Cerebral aneurysm

In patients who have suspected subarachnoid haemorrhage (SAH) but no angiographical evidence for aneurysms or arteriovenous malformations on any studies, angiography is repeated within 1 week, and then again in 1 to 6 weeks.[66]van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001 Feb;124(Pt 2):249-78. http://brain.oxfordjournals.org/content/124/2/249.long http://www.ncbi.nlm.nih.gov/pubmed/11157554?tool=bestpractice.com Patients with a confirmed SAH and aneurysms generally have a post-operative angiogram if clipped, or a 6-month follow-up angiogram if coiled.

Any suspicion of an incomplete occlusion during aneurysm treatment should be followed with repeat angiography at 6 months, then periodically with non-invasive imaging with increasing duration between investigations. Strong consideration should be given to re-treatment, either by repeat coiling or microsurgical clipping, if there is a clinically significant (e.g., growing) remnant.​[20]Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70. https://www.ahajournals.org/doi/10.1161/STR.0000000000000436 http://www.ncbi.nlm.nih.gov/pubmed/37212182?tool=bestpractice.com ​

Patients with a history of cerebral aneurysms, who are at higher risk for developing future de novo cerebral aneurysms, should undergo periodic non-invasive cerebral vascular imaging, including magnetic resonance or CT angiography of the brain.