Unruptured intracranial aneurysm
Posted On February 19, 2020
AAN 2015 guideline
- Link to original article = please read the original article
- Unruptured intracranial aneurysm = UIA
- Subarachnoid hemorrhage = SAH
Risk factors and recommendations
- Smoking increase risks of UIA: smoking cessation
- Hypertension may play a role in growth and rupture: treat Hypertension
- Intermittent imaging studies needed to follow the size of UIA
Diagnosis and imaging
- DSA is most sensitive imaging
- CTA, MRA are useful
- Coiled aneurysms, especially with wider neck or have residual filling, should have follow up evaluation.
Screening recommendation
- Patients with 2 or more family members with intracranial aneurysm or SAH, should be offered screening with CTA or MRA
- history of autosomal dominant polycystic kidney disease, or coarctation of aorta
Natural history – recommendations
- Prior history of aneurysm rupture, at risk for smaller aneurysm rupture
- Documented enlargement during follow up should be offered treatment
- Family history of Intracranial aneurysm, treatment may be offered even a smaller aneurysm size
Natural history of UIA – based on studies isuia and ucas Japan
- No history of SAH and aneurysm < 7mm
- anterior circulation: no rupture
- risks of rupture in post circulation: 2.5%/year
- history of SAH, size < 7mm
- Risk of rupture anterior circulation: 1.5%/year
- Risk of rupture post circulation: 3.4%/year
- Risk factors for rupture includes
- > 60 years old
- Female
- Japanese or Finish descent
- symptomatic aneurysm
- diameter > 5mm
- posterior circulation
- Overall rupture rate for aneurysm <7 mm is 0.4%/year