Unruptured saccular intracranial aneurysm (sIA) is a relatively common disease (2%-3% prevalence).1 Asymptomatic unruptured sIAs are diagnosed increasingly frequently due to improved availability of magnetic resonance imaging (MRI) scans. Although sIAs may rupture causing devastating hemorrhage with mortality of 30% to 50%,2 most sIAs never rupture.3 The pathobiology of sIA formation and rupture need to be elucidated in order to focus follow-up efforts and therapy to those patients at risk of developing sIAs or at risk of sIA rupture.
Formation and rupture of sIAs are multifactorial processes affected by genetic background (ethnicity, gender, family history)4–7 and multiple acquired risk factors (smoking, hypertension, stimulant abuse).8,4 Formation of sIAs occurs mostly at specific locations in the cerebral arteries, and location affects the risk of rupture.9,10 How the formation of sIAs in different locations is affected by patient-related risk factors is not well known. In addition to patient-related risk factors, aneurysm-related factors that reflect unstable wall and predict rupture (size and shape) are known11,12 and used to guide clinical decisions.
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