title: Extended follow-up of unruptured intracranial aneurysms detected by presymptomatic screening in patients with autosomal dominant polycystic kidney disease.
abstract: OBJECTIVE
  Autosomal dominant polycystic kidney disease (ADPKD) patients have an increased risk for intracranial aneurysms (IAs). The importance of screening for unruptured IAs (UIAs) depends on their risks for growth and rupture.
  
  
  METHODS
  ADPKD patients with UIAs found by presymptomatic screening with magnetic resonance angiography (MRA) during 1989 to 2009 were followed initially at 6 months and annually, and less frequently after demonstration of stability.
  
  
  RESULTS
  Forty-five saccular aneurysms were detected in 38 patients from 36 families. Most were small (median diameter 3.5 mm) and in the anterior circulation (84%). Median age at diagnosis was 49 years. During cumulative imaging follow-up of 243 years, one de novo UIA was detected and increased in size from 2 to 4.4 mm over 144 months and two UIAs grew from 4.5 to 5.9 mm and 4.7 to 6.2 mm after 69 and 184 months, respectively. Seven patients did not have imaging follow-up. No change was detected in the remaining 28 patients. During cumulative clinical follow-up of 316 years, no aneurysm ruptured. Five patients died from unrelated causes and two were lost to follow-up after 8 and 120 months. Three patients underwent surgical clipping.
  
  
  CONCLUSIONS
  Most UIAs detected by presymptomatic screening in ADPKD patients are small and in the anterior circulation. Growth and rupture risks are not higher than those of UIAs in the general population. These data support very selective screening for UIAs in ADPKD patients, and widespread screening is not indicated.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55901, USA.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Irazabal
authors.forename: John
authors.initials: J
authors.lastname: Huston
authors.forename: Vickie
authors.initials: V
authors.lastname: Kubly
authors.forename: Sandro
authors.initials: S
authors.lastname: Rossetti
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Sundsbak
authors.forename: Marie C
authors.initials: MC
authors.lastname: Hogan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Harris
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Vicente E
authors.initials: VE
authors.lastname: Torres
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D058070:Asymptomatic Diseases; D002533:Cerebral Angiography / Q000379:methods*; D004252:DNA Mutational Analysis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009154:Mutation; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000235:genetics; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult