Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group.

Etminan, Nima; Beseoglu, Kerim; Barrow, Daniel L; Bederson, Joshua; Brown, Robert D; Connolly, E Sander; Derdeyn, Colin P; Hänggi, Daniel; Hasan, David; Juvela, Seppo; Kasuya, Hidetoshi; Kirkpatrick, Peter J; Knuckey, Neville; Koivisto, Timo; Lanzino, Giuseppe; Lawton, Michael T; LeRoux, Peter; McDougall, Cameron G; Mee, Edward; Mocco, J; ... (2014). Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group. Stroke, 45(5), pp. 1523-1530. Lippincott Williams & Wilkins 10.1161/STROKEAHA.114.004519

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BACKGROUND AND PURPOSE To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. METHODS After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. RESULTS Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. CONCLUSIONS Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Raabe, Andreas


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Nicole Söll

Date Deposited:

17 Mar 2015 13:47

Last Modified:

12 Nov 2015 09:01

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Delphi technique, cerebral aneurysm, consensus, incidental aneurysm, natural history, therapeutics




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