Table 2: Treatment recommendations.

SourceRecommendations

American Heart Association’s Stroke Council(1) Treatment of small intracavernous ICAs is not advised. Large intracavernous ICAs should be considered, taking into account age and symptoms.
(2) Symptomatic intradural ICAs should be considered for treatment. However, large or giant symptomatic aneurysms require exhaustive consideration of individual patient characteristics and the expertise of surgeon and facility.
(3) Patient with prior history of aneurysmal SAH should be considered for treatment, especially for UIAs at the basilar apex
(4) Asymptomatic aneurysms <10 mm in patients without prior history of aneurysmal SAH generally should be observed. Special consideration should be given to patient with family history or unique hemodynamic factors.
(5) Asymptomatic UIAs ≥10 mm warrant strong consideration for treatment.

Mayo Clinic College of Medicine(1) With rare exception, all symptomatic UIAs should be treated.
(2) Small incidental aneurysms <5 mm should be managed conservatively.
(3) UIAs >5 mm in patients younger than 60 years of age should be strongly considered for treatment.
(4) UIAs >10 mm in patients younger than 70 years of age should be strongly considered for treatment.
(5)Microsurgical clipping rather than endovascular coiling should be the first-choice treatment in low-risk cases.

Columbia University(1) Patients under the age of 45 should be strongly considered for treatment with exceptions being small, anterior circulation UIAs.
(2) Aneurysms >12 mm should be strongly considered for treatment, except in older patients and those at high risk of intervention
(3) Conservative management is recommended for patients with UIAs <5 mm in anterior circulation and <3 mm in posterior circulation, except if patient is below the age of 45 or has strong family history
(4) Factors to be considered in all UIA cases include aneurysmal factors such as daughter sac formation or multiple lobes and patient factors such as family history, age, and comorbidities
(5) Antihypertensive and smoking cessation therapies should be recommended to all patients with UIAs
(6) Follow-up, noninvasive imaging with MRA or CTA should be done at 6 and 12 months after diagnosis, followed by yearly imaging for at least 3 years to monitor enlargement.