Patients with a history of coarctation of the aorta have a higher prevalence of intracranial aneurysm and frequently suffer subarachnoid hemorrhage at younger ages than the general population.
The American Heart Association (AHA) and American College of Cardiology (ACC) guidelines recommend intracranial aneurysm screening, but appropriate age and interval of screening remain an uncertainty.
The primary endpoint was to determine the best cost-effectiveness ratio, while secondary endpoints included the incidence of aneurysms with prophylactic treatment and prevented deaths that would have been caused by subarachnoid hemorrhage.
In a simulated cohort of 10,000 patients, researchers estimated a 10.1% lifetime cumulative risk of subarachnoid hemorrhage, which would cause 183 deaths.
A systematic resonance angiography screening at ages 10, 20, and 30 would result in prophylactic treatment for 978 unruptured aneurysms, 19 procedure-related deaths, and 65 subarachnoid-hemorrhage-related deaths.
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Adding a screening stage at age 30—instead of just at ages 10 and 20—is cost-effective. Known data about the prognosis of a scheduled aneurysm embolization, when compared to the uncertainty of life quality after a subarachnoid hemorrhage, tilt the scales in favor of adopting a systematic screening approach as the best option.
Conclusion
This probabilistic model supports the AHA/ACC guidelines regarding systematic resonance angiography screening in patients with coarctation of the aorta.
Screening at ages 10, 20, and 30 is cost-effective and increases life expectancy.
Original Title: Screening for Intracranial Aneurysms in Coarctation of the Aorta. A Decision and Cost-Effectiveness Analysis.
Reference: Sarah S. Pickard et al. Circ Cardiovasc Qual Outcomes. 2020;13:e006406. DOI: 10.1161/CIRCOUTCOMES.119.006406.
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