European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage
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Open Access
- 7 February 2013
- journal article
- practice guideline
- Published by S. Karger AG in Cerebrovascular Diseases
- Vol. 35 (2), 93-112
- https://doi.org/10.1159/000346087
Abstract
Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50–60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.Keywords
This publication has 100 references indexed in Scilit:
- Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trialThe Lancet, 2012
- Guidelines for the Management of Aneurysmal Subarachnoid HemorrhageStroke, 2012
- Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid HemorrhageCerebrovascular Diseases, 2012
- Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-upThe Lancet Neurology, 2009
- Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trendsJournal of Neurology, Neurosurgery & Psychiatry, 2007
- Risks of Subarachnoid Hemorrhage in Siblings: A Nationwide Epidemiological Study from SwedenNeuroepidemiology, 2007
- Achieved serum magnesium concentrations and occurrence of delayed cerebral ischaemia and poor outcome in aneurysmal subarachnoid haemorrhageJournal of Neurology, Neurosurgery & Psychiatry, 2006
- “Occult” ruptured cerebral aneurysms revealed by repeat angiography: result from a large retrospective studyClinical Neurology and Neurosurgery, 2003
- Validation of Family History in Subarachnoid HemorrhageStroke, 1996
- Genetic Influence on Smoking — A Study of Male TwinsThe New England Journal of Medicine, 1992