Targeted Screening of Unruptured Intracranial Aneurysms in 50- to 60-Year-Old Female Smokers – Inconsiderate Overdiagnosis or a Chance to Improve Women’s Health?

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ABSTRACT Introduction Aneurysmal subarachnoid hemorrhage (aSAH) causes a substantial proportion of all deaths among middle-aged people, especially women. Since female smokers in particular have a high risk of aSAH and SAH deaths, targeted screening of 50–60-year-old female smokers could be justified as a preventive action to reduce premature deaths and morbidity. Methods This prospective screening study has been carried out at Helsinki University Hospital in the Department of Neurosurgery in two phases during 2020 and 2023–2024. In order to minimize recruitment bias, the Helsinki Biobank and THL Biobank were responsible for sending out preliminary invitation letters to self-caring 50- to 60-year-old women who were known to be active smokers. We informed the potential candidates about the study and answered any questions before their decision to participate. Once written consent was provided, participants filled in a detailed questionnaire on lifestyle and health, and underwent computed tomography angiography (CTA) analysis. We studied the prevalence of unruptured intracranial aneurysms (UIAs) among the study participants. Moreover, we assessed morbidity, mortality and costs related to screening. Results Of the 458 preliminary invitation letters, 160 potential participants initially replied. Of these, 116 returned questionnaires and written consents. Ultimately, 108 smoking women underwent CTA imaging. Eleven UIAs were found in eleven (10%) female smokers, one of which was intracavernous and extradural. Two women were operated on without complications – one with a middle cerebral artery aneurysm and one with a posterior communicating artery aneurysm. Most (n=8) patients with small (<5mm) intradural aneurysms were treated with non-invasive preventive actions (smoking cessation, blood pressure control) and followed with CTA or MRA thereafter. Conclusions Small UIAs, which may be best suited for non-invasive preventive actions, seem to be common in 50- to 60-year-old female smokers. Targeted screening of women in this age group may offer a chance to reduce morbidity or mortality of aSAH. Whether this leads to improved health and reduction in SAH-related deaths in the long run requires a longer follow-up.

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