Unruptured ICA aneurysms – surveillance or treatment?

I had a 3mm aneurysm but with family history of ruptures, my surgeon recommended that since it had vascular access, stent in my case, I should had it fixed, minimally invasive and high probability of success. That way I didn’t had to worry much about it, and in the unlikely case of failure clipping was always an option. That was 7 years ago, I had periodical checks and in 2020 he recommended I got a second stent, the first one hadn’t done the full job. Again fairly easy procedure. My MRAs since then show no leaks but just to make sure I will have an angiogram in a month and that may clear me completely.

@dmetzy

This brought back memories when I was in the same situation. In 2018, a CT scan performed for another reason revealed a 3.2 cm ICA. What a shock. Met with neurosurgery and neurology in the ER, and they assured me it was safe to go home and follow up with additional testing. A few weeks later, I had an angiogram for further evaluation.

The images are shocking, probably because I have never looked at ICA scans before. One radiologist called it a "giant" aneurysm, which really freaked me out, but it is just a term radiologists use when measuring 25 mm or more in diameter.

My aneurysm is calcified, so the risk of rupture is very low per the neurosurgeon. For the first few years, it was rescanned every 6 months. Then, once a year, it is no longer monitored. Even though scans show it is growing about 1 mm per year.

The only problem I experienced was a few years ago, when the aneurysm was pushing on my Eustachian tube, causing drainage problems and hearing loss. It was resolved by inserting ear tubes.

My neurosurgeon is a consultant at Mayo, so I trust his judgment. I did consider getting a 2nd opinion, but decided not to.

It is nice that you have a primary provider to discuss with.

Are any additional tests ordered, or when do they suggest having it rescanned?

WOW! that is indeed giant!! It’s so nice to know you’re doing well and here to tell the tale. I wasn’t able to see the actual scans, only the radiologist report, but I am considering requesting a copy of the CTA scans because I’m curious and in case I need to show neurosurgeon when I am traveling. I
The next follow up CT angiogram will be next April and that’s about it for now… my GP just told me to keep stress down, no heavy lifting, bearing down or strenuous exercise and don’t take up smoking! Lol! That’s about it… Any other restrictions for you?

@houston13 - thanks for the reply. As far as I know there’s no family history, but the only way we knew I had mine, was because the ER decided to add neck area onto the chest x-ray they were doing for my pericarditis in March. Is yours also c6 ICA? And do you know if it has grown?

@dmetzy mina was an intracranial L paraclinoid aneurysm, it has not grown that I know of but the angiogram that i am due to have in a month will tell me more. Your surgeon will recommend the right path for you, I recommend you get two opinions at least and compare, I did and both surgeons told me exactly the same thing, I was young (54) in good health and the procedure was fairly simple with minimum risk, they recommended to get it done and then I wouldn't have to worry about it as i got older.,

dmetzy: I'll throw in my 2 cents worth. The reason your PCP told you to avoid stress is b/c it raises one's blood pressure. My neurosurgeon told me I needed to keep my blood pressure 130 or lower. Also, you didn't mention it but the neuro doc also said no exercises or activities whereby my head would be hanging upside down; that increases the pressure inside the skull. It took nine months for me to make my decision to have mine (6mm) coiled. It was not the scary ordeal I had imagined.

Thanks, everyone, for your suggestions on things not to do. I will add one more: my provider told me not to have my neck adjusted by a chiropractor.

Of course, everyone is an individual, and your provider's advice might be different.

Great advice, Laurie. I have seen an osteopath for 30 years because of on-going issues with my skeletal system. For those of you who don't know osteopaths do gentle manipulations of the skeletal system when needed. They also prescribe drugs and do surgery the same as an M.D. You will find the designation D.O. after their names, Doctor of Osteopathy. I had an MRI for a totally different reason but the radiologist flagged a left superior ICA aneurysm. I happened to mention this the next time I saw my osteopath and he informed me that he wouldn't be able to work on my neck unless the neurosurgeon, that I had not yet seen, wrote a memo stating it was safe to do so. I resumed my neck manipulations after having my aneurysm coiled.

My 4x8 ICA (brain aneurysm) was discovered in 2021. After monitoring, it has not grown as of late last year (2025). Monitoring was every six months, then every year, now every two years. I have had two friends in the last year lose their adult children from undetected burst brain aneurysms. I lost 3 friends in the last 50 years from the same. In a sense, I am glad I found out and in another sense, terrified. I am lucky though. Never smoked, always had pretty low/normal blood pressure. Retired so not a lot of stress. I had asked about an angiogram so we can see what is going on there. When I told my primary care physician I had thought about an angiogram, she said "so you VOLUNTEERED for that huh?" like what is the matter with you. I would like to hear other experiences with angiograms. I am 74 years old, a little overweight but very healthy on only one med for reflux. My risk of burst is low but hey, I want to get every chance I have to outlive my dogs! lol Experiences with angiograms? Let me know.

My brother and I had brain aneurysms (he actually has 3) one of them burst and he had to have emergency intervention, they coiled his. I got checked after that and they found one, mine was repaired also through embolization but a stent in my case. He lives in Canada, after his repair they only checked his aneurysm with MRAs, I got checked with 1 or 2 angiograms and then MRAs, I had another angiogram 3 years later and they determined I still had some leakage so I got a second stent placed. Again got checked with angiograms first, then MRAs, this year (6 years after the second stent) I will have another angiogram to see if I can be completely cleared. He had a second bleed 2 months after an MRA, he almost died and was left with disabilities, he had to have a craniotomy to get the aneurysm clipped. My surgeon told me Canada does that because angiograms are expensive, and they use probability to decide. Angiograms are a pain, they are not comfortable but I would never doubt one second having one to assess a brain aneurysm, I am convinced if my brother had had at least one at least a year after his surgery, that second event wouldn’t have happened, and he wouldn’t be in the situation he is now.

Hope our story helps you