Cerebral aneurysm

In patients who have suspected subarachnoid hemorrhage (SAH) but no angiographic evidence for aneurysms or arteriovenous malformations on any studies, angiography is repeated within 1 week, and then again in 1 to 6 weeks.[70]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 postoperative 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 noninvasive imaging with increasing duration between investigations. Strong consideration should be given to retreatment, 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 noninvasive cerebral vascular imaging, including magnetic resonance or CT angiography of the brain.