Unruptured ICA aneurysms – surveillance or treatment?

@mkoch Neurosurgeon simply told me that with an angiogram they could take a closer look but it was my choice. 6mm hasn't grown in 5 years at all and he suggested that risk of stroke was a bit higher because of my age if I had the aneurysm dealt with. So since it hasn't grown and it is a lower risk type of aneurysm, I decided to just go ahead and get my 2 year MRI next year and go from there. See what happens. Dying isn't scary (other than leaving my dogs behind) but I hear that when an aneurysm bursts, it is EXTREMELY painful, almost unbearable. And I am in a rural area and an hour drive away from any neurosurgeon.

@shamb52: Just ignore your P.C.P.'s snarky remark. I've had two angiograms. The first after I was diagnosed with an aneurysm about 2 years ago that was found incidentally when I had an MRI to monitor a meningioma. The neurosurgeon wanted a more complete picture than the MRI/MRA could show. There are different types of aneurysms and that can influence next steps to be taken. Then, I had my aneurysm coiled and had a follow up angiogram about 3 or 6 months afterwards (can't remember) to make sure the coiling procedure worked. That being said, I found the angiogram to be a nothing-burger. It was, as I remember, an hour to hour and a half of the actual procedure. (I'm not factoring in the prep beforehand: getting in the gown, vitals taken, visit by anesthesiologist and neurosurgeon.) It was painless. It required no general anesthetic. (I only had to align with an anesthesiologist b/c I have sleep apnea. Don't know why that was of concern but that was the rule.) Going under a general is what is of concern for us older people. (I am 74 as well) Of course, had I been much younger, I would also be worried about all that radiation. But as my neurologist told me, the consequences from the radiation would be 20-30 years down the road and I piped in and finished his thought by saying, "And probably something else will get me by then." Current health care perspective has changed in the last 10 or so years and we, the patient, are allowed and encouraged to take part in the decision making regarding our health care. Don't be deterred by the remarks of your P.C.P. You are entitled to know more about the aneurysm in your brain if that is important to you. There is a post somewhere on this thread where a person writes that she was told the type of aneurysm she had was unlikely to bleed out. One can learn a lot more about their aneurysm from an angiogram. Actually, I am surprised that a follow up angiogram wasn't recommended given that you were only 69 or 70 when it was first discovered.

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

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.

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.

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.

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.

@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.,

@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?

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?