Intracranial Aneurysm Rupture Prevention [Neurosurgery Wiki]

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====== Intracranial Aneurysm Rupture Prevention ======

[[Intracranial Aneurysm Rupture]] [[Prevention]] is a multifaceted [[topic]] that includes identifying high-risk [[aneurysm]]s, controlling [[modifiable risk factors]], and using pharmacological or surgical interventions when appropriate. Here's an overview structured for clinical relevance:

🔍 1. Risk Stratification
Key factors influencing rupture risk include:

Aneurysm Size: >7 mm in anterior circulation, >5 mm in posterior circulation or in patients with family history.

Location: Posterior communicating artery, anterior communicating artery, and basilar tip aneurysms have higher rupture risk.

Shape: Irregular or lobulated aneurysms are more likely to rupture.

Patient Factors:

Hypertension

Smoking

Family history of aneurysmal SAH

Female sex

Certain genetic conditions (e.g. ADPKD, Ehlers-Danlos)

💊 2. Medical Management
Lifestyle and risk factor control:

Strict blood pressure control

Smoking cessation

Avoidance of stimulants (e.g., cocaine, amphetamines)

Lipid and diabetes control

Pharmacologic agents under investigation:

[[Resveratrol]]: see [[Resveratrol for Intracranial Aneurysm Rupture Prevention]]

Statins: Potential anti-inflammatory and endothelial-protective effects (data mixed).

Doxycycline: MMP inhibition proposed as a stabilizing mechanism for the aneurysm wall.

ARBs (e.g., losartan): Experimental evidence suggests attenuation of vessel wall degeneration.

🧠 3. Surgical/Endovascular Intervention
Recommended based on rupture risk vs. treatment risk balance:

Microsurgical clipping: Preferred in young patients, accessible locations, or wide-neck aneurysms.

Endovascular coiling: Minimally invasive, preferred in elderly or patients with comorbidities.

Flow diverters: For wide-neck or fusiform aneurysms, particularly in the internal carotid artery.

Stent-assisted coiling: When simple coiling is not feasible.

Decision tools:

PHASES score: Integrates population, hypertension, age, aneurysm size, earlier SAH, and site to estimate 5-year rupture risk.

UIATS: More individualized, expert-driven recommendation system.

🧪 4. Emerging Research and Biomarkers
Inflammatory biomarkers (e.g., IL-6, CRP)

Wall enhancement on high-resolution vessel wall MRI as a surrogate for instability.

Computational fluid dynamics to evaluate wall shear stress patterns.

📌 Conclusion
Rupture prevention is not only about deciding when to operate — it's about long-term surveillance, risk modification, and individualized decision-making, ideally in a multidisciplinary cerebrovascular board.