Management of Unruptured Cerebral Aneurysm in Patients Over 65 with Medical Comorbidities

This protocol applies to patients older than 65 years with a small, asymptomatic unruptured intracranial aneurysm (UIA) that carries low hemorrhage risk based on location, size, morphology, and family history, and who have associated medical comorbidities.

Advancing age and the presence of medical comorbidities are key factors in estimating treatment risk for UIAs. When the aneurysm is small, asymptomatic, and assessed as low risk by location, size, and morphology, a non-interventional strategy may be appropriate. The specific clinical and aneurysm characteristics that support this decision are set out in the full protocol.

The approach in this scenario centres on observation paired with targeted risk factor modification — addressing certain modifiable cardiovascular and lifestyle factors. The complete evidence-graded regimen, including all recommended steps, is available via the protocol.

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References

DOI: 10.1161/STR.0000000000000070

The treatment risk of patients with UIAs is related to advancing age, medical comorbidities, and aneurysm location and size, so in older patients (>65 years of age) and those with associated medical comorbidities with small asymptomatic UIAs and low hemorrhage risk by location, size, morphology, family history, and other relevant factors, observation is a reasonable alternative (Class IIa; Level of Evidence B).

Given that smoking appears to increase the risk of UIA formation, patients with UIA should be counseled regarding the importance of smoking cessation (Class I; Level of Evidence B).

Given that hypertension may play a role in growth and rupture of IAs, patients with UIA should monitor blood pressure and undergo treatment for hypertension (Class I; Level of Evidence B).

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