Overview
Summary
An unruptured intracranial aneurysm (UIA) is a focal dilation of an intracranial artery found before it has bled, usually incidentally. Most never rupture, so the question is whether rupture risk outweighs the risk of preventive treatment. Rupture risk rises with size, location, shape, earlier subarachnoid haemorrhage, hypertension and age, and growth on serial imaging marks a much higher risk of rupture. The PHASES and ELAPSS scores and the UIATS consensus tool structure the decision, and MRI wall imaging is under study. Screening is considered in autosomal dominant polycystic kidney disease and in families with aneurysmal subarachnoid haemorrhage, after counselling.
Takeaways
- 1
Weigh each aneurysm's estimated rupture risk against treatment risk in a multidisciplinary team before deciding to repair or watch.
- 2
Consider screening only in selected groups, such as polycystic kidney disease with family history or several affected relatives, after counselling.
- 3
Image untreated aneurysms at planned intervals and reassess promptly when growth appears, since growth marks higher rupture risk.
Start here
- Unruptured intracranial aneurysms: development, rupture and preventive management.Etminan 2016 · Nat Rev Neurol
- Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies.Greving 2013 · Lancet Neurol
- European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms.Etminan 2022 · Eur Stroke J
- Radiological surveillance of small unruptured intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of 8428 aneurysmsLee 2020 · Neurosurg Rev
Unruptured intracranial aneurysms
Intracranial aneurysmsChapter 2 of 4
Summary
An unruptured intracranial aneurysm (UIA) is a focal dilation of an intracranial artery found before it has bled, usually incidentally. Most never rupture, so the question is whether rupture risk outweighs the risk of preventive treatment. Rupture risk rises with size, location, shape, earlier subarachnoid haemorrhage, hypertension and age, and growth on serial imaging marks a much higher risk of rupture. The PHASES and ELAPSS scores and the UIATS consensus tool structure the decision, and MRI wall imaging is under study. Screening is considered in autosomal dominant polycystic kidney disease and in families with aneurysmal subarachnoid haemorrhage, after counselling.
Takeaways
- 1
Weigh each aneurysm's estimated rupture risk against treatment risk in a multidisciplinary team before deciding to repair or watch.
- 2
Consider screening only in selected groups, such as polycystic kidney disease with family history or several affected relatives, after counselling.
- 3
Image untreated aneurysms at planned intervals and reassess promptly when growth appears, since growth marks higher rupture risk.
Start here
- Unruptured intracranial aneurysms: development, rupture and preventive management.Etminan 2016 · Nat Rev Neurol
- Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies.Greving 2013 · Lancet Neurol
- European Stroke Organisation (ESO) guidelines on management of unruptured intracranial aneurysms.Etminan 2022 · Eur Stroke J
- Radiological surveillance of small unruptured intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of 8428 aneurysmsLee 2020 · Neurosurg Rev