• Luigi Rigante, Hieronymus D Boogaarts, BartelsRonald H M ARHMADepartment of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands., Priya Vart, Rene Aquarius, J André Grotenhuis, Walid Moudrous, Anthonius M De Korte, and Joost de Vries.
• Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: luigirigante@gmail.com.
• World Neurosurg. 2021 Oct 1; 154: e185-e198.

BackgroundDetection of multiple intracranial aneurysms (MIAs) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is common and the optimal management of the additional unruptured intracranial aneurysms (UIA) is often a matter of debate. We calculate the incidence and the factors associated with subsequent aSAHs from untreated additional aneurysms in a single-center group of patients with aSAH and MIAs.MethodsCharts of patients with MIAs admitted to our neurosurgery department for aSAH between January 2000 and March 2020 were retrospectively reviewed. Incidence rate and factors associated with subsequent aSAHs were calculated with univariable and multivariable analyses.ResultsOf the unruptured aneurysms, 50% were preventively treated. During a median follow-up of 3 years, 20 of 174 patients (11.5%) presented with a second aSAH. Incidence of rupture of an additional untreated aneurysm was 18.05 per 1000 person/years (confidence interval, 10.69-30.47). Rupture incidence of an additional aneurysm located in the anterior circulation was 32.70 per 1000 person/years and 40.73 per 1000 person/years in the posterior circulation. Presence of untreated mirror and de novo aneurysms increased the risk of overall subsequent aSAHs by 16.9-fold and 7.6-fold, respectively. Most untreated additional aneurysms causing a subsequent aSAH were smaller than 7 mm (73.3%), with middle cerebral artery being the most frequent location (40.0%).ConclusionsIncidence of subsequent aSAHs is high in patients with aSAH-MIA. Untreated mirror and de novo aneurysms are associated with higher rupture risk. Longer follow-up and prophylactic treatment of asymptomatic aneurysms at higher rupture risk are recommended to prevent the significant poor outcome of subsequent aSAHs.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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