Primary prevention

In patients at risk of subarachnoid haemorrhage (SAH) (i.e., those with genetic connective tissue disorders or other systemic disorders associated with aneurysm formation, or with first-degree relatives with a history of SAH), treat hypertension and offer advice on smoking cessation according to national guidelines as these are the most important modifiable risk factors.[13][43]​​​ NICE: tobacco - preventing uptake, promoting quitting and treating dependence Opens in new window​ Patients who have two or more first-degree relatives with SAH and individuals with autosomal dominant polycystic kidney disease are potential candidates for aneurysm screening.[29][36]​​[38][40]

Secondary prevention

Treat hypertension and offer advice on smoking cessation according to national guidelines. NICE: tobacco - preventing uptake, promoting quitting and treating dependence Opens in new window NICE: hypertension in adults - diagnosis and management Opens in new window

Asymptomatic unruptured intracranial aneurysms may be found after SAH as additional aneurysms (i.e., they are not the source of the bleed). An unruptured aneurysm discovered during work-up for SAH (caused by a different aneurysm) has a higher annual incidence of rupture than a single unruptured aneurysm.​[17][25]​ In patients with asymptomatic unruptured intracranial aneurysms, the ruptured aneurysm should be treated first.[43]​ The decision whether to treat subsequent unruptured aneurysms depends on:[40][43]​​

  • Aneurysmal factors such as size (the larger the aneurysm, the higher the chance of rupture), and location[40]

  • The estimated lifetime risk of the aneurysm rupturing[38]

  • Procedural risk (range of 5% to 50% vs. spontaneous rupture risk 0% to 10%, per year) and benefit (life expectancy with or without minor deficit)[43]

  • Comorbidities[38][40]

  • Patient preference.[38][40]

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