From the Guidelines
Renal aneurysms and brain aneurysms require distinct management approaches, with renal aneurysms typically requiring intervention when larger than 2 cm, causing hypertension, in women of childbearing age, or showing growth, and brain aneurysms posing a risk of rupture causing subarachnoid hemorrhage, with treatment options including surgical clipping, endovascular coiling, or flow diversion devices. The management of renal and brain aneurysms is guided by the size, location, and symptoms of the aneurysm, as well as the patient's overall health status 1.
Key Considerations
- Renal aneurysms:
- Typically require intervention when larger than 2 cm, causing hypertension, in women of childbearing age, or showing growth 1
- Treatment options include endovascular coiling, stenting, or surgical repair
- Brain aneurysms:
- Pose a risk of rupture causing subarachnoid hemorrhage
- Small, unruptured brain aneurysms (less than 7 mm) may be monitored with regular imaging, while larger ones often warrant treatment
- Management options include surgical clipping, endovascular coiling, or flow diversion devices
Risk Factors
- Hypertension
- Smoking
- Family history
Patient Management
- Regular blood pressure control is essential for patients with either condition
- Those with unruptured aneurysms should avoid activities that cause sudden increases in blood pressure
- Patients with diagnosed aneurysms should maintain regular follow-up with specialists - nephrologists or vascular surgeons for renal aneurysms, and neurosurgeons or interventional neuroradiologists for brain aneurysms 1. The most recent and highest quality study, the International Subarachnoid Aneurysm Trial (ISAT), demonstrated that endovascular coiling appears to have better clinical and neurological outcomes compared to surgical clipping for brain aneurysms 1. However, the management of aneurysms should be individualized and based on the specific characteristics of the patient and the aneurysm, as well as the availability of treatment options and expertise 1.
From the Research
Renal Aneurysm
- Renal artery aneurysms (RAA) are rare, with a general population incidence of 0.09% 2
- The choice of treatment for RAA relies on the operative risk, with open surgery recommended for patients with good surgical risk and endovascular treatment for those with high surgical risk 2
- Endovascular therapy offers less morbidity, but surgery has excellent long-term results 2
- The type of endovascular treatment (stent grafting, coil/glue embolization, multilayer stenting) should be based on the location and shape of the RAA 2
Brain Aneurysm
- Cerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA) 3
- The decision to treat an unruptured cerebral aneurysm should be based on the evaluation of multiple risk factors, including size, shape, and location of the aneurysm, as well as history of hypertension and cigarette smoking and family history of cerebral aneurysms 3
- Neuro-endovascular surgery techniques, including coiling, with or without balloon/stent assistance, and flow diversion, are commonly used to treat cerebral aneurysms 3
- The best outcomes are achieved with management by experienced, high-volume practitioners at specialized cerebrovascular treatment centers 3
- Unruptured intracranial aneurysms often have a relatively benign clinical course, but aneurysmal subarachnoid hemorrhage can lead to significant morbidity and mortality if rupture occurs 4
- Imaging modalities, including CT, CTA, DSA, FLAIR, 3D-TOF-MRA, and CE-MRA, are used to assess aneurysm size, location, and morphology, as well as additional evidence-based risk factors 5
- Advanced MR techniques, such as MR-VWI, DCE-MRI, and CFD, offer a paradigm shift by evaluating factors beyond size and morphology, including vessel wall inflammation, permeability, and hemodynamics 5