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Can Fam Physician
Vol. 54, No. 11, November 2008, pp.1535 - 1538
Copyright © 2008 by The College of Family Physicians of Canada
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Clinical Review

Asymptomatic unruptured intracranial aneurysms

Approach to screening and treatment

John T. Lysack, MD FRCPC
Assistant Professor of Radiology and Clinical Neurosciences at the University of Calgary in Alberta and is a neuroradiologist based at the Foothills Medical Centre in Calgary

Annalee Coakley, MD CCFP
Family physician in Calgary, Alta

Correspondence: Dr John T. Lysack, Diagnostic Imaging, Foothills Medical Centre, 1403-29 St NW, Calgary AB T2N 2T9; e-mailjohn.lysack{at}gmail.com

OBJECTIVE To review the current knowledge of screening and treatment of asymptomatic unruptured intracranial aneurysms (AUIAs) using a case-based approach.

SOURCES OF INFORMATION PubMed was searched from January 1995 to January 2008 using the phrase unruptured intracranial aneurysm. Scientific statements of the Stroke Council of the American Heart Association pertaining to intracranial aneurysms were also reviewed.

MAIN MESSAGE Most small AUIAs (≤ 5 mm) do not rupture, and the risks of treatment are substantial. Most small AUIAs can therefore be managed conservatively. Endovascular coiling or surgical clipping of larger aneurysms (> 5 mm) should be considered on a case-by-case basis.

CONCLUSION There is currently a lack of sound scientific evidence to support treatment of unruptured intracranial aneurysms. A prospective randomized controlled trial—Trial on Endovascular Aneurysm Management—is now under way to address this issue. It is expected to conclude in 2021.






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Copyright © 2008 by The College of Family Physicians of Canada.