What is the treatment of unruptured cerebral aneurysm?
Clinical Scenario
An unruptured cerebral aneurysm is an intracranial arterial outpouching that has not yet bled. Once a decision to treat has been made, the objective is definitive repair to eliminate the risk of future rupture.
Treatment Approach
Definitive repair is the core intervention. The approach involves either a surgical or an endovascular technique — the specific method depends on aneurysm characteristics and patient factors. In carefully selected cases, additional strategies beyond these two primary options may also be considered.
Treatment Goal
The primary objective is complete aneurysm obliteration, confirmed on post-treatment imaging.
Complete obliteration on imaging
References
DOI: 10.1161/STR.0000000000000070
- Surgical clipping is an effective treatment for UIAs that are considered for treatment (Class I; Level of Evidence B).
- Endovascular coiling is an effective treatment for select UIAs that are considered for treatment (Class IIa; Level of Evidence B).
- Endoluminal flow diversion represents a new treatment strategy that may be considered in carefully selected cases (Class IIb; Level of Evidence B).
- Other emerging technologies to treat unruptured cerebral aneurysms, such as liquid embolic agents, represent new treatment strategies that may be considered in carefully selected cases (Class IIb; Level of Evidence C).
- Imaging after surgical intervention, to document aneurysm obliteration, is recommended given the differential risk of growth and hemorrhage for completely versus incompletely obliterated aneurysms (Class I; Level of Evidence B).
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