ACP InternistMKSAP Quiz: Evaluation of an Incidentally Found Aneurysm

Choose your answer from aneurysm clipping, aneurysm coiling, catheter-based angiography, CT angiography, or serial magnetic resonance angiography.

A 31-year-old man with a 5-mm saccular aneurysm in the anterior communicating artery, found incidentally while investigating new-onset trigeminal neuralgia, is asymptomatic with normal physical and neurological examinations. The quiz explores the most appropriate management for this patient, considering various diagnostic and treatment options.

Question:

• Which of the following is the most appropriate management for a 31-year-old man with a 5-mm saccular aneurysm in the anterior communicating artery found incidentally?

Evaluation:

• Aneurysm clipping
  • Involves surgically cutting off blood flow to the aneurysm.
  • Low risk of rupture and high risk of neurologic disability and morbidity.
• Aneurysm coiling
  • A minimally invasive procedure using coils to promote blood clotting within the aneurysm.
  • Similar to clipping
• Catheter-based angiography
  • An invasive imaging technique used to visualize blood vessels.
  • Used if further treatment is planned based on features predicting rupture.
• CT angiography
  • Utilizes CT scans to visualize blood vessels.
  • Unlikely to reveal a change in aneurysm size and carries risks from radiation and contrast medium.
• Serial magnetic resonance angiography
  • Noninvasive imaging technique to track aneurysm growth.
  • Monitors the aneurysm, as its at low risk for rupture.

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Did You Know?
Risk for rupture at 5 years is low for unruptured intracranial arterial aneurysms less than 7 mm in the posterior circulation and less than 12 mm in the anterior circulation. Annual noninvasive imaging is recommended to track potential growth, a key predictor for rupture.