosomal dominant polycystic kidney disease (ADPKD) patients have an increasedrisk for intracranial aneurysms (IAs). The importance of screening for unruptured IAs (UIAs) dependson their risks for growth and rupture.Design, setting, participants, & measurements ADPKD patients with UIAs found by presymptomatic screeningwith magnetic resonance angiography (MRA) during 1989 to 2009 were followed initially at 6 monthsand annually, and less frequently after demonstration of stability.Results Forty-five saccular aneurysms were detected in 38 patients from 36 families. Most were small (mediandiameter 3.5 mm) and in the anterior circulation (84%). Median age at diagnosis was 49 years. During cumulativeimaging follow-up of 243 years, one de novo UIA was detected and increased in size from 2 to 4.4 mm over144 months and two UIAs grew from 4.5 to 5.9 mm and 4.7 to 6.2 mm after 69 and 184 months, respectively.Seven patients did not have imaging follow-up. No change was detected in the remaining 28 patients. Duringcumulative clinical follow-up of 316 years, no aneurysm ruptured. Five patients died from unrelated causes andtwo were lost to follow-up after 8 and 120 months. Three patients underwent surgical clipping.Conclusions Most UIAs detected by presymptomatic screening in ADPKD patients are small and in the anteriorcirculation. Growth and rupture risks are not higher than those of UIAs in the general population. These datasupport very selective screening for UIAs in ADPKD patients, and widespread screening is not indicated.

Original languageEnglish (US)
Pages (from-to)1274-1285
Number of pages12
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2011

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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