A survey of the radiological follow-up of unruptured intracranial aneurysms in the United Kingdom

Samuel Hall (Lead / Corresponding author), Ashraf Abouharb, Ian Anderson, Andrew Bacon, Anuj Bahl, Howard Brydon, Graham Dow, Ioannis Fouyas, James Galea, Anthony Ghosh, Nihal Gurusinghe, Mahmoud Kamel, Pawan Minhas, Patrick Mitchell, David Mowle, Nitin Mukerji, Ramesh Nair, John Norris, Hiren Patel, Jash PatelKrunal Patel, Jerome St George, Mario Teo, Ahmed Toma, Rikin Trivedi, Chris Uff, Anna Visca, Daniel C. Walsh, Edward White, Peter Whitfield, Diederik Bulters

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objective: Unruptured intracranial aneurysms (UIA) are common. For many the treatment risks outweigh their risk of subarachnoid haemorrhage and patients undergo surveillance imaging. There is little data to inform if and how to monitor UIAs resulting in widely varying practices. This study aimed to determine the current practice of unruptured UIA surveillance in the United Kingdom. Methods: A questionnaire was designed to address the themes of surveillance protocols for UIA including when surveillance is initiated, how frequently it is performed, and when it is terminated. Additionally, how aneurysm growth is managed and how clinically meaningful growth is defined were explored. The questionnaire was distributed to members of the British Neurovascular Group using probability-based cluster and non-probability purposive sampling methods. Results: Responses were received from 30 of the 30 (100.0%) adult neurosurgical units in the United Kingdom of which 27 (90.0%) routinely perform surveillance for aneurysm growth. Only four units had a unit policy. The mean patient age up to which a unit would initiate follow-up of a low-risk UIA was 65.4 ± 9.0 years. The time points at which imaging is performed varied widely. There was an even split between whether units use a fixed duration of follow-up or an age threshold for terminating surveillance. Forty percent of units will follow-up patients more than 5 years from diagnosis. The magnitude in the change in size that was felt to constitute growth ranged from 1 to 3mm. No units routinely used vessel wall imaging although 27 had access to 3T MRI capable of performing it. Conclusions: There is marked heterogeneity in surveillance practices between units in the United Kingdom. This study will help units better understand their practice relative to their peers and provide a framework forplanning further research on aneurysm growth.

    Original languageEnglish
    JournalBritish Journal of Neurosurgery
    Early online date5 Nov 2021
    DOIs
    Publication statusE-pub ahead of print - 5 Nov 2021

    Keywords

    • aneurysm growth
    • MRI
    • surveillance protocol
    • Unruptured intracranial aneurysm

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