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The rising of non-invasive vascular imaging techniques has held to an increase in discovering incidental unruptured intracranial aneurysms (UIA). In daily practice is a common issue to deal with patients with these findings. It seems the rupture of an aneurysm is an unusual event in the aneurysm natural history, so this puts a difficult issue in deciding when or how to treat this disease.
The authors of this paper make a great review of the current data and knowledge in UIA. They analyzed several risk factors for rupture with their hazard or risk ratios, confirming high risk factors as: arterial hypertension, smoking, alcohol, age, geographic location, previous SAH, multiplicity, family history of aneurysms, aneurysm location, irregularity, growth, shape and wall enhancement. This last factor it is very interesting because it is an initial approach to view the role of inflammation in aneurysm rupture or evolution. There is also a review in the management of these patients, from the medical therapies to interventions such as endovascular or open surgery approach, with the usual concern of keeping the interventional risk of morbidity and mortality lower than the risk of rupture in natural history.