Asymptomatic unruptured intracranial aneurysms: approach to screening and treatment.

ABSTRACTOBJECTIVETo review the current knowledge of screening and treatment of asymptomatic unruptured intracranial aneurysms (AUIAs) using a case-based approach.SOURCES OF INFORMATIONPubMed was searched from January 1995 to January 2008 using the phrase unruptured intracranial aneurysm. Scientific statements of the Stroke Council of the American Heart Association pertaining to intracranial aneurysms were also reviewed.MAIN MESSAGEMost small AUIAs (</= 5 mm) do not rupture, and the risks of treatment are substantial. Most small AUIAs can therefore be managed conservatively. Endovascular coiling or surgical clipping of larger aneurysms (> 5 mm) should be considered on a case-by-case basis.CONCLUSIONThere is currently a lack of sound scientific evidence to support treatment of unruptured intracranial aneurysms. A prospective randomized controlled trial-Trial on Endovascular Aneurysm Management-is now under way to address this issue. It is expected to conclude in 2021.