In addition, treatment could be considered in patients with severe psychological disturbances secondary to harboring an unruptured aneurysm. Symptomatic UIAs should be treated in principle. For patients at high risk Pacritinib phase 3 of treatment because of co-morbid medical conditions, old age, or location and morphology of the aneurysm, the risks and benefits of treatment should be weighed in the

treatment decision. However, the treatment decision should be determined after taking into account the patient-specific factors of age, co-morbidity, and health condition and aneurysm-specific factors of size, location, and morphology. Treatment is not generally recommended for asymptomatic extradural intracranial aneurysms. Long-term follow-up is recommended after treating an UIA. In particular, for patients managed with endovascular treatment, angiographic follow-up is recommended to detect incomplete

occlusion or recurrence. For patients with an UIA who are managed conservatively without treatment, treatment of high blood pressure, cessation of smoking, and regular noninvasive angiographic follow-up, even without symptoms, are recommended. Frequent Aspirin use may confer a protective effect for risk of intracranial aneurysm rupture. In a case-control study on the protective effect of Aspirin for patients with an untreated intracranial aneurysm, patients who used Aspirin 3 times weekly to daily had a significantly lower odds of hemorrhage (adjusted OR, 0.27; 95% CI, 0.11 – 0.67; P=0.03) compared with those who never take aspirin [56]. However, further clinical investigation is needed to confirm this effect. UIAs generally are monitored annually with MRA or CTA for 2 to 3 years and then every 2 to 5 years thereafter if the UIAs are clinically

and radiographically stable [57]. Recommendations 1. For patients with an unruptured intracranial aneurysm that are managed conservatively without treatment, treatment Drug_discovery of high blood pressure, cessation of smoking, and regular vascular imaging follow-up, even without symptoms, are recommended. 2. Treatment is not generally recommended for an asymptomatic extradural intracranial aneurysm. 3. Symptomatic UIAs should be treated in principle. 4. Considering the natural course of asymptomatic UIA, treatment might be considered for patients who have a life expectancy of more than 10-15 years and have one or more of following conditions. (1) Size of 5 mm or more (2) Size under 5 mm at high risk of rupture (3) Symptomatic intracranial aneurysm [58, 59] (4) Aneurysm located in the posterior circulation, anterior communicating artery, or posterior communicating artery [53, 54, 55].