The ISUIA (International Study of Unruptured Intracranial Aneurysms) identified which factor as most predictive of aneurysm rupture risk?

• A Patient age above 60 years
• B Female sex and family history of aneurysm
• C History of hypertension and tobacco use
• D Aneurysm size and posterior circulation or posterior communicating artery location ✓

Explanation

The ISUIA demonstrated that rupture risk correlates most strongly with aneurysm size (small aneurysms <7 mm in the anterior circulation without prior SAH have very low rupture risk, <0.1%/year) and location (posterior circulation aneurysms and posterior communicating artery aneurysms have significantly higher rupture rates at all sizes). An aneurysm ≥7 mm in the posterior circulation carries >2.5%/year rupture risk. While hypertension and smoking are modifiable risk factors for formation and rupture, size and location are the dominant predictors in ISUIA.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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