Intracranial Aneurysm Rupture Prevention is a multifaceted topic that includes identifying high-risk aneurysms, 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.