Polycystic kidney disease and intracranial aneurysms: Some answers, but many questions remain

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Unruptured intracranial aneurysms (UIA) occur in about 2%–3% of the population. Several medical conditions are associated with a UIA presence, including autosomal dominant polycystic kidney disease (ADPKD). Clinicians and patients want to know the risk of aneurysm growth, rupture, or de novo development, predictors of clinical outcomes, and the optimal initial and follow-up screening for individuals with UIA and ADPKD. Such data are unavailable. The recent American Heart Association–American Stroke Association statement on UIAs recommends that patients with familial risk and patients with conditions in which aneurysms are prevalent such as ADPKD be offered screening.1 The evidence for this recommendation comes from cross-sectional studies of screening in patients with clinically diagnosed ADPKD and follow-up for aneurysmal subarachnoid hemorrhage (aSAH) with substantial variation in prevalence estimates. A few studies, with a small sample size, have clinical and radiologic follow-up for aSAH, aneurysmal change, or new aneurysm development.

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