Treatment of Unruptured Cerebral Aneurysm When Estimated 5-Year Rupture Risk Exceeds the Risk of Preventive Treatment
This protocol applies to adult patients with an unruptured intracranial aneurysm not located in the posterior circulation, where the clinical picture meets one or more criteria favouring preventive intervention.
Clinical Indications for This Protocol
- Estimated 5-year risk of aneurysm rupture is higher than the risk of the preventive treatment modality
- Aneurysm growth of ≥1 mm in any direction detected on follow-up imaging
- Clinical symptoms attributable to the aneurysm — including cranial nerve deficits, mass effect, or thromboembolic events
Treatment Approach
When intervention is warranted, an endovascular approach involving flow-diverting devices may be considered under specific conditions relating to aneurysm anatomy and the overall risk balance. The complete indication criteria, patient selection algorithm, and procedural considerations are contained in the full protocol.
References
DOI: 10.1177/23969873221099736
- In adult patients in whom the estimated 5-year risk of aneurysm rupture is higher than the risk of the preventive treatment modality, we suggest preventive aneurysm repair with the treatment modality that is most effective and safe for that particular aneurysm.
- In adult patients with growth of a UIA detected at follow up imaging, we suggest preventive aneurysm repair.
- In adult patients with UIA who present with clinical symptoms, such as cranial nerve deficits, mass effect and thromboembolic events, we suggest preventive aneurysm repair, taking into account life expectancy and risk of treatment complications.
- In adult patients with UIA, we suggest flow diverting stents as a treatment option only if no other endovascular or microsurgical options to occlude the aneurysm (complete occlusion or neck remnant only) at a risk lower than the expected 5-year risk of rupture are available and if the risk of rupture outweighs the risk of treatment with flow diverting stents.
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