title: Relationship of growth to aneurysm rupture in asymptomatic aneurysms ≤ 7 mm: a systematic analysis of the literature.
abstract: BACKGROUND
  The apparent paradox of natural history data suggesting low rupture risk of small asymptomatic aneurysms and the median size of aneurysm rupture remains unexplained. Aneurysm growth rates and their potential relationship with rupture risk have not been well examined in natural history studies.
  
  
  OBJECTIVE
  To examine the question of whether small asymptomatic aneurysms ≤ 7 mm that are followed up over time rupture and to determine the relationship between aneurysm growth and rupture.
  
  
  METHODS
  We reviewed all publications on unruptured aneurysms published from 1966 to 2009. We then selected all aneurysms ≤ 7 mm for which measurements were reported for at least 2 time points and for which initial asymptomatic status and ultimate outcome (rupture vs unruptured) were reported. Using the Mann-Whitney U test, we compared absolute diameter annual growth rate.
  
  
  RESULTS
  Our search retrieved 64 aneurysms. Thirty aneurysms ruptured during follow-up, of which 27 were enlarged before rupture (90%). Thirty-four aneurysms did not rupture, of which 24 enlarged during follow-up (71%). There was a statistically significant trend toward larger absolute diameter growth for ruptured aneurysms vs unruptured aneurysms (3.89 ± 2.34 vs 1.79 ± 1.02 mm; P < .001), respectively. Annual growth rates for aneurysms for the 2 groups, however, were not statistically different (27.46 ± 18.76 vs 32.00 ± 29.30; P = .92).
  
  
  CONCLUSIONS
  Small aneurysms are prone to growth and rupture. Aneurysm rupture is more likely to occur in aneurysms with larger absolute diameter growth, but rupture can also occur in the absence of growth. The annual growth rate in both groups suggests that rate of growth of aneurysms is highly variable and unpredictable, justifying treatment or close diagnostic follow-up.
authors.affiliation: Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Chmayssani
authors.forename: Jean G
authors.initials: JG
authors.lastname: Rebeiz
authors.forename: Tania J
authors.initials: TJ
authors.lastname: Rebeiz
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged