La idea de cribado poblacional de aneurismas no rotos es interesante dado que, a pesar de los avances en los tratamientos quirúrgico y endovascular, la mortalidad debido a la hemorragia subaracnoidea aneurismática se encuentra en torno al 30%. El cribado está justificado cuando la morbimortalidad asociada al tratamiento (marcadamente menor en aneurismas no rotos frente a los rotos) es inferior al riesgo inherente a ser portador de un aneurisma. A día de hoy, este balance no parece favorecer el cribado a nivel poblacional, aunque sí está justificado en subpoblaciones de alto riesgo de desarrollo o rotura de aneurismas. En esta revisión se analizan los requisitos necesarios para implementar un cribado, en qué situaciones estaría justificado, qué se puede esperar del tratamiento (en términos de efectividad, morbilidad y coste) y qué cuestiones medicolegales son relevantes y condicionan la utilidad del mismo. Proponemos un esquema de estudio que explore la utilidad del cribado poblacional mediante angiorresonancia.
The idea of population screening of unruptured intracranial aneurysms is interesting because, despite recent advances in surgical and endovascular treatment, the mortality related to aneurismal subarachnoid haemorrhage reaches 30%. Screening is justified whenever the morbidity and mortality of the treatment (markedly lower for unruptured compared to ruptured aneurysms) overcomes the inherent risk of harbouring a brain aneurysm. Although, at present, this balance does not seem to favour population-based screening, it is justified in certain sub-populations with an increased risk of rupture. In this review, an analysis is made of the requirements for implementing a screening program, when would it be justified, what is to be expected from treatment (in terms of effectiveness, morbidity and costs), and what medical-legal issues are relevant and to determine the usefulness of the program. A study protocol is proposed aimed at examining the usefulness of population screening for brain aneurysms by magnetic resonance angiography.
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