The Natural History and Treatment Options for Unruptured Intracranial Aneurysms

Table 2

Treatment recommendations.

Source	Recommendations
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.