Risk of rupture in unruptured anterior communicating artery aneurysms: meta-analysis of natural history studies

BackgroundThe decision of whether to operate on patients bearing UIAs is complicated by the limitations in current knowledge of the natural history of such lesions. The ISUIA has estimated the annual risk of rupture below that justifying surgery for most incidentally found lesions less than 7 mm in diameter. However, there is some evidence that aneurysms located in the ACoA show a higher risk of rupture, even with diameters of less than 7 mm. The present study was conducted to investigate the risk of aneurysm rupture in this site.MethodsThe available literature on the subject was thoroughly reviewed, and a meta-analysis was carried out comparing the risk of rupture of aneurysms found in the ACoA with that of aneurysms in other sites.ResultsAneurysms found unruptured in the ACoA show a risk of rupture twice as high as that of other intracranial aneurysms (95% confidence interval, 1.29-3.12). It is the first time this fact has been demonstrated based on the follow-up of unruptured aneurysms.ConclusionWhen deciding whether to operate on UIAs located in the ACoA, surgeons should consider their higher risk of rupture.