Cerebral aneurysms in patients with autosomal dominant polycystic kidney disease--to screen, to clip, to coil?

Abstract

higher frequency in 27 patients with a definite or Subarachnoid haemorrhage (SAH) from ruptured suspected family history for aneurysms. In those two intracranial saccular aneurysms of the circle of Willis clinical studies, only one patient with an aneurysms is a devastating event with a mortality rate of over was younger than 30 years, i.e. 24 years. He had a 325% and an additional high risk of permanent disability mm aneurysm of the petrous segment of the internal [1–5]. The high incidence of intracranial aneurysms in carotid artery, which is associated with a very low risk patients with autosomal dominant polycystic kidney of bleeding. All of the detected aneurysms were smaller disease (ADPKD) has long been recognized. The than 7 mm in diameter. These findings were confirmed availability of non-invasive screening methods for by Ronkainen et al. [9]. asymptomatic aneurysms and the major advances in Based on the available literature, the following conmicrosurgical and endovascular techniques raise the clusions can be drawn: (i) the prevalence of aneurysms question of whether systematic screening and treatment in adult ADPKD patients is approximately 10%; of those patients is warranted. Because many variables (ii) the great majority of such aneurysms is small, less have to be taken into account in order to evaluate the than 10 mm, often less than 5 mm in diameter; natural risk as opposed to the risk of prophylactic (iii) familial clustering does occur; (iv) aneurysms are treatment, a clear consensus has not been reached and rarely present in patients younger than 30 years of age, decision processes vary among institutions. Based on and if so they are very small and are not detected by recent data we discuss the risks and benefits of screenMR angiography; (v) as compared to patients with ing and prophylactic treatment of asymptomatic intrasporadic aneurysms, no significant differences concranial aneurysms in patients with ADPKD. cerning number and location of aneurysms have been