Screening op aneurysmata en operatieve behandeling bij eerstegraadsfamilieleden van patiënten met een sporadische subarachnoïdale bloeding: beperkte levenswinst met meer functionele beperkingen

To determine risks and benefits of screening and surgical treatment of unruptured aneurysms in first-degree relatives (parents, siblings, children) of patients with subarachnoid haemorrhage (SAH).

Methods

193 consecutive SAH patients were contacted. 626 relatives from 160 families underwent non-invasive screening with Magnetic Resonance Angiography. Conventional angiography was subsequently performed in positive cases. Six months after elective operation, outcome was assessed by means of the Rankin scale. This empirical design was combined with a decision analytical model to estimate the effectiveness of screening. The number of relatives needed to be screened to prevent one SAH was calculated to assess the efficiency of screening.

Results

33 aneurysms were found in 25 of 626 relatives (4.0; 95 confidence interval: 2.6-5.8). Eighteen relatives were surgically treated, which resulted in a decrease in functional health in 11 (disabling in 1). On average, operation resulted in a gain in life expectancy of 2.5 years for these 18 persons (equalling 0.9 months for all 626 screenees), at the expense of 19,2 years with a decreased functional health. The number of relatives needed to be screened to prevent one SAH on a lifetime basis was 149 (to prevent one fatal SAH 298).

Conclusion

Implementation of a screening programme for first degree relatives of patients with sporadic SAH is not warranted at this time. The modest gain in life expectancy does not outweigh the risks of preventive surgery.