Prevalence and Perioperative Rupture Risk of Incidentally Diagnosed Unruptured Intracranial Aneurysms in Patients with Cardiovascular Surgery

Abstract

Background: The prevalence and perioperative rupture risk of unruptured intracranial aneurysm (UIA) in patients undergoing cardiovascular surgery remains unclear. Methods: Adult patients (n = 4864) who underwent cardiovascular surgery between January 2010 and December 2016 were included. We assessed the prevalence of UIAs in these patients using preoperative neurovascular imaging. The incidence of postoperative 30-day subarachnoid hemorrhage (SAH) from aneurysmal rupture was investigated in patients undergoing cardiovascular surgery with UIA. Postoperative outcomes were compared between patients with UIA and those without UIA. Findings: Of the 4864 patients, 353 patients had UIAs [incidence rate, 7·26%; 95% confidence interval (CI), 6·52%-8·06%]. Of these, 8 patients received surgical or endovascular treatment before cardiovascular surgery and 345 patients underwent cardiovascular surgery with UIAs. Within 30 days postoperatively, SAH occurred only in one patient, and the cumulative postoperative 30-day SAH incidence was 0·29% (95% CI, 0·01% to 1·61%). The estimated SAH probabilities according to the UIA rupture risk scores were not higher than the previously reported risk in the general population. There were no significant differences in postoperative SAH-free survival, hemorrhagic stroke-free survival, in-hospital mortality, hospital length of stay, intensive care unit length of stay, and extubation time between patients with UIA and those without UIA. Interpretation: The prevalence of UIA in patients undergoing cardiovascular surgery is higher than in general population. However, incidentally detected UIAs are not linked to an increased risk of SAH or adverse postoperative outcomes. Funding: The authors received no specific funding for this work. Declaration of Interest: All authors declare no competing interests. Ethical Approval: The Institutional Review Board of Asan Medical Center approved this study protocol (AMC IRB 20180491) and waived the informed consent owing to the retrospective design. This observational study was implemented in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines.