ISSN: 1899-0967
Polish Journal of Radiology
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vol. 89
Interventional radiology
Review paper

Unruptured intracranial aneurysms: Why should we focus on small aneurysms? A comprehensive update of recent findings

Maciej Jakub Frączek
1, 2
Roger Marek Krzyżewski
Kornelia Maria Kliś
Borys Maria Kwinta
Tadeusz Jan Popiela
Krzysztof Stachura

Department of Neurosurgery and Neurotraumatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Chair of Radiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
© Pol J Radiol 2024; 89: e13-e23
Online publish date: 2024/01/12
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Intracranial aneurysms (IAs) are a significant public health concern because they have the potential to cause deva­stating consequences, including death and disability. Despite advances in diagnostic and treatment modalities, the outcomes for patients with aneurysmal subarachnoid haemorrhage (aSAH) remain poor, with high rates of rebleeding, vasospasm, and cerebral ischaemia. IAs are a significant risk factor for aSAH, and it is estimated that up to 3% of the general population have IAs. Recent studies using novel imaging modalities have shown that the prevalence of IAs may be much higher, with 6.6% of adults aged 40-84 years having intradural saccular IAs ≥ 2 mm. The risk of rupture for IAs is difficult to predict, and the decision to treat them invasively is based on a balance between the estimated rupture risk and the procedural risks of the treatment. However, the mortality and morbidity rates among patients treated for IAs can be as high as 5%. There is a need for clear guidelines on the treatment of IAs, and this review aims to provide an update on recent findings in this area. To achieve this goal, the authors identified and summarized recent, high-impact studies on IAs. The review focuses on the diagnostic and treatment options for IAs, as well as the risks associated with these interventions. The authors also provide an overview of the natural history of IAs and discuss the challenges and uncertainties in managing these patients.

aneurysm, computed tomography angiography, anatomy, natural history, endovascular therapy, risk of rupture

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