Science Times: Understanding Rupture Risk Factors for Intracranial Aneurysms: Which Ticking Time Bomb Needs to be Defused?

Understanding the natural history of a disease is paramount to defining treatment strategies and algorithms. Intracranial aneurysms are no exception to this rule. Over the past decade, an extensive body of literature has been generated with the goal of improving our understanding of intracranial aneurysms and the factors that govern their rupture risk.1-5 However, most large-scale trials have been marred with controversy, including the International Study of Unruptured Intracranial Aneurysms (ISUIA),6 the shortcomings of which are well documented.7-9 Although certain intrinsic and extrinsic factors have consistently been found to be associated with a higher risk of rupture in various studies, there is still a lack of a complete understanding of the natural history of intracranial aneurysms. In addition, in further analysis of the known risk factors, some discrepancies start to emerge. For example, although aneurysm size is a well-documented risk factor, the optimal cutoff size is yet to be defined. Aneurysm location can also affect rupture risk independently of size. In addition, with the increasing number of population-based studies, certain reports of interracial differences have emerged, further adding to the complexity of the matter.5,10

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