How should I assess the risk of rupture in a patient with an unruptured cerebral aneurysm?

To assess the risk of rupture in a patient with an unruptured cerebral aneurysm, a multidisciplinary team (MDT) including an interventional neuroradiologist and neurosurgeon should evaluate the aneurysm considering its size, location, morphology, and the estimated lifetime risk of rupture. The assessment should also incorporate the patient's comorbidities and preferences to guide management decisions such as conservative monitoring, endovascular coiling, or neurosurgical clipping NICE NG156.

Imaging modalities like CT angiography, magnetic resonance angiography (MRA), or digital subtraction angiography (DSA) are essential to characterize the aneurysm and monitor changes over time, which influence rupture risk estimation NICE NG156. The frequency and type of imaging follow-up should be tailored based on the aneurysm characteristics, previous neurointerventions, and the estimated risk of bleeding NICE NG156.

Risk factors for rupture include larger aneurysm size, specific aneurysm locations (e.g., posterior circulation), and morphological features such as irregular shape or daughter sacs. Patient factors such as hypertension and smoking also increase rupture risk and should be managed accordingly NICE NG156[Rinkel 2019].

Recent literature emphasizes the importance of individualized risk stratification models that integrate clinical, radiological, and possibly genetic factors to better predict rupture risk and guide treatment decisions Zuccarello 2001Vergouwen et al. 2018Rinkel 2019. These models support the MDT approach recommended by NICE, highlighting the need for personalized management plans based on comprehensive risk assessment.